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1

Prolonged mechanical ventilation: review of care settings and an update on professional reimbursement.  

PubMed

The goal of this article is to provide an update on recent changes to current procedural terminology codes used for billing physician services for mechanical ventilation in chronic care facilities. In addition to billing information, background data relevant to prolonged mechanical ventilation are reviewed. Topics covered include a description of the settings in which patients receive prolonged mechanical ventilation; home mechanical ventilation; the role of physician extenders; documentation of ventilator services; and reporting and coding ventilator management. PMID:18252920

White, Alexander C; O'Connor, Heidi H; Kirby, Kelly

2008-02-01

2

Pain among mechanically ventilated patients in critical care units  

PubMed Central

Background: Pain is a common experience among mechanically ventilated patients. Pain among mechanically ventilated patients is aggravated by factors such as stage of illness, invasive procedures, and surgical interventions. The aim to this study was to investigate pain levels and predictors among mechanically ventilated patients during rest and routine nursing interventions. Materials and Methods: A cross-sectional descriptive correlational design was used, with a total sample of 301 mechanically ventilated patients. Patients’ pain levels were assessed using Behavioral Pain Scale during rest and routine nursing interventions. Results: The mean pain score levels during rest (mean = 3.69, standard deviation [SD] = 0.81) were lower than mean pain score levels during routine nursing interventions (mean = 7.1, SD = 2.5). During rest, pain scores were significantly correlated with age (r = ?0.12, P = 0.046), and heart rate (r = 0.24, P < 0.001). During nursing interventions, pain scores were significantly correlated with age (r = ?0.25, P < 0.001), heart rate (r = 0.36, P < 0.001), and diastolic blood pressure (BP) (r = 0.21, P < 0.001). The age and past surgical history were found to be significant (age: ? = ?0.009, P = 0.002; past surgical history: ? = ?1.376, P < 0.001). Conclusion: Mechanically ventilated patients experience pain during rest as well as during routine nursing interventions. Pain levels were associated with age, heart rate, and diastolic BP. The age and past surgical history should be considered as important predictive factors.

Al Sutari, Manal M.; Abdalrahim, Maysoon S.; Hamdan-Mansour, Ayman M.; Ayasrah, Shahnaz M.

2014-01-01

3

Intensive care nurses' opinions and practice for oral care of mechanically ventilated patients  

PubMed Central

Context: Oral care is an essential aspect of critical care nursing. However, no study has been published on oral care practice of Iranian and Asian nurses. The majority of published studies were conducted in western and European countries. Aims: This study aimed to evaluate the nurses’ opinions and practice about oral care in patients under mechanical ventilation. Settings and Design: A cross-sectional study was conducted on 130 intensive care nurses from 6 intensive care units in the university hospitals of Iran. Materials and Methods: A questionnaire was used to gather the data and charts of 45 patients were evaluated. Statistical analysis: Descriptive statistical analysis are presented. Results: Oral care obtained the 7th rank in prority and a mean score of 5.7 on a scale of 1-10. More than 21% of subjects did not perform oral care in their usual duties. High load of writing tasks and personnel shortages were the major barriers to oral care. Only 20% of the patients’ charts contained a report on oral care. Conclusions: Nurses did not consider oral care in intensive care patients as a high priority. This result highlights the need to continue education programs on oral care for improving the knowledge and attitude of intensive care nurses with respect to oral care. PMID:23833472

Adib-Hajbaghery, Mohsen; Ansari, Akram; Azizi-Fini, Ismail

2013-01-01

4

Hemodynamic changes associated with manual and automated lateral rotation in mechanically ventilated intensive care patients  

Microsoft Academic Search

Objective: To investigate hemodynamic responses to lateral rotation. ^ Design: Time-series within a randomized controlled trial pilot study. ^ Setting: A medical intensive care unit (ICU) and a medical-surgical ICU in two tertiary care hospitals. ^ Patients: Adult patients receiving mechanical ventilation. ^ Interventions: Two-hourly manual or continuous automated lateral rotation. ^ Measurements and Main Results: Heart rate (HR) and

Shannan K Hamlin

2010-01-01

5

Conventional mechanical ventilation  

PubMed Central

The provision of mechanical ventilation for the support of infants and children with respiratory failure or insufficiency is one of the most common techniques that are performed in the Pediatric Intensive Care Unit (PICU). Despite its widespread application in the PICUs of the 21st century, before the 1930s, respiratory failure was uniformly fatal due to the lack of equipment and techniques for airway management and ventilatory support. The operating rooms of the 1950s and 1960s provided the arena for the development of the manual skills and the refinement of the equipment needed for airway management, which subsequently led to the more widespread use of endotracheal intubation thereby ushering in the era of positive pressure ventilation. Although there seems to be an ever increasing complexity in the techniques of mechanical ventilation, its successful use in the PICU should be guided by the basic principles of gas exchange and the physiology of respiratory function. With an understanding of these key concepts and the use of basic concepts of mechanical ventilation, this technique can be successfully applied in both the PICU and the operating room. This article reviews the basic physiology of gas exchange, principles of pulmonary physiology, and the concepts of mechanical ventilation to provide an overview of the knowledge required for the provision of conventional mechanical ventilation in various clinical arenas. PMID:20927268

Tobias, Joseph D.

2010-01-01

6

Nursing diagnoses in patients having mechanical ventilation support in a respiratory intensive care unit in Turkey.  

PubMed

This research was carried out to find out the nursing diagnoses in patients who have mechanical ventilation support in a respiratory intensive care unit. The study was conducted with 51 evaluations of critically ill adult patients who underwent invasive and non-invasive mechanical ventilation therapy in 2008. Data collection was based on Gordon's 11 Functional Health Patterns, and nursing diagnoses were determined according to North American Nursing Diagnosis Association-International (NANDA-I) Taxonomy II. The nursing diagnoses were determined by two researchers separately. The consistency between the nursing diagnoses defined by the two researchers was evaluated by using Cohen's kappa (?). Forty men (78.4%) and 11 women (21.6%) whose mean ages were 70.19 (SD = 8.96) years were included in the study. Nineteen subgroups of nursing diagnoses about safety/protection domain, and 15 subgroups about activity/rest domain were seen at different rates in the patients. There was a statistically significant difference between mechanical ventilation via tracheostomy or endotracheal tube and decreased cardiac output (d.f. = 1, ?(2) = 4.760, P = 0.029). The relationship between the length of time under mechanical ventilation and impaired physical mobility was considerably significant (d.f. = 3, ?(2) = 24.459, P = 0.000). It was found out that there was a high degree of agreement (96.8%) between the nursing diagnoses defined by the two researchers separately (? = 0.936, SE = 0.08). PMID:21939482

Yücel, ?ebnem Çinar; E?er, Ismet; Güler, Elem Kocaçal; Khorshid, Leyla

2011-10-01

7

Neonatal mechanical ventilation—Experience at a level II care centre  

Microsoft Academic Search

One hundred and fifty nine neonates were ventilated over a period of one year of whom 74 (46.54%) survived. This study aims\\u000a to analyse the indications, complications and outcome of babies requiring mechanical ventilation. The early outcome measures\\u000a were (i) survival rate with respect to birth weight, gestation and indication of ventilation, and (ii) Complications of assisted\\u000a ventilation. One hundred

Sushma Nangia; Arvind Saili; A. K. Dutta; Vani Gaur; Meeta Singh; Anju Seth; S. Kumari

1998-01-01

8

JAMA Patient Page: Mechanical Ventilation  

MedlinePLUS

... of the American Medical Association JAMA PATIENT PAGE Mechanical Ventilation T he support of respiration (breathing) with devices is known as mechanical ventilation . Mechanical ventilation, provided by ventilators , is used ...

9

Sedation and Analgesia in Mechanically Ventilated Preterm Neonates: Continue Standard of Care or Experiment?  

PubMed Central

Attention to comfort and pain control are essential components of neonatal intensive care. Preterm neonates are uniquely susceptible to pain and agitation, and these exposures have a negative impact on brain development. In preterm neonates, chronic pain and agitation are common adverse effects of mechanical ventilation, and opiates or benzodiazepines are the pharmacologic agents most often used for treatment. Questions remain regarding the efficacy, safety, and neurodevelopmental impact of these therapies. Both preclinical and clinical data suggest troubling adverse drug reactions and the potential for adverse longterm neurodevelopmental impact. The negative impacts of standard pharmacologic agents suggest that alternative agents should be investigated. Dexmedetomidine is a promising alternative therapy that requires further interprofessional and multidisciplinary research in this population. PMID:23413121

McPherson, Christopher

2012-01-01

10

Mechanical ventilation in abdominal surgery.  

PubMed

One of the key challenges in perioperative care is to reduce postoperative morbidity and mortality. Patients who develop postoperative morbidity but survive to leave hospital have often reduced functional independence and long-term survival. Mechanical ventilation provides a specific example that may help us to shift thinking from treatment to prevention of postoperative complications. Mechanical ventilation in patients undergoing surgery has long been considered only as a modality to ensure gas exchange while allowing maintenance of anesthesia with delivery of inhaled anesthetics. Evidence is accumulating, however, suggesting an association between intraoperative mechanical ventilation strategy and postoperative pulmonary function and clinical outcome in patients undergoing abdominal surgery. Non-protective ventilator settings, especially high tidal volume (VT) (>10-12mL/kg) and the use of very low level of positive end-expiratory pressure (PEEP) (PEEP<5cmH2O) or no PEEP, may cause alveolar overdistension and repetitive tidal recruitment leading to ventilator-associated lung injury in patients with healthy lungs. Stimulated by previous findings in patients with acute respiratory distress syndrome, the use of lower tidal volume ventilation is becoming increasingly more common in the operating room. However, lowering tidal volume, though important, is only part of the overall multifaceted approach of lung protective mechanical ventilation. In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of mechanical ventilation in patients undergoing abdominal surgery. PMID:25153670

Futier, E; Godet, T; Millot, A; Constantin, J-M; Jaber, S

2014-01-01

11

Etiology of viral pneumopathies in patients in intensive care unit under mechanical ventilation.  

PubMed

The objective of this work was to define the etiology of viral pneumopathies at the patients from reanimation section being under mechanical ventilation, making reference to viruses with respiratory tropism, and also to Chlamydia Pneumoniae and Mycoplasma pneumoniae. The subjects were 36 patients hospitalized into Service of Medical Reanimation from CHU Caen and who needed mechanical ventilation more than 48 hours. The samples from the patients were mostly nasal aspirate, 1 bronchial aspirate and 2 tracheal aspirates. The diagnosis tests were: the test of direct immunofluorescence (DIF) from the samples (for Influenza viruses A and B, Parainfluenza 1,2,3, Adenovirus and Respiratory Syncytial Virus (RSV), inoculation on the tissue culture of diploid cells MRC5, and at the appearance of cythopatic effect specific for Herpes Simplex Virus (HSV), it was made DIF for the detection of type 1 or 2, and also there were made 6 techniques of Polymerase Chain Reaction (PCR). The results of the tests were: at admission before installing the mechanical ventilation, 6 patients presented an infection with Rhinoviruses (RV), 3 with Influenza type A, 3 with HSV type 1 and 2 with Enterovirus. After a period of time from installing the mechanical ventilation, 8 patients presented an infection with HSV typel, among who 1 presented at admission an infection with RV, and 1 patient presented at 7 days from installing the mechanical ventilation an infection with RSV, and at 16 days an infection with HSV type 1. Thus, it could be concluded that in 25% from the cases of viral pneumopathies from patients being under mechanical ventilation it was an endogen reactivation of HSV type1 and only into a single case was diagnosed initially with an infection with RSV, after that it appeared also an infection with HSV typel. PMID:19284161

Tecu, Cristina; Genetay, Evelyne; Vabret, Astrid; Alexandrescu, V; Freymuth, F

2008-01-01

12

[Neurally adjusted ventilator assist in paediatric intensive care].  

PubMed

The adaptation of the patient's breathing to the ventilator is a constant challenge in intensive care units. The use of a neurally adjusted ventilator assist (NAVA) system is growing. This system has shown an improvement in patient-ventilator synchronisation and the comfort of patients undergoing invasive or non-invasive ventilation in paediatric intensive care units. Its benefit in reducing the duration of mechanical ventilation and the length of stayin paediatric intensive care units remains however to be proven. PMID:25174176

Didier, Capucine

2014-01-01

13

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

PubMed

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

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

2011-01-01

14

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

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

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

2014-01-01

15

Incidents associated with mechanical ventilation and intravascular catheters in neonatal intensive care: exploration of the causes, severity and methods for prevention  

Microsoft Academic Search

ObjectivesTo systematically investigate the causes and severity of incidents with mechanical ventilation and intravascular catheters in neonatal intensive care units (NICUs) in the Netherlands, in order to develop effective strategies to prevent such incidents in the future.DesignProspective multicentre survey.MethodsInclusion criteria were: incidents with mechanical ventilation and intravascular catheters reported to a voluntary, non-punitive, incident-reporting system which had been systematically analysed

Cathelijne Snijders; Richard A van Lingen; Tjerk W van der Schaaf; Willem P F Fetter; Harry A Molendijk

2011-01-01

16

Patient-ventilator asynchrony during assisted mechanical ventilation  

Microsoft Academic Search

Objective  The incidence, pathophysiology, and consequences of patient-ventilator asynchrony are poorly known. We assessed the incidence of patient-ventilator asynchrony during assisted mechanical ventilation and we identified associated factors.Methods  Sixty-two consecutive patients requiring mechanical ventilation for more than 24?h were included prospectively as soon as they triggered all ventilator breaths: assist-control ventilation (ACV) in 11 and pressure-support ventilation (PSV) in 51.Measurements  Gross asynchrony detected

Arnaud W. Thille; Pablo Rodriguez; Belen Cabello; François Lellouche; Laurent Brochard

2006-01-01

17

Using protocols to improve patient outcomes in the intensive care unit: focus on mechanical ventilation and sepsis.  

PubMed

The care of critically ill patients has become increasingly complex as severity of illness continues to increase, the number of patients requiring intensive care is on the rise, the amount of clinical information available at the bedside is growing, and the quantity of evidence supporting or refuting specific therapies and interventions for this population is escalating. It has become problematic for clinicians to master all of these tasks and to process the quantity of available clinical and scientific information in an effective and safe manner. Additionally, a culture promoting safety and accountability has emerged in the United States and throughout the world in regard to medical care. The expectation is that patients entering hospitals should receive the highest quality of care with minimal to no medical errors occurring. To accomplish this goal, as well as to allow more accurate monitoring of day to day medical practices, several strategies have been developed that have primarily been employed in the intensive care unit (ICU) setting. These strategies include the use of paper-based or electronic protocols for disease (e.g., severe sepsis and septic shock) or process of care (e.g., weaning of mechanical ventilation) management, national guidelines, and targeted clinician education with or without periodic feedback regarding compliance with best medical practices and resultant patient-based outcomes. This review focuses on the use of protocols in the ICU setting and how they can best be utilized to improve patient outcomes. PMID:20101544

Kollef, Marin H; Micek, Scott T

2010-02-01

18

Mechanical ventilation in cancer patients.  

PubMed

Acute respiratory failure (ARF) in cancer patients remains a frequent and severe complication, despite the general improved outcome over the last decade. The survival of cancer patients requiring ventilatory support in Intensive Care Unit (ICU) has dramatically improved over the last years. The diagnostic approach, including an invasive strategy using fiber optic bronchoscopy or a non-invasive strategy, must be effective to identify a diagnostic, as it is a crucial prognostic factor. The use of non-invasive ventilation (NIV) instead of invasive mechanical ventilation (IMV), has contributed to decrease mortality, but NIV has to be used in appropriate situations. Indeed, NIV failure (i.e., need for IMV) is deleterious. Classical prognostic factors are not relevant anymore. The number of organ failure at admission and over the first 7 ICU days governs outcomes. Ventilatory support can thus be included in different management contexts: full code management with unlimited use of life sustaining therapies, full code management for a limited period, no-intubation decision, or the use of palliative NIV. The objectives of this review article are to summarize the modified ARF diagnostic and therapeutic management, induced by improvements in both intensive care and onco-hematologic management and recent literature data. PMID:24280820

Saillard, C; Mokart, D; Lemiale, V; Azoulay, E

2014-06-01

19

[Recommendations for invasive home mechanical ventilation].  

PubMed

Due to chronic respiratory failure, a proportion of patients require long-term home ventilation therapy. The treating doctors, nurses and therapists, as well as employees of the health insurance provider, all require specialized knowledge in order to establish and monitor home ventilation. The following document represents a consensus formed by the participating specialist societies, the health insurers and their medical advisory services. The recommendations for accomplishing home mechanical ventilation are based on the "S2 Guidelines for Non-Invasive and Invasive Mechanical Ventilation for Treatment of Chronic Respiratory Failure", and provide advice about the necessary qualifications of medical and nursing practitioners working in specialised ventilation centres or in the home setting. Management of transfer, which comprises the medical, technical and organisational requirements for releasing the patient from hospital care, is of paramount importance. In outpatient care, the requirements for the recruitment of resources, monitoring of procedures, adjustment of ventilation, and frequency of check-ups are each addressed. The recommendations are supplemented by appendices which include patient transfer forms, checklists for the supply of basic resources for home ventilation, as well as a template for the letter of discharge from hospital. PMID:21294061

Randerath, W J; Kamps, N; Brambring, J; Gerhard, F; Lorenz, J; Rudolf, F; Rosseau, S; Scheumann, A; Vollmer, V; Windisch, W

2011-02-01

20

Can Selection of Mechanical Ventilation Mode Prevent Increased Intra-Abdominal Pressure in Patients Admitted to the Intensive Care Unit?  

PubMed Central

Background: Increased intra-abdominal pressure (IAP) results in dysfunction of vital organs. The aim of the present study was to evaluate the effect of mechanical ventilation mode on IAP. Methods: In a cohort study, a total of 60 patients aged 20-70 years who were admitted to the ICU and underwent mechanical ventilation were recruited. Mechanical ventilation included one of the three modes: Biphasic positive airway pressure (BIPAP) group, synchronize intermittent mandatory ventilation (SIMV) group, or continuous positive airway pressure (CPAP) group. For each patient, mechanical ventilation mode and its parameters, blood pressure, SpO2, and status of tube feeding and IAP were recorded. Results: Our findings indicate that the study groups were not significantly different in terms of anthropometric characteristics including age (64.5 ± 4, P = 0.1), gender (male/female 31/29, P = 0.63), and body mass index (24 ± 1.2, P = 0.11). Increase IAP was related to the type of respiratory mode with the more increased IAP observed in SIMV mode, followed by BIPAP and CPAP modes (P = 0.01). There were significant correlations between increased IAP and respiratory variables including respiratory rate, pressure support ventilation, and inspiratory pressure (P < 0.05). Tube feeding tolerance through NG-tube was lower in SIMV group, followed by BIPAP and CPAP groups (P < 0.05). Conclusions: There is a significant relationship between respiratory modes and IAP; therefore, it is better to utilize those types of mechanical ventilation like CPAP and BIPAP mode in patients who are prone to Intra-abdominal hypertension. PMID:23930166

Rafiei, Mohammad Reza; Aghadavoudi, Omid; Shekarchi, Babak; Sajjadi, Seyed Sajed; Masoudifar, Mehrdad

2013-01-01

21

Music therapy—a complementary treatment for mechanically ventilated intensive care patients  

Microsoft Academic Search

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

Sofia Almerud; Kerstin Petersson

2003-01-01

22

The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study  

PubMed Central

Background We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings. Methods A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated. Results A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT. Conclusion CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series. PMID:24400646

2014-01-01

23

Anxiety and Agitation in Mechanically Ventilated Patients  

PubMed Central

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

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

2013-01-01

24

Respiratory infections in patients undergoing mechanical ventilation.  

PubMed

Lower respiratory tract infections in mechanically ventilated patients are a frequent cause of antibiotic treatment in intensive-care units. These infections present as severe sepsis or septic shock with respiratory dysfunction in intubated patients. Purulent respiratory secretions are needed for diagnosis, but distinguishing between pneumonia and tracheobronchitis is not easy. Both presentations are associated with longlasting mechanical ventilation and extended intensive-care unit stay, providing a rationale for antibiotic treatment initiation. Differentiation of colonisers from true pathogens is difficult, and microbiological data show Staphylococcus aureus and Pseudomonas aeruginosa to be of great concern because of clinical outcomes and therapeutic challenges. Key management issues include identification of the pathogen, choice of initial empirical antibiotic, and decisions with regard to the resolution pattern. PMID:25151022

Rello, Jordi; Lisboa, Thiago; Koulenti, Despoina

2014-09-01

25

Bedside measurement of changes in lung impedance to monitor alveolar ventilation in dependent and non-dependent parts by electrical impedance tomography during a positive end-expiratory pressure trial in mechanically ventilated intensive care unit patients  

PubMed Central

Introduction As it becomes clear that mechanical ventilation can exaggerate lung injury, individual titration of ventilator settings is of special interest. Electrical impedance tomography (EIT) has been proposed as a bedside, regional monitoring tool to guide these settings. In the present study we evaluate the use of ventilation distribution change maps (?fEIT maps) in intensive care unit (ICU) patients with or without lung disorders during a standardized decremental positive end-expiratory pressure (PEEP) trial. Methods Functional EIT (fEIT) images and PaO2/FiO2 ratios were obtained at four PEEP levels (15 to 10 to 5 to 0 cm H2O) in 14 ICU patients with or without lung disorders. Patients were pressure-controlled ventilated with constant driving pressure. fEIT images made before each reduction in PEEP were subtracted from those recorded after each PEEP step to evaluate regional increase/decrease in tidal impedance in each EIT pixel (?fEIT maps). Results The response of regional tidal impedance to PEEP showed a significant difference from 15 to 10 (P = 0.002) and from 10 to 5 (P = 0.001) between patients with and without lung disorders. Tidal impedance increased only in the non-dependent parts in patients without lung disorders after decreasing PEEP from 15 to 10 cm H2O, whereas it decreased at the other PEEP steps in both groups. Conclusions During a decremental PEEP trial in ICU patients, EIT measurements performed just above the diaphragm clearly visualize improvement and loss of ventilation in dependent and non-dependent parts, at the bedside in the individual patient. PMID:20509966

2010-01-01

26

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

ERIC Educational Resources Information Center

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

Young, Jenny M.; And Others

1994-01-01

27

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

PubMed

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 15-20 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

Schlanger, Judit; Fritúz, Gábor; Varga, Katalin

2013-12-01

28

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

PubMed Central

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 15–20 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

Frituz, Gabor; Varga, Katalin

2013-01-01

29

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

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

2011-01-01

30

Quality control of mechanical ventilation at the patient's home  

Microsoft Academic Search

Objective. During home mechanical ventilation the prescribed settings are applied without permanent supervision of health professionals. After a long-time period of unattended operation at home the ventilator may not apply the ventilation parameters prescribed. This quality control study of home mechanical ventilation assessed whether tidal volume (VT), frequency (f), and minute ventilation (V' E) actually applied by the ventilator coincide

Ramon Farré; Esther Giró; Vinyet Casolivé; Daniel Navajas; Joan Escarrabill

2003-01-01

31

46 CFR 154.1205 - Mechanical ventilation system: Standards.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Mechanical ventilation system: Standards. 154...Construction and Equipment Cargo Area: Mechanical Ventilation System § 154.1205 Mechanical ventilation system: Standards....

2013-10-01

32

46 CFR 154.1205 - Mechanical ventilation system: Standards.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 2012-10-01 false Mechanical ventilation system: Standards. 154...Construction and Equipment Cargo Area: Mechanical Ventilation System § 154.1205 Mechanical ventilation system: Standards....

2012-10-01

33

46 CFR 154.1205 - Mechanical ventilation system: Standards.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Mechanical ventilation system: Standards. 154...Construction and Equipment Cargo Area: Mechanical Ventilation System § 154.1205 Mechanical ventilation system: Standards....

2010-10-01

34

46 CFR 154.1205 - Mechanical ventilation system: Standards.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Mechanical ventilation system: Standards. 154...Construction and Equipment Cargo Area: Mechanical Ventilation System § 154.1205 Mechanical ventilation system: Standards....

2011-10-01

35

Tracheobronchomegaly in preterm infants on mechanical ventilation  

Microsoft Academic Search

Tracheobronchomegaly (TBM) was diagnosed on chest radiographs as an apparent dilatation of the trachea and main bronchi in four premature infants on prolonged mechanical ventilation for respiratory distress syndrome. In a retrospective study, the parameters of assisted ventilation, the Apgar score, the presence of conatal or later infection, and hypotension were reviewed and analyzed as factors possibly contributing to the

Ž. Zupan?i?; J. Primoži?

1995-01-01

36

Simulations for Mechanical Ventilation in Children: Review and Future Prospects  

PubMed Central

Mechanical ventilation is a very effective therapy, but with many complications. Simulators are used in many fields, including medicine, to enhance safety issues. In the intensive care unit, they are used for teaching cardiorespiratory physiology and ventilation, for testing ventilator performance, for forecasting the effect of ventilatory support, and to determine optimal ventilatory management. They are also used in research and development of clinical decision support systems (CDSSs) and explicit computerized protocols in closed loop. For all those reasons, cardiorespiratory simulators are one of the tools that help to decrease mechanical ventilation duration and complications. This paper describes the different types of simulators described in the literature for physiologic simulation and modeling of the respiratory system, including a new simulator (SimulResp), and proposes a validation process for these simulators. PMID:23533735

Flechelles, Olivier; Ho, Annie; Hernert, Patrice; Emeriaud, Guillaume; Zaglam, Nesrine; Cheriet, Farida; Jouvet, Philippe A.

2013-01-01

37

Noninvasive ventilation in postoperative care of lung transplant recipients.  

PubMed

Noninvasive positive pressure ventilation (NIPPV), which provides consolidated treatment of both acute and chronic respiratory failure, is increasingly being used in the postoperative care of lung transplant patients. Graft- and patient-related respiratory insufficiency requiring mechanical ventilation are common features in the postoperative period; they may persist for hours to days. Prolonged intubation, particularly in these immunocompromised patients, has been considered one of the main predisposing factors for developing nosocomial pneumonia. It has been associated with increased length of intensive care unit (ICU) stay as well. Noninvasive mechanical ventilation is nowadays an attractive choice to shorten weaning time and avoid reintubation following lung transplantation. Rapid extubation plus prompt NIPPV application is a useful strategy for lung recipients who do not completely fulfill the criteria for safe extubation. Unloading respiratory muscles, decreasing respiratory rate and sensation of dyspnea, improving ventilation/perfusion abnormalities, decreasing the heart rate, and improving hemodynamics are among the recognized benefits. Adding a noninvasive inspiratory support plus positive end-expiratory pressure (PEEP) to lung transplant recipients has been helpful to prevent airway injury and infections, avoiding the need for reintubation in cases of extubation failure, facilitating nocturnal sedation, treating the post-reimplantation syndrome and postoperative phrenic nerve dysfunction, and preventing reintubation in cases of readmission to the ICU. In our practice, the helmet system has emerged as the preferred interface; in cases of dyshomogeneous dorsobasal lung infiltrates, it allows effective ventilatory support in the prone position as well. PMID:19460554

Feltracco, P; Serra, E; Barbieri, S; Milevoj, M; Furnari, M; Rizzi, S; Rea, F; Marulli, G; Ori, C

2009-05-01

38

Optimizing Communication in Mechanically Ventilated Patients  

PubMed Central

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.

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

2014-01-01

39

New modes of assisted mechanical ventilation.  

PubMed

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

Suarez-Sipmann, F

2014-05-01

40

Iatrogenic pneumothorax related to mechanical ventilation  

PubMed Central

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

Hsu, Chien-Wei; Sun, Shu-Fen

2014-01-01

41

Brazilian recommendations of mechanical ventilation 2013. Part 2  

PubMed Central

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

Barbas, Carmen Silvia Valente; Isola, Alexandre Marini; Farias, Augusto Manoel de Carvalho; Cavalcanti, Alexandre Biasi; Gama, Ana Maria Casati; Duarte, Antonio Carlos Magalhaes; Vianna, Arthur; Serpa Neto, Ary; Bravim, Bruno de Arruda; Pinheiro, Bruno do Valle; Mazza, Bruno Franco; de Carvalho, Carlos Roberto Ribeiro; Toufen Junior, Carlos; David, Cid Marcos Nascimento; Taniguchi, Corine; Mazza, Debora 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, Joao Claudio; Valiatti, Jorge Luis dos Santos; Teles, Jose Mario Meira; Victorino, Josue Almeida; Ferreira, Juliana Carvalho; Prodomo, Luciana Passuello do Vale; Hajjar, Ludhmila Abrahao; Martins, Luiz Claudio; Malbouisson, Luis Marcelo Sa; Vargas, Mara Ambrosina de Oliveira; Reis, Marco Antonio Soares; Amato, Marcelo Brito Passos; Holanda, Marcelo Alcantara; Park, Marcelo; Jacomelli, Marcia; Tavares, Marcos; Damasceno, Marta Cristina Paulette; Assuncao, Murillo Santucci Cesar; Damasceno, Moyzes Pinto Coelho Duarte; Youssef, Nazah Cherif Mohamed; Teixeira, Paulo Jose Zimmermann; Caruso, Pedro; Duarte, Pericles 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, Veronica Moreira

2014-01-01

42

Brazilian recommendations of mechanical ventilation 2013. Part I  

PubMed Central

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

2014-01-01

43

A Dual Closed-Loop Control System for Mechanical Ventilation  

Microsoft Academic Search

Objective. Closed-loop mechanical ventilation has the potential to provide more effective ventilatory support to patients with less complexity than conventional ventilation. The purpose of this study was to investigate the effectiveness of an automatic technique for mechanical ventilation. Methods. Two closed-loop control systems for mechanical ventilation are combined in this study. In one of the control systems several physiological data

Fleur Tehrani; Mark Rogers; Takkin Lo; Thomas Malinowski; Samuel Afuwape; Michael Lum; Brett Grundl; Michael Terry

2004-01-01

44

Home Mechanical Ventilation in South Korea  

PubMed Central

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 (34.9±20.3 yrs), and used for longer (14.7±7.5) 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

Kim, Dong Hyun; Choi, Won Ah

2014-01-01

45

Delirium during Weaning from Mechanical Ventilation  

PubMed Central

Background. We compare the incidence of delirium before and after extubation and identify the risk factors and possible predictors for the occurrence of delirium in this group of patients. Methods. Patients weaned from mechanical ventilation (MV) and extubated were included. The assessment of delirium was conducted using the confusion assessment method for the ICU and completed twice per day until discharge from the intensive care unit. Results. Sixty-four patients were included in the study, 53.1% of whom presented with delirium. The risk factors of delirium were age (P = 0.01), SOFA score (P = 0.03), APACHE score (P = 0.01), and a neurological cause of admission (P = 0.01). The majority of the patients began with delirium before or on the day of extubation. Hypoactive delirium was the most common form. Conclusion. Acute (traumatic or medical) neurological injuries were important risk factors in the development of delirium. During the weaning process, delirium developed predominantly before or on the same day of extubation and was generally hypoactive (more difficult to detect). Therefore, while planning early prevention strategies, attention must be focused on neurological patients who are receiving MV and possibly even on patients who are still under sedation. PMID:24982804

Osaku, Erica Fernanda; Costa, Claudia Rejane Lima de Macedo; Cândia, Maria Fernanda; Toccolini, Beatriz; Covatti, Caroline; Costa, Nicolle Lamberti; Nogueira, Sandy Teixeira; Ogasawara, Suely Mariko; de Albuquerque, Carlos Eduardo; Piana, Pitágoras Augusto; Jorge, Amaury Cezar; Duarte, Péricles Almeida Delfino

2014-01-01

46

[Monitorization of respiratory mechanics in the ventilated patient].  

PubMed

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

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

2014-01-01

47

A special compressor used in portable mechanical ventilators  

Microsoft Academic Search

Portable mechanical ventilators currently used on the battlefield are designed to maintain life support. But it's still difficult to design an appropriate compressor for portable mechanical ventilators. A new type of compressor with small size, high output pressure, and high flow-rate is designed to satisfy the demands of portable mechanical ventilators. The special compressor has a new structure which is

Shilin Wu; Qi Zhang; Zhiping Huang; Jiulong Xiong

2009-01-01

48

Ozonolysis of monoterpenes in mechanical ventilation systems  

NASA Astrophysics Data System (ADS)

In this investigation the ozonolysis of of three monoterpenes ( ?-pinene, ?3-carene and limonene) was studied was studied in authentic mechanical ventilation systems, that included either a cross flow or a rotary heat exchanger. The effects of varying three experimental parameters were investigated: the level of ozone (25 and 75 ppb), the reaction time (25 and 75 s), and the surface area in the ventilation duct (14.8 and 29.5 m 2). The initial concentration of each of the monoterpenes was 20 ppb in every experiment, and 1-16% of the ?-pinene, <0.5-13% of the ?3-carene, and <0.5-16% of the limonene reacted. The effects of humidity (g m -3) and temperature of the outdoor and supply air, and water losses in the ventilation duct, were also evaluated. Experiments were based on a chemometric statistical design. Comparison of the results to theoretically calculated values showed that theoretical calculations underestimated the amounts that reacted in the ventilation systems by factors of 2-13, depending on the monoterpene and experimental settings.

Fick, Jerker; Pommer, Linda; Åstrand, Anders; Östin, Ronny; Nilsson, Calle; Andersson, Barbro

49

Injurious mechanical ventilation affects neuronal activation in ventilated rats  

PubMed Central

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

2011-01-01

50

Comparison of different mechanical ventilators for patients with poliomyelitis.  

PubMed

Poliomyelitis can affect patients with severe hypoxia and hypercapnia. Historically, most of these patients were supported by mechanical ventilation via tracheostomy. However, this procedure can lead to serious complications. Subsequently, non-invasive alternative procedures have been introduced that provide mechanical respiratory support; these include negative pressure ventilators and positive pressure ventilation via a nasal, oral, and oronasal interface. Although these ventilators are effective, various limitations have been noted. The strapless oronasal interface positive pressure ventilator appears to have the fewest limitations, and through the use of advanced dental techniques and improved dental materials, this ventilator is easily fabricated and has been noted by patients to be more comfortable. PMID:7659227

Choi, J W; Saunders, T R; Tebrock, O; Hansen, N A

1995-06-01

51

Clinical review: Independent lung ventilation in critical care  

PubMed Central

Independent lung ventilation (ILV) can be classified into anatomical and physiological lung separation. It requires either endobronchial blockade or double-lumen endotracheal tube intubation. Endobronchial blockade or selective double-lumen tube ventilation may necessitate temporary one lung ventilation. Anatomical lung separation isolates a diseased lung from contaminating the non-diseased lung. Physiological lung separation ventilates each lung as an independent unit. There are some clear indications for ILV as a primary intervention and as a rescue ventilator strategy in both anatomical and physiological lung separation. Potential pitfalls are related to establishing and maintaining lung isolation. Nevertheless, ILV can be used in the intensive care setting safely with a good understanding of its limitations and potential complications. PMID:16356244

Anantham, Devanand; Jagadesan, Raghuram; Tiew, Philip Eng Cher

2005-01-01

52

Evaluation of a clinical pathway for sedation and analgesia of mechanically ventilated patients in a cardiac intensive care unit (CICU): The Brigham and Women's Hospital Levine CICU sedation pathways  

PubMed Central

Background: Intravenous sedation and analgesia are important therapies during mechanical ventilation (MV). However, daily interruption of these medications is associated with improved outcomes in mechanically ventilated patients. We tested a clinical pathway for the use of sedation and analgesia during MV in a cardiac intensive care unit (CICU). Methods and results: We evaluated all mechanically ventilated patients in a CICU during two phases: phase 1 prior to pathway implementation (PRE) and phase 2 post-pathway implementation (POST). A total of 198 patients (98 PRE and 100 POST) and 1012 days of intubation (574 PRE and 434 POST) were included in this analysis. We found an increase in the frequency of daily interruptions of sedation post-implementation (49.3% PRE and 58.4% POST, p=0.0041). There was a significant decrease in the mean duration of MV in the POST vs PRE periods (5.0±2.3 vs 6.1±2.8 days, p=0.015). There was also a significant decrease in total neuroimaging studies (9 vs 49, p=0.001) and a trend toward a decrease in tracheostomies (3.0% vs 6.1%, p=0.33). Mean CICU length of stay (LOS) and hospital LOS respectively were 10.4 days and 16.8 days PRE and 10.4 days and 17.9 days POST (p=0.99 and p=0.55). Mortality did not differ (PRE 36.7% vs POST 32.0% p=0.55). Conclusions: Implementation of a pragmatic pathway for sedation and analgesia in a CICU was associated with an increase in the daily interruption of sedation and a corresponding decrease in the duration of MV days and the need for neuroimaging. PMID:24338288

Aday, Aaron W; Dell'Orfano, Heather; Hirning, Beth A; Matta, Lina; O'Brien, Molly H; Scirica, Benjamin M; Avery, Kathleen R

2013-01-01

53

How safe is non-bronchoscopic bronchoalveolar lavage in critically ill mechanically ventilated children?  

Microsoft Academic Search

Objective: To assess the safety of non-bronchoscopic bronchoalveolar lavage (NB-BAL) in critically ill mechanically ventilated children. Setting: Paediatric intensive care unit in a tertiary children's hospital. Methods: The data from 60 consecutive critically ill mechanically ventilated children who underwent NB-BAL was reviewed from November 1997 to December 1999. PRISM score prior to NB-BAL, observations at the time of NB-BAL and

Margarita Burmester; Quen Mok

2001-01-01

54

Pulmonary deposition of a nebulised aerosol during mechanical ventilation  

Microsoft Academic Search

BACKGROUND: There is increasing use of therapeutic aerosols in patients undergoing mechanical ventilation. Few studies have measured aerosol delivery to the lungs under these conditions with adequate experimental methods. Hence this study was performed to measure pulmonary aerosol deposition and to determine the reproducibility of the method of measurement during mechanical ventilation. METHODS: Nine male patients were studied during mechanical

S H Thomas; M J ODoherty; H M Fidler; C J Page; D F Treacher; T O Nunan

1993-01-01

55

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

PubMed Central

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

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

2011-01-01

56

Inhaled antibiotics in mechanically ventilated patients.  

PubMed

During the last decade, inhaled antibiotics, especially colistin, has been widely used worldwide as a therapeutic option, supplementary to conventional intravenous antibiotics, for the treatment of multidrug-resistant (MDR) Gram-negative nosocomial and ventilator-associated pneumonia (VAP). Antimicrobial aerosols are commonly used in mechanically ventilated patients with VAP, although information regarding their efficacy and optimal technique of administration has been limited. Recent studies showed that the administration of inhaled antibiotics in addition to systemic antibiotics provided encouraging results associated with low toxicity for the management of VAP mainly due to MDR Gram negative bacteria. Although the theory behind aerosolized administration of antibiotics seems to be sound, there are limited data available to support the routine use of this modality since very few randomized controlled trials (RCTs) have still examined the efficacy of this approach in patients with VAP. Additionally, this route of antibiotic delivery has not been approved until now neither by the FDA nor by the European Medicines Agency (EMEA) in patients with VAP. However, since the problem of VAP due to MDR bacteria has been increased worldwide RCTs are urgently needed in order to prove the safety, efficiency and efficacy of inhaled antimicrobial agents administered alone or in conjunction with parenteral antibiotics for the management of VAP in critically ill patients. Indeed, more data are needed to establish the appropriate role of inhaled antibiotics for the treatment of VAP. PMID:24107830

Michalopoulos, A S; Falagas, M E

2014-02-01

57

Modeling study of ventilation, IAQ and energy impacts of residential mechanical ventilation  

Microsoft Academic Search

This paper reports on a simulation study of indoor air quality, ventilation and energy impacts of several mechanical ventilation approaches in a single-family residential building. The study focused on a fictitious two-story house in Spokane, Washington and employed the multizone airflow and contaminant dispersal model CONTAM. The model of the house included a number of factors related to airflow including

Persily

1998-01-01

58

Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients: a randomised trial [ISRCTN47583497  

PubMed Central

Introduction This randomised, open-label, multicentre study compared the safety and efficacy of an analgesia-based sedation regime using remifentanil with a conventional hypnotic-based sedation regime in critically ill patients requiring prolonged mechanical ventilation for up to 10 days. Methods One hundred and five randomised patients received either a remifentanil-based sedation regime (initial dose 6 to 9 ?g kg-1 h-1 (0.1 to 0.15 ?g kg-1 min-1) titrated to response before the addition of midazolam for further sedation (n = 57), or a midazolam-based sedation regime with fentanyl or morphine added for analgesia (n = 48). Patients were sedated to an optimal Sedation–Agitation Scale (SAS) score of 3 or 4 and a pain intensity (PI) score of 1 or 2. Results The remifentanil-based sedation regime significantly reduced the duration of mechanical ventilation by more than 2 days (53.5 hours, P = 0.033), and significantly reduced the time from the start of the weaning process to extubation by more than 1 day (26.6 hours, P < 0.001). There was a trend towards shortening the stay in the intensive care unit (ICU) by 1 day. The median time of optimal SAS and PI was the same in both groups. There was a significant difference in the median time to offset of pharmacodynamic effects when discontinuing study medication in patients not extubated at 10 days (remifentanil 0.250 hour, comparator 1.167 hours; P < 0.001). Of the patients treated with remifentanil, 26% did not receive any midazolam during the study. In those patients that did receive midazolam, the use of remifentanil considerably reduced the total dose of midazolam required. Between days 3 and 10 the weighted mean infusion rate of remifentanil remained constant with no evidence of accumulation or of a development of tolerance to remifentanil. There was no difference between the groups in SAS or PI score in the 24 hours after stopping the study medication. Remifentanil was well tolerated. Conclusion Analgesia-based sedation with remifentanil was well tolerated; it reduces the duration of mechanical ventilation and improves the weaning process compared with standard hypnotic-based sedation regimes in ICU patients requiring long-term ventilation for up to 10 days. PMID:15987391

Breen, Des; Karabinis, Andreas; Malbrain, Manu; Morais, Rex; Albrecht, Sven; Jarnvig, Inge-Lise; Parkinson, Pauline; Kirkham, Andrew JT

2005-01-01

59

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 08/09) CALIFORNIA ENERGY COMMISSION INSTALLATION CERTIFICATE CF-6R-MECH-05 Indoor Air Quality and Mechanical August 2009 Ventilation for Indoor Air Quality (IAQ): All dwelling units shall meet the requirements

60

Weaning of mechanically ventilated chronic obstructive pulmonary disease patients by using non-invasive positive pressure ventilation: A prospective study  

PubMed Central

Background: Chronic obstructive pulmonary disease (COPD) patients frequently pose difficulty in weaning from invasive mechanical ventilation (MV). Prolonged invasive ventilation brings along various complications. Non-invasive positive pressure ventilation (NIPPV) is proposed to be a useful weaning modality in such cases. Objective: To evaluate the usefulness of NIPPV in weaning COPD patients from invasive MV, and compare it with weaning by conventional pressure support ventilation (PSV). Materials and Methods: For this prospective randomized controlled study, we included 50 COPD patients with type II respiratory failure requiring initial invasive MV. Upon satisfying weaning criteria and failing a t-piece weaning trial, they were randomized into two groups: Group I (25 patients) weaned by NIPPV, and group II (25 patients) weaned by conventional PSV. The groups were similar in terms of disease severity, demographic, clinical and biochemical parameters. They were compared in terms of duration of MV, weaning duration, length of intensive care unit (ICU) stay, occurrence of nosocomial pneumonia and outcome. Results: Statistically significant difference was found between the two groups in terms of duration of MV, weaning duration, length of ICU stay, occurrence of nosocomial pneumonia and outcome. Conclusion: NIPPV appears to be a promising weaning modality for mechanically ventilated COPD patients and should be tried in resource-limited settings especially in developing countries. PMID:24778474

Mishra, Mayank; Chaudhri, Sudhir; Tripathi, Vidisha; Verma, Ajay K.; Sampath, Arun; Chauhan, Nishant K.

2014-01-01

61

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

Microsoft Academic Search

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

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

2009-01-01

62

Biologic Variability in Mechanical Ventilation Rate and Tidal Volume Does Not Improve Oxygenation or Lung Mechanics in Canine Oleic Acid Lung Injury  

Microsoft Academic Search

Mechanical ventilation in patients with acute respiratory distress syndrome and acute lung injury (ALI) remains a difficult challenge because of the conflict between maintaining adequate gas ex- change and furthering lung injury via overdistention. In a recent study, Lefevre and colleagues ( Am. J. Respir. Crit. Care Med. 1996;154: 1567-1572) suggested that mechanical ventilation with natural biologic variability (BV) in

ARTHUR J. NAM; ROY G. BROWER; HENRY E. FESSLER; BRETT A. SIMON

2000-01-01

63

Critical Pertussis in a Young Infant Requiring Mechanical Ventilation  

PubMed Central

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

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

2013-01-01

64

Ammonia emissions from two mechanically ventilated UK livestock buildings  

NASA Astrophysics Data System (ADS)

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

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

65

Mechanical ventilation in critically ill cancer patients: outcome and utilisation of resources  

Microsoft Academic Search

Intensive care is increasingly being used in the management of cancer patients. It is important that a disproportionate share\\u000a of special care resources is not expended on futile care of terminally ill patients. A requirement for mechanical ventilation\\u000a has been stated to affect survival in cancer patients. The objectives of this study were to determine our hospital utilisation\\u000a of ICU

Ulf E. Kongsgaard; Nina K. Meidell

1999-01-01

66

A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting  

PubMed Central

Background Ventilator-associated pneumonia (VAP) is a common infection in the intensive care unit (ICU) and associated with a high mortality. Methods A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed from October 2008 to December 2010. All of these processes, including the Institute for Healthcare Improvement’s (IHI) ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions (CASS), were adopted for patients undergoing mechanical ventilation. Results We evaluated a total of 21,984 patient-days, and a total of 6,052 ventilator-days (ventilator utilization rate of 0.27). We found VAP rates of 1.3 and 2.0 per 1,000 ventilator days respectively in 2009 and 2010, achieving zero incidence of VAP several times during 12 months, whenever VAP bundle compliance was over 90%. Conclusion These results suggest that it is possible to reduce VAP rates to near zero and sustain these rates, but it requires a complex process involving multiple performance measures and interventions that must be permanently monitored. PMID:23020101

2012-01-01

67

Lumican Expression in Diaphragm Induced by Mechanical Ventilation  

PubMed Central

Background Diaphragmatic dysfunction found in the patients with acute lung injury required prolonged mechanical ventilation. Mechanical ventilation can induce production of inflammatory cytokines and excess deposition of extracellular matrix proteins via up-regulation of transforming growth factor (TGF)-?1. Lumican is known to participate in TGF-?1 signaling during wound healing. The mechanisms regulating interactions between mechanical ventilation and diaphragmatic injury are unclear. We hypothesized that diaphragmatic damage by short duration of mechanical stretch caused up-regulation of lumican that modulated TGF-?1 signaling. Methods Male C57BL/6 mice, either wild-type or lumican-null, aged 3 months, weighing between 25 and 30 g, were exposed to normal tidal volume (10 ml/kg) or high tidal volume (30 ml/kg) mechanical ventilation with room air for 2 to 8 hours. Nonventilated mice served as control groups. Results High tidal volume mechanical ventilation induced interfibrillar disassembly of diaphragmatic collagen fiber, lumican activation, type I and III procollagen, fibronectin, and ?-smooth muscle actin (?-SMA) mRNA, production of free radical and TGF-?1 protein, and positive staining of lumican in diaphragmatic fiber. Mechanical ventilation of lumican deficient mice attenuated diaphragmatic injury, type I and III procollagen, fibronectin, and ?-SMA mRNA, and production of free radical and TGF-?1 protein. No significant diaphragmatic injury was found in mice subjected to normal tidal volume mechanical ventilation. Conclusion Our data showed that high tidal volume mechanical ventilation induced TGF-?1 production, TGF-?1-inducible genes, e.g., collagen, and diaphragmatic dysfunction through activation of the lumican. PMID:21931815

Li, Li-Fu; Chen, Bao-Xiang; Tsai, Ying-Huang; Kao, Winston W.-Y.

2011-01-01

68

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

PubMed Central

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

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

2011-01-01

69

Commissioning Trial for Mechanical Ventilation System Installed in Houses  

E-print Network

COMMISSIONING TRIAL FOR MECHANICAL VENTILATION SYSTEM INSTALLED IN HOUSES Isamu Ohta* Akira Fukushima** * Misawa Homes Co., Ltd., 2-4-5 Takaido-Higashi Suginami-ku Tokyo Japan 168-8533 ** Hokkaido Government, 6 Nishi 3Jyou Kita Chuuo...COMMISSIONING TRIAL FOR MECHANICAL VENTILATION SYSTEM INSTALLED IN HOUSES Isamu Ohta* Akira Fukushima** * Misawa Homes Co., Ltd., 2-4-5 Takaido-Higashi Suginami-ku Tokyo Japan 168-8533 ** Hokkaido Government, 6 Nishi 3Jyou Kita Chuuo...

Ohta, I.; Fukushima, A.

2004-01-01

70

Mechanical ventilation alters the immune response in children without lung pathology  

Microsoft Academic Search

Objective: This study was undertaken to examine the hypothesis that mechanical ventilation in association with anesthesia would alter the cytokine profile in infants without preexisting lung pathology. Design and setting: Prospective observational study in pediatric intensive care unit in a university hospital. Patients: Twelve infants who were subjected to an uncomplicated diagnostic cardiac catheterization procedure were studied. All subjects were

Frans B. Plötz; Harriet A. Vreugdenhil; Arthur S. Slutsky; Jitske Zijlstra; Cobi J. Heijnen; Hans van Vught

2002-01-01

71

Detection of expiratory flow limitation during mechanical ventilation: a simulation study  

Microsoft Academic Search

Expiratory flow limitation (EFL) is frequent in mechanically ventilated patients with obstructive pulmonary disease and its prompt detection is important to optimize respiratory assistance. The present study aims to compare by simulation two methods for the detection of flow limitation in intensive care unit: the negative expiratory pressure (NEP) method and the external resistance (?R) method. To this purpose, a

C. Brighenti; P. Barbini; G. Gnudi

2004-01-01

72

Determinants of ventilator associated pneumonia and its impact on prognosis: A tertiary care experience  

PubMed Central

Background: Ventilator associated pneumonia (VAP) is a major cause of poor outcome among patients in the intensive care units (ICU) world-wide. We sought to determine the factors associated with development of VAP and its prognosis among patients admitted to different ICUs of a Tertiary Care Hospital in India. Methodology: We did a matched case control study during October 2009 to May 2011 among patients, ?18 years with mechanical ventilation. Patients who developed pneumonia after 48 h of ventilation were selected in the case group and those who did not develop pneumonia constituted the control group. Patients’ history, clinical and laboratory findings were recorded and analyzed. Results: There were 52 patients included in each group. Among cases, early onset ventilator associated pneumonia (EVAP) occurred in 27 (51.9%) and late onset ventilator associated pneumonia (LVAP) in 25 (48.1%). Drug resistant organisms contributed to 76.9% of VAP. Bacteremia (P = 0.002), prior use of steroid/immunosuppressant (P = 0.004) and re-intubations (P = 0.021) were associated with the occurrence of VAP. The association of Acinetobacter (P = 0.025) and Pseudomonas (P = 0.047) for LVAP was found to be statistically significant. Duration of mechanical ventilation (P = 0.001), ICU stay (P = 0.049) and requirement for tracheostomy (P = 0.043) were significantly higher in VAP. Among each case and control groups, 19 (36.5%) expired. Conclusion: We found a higher proportion of LVAP compared with EVAP and a higher proportion of drug resistant organisms among LVAP, especially Pseudomonas and Acinetobacter. Drug resistant Pseudomonas was associated with higher mortality. PMID:24501484

Saravu, Kavitha; Preethi, V.; Kumar, Rishikesh; Guddattu, Vasudev; Shastry, Ananthakrishna Barkur; Mukhopadhyay, Chiranjay

2013-01-01

73

Impact of mechanical ventilation and fluid load on pulmonary glycosaminoglycans.  

PubMed

The combined effect of mechanical ventilation and fluid load on pulmonary glycasaminoglycans (GAGs) was studied in anaesthetized rats ((BW 290±21.8 (SE)g) mechanically ventilated for 4h: (a) at low (?7.5mlkg(-1)) or high (?23mlkg(-1)) tidal volume (V(T)) and zero alveolar pressure; (b) at low or high V(T) at 5cmH(2)O positive end-expiratory pressure (PEEP); (c) with or without 7mlkg(-1)h(-1) intravenous infusion of Phosphate Buffer Solution (PBS). Compared to spontaneous breathing, GAGs extractability decreased by 52.1±1.5% and 42.2±7.3% in not-infused lungs mechanically ventilated at low V(T) or at high V(T) and PEEP, respectively. In contrast, in infused lungs, GAGs extractability increased by 56.1±4.0% in spontaneous ventilation and PEEP and up to 81.1% in all mechanically ventilated lungs, except at low V(T) without PEEP. In the absence of an inflammatory process, these results suggest that PEEP was protective at low but not at high V(T) when alveolar structures experience exceedingly high stresses. When combined to mechanical ventilation, fluid load might exacerbate edema development and lung injury. PMID:22484819

Moriondo, Andrea; Marcozzi, Cristiana; Bianchin, Francesca; Reguzzoni, Marcella; Severgnini, Paolo; Protasoni, Marina; Raspanti, Mario; Passi, Alberto; Pelosi, Paolo; Negrini, Daniela

2012-05-31

74

"Fighting the system": Families caring for ventilator-dependent children and adults with complex health care needs at home  

PubMed Central

Background An increasing number of individuals with complex health care needs now receive life-long and life-prolonging ventilatory support at home. Family members often take on the role of primary caregivers. The aim of this study was to explore the experiences of families giving advanced care to family members dependent on home mechanical ventilation. Methods Using qualitative research methods, a Grounded Theory influenced approach was used to explore the families' experiences. A total of 15 family members with 11 ventilator-dependent individuals (three children and eight adults) were recruited for 10 in-depth interviews. Results The core category, "fighting the system," became the central theme as family members were asked to describe their experiences. In addition, we identified three subcategories, "lack of competence and continuity", "being indispensable" and "worth fighting for". This study revealed no major differences in the families' experiences that were dependent on whether the ventilator-dependent individual was a child or an adult. Conclusions These findings show that there is a large gap between family members' expectations and what the community health care services are able to provide, even when almost unlimited resources are available. A number of measures are needed to reduce the burden on these family members and to make hospital care at home possible. In the future, the gap between what the health care can potentially provide and what they can provide in real life will rapidly increase. New proposals to limit the extremely costly provision of home mechanical ventilation in Norway will trigger new ethical dilemmas that should be studied further. PMID:21726441

2011-01-01

75

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

PubMed Central

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 (min–max) of the ventilatory parameters were the following: inspired tidal volume = 607 ± 36 (530–723) mL, expired tidal volume = 608 ± 36 (530–728) mL, peak pressure = 20.8 ± 2.3 (17.2–25.9) cmH2O, respiratory rate = 20.09 ± 0.35 (19.5–21.6) breaths/minute, PEEP = 8.43 ± 0.57 (7.26–10.8) cmH2O, oxygen fraction = 0.49 ± 0.014 (0.41–0.53). 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

Govoni, Leonardo; Dellaca', Raffaele L; Penuelas, Oscar; Bellani, Giacomo; Artigas, Antonio; Ferrer, Miquel; Navajas, Daniel; Pedotti, Antonio; Farre, Ramon

2012-01-01

76

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

PubMed

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 cmH(2)O/L/s) - elastance (100 mL/cmH(2)O) 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 cmH(2)O, and oxygen fraction = 0.5. The signals from the sensors were recorded to compute the ventilation parameters. The average ± standard deviation and range (min-max) of the ventilatory parameters were the following: inspired tidal volume = 607 ± 36 (530-723) mL, expired tidal volume = 608 ± 36 (530-728) mL, peak pressure = 20.8 ± 2.3 (17.2-25.9) cmH(2)O, respiratory rate = 20.09 ± 0.35 (19.5-21.6) breaths/minute, PEEP = 8.43 ± 0.57 (7.26-10.8) cmH(2)O, oxygen fraction = 0.49 ± 0.014 (0.41-0.53). 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

Govoni, Leonardo; Dellaca', Raffaele L; Peñuelas, Oscar; Bellani, Giacomo; Artigas, Antonio; Ferrer, Miquel; Navajas, Daniel; Pedotti, Antonio; Farré, Ramon

2012-01-01

77

How outcomes are defined in clinical trials of mechanically ventilated adults and children.  

PubMed

Systematic reviews have considerable potential to provide evidence-based data to aid clinical decision-making. However, there is growing recognition that trials involving mechanical ventilation lack consistency in the definition and measurement of ventilation outcomes, creating difficulties in combining data for meta-analyses. To address the inconsistency in outcome definitions, international standards for trial registration and clinical trial protocols published recommendations, effectively setting the "gold standard" for reporting trial outcomes. In this Critical Care Perspective, we review the problems resulting from inconsistent outcome definitions and inconsistent reporting of outcomes (outcome sets). We present data highlighting the variability of the most commonly reported ventilation outcome definitions. Ventilation outcomes reported in trials over the last 6 years typically fall into four domains: measures of ventilator dependence; adverse outcomes; mortality; and resource use. We highlight the need, first, for agreement on outcome definitions and, second, for a minimum core outcome set for trials involving mechanical ventilation. A minimum core outcome set would not restrict trialists from measuring additional outcomes, but would overcome problems of variability in outcome selection, measurement, and reporting, thereby enhancing comparisons across trials. PMID:24512505

Blackwood, Bronagh; Clarke, Mike; McAuley, Danny F; McGuigan, Peter J; Marshall, John C; Rose, Louise

2014-04-15

78

Vigilancia y control de la neumonía asociada a ventilación mecánica Surveillance and control of pneumonia associated with mechanical ventilation  

Microsoft Academic Search

Basis. Pneumonia associated with mechanical ventilation (PAV) is one the of most frequent nosocomial infections in Inten- sive Care Units (ICUs). Its incidence in Spain being of 6.9%, with 10.30\\/00 by days of stay, and with a standard of between 15-20% by days of mechanical ventilation in the ICU, which increases mortality by 20-5%. The aim of this paper is

J. M. Martínez Segura; J. Izura; A. Gutiérrez; J. A. Tihista

2000-01-01

79

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

PubMed Central

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

Fukuhara, Toru; Aoi, Mizuho; Namba, Yoichiro

2014-01-01

80

Our paper 20 years later: how has withdrawal from mechanical ventilation changed?  

PubMed

Withdrawal from mechanical ventilation (or weaning) is one of the most common procedures in intensive care units. Almost 20 years ago, we published one of the seminal papers on weaning in which we showed that the best method for withdrawal from mechanical ventilation in difficult-to-wean patients was a once-daily spontaneous breathing trial with a T-piece. Progress has not stood still, and in the intervening years up to the present several other studies, by our group and others, have shaped weaning into an evidence-based technique. The results of these studies have been applied progressively to routine clinical practice. Currently, withdrawal from mechanical ventilation can be summarized as the evaluation of extubation readiness based on the patient's performance during a spontaneous breathing trial. This trial can be performed with a T-piece, which is the most common approach, or with continuous positive airway pressure or low levels of pressure support. Most patients can be disconnected after passing the first spontaneous breathing trial. In patients who fail the first attempt at withdrawal, the use of a once-daily spontaneous breathing trial or a gradual reduction in pressure support are the preferred weaning methods. However, new applications of standard techniques, such as noninvasive positive pressure ventilation, or new methods of mechanical ventilation, such as automatic tube compensation, automated closed-loop systems, and automated knowledge-based weaning systems, can play a role in the management of the patients with difficult or prolonged weaning. PMID:25053247

Frutos-Vivar, Fernando; Esteban, Andrés

2014-10-01

81

[Interface type helmet non-invasive mechanical ventilation].  

PubMed

Non-invasive mechanical ventilation is a technique that has ceased to be exclusively used in intensive medicine services to form part of the armamentarium of emergency and critical services, assuming an adaptation to this procedure by the nursing staff whose participation is crucial to achieve the triumph of technique. Composed basically of a mechanical ventilator and a mask (interface) which is interposed between the patient and the fan without invading the airway, requires the collaboration of the patient unlike conventional mechanical ventilation and, initially, a longer time of dedication of the nurse. Interfaces models and the evolution of the same to achieve the effects desired with good tolerance by the patient came to the development of the Helmet, a device in the form of diving, well tolerated by the patient, allowing the use of high pressure for alveolar recruitment, but that, by design, has connotations that must be known before use. PMID:24547633

Migallón Buitrago, M Elvira; García-Velasco Sánchez-Morago, Santiago; Ramírez de Orol, Miguel Angel; Puyana Manrique de Lara, M del Carmen

2013-12-01

82

Cerebral Arterial Air Embolism Associated with Mechanical Ventilation and Deep Tracheal Aspiration  

PubMed Central

Arterial air embolism associated with pulmonary barotrauma has been considered a rare but a well-known complication of mechanical ventilation. A 65-year-old man, who had subarachnoid hemorrhage with Glasgow coma scale of 8, was admitted to intensive care unit and ventilated with the help of mechanical ventilator. Due to the excessive secretions, deep tracheal aspirations were made frequently. GCS decreased from 8–10 to 4-5, and the patient was reevaluated with cranial CT scan. In CT scan, air embolism was detected in the cerebral arteries. The patient deteriorated and spontaneous respiratory activity lost just after the CT investigation. Thirty minutes later cardiac arrest appeared. Despite the resuscitation, the patient died. We suggest that pneumonia and frequent tracheal aspirations are predisposing factors for cerebral vascular air embolism. PMID:22934224

Gursoy, S.; Duger, C.; Kaygusuz, K.; Ozdemir Kol, I.; Gurelik, B.; Mimaroglu, C.

2012-01-01

83

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

PubMed

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

Valenzuela, Jorge; Araneda, Patricio; Cruces, Pablo

2014-03-01

84

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

PubMed Central

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

Basuni, Ahmed Sobhy

2014-01-01

85

Exhaled Breath Condensate Collection in the Mechanically Ventilated Patient  

PubMed Central

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

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

2012-01-01

86

Noninvasive Mechanical Ventilation in the Weaning of Patients with Respiratory Failure Due to Chronic Obstructive Pulmonary Disease A Randomized, Controlled Trial  

Microsoft Academic Search

Background: In patients with acute exacerbations of chronic obstructive pulmonary disease, mechanical venti­ lation is often needed. The rate of weaning failure is high in these patients, and prolonged mechanical ventilation increases intubation-associated complications. Objective: To determine whether noninvasive ventila­ tion improves the outcome of weaning from invasive me­ chanical ventilation. Design: Multicenter, randomized trial. Setting: Three respiratory intensive care

Stefano Nava; Nicolino Ambrosino; Enrico Clini; Maurizio Prato; Giacomo Orlando; Michele Vitacca; Paolo Brigada; Claudio Fracchia; Fiorenzo Rubini

87

GASTRIC REFLUX IN MECHANICALLY VENTILATED GASTRIC FED ICU PATIENTS  

E-print Network

to enrollment in the study. A randomized 2-day crossover trial was conducted in a surgical and medical ICU. Mechanically ventilated gastric fed subjects were randomly assigned to 1 of the 2 HOB elevation sequences, HOB 30? for 12 hours (hrs) on day 1 and 45...

Schallom, Marilyn

2013-08-31

88

Anticipation of distress after discontinuation of mechanical ventilation in the ICU at the end of life  

PubMed Central

Background A considerable number of patients admitted to the intensive care unit (ICU) die following withdrawal of mechanical ventilation. After discontinuation of ventilation without proper preparation, excessive respiratory secretion is common, resulting in a ‘death rattle’. Post-extubation stridor can give rise to the relatives’ perception that the patient is choking and suffering. Existing protocols lack adequate anticipatory preparation to respond to all distressing symptoms. Methods We analyzed existing treatment strategies in distressing symptoms after discontinuation of mechanical ventilation. Conclusion The actual period of discontinuation of mechanical ventilation can be very short, but thoughtful anticipation of distressing symptoms takes time. There is an ethical responsibility to anticipate and treat (iatrogenic) symptoms such as pain, dyspnea-associated respiratory distress, anxiety, delirium, post-extubation stridor, and excessive broncho-pulmonary secretions. This makes withdrawal of mechanical ventilation in ICU patients a thoughtful process, taking palliative actions instead of fast terminal actions. We developed a flowchart covering all possible distressing symptoms that can occur after withdrawal of mechanical ventilation and extubation. We recommend a two-phase process. Six hours before extubation, enteral feeding should be stopped and parenteral fluids reduced, overhydrated patients should be dehydrated with furosemide, administration of sedatives (for distress) and opioids (for pain and/or dyspnea) should be continued or started and methylprednisolone should be given in anticipation of stridor after extubation. Thirty minutes before extubation, Butylscopolamine should be given and methylprednisolone repeated. After this the patient should be extubated to secure a dying process as natural as possible with the lowest burden due to distress. PMID:18516588

van der Hoven, B.; Bakker, J.

2008-01-01

89

Interval neurophysiological changes in non septic critically ill mechanically ventilated patients.  

PubMed

Peripheral nerve changes in critically ill patients are common, sepsis being the most important risk factor. The aim of our study is to investigate interval neurophysiological changes in non septic mechanically ventilated critically ill patients, a group who has not been the focus of previous studies. Consecutive non septic mechanically ventilated critically ill patients were included. Baseline nerve conduction studies (NCS) were done within 3 days of intensive care unit admission, and 48 hours after the initiation of mechanical ventilation, and were followed up 7-8 days later. Sural and ulnar sensory, and median and peroneal motor nerves were tested. Nine patients were studied, five (56%) showed significant changes in their NCS compared to baseline. The peroneal and sural nerve amplitudes significantly dropped in all of the five affected patients, with drop of those of the median motor nerves in two, and ulnar sensory nerves in three patients. In conclusion, interval changes in peripheral nerves can exist in critically ill mechanically ventilated non septic patients. The pattern is similar to critically ill patients with sepsis. Theories of possible pathophysiology of critical illness neuropathy should not merely depend on the presence of sepsis as a trigger and other mechanisms should be investigated. PMID:22854770

El-Salem, Khalid; Khassawneh, Basheer; Alrefai, Ali; Dwairy, Abdel Raheem; Rawashdeh, Sukaina

2012-08-01

90

Functional residual capacity tool: A practical method to assess lung volume changes during pulmonary complications in mechanically ventilated patients  

PubMed Central

In this report, we describe a patient in whom we used a functional residual capacity (FRC) tool available on a critical care ventilator to identify the loss of lung volume associated with pulmonary complications and increase in FRC with the application of a recruitment maneuver. The case report underlines the utility of the FRC tool in rapid visualization of the lung volume changes and the effects of application of corrective strategies in patients receiving mechanical ventilation. PMID:21253350

Veena, S.; Palepu, Sudeep; Umamaheswara Rao, G. S.; Ramesh, V. J.

2010-01-01

91

Clinical review: Independent lung ventilation in critical care  

Microsoft Academic Search

Independent lung ventilation (ILV) can be classified into anatomical and physiological lung separation. It requires either endobronchial blockade or double-lumen endotracheal tube intubation. Endobronchial blockade or selective double-lumen tube ventilation may necessitate temporary one lung ventilation. Anatomical lung separation isolates a diseased lung from contaminating the non-diseased lung. Physiological lung separation ventilates each lung as an independent unit. There are

Devanand Anantham; Raghuram Jagadesan; Philip Eng Cher Tiew

2005-01-01

92

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

PubMed Central

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.

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

2014-01-01

93

Adverse events during rotary-wing transport of mechanically ventilated patients: a retrospective cohort study  

PubMed Central

Introduction Patients triaged to tertiary care centers frequently undergo rotary-wing transport and may be exposed to additional risk for adverse events. The incidence of physiologic adverse events and their predisposing factors in mechanically ventilated patients undergoing aeromedical transport are unknown. Methods We performed a retrospective review of flight records of all interfacility, rotary-wing transports to a tertiary care, university hospital during 2001 to 2003. All patients receiving mechanical ventilation via endotracheal tube or tracheostomy were included; trauma, scene flights, and fixed transports were excluded. Data were abstracted from patient flight and hospital records. Adverse events were classified as either major (death, arrest, pneumothorax, or seizure) or minor (physiologic decompensation, new arrhythmia, or requirement for new sedation/paralysis). Bivariate associations between hospital and flight characteristics and the presence of adverse events were examined. Results Six hundred eighty-two interfacility flights occurred during the period of review, with 191 patients receiving mechanical ventilation. Fifty-eight different hospitals transferred patients, with diagnoses that were primarily cardiopulmonary (45%) and neurologic (37%). Median flight distance and time were 42 (31 to 83) km and 13 (8 to 22) minutes, respectively. No major adverse events occurred during flight. Forty patients (22%) experienced a minor physiologic adverse event. Vasopressor requirement prior to flight and flight distance were associated with the presence of adverse events in-flight (P < 0.05). Patient demographics, time of day, season, transferring hospital characteristics, and ventilator settings before and during flight were not associated with adverse events. Conclusion Major adverse events are rare during interfacility, rotary-wing transfer of critically ill, mechanically ventilated patients. Patients transferred over a longer distance or transferred on vasopressors may be at greater risk for minor adverse events during flight. PMID:18498659

Seymour, Christopher W; Kahn, Jeremy M; Schwab, C William; Fuchs, Barry D

2008-01-01

94

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

E-print Network

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

95

Fuzzy logic control of mechanical ventilation during anaesthesia.  

PubMed

We have examined a new approach, using fuzzy logic, to the closed-loop feedback control of mechanical ventilation during general anaesthesia. This control system automatically adjusts ventilatory frequency (f) and tidal volume (VT) in order to achieve and maintain the end-tidal carbon dioxide fraction (FE'CO2) at a desired level (set-point). The controller attempts to minimize the deviation of both f and VT per kg body weight from 10 bpm and 10 ml kg-1, respectively, and to maintain the plateau airway pressure within suitable limits. In 30 patients, undergoing various surgical procedures, the fuzzy control mode was compared with human ventilation control. For a set-point of FE'CO2 = 4.5 vol% and during measurement periods of 20 min, accuracy, stability and breathing pattern did not differ significantly between fuzzy logic and manual ventilation control. After step-changes in the set-point of FE'CO2 from 4.5 to 5.5 vol% and vice versa, overshoot and rise time did not differ significantly between the two control modes. We conclude that to achieve and maintain a desired FE'CO2 during routine anaesthesia, fuzzy logic feedback control of mechanical ventilation is a reliable and safe mode of control. PMID:8957981

Schäublin, J; Derighetti, M; Feigenwinter, P; Petersen-Felix, S; Zbinden, A M

1996-11-01

96

[Non-invasive home mechanical ventilation: qualification, initiation, and monitoring].  

PubMed

Following the introduction of non-invasive positive pressure ventilation (NPPV), the number of patients using home mechanical ventilation has increased substantially and continues to rise worldwide. This is primarily explained by both the effectiveness and comfort that are offered by NPPV in most patients, and particularly in patients with chest wall and neuromuscular diseases. For clinically stable patients the qualification for NPPV largely depends on the presence of complaints or signs of (nocturnal) hypoventilation with accompanying hypercapnia. For patients who are referred by an ICU there are additional prerequisites. In any case, the aims of NPPV should be met and NPPV should be effective. The initiation of NPPV, whether in the clinic or not, should always be tailored to the individual patient. Based on effectiveness, safety, and comfort, the best ventilator has to be chosen. Although with modern interfaces NPPV may be provided continuously, for continuing NPPV over the years, adding manual and/or mechanical cough augmentation techniques is usually mandatory. To control the ongoing effectiveness of NPPV regular monitoring of the patient is essential, and nowadays transcutaneous measurement of CO2 seems the most reliable and appropriate technique. For trend analysis, downloaded data of modern ventilators may be helpful as well. The ultimate goal of NPPV, to prevent tracheotomy, can only be reached if the patient has continuous access to a centre with expertise in cough augmentation techniques and both nocturnal and diurnal NPPV. PMID:22926911

Kampelmacher, Mike J

2012-01-01

97

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

PubMed

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

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

2013-10-01

98

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

PubMed Central

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

Bach, J. R.

1992-01-01

99

Modeling study of ventilation, IAQ and energy impacts of residential mechanical ventilation  

SciTech Connect

This paper reports on a simulation study of indoor air quality, ventilation and energy impacts of several mechanical ventilation approaches in a single-family residential building. The study focused on a fictitious two-story house in Spokane, Washington and employed the multizone airflow and contaminant dispersal model CONTAM. The model of the house included a number of factors related to airflow including exhaust fan and forced-air system operation, duct leakage and weather effects, as well as factors related to contaminant dispersal including adsorption/desorption of water vapor and volatile organic compounds, surface losses of particles and nitrogen dioxide, outdoor contaminant concentrations, and occupant activities. The contaminants studied include carbon monoxide, carbon dioxide, nitrogen dioxide, water vapor, fine and coarse particles, and volatile organic compounds. One-year simulations were performed for four different ventilation approaches: a base case of envelope infiltration only, passive inlet vents in combination with exhaust fan operation, an outdoor intake duct connected to the forced-air system return balanced by exhaust fan operation, and a continuously-operated exhaust fan. Results discussed include whole building air change rates, air distribution within the house, heating and cooling loads, contaminants concentrations, and occupant exposure to contaminants.

Persily, A.K.

1998-05-01

100

Absolute electrical impedance tomography (aEIT) guided ventilation therapy in critical care patients: simulations and future trends.  

PubMed

Thoracic electrical impedance tomography (EIT) is a noninvasive, radiation-free monitoring technique whose aim is to reconstruct a cross-sectional image of the internal spatial distribution of conductivity from electrical measurements made by injecting small alternating currents via an electrode array placed on the surface of the thorax. The purpose of this paper is to discuss the fundamentals of EIT and demonstrate the principles of mechanical ventilation, lung recruitment, and EIT imaging on a comprehensive physiological model, which combines a model of respiratory mechanics, a model of the human lung absolute resistivity as a function of air content, and a 2-D finite-element mesh of the thorax to simulate EIT image reconstruction during mechanical ventilation. The overall model gives a good understanding of respiratory physiology and EIT monitoring techniques in mechanically ventilated patients. The model proposed here was able to reproduce consistent images of ventilation distribution in simulated acutely injured and collapsed lung conditions. A new advisory system architecture integrating a previously developed data-driven physiological model for continuous and noninvasive predictions of blood gas parameters with the regional lung function data/information generated from absolute EIT (aEIT) is proposed for monitoring and ventilator therapy management of critical care patients. PMID:19906599

Denaï, Mouloud A; Mahfouf, Mahdi; Mohamad-Samuri, Suzani; Panoutsos, George; Brown, Brian H; Mills, Gary H

2010-05-01

101

Mechanical Ventilation for Ards: Should we Reduce Tidal Volume?  

Microsoft Academic Search

\\u000a For the last ten years, barotrauma has been proposed as a major cause for our failure in salvaging patiens having the Acute\\u000a Respiratory Distress Syndrome (ARDS). After the first descriptions1,2 of cysts, bullae and emphysematous-like lesions supposedly caused by mechanical ventilation, many authors related the incidence\\u000a and severity of barotrauma -not only overdistension of airspaces, but also pneumothoraces- to the

François Lemaire; Eric Roupie

102

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

PubMed

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

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

2014-06-01

103

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

PubMed Central

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

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

2014-01-01

104

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

PubMed

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

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

2013-01-01

105

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

PubMed Central

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

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

2010-01-01

106

The ventilator-dependent infant requiring palliative care in the neonatal intensive care unit: A literature review  

Microsoft Academic Search

Aim: To review the literature relevant to palliative care of the ventilated infant and their family.\\u000aBackground: Impeccable symptom assessment and management is necessary to ensure the optimal quality of life for the ventilated palliative infant and their family. There is a plethora of literature regarding symptom assessment and care when a decision has been made to withdraw ventilatory support.

Christine Foster; Leanne Monterosso

2012-01-01

107

Design and prototyping of a low-cost portable mechanical ventilator  

E-print Network

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 ...

Powelson, Stephen K. (Stephen Kirby)

2010-01-01

108

The long-term mechanically ventilated patient. An outcomes management approach.  

PubMed

As noted previously, prior to permanently instituting an outcomes approach, we compared the effects of such a model to a nonoutcomes-managed approach. The positive trend noted during the study interval has been sustained 2 years later, and the variables of cost, LOS, and ventilator duration (median = 9 days for DRG 475, 483 combined) for these patients continue to be favorably affected (see Figure 2). In addition, the outcomes-management model has been well accepted by all members of the health care team. The outcomes manager is a respected and valued member of the team and is central to the ongoing success of the approach. Although the clinical pathway is an essential tool for focusing and delineating multidisciplinary best-practice, the pathway (and processes of care contained within) must be continually evaluated and changed as needed. The pathway cannot be static if care is to be progressive. Essential to the process is a method of collecting and processing data in a timely way. Further, it is important that data collection, while important, not be the focus of the role of outcomes manager. Instead, the focus is the delivery of timely and effective care. Our current outcomes model applies to management of patients beyond the boundaries of the MICU or pulmonary suite. In other words, once weaned and transferred to a regular floor the outcomes manager no longer manages the patients (although she does track selected outcomes). Management of patients throughout hospitalization is a future goal, but we are convinced that this cannot be accomplished by a single outcomes manager. Although we are aware that other outcomes models do follow patients throughout the continuum of hospitalization and beyond, our highly clinically interactive model precludes that possibility. We are currently considering other similar unit-based positions to provide the desired continuity following discharge from the MICU or pulmonary suite. Despite our enthusiasm for the outcomes-management model, we recognize that other models may also result in comparable, favorable outcomes. It is important that those who adopt similar models of care delivery for managing patients requiring prolonged ventilation be scientific in their approach. Long-term studies of the efficacy of these models are essential if we are to truly provide quality care for our patients in the future. Unfortunately, as noted earlier, bias will be hard to overcome. Hospitals vested in rapidly establishing a stable financial bottom-line are likely to embrace quick applications. Projects with a true experimental design to evaluate efficacy, such as this one, will be rare in these organizations. Finally, it is critical that variables of interest be inclusive of specific quality indicators such as ventilator duration and complications rather than global institutional markers such as LOS. Standardization of variables of interest is imperative if outcomes are to be compared. For example, patients requiring long-term mechanical ventilation are identified by the AACN's Third National Study Group on weaning as those who require mechanical ventilation for more than 3 days. If we are to compare other variables of interest such as total ventilator duration, such as definition is essential or we will be comparing apples and oranges in the future. Provision of quality, cost-effective care for patients requiring prolonged ventilation is a true clinical challenge. Outcomes management is a multidisciplinary method of care delivery that is systematic and comprehensive in approach. Although little science exists related to the application of the model for patients requiring prolonged ventilation, preliminary reports are promising and warrant future applications and evaluation of the same. PMID:9644351

Burns, S M

1998-03-01

109

Helium-oxygen reduces the production of carbon dioxide during weaning from mechanical ventilation  

PubMed Central

Background Prolonged weaning from mechanical ventilation has a major impact on ICU bed occupancy and patient outcome, and has significant cost implications. There is evidence in patients around the period of extubation that helium-oxygen leads to a reduction in the work of breathing. Therefore breathing helium-oxygen during weaning may be a useful adjunct to facilitate weaning. We hypothesised that breathing helium-oxygen would reduce carbon dioxide production during the weaning phase of mechanical ventilation. Materials/patients and methods We performed a prospective randomised controlled single blinded cross-over trial on 19 adult intensive care patients without significant airways disease who fulfilled criteria for weaning with CPAP. Patients were randomised to helium-oxygen and air-oxygen delivered during a 2 hour period of CPAP ventilation. Carbon dioxide production (VCO2) was measured using a near patient main stream infrared carbon dioxide sensor and fixed orifice pneumotachograph. Results Compared to air-oxygen, helium-oxygen significantly decreased VCO2 production at the end of the 2 hour period of CPAP ventilation; there was a mean difference in CO2 production of 48.9 ml/min (95% CI 18.7-79.2 p = 0.003) between the groups. There were no significant differences in other respiratory and haemodynamic parameters. Conclusion This study shows that breathing a helium-oxygen mixture during weaning reduces carbon dioxide production. This physiological study supports the need for a clinical trial of helium-oxygen mixture during the weaning phase of mechanical ventilation with duration of weaning as the primary outcome. Trial registration ISRCTN56470948 PMID:20796307

2010-01-01

110

Pulmonary deposition of a nebulised aerosol during mechanical ventilation.  

PubMed Central

BACKGROUND: There is increasing use of therapeutic aerosols in patients undergoing mechanical ventilation. Few studies have measured aerosol delivery to the lungs under these conditions with adequate experimental methods. Hence this study was performed to measure pulmonary aerosol deposition and to determine the reproducibility of the method of measurement during mechanical ventilation. METHODS: Nine male patients were studied during mechanical ventilation after open heart surgery and two experiments were performed in each to determine the reproducibility of the method. A solution of technetium-99m labelled human serum albumin (99mTc HSA (50 micrograms); activity in experiment 1, 74 MBq; in experiment 2, 185 MBq) in 3 ml saline was administered with a Siemens Servo 945 nebuliser system (high setting) and a System 22 Acorn nebuliser unit. Pulmonary deposition was quantified by means of a gamma camera and corrections derived from lung phantom studies. RESULTS: Pulmonary aerosol deposition was completed in 22 (SD 4) minutes. Total pulmonary deposition (% nebuliser dose (SD)) was 2.2 (0.8)% with 1.5% and 0.7% depositing in the right and left lungs respectively; 0.9% of the nebuliser activity was detected in the endotracheal tube or trachea and 51% was retained within the nebuliser unit. Considerable variability between subjects was found for total deposition (coefficient of variation (CV) 46%), but within subject reproducibility was good (CV 15%). CONCLUSIONS: Administration of aerosol in this way is inefficient and further research is needed to find more effective alternatives in patients who require mechanical respiratory support. This method of measurement seems suitable for the assessment of new methods of aerosol delivery in these patients. Images PMID:8493630

Thomas, S H; O'Doherty, M J; Fidler, H M; Page, C J; Treacher, D F; Nunan, T O

1993-01-01

111

Performance of mechanical ventilators at the patient’s home: a multicentre quality control study  

Microsoft Academic Search

Background: Quality control procedures vary considerably among the providers of equipment for home mechanical ventilation (HMV).Methods: A multicentre quality control survey of HMV was performed at the home of 300 patients included in the HMV programmes of four hospitals in Barcelona. It consisted of three steps: (1) the prescribed ventilation settings, the actual settings in the ventilator control panel, and

R Farre?; D Navajas; E Prats; S Marti; R Guell; J M Montserrat; C Tebe; J Escarrabill

2006-01-01

112

Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation  

Microsoft Academic Search

of mechanical ventilation. When expressed per predicted body weight, women were ventilated with larger tidal volume than men (mean 11.4 vs. 10.4 mL\\/kg predicted body weight, p < .001) and tended to develop acute lung injury more often (29% vs. 20%, p .068). In a multivariate analysis, the main risk factors associated with the development of acute lung injury were

Ognjen Gajic; Saqib I. Dara; Jose L. Mendez; Adebola O. Adesanya; Emir Festic; Sean M. Caples; Rimki Rana; Jennifer L. St. Sauver; James F. Lymp; Bekele Afessa; Rolf D. Hubmayr

2004-01-01

113

Comparison of environment and mice in static and mechanically ventilated isolator cages with different air velocities and ventilation designs.  

PubMed

The purpose of this study was to compare environmental conditions and mice in cages with four different mechanical ventilation designs and a static isolator cage. Environmental conditions (air velocity, temperature, relative humidity, bedding weight change, airborne dust, NH3, and CO2) were compared for each cage type (n = 5 per cage). Bedding type was chipped hardwood. Mouse response in each cage type was evaluated by body weight, feed consumption, water intake, location of specific behaviors, and building of bedding mounds. Commercial polycarbonate mouse caging units (29.2 x 19.1 x 12.7 cm shoebox style, stainless-steel round wire bar lids, and 7-cm-deep isolator cage filter tops) were modified to fit the mechanical ventilation cage types and were used for the static isolator cages. Mechanically ventilated cages were fitted with forced air inlets centered 5 cm above the cage floor on the 19.1 cm-side of the cage. Inlet air velocity was either 40 or 200 feet/min (n = 10 cages each), and the air volume exchange rate was 9.3 L/min. In half of the mechanically ventilated cages, the exhaust air was forced through a filter in the isolator cage top, whereas in the remaining mechanically ventilated cages, the air was forced through a single exhaust port fixed in the narrow side of the cage top directly above the air inlet. Inlet air velocity but not exhaust design affected intracage air velocity distribution. Other environmental conditions were similar between the four mechanical ventilation designs. Relative to the mechanically ventilated cages, the static isolator cages had lower air velocities, higher relative humidities, higher NH3 levels, higher CO2 levels, lower body weight gain, and lower water consumption; temperatures, particulate levels, and feed consumption rates did not differ significantly between cage types. Locations of bedding mounds and behaviors were similar in all cage treatments. PMID:14984284

Memarzadeh, Farhad; Harrison, Paul C; Riskowski, Gerald L; Henze, Tonja

2004-01-01

114

Brief mechanical ventilation impacts airway cartilage properties in neonatal lambs  

PubMed Central

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

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

2012-01-01

115

Impact of tongue biofilm removal on mechanically ventilated patients  

PubMed Central

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

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

2013-01-01

116

Quality of life of ALS and LIS patients with and without invasive mechanical ventilation.  

PubMed

There are very few studies where quality of life (QOL) is assessed in patients with complete physical and functional disability and dependence to invasive mechanical ventilation (IV). We compared QOL of amyotrophic lateral sclerosis (ALS) and locked-in-syndrome (LIS) patients with invasive mechanical ventilation to ALS and LIS patients without mechanical invasive ventilation. Thirty-four patients, 27 with ALS and seven with LIS (vascular or tumoral aetiology) were included in the study. Twelve had invasive ventilation, 22 had non-invasive ventilation, and in the non-invasive ventilation group, five of them had ventilation via mask. The following scales were used for patients: ALS Functional Rating Scale (ALSFRS), McGILL, Short-Form 36 (SF36), Beck Depression Inventory-II, the Toronto Alexithymia Scale and the anxiety inventory of Spielberger. Mean ALSFRS scores were significantly lower in the invasive ventilation group (IV) than in the non-invasive ventilation group. McGILL and SF36 were not significantly different between the IV group and the non-invasive ventilation group; there were no significant differences between the two groups for others scales either. Comparison between IV group and LIS without invasive mechanical ventilation revealed no significant difference for SF36 and McGILL QOL scores. QOL was not significantly different between the IV and not invasively ventilated patients, but ALSFRS was significantly lower in the IV group, and comparison of QOL scores between non-ventilated LIS patients who had the same score of dependence that invasively ventilated patients did not show any difference. Invasive mechanical ventilation for patients who accept tracheotomy allows life prolongation and their QOL is not affected; medical teams should be aware of that. PMID:21461685

Rousseau, Marie-Christine; Pietra, Stéphane; Blaya, José; Catala, Anne

2011-10-01

117

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

NASA Astrophysics Data System (ADS)

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.

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

2010-04-01

118

Mechanical ventilation, diaphragm weakness and weaning: A rehabilitation perspective  

PubMed Central

Most patients are easily liberated from mechanical ventilation (MV) following resolution of respiratory failure and a successful trial of spontaneous breathing, but about 25% of patients experience difficult weaning. MV use leads to cellular changes and weakness, which has been linked to weaning difficulties and has been labeled ventilator induced diaphragm dysfunction (VIDD). Aggravating factors in human studies with prolonged weaning include malnutrition, chronic electrolyte abnormalities, hyperglycemia, excessive resistive and elastic loads, corticosteroids, muscle relaxant exposure, sepsis and compromised cardiac function. Numerous animal studies have investigated the effects of MV on diaphragm function. Virtually all of these studies have concluded that MV use rapidly leads to VIDD and have identified cellular and molecular mechanisms of VIDD. Molecular and functional studies on the effects of MV on the human diaphragm have largely confirmed the animal results and identified potential treatment strategies. Only recently have potential VIDD treatments been tested in humans, including pharmacologic interventions and diaphragm “training”. A limited number of human studies have found that specific diaphragm training can increase respiratory muscle strength in FTW patients and facilitate weaning, but larger, multicenter trials are needed. PMID:23692928

Martin, A Daniel; Smith, Barbara; Gabrielli, Andrea

2013-01-01

119

Early tracheostomy in severe traumatic brain injury: evidence for decreased mechanical ventilation and increased hospital mortality  

PubMed Central

Objective: In the past, the authors performed a comprehensive literature review to identify all randomized controlled trials assessing the impact of early tracheostomy on severe brain injury outcomes. The search produced only two trials, one by Sugerman and another by Bouderka. Subjects and methods: The current authors initiated an Institutional Review Board-approved severe brain injury randomized trial to evaluate the impact of early tracheostomy on ventilator-associated pneumonia rates, intensive care unit (ICU)/ventilator days, and hospital mortality. Current study results were compared with the other randomized trials and a meta-analysis was performed. Results: Early tracheostomy pneumonia rates were Sugerman-48.6%, Bouderka-58.1%, and current study-46.7%. No early tracheostomy pneumonia rates were Sugerman-53.1%, Bouderka-61.3%, and current study-44.4%. Pneumonia rate meta-analysis showed no difference for early tracheostomy and no early tracheostomy (OR 0.89; p = 0.71). Early tracheostomy ICU/ventilator days were Sugerman-16 ± 5.9, Bouderka-14.5 ± 7.3, and current study-14.1 ± 5.7. No early tracheostomy ICU/ventilator days were Sugerman-19 ± 11.3, Bouderka-17.5 ± 10.6, and current study-17 ± 5.4. ICU/ventilator day meta-analysis showed 2.9 fewer days with early tracheostomy (p = 0.02). Early tracheostomy mortality rates were Sugerman-14.3%, Bouderka-38.7%, and current study-0%. No early tracheostomy mortality rates were Sugerman-3.2%, Bouderka-22.6%, and current study-0%. Randomized trial mortality rate meta-analysis showed a higher rate for early tracheostomy (OR 2.68; p = 0.05). Because the randomized trials were small, a literature assessment was undertaken to find all retrospective studies describing the association of early tracheostomy on severe brain injury hospital mortality. The review produced five retrospective studies, with a total of 3,356 patients. Retrospective study mortality rate meta-analysis demonstrated a larger mortality for early tracheostomy (OR 1.97; p < 0.0001). Conclusion: For severe brain injury, analyses indicate that ventilator-associated pneumonia rates are not decreased with early tracheostomy. Further, this study implies that mechanical ventilation is reduced with early tracheostomy. Both the randomized trial and retrospective meta-analysis indicate that risk for hospital death increases with early tracheostomy. Findings imply that early tracheostomy for severe brain injury is not a prudent routine policy. PMID:24624310

Dunham, C Michael; Cutrona, Anthony F; Gruber, Brian S; Calderon, Javier E; Ransom, Kenneth J; Flowers, Laurie L

2014-01-01

120

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

PubMed

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

Frutos-Vivar, F; Esteban, A

2013-12-01

121

Ethical issues in invasive mechanical ventilation for amyotrophic lateral sclerosis.  

PubMed

Currently in Japan, discontinuing an invasive mechanical ventilator (IMV) is illegal; therefore IMV-related decision making is a crucial issue. This study examined IMV decision-making factors and psychological conflict in 50 patients with amyotrophic lateral sclerosis. The Herth Hope Index was used for the assessment of pre- and post-IMV conflict. Interviews identified some decision-making factors: patient's decision, patient's and family's mutual decision, family's decision, and emergency-induced without patient's or family's consent. Participants who experienced no IMV-related regret received sufficient prior IMV education from physicians and nurses, and time for reflection and family consultation. Their hope was similar to their pre-onset levels. Patients who received no prior IMV education accepted treatment as a natural progression. Their hope levels were lower than pre-onset. Those who received only a brief prior IMV explanation rejected the ventilator, experiencing regret if they were given an emergency IMV. Their hope levels were among the lowest. However, some of these patients managed to overcome their regret through being helped by nurses. Sufficient physician explanation and nursing advocacy for autonomous patient decision making are critical for improving hope in this patient group. PMID:20089625

Hirano, Yuko; Yamazaki, Yoshihiko

2010-01-01

122

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

PubMed Central

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

2011-01-01

123

Impact of oral care with versus without toothbrushing on the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials  

PubMed Central

Introduction Ventilator-associated pneumonia (VAP) remains a common hazardous complication in mechanically ventilated patients and is associated with increased morbidity and mortality. We undertook a systematic review and meta-analysis of randomized controlled trials to assess the effect of toothbrushing as a component of oral care on the prevention of VAP in adult critically ill patients. Methods A systematic literature search of PubMed and Embase (up to April 2012) was conducted. Eligible studies were randomized controlled trials of mechanically ventilated adult patients receiving oral care with toothbrushing. Relative risks (RRs), weighted mean differences (WMDs), and 95% confidence intervals (CIs) were calculated and heterogeneity was assessed with the I2 test. Results Four studies with a total of 828 patients met the inclusion criteria. Toothbrushing did not significantly reduce the incidence of VAP (RR, 0.77; 95% CI, 0.50 to 1.21) and intensive care unit mortality (RR, 0.88; 95% CI, 0.70 to 1.10). Toothbrushing was not associated with a statistically significant reduction in duration of mechanical ventilation (WMD, -0.88 days; 95% CI, -2.58 to 0.82), length of intensive care unit stay (WMD, -1.48 days; 95% CI, -3.40 to 0.45), antibiotic-free day (WMD, -0.52 days; 95% CI, -2.82 to 1.79), or mechanical ventilation-free day (WMD, -0.43 days; 95% CI, -1.23 to 0.36). Conclusions Oral care with toothbrushing versus without toothbrushing does not significantly reduce the incidence of VAP and alter other important clinical outcomes in mechanically ventilated patients. However, the results should be interpreted cautiously since relevant evidence is still limited, although accumulating. Further large-scale, well-designed randomized controlled trials are urgently needed. PMID:23062250

2012-01-01

124

Early tracheotomy in neutropenic, mechanically ventilated patients: rationale and results of a pilot study  

Microsoft Academic Search

Despite substantial advances in the management of such patients, the prognosis of ventilated neutropenic patients remains grim. The objective of our study was to evaluate the benefit of tracheotomy in this category of patients, in terms of mortality while they were in the intensive-care unit and nosocomial pneumonias. The charts of 53 consecutive, ventilated, neutropenic patients, or those destined to

F. Blot; S. Antoun; B. Leclercq; G. Nitenberg; B. Escudier; M. Gurguet

1995-01-01

125

Developing a readiness assessment tool for weaning patients under mechanical ventilation  

PubMed Central

Background: Mechanical ventilation is one of the major supportive interventions in intensive care units. Weaning the patients from mechanical ventilation and its related criteria are of great importance due to the related complications. As there is no comprehensive standard to allocate the time of weaning and due to lack of local research in this field, development of a comprehensive tool to measure patients’ readiness for weaning from mechanical ventilation is essential. Therefore, the present study was conducted with an aim to develop a readiness assessment tool for weaning patients from mechanical ventilation. Materials and Methods: This was a qualitative study with Delphi multi-triangulation design. In the first stage, the related items were extracted from the textbook and through searching the databases. In the second stage, after primary development of the items and based on supervisors’ indications, a questionnaire was made and used for assessment through Delphi methods. Twenty individuals, meeting the inclusion criteria, were selected through purposive sampling and their viewpoints concerning acceptability of the items were collected. In the third stage, the items with appropriateness over 70% were selected, and in the fourth stage, the final questionnaire was developed after a session with a panel of experts and supervisors. In the present study, in the first stage, the needed items were collected from various articles and books to provide items extraction. In stages two to four, manual calculation and investigation made by a panel of experts and the research team were adopted. Results: In the first stage, 100 articles and 51 related books were selected. In the second stage, 87 items were extracted from the articles and books and were sent as semi-open questions of assessment. In the third stage, 28 items with consensus >70% were extracted, and in the fourth stage, 26 items were selected by a panel of experts and the finalized questionnaire with the title “Persian Weaning Tool” (PWT) was developed in three domains: Respiration with 9 items, cardiovascular with 4 items, and other related factors with 13 items. Conclusions: A three-domain questionnaire is the product of experts’ consensus in the present study, which can be used to reduce the length of connection to mechanical ventilation and its complications. PMID:24949066

Irajpour, Alireza; Khodaee, Mahnaz; Yazdannik, Ahmadreza; Abbasi, Saeed

2014-01-01

126

Modern methods of assessment of lung aeration during mechanical ventilation.  

PubMed

Despite the fact that several modes of ventilation are being used, it is not always possible to maintain adequate parameters of gas exchange. In order to provide proper ventilation, it is necessary to assess the lung function. The aim of this article is presentation of different methods of assesment of lung aerations including its advantages, disadvantages and possibilities for implementation in clinical practice. Computed tomography provides information regarding morphology and aeration of lung tissue, but has several limitations: necessity of patients transportation, it cannot be performed in a continuous manner, a quantitative assessment of picture seems to be rather complicated. Ultrasonography is widely used in intensive care and is a noninvasive and bedside method. It gives the opportunity to assess an investigated organ in real time. Its clinical utility in patients with ARDS was proved by Lichtenstein et al. Another technology which has been implemented for the purpose of lungs visualization is electrobioimpedancy (EIT). This new method consists of continuous monitoring of chest electrobioimpedancy changes due to its air content. Unlike to techniques mentioned above, lung images generated with EIT do not provide any information about morphology of affected tissue. The method which indirectly describes the sum of lung interactions is the assessment of quasi-static P/V curve. This method provides information allowing to draw conclusions regarding the usefulness of recruitment maneuvers, but does not provide information regarding the nature of morphologic changes and their location. In the search for the ideal method of lung aeration assessment, it is necessary to define its characteristics, such as noninvasiveness, availability and visualization of tissue morphologic changes in real time. PMID:23348492

Wierzejski, Wojciech; Adamski, Jan; Weigl, Wojciech; Gerega, Anna

2012-01-01

127

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

Introduction  Given 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

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

2011-01-01

128

Resolution of obstructive atelectasis with non-invasive mechanical ventilation.  

PubMed

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

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

2014-10-01

129

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

Microsoft Academic Search

Introduction  A semi-upright position in ventilated patients is recommended to prevent ventilator-associated pneumonia (VAP) and is one\\u000a of the components in the Ventilator Bundle of the Institute for Health Care Improvement. This recommendation, however, is\\u000a not an evidence-based one.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A systematic review on the benefits and disadvantages of semi-upright position in ventilated patients was done according to\\u000a PRISMA guidelines. Then a

Barbara S Niël-Weise; Petra Gastmeier; Axel Kola; Ralf P Vonberg; Jan C Wille; Peterhans J van den Broek

2011-01-01

130

Validity of the Modified Richmond Agitation-Sedation Scale for Use in Sedated, Mechanically Ventilated Swine  

PubMed Central

A valid and reliable scale for assessing level of sedation would facilitate appropriate sedation management in a porcine intensive care unit (ICU) model. The Richmond Agitation–Sedation Scale (RASS) is used often for human ICU patients. The purpose of this study was to estimate the content validity of the modified RASS for use in sedated, mechanically ventilated swine. The modified RASS includes descriptors specific for swine. A content validity assessment form was developed with 4 items and 5 response choices to assess the modified RASS for relevancy, sufficiency, clarity, and representativeness. The modified RASS and content validity assessment form were emailed to 23 veterinarians with experience in the care of swine or other large animals; participants judged the extent to which the modified RASS is valid for assessing sedation in mechanically ventilated critically ill swine. The criterion for acceptable validity evidence was a content validity index (CVI) of 0.80 or greater. Eight (67%) of 12 veterinarians who responded to the invitation to participate completed the assessment form. The item CVI varied from 0.50 to 0.88; scale CVI was 0.66. Because these values did not meet the a priori criterion, we concluded that the modified RASS does not have sufficient evidence of content validity for use with swine. The reliability of the modified RASS will be tested in the porcine ICU model, and experience with its use in swine will inform refinement of the scale descriptors for repeat assessment of content validity. PMID:22330870

Leyden, Katrina N; Hanneman, Sandra K

2012-01-01

131

Sleep Disturbances in Patients Admitted to a Step-Down Unit After ICU Discharge: the Role of Mechanical Ventilation  

PubMed Central

Background: Severe sleep disruption is a well-documented problem in mechanically ventilated, critically ill patients during their time in the intensive care unit (ICU), but little attention has been paid to the period when these patients become clinically stable and are transferred to a step-down unit (SDU). We monitored the 24-h sleep pattern in 2 groups of patients, one on mechanical ventilation and the other breathing spontaneously, admitted to our SDU to assess the presence of sleep abnormalities and their association with mechanical ventilation. Methods: Twenty-two patients admitted to an SDU underwent 24-h polysomnography with monitoring of noise and light. Results: One patient did not complete the study. At night, 10 patients showed reduced sleep efficiency, 6 had reduced percentage of REM sleep, and 3 had reduced percentage of slow wave sleep (SWS). Sleep amount and quality did not differ between patients breathing spontaneously and those on mechanical ventilation. Clinical severity (SAPSII score) was significantly correlated with daytime total sleep time and efficiency (r = 0.51 and 0.5, P < 0.05, respectively); higher pH was correlated with reduced sleep quantity and quality; and higher PaO2 was correlated with increased SWS (r = 0.49; P = 0.02). Conclusions: Patients admitted to an SDU after discharge from an ICU still have a wide range of sleep abnormalities. These abnormalities are mainly associated with a high severity score and alkalosis. Mechanical ventilation does not appear to be a primary cause of sleep impairment. Citation: Fanfulla F; Ceriana P; Lupo ND; Trentin R; Frigerio F; Nava S. Sleep disturbances in patients admitted to a step-down unit after ICU discharge: the role of mechanical ventilation. SLEEP 2011;34(3):355-362. PMID:21358853

Fanfulla, Francesco; Ceriana, Piero; D'Artavilla Lupo, Nadia; Trentin, Rossella; Frigerio, Francesco; Nava, Stefano

2011-01-01

132

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

SciTech Connect

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.

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

2011-11-08

133

New perspectives on the evolution of lung ventilation mechanisms in vertebrates  

Microsoft Academic Search

In the traditional view of vertebrate lung ventilation mechanisms, air-breathing fishes and amphibians breathe with a buccal pump, and amniotes breathe with an aspiration pump. According to this view, no extant animal exhibits a mechanism that is intermediate between buccal pumping and aspiration breathing; all lung ventilation is produced either by expansion and compression of the mouth cavity via the

E. L. Brainerd

1999-01-01

134

An Evaluation of the Laryngeal Tube?? During General Anesthesia Using Mechanical Ventilation  

Microsoft Academic Search

The Laryngeal Tube® is a new supraglottic ventilatory device for airway management. It has been developed to secure a patent airway during either spontaneous or mechanical ventilation. In this study, we sought to de- termine the effectiveness of the Laryngeal Tube for pri- mary airway management during routine surgery with mechanical ventilation. One-hundred-seventy-five subjects classified as ASA physical status I

Luis A. Gaitini; Sonia J. Vaida; Mostafa Somri; Victor Kaplan; Boris Yanovski; Robert Markovits; Carin A. Hagberg

2003-01-01

135

Increased Postnatal Inflammation in Mechanically Ventilated Preterm Infants Born to Mothers with Early-Onset Preeclampsia  

Microsoft Academic Search

Background: Preeclampsia and preterm labor often underlie preterm birth, and are associated with maternal inflammation. In preterm infants, respiratory distress syndrome (RDS) and mechanical ventilation are associated with systemic inflammation. Objective: We aimed to study whether early-onset preeclampsia or preterm labor modulate the systemic inflammation affecting preterm infants with RDS. Methods: We recruited mechanically ventilated infants with gestational ages <32

Riikka Turunen; Sture Andersson; Hannele Laivuori; Eero Kajantie; Sanna Siitonen; Heikki Repo; Irmeli Nupponen

2011-01-01

136

Transthoracic electrical bioimpedance versus thermodilution technique for cardiac output measurement during mechanical ventilation  

Microsoft Academic Search

To study the possible influence of mechanical ventilation on the accurracy of thoracic electrical bioimpedance (TEI) in the measurement of cardiac output, we determined cardiac output concurrently by TEI using Kubicek's equation and by thermodilution in 8 acutely ill patients who were mechanically ventilated (assist\\/control mode) but who had no underlying respiratory failure. Cardiac outputs were lower with TEI than

J. C. Preiser; A. Daper; J.-N. Parquier; B. Contempré; J.-L. Vincent

1989-01-01

137

Factors influencing intensive care nurses' knowledge and attitudes regarding ventilator-associated pneumonia and oral care practice in intubated patients in Croatia.  

PubMed

Adequate oral care in intubated patients may reduce occurrence of ventilator-associated pneumonia. The purpose of this study was to explore knowledge, attitudes, and oral care practice in Croatian intensive care units and influencing factors. Nurses' knowledge is insufficient; however, most of them reported positive attitude toward the importance of oral care. Performed oral hygiene measures are mostly inappropriate. There is a need to improve the knowledge of ventilator-associated pneumonia and oral care. PMID:25278406

Jordan, Ante; Badovinac, Ana; Spalj, Stjepan; Par, Matej; Slaj, Martina; Plan?ak, Darije

2014-10-01

138

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

PubMed

The aim of this article is to develop a knowledge-based therapy for management of rats with respiratory distress. A mechanical ventilator was designed to achieve this aim. The designed ventilator is called an intelligent mechanical ventilator since fuzzy logic was used to control the pneumatic equipment according to the rat's status. LabVIEW software was used to control all equipments in the ventilator prototype and to monitor respiratory variables in the experiment. The designed ventilator can be controlled both manually and by fuzzy logic. Eight female Wistar-Albino rats were used to test the designed ventilator and to show the effectiveness of fuzzy control over manual control on pressure control ventilation mode. The anesthetized rats were first ventilated for 20 min manually. After that time, they were ventilated for 20 min by fuzzy logic. Student's t-test for p?ventilator and developed knowledge-based therapy support artificial respiration of living things successfully. PMID:25205667

Guler, Hasan; Ata, Fikret

2014-09-01

139

Numerical studies of airflows induced by mechanical ventilation and air-conditioning (MVAC) systems  

Microsoft Academic Search

Indoor air flows induced by mechanical ventilation and air-conditioning (MVAC) systems are simulated by the technique of computational fluid dynamics (CFD). Examples are taken to illustrate the capability of the technique. These include the evaluation of basic ventilation system designs, ventilation systems in an enclosed car-park, spot cooling system, air-conditioning system with chilled ceiling, cold air distribution system, effect of

W. K. Chow

2001-01-01

140

Application of Information Technology: Enhanced Notification of Critical Ventilator Events  

Microsoft Academic Search

Mechanical ventilators are designed to generate alarms when patients become disconnected or experience other critical ventilator events. However, these alarms can blend in with other accustomed sounds of the intensive care unit. Ventilator alarms that go unnoticed for extended periods of time often result in permanent patient harm or death. We developed a system to monitor critical ventilator events through

R. Scott Evans; Kyle V. Johnson; Vrena B. Flint; Tupper Kinder; Charles R. Lyon; William L. Hawley; David K. Vawdrey; George E. Thomsen

2005-01-01

141

Effect of enhanced ultraviolet germicidal irradiation in the heating ventilation and air conditioning system on ventilator-associated pneumonia in a neonatal intensive care unit  

Microsoft Academic Search

Objective:The objective of this study was to test the hypothesis that enhanced ultraviolet germicidal irradiation (eUVGI) installed in our neonatal intensive care unit (NICU) heating ventilation and air conditioning system (HVAC) would decrease HVAC and NICU environment microbes, tracheal colonization and ventilator-associated pneumonia (VAP).StudyDesign:The study was designed as a prospective interventional pre- and post-single-center study. University-affiliated Regional Perinatal Center NICU.

R M Ryan; G E Wilding; R J Wynn; R C Welliver; B A Holm; C L Leach

2011-01-01

142

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

PubMed

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

K Szilágyi, Adrienn; Diószeghy, Csaba; Fritúz, Gábor; Gál, János; Varga, Katalin

2014-03-01

143

Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese Patients  

PubMed Central

Background. The optimal timing of tracheotomy and its impact on weaning from mechanical ventilation in critically ill morbidly obese patients remain controversial. Methods. We conducted a retrospective chart review of morbidly obese subjects (BMI ? 40?kg/m2 or BMI ? 35?kg/m2 and one or more comorbid conditions) who underwent a tracheotomy between July 2008 and June 2013 at a medical intensive care unit (ICU). Clinical characteristics, rates of nosocomial pneumonia (NP), weaning from mechanical ventilation (MV), and mortality rates were analyzed. Results. A total of 102 subjects (42 men and 60 women) were included; their mean age and BMI were 56.3 ± 15.1 years and 53.3 ± 13.6?kg/m2, respectively. There was no difference in the rate of NP between groups stratified by successful weaning from MV (P = 0.43). Mortality was significantly higher in those who failed to wean (P = 0.02). A cutoff value of 9 days for the time to tracheotomy provided the best balanced sensitivity (72%) and specificity (59.8%) for predicting NP onset. Rates of NP and total duration of MV were significantly higher in those who had tracheostomy ? 9 days (P = 0.004 and P = 0.002, resp.). Conclusions. The study suggests that tracheotomy in morbidly obese subjects performed within the first 9 days may reduce MV and decrease NP but may not affect hospital mortality. PMID:25298891

Hussain, Kashif; El-Solh, Ali A.

2014-01-01

144

Mechanical ventilation in recently built Dutch homes: technical shortcomings, possibilities for improvement, perceived indoor environment and health effects  

Microsoft Academic Search

This article presents the results of a Dutch national study into performance of mechanical ventilation systems and its effect on the self-reported health and perceived indoor environmental quality of occupants. Ventilation systems with natural supply and mechanical exhaust ventilation (MEV) and balanced mechanical supply and exhaust systems with heat recovery (MVHR) were investigated. Surveys were performed in 299 homes, which

Jaap Balvers; Rik Bogers; Rob Jongeneel; Irene van Kamp; Atze Boerstra; Froukje van Dijken

2012-01-01

145

The pathogenesis of ventilator-associated pneumonia: I. Mechanisms of bacterial transcolonization and airway inoculation  

Microsoft Academic Search

Ventilator-associated pneumonia (VAP) is an infection of the lung parenchyma developing in patients on mechanical ventilation for more than 48 h. VAP is associated with a remarkably constant spectrum of pathogenic bacteria, most of which are aerobic Gramnegative bacilli (AGNB) and, to a lesser extentStaphyloccus aureus. Most authorities agree that VAP develops as a result of aspiration of secretions contaminated

R. J. Estes; G. U. Meduri

1995-01-01

146

Respiratory mechanics in patients ventilated for critical lung disease.  

PubMed

Respiratory mechanics, using flow interruption, was previously studied during the complete breath in healthy ventilated man, numerical techniques relieving constraints regarding flow pattern. The classical linear model of non-Newtonian behaviour was found to be valid. The present study was extended to subjects with critical lung disease. Subjects with acute lung injury (ALI; n = 2), acute respiratory distress syndrome (ARDS; n = 4), and chronic obstructive pulmonary disease (COPD; n = 3) were studied with and without positive end-expiratory pressure (PEEP). Functional residual capacity (FRC) was measured with sulphur hexafluoride (SF6) wash-out. The static pressure-volume (P-V) curve was linear at zero end-expiratory pressure (ZEEP), but nonlinear at PEEP. Its hysteresis was nonsignificant. In ALI/ARDS, PEEP increased lung volume by distension and recruitment, but only by distension in COPD. In ALI/ARDS, resistance was increased, at ZEEP. In COPD, resistance became extremely high during expiration at ZEEP. In ALI/ARDS at ZEEP, non-Newtonian behaviour, representing tissue stress relaxation and pendel-luft, complied with the classical linear model. At PEEP, the non-Newtonian compliance became volume-dependent to an extent correlated to the nonlinearity of the static P-V curve. In COPD, non-Newtonian behaviour was adequately explained only with a model with different inspiratory and expiratory behaviour. The classical model of the respiratory system is valid in ALI/ARDS at ZEEP. More advanced models are needed at PEEP and in COPD. PMID:8777962

Beydon, L; Svantesson, C; Brauer, K; Lemaire, F; Jonson, B

1996-02-01

147

Differences in the prognosis among severe trauma and medical patients requiring mechanical ventilation  

PubMed Central

Objetive. To find the differences between the prognosis of the patients with severe traumatism injury and those who were admitted with medical pathology who also required mechanical ventilation in our ICU. Patients and Method. Retrospective descriptive study in a polyvalent ICU of a third level hospital for a period of 8 years. Epidemiological variables such as age, sex, average stay, mortality, APACHE II at admission and days of mechanical ventilation, were analyzed in patients with severe traumatism injury and patients with medical pathology that were admitted in ICU and received mechanical ventilation during this period. Results. During the study period were admitted 208 patients with severe traumatism injury and 732 medical patients, all of them required mechanical ventilation. Patients with severe traumatism injury are more younger (41.8 vs 55.3 years, p = 0.001) and entered ICU in a state of minor severity, according to the prognostic index APACHE II (14.8 vs 17.4, p < 0.001), despite which they required more days of mechanical ventilation (9.8 vs 7.8 days, p = 0.017) and had a higher average stay (11.4 vs 9.4 days, p = 0.027), although the mortality was significantly lower (38.2% vs 28.2%, p = 0.005). Multivariate analysis showed as independent variables associated with mortality, the APACHE II (p < 0.0001), the average stay in ICU (p < 0.0001), days of mechanical ventilation (p < 0.0001) and type patient (p = 0.016). Conclusions. Patients with severe traumatic injury that require mechanical ventilation despite to be admitted in ICU in a state of greater severity, having an increased ICU stay and more days of mechanical ventilation, have a better prognosis than medical patients that required also mechanical ventilation at ICU stay, likely to be younger. PMID:24273698

Santana-Cabrera, Luciano; Sanchez-Palacios, Manuel; Rodriguez, Alina Uriarte

2013-01-01

148

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

PubMed

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

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

2014-02-01

149

Incidence and causes of non-invasive mechanical ventilation failure after initial success  

PubMed Central

BACKGROUND—The rate of failure of non-invasive mechanical ventilation (NIMV) in patients with chronic obstructive pulmonary disease (COPD) with acute respiratory insufficiency ranges from 5% to 40%. Most of the studies report an incidence of "late failure" (after >48 hours of NIMV) of about 10-20%. The recognition of this subset of patients is critical because prolonged application of NIMV may unduly delay the time of intubation.?METHODS—In this multicentre study the primary aims were to assess the rate of "late NIMV failure" and possible associated predictive factors; secondary aims of the study were evaluation of the best ventilatory strategy in this subset of patients and their outcomes in and out of hospital. The study was performed in two respiratory intensive care units (ICUs) on patients with COPD admitted with an episode of hypercapnic respiratory failure (mean (SD) pH 7.23(0.07), PaCO2 85.3 (15.8) mm Hg).?RESULTS—One hundred and thirty seven patients initially responded to NIMV in terms of objective (arterial blood gas tensions) and subjective improvement. After 8.4 (2.8) days of NIMV 31 patients (23%; 95% confidence interval (CI) 18 to 33) experienced a new episode of acute respiratory failure while still ventilated. The occurrence of "late NIMV failure" was significantly associated with functional limitations (ADL scale) before admission to the respiratory ICU, the presence of medical complications (particularly hyperglycaemia), and a lower pH on admission. Depending on their willingness or not to be intubated, the patients received invasive ventilation (n=19) or "more aggressive" (more hours/day) NIMV (n=12). Eleven (92%) of those in this latter subgroup died while in the respiratory ICU compared with 10 (53%) of the patients receiving invasive ventilation. The overall 90 day mortality was 21% and, after discharge from hospital, was similar in the "late NIMV failure" group and in patients who did not experience a second episode of acute respiratory failure.?CONCLUSIONS—The chance of COPD patients with acute respiratory failure having a second episode of acute respiratory failure after an initial (first 48 hours) successful response to NIMV is about 20%. This event is more likely to occur in patients with more severe functional and clinical disease who have more complications at the time of admission to the ICU. These patients have a very poor in-hospital prognosis, especially if NIMV is continued rather than prompt initiation of invasive ventilation.?? PMID:10992532

Moretti, M.; Cilione, C.; Tampieri, A.; Fracchia, C.; Marchioni, A.; Nava, S.

2000-01-01

150

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

Microsoft Academic Search

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

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

1993-01-01

151

Nonpharmacological interventions to manage common symptoms in patients receiving mechanical ventilation.  

PubMed

Patients receiving mechanical ventilation can experience symptoms such as pain, anxiety, agitation, and lack of sleep while in the intensive care unit, all of which can affect healing. Nonpharmacological complementary therapies can be used as adjuncts to sedatives and analgesics. By incorporating appropriate use of complementary therapies in conjunction with mainstream medical therapies, nurses can decrease patients' anxiety, promote sleep, and promote a healing environment to improve outcomes. Minimizing noise and providing access to natural light help promote a healing environment. Methods to promote sleep include relaxation techniques such as progressive muscle relaxation and massage and communication with patients' and their families to determine the patients' normal sleep patterns. Complementary therapies to relieve anxiety and agitation include music intervention, imagery, presence, and animal-assisted therapy. PMID:21632591

Tracy, Mary Fran; Chlan, Linda

2011-06-01

152

A bench study of intensive-care-unit ventilators: new versus old and turbine-based versus compressed gas-based ventilators  

Microsoft Academic Search

Objective  To compare 13 commercially available, new-generation, intensive-care-unit (ICU) ventilators in terms of trigger function,\\u000a pressurization capacity during pressure-support ventilation (PSV), accuracy of pressure measurements, and expiratory resistance.\\u000a \\u000a \\u000a \\u000a Design and setting  Bench study at a research laboratory in a university hospital.\\u000a \\u000a \\u000a \\u000a Methods  Four turbine-based ventilators and nine conventional servo-valve compressed-gas ventilators were tested using a two-compartment\\u000a lung model. Three levels of effort were

Arnaud W. Thille; Aissam Lyazidi; Jean-Christophe M. Richard; Fabrice Galia; Laurent Brochard

2009-01-01

153

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

PubMed

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

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

2014-10-01

154

Pulmonary function after prolonged mechanical ventilation with high concentrations of oxygen.  

PubMed Central

The mortality and morbidity resulting from mechanical ventilation with high concentrations of inspired oxygen has been investigated in two groups of patients. Ninety-one patients requiring mechanical ventilation for pulmonary disease included six (group 1) in whom death was attributed directly to respiratory failure but only three in whom oxygen toxicity might have been relevant. Review of the clinical and postmortem findings suggests that oxygen was probably not a contributory factor in two of these three. A second group of 16 patients who survived prolonged mechanical ventilation with oxygen in excess of 40% (average 14.5 days) included five who had been ventilated with 75% oxygen or more for an average of 38 hours. Lung function studies carried out on this second group of patients approximately one year later demonstrated that all but three had significant defects in either ventilation, gas transfer, or both. Oxygen toxicity was thought to be a likely cause in one and a possible contributory factor in three more. It is suggested that the adverse effects of oxygen on the alveolar epithelium are rarely of practical importance in hypoxaemic patients requiring mechanical ventilation but disturbance to the pulmonary defences against infection may well be of greater importance. The fear of inducing oxygen toxicity should not be allowed to interfere with the relief of arterial hypoxaemia in ventilated patients. PMID:7022735

Gillbe, C E; Salt, J C; Branthwaite, M A

1980-01-01

155

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

E-print Network

Previous antibiotic exposure and evolution of antibiotic resistance in mechanically ventilated, Taichung, Taiwan Keywords: Antibiotic resistance; Antibiotic exposure; Antibiotic selection pressure; Antibiotic stewardship; Nosocomial infection Abstract Purpose: This study aimed to evaluate the impact

Cochran-Stafira, D. Liane

156

Lung volume in mechanically ventilated patients: measurement by simplified helium dilution compared to quantitative CT scan  

Microsoft Academic Search

Objective We describe a simplified helium dilution technique to measure end-expiratory lung volume (EELV) in mechanically ventilated patients. We assessed both its accuracy in comparison with quantitative computerized tomography (CT) and its precision. Design and setting Prospective human study. Patients Twenty-one mechanically ventilated ALI\\/ARDS patients. Interventions All patients underwent a spiral CT scan of the thorax during an end-expiratory occlusion.

Nicolò Patroniti; Giacomo Bellani; Annamaria Manfio; Elena Maggioni; Angela Giuffrida; Giuseppe Foti; Antonio Pesenti

2004-01-01

157

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

Microsoft Academic Search

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

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

158

[Intensive care and home artificial ventilation. How do nurses experience artificial respiratory care in the home of patients?].  

PubMed

In Germany, the number of patients who receive artificial respiration in their own home is increasing. One reason for long time ventilation is the rise of technical possibilities. Bringing "intensive care" to the home of people challenges original understandings of home care. While intensive care and artificial respiration are technology-oriented, home-care is social-oriented, respecting the familiar environment of the patient. An international literature review reveals that research has been done by investigating the experiences of relatives and patients but not those of nurses. The few studies with a focus on nurses relate to themes of privacy and how to set limits. In Germany, not one study could be found that dealt with the question of how nurses experience artificial respiratory care in patients' homes. Considering the involved changes of care, the question rises, how nurses experience artificial respiratory care in the home of patients. This research is explorative and allows an insight into what home care is like when technology comes in. The exploration is based on eight narrative interviews with nurses who are experiencing respiratory care for patients in their home. The findings reveal professional challenges nurses have to face when caring for patients who are dependent on technological devices. The relatives are included in the caring activities and cooperating with them is crucial. PMID:23634549

Gödecke, Christiane; Kohlen, Helen

2013-04-01

159

Impact of Residential Mechanical Ventilation on Energy Cost and Humidity Control  

SciTech Connect

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.

Martin, E.

2014-01-01

160

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

SciTech Connect

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.

Sherman, Max; Logue, Jennifer; Singer, Brett

2010-06-01

161

Measured Air Distribution Effectiveness for Residential Mechanical Ventilation Systems  

SciTech Connect

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.

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

2008-05-01

162

The impact of rescue or maintenance therapy with EGFR TKIs for Stage IIIb-IV non-squamous non-small-cell lung cancer patients requiring mechanical ventilation  

PubMed Central

Background The toxicity of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) is less than that of cytotoxic agents. The reports of dramatic response and improvement in performance status with the use of EGFR TKIs may influence a physician’s decision-making for patients with non-squamous non-small cell lung cancer (NSCLC) and life-threatening respiratory distress. The aim of this study was to evaluate the outcome of rescue or maintenance therapy with EGFR TKI for stage IIIb-IV non-squamous NSCLC patients requiring mechanical ventilation. Methods Eighty-three Asian patients with stage IIIb-IV non-squamous NSCLC and who required mechanical ventilation between June 2005 and January 2010 were evaluated. Results Of the 83 patients, 16 (19%) were successfully weaned from the ventilator. The use of EGFR TKI as rescue or maintenance therapy during respiratory failure did not improve the rate of successful weaning (standard care 18% vs. with EGFR TKI, 22%; p?=?0.81) in univariate and multivariate analyses. Conclusions Rescue or maintenance therapy with EGFR TKI for stage IIIb-IV non-squamous NSCLC patients requiring mechanical ventilation was not associated with better outcome. An end-of-life discussion should be an important aspect in the care of this group of patients, since only 19% were successfully weaned from mechanical ventilation. PMID:25050082

2014-01-01

163

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

PubMed Central

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

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

2011-01-01

164

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

PubMed Central

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 48 hours of ICU admissions, was performed. Sedation depth was evaluated after 48 hours 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

2014-01-01

165

Performance of a novel mechanical ventilation heat recovery heat pump system  

Microsoft Academic Search

The ventilation, heating and cooling of a building can be provided by advanced mechanical ventilation heat recovery systems (MVHR) which incorporate heat pumps. This paper covers the testing and performance of a novel MVHR heat pump system developed for the domestic market [S.B. Riffat, The University of Nottingham: Patent no. GB9522882.1, 1995; Patent no. GB9522882.1, 1996; Patent no. GB9507035.5, 1995].

S. B. Riffat; M. C. Gillott

2002-01-01

166

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

PubMed Central

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 children’s 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: 12–19%) and 20% patients (95%CI: 16–24%) respectively. Among patients receiving opioids for longer than 3 days (n=225), this occurred in 28% (95%CI 22–33%) and 35% (95%CI 29–41%) 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 4.3–14.3; p<0.001) or co-therapy with midazolam (OR 5.6, 95%CI 2.4–12.9; 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 0.25–0.92; p=0.03), for patients receiving higher initial doses (OR 0.96, 95%CI 0.95–0.98; p<0.001), or if patients had prior PICU admissions (OR 0.37, 95%CI 0.15–0.89, 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

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

167

Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis  

PubMed Central

Objective To investigate the effects of weaning protocols on the total duration of mechanical ventilation, mortality, adverse events, quality of life, weaning duration, and length of stay in the intensive care unit and hospital. Design Systematic review. Data sources Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, LILACS, ISI Web of Science, ISI Conference Proceedings, Cambridge Scientific Abstracts, and reference lists of articles. We did not apply language restrictions. Review methods We included randomised and quasi-randomised controlled trials of weaning from mechanical ventilation with and without protocols in critically ill adults. Data selection Three authors independently assessed trial quality and extracted data. A priori subgroup and sensitivity analyses were performed. We contacted study authors for additional information. Results Eleven trials that included 1971 patients met the inclusion criteria. Compared with usual care, the geometric mean duration of mechanical ventilation in the weaning protocol group was reduced by 25% (95% confidence interval 9% to 39%, P=0.006; 10 trials); the duration of weaning was reduced by 78% (31% to 93%, P=0.009; six trials); and stay in the intensive care unit length by 10% (2% to 19%, P=0.02; eight trials). There was significant heterogeneity among studies for total duration of mechanical ventilation (I2=76%, P<0.01) and duration of weaning (I2=97%, P<0.01), which could not be explained by subgroup analyses based on type of unit or type of approach. Conclusion There is evidence of a reduction in the duration of mechanical ventilation, weaning, and stay in the intensive care unit when standardised weaning protocols are used, but there is significant heterogeneity among studies and an insufficient number of studies to investigate the source of this heterogeneity. Some studies suggest that organisational context could influence outcomes, but this could not be evaluated as it was outside the scope of this review. PMID:21233157

2011-01-01

168

Patient-ventilator asynchronies: may the respiratory mechanics play a role?  

PubMed Central

Introduction The mechanisms leading to patient/ventilator asynchrony has never been systematically assessed. We studied the possible association between asynchrony and respiratory mechanics in patients ready to be enrolled for a home non-invasive ventilatory program. Secondarily, we looked for possible differences in the amount of asynchronies between obstructive and restrictive patients and a possible role of asynchrony in influencing the tolerance of non-invasive ventilation (NIV). Methods The respiratory pattern and mechanics of 69 consecutive patients with chronic respiratory failure were recorded during spontaneous breathing. After that patients underwent non-invasive ventilation for 60 minutes with a "dedicated" NIV platform in a pressure support mode during the day. In the last 15 minutes of this period, asynchrony events were detected and classified as ineffective effort (IE), double triggering (DT) and auto-triggering (AT). Results The overall number of asynchronies was not influenced by any variable of respiratory mechanics or by the underlying pathologies (that is, obstructive vs restrictive patients). There was a high prevalence of asynchrony events (58% of patients). IEs were the most frequent asynchronous events (45% of patients) and were associated with a higher level of pressure support. A high incidence of asynchrony events and IE were associated with a poor tolerance of NIV. Conclusions Our study suggests that in non-invasively ventilated patients for a chronic respiratory failure, the incidence of patient-ventilator asynchronies was relatively high, but did not correlate with any parameters of respiratory mechanics or underlying disease. PMID:23531269

2013-01-01

169

A new tool for respiratory monitoring and pulmonary mechanics measurements in mechanically ventilated children  

Microsoft Academic Search

METHODS A computer based system for respiratory monitoring and pnlmonary mechdu measurements in mechdcally ventilated children is described. Primary information, flow and pressure, are measured at the aimay opening through a pneaumhchymeter inserted between the endotrachd, &be and tbe ventilator circuit. The computer performs several data procesging alIowiag the supervision of the patient's ventilation by continuously displaying the curves of

R. Logier; A. l. Gehin; M. Bayart; M. Couvreur; M. Staroswiecki

1993-01-01

170

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

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

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

2014-01-01

171

Doxofylline and respiratory mechanics. Short-term effects in mechanically ventilated patients with airflow obstruction and respiratory failure.  

PubMed

To assess the short-term effects of a methylxanthine (doxofylline) on respiratory mechanics in mechanically ventilated patients with airway obstruction and respiratory failure, nine consecutive patients were examined within three days from the onset of mechanical ventilation. Flow, changes in pulmonary volume, and Paw were measured using a ventilator (Servo 900C). End-expiratory and end-inspiratory airway occlusion was performed to measure PEEPi, Cstrs, Rrsmax, and Rrsmin. Measurements were performed before and at 5, 15, and 30 minutes after an intravenous loading dose of doxofylline (5 to 6 mg/kg). We found that doxofylline determined, on the average, a marked decrease in respiratory resistance (Rrsmax and Rrsmin, -27.2 percent and -36.5 percent, respectively) without significant changes in Cstrs and Pmax. The PEEPi, reflecting pulmonary dynamic hyperinflation, was also significantly decreased by doxofylline (-41 percent, on the average). The Pmax was not reliable for evaluation of a single patient, since changes in the elastic pressure can offset changes in the resistive one. No patient experienced significant side effects due to doxofylline. We conclude that (1) the effects of therapy can be assessed noninvasively at bedside in critically ill patients; (2) doxofylline is a rapid and efficient bronchodilator in mechanically ventilated patients with ARF and airflow obstruction; and (3) the decrease in the respiratory resistance and PEEPi, associated with an improved mechanical efficiency of the respiratory muscles at a lower pulmonary volume, can provide better conditions for the patient-ventilator interaction and for weaning. PMID:2791671

Poggi, R; Brandolese, R; Bernasconi, M; Manzin, E; Rossi, A

1989-10-01

172

Impact of supplemental oxygen in mechanically ventilated adult and infant mice.  

PubMed

The aim of the present study was to determine the short-term effects of hyperoxia on respiratory mechanics in mechanically ventilated infant and adult mice. Eight and two week old BALB/c mice were exposed to inspired oxygen fractions [Formula: see text] of 0.21, 0.3, 0.6, and 1.0, respectively, during 120 min of mechanical ventilation. Respiratory system mechanics and inflammatory responses were measured. Using the low-frequency forced oscillation technique no differences were found in airway resistance between different [Formula: see text] groups when corrected for changes in gas viscosity. Coefficients of lung tissue damping and elastance were not different between groups and showed similar changes over time in both age groups. Inflammatory responses did not differ between groups at either age. Hyperoxia had no impact on respiratory mechanics during mechanical ventilation with low tidal volume and positive end-expiratory pressure. Hence, supplemental oxygen can safely be applied during short-term mechanical ventilation strategies in infant and adult mice. PMID:18992373

Cannizzaro, Vincenzo; Berry, Luke J; Zosky, Graeme R; Turner, Debra J; Hantos, Zoltán; Sly, Peter D

2009-01-01

173

Endotracheal tube resistance and inertance in a model of mechanical ventilation of newborns and small infants-the impact of ventilator settings on tracheal pressure swings.  

PubMed

Resistive properties of endotracheal tubes (ETTs) are particularly relevant in newborns and small infants who are generally ventilated through ETTs with a small inner diameter. The ventilation rate is also high and the inspiratory time (ti) is short. These conditions effectuate high airway flows with excessive flow acceleration, so airway resistance and inertance play an important role. We carried out a model study to investigate the impact of varying ETT size, lung compliance and ventilator settings, such as peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP) and inspiratory time (ti) on the pressure-flow characteristics with respect to the resistive and inertive properties of the ETT. Pressure at the Y piece was compared to direct measurement of intratracheal pressure (P(trach)) at the tip of the ETT, and pressure drop (?P(ETT)) was calculated. Applying published tube coefficients (Rohrer's constants and inertance), P(trach) was calculated from ventilator readings and compared to measured P(trach) using the root-mean-square error. The most relevant for ?P(ETT) was the ETT size, followed by (in descending order) PIP, compliance, ti and PEEP, with gas flow velocity being the principle in common for all these parameters. Depending on the ventilator settings ?P(ETT) exceeded 8 mbar in the smallest 2.0 mm ETT. Consideration of inertance as an additional effect in this setting yielded a better agreement of calculated versus measured P(trach) than Rohrer's constants alone. We speculate that exact tracheal pressure tracings calculated from ventilator readings by applying Rohrer's equation and the inertance determination to small size ETTs would be helpful. As an integral part of ventilator software this would (1) allow an estimate of work of breathing and implementation of an automatic tube compensation, and (2) be important for gentle ventilation in respiratory care, especially of small infants, since it enables the physician to estimate consequences of altered ventilator settings at the tracheal level. PMID:21799238

Hentschel, Roland; Buntzel, Julia; Guttmann, Josef; Schumann, Stefan

2011-09-01

174

Impact of renal replacement therapy on the respiratory function of patients under mechanical ventilation  

PubMed Central

Objective To assess the oxygenation behavior and ventilatory mechanics after hemodialysis in patients under ventilatory support. Methods The present study was performed in the general intensive care unit of a tertiary public hospital. Patients over 18 years of age under mechanical ventilation and in need of dialysis support were included. Each patient was submitted to 2 evaluations (pre- and post-dialysis) regarding the cardiovascular and ventilatory parameters, the ventilatory mechanics and a laboratory evaluation. Results Eighty patients with acute or chronic renal failure were included. The analysis of the ventilatory mechanics revealed a reduction in the plateau pressure and an increased static compliance after dialysis that was independent of a reduction in blood volume. The patients with acute renal failure also exhibited a reduction in peak pressure (p=0.024) and an increase in the dynamic compliance (p=0.026), whereas the patients with chronic renal failure exhibited an increase in the resistive pressure (p=0.046) and in the resistance of the respiratory system (p=0.044). The group of patients with no loss of blood volume after dialysis exhibited an increase in the resistive pressure (p=0.010) and in the resistance of the respiratory system (p=0.020), whereas the group with a loss of blood volume >2,000mL exhibited a reduction in the peak pressure (p=0.027). No changes in the partial pressure of oxygen in arterial blood (PaO2) or in the PaO2/the fraction of inspired oxygen (PaO2/FiO2) ratio were observed. Conclusion Hemodialysis was able to alter the mechanics of the respiratory system and specifically reduced the plateau pressure and increased the static compliance independent of a reduction in blood volume. PMID:24213090

Lopes, Fernanda Maia; Ferreira, Jose Roberval; Gusmao-Flores, Dimitri

2013-01-01

175

Comparison of Dexmedetomidine, Propofol and Midazolam for Short-Term Sedation in Postoperatively Mechanically Ventilated Neurosurgical Patients  

PubMed Central

Background: Effective management of analgesia and sedation in the intensive care unit depends on the needs of the patient, subjective and/or objective measurement and drug titration to achieve specific endpoints. Aim: The present study compared the efficacy of dexmedetomidine, propofol and midazolam for sedation in neurosurgical patients for postoperative mechanical ventilation. Materials and Methods: Ninety patients aged 20-65 years, ASA physical status I to III, undergoing neurosurgery and requiring postoperative ventilation were included. The patients were randomly divided into three groups of 30 each. Group D received dexmedetomidine 1 mcg/kg over 15 minutes as a loading dose, followed by 0.4-0.7 mcg/kg/h. Group P received propofol 1 mg/kg over 15 minutes as a loading dose, followed by 1-3 mg/kg/h. Group M received midazolam 0.04 mg/kg over 15 minutes as a loading dose, followed by 0.08 mg/kg/h. Measurements: Heart rate, mean arterial pressure, sedation level, fentanyl requirement, ventilation and extubation time were recorded. Results: Adequate sedation level was achieved with all three agents. Dexmedetomidine group required less fentanyl for postoperative analgesia. In group D there was a decrease in HR after dexmedetomidine infusion (p<0.05), but there was no significant difference in HR between group P and group M. After administration of study drug there was a significant decrease in MAP comparison to baseline value in all groups at all time intervals (p<0.05), except postextubation period (p>0.05). Extubation time was lowest in group P (p<0.05). Conclusion: Dexmedetomidine is safer and equally effective agent compared to propofol and midazolam for sedation of neurosurgical mechanically ventilated patients with good hemodynamic stability and extubation time as rapid as propofol. Dexmedetomidine also reduced postoperative fentanyl requirements. PMID:25386451

Agrawal, Sanjay; Kumar, Sanjay; Mishra, Abhishek; Sharma, Sunil; Kumar, Raj

2014-01-01

176

Mechanical ventilation augments bleomycin-induced epithelial-mesenchymal transition through the Src pathway.  

PubMed

Mechanical ventilation used in patients with acute respiratory distress syndrome (ARDS) can damage pulmonary epithelial cells by producing inflammatory cytokines and depositing excess collagen. Src participates in plasminogen activator inhibitor-1 (PAI-1) and transforming growth factor-?1(TGF-?1) production during the fibroproliferative phase of ARDS, which involves a process of epithelial-mesenchymal transition (EMT). The mechanisms regulating interactions between mechanical ventilation and EMT are unclear. We hypothesized that EMT induced by high-tidal volume (VT) mechanical stretch-augmented lung inflammation occurs through upregulation of the Src pathway. Five days after administering bleomycin to simulate acute lung injury (ALI), male C57BL/6 mice, either wild-type or Src-deficient, aged 3 months, weighing between 25 and 30?g, were exposed to low-VT (6?ml/kg) or high-VT (30?ml/kg) mechanical ventilation with room air for 1-5?h. Nonventilated mice were used as control subjects. We observed that high-VT mechanical ventilation increased microvascular permeability, PAI-1 and TGF-?1 protein levels, Masson's trichrome staining, extracellular collagen levels, collagen gene expression, fibroblast accumulation, positive staining of ?-smooth muscle actin and type I collagen, activation of Src signaling and epithelial apoptotic cell death in wild-type mice (P<0.05). Decreased staining of the epithelial marker, Zonula occludents-1, was also observed. Mechanical stretch-augmented EMT and epithelial apoptosis were attenuated in Src-deficient mice and pharmacological inhibition of Src activity by PP2 (P<0.05). Our data suggest that high-VT mechanical ventilation-augmented EMT after bleomycin-induced ALI partially depends on the Src pathway. PMID:24955896

Li, Li-Fu; Liu, Yung-Yang; Kao, Kuo-Chin; Wu, Chen-Te; Chang, Chih-Hao; Hung, Chen-Yiu; Yang, Cheng-Ta

2014-09-01

177

The Esophageal Pressure-Guided Ventilation 2 (EPVent2) trial protocol: a multicentre, randomised clinical trial of mechanical ventilation guided by transpulmonary pressure  

PubMed Central

Introduction Optimal ventilator management for patients with acute respiratory distress syndrome (ARDS) remains uncertain. Lower tidal volume ventilation appears to be beneficial, but optimal management of positive end-expiratory pressure (PEEP) remains unclear. The Esophageal Pressure-Guided Ventilation 2 Trial (EPVent2) aims to examine the impact of mechanical ventilation directed at maintaining a positive transpulmonary pressure (PTP) in patients with moderate-to-severe ARDS. Methods and analysis EPVent2 is a multicentre, prospective, randomised, phase II clinical trial testing the hypothesis that the use of a PTP-guided ventilation strategy will lead to improvement in composite outcomes of mortality and time off the ventilator at 28?days as compared with a high-PEEP control. This study will enrol 200 study participants from 11 hospitals across North America. The trial will utilise a primary composite end point that incorporates death and days off the ventilator at 28?days to test the primary hypothesis that adjusting ventilator pressure to achieve positive PTP values will result in improved mortality and ventilator-free days. Ethics and dissemination Safety oversight will be under the direction of an independent Data and Safety Monitoring Board (DSMB). Approval of the protocol was obtained from the DSMB prior to enrolling the first study participant. Approvals of the protocol as well as informed consent documents were also obtained from the Institutional Review Board of each participating institution prior to enrolling study participants at each respective site. The findings of this investigation, as well as associated ancillary studies, will be disseminated in the form of oral and abstract presentations at major national and international medical specialty meetings. The primary objective and other significant findings will also be presented in manuscript form. All final, published manuscripts resulting from this protocol will be submitted to PubMed Central in accordance with the National Institute of Health Public Access Policy. Trial registration number ClinicalTrials.gov under number NCT01681225. PMID:25287106

Fish, Emily; Novack, Victor; Banner-Goodspeed, Valerie M; Sarge, Todd; Loring, Stephen; Talmor, Daniel

2014-01-01

178

Quality control of equipment in home mechanical ventilation: a European survey  

Microsoft Academic Search

Quality control of the equipment used in home mechanical ventilation is necessary in order to ensure that patients safely and accurately receive the prescribed ventilatory support. The aim of this study was to carry out a survey on the quality-control procedures in different centres and countries. The survey was carried out in the context of a European Commission Concerted Action

R. Farre; S. J. Lloyd-Owen; N. Ambrosino; G. Donaldson; J. Escarrabill; B. Fauroux; D. Roberte; B. Schoenhofer; A. Simonds; J. A. Wedzicha

2005-01-01

179

A Concept on Dual Control of Mechanical Ventilation Based on the Extension Strategy  

Microsoft Academic Search

Though volume control and pressure control modes are both commonly used in mechanical ventilation, they have their shortcomings that the former may generate high peak pressures and the latter may be prone to unstable gas exchange. Therefore, a dual control mode, which attempts to deliver a constant tidal volume while limiting peak pressure or attempts to limit peak pressure but

Hui Zhu; Knut Möller

2010-01-01

180

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

Microsoft Academic Search

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

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

1998-01-01

181

An improved telemedicine system for remote titration and optimization of Home Mechanical Ventilation  

Microsoft Academic Search

Home Mechanical Ventilation is applied to patients with different chronic respiratory diseases and, in order to be effective, it requires accurate individual titration. Nowadays this can be obtained only in the hospital during day or night visits, and this is associated with long waiting lists and high costs. The aim of this work was to realize and test a simple

Leonardo Govoni; R. Farre?; Antonio Pedotti; Josep M. Montserrat; Raffaele L. Dellaca

2010-01-01

182

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

PubMed

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

Ozy?lmaz, Ezgi; Kaya, Ak?n

2012-01-01

183

New insights into mechanism of Eustachian tube ventilation based on cine computed tomography images  

PubMed Central

Objective There is debate concerning the mechanism of Eustachian tube (ET) ventilation. While a mechanism of complete opening has been advocated previously, sequential contraction of the levator veli palatini and medial pterygoid muscles followed by the tensor veli palatini and lateral pterygoid muscles may produce a transient sequential opening mechanism, allowing an air bolus to traverse the ET. This may explain confusion surrounding sonotubometry reports that not every swallow leads to sound passage in normal subjects. We hypothesize that the ET may not need to open completely when ventilating the middle ear; rather, a discrete air bolus can pass through it. Subjects and Methods Five normal and five disordered subjects underwent low-radiation dose cine computed tomography (CT) scans of the ET. Sixteen contiguous 2.5 mm slice locations were chosen through a 4 cm area in the nasopharynx that were parallel to and encompassed the entire ET. Twelve images were acquired at each slice over 4.8 seconds during swallowing and other tasks. Serial images were analyzed. Results An air bolus was observed passing through the ET in the normal subjects, but not the subject with ET dysfunction. Medial and lateral pterygoid contractions were also observed. Conclusion A new hypothetical mechanism of transient sequential ET ventilation is presented. This is not a definitive conclusion, as the number of scans taken and maneuvers used was limited. Improved understanding of ET ventilation may facilitate management of middle ear disease as treatment evolves from ventilatory tube placement to ET manipulation. PMID:22120826

McDonald, Michael H.; Hoffman, Matthew R.; Gentry, Lindell R.; Jiang, Jack J.

2013-01-01

184

Interplay between Nuclear Factor Erythroid 2-Related Factor 2 and Amphiregulin during Mechanical Ventilation.  

PubMed

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

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

185

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

PubMed

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

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

2013-10-01

186

Influence of hyperoxia and mechanical ventilation in lung inflammation and diaphragm function in aged versus adult rats.  

PubMed

Although assist ventilation with FIO2 0.21 is the preferable mode of ventilation in the intensive care unit, sometimes controlled ventilation with hyperoxia is needed. But the impact of this setting has not been extensively studied in elderly subjects. We hypothesized that a high fraction of inspired oxygen (FiO(2)) and controlled mechanical ventilation (CMV) is associated with greater deleterious effects in old compared to adult subjects. Adult and old rats were submitted to CMV with low tidal volume (6 ml/kg) and FiO(2) 1 during 3 or 6 h. Arterial blood gas samples were measured at 0, 60 and 180 min (four groups: old and adult rats, 3 or 6 h of CMV), and additionally at 360 min (two groups: old and adult rats, 6 h of CMV). Furthermore, total protein content (TPC) and tumor necrosis factor-alpha (TNF-?) in bronchoalveolar lavage were assessed; lung tissue was used for malondialdehyde and histological analyses, and the diaphragm for measurement of contractile function. Arterial blood gas analysis showed an initial (60 min) greater PaO(2) in elderly versus adult animals; after that time, elderly animals had lowers pH and PaO(2), and greater PaCO(2). After 3 h of CMV, TPC and TNF-? levels were higher in the old compared with the adult group (P?

Andrade, P V; dos Santos, J M; Silva, H C A; Wilbert, D D; Cavassani, S S; Oliveira-Júnior, I S

2014-04-01

187

[Music therapy effectiveness to decrease anxiety in mechanically ventilated patients].  

PubMed

The aim of this review is to find out whether or not music therapy is an effective nursing intervention to decrease anxiety and promote relaxation in ventilator-dependent patients. For the purpose of this review, relaxation has been considered as a reduction in state anxiety and physiologic signs (heart rate, blood pressure or respiratory rate). A comprehensive search has been conducted in electronic databases (Cochrane Library, Medline, CINHAL, Embase and PsycLit) in order to identify systematic reviews on music therapy effectiveness or randomised control trials that compare the effectiveness of music therapy versus no music or other relaxation techniques in patients receiving ventilatory assistance. Three studies, two randomised control trials and a systematic review accomplished the inclusion criteria of this review. All studies found a significant difference between groups on the mean post-test state anxiety, concluding that there was a greater reduction in state anxiety in the experimental condition due to the intervention. Findings in terms of physiologic measures have been contradictory from study to study, reaching different conclusions. None of the three studies have accomplished the quality criteria established for this review. Some methodological limitations make their results be not fully reliable and therefore, it has not been possible to reach a satisfactory answer. Further and more rigorous research is needed on this area, as there is not enough valid research to conclude that music therapy is an effective nursing intervention for decreasing patients' anxiety. As it causes no harm and is a relatively inexpensive intervention, it would be worth exploring its effects on different kind of outcomes and settings. PMID:12952774

Iriarte Roteta, Andrea

2003-01-01

188

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

PubMed

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

Megido, Joaquín Alfonso; Franco, Alvaro González

2014-03-01

189

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

PubMed Central

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 126±1 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 6.8±0.8 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

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

2014-01-01

190

Non-bronchoscopic bronchoalveolar lavage in the microbiological diagnosis of pneumonia in mechanically ventilated patients.  

PubMed

A prospective study comparing standardized non-bronchoscopic bronchoalveolar lavage (sNB-BAL) and non-specific endotracheal aspirate (NsETA) in the microbiological diagnosis of pneumonia in mechanically ventilated patients is described. One hundred episodes in 82 mechanically ventilated patients with or without radiological and clinical diagnostic criteria of pneumonia were studied. NsETA and sNB-BAL was performed on the day of study. Fifty-one patients had pneumonia (21 ventilator-associated, 12 hospital-acquired, 18 community-acquired) and 49 had no pneumonia as defined by widely accepted clinico-radiological criteria. The sNB-BAL was found to be significantly more specific (0. 73) compared to NsETA (0.35) for the microbiological diagnosis of pneumonia. Colonization rates with NsETA were significantly higher compared to sNB-BAL (P value <0.0001). No patient had complications attributable to the sNB-BAL procedure. We conlude that sNB-BAL is a safe, effective, sensitive, specific and inexpensive procedure for the serial evaluation of pneumonia in mechanically ventilated patients. PMID:11939432

Arora, S C; Mudaliar, Y M; Lee, C; Mitchell, D; Iredell, J; Lazarus, R

2002-02-01

191

A new nasal cavity nursing methods application in patients with mechanical ventilation  

PubMed Central

Objective: To compare different nasal cavity nursing methods on mechanically ventilated patients. Methods: According to acute physiology and chronic health evaluation (APACHEII), 615 cases of mechanically ventilated patients were divided into group A, group B and group C by stratified random method. Traditional oral nursing plus aspirating secretions from oral cavity and nasal cavity q6h were done in group A. Based on methods in group A, normal saline was used for cleaning nasal cavity in group B. Besides the methods in group A, atomizing nasal cleansing a6h was also used in group C. Incidence rate of Ventilator-Associated Pneumonia (VAP) and APACHE II scores after administrating were compared. The correlation between APACHE II score and outcomes was analyzed by Spearman-rank correlation. Results: In group A, incidence of VAP was 36.76%, group B was 30.24%, group C was 20.38%, and the difference was statistically significant. APACHE II scores in group C were significantly lower compared with group A and B. APACHE II score was negatively correlated with clinical outcomes. Conclusions: For mechanically ventilated patients, nasal nursing can’t be ignored and the new atomizing nasal cleaning is an effective method for VAP prevention. PMID:24353671

Wei, Liuqing; Qin, Gang; Yang, Xining; Hu, Meichun; Jiang, Fufu; Lai, Tianwei

2013-01-01

192

Effect of histamine-2-receptor antagonists versus sucralfate on stress ulcer prophylaxis in mechanically ventilated patients: a meta-analysis of 10 randomized controlled trials  

Microsoft Academic Search

INTRODUCTION: We conducted a meta-analysis in order to investigate the effect of histamine-2-receptor antagonists (H2RA) versus sucralfate on stress ulcer prophylaxis in mechanically ventilated patients in the intensive care unit (ICU). METHODS: A systematic literature search of Medline, EMBASE, Cochrane Central Register of Controlled Trials (1966 to January 2010) was conducted using specific search terms. A review of Web of

Jiahao Huang; Yunfei Cao; Cun Liao; Liucheng Wu; Feng Gao

2010-01-01

193

The effect of open and closed endotracheal tube suctioning system on respiratory parameters of infants undergoing mechanical ventilation  

PubMed Central

Aims: Mechanical ventilation is used for some infants in neonatal intensive care units (NICU) due to many physiological and clinical causes. Since these patients have endotracheal tubes, cleaning and keeping the airways open through suctioning should be done to increase oxygenation. This study aimed to evaluate effect of open and closed suctioning methods on respiratory parameters of infants undergoing mechanical ventilation. Materials and Methods: In this crossover clinical trial, 44 infants were selected among those undergone mechanical ventilation in NICU of Isfahan's Al-Zahra Hospital using convenience sampling method. The subjects were randomly divided into two groups. In the first group, open suctioning was carried out and after three hours of cleaning, closed suctioning was done. In the second group, closed suctioning was firstly done and following three hours of cleaning, open suctioning was implemented. Respiratory rate (RR) and percentage of arterial blood oxygen saturation was measured before, during and after each type of suctioning. Data were analyzed using repeated measures ANOVA and independent student's t-test. Findings: There was a significant difference between mean respiratory rate and arterial blood oxygen saturation in infants before, during and after the closed and open suctioning. The percentage of arterial blood oxygen saturation had a significant reduction in open method compared to closed method during suctioning and immediately after it. RR three minutes after suctioning showed a significant reduction in both steps in open method compared to closed method. Conclusions: Close method caused fewer changes in hemodynamic status of infants. Therefore, in order to prevent respiratory complications in infants, nurses are recommended to perform the endotracheal tube suctioning by closed method. PMID:23493041

Taheri, Parvin; Asgari, Narges; Mohammadizadeh, Majid; Golchin, Mehri

2012-01-01

194

Legal mechanisms supporting accountable care principles.  

PubMed

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

Ramanathan, Tara

2014-11-01

195

Care of a cardiac pt on mechanical ventilation  

E-print Network

. Synchronized or not #12;Volume vs Pressure Volume control Pressure control Cycle Vol Time or flow Trigger Child: inspiratory or expiratory 3. Tidal volume: volume of air inspired in 1 normal breathnormal breath #12 or pressure control 2. Volume support or volume control 3. PRVC (SIMV): pressure regulated volume control

Kay, Mark A.

196

A knowledge- and model-based system for automated weaning from mechanical ventilation: technical description and first clinical application.  

PubMed

To describe the principles and the first clinical application of a novel prototype automated weaning system called Evita Weaning System (EWS). EWS allows an automated control of all ventilator settings in pressure controlled and pressure support mode with the aim of decreasing the respiratory load of mechanical ventilation. Respiratory load takes inspired fraction of oxygen, positive end-expiratory pressure, pressure amplitude and spontaneous breathing activity into account. Spontaneous breathing activity is assessed by the number of controlled breaths needed to maintain a predefined respiratory rate. EWS was implemented as a knowledge- and model-based system that autonomously and remotely controlled a mechanical ventilator (Evita 4, Dräger Medical, Lübeck, Germany). In a selected case study (n = 19 patients), ventilator settings chosen by the responsible physician were compared with the settings 10 min after the start of EWS and at the end of the study session. Neither unsafe ventilator settings nor failure of the system occurred. All patients were successfully transferred from controlled ventilation to assisted spontaneous breathing in a mean time of 37 ± 17 min (± SD). Early settings applied by the EWS did not significantly differ from the initial settings, except for the fraction of oxygen in inspired gas. During the later course, EWS significantly modified most of the ventilator settings and reduced the imposed respiratory load. A novel prototype automated weaning system was successfully developed. The first clinical application of EWS revealed that its operation was stable, safe ventilator settings were defined and the respiratory load of mechanical ventilation was decreased. PMID:23892513

Schädler, Dirk; Mersmann, Stefan; Frerichs, Inéz; Elke, Gunnar; Semmel-Griebeler, Thomas; Noll, Oliver; Pulletz, Sven; Zick, Günther; David, Matthias; Heinrichs, Wolfgang; Scholz, Jens; Weiler, Norbert

2014-10-01

197

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

PubMed Central

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 3 hours. 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 3 hours. 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

2014-01-01

198

Instituting a music listening intervention for critically ill patients receiving mechanical ventilation: Exemplars from two patient cases  

PubMed Central

Music is an ideal intervention to reduce anxiety and promote relaxation in critically ill patients receiving mechanical ventilatory support. This article reviews the basis for a music listening intervention and describes two case examples with patients utilizing a music listening intervention to illustrate the implementation and use of the music listening protocol in this dynamic environment. The case examples illustrate the importance and necessity of engaging a music therapist in not only assessing the music preferences of patients, but also for implementing a music listening protocol to manage the varied and challenging needs of patients in the critical care setting. Additionally, the case examples presented in this paper demonstrate the wide array of music patients prefer and how the ease of a music listening protocol allows mechanically ventilated patients to engage in managing their own anxiety during this distressful experience. PMID:22081788

Heiderscheit, Annie; Chlan, Linda; Donley, Kim

2011-01-01

199

Empiric antibiotic, mechanical ventilation, and central venous catheter duration as potential factors mediating the effect of a checklist prompting intervention on mortality: an exploratory analysis  

PubMed Central

Background Checklists are clinical decision support tools that improve process of care and patient outcomes. We previously demonstrated that prompting critical care physicians to address issues on a daily rounding checklist that were being overlooked reduced utilization of empiric antibiotics and mechanical ventilation, and reduced risk-adjusted mortality and length of stay. We sought to examine the degree to which these process of care improvements explained the observed difference in hospital mortality between the group that received prompting and an unprompted control group. Methods In the medical intensive care unit (MICU) of a tertiary care hospital, we conducted face-to-face prompting of critical care physicians if processes of care on a checklist were being overlooked. A control MICU team used the checklist without prompting. We performed exploratory analyses of the mediating effect of empiric antibiotic, mechanical ventilation, and central venous catheter (CVC)duration on risk-adjusted mortality. Results One hundred forty prompted group and 125 control group patients were included. One hundred eighty-three patients were exposed to at least one day of empiric antibiotics during MICU admission. Hospital mortality increased as empiric antibiotic duration increased (P<0.001). Prompting was associated with shorter empiric antibiotic duration and lower risk-adjusted mortality in patients receiving empiric antibiotics (OR 0.41, 95% CI 0.18-0.92, P=0.032). When empiric antibiotic duration was added to mortality models, the adjusted OR for the intervention was attenuated from 0.41 to 0.50, suggesting that shorter duration of empiric antibiotics explained 15.2% of the overall benefit of prompting. Evaluation of mechanical ventilation was limited by study size. Accounting for CVC duration changed the intervention effect slightly. Conclusions In this analysis, some improvement in mortality associated with prompting was explained by shorter empiric antibiotic duration. However, most of the mortality benefit of prompting was unexplained. PMID:22794349

2012-01-01

200

Comparison of four methods for assessing airway bacteriology in intubated, mechanically ventilated patients.  

PubMed

A prospective evaluation of lower airway bacteriology from intubated, mechanically ventilated patients was performed by comparing the qualitative and quantitative recovery of bacteria using four different techniques. Twelve intubated, mechanically ventilated patients who satisfied accepted clinical criteria for the suspicion of ventilator-associated pneumonia were studied. Airway secretions were obtained from each patient by: (1) blind endotracheal aspiration (ET); (2) Accu-cath pulmonary culture catheter (Accu); (3) bronchoscopic protected specimen brush (BPSB); and (4) bronchoalveolar lavage (BAL). ET specimens were cultured semi-quantitatively (1+ to 4+) aerobically, and all other specimens were cultured quantitatively both aerobically and anaerobically. The BPSB recovered 9 organisms in > or = 10(3) colony forming units/ml, a standard number often used to indicate significant growth. Of these 9 organisms, 7 were recovered at > or = 10(3) cfu/ml by Accu, and 6 were recovered at > or = 10(4) cfu/ml by BAL. All 8 aerobic isolates recovered in > or = 10(3) cfu/ml by BPSB also were recovered by ET aspirate. Five of these were recovered in > or = 3+ semi-quantitative growth by ET aspirate. Of 30 organisms recovered in < 3+ semi-quantitative growth by ET aspirate, 28 were recovered in < 10(3) cfu/ml by BPSB, indicating a negative predictive value of 93%. Thus, it appears that these four methods provide reasonably similar qualitative and quantitative recovery of bacteria from the lower airways of intubated, mechanically ventilated patients. In addition, routine Gram's stain and semi-quantitative aerobic culture of endotracheal aspirate may provide useful information in patients with suspected ventilator-associated pneumonia. PMID:1415319

Middleton, R; Broughton, W A; Kirkpatrick, M B

1992-10-01

201

Development of Localized Pulmonary Interstitial Emphysema in a Late Preterm Infant without Mechanical Ventilation  

PubMed Central

Pulmonary interstitial emphysema (PIE) is not an uncommon finding in premature infants with respiratory distress who need respiratory support by mechanical ventilation. PIE has been reported in a few cases of neonates in whom either no treatment other than room air was given or they were given continuous positive end-expiratory pressure (CPAP) support. We present a case of a premature neonate who presented with respiratory distress, in whom PIE and spontaneous pneumothorax (PTX) developed while on CPAP therapy only. The patient was treated conservatively with subsequent resolution of the radiological findings and clinical improvement. No surgical intervention was required. It is important to know that PIE may develop independently of mechanical ventilation. We would like to add this case to the literature and describe the pertinent plain film and computed tomography (CT) findings of this entity, the possible mechanism of development, and the differential diagnosis. A review of the literature is also provided. PMID:24744939

Soontarapornchai, Kultida; Perenyi, Agnes; Amodio, John

2014-01-01

202

A Mobile Care System With Alert Mechanism  

Microsoft Academic Search

Abstract—Hypertension and arrhythmia are chronic diseases, which can be effectively prevented and controlled only if the physi- ological parameters of the patient are constantly monitored, along with the full support of the health education and professional med- ical care. In this paper, a role-based intelligent mobile care system with alert mechanism in chronic care environment is proposed and implemented. The

Ren-guey Lee; Kuei-chien Chen; Chun-chieh Hsiao; Chwan-lu Tseng

2007-01-01

203

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

PubMed

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

Mendes, Ana; Aelenei, Daniel; Papoila, Ana Luísa; Carreiro-Martins, Pedro; Aguiar, Lívia; Pereira, Cristiana; Neves, Paula; Azevedo, Susana; Cano, Manuela; Proença, Carmo; Viegas, João; Silva, Susana; Mendes, Diana; Neuparth, Nuno; Teixeira, João Paulo

2014-01-01

204

Experiences of exclusion when living on a ventilator: reflections based on the application of Julia Kristeva's philosophy to caring science.  

PubMed

The research presented in this work represents reflections in the light of Julia Kristeva's philosophy concerning empirical data drawn from research describing the everyday life of people dependent on ventilators. It also presents a qualitative and narrative methodological approach from a person-centred perspective. Most research on home ventilator treatment is biomedical. There are a few published studies describing the situation of people living at home on a ventilator but no previous publications have used the thoughts in Kristeva's philosophy applied to this topic from a caring science perspective. The paper also addresses what a life at home on a ventilator may be like and will hopefully add some new aspects to the discussion of philosophical issues in nursing and the very essence of care. Kristeva's philosophy embraces phenomena such as language, abjection, body, and love, allowing her writings to make a fruitful contribution to nursing philosophy in that they strengthen, expand, and deepen a caring perspective. Moreover, her writings about revolt having the power to create hope add an interesting aspect to the work of earlier philosophers and nursing theorists. PMID:21143574

Lindahl, Berit

2011-01-01

205

The role of endocrine mechanisms in ventilator-associated lung injury in critically ill patients.  

PubMed

The critically ill subjects are represented by a heterogeneous group of patients suffering from a life-threatening event of different origin, e.g. trauma, cardiopulmonary failure, surgery or sepsis. The majority of these patients are dependent on the artificial lung ventilation, which means a life-saving chance for them. However, the artificial lung ventilation may trigger ventilation-associated lung injury (VALI). The mechanical ventilation at higher volumes (volutrauma) and pressure (barotrauma) can cause histological changes in the lungs including impairments in the gap and adherens junctions and desmosomes. The injured lung epithelium may lead to an impairment of the surfactant production and function, and this may not only contribute to the pathophysiology of VALI but also to acute respiratory distress syndrome. Other components of VALI are atelectrauma and toxic effects of the oxygen. Collectively, all these effects may result in a lung inflammation associated with a subsequent profibrotic changes, endothelial dysfunction, and activation of the local and systemic endocrine responses such as the renin-angiotensin system (RAS). The present review is aimed to describe some of the pathophysiologic aspects of VALI providing a basis for novel therapeutic strategies in the critically ill patients. PMID:22808908

Penesova, A; Galusova, A; Vigas, M; Vlcek, M; Imrich, R; Majek, M

2012-07-01

206

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

Microsoft Academic Search

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

Jill P. Karpel; Thomas K. Aldrich

1986-01-01

207

Delivery of hyperbaric oxygen therapy to critically Ill, mechanically ventilated children  

Microsoft Academic Search

Purpose:The purpose of this article is (1) to describe our method of mechanical ventilation and monitoring of critically ill children during administration of hyperbaric oxygen therapy (HBO2) in a multiplace chamber; and (2) to review the complications they experienced during transport to the HBO2 chamber and HBO2 treatment.Materials and Methods:A case series from a universitya-ffiliated children's hospital and regional hyperbaric

Heather T. Keenan; Susan L. Bratton; Diane M. Norkool; Thomas V. Brogan; Neil B. Hampson

1998-01-01

208

Autonomic Nervous System Function and Depth of Sedation in Adults Receiving Mechanical Ventilation  

PubMed Central

Background The effect of the depth of sedation on the function of the autonomic nervous system is not well known. Objectives To describe the effect of level of sedation on heart rate variability as a marker of the function of the autonomic nervous system in patients receiving mechanical ventilation. Methods This pilot study was part of a larger study in which sedation level was measured continuously for up to 24 hours. The sample consisted of 14 patients receiving mechanical ventilation. The R-R interval was measured continuously via electrocardiography. Sedation level was determined by using the Patient State Index and was categorized as deep (<60) or light (?60). Continuous heart rate data of 5 to 10 minutes for each sedation level for each patient were analyzed. Results Parasympathetic activity as indicated by root mean square of successive difference of the R-R interval, the high-frequency component, and the percentage of differences of successive N-N intervals (intervals due to normal sinus depolarization) that differed more than 50 milliseconds was significantly lower for deep sedation than for light sedation. The markers indicating sympathetic activity, including the low-frequency component and the ratio of the low-frequency component to the high-frequency component, did not differ significantly between the 2 levels of sedation. Most patients were receiving benzodiazepines. Conclusions Deep sedation may be associated with depression of parasympathetic function in patients receiving mechanical ventilation. Use of benzodiazepines most likely contributed to this finding. PMID:19116404

Unoki, Takeshi; Grap, Mary Jo; Sessler, Curtis N.; Best, Al M.; Wetzel, Paul; Hamilton, Anne; Mellott, Karen G.; Munro, Cindy L.

2013-01-01

209

Feasibility and reliability of an automated controller of inspired oxygen concentration during mechanical ventilation  

PubMed Central

Introduction Hypoxemia and high fractions of inspired oxygen (FiO2) are concerns in critically ill patients. An automated FiO2 controller based on continuous oxygen saturation (SpO2) measurement was tested. Two different SpO2-FiO2 feedback open loops, designed to react differently based on the level of hypoxemia, were compared. The results of the FiO2 controller were also compared with a historical control group. Methods The system measures SpO2, compares with a target range (92% to 96%), and proposes in real time FiO2 settings to maintain SpO2 within target. In 20 patients under mechanical ventilation, two different FiO2-SpO2 open loops were applied by a dedicated research nurse during 3 hours, each in random order. The times spent in and outside the target SpO2 values were measured. The results of the automatic controller were then compared with a retrospective control group of 30 ICU patients. SpO2-FiO2 values of the control group were collected over three different periods of 6 hours. Results Time in the target range was higher than 95% with the controller. When the 20 patients were separated according to the median PaO2/FiO2 (160(133-176) mm Hg versus 239(201-285)), the loop with the highest slope was slightly better (P?=?0.047) for the more-hypoxemic patients. Hyperoxemia and hypoxemia durations were significantly shorter with the controller compared with usual care: SpO2 target range was reached 90% versus 24%, 27% and 32% (P?care. PMID:24552490

2014-01-01

210

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

PubMed Central

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

2012-01-01

211

Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success  

Microsoft Academic Search

BACKGROUND--Non-invasive mechanical ventilation is increasingly used in the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to identify simple parameters to predict the success of this technique. METHODS--Fifty nine episodes of acute respiratory failure in 47 patients with COPD treated with non-invasive mechanical ventilation were analysed, considering each one

N Ambrosino; K Foglio; F Rubini; E Clini; S Nava; M Vitacca

1995-01-01

212

Gastric and pharyngeal flora in nosocomial pneumonia acquired during mechanical ventilation.  

PubMed

We studied the interrelations between gastric, pharyngeal, proximal, and distal airway bacterial flora in ventilator-associated pneumonia (VAP) on 36 patients with nosocomial pneumonia acquired during mechanical ventilation (MV) and 27 mechanically ventilated control subjects without pulmonary infection. Gastric, pharyngeal, and endotracheal (EA) sampling for quantitative cultures were performed upon all patients, as well as fiberoptic bronchoscopy with protected specimen brush (PSB) sampling. Mean bacterial and fungi colony counts were significantly increased in pharyngeal, EA, and PSB samples in patients with VAP compared with control subjects. The overall increase in colonization was due to gram-positive cocci in all samples. In addition, gram-negative bacilli and fungi mean counts increased significantly in PSB pneumonia samples versus control samples. However, mean gastric colonization was similar in both patients with VAP and control subjects. In the former group there was an increase in coincident microorganisms isolated from gastric, pharyngeal, and EA samples in relation to PSB samples compared with control samples. Among the different quantitative cultures analyzed, only those obtained from EA significantly correlated with PSB cultures in patients with pneumonia (r = 0.67, p = 0.001). In summary, the present study shows that the coincidence between microorganisms isolated in PSB cultures and those from gastric and oropharynx increase in MV patients with pneumonia, indicating that both reservoirs play a key role in the pathogenesis of pneumonia. Conceivably, preventing both gastric and pharyngeal colonization may reduce the incidence of ventilator-associated pneumonia. From all the noninvasive samples studied only endotracheal aspirate cultures were useful for inferring the etiology of some VAP pneumonias. PMID:8342898

Torres, A; el-Ebiary, M; González, J; Ferrer, M; Puig de la Bellacasa, J; Gené, A; Martos, A; Rodriguez-Roisin, R

1993-08-01

213

Nuclear Factor-Kappa B Expression in Alveolar Macrophages of Mechanically Ventilated Neonates with Respiratory Distress Syndrome  

Microsoft Academic Search

Background: Inflammatory reaction and injury in mature lungs are associated with activation of nuclear factor-?B (NF-?B) to trigger proinflammatory cytokine release. In preterm infants with immature lungs, this mechanism is not yet fully understood, therefore we investigated this mechanism in mechanically ventilated neonates with respiratory distress syndrome (RDS). Methods: Serial samples of the airway aspirates (AA) were obtained during mechanical

Lei Cao; Cuiqing Liu; Baoping Cai; Xiqun Jia; Limin Kang; Christian P. Speer; Bo Sun

2004-01-01

214

Intensive care in paradise--a review of 57 ventilated patients in ICU in Vanuatu over five years.  

PubMed

Intensive care is not a medical priority for developing nations. Vila Central Hospital is the major referral centre for the developing Pacific island nation of Vanuatu and runs an 'as-needed' intensive care service. Between January 1999 and January 2004, fifty-seven patients were ventilated at Vila Central Hospital. Twenty-two patients survived and 35 died. Eleven patients were declared brain dead, eight died from renal failure, six from overwhelming respiratory failure, three from sepsis, four due to equipment or technical failure, two of unknown causes and one died after transfer to Australia. The patient age range extended from newborns to 80 years. Survivors were ventilated for durations of four hours, (postoperative), to 14.5 days, (ARDS), the median being two days. PMID:16235483

Grace, R F

2005-10-01

215

Sedation during noninvasive mechanical ventilation with dexmedetomidine or midazolam: A randomized, double-blind, prospective study  

PubMed Central

Background: Effective noninvasive mechanical ventilation (NIV) requires a patient to be comfortable and in synch with the ventilator, for which sedation is usually needed. Choice of the proper drug for sedation can lead to improved clinical outcomes. Objective: The aim of this study was to compare the effectiveness of dexmedetomidine and midazolam on sedation and their effects on hemodynamics and gas exchange. Methods: In this randomized, double-blind study, intensive care unit patients with acute respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease undergoing NIV were equally randomized to receive a loading dose of 1 ?g/kg IV dexmedetomidine or 0.05 ?g/kg midazolam over 10 minutes followed by a maintenance infusion of 0.5 ?g/kg/h dexmedetomidine (group D) or 0.1 mg/kg/h midazolam (group M). The following parameters were measured by a blinded clinician at baseline and 1, 2, 4, 6, 8, 12, and 24 hours after the loading dose was administered: Ramsay Sedation Score (RSS), Riker Sedation-Agitation Scale (RSAS), Bispectral Index (BIS), arterial blood gases, and vital signs. A second blinded investigator determined dosing changes according to the outcome of maintaining a target sedation level of RSS 2 to 3, RSAS 3 to 4, and BIS >85. Results: A total of 45 patients were assessed for enrollment in the study; 4 did not meet the inclusion criteria and 1 refused to participate (men/women 19/21; mean age 58/60; all patients were receiving bronchodilators, steroids, antibiotics, and mucolytics). In both groups (n = 20), RSS significantly increased and RSAS levels and BIS values significantly decreased after the loading dose, compared with baseline (P < 0.05). RSS levels were significantly lower beginning at 4 hours in group D compared with group M (P < 0.05). RSAS levels were not significantly different between the 2 groups in the first 8 hours. However, RSAS levels were significantly higher at 8 hours after the loading dose was administered in group D compared with group M (P < 0.01). BIS was significantly higher in group D throughout the study period (P < 0.05). Respiratory rates and gas exchange values were not significantly different between the Accepted for publication April 7, 2010. 2 groups. The number of times a change in infusion dose was needed was significantly lower in group D (2 patients with 1 change each) than in group M (3 patients with 1 change, 1 patient with 2 changes, and 3 patients with 3 changes each) (P < 0.01). Conclusions: Dexmedetomidine and midazolam are both effective sedatives for patients with NIV. Dexmedetomidine required fewer adjustments in dosing compared with midazolam to maintain adequate sedation. PMID:24683260

Senoglu, Nimet; Oksuz, Hafize; Dogan, Zafer; Yildiz, Huseyin; Demirkiran, Hilmi; Ekerbicer, Hasan

2010-01-01

216

Alveolar instability caused by mechanical ventilation initially damages the nondependent normal lung  

PubMed Central

Background Septic shock is often associated with acute respiratory distress syndrome, a serious clinical problem exacerbated by improper mechanical ventilation. Ventilator-induced lung injury (VILI) can exacerbate the lung injury caused by acute respiratory distress syndrome, significantly increasing the morbidity and mortality. In this study, we asked the following questions: what is the effect of the lung position (dependent lung versus nondependent lung) on the rate at which VILI occurs in the normal lung? Will positive end-expiratory pressure (PEEP) slow the progression of lung injury in either the dependent lung or the nondependent lung? Materials and methods Sprague–Dawley rats (n = 19) were placed on mechanical ventilation, and the subpleural alveolar mechanics were measured with an in vivo microscope. Animals were placed in the lateral decubitus position, left lung up to measure nondependent alveolar mechanics and left lung down to film dependent alveolar mechanics. Animals were ventilated with a high peak inspiratory pressure of 45 cmH2O and either a low PEEP of 3 cmH2O or a high PEEP of 10 cmH2O for 90 minutes. Animals were separated into four groups based on the lung position and the amount of PEEP: Group I, dependent + low PEEP (n = 5); Group II, nondependent + low PEEP (n = 4);Group III, dependent + high PEEP (n = 5); and Group IV, nondependent + high PEEP (n = 5). Hemodynamic and lung function parameters were recorded concomitant with the filming of alveolar mechanics. Histological assessment was performed at necropsy to determine the presence of lung edema. Results VILI occurred earliest (60 min) in Group II. Alveolar instability eventually developed in Groups I and II at 75 minutes. Alveoli in both the high PEEP groups were stable for the entire experiment. There were no significant differences in arterial PO2 or in the degree of edema measured histologically among experimental groups. Conclusion This open-chest animal model demonstrates that the position of the normal lung (dependent or nondependent) plays a role on the rate of VILI. PMID:17877789

Pavone, Lucio; Albert, Scott; DiRocco, Joseph; Gatto, Louis; Nieman, Gary

2007-01-01

217

Sulfide toxicity: Mechanical ventilation and hypotension determine survival rate and brain necrosis  

SciTech Connect

Occupational exposure to hydrogen sulfide is one of the leading causes of sudden death in the workplace, especially in the oil and gas industry. High-dose exposure causes immediate neurogenic apnea and death; lower doses cause [open quotes]knockdown[close quotes] (transient loss of consciousness, with apnea). Because permanent neurological sequelae have been reported, the authors sought to determine whether sulfide can directly kill central nervous system neurons. Ventilated and unventilated rats were studied to allow administration of higher doses of sulfide and to facilitate physiological monitoring. It was extremely difficult to produce cerebral necrosis with sulfide. Only one of eight surviving unventilated rats given high-dose sulfide (a dose that was lethal in [ge]50% of animals) showed cerebral necrosis. Mechanical ventilation shifted the dose that was lethal in 50% of the animals to 190 mg/kg from 94 mg/kg in the unventilated rats. Sulfide was found to potently depress blood pressure. Cerebral necrosis was absent in the ventilated rats (n = 11), except in one rat that showed profound and sustained hypotension to [le]35 Torr. Electroencephalogram activity ceased during exposure but recovered when the animals regained consciousness. The authors conclude that very-high-dose sulfide is incapable of producing cerebral necrosis by a direct histotoxic effect. 32 refs., 5 figs.

Baldelli, R.J.; Green, F.H.Y.; Auer, R.N. (Univ. of Calgary, Alberta (Canada))

1993-09-01

218

Outcomes of a ventilator-associated pneumonia bundle on rates of ventilator-associated pneumonia and other health care-associated infections in a long-term acute care hospital setting.  

PubMed

Long-term trends in ventilator-associated pneumonia (VAP) rates, and other health care-associated infections, were examined prior to, during, and after introduction of a VAP bundle in a long-term acute care hospital setting. VAP incidence rate declined in a step-wise fashion and reached a null value. Incidence rates of bacteremia from any cause declined in a similar fashion. The incidence rates of vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus colonization or infection rates also decreased, but that of Clostridium difficile infection did not. VAP in the long-term acute care hospital setting can be controlled over time with implementation of Centers for Disease Control and Prevention-based VAP bundle. This outcome also may decrease certain other health care-associated infections. PMID:24773791

Sulis, Carol A; Walkey, Allan J; Abadi, Yafet; Campbell Reardon, Christine; Joyce-Brady, Martin

2014-05-01

219

Prone position improves mechanics and alveolar ventilation in acute respiratory distress syndrome  

Microsoft Academic Search

ObjectiveWe tested the hypothesis that ventilation in the prone position might improve homogenization of tidal ventilation by reducing time-constant inequalities, and thus improving alveolar ventilation. We have recently reported in ARDS patients that these inequalities are responsible for the presence of a “slow compartment,” excluded from tidal ventilation at supportive respiratory rate.DesignIn 11 ARDS patients treated by ventilation in the

Antoine Vieillard-Baron; Anne Rabiller; Karin Chergui; Olivier Peyrouset; Bernard Page; Alain Beauchet; François Jardin

2005-01-01

220

Short-term outcome of mechanically ventilated infants weighing more than 2499 g at birth: a population based study.  

PubMed

Very little data exist describing the neonatal outcome of infants of birthweight 2500 g or more who require mechanical ventilation. Our aim was to collect population-based data on such infants in New South Wales (NSW), and to monitor their neonatal morbidity, mortality to 1 year of age and the associated risk factors. The study group (NICUS infants) comprised all 341 infants weighing > 2499 g who were admitted to the seven neonatal intensive care units in New South Wales and mechanically ventilated for 4 h or more between 1 January and 31 December, 1987. Two groups of infants emerged: those who were preterm and mostly had hyaline membrane disease, and term and post-term infants for whom the most common problem was 'perinatal asphyxia'. The most important factors associated with dying were a birthweight of over 3499 g (OR = 2.6; CI 1.03-6.6) and a 1 min Apgar score < 4 (OR = 4.8; CI 1.4-16.9). Study group mothers were significantly more likely than all NSW mothers to have had a spontaneous abortion in the previous pregnancy (P < 0.01), a pre-existing medical condition or an obstetric complication in this pregnancy, or a Caesarean section for this delivery (P < 0.001). This is the first population-based study of high-risk neonates without congenital anomalies to clearly document the worsening prognosis associated with a birthweight over 3499 g. Further research should be directed towards identifying prenatal and perinatal factors which might minimize the morbidity and mortality in this group of babies. PMID:8286156

Sutton, L; Bajuk, B; Duffy, B; Alexander, I; Arnold, J; Leslie, G; Henderson-Smart, D; John, E; Roberts, V; Berry, A

1993-12-01

221

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

PubMed

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

Lorx, András; Szabó, Barna; Hercsuth, Magdolna; Pénzes, István; Hantos, Zoltán

2009-12-01

222

Evaluation of dexmedetomidine versus propofol-based sedation therapy in mechanically ventilated cardiac surgery patients at a tertiary academic medical center.  

PubMed

Management of pain and sedation therapy is a vital component of optimizing patient outcomes; however, the ideal pharmacotherapy regimen has not been identified in the postoperative cardiac surgery population. We sought to evaluate efficacy and safety outcomes between postoperative mechanically ventilated cardiac surgery patients receiving dexmedetomidine versus propofol therapy upon arrival to the intensive care unit (ICU). We conducted a single center, descriptive study of clinical practice at a 20-bed cardiac surgery ICU in a tertiary academic medical center. Adult mechanically ventilated postcardiac surgery patients who received either dexmedetomidine or propofol for sedation therapy upon admission to the ICU between October 20, 2006 and December 15, 2006 were evaluated. A pharmacy database was used to identify patients receiving dexmedetomidine or propofol therapy for perioperative sedation during cardiac surgery. Patients were matched according to surgical procedure type. Fifty-six patients who received either dexmedetomidine (n = 28) or propofol (n = 28) were included in the analysis. No differences in the ICU length of stay (58.67 ± 32.61 vs. 61 ± 33.1 hours; P = 0.79) and duration of mechanical ventilation (16.21 ± 6.05 vs. 13.97 ± 4.62 hours; P = 0.13) were seen between the propofol and dexmedetomidine groups, respectively. Hypotension (17 [61%] vs. 9 [32%]; P = 0.04), morphine use (11 [39.3%] vs. 1 [3.6%]; P = 0.002), and nonsteroidal anti-inflammatory use (7 [25%] vs. 1 [3.6%]; P = 0.05) occurred more during dexmedetomidine therapy versus propofol. Dexmedetomidine therapy resulted in a higher incidence of hypotension and analgesic consumption compared with propofol-based sedation therapy. Further evaluation is needed to assess differences in clinical outcomes of propofol and dexmedetomidine-based therapy in mechanically ventilated cardiac surgery patients. PMID:21119342

Anger, Kevin E; Szumita, Paul M; Baroletti, Steven A; Labreche, Matthew J; Fanikos, John

2010-12-01

223

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

PubMed Central

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. Dorsal–caudal 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 (6–7 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-1–dependent fashion. Prone positioning is protective and induces MKP-1. PG490-88 induced MKP-1 and was protective against high Vt in a nuclear factor-?B–dependent manner. MKP-1 is a potential target for modulating regional effects of injurious ventilation. PMID:22582160

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

2012-01-01

224

The Effect of the Open and Closed System Suctions on Cardiopulmonary Parameters: Time and Costs in Patients Under Mechanical Ventilation  

PubMed Central

Background: One of the measures to keep the airway open is suctioning of endotracheal tube in patients under ventilation. This procedure can be accompanied with some complications. Selection of appropriate method of suctioning can prevent incidence of acute complications. Objectives: This study aimed to compare the effects of the open and closed system suctioning methods on blood pressure, mean arterial pressure, heart rate, percentage of arterial oxygen saturation, time, and costs in patients under mechanical ventilation. Patients and Methods: This clinical trial study was conducted on 40 patients in ICU. Patients’ blood pressure, heart rate, arterial oxygen saturation, related costs, and length of suctioning procedure were measured and recorded immediately before and one, five, ten, and fifteen minutes after suctioning. Data were analyzed using paired t test and repeated measure analysis of variance. Results: No significant differences were observed between the two suctioning methods in terms of mean systolic blood pressure (P = 0.075), diastolic blood pressure (P = 0.405), and mean arterial pressure (P = 0.257) in the five consecutive measurements. However, significant changes were observed in heart rate (P = 0.025) and percentage of arterial oxygen saturation (P < 0.001). The mean lengths of time in open and closed suctioning methods were 5.59 ± 0.211 and 4.34 ± 0.039 seconds, respectively (P < 0.001). The cost of the closed system was lower than the open method for the patients who were admitted to ICU for longer than two days. Conclusions: Closed suction caused fewer disturbances in patients’ hemodynamic condition, took shorter time, and is more economical. Therefore, this method can replace open suction method in caring of severely critically ill patients.

Afshari, Ali; Safari, Mahmoud; Oshvandi, Khodayar; Soltanian, Ali Reza

2014-01-01

225

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

Code of Federal Regulations, 2013 CFR

...for the availability of respiratory care services, would require respiratory care as an inpatient in a hospital...to have payment made for inpatient care under the State plan; (4) Has adequate social support services to be cared...

2013-10-01

226

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

Code of Federal Regulations, 2012 CFR

...for the availability of respiratory care services, would require respiratory care as an inpatient in a hospital...to have payment made for inpatient care under the State plan; (4) Has adequate social support services to be cared...

2012-10-01

227

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

Code of Federal Regulations, 2011 CFR

...for the availability of respiratory care services, would require respiratory care as an inpatient in a hospital...to have payment made for inpatient care under the State plan; (4) Has adequate social support services to be cared...

2011-10-01

228

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

Code of Federal Regulations, 2010 CFR

...for the availability of respiratory care services, would require respiratory care as an inpatient in a hospital...to have payment made for inpatient care under the State plan; (4) Has adequate social support services to be cared...

2010-10-01

229

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

Microsoft Academic Search

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,

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

2005-01-01

230

Ventilator Associated Pneumonia in Critically Ill Patients: Prevention and Treatment  

Microsoft Academic Search

Ventilator associated pneumonia (VAP) represents a major threat to the recovery of patients receiving mechanical ventilation, and is a difficult diagnostic and therapeutic challenge for critical care physicians. VAP occurs in 5-25% of all patients with different varieties of respiratory failure, and its incidence exceeds 70% in patients who die of adult respiratory distress syndrome (ARDS). The microaspiration of bacteria

Argyris MICHALOPOULOS; Stefanos GEROULANOS

231

Does the presence of oral care guidelines affect oral care delivery by intensive care unit nurses? A survey of Saudi intensive care unit nurses.  

PubMed

Mechanically ventilated patients rely on nurses for their oral care needs, signifying the importance of nurses in intensive care units (ICUs). This study aimed to evaluate the impact of oral care guidelines on the oral care delivered to mechanically ventilated patients by ICU nurses. A total of 215 nurses were enrolled. Demographic data and oral care practices were recorded through a self-administered survey. Participants governed by oral care guidelines had significantly higher oral care practice scores than their counterparts from ICUs without similar guidelines (P = .034; t = 2.13). Oral care guidelines in ICUs can contribute to reduction of morbidity and mortality caused by ventilator-associated pneumonia. PMID:25087146

Alotaibi, Ahmed K; Alshayiqi, Mohammed; Ramalingam, Sundar

2014-08-01

232

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

NASA Astrophysics Data System (ADS)

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.

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

2002-06-01

233

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

PubMed Central

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

2014-01-01

234

Mechanical Ventilation Injury and Repair in Extremely and Very Preterm Lungs  

PubMed Central

Background Extremely preterm infants often receive mechanical ventilation (MV), which can contribute to bronchopulmonary dysplasia (BPD). However, the effects of MV alone on the extremely preterm lung and the lung’s capacity for repair are poorly understood. Aim To characterise lung injury induced by MV alone, and mechanisms of injury and repair, in extremely preterm lungs and to compare them with very preterm lungs. Methods Extremely preterm lambs (0.75 of term) were transiently exposed by hysterotomy and underwent 2 h of injurious MV. Lungs were collected 24 h and at 15 d after MV. Immunohistochemistry and morphometry were used to characterise injury and repair processes. qRT-PCR was performed on extremely and very preterm (0.85 of term) lungs 24 h after MV to assess molecular injury and repair responses. Results 24 h after MV at 0.75 of term, lung parenchyma and bronchioles were severely injured; tissue space and myofibroblast density were increased, collagen and elastin fibres were deformed and secondary crest density was reduced. Bronchioles contained debris and their epithelium was injured and thickened. 24 h after MV at 0.75 and 0.85 of term, mRNA expression of potential mediators of lung repair were significantly increased. By 15 days after MV, most lung injury had resolved without treatment. Conclusions Extremely immature lungs, particularly bronchioles, are severely injured by 2 h of MV. In the absence of continued ventilation these injured lungs are capable of repair. At 24 h after MV, genes associated with injurious MV are unaltered, while potential repair genes are activated in both extremely and very preterm lungs. PMID:23704953

Brew, Nadine; Hooper, Stuart B.; Zahra, Valerie; Wallace, Megan; Harding, Richard

2013-01-01

235

Comparative study between dexmedetomidine and fentanyl for sedation during mechanical ventilation in post-operative paediatric cardiac surgical patients  

PubMed Central

Aims and Objectives: To compare the efficacy of sedation and time taken for extubation using dexmedetomidine and fentanyl sedation in post-operative paediatric cardiac surgical patients. Methods: A prospective randomized double-blind study involving 60 children undergoing open heart surgery was conducted. The patients were divided into two groups, each involving 30 patients. One group received fentanyl at 1 ?g/kg/h (Group A) and the other received dexmedetomidine at 0.5 ?g/kg/h (Group B) for post-operative sedation with intermittent rescue fentanyl 0.5 ?g/kg bolus in either group as per requirement during suctioning. The efficacy of sedation was assessed using the Ramsay sedation score, paediatric intensive care unit sedation score and the tracheal suction score. The time taken for extubation from the stoppage of infusion was noted. Results: Haemodynamic parameters between the two groups were comparable. All sedation scores were comparable in the fentanyl and dexmedetomidine groups. Average time (in minutes) required for extubation was 131.0 (±51.06 SD) in the dexmedetomidine group compared with 373.0 (±121.4 SD) in the fentanyl group. The difference in mean time for extubation was statistically significant. Conclusions: Dexmedetomidine facilitates adequate sedation for mechanical ventilation and also early extubation as compared with fentanyl. PMID:23325939

Prasad, SR; Simha, Parimala Prasanna; Jagadeesh, AM

2012-01-01

236

Can heterogeneity in ventilation be good?  

PubMed Central

Selection of the optimal positive end-expiratory pressure (PEEP) to avoid ventilator-induced lung injury in patients under mechanical ventilation is still a matter of debate. Many methods are available, but none is considered the gold standard. In the previous issue of Critical Care, Zhao and colleagues applied a method based on electrical impedance tomography to help select the PEEP that minimized ventilation inhomogeneities. Though promising when alveolar collapse and overdistension are present, this method might be misleading in patients with normal lungs. PMID:20359315

2010-01-01

237

Ventilation and ventilators.  

PubMed

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

Hayes, B

1982-01-01

238

Feasibility Study of an Indoor Air Quality Measurement Protocol on 12 Parameters in Mechanically Ventilated and Air-Conditioned Buildings  

Microsoft Academic Search

The Hong Kong Environmental Protection Department has recently launched a set of guidance notes on indoor air quality (IAQ) management for offices and public places. An IAQ Certification Programme will be con ducted on a self-regulatory basis that is intended to divide IAQ in mechanically ventilated buildings into three classes. Due to the large number of buildings in Hong Kong

Christopher Y. Chao; George Y. Chan; Lewis Ho

2001-01-01

239

Outcome of direct percutaneous endoscopic jejunostomy tube placement for nutritional support in critically ill, mechanically ventilated patients  

Microsoft Academic Search

Purpose: Gastrointestinal function is adversely affected in critically ill mechanically ventilated patients. The most common abnormality is delayed gastric emptying. Among the options for postpyloric feeds, direct percutaneous endoscopic jejunostomy (PEJ) provides a permanent, reliable, and direct access to the small bowel and can be used for full enteral feedings, thus eliminating the need for parenteral nutrition. Patients and Methods:

Rafael Barrera; Mark Schattner; Stephen Nygard; Michael Ahdoot; Allan Ahdoot; Samuel Adeyeye; Jeffrey Groeger; Moshe Shike

2001-01-01

240

Bench-to-bedside review: Paediatric viral lower respiratory tract disease necessitating mechanical ventilation – should we use exogenous surfactant?  

Microsoft Academic Search

Treatment of infants with viral lower respiratory tract disease (LRTD) necessitating mechanical ventilation is mainly symptomatic. The therapeutic use of surfactant seems rational because significantly lower levels of surfactant phospholipids and proteins, and impaired capacity to reduce surface tension were observed among infants and young children with viral LRTD. This article reviews the role of pulmonary surfactant in the pathogenesis

Martin CJ Kneyber; Frans B Plötz; Jan LL Kimpen

2005-01-01

241

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

Microsoft Academic Search

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

Theodoros Vassilakopoulos; Spyros Zakynthinos; Charis Roussos

2005-01-01

242

Measurement of end-expiratory lung volume by oxygen washin–washout in controlled and assisted mechanically ventilated patients  

Microsoft Academic Search

Objective  Assessing limits of agreement with helium dilution and repeatability of a new system (lung funcution, LUFU) that measures\\u000a end-expiratory lung volume (EELV) in mechanically ventilated patients using the O2 washin (EELVWin) and washout (EELVWout) technique. LUFU consists of an Evita 4 ventilator, a side-stream oxygen analyzer, and a dedicated PC software.\\u000a \\u000a \\u000a \\u000a Design and setting  Prospective human study in a general ICU

N. Patroniti; M. Saini; A. Zanella; D. Weismann; S. Isgrò; G. Bellani; G. Foti; A. Pesenti

2008-01-01

243

A patient-specific airway branching model for mechanically ventilated patients.  

PubMed

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: 0.54-0.63; range: 0.45-0.66) 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

Damanhuri, Nor Salwa; Docherty, Paul D; Chiew, Yeong Shiong; van Drunen, Erwin J; Desaive, Thomas; Chase, J Geoffrey

2014-01-01

244

A Patient-Specific Airway Branching Model for Mechanically Ventilated Patients  

PubMed Central

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: 0.54–0.63; range: 0.45–0.66) 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.

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

2014-01-01

245

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

PubMed

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

Wu, Shiau-Jiun; Chou, Fan-Hao

2008-10-01

246

76 FR 37307 - Rural Health Care Support Mechanism  

Federal Register 2010, 2011, 2012, 2013

...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...

2011-06-27

247

77 FR 42185 - Rural Health Care Support Mechanism  

Federal Register 2010, 2011, 2012, 2013

...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...

2012-07-18

248

Application of heart-rate variability in patients undergoing weaning from mechanical ventilation  

PubMed Central

Introduction The process of weaning may impose cardiopulmonary stress on ventilated patients. Heart-rate variability (HRV), a noninvasive tool to characterize autonomic function and cardiorespiratory interaction, may be a promising modality to assess patient capability during the weaning process. We aimed to evaluate the association between HRV change and weaning outcomes in critically ill patients. Methods This study included 101 consecutive patients recovering from acute respiratory failure. Frequency-domain analysis, including very low frequency, low frequency, high frequency, and total power of HRV was assessed during a 1-hour spontaneous breathing trial (SBT) through a T-piece and after extubation after successful SBT. Results Of 101 patients, 24 (24%) had SBT failure, and HRV analysis in these patients showed a significant decrease in total power (P = 0.003); 77 patients passed SBT and were extubated, but 13 (17%) of them required reintubation within 72 hours. In successfully extubated patients, very low frequency and total power from SBT to postextubation significantly increased (P = 0.003 and P = 0.004, respectively). Instead, patients with extubation failure were unable to increase HRV after extubation. Conclusions HRV responses differ between patients with different weaning outcomes. Measuring HRV change during the weaning process may help clinicians to predict weaning results and, in the end, to improve patient care and outcome. PMID:24456585

2014-01-01

249

Pressure-volume curves, static compliances and gas exchange in hyaline membrane disease during conventional mechanical and high-frequency ventilation  

Microsoft Academic Search

Eight premature infants with hyaline membrane disease needing artificial ventilation were studied at a mean age of 26.5 h.\\u000a After a preparative phase they were randomly assigned either first to conventional mechanical ventilation (CMV; delivered\\u000a by a Siemens Servo 900 C), followed by high-frequency ventilation (HFV; delivered by Percussionaire VDR 1 at 10 Hz) or vice\\u000a versa, each period lasting

J. Pfenninger; C. Minder

1988-01-01

250

Comparison of the Pharmacodynamics and Pharmacokinetics of an Infusion of cis-Atracurium (51W89) or Atracurium in Critically 111 Patients Undergoing Mechanical Ventilation in an Intensive Therapy Unit  

Microsoft Academic Search

Summary We have studied 12 critically ill, sedated patients who required a neuromuscular blocking drug to assist mechanical ventilation in an intensive care unit. Patients were randomized to receive an infusion of cis-atracurium 0.18 mg kg1 h1 (group 1, n 6) or atracurium 0.6 mg kg1 h1 (group 2, n 6) preceded, if necessary, by a bolus dose of 2

A. H. BOYD; N. B. EASTWOOD; C. J. R. PARKER; J. M. HUNTER

1997-01-01

251

Prospective study of nosocomial pneumonia and of patient and circuit colonization during mechanical ventilation with circuit changes every 48 hours versus no change.  

PubMed

Circuits on mechanical ventilators with cascade humidifiers are routinely changed every day or every other day, although humidifying cascades have been considered unlikely to increase the risk of respiratory infection because they do not generate aerosols. Moreover, changing ventilator tubings every 24 rather than every 48 h increases the risk of ventilator-associated pneumonia. To study the effects of ventilator circuit changes on the rate of nosocomial pneumonia and on patient and circuit colonization, 73 consecutive patients requiring continuous mechanical ventilation for more than 48 h were randomly assigned to either ventilator circuit changes every 48 h (Group 1, n = 38) or no change (Group 2, n = 35). Patients dying or being weaned before 96 h were not analyzed (Group 1 n = 3; Group 2 n = 7; leaving Group 1 n = 35 and Group 2 n = 28; p = 0.13). Ventilator-associated pneumonia was defined as the occurrence during mechanical ventilation or within 48 h after weaning of a new and persistent infiltrate on chest X-ray, purulent tracheal secretions, and a positive culture of a protected brush specimen (greater than or equal to 10(3) cfu/ml). Bacterial colonization was assessed every 48 h by quantitative cultures of pharyngeal swab, tracheal aspirate, humidifying cascade, and expiratory tubing trap. The two groups were similar in terms of age, indication for and duration of ventilation, and severity of illness.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2008985

Dreyfuss, D; Djedaini, K; Weber, P; Brun, P; Lanore, J J; Rahmani, J; Boussougant, Y; Coste, F

1991-04-01

252

Inhaled fenoterol-ipratropium bromide in mechanically ventilated patients with chronic obstructive pulmonary disease.  

PubMed

In 18 patients with chronic obstructive pulmonary disease intubated and mechanically ventilated, we prospectively randomized 200 micrograms fenoterol-80 micrograms ipratropium bromide (four puffs) from a metered-dose inhaler (MDI) versus 1.25 mg fenoterol-500 micrograms ipratropium bromide in 5 ml saline from a nebulizer (NEB). Respiratory mechanics were assessed before and 30 min after the end of each delivery by the rapid end-inspiratory airway occlusion technique. We did vary on single breaths the inflation flow (V) from 0.2 to 1.2 L. s-1, at constant inflation volume. The total respiratory resistance of the respiratory system (Rrs) was partitioned into airway (Rint,rs) and tissue (DeltaRrs) resistances. We found that Rrs was equivalently reduced, from 16.49 +/- 1.37 to 14.85 +/- 1.88 cm H2O. L-1. s with MDI (p < 0.05) and from 18.04 +/- 1.85 to 15.15 +/- 1.33 cm H2O. L-1. s with NEB (p < 0.01). Whereas the prevailing effect of MDI was to reduce Rint,rs, that of NEB was to decrease DeltaRrs. In addition, the V resistance of the respiratory system over the whole range of V was significantly affected by NEB but not by MDI. PMID:10194143

Guerin, C; Chevre, A; Dessirier, P; Poncet, T; Becquemin, M H; Dequin, P F; Le Guellec, C; Jacques, D; Fournier, G

1999-04-01

253

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

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 University’s general SICUs (6.3±2.8 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 University’s 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

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

2014-01-01

254

Open lung approach with low tidal volume mechanical ventilation attenuates lung injury in rats with massive brain damage  

PubMed Central

Introduction The ideal ventilation strategy for patients with massive brain damage requires better elucidation. We hypothesized that in the presence of massive brain injury, a ventilation strategy using low (6 milliliters per kilogram ideal body weight) tidal volume (VT) ventilation with open lung positive end-expiratory pressure (LVT/OLPEEP) set according to the minimal static elastance of the respiratory system, attenuates the impact of massive brain damage on gas-exchange, respiratory mechanics, lung histology and whole genome alterations compared with high (12 milliliters per kilogram ideal body weight) VT and low positive end-expiratory pressure ventilation (HVT/LPEEP). Methods In total, 28 adult male Wistar rats were randomly assigned to one of four groups: 1) no brain damage (NBD) with LVT/OLPEEP; 2) NBD with HVT/LPEEP; 3) brain damage (BD) with LVT/OLPEEP; and 4) BD with HVT/LPEEP. All animals were mechanically ventilated for six hours. Brain damage was induced by an inflated balloon catheter into the epidural space. Hemodynamics was recorded and blood gas analysis was performed hourly. At the end of the experiment, respiratory system mechanics and lung histology were analyzed. Genome wide gene expression profiling and subsequent confirmatory quantitative polymerase chain reaction (qPCR) for selected genes were performed. Results In NBD, both LVT/OLPEEP and HVT/LPEEP did not affect arterial blood gases, as well as whole genome expression changes and real-time qPCR. In BD, LVT/OLPEEP, compared to HVT/LPEEP, improved oxygenation, reduced lung damage according to histology, genome analysis and real-time qPCR with decreased interleukin 6 (IL-6), cytokine-induced neutrophil chemoattractant 1 (CINC)-1 and angiopoietin-4 expressions. LVT/OLPEEP compared to HVT/LPEEP improved overall survival. Conclusions In BD, LVT/OLPEEP minimizes lung morpho-functional changes and inflammation compared to HVT/LPEEP. PMID:24693992

2014-01-01

255

Effect Of Pressure Support Versus Unassisted Breathing Through A Tracheostomy Collar On Weaning Duration In Patients Requiring Prolonged Mechanical Ventilation: A Randomized Trial  

PubMed Central

Context Patients requiring prolonged mechanical ventilation (more than 21 days) are commonly weaned at long-term acute care hospitals (LTACHs). The most effective method of weaning such patients has not been investigated. Objective To compare weaning duration with pressure support versus unassisted breathing through a tracheostomy (trach collar) in patients transferred to a LTACH for weaning from prolonged ventilation. Design, Settings, and Participants Between 2000 and 2010, a randomized study was conducted in tracheotomized patients transferred to a single LTACH for weaning from prolonged ventilation. Of 500 patients who underwent a five-day screening procedure, 316 failed and were randomly assigned to wean with pressure support (n=155) or a trach collar (n=161). Six- and twelve-month survival was also determined. Main outcome measure Primary outcome was weaning duration. Secondary outcome was survival at six and twelve months after enrollment. Results Of 316 patients, four were withdrawn and not included in analysis. Of 152 patients in the pressure-support arm, 68 (44.7%) were weaned; 22 (14.5%) died. Of 160 patients in the trach-collar arm, 85 (53.1%) were weaned; 16 (10.0%) died. Median weaning time was shorter with trach collar than with pressure support: 15 [interquartile range, 8–25] versus 19 [12–31] days, p=0.004. The hazard ratio (HR) for successful weaning rate was higher with trach collar than with pressure support (HR, 1.43; 95% confidence interval [CI], 1.03–1.98, p<0.03) after adjusting for baseline clinical covariates. Trach collar achieved faster weaning than did pressure support among subjects who failed the screening procedure at 12–120 hours (HR, 3.33; 95% CI, 1.44–7.70, p<0.01), whereas weaning time was equivalent with the two methods in patients who failed the screening procedure within 0–12 hours. Mortality was equivalent in the pressure-support and trach-collar arms at six months (55.9% versus 51.3%; 4.7 difference, 95% CI ?6.4 to 15.7%) and twelve months (66.4% versus 60.0%; 6.5 difference, 95% CI ?4.2 to 17.1 %). Conclusion Among patients requiring prolonged mechanical ventilation and treated at a single long-term care facility, unassisted breathing through a tracheostomy, compared with pressure support, resulted in shorter median weaning time, although weaning mode had no effect on survival at 6 and 12 months. PMID:23340588

Jubran, Amal; Grant, Brydon J.B.; Duffner, Lisa A.; Collins, Eileen G.; Lanuza, Dorothy M.; Hoffman, Leslie A.; Tobin, Martin J.

2013-01-01

256

Plasma-Derived Human C1-Esterase Inhibitor Does Not Prevent Mechanical Ventilation-Induced Pulmonary Complement Activation in a Rat Model of Streptococcus pneumoniae Pneumonia.  

PubMed

Mechanical ventilation has the potential to cause lung injury, and the role of complement activation herein is uncertain. We hypothesized that inhibition of the complement cascade by administration of plasma-derived human C1-esterase inhibitor (C1-INH) prevents ventilation-induced pulmonary complement activation, and as such attenuates lung inflammation and lung injury in a rat model of Streptococcus pneumoniae pneumonia. Forty hours after intratracheal challenge with S. pneumoniae causing pneumonia rats were subjected to ventilation with lower tidal volumes and positive end-expiratory pressure (PEEP) or high tidal volumes without PEEP, after an intravenous bolus of C1-INH (200 U/kg) or placebo (saline). After 4 h of ventilation blood, broncho-alveolar lavage fluid and lung tissue were collected. Non-ventilated rats with S. pneumoniae pneumonia served as controls. While ventilation with lower tidal volumes and PEEP slightly amplified pneumonia-induced complement activation in the lungs, ventilation with higher tidal volumes without PEEP augmented local complement activation more strongly. Systemic pre-treatment with C1-INH, however, failed to alter ventilation-induced complement activation with both ventilation strategies. In accordance, lung inflammation and lung injury were not affected by pre-treatment with C1-INH, neither in rats ventilated with lower tidal volumes and PEEP, nor rats ventilated with high tidal volumes without PEEP. Ventilation augments pulmonary complement activation in a rat model of S. pneumoniae pneumonia. Systemic administration of C1-INH, however, does not attenuate ventilation-induced complement activation, lung inflammation, and lung injury. PMID:24760631

de Beer, F M; Aslami, H; Hoeksma, J; van Mierlo, G; Wouters, D; Zeerleder, S; Roelofs, J J T H; Juffermans, N P; Schultz, M J; Lagrand, W K

2014-11-01

257

Endomicroscopic analysis of time- and pressure-dependent area of subpleural alveoli in mechanically ventilated rats.  

PubMed

We investigated the effects of recruitment maneuvers on subpleural alveolar area in healthy rats. 36 mechanically ventilated rats were allocated to either ZEEP-group or PEEP - 5cmH2O - group. The subpleural alveoli were observed using a transthoracal endoscopic imaging technique. Two consecutive low-flow maneuvers up to 30cmH2O peak pressure each were performed, interrupted by 5s plateau phases at four different pressure levels. Alveolar area change at maneuver peak pressures and during the plateau phases was calculated and respiratory system compliance before and after the maneuvers was analyzed. In both groups alveolar area at the second peak of the maneuver did not differ significantly compared to the first peak. During the plateau phases there was a slight increase in alveolar area. After the maneuvers, compliance increased by 30% in ZEEP group and 20% in PEEP group. We conclude that the volume insufflated by the low-flow recruitment maneuver is distributed to deeper but not to subpleural lung regions. PMID:25150503

Runck, Hanna; Schwenninger, David; Haberstroh, Jörg; Guttmann, Josef

2014-11-01

258

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

PubMed Central

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

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

2010-01-01

259

Transfer of carbon monoxide during an inspiratory pause procedure in mechanically ventilated pigs.  

PubMed

We studied the effect of forced inflation at different alveolar volumes (VA) on carbon monoxide diffusing capacity (DLCO) in anaesthetized, paralysed and mechanically ventilated healthy pigs. An inspiratory pause procedure (equivalent of the single-breath technique) consisting of a pause between an inflation and expiration, both at a constant flow rate, was used. The procedure was computer-controlled and could easily be standardized. In five pigs, VA was varied at constant inflation volume by increasing positive end-expiratory pressure (PEEP) from 2 to 10 cmH2O. Inspiratory pause time was varied from 1 to 8 s to verify whether the decay of CO was exponential. In nine pigs, DLCO was estimated at four different VA values by inflating with 15-30 ml kg-1 at 2 cmH2O PEEP. An exponential decay of CO was always obtained. With increasing VA by either an increase in PEEP or inflation volume, DLCO remained constant. Since the diffusing capacity of the pulmonary membrane is expected to increase with increasing VA, the constant DLCO may be attributed to a decrease in capillary blood volume. PMID:8937801

te Nijenhuis, F C; Jansen, J R; Versprille, A

1996-11-01

260

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

PubMed

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

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

2010-10-01

261

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

PubMed Central

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

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

1999-01-01

262

Pulmonary MMP-9 Activity in Mechanically Ventilated Children with RSV Disease  

PubMed Central

Hypothesis RSV infection is a potent stimulus for airway epithelial expression of MMP-9, and MMP-9 activity in vivo is a predictor of disease severity in children with RSV-induced respiratory failure (RSV-RF). Methods Human airway epithelial cells were infected with RSV A2 strain, and analyzed for MMP-9 and tissue inhibitor of metalloproteinases-1 (TIMP-1, a natural inhibitor of MMP-9) release. In addition, endotracheal samples from children with RSV-RF and controls (non-RSV pneumonia and non-lung disease controls) were analyzed for MMP-9, TIMP-1, human neutrophil elastase (HNE) and myeloperoxidase (MPO) activity. Results RSV infection of airway epithelia was sufficient to rapidly induce MMP-9 transcription and protein release. Pulmonary MMP-9 activity peaked at 48 hours in infants with RSV-RF compared to controls. In the RSV group, MMP-9 activity and MMP-9:TIMP-1 ratio imbalance predicted higher oxygen requirement and worse Pediatric Risk of Mortality scores. Highest levels of HNE and MPO were measured in the RSV cohort but unlike MMP-9, these neutrophil markers failed to predict disease severity. Conclusions These results support the hypothesis that RSV is a potent stimulus for MMP-9 expression and release from human airway epithelium, and that MMP-9 is an important biomarker of disease severity in mechanically ventilated children with RSV lung infection. PMID:24311764

Kong, Michele YF; Clancy, JP; Peng, Ning; Li, Yao; Szul, Tomasz; Xu, Xin; Oster, Robert; Sullender, Wayne; Ambalavanan, Namasivayam; Blalock, J. Edwin; Gaggar, Amit

2014-01-01

263

Uneven distribution of ventilation in acute respiratory distress syndrome  

PubMed Central

Introduction The aim of this study was to assess the volume of gas being poorly ventilated or non-ventilated within the lungs of patients treated with mechanical ventilation and suffering from acute respiratory distress syndrome (ARDS). Methods A prospective, descriptive study was performed of 25 sedated and paralysed ARDS patients, mechanically ventilated with a positive end-expiratory pressure (PEEP) of 5 cmH2O in a multidisciplinary intensive care unit of a tertiary university hospital. The volume of poorly ventilated or non-ventilated gas was assumed to correspond to a difference between the ventilated gas volume, determined as the end-expiratory lung volume by rebreathing of sulphur hexafluoride (EELVSF6), and the total gas volume, calculated from computed tomography images in the end-expiratory position (EELVCT). The methods used were validated by similar measurements in 20 healthy subjects in whom no poorly ventilated or non-ventilated gas is expected to be found. Results EELVSF6 was 66% of EELVCT, corresponding to a mean difference of 0.71 litre. EELVSF6 and EELVCT were significantly correlated (r2 = 0.72; P < 0.001). In the healthy subjects, the two methods yielded almost identical results. Conclusion About one-third of the total pulmonary gas volume seems poorly ventilated or non-ventilated in sedated and paralysed ARDS patients when mechanically ventilated with a PEEP of 5 cmH2O. Uneven distribution of ventilation due to airway closure and/or obstruction is likely to be involved. PMID:15774050

Rylander, Christian; Tylen, Ulf; Rossi-Norrlund, Rauni; Herrmann, Peter; Quintel, Michael; Bake, Bjorn

2005-01-01

264

The impact of pre-transplant mechanical ventilation on short- and long-term survival after lung transplantation  

PubMed Central

Lung transplantation in mechanically ventilated (MV) patients has been associated with decreased post-transplant survival. Under the Lung Allocation Score (LAS) system, patients at greatest risk of death on the waiting list, particularly those requiring MV, are prioritized for lung allocation. We evaluated whether pre-transplant MV is associated with poorer post-transplant survival in the LAS era. Using a national registry, we analyzed all adults undergoing lung transplantation in the U.S. from 2005-2010. Propensity scoring identified non-ventilated matched referents for 419 subjects requiring MV at the time of transplantation. Survival was evaluated using Kaplan-Meier methods. Risk of death was estimated by hazard ratios employing time-dependent covariates. We found that pre-transplant MV was associated with decreased overall survival after lung transplantation. In the first six-months post-transplant, ventilated subjects had a two-fold higher risk of death compared to non-ventilated subjects. However, after six-months post-transplant, survival did not differ by MV status. We also found that pre-transplant MV was not associated with decreased survival in non-cystic fibrosis obstructive lung diseases. These results suggest that under the LAS, pre-transplant MV is associated with poorer short-term survival post-transplant. Notably, the increased risk of death appears to be strongest the early post-transplant period and limited to certain pre-transplant diagnoses. PMID:21831157

Singer, JP; Blanc, PD; Hoopes, C; Golden, JA; Koff, JL; Leard, LE; Cheng, S; Chen, H

2014-01-01

265

Effect of dynamic random leaks on the monitoring accuracy of home mechanical ventilators: a bench study  

PubMed Central

Background So far, the accuracy of tidal volume (VT) and leak measures provided by the built-in software of commercial home ventilators has only been tested using bench linear models with fixed calibrated and continuous leaks. The objective was to assess the reliability of the estimation of tidal volume (VT) and unintentional leaks in a single tubing bench model which introduces random dynamic leaks during inspiratory or expiratory phases. Methods The built-in software of four commercial home ventilators and a fifth ventilator-independent ad hoc designed external software tool were tested with two levels of leaks and two different models with excess leaks (inspiration or expiration). The external software analyzed separately the inspiratory and expiratory unintentional leaks. Results In basal condition, all ventilators but one underestimated tidal volume with values ranging between -1.5?±?3.3% to -8.7%?±?3.27%. In the model with excess of inspiratory leaks, VT was overestimated by all four commercial software tools, with values ranging from 18.27?±?7.05% to 35.92?±?17.7%, whereas the ventilator independent-software gave a smaller difference (3.03?±?2.6%). Leaks were underestimated by two applications with values of -11.47?±?6.32 and -5.9?±?0.52 L/min. With expiratory leaks, VT was overestimated by the software of one ventilator and the ventilator-independent software and significantly underestimated by the other three, with deviations ranging from +10.94?±?7.1 to -48?±?23.08%. The four commercial tools tested overestimated unintentional leaks, with values between 2.19?±?0.85 to 3.08?±?0.43 L/min. Conclusions In a bench model, the presence of unintentional random leaks may be a source of error in the measurement of VT and leaks provided by the software of home ventilators. Analyzing leaks during inspiration and expiration separately may reduce this source of error. PMID:24325396

2013-01-01

266

Recruitment bronchoscopy by trans-glottic approach successfully treated lung collapse in an intubated mechanically ventilated patient.  

PubMed

Pulmonary lower lobe atelectasis/collapse is a common problem in patients undergoing mechanical ventilation. It also occurs in non-intubated patients with traumatic brain or spinal cord injuries, morbid obesities and chest wall disorders. Conventional manoeuvres such as chest physiotherapy, bronchodilators and positive-end expiratory pressure (PEEP) administration are frequently used in its management with variable success rates. However, despite the reported success of bronchoscopic recruitment manoeuvres, selective intrabronchial air insufflation during fiberoptic bronchoscopy to re-expand collapsed lungs is an underutilised practice. Here, we report an example of successful selective intrabronchial air insufflation in an intubated patient with bilateral lower lobe collapses after surgery for an incarcerated hernia. To our knowledge, this is the first successful report of recruitment manoeuvre by trans-glottic bronchoscopy in an intubated, mechanically ventilated patient. PMID:23925687

Abtahi, Hamidreza; Gharabaghi, Mehrnaz Asadi; Azimi, Mehdi

2013-01-01

267

System identification and closed-loop control of end-tidal CO2 partial pressure in mechanically ventilated patients  

Microsoft Academic Search

This paper presents a systematic approach to system identification and closed-loop control of end-tidal carbon dioxide partial pressure (PETCO2) in mechanically ventilated patients. An empirical model consisting of a linear dynamic system followed by an affine transform is proposed to derive a low-order and high-fidelity representation that can reproduce the positive and inversely proportional dynamic input-output relationship between PETCO2 and

Jin-Oh Hahn; Guy A. Dumont; J. Mark Ansermino

2011-01-01

268

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

PubMed Central

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 55±17 years, SOFA = 6 ± 3, SAPS3 score = 58 ± 13, PaO2/FIO2 = 223±75). The median time of mechanical ventilation was 1 day (02), and 68% (n=13) of our patients required norepinephrine (maximum concentration = 0.47 µg.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

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

2013-01-01

269

Prognostic factors for complications following pulmonary resection: pre-albumin analysis, time on mechanical ventilation, and other factors  

Microsoft Academic Search

Objective: To determine whether pre-operative nutritional status and post-operative time on mechanical ventilation, as well as others factors, are correlated with post-operative complications (general or pulmonary) in patients undergoing elective thoracic surgery. Methods: A prospective study was conducted, involving 71 patients undergoing elective pulmonary resection. The data collected pre-operatively included gender, age, smoking status, pre-albumin level, lymphocyte count, and body

RENATA CRISTIANE; GENNARI BIANCHI; JULIANA NALIN DE SOUZA; NEUCY FENALTI HÖEHR; IVAN FELIZARDO; CONTRERA TORO

2006-01-01

270

Last 3 months of life in home-ventilated patients: the family perception.  

PubMed

We studied the family's perception of care in patients under home mechanical ventilation during the last 3 months of life. In 11 respiratory units, we submitted a 35-item questionnaire to relatives of 168 deceased patients exploring six domains: symptoms, awareness of disease, family burden, dying, medical and technical problems. Response rate was 98.8%. The majority of patients complained respiratory symptoms and were aware of the severity and prognosis of the disease. Family burden was high especially in relation to money need. During hospitalisation, 74.4% of patients were admitted to the intensive care unit (ICU). 78 patients died at home, 70 patients in a medical ward and 20 in ICU. 27% of patients received resuscitation manoeuvres. Hospitalisations and family economical burden were unrelated to diagnosis and mechanical ventilation. Families of the patients did not report major technical problems on the use of ventilators. In comparison with mechanical invasively ventilated patients, noninvasively ventilated patients were more aware of prognosis, used more respiratory drugs, changed ventilation time more frequently and died less frequently when under mechanical ventilation. We have presented good points and bad points regarding end-of-life care in home mechanically ventilated patients. Noninvasive ventilation use and diagnosis have impact on this burden. PMID:19717483

Vitacca, M; Grassi, M; Barbano, L; Galavotti, G; Sturani, C; Vianello, A; Zanotti, E; Ballerin, L; Potena, A; Scala, R; Peratoner, A; Ceriana, P; Di Buono, L; Clini, E; Ambrosino, N; Hill, N; Nava, S

2010-05-01

271

Ventilator-associated pneumonia in an adult clinical-surgical intensive care unit of a Brazilian university hospital: incidence, risk factors, etiology, and antibiotic resistance.  

PubMed

The objective of this study was to evaluate clinical characteristics, etiology, and resistance to antimicrobial agents, among patients with ventilator-associated pneumonia (VAP). A case study vs. patients control under mechanical ventilation and hospitalized into clinical-surgical adults ICU of HC-UFU was performed from March/2005 to March/2006. Patients under ventilation for over 48 h were included in the study including 84 with diagnosis of VAP, and 191 without VAP (control group). Laboratory diagnosis was carried out through quantitative microbiological evaluation of tracheal aspirate. The identification of pathogens was performed by classical microbiological tests, and the antibiotics sensitivity spectrum was determined through the CLSI technique. VAP incidence rate over 1,000 days of ventilation was 24.59. The mean (+/- SD) duration of mechanical ventilation prior to VAP diagnosis was 23.2 +/- 17.2 days. By multivariate analysis the risk factors predisposing for VAP were: mechanical ventilation time and mechanical ventilation > seven days, tracheostomy and use of > or = three antibiotics. Mortality rate was high (32.1 %) but lower than that of the control group (46.5%). Major pathogens were identified in most of patients (95.2%) and included: Pseudomonas aeruginosa (29%), Staphylococcus aureus (26%), Enterobacter/Klebsiella/Serratia (19%) and Acinetobacter spp. (18%), with expressive frequencies of P. aeruginosa (52%), S. aureus (65.4%) and Enterobacteriaceae (43.7%) resistant to imipenem, oxacillin and 3/4 generation cephalosporins, respectively. In conclusion, our observation showed VAPs caused by multiresistant microorganisms, the prescription of > or = three antibiotics, and mortality with unacceptably high rates. The practice of de-escalation therapy appears to be urgently needed in order to improve the situation. PMID:18553020

Rocha, Laura de Andrade da; Vilela, Carolina Assis Pereira; Cezário, Renata Cristina; Almeida, Alair Benedito; Gontijo Filho, Paulo

2008-02-01

272

Year in review in Critical Care, 2003 and 2004: respirology and critical care  

PubMed Central

We summarize all original research in the field of respirology and critical care published in 2003 and 2004 in Critical Care. Articles were grouped into the following categories to facilitate a rapid overview: pathophysiology, therapeutic approaches, and outcome in acute lung injury and acute respiratory distress syndrome; hypoxic pulmonary arterial hypertension; mechanical ventilation; liberation from mechanical ventilation and tracheostomy; ventilator-associated pneumonia; multidrug-resistant infections; pleural effusion; sedation and analgesia; asthma; and techniques and monitoring. PMID:16277741

Brander, Lukas; Slutsky, Arthur

2005-01-01

273

Music therapy as an adjunctive treatment in the management of stress for patients being weaned from mechanical ventilation.  

PubMed

This project investigated music therapy (MT) in managing anxiety associated with weaning from mechanical ventilation. The use of sedation to treat anxiety during weaning is problematic because side effects (e.g., respiratory depression) are precisely the symptoms that cause the weaning process to be interrupted and consequently prolonged. Study goals were to determine the feasibility of incorporating MT into the weaning process and to evaluate the efficacy of the intervention, based on levels of anxiety, Days to Wean (DTW), and patient/nurse satisfaction. Adult patients received multiple MT sessions per week while undergoing weaning trials from mechanical ventilation. Feasibility was determined by successful enrollment in the study and nurse survey. Efficacy was evaluated through anxiety, as measured by heart rate, respiratory rate, and patient/nurse survey; DTW; and patient/nurse satisfaction. Nurse surveys reported that MT was successfully incorporated into the milieu and 61 subjects were enrolled. Significant differences in heart rate and respiratory rate were found from the beginning to the end of MT sessions (p < .05 and p < .0001, respectively), indicating a more relaxed state. No significant difference in mean DTW was found between study and control subjects. Patient/nurse satisfaction was high. Music therapy can be used successfully to treat anxiety associated with weaning from mechanical ventilation. Limitations and suggestions for further research are discussed. PMID:21275332

Hunter, Bryan C; Oliva, Rosemary; Sahler, Olle Jane Z; Gaisser, D'Arcy; Salipante, Diane M; Arezina, Clare H

2010-01-01

274

Successful weaning from mechanical ventilation in the quadriplegia patient with C2 spinal cord injury undergoing C2-4 spine laminoplasty -A case report-  

PubMed Central

In patients with cervical spine injuries, respiratory function requires careful attention. Voluntary respiratory control is usually possible with lesions below C4 level although paralysis of the abdominal musculature results in a decreased ability to cough and to clear secretions, which may later lead to respiratory insufficiency. Therefore, injuries above C5 usually necessitate long term mechanical ventilation. Even though weaning criteria are not definitive for the quadriplegic patient, M-mode ultrasonography of the diaphragm may be useful in identifying patients at high risk of difficulty weaning. Diaphragmatic dysfunction (vertical excursion < 10 mm or paradoxical movements) results in frequent early and delayed weaning failures. We present our clinical experience with successful weaning by using M-mode ultrasonography and a cough-assist device for secretion clearance after extubation in a quadriplegic patient undergoing C2-4 spine laminoplasty. PMID:23814658

Chang, Jee-Eun; Do, Sang-Hwan; Song, In Ae

2013-01-01

275

30 CFR 57.22201 - Mechanical ventilation (I-A, I-B, I-C, II-A, II-B, III, IV, V-A, and V-B mines).  

...Resources 1 2014-07-01 2014-07-01 false Mechanical ventilation (I-A, I-B, I-C, II-A, II-B, III...in Metal and Nonmetal Mines Ventilation § 57.22201 Mechanical ventilation (I-A, I-B, I-C, II-A, II-B,...

2014-07-01

276

30 CFR 57.22201 - Mechanical ventilation (I-A, I-B, I-C, II-A, II-B, III, IV, V-A, and V-B mines).  

Code of Federal Regulations, 2012 CFR

...Resources 1 2012-07-01 2012-07-01 false Mechanical ventilation (I-A, I-B, I-C, II-A, II-B, III...in Metal and Nonmetal Mines Ventilation § 57.22201 Mechanical ventilation (I-A, I-B, I-C, II-A, II-B,...

2012-07-01

277

30 CFR 57.22201 - Mechanical ventilation (I-A, I-B, I-C, II-A, II-B, III, IV, V-A, and V-B mines).  

Code of Federal Regulations, 2010 CFR

...Resources 1 2010-07-01 2010-07-01 false Mechanical ventilation (I-A, I-B, I-C, II-A, II-B, III...in Metal and Nonmetal Mines Ventilation § 57.22201 Mechanical ventilation (I-A, I-B, I-C, II-A, II-B,...

2010-07-01

278

30 CFR 57.22201 - Mechanical ventilation (I-A, I-B, I-C, II-A, II-B, III, IV, V-A, and V-B mines).  

Code of Federal Regulations, 2011 CFR

...Resources 1 2011-07-01 2011-07-01 false Mechanical ventilation (I-A, I-B, I-C, II-A, II-B, III...in Metal and Nonmetal Mines Ventilation § 57.22201 Mechanical ventilation (I-A, I-B, I-C, II-A, II-B,...

2011-07-01

279

15. NAVFAC Drawing 1,174,312(463AM4)(1970), 'Alterations for Laboratory FacilityHood VentilationMechanical' ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

15. NAVFAC Drawing 1,174,312(463A-M-4)(1970), 'Alterations for Laboratory Facility-Hood Ventilation-Mechanical' - Mare Island Naval Shipyard, Battery Test Office & Storage Facility, California Avenue & E Street, Vallejo, Solano County, CA

280

Effects of pneumoperitoneum created through CO 2 insufflation and parameters of mechanical ventilation (PEEP application) on systemic dissemination of intraabdominal infections  

Microsoft Academic Search

Background To examine whether CO 2 pneumoperitoneum and positive end expiratory pressure (PEEP) in mechanical ventilation affect the systemic spread of intraabdominal infection. Methods Sprague-Dawley male rats weighing 200–300 g were allocated to three groups of 12 animals in each. All rats received mechanical ventilation under general anesthesia. An intraabdominal infection model was established by injecting with 1 ml of Escherichia coli

U. Barbaros; S. Ozarmagan; Y. Erbil; A. Bozbora; N. Cakar; H. Eraksoy; Y. Kapran; B. Kiran

2004-01-01

281

A complete audit cycle to assess adherence to a lung protective ventilation strategy  

PubMed Central

There is clear evidence for the use of a protective ventilation protocol in patients with acute respiratory distress syndrome (ARDS). There is evidence to suggest that protective ventilation is beneficial in patients at risk of ARDS. A protective ventilation strategy was implemented on our intensive care unit in critical care patients who required mechanical ventilation for over 48 h, with and at risk for ARDS. A complete audit cycle was performed over 13 months to assess compliance with a safe ventilation protocol in intensive care. The ARDS network mechanical ventilation protocol was used as the standard for our protective ventilation strategy. This recommends ventilation with a tidal volume (Vt) of 6 ml/kg of ideal body weight (IBW) and plateau airway pressure of ?30 cm H2O. The initial audit failed to meet this standard with Vt's of 9.5 ml/kg of IBW. Following the implementation of a ventilation strategy and an educational program, we demonstrate a significant improvement in practice with Vt's of 6.6 ml/kg of IBW in the re-audit. This highlights the importance of simple interventions and continuous education in maintaining high standards of care.

Joynes, Emma; Dalay, Satinder; Patel, Jaimin M.; Fayek, Samia

2014-01-01

282

Bench-to-bedside review: Ventilator strategies to reduce lung injury – lessons from pediatric and neonatal intensive care  

Microsoft Academic Search

As in the adult with acute lung injury and acute respiratory distress syndrome, the use of lung-protective ventilation has improved outcomes for neonatal lung diseases. Animal models of neonatal respiratory distress syndrome and congenital diaphragmatic hernia have provided evidence that 'gentle ventilation' with low tidal volumes and 'open-lung' strategies of using positive end-expiratory pressure or high-frequency oscillatory ventilation result in

Sally H Vitali; John H Arnold

2005-01-01

283

Challenges of prolonged continuous monitoring of mechanically ventilated pediatric patients using electrical impedance tomography  

E-print Network

of electrode gel, etc. We have recently developed an acquisition system to simultaneously acquire EIT built-in serial port in real time. Such data include volume, pressure and flow curves, as well as alarms on the ventilator data and the temperature sensor inside the EIT system; 2) an algorithm to automatically validate

Adler, Andy

284

Effect of a spacer on pulmonary aerosol deposition from a jet nebuliser during mechanical ventilation  

Microsoft Academic Search

BACKGROUND--Several factors have been identified which improve nebulised aerosol delivery in vitro. One of these is the addition of a spacer to the ventilator circuit which improves aerosol delivery from a jet nebuliser to a model lung by approximately 30%. The current study was designed to demonstrate whether similar improvements could be demonstrated in vivo. METHODS--Ten patients (seven men) were

C J Harvey; M J ODoherty; C J Page; S H Thomas; T O Nunan; D F Treacher

1995-01-01

285

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  

PubMed Central

Introduction Given the high morbidity and mortality attributable to ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients, prevention plays a key role in the management of patients undergoing mechanical ventilation. One of the candidate preventive interventions is the selective decontamination of the digestive or respiratory tract (SDRD) by topical antiseptic or antimicrobial agents. We performed a meta-analysis to investigate the effect of topical digestive or respiratory tract decontamination with antiseptics or antibiotics in the prevention of VAP, of mortality and of all ICU-acquired infections in mechanically ventilated ICU patients. Methods A meta-analysis of randomised controlled trials was performed. The U.S. National Library of Medicine's MEDLINE database, Embase, and Cochrane Library computerized bibliographic databases, and reference lists of selected studies were used. Selection criteria for inclusion were: randomised controlled trials (RCTs); primary studies; examining the reduction of VAP and/or mortality and/or all ICU-acquired infections in ICU patients by prophylactic use of one or more of following topical treatments: 1) oropharyngeal decontamination using antiseptics or antibiotics, 2) gastrointestinal tract decontamination using antibiotics, 3) oropharyngeal plus gastrointestinal tract decontamination using antibiotics and 4) respiratory tract decontamination using antibiotics; reported enough data to estimate the odds ratio (OR) or risk ratio (RR) and their variance; English language; published through June 2010. Results A total of 28 articles met all inclusion criteria and were included in the meta-analysis. The overall estimate of efficacy of topical SDRD in the prevention of VAP was 27% (95% CI of efficacy = 16% to 37%) for antiseptics and 36% (95% CI of efficacy = 18% to 50%) for antibiotics, whereas in none of the meta-analyses conducted on mortality was a significant effect found. The effect of topical SDRD in the prevention of all ICU-acquired infections was statistically significant (efficacy = 29%; 95% CI of efficacy = 14% to 41%) for antibiotics whereas the use of antiseptics did not show a significant beneficial effect. Conclusions Topical SDRD using antiseptics or antimicrobial agents is effective in reducing the frequency of VAP in ICU. Unlike antiseptics, the use of topical antibiotics seems to be effective also in preventing all ICU-acquired infections, while the effectiveness on mortality of these two approaches needs to be investigated in further research. PMID:21702946

2011-01-01

286

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

PubMed Central

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

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

2013-01-01

287

The open lung concept: pressure controlled ventilation is as effective as high frequency oscillatory ventilation in improving gas exchange and lung mechanics in surfactant-deficient animals  

Microsoft Academic Search

Objective: To demonstrate in experimental animals with respiratory insufficiency that under well-defined conditions, commercially available\\u000a ventilators allow settings which are as effective as high frequency oscillatory ventilators (HFOV), with respect to the levels\\u000a of gas exchange, protein infiltration, and lung stability. Design: Prospective, randomized, animal study. Setting: Experimental laboratory of a university. Subjects: 18 adult male Sprague-Dawley rats. Interventions: Lung

G. F. Vazquez de Anda; A. Hartog; S. J. C. Verbrugge; D. Gommers; B. Lachmann

1999-01-01

288

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

PubMed Central

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

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

2013-01-01

289

76 FR 37280 - Rural Health Care Support Mechanism  

Federal Register 2010, 2011, 2012, 2013

...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,...

2011-06-27

290

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

PubMed Central

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 6–12 years) in Sapporo, Japan. From November 2008 through January 2009, parents completed questionnaires regarding their home environment and their children’s 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, 1.03–2.64) and unflued heaters with ventilation (OR = 1.77; 95% CI, 1.09–2.95) or without ventilation (OR = 2.23; 95% CI, 1.31–3.85). 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

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

2014-01-01

291

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

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 medical–surgical ICUs at two different tertiary referral hospitals. We included all

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

2010-01-01

292

Perception of pain and distress in intubated and mechanically ventilated newborn infants by parents and health professionals  

PubMed Central

Background An understanding of perceptions of parents and health caregivers who assist critically ill neonates is necessary to comprehend their actions and demands. Therefore this study aim to analyze the agreement among parents, nurse technicians and pediatricians regarding the presence and intensity of pain and distress in mechanically ventilated and intubated newborn infants. Methods Cross-sectional study comprising 52 infants and 52 trios of adults composed of one parent, one nurse technician, and one pediatrician who all observed the same infant. All infants were intubated and under mechanical ventilation and were not handled during the observations. Each newborn was simultaneously observed by the trio of adults for 1 minute to evaluate the presence of pain and distress. The intensity of pain and distress that the adults believed was felt by the infants was marked in a visual analogical scale. Adults’ agreement about the simultaneous presence of pain and distress in each infant was analyzed by marginal homogeneity and Cochran tests. The agreement about the intensity of pain and distress in each infant was studied by Bland-Altman plot and intraclass correlation coefficient (ICC). Results The assessments of pain and distress were heterogeneous in all three investigated groups of adults as determined by the results of a Bland-Altman plot. The presence of distress was more frequently reported compared with pain (marginal heterogeneity, p?mechanically ventilated newborns, without recognizing the association between them. PMID:24528475

2014-01-01

293

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

PubMed Central

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

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

2014-01-01

294

NanoCluster budesonide formulations enable efficient drug delivery driven by mechanical ventilation.  

PubMed

Agglomerates of budesonide nanoparticles (also known as 'NanoClusters') are fine dry powder aerosols that were hypothesized to enable drug delivery through ventilator circuits. These engineered powders were delivered via a Monodose inhaler or a novel device, entrained through commercial endotracheal tubes, and analyzed by cascade impaction. Inspiration flow rates and other parameters such as inspiration patterns and inspiration volumes were controlled by a ventilator. NanoCluster budesonide (NC-Bud) formulations had a higher efficiency of aerosol delivery compared to micronized budesonide with NC-Bud showing a much higher percent emitted fraction (%EF). Different inspiration patterns (sine, square, and ramp) did not affect the powder performance of NC-Bud when applied through a 5.0 mm endotracheal tube. The aerosolization of NC-Bud also did not change with the inspiration volume (1.5-2.5 L) nor with the inspiration flow rate (20-40 L/min) suggesting fast emptying times for budesonide capsules. The %EF of NC-Bud was higher at 51% relative humidity compared to 82% RH. The novel device and the Monodose showed the same efficiency of drug delivery but the novel device fit directly to a ventilator and endotracheal tubing connections. The new device combined with NanoCluster formulation technology allowed convenient and efficient drug delivery through endotracheal tubes. PMID:24374223

Pornputtapitak, Warangkana; El-Gendy, Nashwa; Mermis, Joel; O'Brien-Ladner, Amy; Berkland, Cory

2014-02-28

295

Aerosol therapy in patients receiving noninvasive positive pressure ventilation.  

PubMed

In selected patients, noninvasive positive pressure ventilation (NIPPV) with a facemask is now commonly employed as the first choice for providing mechanical ventilation in the intensive care unit (ICU). Aerosol therapy for treatment of acute or acute-on-chronic respiratory failure in this setting may be delivered by pressurized metered-dose inhaler (pMDI) with a chamber spacer and facemask or nebulizer and facemask. This article reviews the host of factors influencing aerosol delivery with these devices during NIPPV. These factors include (1) the type of ventilator, (2) mode of ventilation, (3) circuit conditions, (4) type of interface, (5) type of aerosol generator, (6) drug-related factors, (7) breathing parameters, and (8) patient-related factors. Despite the impediments to efficient aerosol delivery because of continuous gas flow, high inspiratory flow rates, air leaks, circuit humidity, and patient-ventilator asynchrony, significant therapeutic effects are achieved after inhaled bronchodilator administration to patients with asthma and chronic obstructive pulmonary disease. Similarly to invasive mechanical ventilation, careful attention to the technique of drug administration is required to optimize therapeutic effects of inhaled therapies during NIPPV. Assessment of the patient's ability to tolerate a facemask, the level of respiratory distress, hemodynamic status, and synchronization of aerosol generation with inspiratory airflow are important factors contributing to the success of aerosol delivery during NIPPV. Further research into novel delivery methods, such as the use of NIPPV with nasal cannulae, could enhance the efficiency, ease of use, and reproducibility of inhalation therapy during noninvasive ventilation. PMID:22191396

Dhand, Rajiv

2012-04-01

296

Four-dimensional visualization of subpleural alveolar dynamics in vivo during uninterrupted mechanical ventilation of living swine  

PubMed Central

Pulmonary alveoli have been studied for many years, yet no unifying hypothesis exists for their dynamic mechanics during respiration due to their miniature size (100-300 ?m dimater in humans) and constant motion, which prevent standard imaging techniques from visualizing four-dimensional dynamics of individual alveoli in vivo. Here we report a new platform to image the first layer of air-filled subpleural alveoli through the use of a lightweight optical frequency domain imaging (OFDI) probe that can be placed upon the pleura to move with the lung over the complete range of respiratory motion. This device enables in-vivo acquisition of four-dimensional microscopic images of alveolar airspaces (alveoli and ducts), within the same field of view, during continuous ventilation without restricting the motion or modifying the structure of the alveoli. Results from an exploratory study including three live swine suggest that subpleural alveolar air spaces are best fit with a uniform expansion (r 2 = 0.98) over a recruitment model (r 2 = 0.72). Simultaneously, however, the percentage change in volume shows heterogeneous alveolar expansion within just a 1 mm x 1 mm field of view. These results signify the importance of four-dimensional imaging tools, such as the device presented here. Quantification of the dynamic response of the lung during ventilation may help create more accurate modeling techniques and move toward a more complete understanding of alveolar mechanics. PMID:24298409

Namati, Eman; Warger, William C.; Unglert, Carolin I.; Eckert, Jocelyn E.; Hostens, Jeroen; Bouma, Brett E.; Tearney, Guillermo J.

2013-01-01

297

Diaphragm pacing with natural orifice transluminal endoscopic surgery: potential for difficult-to-wean intensive care unit patients  

Microsoft Academic Search

Background  Up to 50% of the patients in the intensive care unit (ICU) require mechanical ventilation, with 20% requiring the use of a\\u000a ventilator for more than 7 days. More than 40% of this time is spent weaning the patient from mechanical ventilation. Failure\\u000a to wean from mechanical ventilation can in part be attributable to rapid onset of diaphragm atrophy, barotrauma,

R. Onders; M. F. McGee; J. Marks; A. Chak; R. Schilz; M. J. Rosen; A. Ignagni; A. Faulx; M. J. Elmo; S. Schomisch; J. Ponsky

2007-01-01

298

Effect of mechanical ventilation on intra-abdominal pressure in critically ill patients without other risk factors for abdominal hypertension: an observational multicenter epidemiological study  

PubMed Central

Background Mechanical ventilation (MV) is considered a predisposing factor for increased intra-abdominal pressure (IAP), especially when positive end-expiratory pressure (PEEP) is applied or in the presence of auto-PEEP. So far, no prospective data exists on the effect of MV on IAP. The study aims to look on the effects of MV on IAP in a group of critically ill patients with no other risk factors for intra-abdominal hypertension (IAH). Methods An observational multicenter study was conducted on a total of 100 patients divided into two groups: 50 patients without MV and 50 patients with MV. All patients were admitted to the intensive care units of the Medical and Surgical Research Centre, the Carlos J. Finlay Hospital, the Julio Trigo University Hospital, and the Calixto García Hospital, in Havana, Cuba between July 2000 and December 2004. The IAP was measured twice daily on admission using a standard transurethral technique. IAH was considered if IAP was greater than 12 mmHg. Correlations were made between IAP and body mass index (BMI), diagnostic category, gender, age, and ventilatory parameters. Results The mean IAP in patients on MV was 6.7 ± 4.1 mmHg and significantly higher than in patients without MV (3.6 ± 2.4 mmHg, p < 0.0001). This difference was maintained regardless of gender, age, BMI, and diagnosis. The use of MV and BMI were independent predictors for IAH for the whole population, while male gender, assisted ventilation mode, and the use of PEEP were independent factors associated with IAH in patients on MV. Conclusions In this study, MV was identified as an independent predisposing factor for the development of IAH. Critically ill patients, which are on MV, present with higher IAP values on admission and should be monitored very closely, especially if PEEP is applied, even when they have no other apparent risk factors for IAH. PMID:23281625

2012-01-01

299

Automatic selection of tidal volume, respiratory frequency and minute ventilation in intubated ICU patients as startup procedure for closed-loop controlled ventilation  

Microsoft Academic Search

Objective:  Before a patient can be connected to a mechanical ventilator, the controls of the apparatus need to be set up appropriately.\\u000a Today, this is done by the intensive care professional. With the advent of closed loop controlled mechanical ventilation,\\u000a methods will be needed to select appropriate startup settings automatically. The objective of our study was to test such a\\u000a computerized

Thomas P. Laubscher; Adrian Frutiger; Sergio Fanconi; Hans Jutzi; Josef X. Brunner

1994-01-01

300

Ventilative cooling  

E-print Network

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 ...

Graça, Guilherme Carrilho da, 1972-

1999-01-01

301

Effects of positive end-expiratory pressure on intracranial pressure in mechanically ventilated dogs under hyperbaric oxygenation.  

PubMed

Mechanical ventilation with positive end-expiratory pressure (PEEP) has been advocated as an essential life support for critical patients. However, its side effect, which is demonstrated by an elevation of intracranial pressure (ICP) under normobaric (NBO2) conditions, is potentially detrimental to patients. Hyperbaric oxygen (HBO2) therapy, on the other hand, is frequently applied for the same group of patients, and its efficacy is shown by maintaining a higher PaO2 and a reduced ICP. Our study investigated the effect of HBO2 and NBO2 on ICP with or without PEEP ventilation on healthy dogs by comparing cerebrospinal fluid pressure (CSFP) and concluded that the elevation of PEEP resulted in a significant increase of ICP (CSFP) under both conditions (p < 0.05). HBO2 leads to a lower ICP increase compared to the NBO2 group. Under the same level of PEEP, the joint use of PEEP and HBO2 is safe and highly practical in clinical medicine. PMID:25109079

Sun, Qing; Wu, Di; Yu, Tao; Yang, Ying; Wei, Li; Lv, Fuxiang; Gao, Guangkai

2014-01-01

302

Identifying prioritization criteria to supplement critical care triage protocols for the allocation of ventilators during a pandemic influenza.  

PubMed

The purpose of this study was to identify supplementary criteria to provide direction when the Ontario Health Plan for an Influenza Pandemic (OHPIP) critical care triage protocol is rendered insufficient by its inability to discriminate among patients assessed as urgent, and there are insufficient critical care resources available to treat those in that category. To accomplish this task, a Supplementary Criteria Task Force for Critical Care Triage was struck at the University of Toronto Joint Centre for Bioethics. The task force reviewed publically available protocols and policies on pandemic flu planning, identified 13 potential triage criteria and determined a set of eight key ethical, legal and practical considerations against which it assessed each criterion. An online questionnaire was distributed to clinical, policy and community stakeholders across Canada to obtain feedback on the 13 potential triage criteria toward selecting those that best met the eight considerations. The task force concluded that the balance of arguments favoured only two of the 13 criteria it had identified for consideration: first come, first served and random selection. The two criteria were chosen in part based on a need to balance the clearly utilitarian approach employed in the OHPIP with equity considerations. These criteria serve as a defensible "fail safe" mechanism for any triage protocol. PMID:25191808

Winsor, Shawn; Bensimon, Cécile M; Sibbald, Robert; Anstey, Kyle; Chidwick, Paula; Coughlin, Kevin; Cox, Peter; Fowler, Robert; Godkin, Dianne; Greenberg, Rebecca A; Shaul, Randi Zlotnik

2014-01-01

303

Midline Submental Orotracheal Intubation in Maxillofacial Injuries: A Substitute to Tracheostomy Where Postoperative Mechanical Ventilation is not Required  

PubMed Central

Background: Maxillofacial fractures present unique airway problems to the anaesthesiologist. Nasotracheal intubation is contraindicated due to associated Lefort I, II or III fractures. The requirement for intraoperative maxillomandibular fixation (MMF) to re-establish dental occlusion in such cases precludes orotracheal intubation. Tracheostomy has a high complication rate and in many patients, an alternative to the oral airway is not required beyond the perioperative period. Hernandez1 in 1986 first described “The submental route for endotracheal intubation”. Later some workers faced difficult tube passage, bleeding, and sublingual gland involvement with this approach. They modified this to strict midline submental intubation and there were no operative or postoperative complications in their cases.67&8. Therefore we used mid line approach for submental orotracheal intubation in this study to demonstrate its feasibility and reliability and that it can be used as an excellent substitute to short term tracheostomy. Patients & Methods: We used midline submental intubation in 25 cases selected out of 310 consecutively treated patients with maxillofacial trauma over a 3 year period. After induction orotracheal intubation was done with spiral re-inforced tube. A 1.5-2.0 cm skin incision was made in the submental region in the midline 2.0 cm behind the symphysis and endotracheal tube was taken out through this incision in all the cases. At the end of the surgery the procedure was reversed, the submental wound was stitched; all the patients could be extubated & none of them required post-operative mechanical ventilation. Conclusion: There were no significant operative or postoperative complications. Postoperative submental scarring was acceptable[6]. We conclude that midline submental intubation is a simple and useful technique with low morbidity. It can be chosen in selected cases of maxillofacial trauma and is an excellent substitute to tracheostomy where postoperative mechanical ventilation is not required. PMID:21547178

Agrawal, Malti; Kang, L. S.

2010-01-01

304

Meeting Residential Ventilation Standards Through Dynamic Control of Ventilation Systems  

SciTech Connect

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).

Sherman, Max H.; Walker, Iain S.

2011-04-01

305

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

Microsoft Academic Search

ABSTRACT: 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

Pratik Pandharipande; Arna Banerjee; Stuart McGrane; E Wesley Ely

2010-01-01

306

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

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

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; Baker, Stephen

2014-10-01

307

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

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

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

308

Ventilator-Associated Pneumonia: When to hold the breath?  

PubMed Central

Ventilator-associated pneumonia (VAP) is the most common infection in mechanically ventilated patients, and carries the highest mortality. An early diagnosis and definitive management not only reduces the overall mortality, but also brings down the burden of health care to the patient by reducing the cost, length of Intensive Care Unit (ICU) stay, duration of mechanical ventilation, and so on. Out of the various scoring systems, the Clinical Pulmonary Infection Score (CPIS) calculation for VAP has a good sensitivity (72%) and specificity (85%) and the targeted antibiotic therapy in the appropriate dosage is found to be more beneficial than empirical treatment. Although controversies persist on several issues, preventive strategies like head elevation by 30 degrees, cuff pressure monitoring, avoidance of sedatives and muscle relaxants, and so on, have been found to reduce the occurrence of VAP. PMID:24404453

Choudhuri, Anirban H

2013-01-01

309

Prolonged acute mechanical ventilation and hospital bed utilization in 2020 in the United States: implications for budgets, plant and personnel planning  

Microsoft Academic Search

BACKGROUND: Adult patients on prolonged acute mechanical ventilation (PAMV) comprise 1\\/3 of all adult MV patients, consume 2\\/3 of hospital resources allocated to MV population, and are nearly twice as likely to require a discharge to a skilled nursing facility (SNF). Their numbers are projected to double by year 2020. To aid in planning for this growth, we projected their

Marya D Zilberberg; Andrew F Shorr

2008-01-01

310

Serum Interleukin6 and interleukin-8 are early biomarkers of acute kidney injury and predict prolonged mechanical ventilation in children undergoing cardiac surgery: a case-control study  

Microsoft Academic Search

INTRODUCTION: Acute kidney injury (AKI) is associated with high mortality rates. New biomarkers that can identify subjects with early AKI (before the increase in serum creatinine) are needed to facilitate appropriate treatment. The purpose of this study was to test the role of serum cytokines as biomarkers for AKI and prolonged mechanical ventilation. METHODS: This was a case-control study of

Kathleen D Liu; Christopher Altmann; Gerard Smits; Catherine D Krawczeski; Charles L Edelstein; Prasad Devarajan; Sarah Faubel

2009-01-01

311

Novel method for conscious airway resistance and ventilation estimation in neonatal rodents using plethysmography and a mechanical lung.  

PubMed

In unrestrained whole body plethysmography, tidal volume is commonly determined using the barometric method, which assumes that temperature and humidity changes (the 'barometric component') are solely responsible for breathing-related chamber pressure fluctuations. However, in small animals chamber pressure is also influenced by a 'mechanical component' dependent on airway resistance and airflow. We devised a novel 'mechanical lung' capable of simulating neonatal mouse breathing in the absence of temperature or humidity changes. Using this device, we confirm that the chamber pressure fluctuations produced by breathing of neonatal mice are dominated by the mechanical component, precluding direct quantitative assessment of tidal volume. Recognizing the importance of airway resistance to the chamber pressure signal and the ability of our device to simulate neonatal breathing at different frequencies and tidal volumes, we invented a novel in vivo, non-invasive method for conscious airway resistance and ventilation estimation (CARVE) in neonatal rodents. This technique will allow evaluation of developmental, pathological and pharmaceutical effects on airway resistance. PMID:25017785

Zhang, Boyang; McDonald, Fiona B; Cummings, Kevin J; Frappell, Peter B; Wilson, Richard J A

2014-09-15

312

PEEP-ZEEP technique: cardiorespiratory repercussions in mechanically ventilated patients submitted to a coronary artery bypass graft surgery  

PubMed Central

Background The PEEP-ZEEP technique is previously described as a lung inflation through a positive pressure enhancement at the end of expiration (PEEP), followed by rapid lung deflation with an abrupt reduction in the PEEP to 0 cmH2O (ZEEP), associated to a manual bilateral thoracic compression. Aim To analyze PEEP-ZEEP technique's repercussions on the cardio-respiratory system in immediate postoperative artery graft bypass patients. Methods 15 patients submitted to a coronary artery bypass graft surgery (CABG) were enrolled prospectively, before, 10 minutes and 30 minutes after the technique. Patients were curarized, intubated, and mechanically ventilated. To perform PEEP-ZEEP technique, saline solution was instilled into their orotracheal tube than the patient was reconnected to the ventilator. Afterwards, the PEEP was increased to 15 cmH2O throughout 5 ventilatory cycles and than the PEEP was rapidly reduced to 0 cmH2O along with manual bilateral thoracic compression. At the end of the procedure, tracheal suction was accomplished. Results The inspiratory peak and plateau pressures increased during the procedure (p < 0.001) compared with other pressures during the assessment periods; however, they were within lung safe limits. The expiratory flow before the procedure were 33 ± 7.87 L/min, increasing significantly during the procedure to 60 ± 6.54 L/min (p < 0.001), diminishing to 35 ± 8.17 L/min at 10 minutes and to 36 ± 8.48 L/min at 30 minutes. Hemodynamic and oxygenation variables were not altered. Conclusion The PEEP-ZEEP technique seems to be safe, without alterations on hemodynamic variables, produces elevated expiratory flow and seems to be an alternative technique for the removal of bronchial secretions in patients submitted to a CABG. PMID:21914178

2011-01-01

313

Minimum effective dose of midazolam for sedation of mechanically ventilated neonates  

Microsoft Academic Search

SUMMARY Objective: To determine the minimal effective dose (MED) of intravenous midazolam, required for appropriate sedation in 95% of patients, 1 h after drug administration. Methods: A double-blind dose-finding study using the continual reassessment method, a Bayesian sequential design. Twenty-three new- born infants hospitalized in intensive care unit participated. Inclusion criteria were: (i) post- natal age <28 days, (ii) gestational

J.-M. Treluyer; S. Zohar; E. Rey; P. HubertMD; F. IserinMD; M. Jugie; R. Lenclen; S. Chevret; G. Pons

2005-01-01

314

Mechanical Versus Manual Ventilation via a Face Mask During the Induction of Anesthesia: A Prospective, Randomized, Crossover Study  

Microsoft Academic Search

One approach to make ventilation safer in an unpro- tected airway has been to limit tidal volumes; another one might be to limit peak airway pressure, although it is unknown whether adequate tidal volumes can be de- livered. Accordingly, the purpose of this study was to evaluate the quality of automatic pressure-controlled ventilation versus manual circle system face-mask ven- tilation

Achim von Goedecke; Wolfgang G. Voelckel; Volker Wenzel; Horst G. Wagner-Berger; Karl H. Lindner; Christian Keller

2004-01-01

315

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

PubMed Central

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

2011-01-01

316

Cost per QALY (Quality-Adjusted Life Year) and Lifetime Cost of Prolonged Mechanical Ventilation in Taiwan  

PubMed Central

Introduction Patients who require prolonged mechanical ventilation (PMV) are increasing and producing financial burdens worldwide. This study determines the cost per QALY (quality-adjusted life year), out-of-pocket expenses, and lifetime costs for PMV patients stratified by underlying diseases and cognition levels. Methods A nationwide sample of 50,481 patients with continual mechanical ventilation for more than 21 days was collected during 1997–2007. After stratifying the patients according to specific diagnoses, a latent class analysis (LCA) was performed to categorise PMV patients with multiple co-morbidities into several homogeneous groups. The survival functions were estimated for individual groups using the Kaplan-Meier method and extrapolated to 300 months through a semi-parametric method. The survival functions were adjusted using an EQ-5D utility value derived from a convenience sample of 142 PMV patients to estimate quality-adjusted life expectancies (QALE). Another convenience sample of 165 patients was used to estimate the out-of-pocket expenses. The lifetime expenditures paid by the single-payer National Health Insurance (NHI) system and patients' families were estimated by multiplying average monthly expenditures by the survival probabilities and summing the values over lifetime. Results PMV therapy costs more than 100,000 U.S. dollars (USD) per QALY for all patients with poor cognition. For patients with partial cognition, PMV therapy costs less than 56,000 USD per QALY for those with liver cirrhosis, intracranial or spinal cord injuries, and 57,000–69,000 USD for patients with multiple co-morbidities under age of 65. The average lifetime cost of PMV was usually below 56,000 USD. The out-of-pocket expenses were often more than one-third of the total cost of treatment. Conclusions PMV treatment for patients with poor cognition would cost more than 5 times Taiwan's GDP (gross domestic products), or less cost-effective. The out-of-pocket expenses for PMV provision should also be considered in policy decision. PMID:22970160

Hung, Mei-Chuan; Lu, Hsin-Ming; Chen, Likwang; Lin, Ming-Shian; Chen, Cheng-Ren; Yu, Chong-Jen; Wang, Jung-Der

2012-01-01

317

[High frequency jet ventilation].  

PubMed

High frequency jet ventilation (HFJV) is a new ventilation technique which ensures satisfactory gas exchanges with tidal volumes of about 2 ml . kg-1. A gas mixture under high pressure is "chopped up" by an electrically-controlled solenoid valve and delivered to the patient by an injection system. A specific heater-humidifier is required for optimal humidity and warmth of the gas mixture. HFJV creates a positive end-expiratory pressure effect in the alveoles, and the increase of mean intratracheal pressure observed accurately reflects the increase of mean alveolar pressure. Convection by direct alveolar ventilation plays a determinant role in CO2 clearance under HFJV, the other gas transport mechanisms being accessory. In respiratory failure with shock HFJV is better tolerated haemodynamically than conventional ventilation. The main indications of the new technique are ENT surgery, thoracic and tracheal surgery, lithotripsy, broncho-pleural and oesophago-tracheal fistulae and circulatory shock. PMID:2958820

Rouby, J J; Viars, P

1987-09-26

318

Child Care Subsidy Use and Child Development: Potential Causal Mechanisms  

ERIC Educational Resources Information Center

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…

Hawkinson, Laura E.

2011-01-01

319

Year in review 2011: Critical Care - respirology  

PubMed Central

Management of acute respiratory failure is an important component of intensive care. In this review, we analyze 21 original research articles published last year in Critical Care in the field of respiratory and critical care medicine. The articles are summarized according to the following topic categories: acute respiratory distress syndrome, mechanical ventilation, adjunctive therapies, and pneumonia.

2012-01-01

320

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

SciTech Connect

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.

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

321

RESEARCH Open Access Hydrogen inhalation ameliorates ventilator-induced lung injury  

E-print Network

Introduction: Mechanical ventilation (MV) can provoke oxidative stress and an inflammatory response, and subsequently cause ventilator-induced lung injury (VILI), a major cause of mortality and morbidity of patients in the intensive care unit. Inhaled hydrogen can act as an antioxidant and may be useful as a novel therapeutic gas. We hypothesized that, owing to its antioxidant and anti-inflammatory properties, inhaled hydrogen therapy could ameliorate VILI.

Chien-sheng Huang; Tomohiro Kawamura; Sungsoo Lee; Naobumi Tochigi; Norihisa Shigemura; Bettina M Buchholz; John D Kloke; Timothy R Billiar; Yoshiya Toyoda; Atsunori Nakao

322

Bedside adherence to clinical practice guidelines for enteral nutrition in critically ill patients receiving mechanical ventilation: a prospective, multi-centre, observational study  

PubMed Central

Introduction The primary aim was to measure the amount of nutrients required, prescribed and actually administered in critically ill patients. Secondary aims were to assess adherence to clinical practice guidelines, and investigate factors leading to non-adherence. Methods Observational, multicenter, prospective study, including 203 patients in a total of 19 intensive care units in France. The prescribed calorie supply was compared with the theoretical minimal required calorie intake (25 Kcal/Kg/day) and with the supply actually delivered to the patient to calculate the ratio of calories prescribed/required and the ratio of calories delivered/prescribed. Clinical factors suspected to influence enteral nutrition were analyzed by univariate and multivariate analysis. Results The median ratio of prescribed/required calories per day was 43 [37-54] at day 1 and increased until day 7. From day 4 until the end of the study, the median ratio was > 80%. The median ratio of delivered/prescribed per day was > 80% for all 7 days from the start of enteral nutrition. Among the variables tested (hospital type, use of a local nutrition protocol, sedation, vasoactive drugs, number of interruptions of enteral nutrition and measurement of gastric residual volume), only measurement of residual volume was significant by univariate analysis. This was confirmed by multivariate analysis, where gastric residual volume measurement was the only variable independently associated with the ratio of delivered/prescribed calories (OR = 1.38; 95%CI, 1.12-2.10, p = .024). Conclusions The translation of clinical research and recommendations for enteral nutrition into routine bedside practice in critically ill patients receiving mechanical ventilation was satisfactory, but could probably be improved with a multidisciplinary approach. PMID:20233424

2010-01-01

323

Patient Safety: Reduce the Risk of Ventilator-Associated Pneumonia  

Microsoft Academic Search

ISSUE: Ventilator-associated pneumonia (VAP) is a common complication in the intensive care unit (ICU) in ventilated patients.PROJECT: To reduce the risk of healthcare-acquired, ventilator-associated pneumonia with nursing practice improvements and a comprehensive oral care program. A multidisciplinary team reviewed infection rates and current patient-care practices of ventilated patients in the ICU. Actions were taken and evaluated during a 6-month period.

R. Hall; N. Simpson

2004-01-01

324

Effect of shrinkage and mechanical wear of the adsorbent on the aerodynamic parameters of AU1500 carbon adsorbers for ventilation systems of nuclear power plants  

Microsoft Academic Search

A possible mechanism leading to a substantial increase in the aerodynamic resistance of AU-1500 iodine carbon adsorbers used\\u000a in the ventilation systems of nuclear power plants is examined. It is shown that the relatively small wear (several percent)\\u000a of SKT-3 adsorbent granules with formation of a dust fraction can result in a substantial (ten-fold) increase of the aerodynamic\\u000a resistance of

L. I. Fedorova; P. Ya. Poltinin; L. V. Karnatsevich; M. A. Zhazhmuradov; S. O. Lystsov; V. V. Teslenko; Yu. L. Kovrizhkin

1999-01-01

325

Intensive care unit-acquired weakness: clinical phenotypes and molecular mechanisms.  

PubMed

Intensive care unit-acquired weakness (ICUAW) begins within hours of mechanical ventilation and may not be completely reversible over time. It represents a major functional morbidity of critical illness and is an important patient-centered outcome with clear implications for quality of life and resumption of prior work and lifestyle. There is heterogeneity in functional outcome related to ICUAW across various patient populations after an episode of critical illness. This state-of-the art review argues that this observed heterogeneity may represent a clinical spectrum of disability in which there are recognizable clinical phenotypes for outcome according to age, burden of comorbid illness, and ICU length of stay. It further argues that these functional outcomes are modified by mood, cognition, and caregiver physical and mental health. This proposed construct of clinical phenotypes will be used as a framework for a review of the current literature on the molecular biology of muscle and nerve injury. This translational approach for the development of models pairing clinical phenotypes for different functional outcomes after critical illness with molecular mechanism of injury may offer unique insights into the diagnosis and treatment of muscle and nerve lesions. PMID:23204256

Batt, Jane; dos Santos, Claudia C; Cameron, Jill I; Herridge, Margaret S

2013-02-01

326

Appraising Pulmonary Edema Using Supine Chest Roentgenograms in Ventilated Patients  

Microsoft Academic Search

The role of portable, anteroposterior, supine chest X-rays (CXRs) in distinguishing hydrostatic pulmo- nary edema (HPE) from permeability pulmonary edema (PPE) in mechanically ventilated patients is controversial. We prospectively obtained and evaluated such CXRs in 33 supine, mechanically venti- lated intensive-care-unit patients with pulmonary artery catheters. Three chest radiologists indepen- dently reviewed CXRs without clinical information and recorded the cardiothoracic

JASON W. W. THOMASON; E. WESLEY ELY; CAROLINE CHILES; GILBERT FERRETTI; RITA I. FREIMANIS; EDWARD F. HAPONIK

1998-01-01

327

Mortality and intensive care volume in ventilated patients from 1995 to 2009 in the Australian and New Zealand binational adult  

E-print Network

and New Zealand binational adult patient intensive care database John L. Moran, MBBS, FRACP, FCICM, MD- terval [CI], 0.76­0.92) with respect to a median annual admission volume of 711 patients, as opposed Intensive Care (ANZICS) Adult Patient Database (APD) (21) for the years 1993­2003 for 223,129 patients. We

Solomon, Patty

328

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

PubMed Central

Introduction Several aspects of ventilator-associated tracheobronchitis (VAT)—including diagnostic criteria, overlap with ventilator-associated pneumonia (VAP), and appropriate treatment regimens—remain 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

2014-01-01

329

Family satisfaction with care in the intensive care unit: Results of a multiple center study  

Microsoft Academic Search

Objective: To determine the level of satisfaction of family mem- bers with the care that they and their critically ill relative received. Design: Prospective cohort study. Setting: Six university-affiliated intensive care units across Canada. Methods: We administered a validated questionnaire to family members who made at least one visit to intensive care unit patients who received mechanical ventilation for >48

Daren K. Heyland; Graeme M. Rocker; Peter M. Dodek; Demetrios J. Kutsogiannis; Elsie Konopad; Deborah J. Cook; Sharon Peters; Joan E. Tranmer

2002-01-01

330

Albuterol delivery in a model of mechanical ventilation. Comparison of metered-dose inhaler and nebulizer efficiency.  

PubMed

Using an in vitro model, we compared efficiencies of jet nebulizers and metered-dose inhalers (MDI) with actuator devices to deliver albuterol in various conditions of mechanical ventilation. Factors tested included influence of humidification, MDI actuator device (Aerovent spacer or Marquest 172275 MDI adaptor), and synchronization of MDI to the respiratory cycle. With the nebulizer (AeroTech II) filled with 2.5 mg albuterol sulfate in 3 ml water and run until dry, inhaled mass was 42 +/- 2.6% and mass median aerodynamic diameter (MMAD) was 1.3 microns on a nonhumidified circuit. With the MDI+ Aerovent, the inhaled mass percentage per 90 microgm puff was 15.4 +/- 0.2% with humidification and 25.1 +/- 3.7% without humidification, actuations being synchronized with the beginning of inspiration and separated by a 1-min pause. Failure to synchronize actuations with inspiration or to pause 1 min resulted in significant reductions in inhaled mass (by 35 and 72%, respectively). The Marquest adaptor was less efficient, with an inhaled mass of 7.2 +/- 0.7% under optimal conditions. Metered-dose inhaler actuation during expiration resulted in relatively large particles (MMAD = 2.0 microns). All other MDI actuations led to essentially biphasic distributions, with particles greater than 1 micron following a distribution similar to the nebulizer and the overall MMAD estimated to be 0.22 microns. The AeroTech II delivered a cumulative 1,000 micrograms of drug (2,500 x 0.40) over 40 min. To achieve that amount, the MDI connected to the Aerovent and used in its most efficient sequence would require 45 timed puffs (90 micrograms per puff, 25.1% mean inhaled mass) and take 45 min of an experienced therapist's time.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7551401

Diot, P; Morra, L; Smaldone, G C

1995-10-01

331

Pharmacokinetics of Ciprofloxacin and Its Penetration into Bronchial Secretions of Mechanically Ventilated Patients with Chronic Obstructive Pulmonary Disease?  

PubMed Central

We evaluated the pharmacokinetic profile of ciprofloxacin and its penetration into bronchial secretions of critically ill patients with chronic obstructive pulmonary disease (COPD). Twenty-five mechanically ventilated patients with severe COPD who were suffering from an acute, infectious exacerbation were included in this prospective, open-label study. All subjects received a 1-hour intravenous infusion of 400 mg ciprofloxacin every 8 h. Serial blood and bronchial secretion samples were obtained at steady state, and concentrations were determined using high-performance liquid chromatography. The pharmacodynamic parameters that are associated with the efficacy of fluoroquinolones against Gram-negative pathogens were also calculated. The mean peak (maximum) concentration (Cmax) and trough (minimum) concentration in plasma were 5.37 ± 1.57 and 1 ± 0.53 mg/liter, respectively. Mean values for volume of distribution, clearance, half-life, and area under the curve from 0 to 24 h (AUC0–24) were 169.87 ± 84.11 liters, 26.96 ± 8.86 liters/h, 5.35 ± 2.21 h, and 47.41 ± 17.02 mg · h/liter, respectively. In bronchial secretions, a mean Cmax of 3.08 ± 1.21 mg/liter was achieved in 3.12 ± 1.01 h, and the penetration ratio was 1.16 ± 0.59. The target of AUC0–24/MIC of ?125 was attained in all patients, in the majority of them (76%), and in none at MICs of 0.125, 0.25, and 1 ?g/ml, respectively. Slightly better results were obtained for the ratio Cmax/MIC of ?10. In conclusion, ciprofloxacin demonstrates excellent penetration into bronchial secretions. There is wide interindividual variability in its pharmacokinetic parameters in critically ill COPD patients and inadequate pharmacodynamic exposure against bacteria with MICs of ?0.5 ?g/ml. PMID:21670178

Kontou, Paschalina; Chatzika, Kalliopi; Pitsiou, Georgia; Stanopoulos, Ioannis; Argyropoulou-Pataka, Paraskevi; Kioumis, Ioannis

2011-01-01

332

Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States.  

PubMed

SCT indications and procedures are increasing worldwide. We sought to estimate the prevalence of acute respiratory failure (ARF) of any cause in hospitalized SCT patients, and assess the impact of invasive mechanical ventilation (IMV) on outcomes. We hypothesize that duration of IMV in such patients is an independent predictor of higher mortality. We performed a retrospective analysis of the largest all-payer hospitalization data set in the United States, Nationwide In-patient Sample for years 2004-2010. Of the 101?462 SCT hospitalizations, 6074 (6%) developed ARF and were the final cohort. Type of SCT with ARF included autologous 1987 (32.7%), allogeneic 3467 (57.1%) and cord blood 655 (10.8%). Duration of IMV included <96?h (17.1%) and ?96?h (41.1%). Overall in-hospital mortality (IHM) was 50.6% (3075). Predictors of IHM were IMV <96?h (odds ratio=3.42 (2.44-4.79), P<0.0001) or IMV ?96?h (OR=4.61 (3.17-6.70), P<0.0001). Type of SCT, comorbid burden, gender, hospital-teaching status/bed size or insurance did not influence IHM. IMV ?96?h was associated with higher hospital charges (mean $762?515, 95% estimate 0.3991 (0.3123-0.4859), increase of $304?474, P<0.0001) and higher length of stay (mean 61.5 days, 95% estimate 0.2198 (0.1531-0.2866), increase of 13 days, P<0.0001). In conclusion, ARF in hospitalized SCT patients is not an uncommon occurrence and is associated with 50% mortality. Duration of IMV (?96?h) was an independent predictor of higher mortality rates. Hospital resource utilization was significant. PMID:25111514

Allareddy, V; Roy, A; Rampa, S; Lee, M K; Nalliah, R P; Allareddy, V; Rotta, A T

2014-10-01

333

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

PubMed Central

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 patient’s 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

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

334

Effect of heat and moisture exchangers on the prevention of ventilator-associated pneumonia in critically ill patients  

PubMed Central

Ventilator-associated pneumonia (VAP) remains one of the major causes of infection in the intensive care unit (ICU) and is associated with the length of hospital stay, duration of mechanical ventilation, and use of broad-spectrum antibiotics. We compared the frequency of VAP 10 months prior to (pre-intervention group) and 13 months after (post-intervention group) initiation of the use of a heat and moisture exchanger (HME) filter. This is a study with prospective before-and-after design performed in the ICU in a tertiary university hospital. Three hundred and fourteen patients were admitted to the ICU under mechanical ventilation, 168 of whom were included in group HH (heated humidifier) and 146 in group HME. The frequency of VAP per 1000 ventilator-days was similar for both the HH and HME groups (18.7 vs 17.4, respectively; P = 0.97). Duration of mechanical ventilation (11 vs 12 days, respectively; P = 0.48) and length of ICU stay (11 vs 12 days, respectively; P = 0.39) did not differ between the HH and HME groups. The chance of developing VAP was higher in patients with a longer ICU stay and longer duration of mechanical ventilation. This finding was similar when adjusted for the use of HME. The use of HME in intensive care did not reduce the incidence of VAP, the duration of mechanical ventilation, or the length of stay in the ICU in the study population. PMID:23044627

Auxiliadora-Martins, M.; Menegueti, M.G.; Nicolini, E.A.; Alkmim-Teixeira, G.C.; Bellissimo-Rodrigues, F.; Martins-Filho, O.A.; Basile-Filho, A.

2012-01-01

335

Effect of heat and moisture exchangers on the prevention of ventilator-associated pneumonia in critically ill patients.  

PubMed

Ventilator-associated pneumonia (VAP) remains one of the major causes of infection in the intensive care unit (ICU) and is associated with the length of hospital stay, duration of mechanical ventilation, and use of broad-spectrum antibiotics. We compared the frequency of VAP 10 months prior to (pre-intervention group) and 13 months after (post-intervention group) initiation of the use of a heat and moisture exchanger (HME) filter. This is a study with prospective before-and-after design performed in the ICU in a tertiary university hospital. Three hundred and fourteen patients were admitted to the ICU under mechanical ventilation, 168 of whom were included in group HH (heated humidifier) and 146 in group HME. The frequency of VAP per 1000 ventilator-days was similar for both the HH and HME groups (18.7 vs 17.4, respectively; P = 0.97). Duration of mechanical ventilation (11 vs 12 days, respectively; P = 0.48) and length of ICU stay (11 vs 12 days, respectively; P = 0.39) did not differ between the HH and HME groups. The chance of developing VAP was higher in patients with a longer ICU stay and longer duration of mechanical ventilation. This finding was similar when adjusted for the use of HME. The use of HME in intensive care did not reduce the incidence of VAP, the duration of mechanical ventilation, or the length of stay in the ICU in the study population. PMID:23044627

Auxiliadora-Martins, M; Menegueti, M G; Nicolini, E A; Alkmim-Teixeira, G C; Bellissimo-Rodrigues, F; Martins-Filho, O A; Basile-Filho, A

2012-12-01

336

24 CFR 3280.103 - Light and ventilation.  

...ventilation capacity must be provided by a mechanical system or a combination passive and mechanical system. The ventilation system or provisions...pressure condition in Uo Value Zone 1. Mechanical systems must be balanced....

2014-04-01

337

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

Microsoft Academic Search

(1) Differing models of the ocean circulation support different rates of ventilation, which in turn produce different distributions of radiocarbon, oxygen, and export production. We examine these fields within a suite of general circulation models run to examine the sensitivity of the circulation to the parameterization of subgridscale mixing and surface forcing. We find that different models can explain relatively

Anand Gnanadesikan; John P. Dunne; Robert M. Key; Katsumi Matsumoto; Jorge L. Sarmiento; Richard D. Slater; P. S. Swathi

2004-01-01

338

Predicting clinical physiology: a Markov chain model of heart rate recovery after spontaneous breathing trials in mechanically ventilated patients.  

PubMed

Analysis of heart rate (HR) dynamics before, during, and after a physiologic stress has clinical importance. For example, the celerity of heart rate recovery (HRR) after a cardiac stress test (eg, treadmill exercise test) has been shown to be an independent predictor of all-cause mortality. Heart rate dynamics are modulated, in part, by the autonomic nervous system. These dynamics are commonly abstracted using metrics of heart rate variability (HRV), which are known to be sensitive to the influence of the autonomic nervous system on HR. The patient-specific modulators of HR should be reflected both in the response to stress as well as in the recovery from stress. We therefore hypothesized that the patient-specific HR response to stress could be used to predict the HRR after the stress. We devised a Markov chain model to predict the poststress HRR dynamics using the parameters (transition matrix) calculated from HR data during the stress. The model correctly predicts the exponential shape of poststress HRR. This model features a simple analytical relationship linking poststress HRR time constant (T(off)) with a standard measure of HRV, namely the correlation coefficient of the Poincaré plot (first return map) of the HR recorded during the stress. A corresponding relationship exists between the time constant (T(on)) of R-R interval decrease at the onset of stress and the correlation coefficient of the Poincaré plot of prestress R-R intervals. Consequently, the model can be used for the prediction of poststress HRR using the HRV measured during the stress. This direct relationship between the event-to-event microscopic fluctuations (HRV) during the stress and the macroscopic response (HRR) after the stress terminates can be interpreted as an instance of a fluctuation-dissipation relationship. We have thus applied the fluctuation-dissipation theorem to the analysis of heart rate dynamics. The approach is specific neither to cardiac physiology nor to transitions between mechanical and free ventilation as a specific stress. It may therefore have wider applicability to physiologic systems subject to modest stresses. PMID:19664524

Lu, Yan; Burykin, Anton; Deem, Michael W; Buchman, Timothy G

2009-09-01

339

Using physiological models and decision theory for selecting appropriate ventilator settings  

Microsoft Academic Search

Objective  To present a decision support system for optimising mechanical ventilation in patients residing in the intensive care unit.\\u000a \\u000a \\u000a \\u000a Methods  Mathematical models of oxygen transport, carbon dioxide transport and lung mechanics are combined with penalty functions describing\\u000a clinical preference toward the goals and side-effects of mechanical ventilation in a decision theoretic approach. Penalties\\u000a are quantified for risk of lung barotrauma, acidosis or

S. E. Rees; C. Allerød; D. Murley; Y. Zhao; B. W. Smith; S. Kjærgaard; P. Thorgaard; S. Andreassen

2006-01-01

340

Tracheal extubation under deep sevoflurane anesthesia: A novel strategy for weaning difficulties in intensive care  

PubMed Central

Various criteria for weaning patients from ventilators in intensive care have been widely published. These criteria are increasingly incorporated into guidelines, protocols, and more recently, care pathways. We present a case where a patient’s lungs were ventilated for 4 days with an infective exacerbation of chronic obstructive pulmonary disease (COPD). We successfully weaned off mechanical ventilation and rapidly extubated the patient’s trachea utilizing deep sevoflurane anesthesia. Published weaning indices suggest that this would have been an inappropriate course of action at the time. However, our patient clearly benefited and avoided the need for tracheostomy and prolonged ventilation. PMID:23878449

Sethi, Rajesh; Mahon, Simon V

2013-01-01

341

Effect of Surfactant and Partial Liquid Ventilation Treatment on Gas Exchange and Lung Mechanics in Immature Lambs: Influence of Gestational Age  

PubMed Central

Objectives Surfactant (SF) and partial liquid ventilation (PLV) improve gas exchange and lung mechanics in neonatal RDS. However, variations in the effects of SF and PLV with degree of lung immaturity have not been thoroughly explored. Setting Experimental Neonatal Respiratory Physiology Research Unit, Cruces University Hospital. Design Prospective, randomized study using sealed envelopes. Subjects 36 preterm lambs were exposed (at 125 or 133-days of gestational age) by laparotomy and intubated. Catheters were placed in the jugular vein and carotid artery. Interventions All the lambs were assigned to one of three subgroups given: 20 mL/Kg perfluorocarbon and managed with partial liquid ventilation (PLV), surfactant (Curosurf®, 200 mg/kg) or (3) no pulmonary treatment (Controls) for 3 h. Measurements and Main Results Cardiovascular parameters, blood gases and pulmonary mechanics were measured. In 125-day gestation lambs, SF treatment partially improved gas exchange and lung mechanics, while PLV produced significant rapid improvements in these parameters. In 133-day lambs, treatments with SF or PLV achieved similarly good responses. Neither surfactant nor PLV significantly affected the cardiovascular parameters. Conclusion SF therapy response was more effective in the older gestational age group whereas the effectiveness of PLV therapy was not gestational age dependent. PMID:23418521

Rey-Santano, Carmen; Mielgo, Victoria; Gastiasoro, Elena; Valls-i-Soler, Adolfo; Murgia, Xabier

2013-01-01

342

Preventing Ventilator-Associated Pneumonia: Does the Evidence Support the Practice?  

PubMed Central

Ventilator-associated pneumonia (VAP) represents one of the most common infections in patients requiring endotracheal tubes with mechanical ventilation. It is a major healthcare burden measured by increased hospital costs, greater number of ICU days, longer duration of mechanical ventilation, and higher mortality. However, despite widely accepted recommendations for interventions designed to reduce rates of VAP, there are surprisingly few studies that validate the ability of these interventions to improve patient outcomes, namely fewer intensive care unit (ICU) or hospital days, and mortality. Possible reasons for this absence of convincing data include the inability to correctly diagnose VAP and/or an overly expansive interpretation of what the evidence in the literature supports. As advances in our understanding of VAP improve, and new technologies to reduce VAP become available, studies should directly assess patient outcomes before the health care community broadly requires specific prevention approaches in clinical practice. PMID:22797453

O'Grady, Naomi P.; Murray, Patrick R.; Ames, Nancy

2014-01-01

343

[Non-invasive ventilation].  

PubMed

The advent of non-invasive mechanical ventilation (NIMV) has radically changed the management of acute and chronic respiratory failure. Over the last few years, the number of possible applications of NIMV has progressively increased, both in the hospital and extrahospital setting. NIMV is now used in all hospitals and resident physicians currently receive specific training -nonexistent until a few years ago- in this modality. It falls to all of us to push forward the clinical and scientific advances represented by the development of NIMV, by promoting the events that accompany better knowledge of the physiopathological bases of ventilation and of its continuous applications in daily clinical practice and by perfecting the elements required for the correct application of this technique. The present review aims to provide a broad overview of NIMV, from the most theoretical knowledge (the physiopathology of NIMV) to the most practical skills (recognition of patient-ventilator asynchrony). Through this progression from the complex to the most basic, or from the basics to the most complex, depending on the perspective taken, we aim to provide deeper knowledge of the concepts required to understand the technical functioning of the ventilator, describing its distinct modes and parameters and the abilities that must be developed for the correct indication, use and monitoring of the technique. We provide a final reflection on other forms of respiratory support that can be offered to patients with ventilatory failure. PMID:21316544

Gallardo Romero, Jose Manuel; García, Teresa Gómez; Sancho Chust, José Norberto; González Martínez, Mónica

2010-10-01

344

What are the hemodynamic and respiratory effects of passive limb exercise for mechanically ventilated patients receiving low-dose vasopressor/inotropic support?  

PubMed

Passive limb exercises (PLEs) are used widely in the management of unconscious patients and an early start is recommended. The aim of this study was to determine the effects of PLEs on hemodynamic and respiratory parameters in mechanically ventilated critically ill patients receiving low-dose vasopressor/inotropic support. The charts of 120 mechanically ventilated patients who underwent PLEs were evaluated retrospectively between January 2000 and July 2002. Patients were grouped on the basis of administration of vasopressor/inotropic support. Thirty-eight patients did not get vasopressor/inotropic support (group 1) and 82 patients received low-dose vasopressor/inotropic support (dopamine <10 ?g/kg/min, noradrenaline/adrenaline <0.1; group 2). Central venous pressure, heart rate, mean arterial pressure, and oxygen saturation were recorded before and immediately after PLEs. After PLEs in group 1 patients, central venous pressure and mean arterial pressure values increased significantly, and in group 2 patients, central venous pressure increased significantly (P < .05). No statistically significant difference was observed in the rate of change of hemodynamic or respiratory parameters between the 2 groups after the PLEs (P > .05). This retrospective study confirmed that PLEs result in similar hemodynamic and respiratory changes in critically ill patients who received low-dose vasopressor/inotropic support versus those who do not. PMID:24595252

Genc, Arzu; Koca, Ugur; Gunerli, Ali

2014-01-01

345

Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial.  

PubMed

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

Lorente, L; Lecuona, M; Jiménez, A; Palmero, S; Pastor, E; Lafuente, N; Ramos, M J; Mora, M L; Sierra, A

2012-10-01

346

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

PubMed Central

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 as possible. If inadequate resources are available despite optimal incident management, a process that is evidence-based and as objective as possible should be used to allocate ventilators. The process and decision tools should be codified pre-event by the local and regional healthcare entities, public health agencies, and the community. A proposed decision tool uses predictive scoring systems, disease-specific prognostic factors, response to current mechanical ventilation, duration of current and expected therapies, and underlying disease states to guide decisions about which patients will receive mechanical ventilation. Although research in the specifics of the decision tools remains nascent, critical care physicians are urged to work with their health care facilities, public health agencies, and communities to ensure that a just and clinically sound systematic approach to these situations is in place prior to their occurrence. PMID:17601354

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

2007-01-01

347

Measuring the mechanical properties of the respiratory system in patients  

E-print Network

/equipment manufacturers � Critical Care, Neonatal & Ambulatory Care settings Disposable Impedance Adaptor (DIA) InventorMeasuring the mechanical properties of the respiratory system in patients on mechanical ventilators's lungs. � Only system capable of convenient, ongoing assessment of respiratory mechanical function

Hayden, Nancy J.

348

[High-frequency jet ventilation of the lungs during intensive care of cardiogenic shock and pulmonary edema in patients with myocardial infarction].  

PubMed

High-frequency (HF) jet ventilation through transtracheal catheter has been used for the therapy of acute respiratory failure in 30 patients ith myocardial infarction complicated by pulmonary edema and cardiogenic shock. Gas exchange and central hemodynamics have been assessed, using a Swan-Ganz catheter fixed in the pulmonary artery. HF ventilation led to a decrease of hypoxemia, pulmonary blood shunting and to a moderate increase in the cardiac output. PMID:8185074

Gologorski?, V A; Orlov, Iu M; Zagrebel'ny?, O N; Lapin, A Iu; Bolotov, P A

1993-01-01

349

A pilot study of the effect of mechanical ventilation and heat exchange on house-dust mites and Der p 1 in New Zealand homes.  

PubMed

We have examined the effect of reducing relative humidity (RH), with inbuilt mechanical ventilation and heat-exchange (MVHE) units, on house-dust-mite (HDM) counts and allergen levels, in a pilot study of 10 Wellington dwellings. Recent international prevalence studies in adults and children have confirmed a high prevalence of asthma in New Zealand. Sensitivity to HDM is common among the general population, and HDM is the major allergen associated with asthma. Recent studies of allergen levels have confirmed high concentrations of Der p 1 in the domestic environment. While humidity was significantly reduced in those dwellings fitted with ventilation units, no systematic effect on mites or Der p 1 was observed during the study period. When the reductions in humidity were examined in the context of the time spent below the critical equilibrium humidity (CEH), the intervention led to RH values below the CEH for only 39% of the total of 24-h periods for which measurements were made. Reducing RH by means of MVHE in New Zealand domestic dwellings does not lower humidity sufficiently, or long enough, to have any measurable effect on HDM populations. PMID:9722224

Crane, J; Ellis, I; Siebers, R; Grimmet, D; Lewis, S; Fitzharris, P

1998-08-01

350

Energy saving in buildings by control of ventilation as a function of indoor carbon dioxide concentration  

Microsoft Academic Search

Many mechanically ventilated and air conditioned buildings are over-ventilated since ventilation rates are usually based on a fixed number of people which is often considerably in excess of the average occupancy. Over-ventilation also occurs because no allowance can usually be made for infiltration. If ventilation rates could be modulated so as never to exceed the requirements of the actual number

B. F. Warren

1982-01-01

351

Ventilator-associated pneumonia.  

PubMed

Ventilator-associated pneumonia is a pneumonia that develops initially more than 48 h from the start of tracheal intubation and mechanical ventilation. The route of infection is almost always through the respiratory tract. Intake of contaminants from outside the tracheal tube (silent aspiration) is considered a key route, and suctioning of secretions that have accumulated above the cuff of the endotracheal tubes is effective in preventing infection. The circuit is managed and heated-wire humidifiers and suction are manipulated based on appropriate infection control measures. To diagnose pathogens, efforts should be made to collect specimens from the pneumonia focus. Realistically, however, diagnosis can also be achieved based on the clinical course and from the results of culture of samples from tracheal aspirate. Use of prophylactic antimicrobials is not recommended, but once a diagnosis is made, antimicrobials are administered that combat the causative microorganism. PMID:19857223

2009-11-01

352

Modeling buoyancy-driven airflow in ventilation shafts  

E-print Network

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 ...

Ray, Stephen D. (Stephen Douglas)

2012-01-01

353

46 CFR 169.315 - Ventilation (other than machinery spaces).  

Code of Federal Regulations, 2011 CFR

...manner suitable for the purpose of the space. (b) A means must be provided...vents and ventilators. (c) Living spaces must be ventilated by a mechanical...vessel's design waterline length times its maximum beam. Living...

2011-10-01

354

46 CFR 169.315 - Ventilation (other than machinery spaces).  

Code of Federal Regulations, 2012 CFR

...manner suitable for the purpose of the space. (b) A means must be provided...vents and ventilators. (c) Living spaces must be ventilated by a mechanical...vessel's design waterline length times its maximum beam. Living...

2012-10-01

355

46 CFR 169.315 - Ventilation (other than machinery spaces).  

Code of Federal Regulations, 2013 CFR

...manner suitable for the purpose of the space. (b) A means must be provided...vents and ventilators. (c) Living spaces must be ventilated by a mechanical...vessel's design waterline length times its maximum beam. Living...

2013-10-01

356

46 CFR 169.315 - Ventilation (other than machinery spaces).  

Code of Federal Regulations, 2010 CFR

...manner suitable for the purpose of the space. (b) A means must be provided...vents and ventilators. (c) Living spaces must be ventilated by a mechanical...vessel's design waterline length times its maximum beam. Living...

2010-10-01

357

Study of natural ventilation in buildings with large eddy simulation  

E-print Network

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 ...

Jiang, Yi, 1972-

2002-01-01

358

International randomised controlled trial of patient triggered ventilation in neonatal respiratory distress syndrome  

Microsoft Academic Search

AIMTo compare the effects of patient triggered ventilation (PTV) with conventional ventilation (IMV) in preterm infants ventilated for respiratory distress syndrome (RDS).METHODSNine hundred and twenty four babies from 22 neonatal intensive care units were assessed. They were under 32 weeks of gestation and had been ventilated for respiratory distress syndrome (RDS) for less than 6 hours within 72 hours of

J H Baumer

2000-01-01

359

Meeting Residential Ventilation Standards  

E-print Network

LBNL 4591E Meeting Residential Ventilation Standards Through Dynamic Control of Ventilation Systems Orlando Lawrence Berkeley National Laboratory is an equal opportunity employer. #12;ABSTRACT Existing of whole-house ventilation systems to meet the intent of ventilation standards and demonstrates the dynamic

360

Development of a Residential Integrated Ventilation Controller  

SciTech Connect

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.

Staff Scientist; Walker, Iain; Sherman, Max; Dickerhoff, Darryl

2011-12-01

361

VENTILATION NEEDS DURING CONSTRUCTION  

SciTech Connect

The purpose of this analysis is to determine ventilation needs during construction and development of the subsurface repository and develop systems to satisfy those needs. For this analysis, construction is defined as pre-emplacement excavation and development is excavation that takes place simultaneously with emplacement. The three options presented in the ''Overall Development and Emplacement Ventilation Systems'' analysis (Reference 5.5) for development ventilation will be applied to construction ventilation in this analysis as well as adding new and updated ventilation factors to each option for both construction and development. The objective of this analysis is to develop a preferred ventilation system to support License Application Design. The scope of this analysis includes: (1) Description of ventilation conditions; (2) Ventilation factors (fire hazards, dust control, construction logistics, and monitoring and control systems); (3) Local ventilation alternatives; (4) Global ventilation options; and (5) Evaluation of options.

C.R. Gorrell

1998-07-23

362

Infusion of 2.5 meq/min of lactic acid minimally increases CO2 production compared to an isocaloric glucose infusion in healthy anesthetized, mechanically ventilated pigs  

PubMed Central

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?±?5 kg) were sedated and mechanically ventilated. Estimated caloric needs were 2,300–2,400 Kcal/die (95 to 100 Kcal/h). A sequence of two steps lasting four hours each was performed: 1) Glucose, 97 kcal/h were administered as 50% glucose solution, and 2) Lactic Acid, approximately 48.5 kcal/h were administered as lactic acid and approximately 48.5 kcal/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 50 mmHg, a normal value for our animal model. Results During Lactic Acid steps VCO2 increased less than 5% compared to the Glucose steps (282 vs. 269 ml/min, P?<0.05); blood glucose did not differ between the two groups (respectively 101?±?12 vs. 103?±?8 mg/dl). Arterial lactate was always lower than 3 mmol/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

2013-01-01

363

Positive-Pressure Ventilation Equipment for Mass Casualty Respiratory Failure  

Microsoft Academic Search

In the event of an influenza pandemic, patients with severe acute respiratory failure (ARF) due to in- fluenza will require positive-pressure ventilation (PPV) in order to survive. In countries with widely available critical care services, PPV is delivered almost exclusively through use of full-feature me- chanical ventilators in intensive care units (ICUs) or specialized hospital wards. But the supply of

Lewis Rubinson; Richard D. Branson; Nicki Pesik; Daniel Talmor

2006-01-01

364

Non-invasive ventilation and sleep  

Microsoft Academic Search

In this paper, we review the effects of nocturnal mechanical ventilation on sleep. Indeed, although non-invasive assisted ventilation during sleep has been applied extensively, the exact effects of this treatment on sleep quality have not been thoroughly studied. In patients with severe chronic obstructive pulmonary disease and severe restrictive ventilatory defects, the resulting respiratory failure is aggravated by the specific

Mónica M. González; Veronica F. Parreira; Daniel O. Rodenstein

2002-01-01

365

75 FR 48235 - Rural Health Care Universal Service Support Mechanism  

Federal Register 2010, 2011, 2012, 2013

...therapists, occupational therapists or speech pathologists or audiologists; and (3) the patient needs skilled care on a...Offices of Physical, Occupational and Speech Therapists and Audiologists; Offices of Podiatrists; Offices of All Other...

2010-08-09

366

An intelligent control system for ventilators.  

PubMed

This study reports on a ventilator system that consists of several intelligent modules for controlling ventilator operation. These modules are software programs in two controllers. One controller is a personal computer used for diagnoses, determining settings and checking the effects of settings. The other controller is a single-chip microprocessor in a ventilator that controls the ventilator's settings in accordance with the computer settings. After setting up the system, an artificial lung model simulating a patient's lung is used to test the system. The result of test run indicated that it always responds to a patient's lung condition in a stable manner. Thus, the proposed system with its intelligent modules may assist clinicians in caring for patients and managing ventilator operation. PMID:9832029

Wang, C S; Shaw, D; Jih, K S

1998-10-01

367

Application of fiberoptic bronchscopy in patients with acute exacerbations of chronic obstructive pulmonary disease during sequential weaning of invasive-noninvasive mechanical ventilation  

PubMed Central

BACKGROUND: Early withdrawal of invasive mechanical ventilation (IMV) followed by noninvasive MV (NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with acute respiratory failure (ARF). Using pulmonary infection control window (PIC window) as the switch point for transferring from invasive to noninvasive MV, the time for early extubation can be more accurately judged, and therapy efficacy can be improved. This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy (FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV. METHODS: Since July 2006 to January 2011, 106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization. Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used (group A, n=54) or not (group B, n=52) during sequential weaning from invasive to noninvasive MV. In group A, for sputum suction and bronchoalveolar lavage (BAL), a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube, which was accompanied with uninterrupted use of a ventilator. After achieving PIC window, patients of both groups changed to NIMV mode, and weaned from ventilation. The following listed indices were used to compare between the groups after treatment: 1) the occurrence time of PIC, the duration of MV, the length of ICU stay, the success rate of weaning from MV for the first time, the rate of reventilation and the occurrence rate of ventilator-associated pneumonia (VAP); 2) the convenience and safety of FOB manipulation. The results were compared using Student’s t test and the Chi-square test. RESULTS: The occurrence time of PIC was (5.01±1.49) d, (5.87±1.87) d in groups A and B, respectively (P<0.05); the duration of MV was (6.98±1.84) d, (8.69±2.41) d in groups A and B, respectively (P<0.01); the length of ICU stay was (9.25±1.84) d, (11.10±2.63) d in groups A and B, respectively (P<0.01); the success rate of weaning for the first time was 96.30%, 76.92% in groups A and B, respectively (P<0.01); the rate of reventilation was 5.56%, 19.23% in groups A and B, respectively (P<0.05); and the occurrence rate of VAP was 3.70%, 23.07% in groups A and B, respectively (P<0.01). Moreover, it was easy and safe to manipulate FOB, and no side effect was observed. CONCLUSIONS: The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU. It can decrease the duration of MV and the length of ICU stay, increase the success rate from weaning MV for the first time, reduce the rate of reventilation and the occurrence rate of VAP. In addition, such a method is convenient and safe in patients of this kind.

Song, Rong-rong; Qiu, Yan-ping; Chen, Yong-ju; Ji, Yong

2012-01-01

368

Infiltration in ASHRAE's Residential Ventilation Standards  

SciTech Connect

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.

Sherman, Max

2008-10-01

369

Implementation of a Respiratory Drive Monitor on a Servo Ventilator  

Microsoft Academic Search

Objective. To design and evaluate a clinical monitor of respiratory drive (P0.1) and other respiratory variables in a simple way, using a commercial ventilator. Methods. Nine healthy males were studied as they were breathing spontaneously in a Servo 900C Ventilator, at rest and during light exercise (50 W). The ventilator was slightly modified to improve its mechanical performance during spontaneous

Lars Gösta Hellström; Hans Larsson; Dag Linnarsson

1999-01-01

370

Episodic ventilation lowers the efficiency of pulmonary CO2 excretion.  

PubMed

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 ml·min(-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

Malte, Christian Lind; Malte, Hans; Wang, Tobias

2013-11-01

371

Time to wean after tracheotomy differs among subgroups of critically ill patients: Retrospective analysis in a mixed medical\\/surgical intensive care unit  

Microsoft Academic Search

OBJECTIVE: To determine the time to wean from mechanical ventilation and time spent off the ventilator per day after tracheotomy in critically ill patients in a 28-bed mixed medical and surgical intensive care unit (ICU) in Amsterdam, Netherlands. METHODS: We conducted a retrospective analysis of consecutive patients during the 14-month period from November 1, 2003, through January 1, 2005. Included

Lely van der A. J. W. J; D. P. Veelo; D. A. Dongelmans; J. C. Korevaar; M. B. Vroom; M. J. Schultz

2006-01-01

372

Clinical review: Biphasic positive airway pressure and airway pressure release ventilation  

PubMed Central

This review focuses on mechanical ventilation strategies that allow unsupported spontaneous breathing activity in any phase of the ventilatory cycle. By allowing patients with the acute respiratory distress syndrome to breathe spontaneously, one can expect improvements in gas exchange and systemic blood flow, based on findings from both experimental and clinical trials. In addition, by increasing end-expiratory lung volume, as occurs when using biphasic positive airway pressure or airway pressure release ventilation, recruitment of collapsed or consolidated lung is likely to occur, especially in juxtadiaphragmatic lung legions. Traditional approaches to mechanical ventilatory support of patients with acute respiratory distress syndrome require adaptation of the patient to the mechanical ventilator using heavy sedation and even muscle relaxation. Recent investigations have questioned the utility of sedation, muscle paralysis and mechanical control of ventilation. Furthermore, evidence exists that lowering sedation levels will decrease the duration of mechanical ventilatory support, length of stay in the intensive care unit, and overall costs of hospitalization. Based on currently available data, we suggest considering the use of techniques of mechanical ventilatory support that maintain, rather than suppress, spontaneous ventilatory effort, especially in patients with severe pulmonary dysfunction. PMID:15566621

Putensen, Christian; Wrigge, Hermann

2004-01-01

373

78 FR 54967 - Rural Health Care Support Mechanism  

Federal Register 2010, 2011, 2012, 2013

In this document, the Commission announces that the Office of Management and Budget (OMB) has approved, for a period of three years, the information collection associated with the Commission's Universal Service--Rural Health Care Program, Report and Order (Order). This notice is consistent with the Order, which stated that the Commission would publish a document in the Federal Register announcing......

2013-09-09

374

78 FR 38606 - Rural Health Care Support Mechanism  

Federal Register 2010, 2011, 2012, 2013

In this document, the Commission announces that the Office of Management and Budget (OMB) has approved the non-substantive revisions to the information collection associated with the Commission's Service Provider Identification Number and Contact Form. This announcement is consistent with the Universal Service--Rural Health Care Program, Report and Order (Order), which stated that the Commission......

2013-06-27

375

Retrospective review of the reduction of oral pressure ulcers in mechanically ventilated patients: a change in practice.  

PubMed

Hospital-acquired pressure ulcers (HAPU) are a growing concern in patient care. Mucosal pressure ulcers (PUs) on the lips, mouth, gums, and tongue caused by oral intubation and their securement devices can be difficult to identify and prevent. In an effort to address this problem and reduce mucosal PU, implementation of an alternative securement device, the Hollister ETAD endotracheal (ET) tube securing device, in conjunction with the B&B Medical Universal Bite Block, was introduced at our institution, a level 1 trauma and burn center, in July 2007. The ETAD was later replaced by the Hollister AnchorFast ET tube securing device in December 2007. By April 2009, they became the standard devices and method used to secure oral ET tubes. We hypothesized the use of the new securement devices and bite block would lead to a decrease of HAPUs on the lips, mouth, gums, and tongue of orally intubated critical care patients because these allow for better oral assessment and ET tube manipulation to redistribute pressure. Using data collected from our electronic medical record and our HAPU incidence tracking system, we analyzed the number of PUs on the lips, mouth, gums, and tongue of orally intubated patients in our preintervention (phase 1) group compared with the data from our postintervention (phases 2 and 3) groups. A clinically significant decrease in the reported incidence of HAPUs on the lips, mouth, gums, and tongue was noted in our phases 2 and 3 groups following introduction of the ETAD, AnchorFast, and Universal Bite Block in our institution. PMID:22668998

Zaratkiewicz, Sunniva; Teegardin, Christopher; Whitney, JoAnne D

2012-01-01

376

Role of artificial ventilation of the lungs in mechanisms of development of generalized electrical activity of limbic origin after resuscitation  

Microsoft Academic Search

Considering the generalized character of the activity, its high amplitude, and its connection with parts of the brain influencing homeostasis, many autonomic functions, and electrogenesis of the brain itself, as well as the known dependence of its appearance on the severity of hypoxic brain damage, it was decided to study the conditions and mechanisms of its appearance in the ECoG

Yu. V. Zarzhetskii

1980-01-01

377

Identification of mechanisms enabling integrated care for patients with chronic diseases: a literature review  

PubMed Central

Introduction Notwithstanding care for chronically ill patients requires a shift towards care that is well coordinated and focused on prevention and self-care, the concept of integrated care lacks specificity and clarity. This article presents a literature review to identify mechanisms for achieving integrated care objectives. Theory and methods Existing models often present a large variety of dimensions, archetypes and categories of integration without specifying them. Models and programmes describing integrated care for chronic diseases were reviewed. Data were extracted related to objectives and clusters of mechanisms of integration. Results Thirty-four studies presented four objectives: functional, organisational, professional and service integration. We categorised approaches and interventions to achieve these objectives by strategy and clusters of ‘mechanisms of integration’: degree, patient centredness and normative aspects. Conclusions and discussion The clarification of mechanisms to achieve objectives of integrated care as presented may be used as starting point for the development and refinement of integrated care programmes, including methodological grounding of their evaluation. Given that most studies reviewed lack both empirical data and descriptions of the methods used, future research needs to close these gaps. Validation of the findings by a large panel of experts is suggested as recommendation to work towards a grounded framework. PMID:25114665

van der Klauw, Denise; Molema, Hanneke; Grooten, Liset; Vrijhoef, Hubertus

2014-01-01

378

Single-use lancet and capillary loading mechanism for complete blood count point of care device  

E-print Network

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 ...

Zimmerman, Julia C

2011-01-01

379

Midlevel ventilation's constraint on tropical cyclone intensity  

E-print Network

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 ...

Tang, Brian Hong-An

2010-01-01

380

Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials.  

PubMed

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

Carron, M; Freo, U; BaHammam, A S; Dellweg, D; Guarracino, F; Cosentini, R; Feltracco, P; Vianello, A; Ori, C; Esquinas, A

2013-06-01

381

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 ...

382

Are tidal volume measurements in neonatal pressure-controlled ventilation accurate?  

PubMed

Bedside pulmonary mechanics monitors (PMM) have become useful in ventilatory management in neonates. These monitors are used more frequently due to recent improvements in data-processing capabilities. PMM devices are often part of the ventilator or are separate units. The accuracy and reliability of these systems have not been carefully evaluated. We compared a single ventilatory parameter, tidal volume (V(t)), as measured by several systems. We looked at two freestanding PMMs: the Ventrak Respiratory Monitoring System (Novametrix, Wallingford, CT) and the Bicore CP-100 Neonatal Pulmonary Monitor (Allied Health Care Products, Riverside, CA), and three ventilators with built-in PMM: the VIP Bird Ventilator (Bird Products Corp., Palm Springs, CA), Siemens Servo 300A (Siemens-Elema AB, Solna, Sweden), and Drager Babylog 8000 (Drager, Inc., Chantilly, VA). A calibrated syringe (Hans Rudolph, Inc., Kansas City, MO) was used to deliver tidal volumes of 4, 10, and 20 mL to each ventilator system coupled with a freestanding PMM. After achieving steady state, six consecutive V(t) readings were taken simultaneously from the freestanding PMM and each ventilator. In a second portion of the bench study, we used pressure-control ventilation and measured exhaled tidal volume (V(te)) while ventilating a Bear Test Lung with the same three ventilators. We adjusted peak inspiratory pressure (PIP) under controlled conditions to achieve the three different targeted tidal volumes on the paired freestanding PMM. Again, six V(te) measurements were recorded for each tidal volume. Means and standard deviations were calculated.The percentage difference in measurement of V(t) delivered by calibrated syringe varied greatly, with the greatest discrepancy seen in the smallest tidal volumes, by up to 28%. In pressure control mode, V(te) as measured by the Siemens was significantly overestimated by 20-95%, with the biggest discrepancy at the smallest V(te), particularly when paired with the Bicore PMM. V(te), as measured by the VIP Bird and Drager paired with the Ventrak PMM, had a tendency to underestimate V(t) by up to 25% at the smallest V(te). However, when paired with the Bicore PMM, these same two ventilators read over target by up to 18%. Under controlled laboratory conditions, we demonstrated that true delivered V(te), as measured by the three ventilators and two freestanding PMM, differed markedly. In general, decreasing dynamic compliance of the tubing was not associated with greater inaccuracy in V(te) measurements. PMID:12203848

Chow, Lily C; Vanderhal, Andre; Raber, Jorge; Sola, Augusto

2002-09-01

383

Pandemic Ventilator Rationing and Appeals Processes  

PubMed Central

In a severe influenza pandemic, hospitals will likely experience serious and widespread shortages of patient pulmonary ventilators and of staff qualified to operate them. Deciding who will receive access to mechanical ventilation will often determine who lives and who dies. This prospect raises an important question whether pandemic preparedness plans should include some process by which individuals affected by ventilator rationing would have the opportunity to appeal adverse decisions. However, the issue of appeals processes to ventilator rationing decisions has been largely neglected in state pandemic planning efforts. If we are to devise just and effective plans for coping with a severe influenza pandemic, more attention to the issue of appeals processes for pandemic ventilator rationing decisions is needed. Arguments for and against appeals processes are considered, and some suggestions are offered to help efforts at devising more rational pandemic preparedness plans. PMID:20354793

Patrone, Daniel; Resnik, David

2014-01-01

384

Therapeutic application of helium-oxygen and mechanical ventilation in a child with acute myelogenous leukemia and airway obstruction.  

PubMed

Children with mediastinal masses can have a variety of disparate clinical presentations, including chest pain, superior vena cava syndrome, Horner syndrome, pericardial effusion, and cardiac tamponade. Nonetheless, respiratory symptoms are present in 80% of children at presentation and are the most common presenting symptom. Management of respiratory failure due to mediastinal masses is challenging because intubation-with the accompanying sedation and paralysis-is likely to worsen the respiratory failure. For this reason, any new treatments for this condition are welcome. We report the case of an intubated 2-year-old girl with respiratory failure from a mediastinal mass who was successfully weaned from mechanical ventilatory support through the use of a 70%:30% helium-oxygen admixture (heliox). We then review mediastinal masses and the biophysical rationale for use of heliox in airway narrowing. PMID:19606007

Bigham, Michael T; Nowak, Jeffrey E; Wheeler, Derek S

2009-07-01

385

An intelligent control system architecture for the control of patient-ventilator synchrony  

Microsoft Academic Search

Describes an intelligent control system architecture for the control of patient-ventilator synchrony. The long-term objective of the research is to develop an innovative intelligent system for controlling the process of mechanical ventilatory support for patients undergoing therapy in a hospital intensive care unit (ICU). The initial work focuses on the requirements for a medical-advisory\\/decision-support system. The hierarchical structure of the

Dalton S. Nelson; Thomas C. Jannett

2002-01-01

386

Fatores prognósticos em complicações pós-operatórias de ressecção pulmonar: análise de pré-albumina, tempo de ventilação mecânica e outros* Prognostic factors for complications following pulmonary resection: pre-albumin analysis, time on mechanical ventilation, and other factors  

Microsoft Academic Search

Objective: To determine whether pre-operative nutritional status and post-operative time on mechanical ventilation, as well as others factors, are correlated with post-operative complications (general or pulmonary) in patients undergoing elective thoracic surgery. Methods: A prospective study was conducted, involving 71 patients undergoing elective pulmonary resection. The data collected pre-operatively included gender, age, smoking status, pre-albumin level, lymphocyte count, and body

RENATA CRISTIANE; GENNARI BIANCHI; JULIANA NALIN DE SOUZA

2006-01-01

387

Mechanism-based Classification of Pain for Physical Therapy Management in Palliative care: A Clinical Commentary  

PubMed Central

Pain relief is a major goal for palliative care in India so much that most palliative care interventions necessarily begin first with pain relief. Physical therapists play an important role in palliative care and they are regarded as highly proficient members of a multidisciplinary healthcare team towards management of chronic pain. Pain necessarily involves three different levels of classification–based upon pain symptoms, pain mechanisms and pain syndromes. Mechanism-based treatments are most likely to succeed compared to symptomatic treatments or diagnosis-based treatments. The objective of this clinical commentary is to update the physical therapists working in palliative care, on the mechanism-based classification of pain and its interpretation, with available therapeutic evidence for providing optimal patient care using physical therapy. The paper describes the evolution of mechanism-based classification of pain, the five mechanisms (central sensitization, peripheral neuropathic, nociceptive, sympathetically maintained pain and cognitive-affective) are explained with recent evidence for physical therapy treatments for each of the mechanisms. PMID:21633629

Kumar, Senthil P; Saha, Sourov

2011-01-01

388

Ventilator-induced lung injury in preterm infants  

PubMed Central

In preterm infants, the need for intubation and mechanical ventilation is associated with ventilator-induced lung injuries and subsequent bronchopulmonary dysplasia. The aim of the present review was to improve the understanding of the mechanisms of injury that involve cytokine-mediated inflammation to contribute to the development of new preventive strategies. Relevant articles were retrieved from the PubMed database using the search terms "ventilator-induced lung injury preterm", "continuous positive airway pressure", "preterm", and "bronchopulmonary dysplasia". The resulting data and other relevant information were divided into several topics to ensure a thorough, critical view of ventilation-induced lung injury and its consequences in preterm infants. The role of pro-inflammatory cytokines (particularly interleukins 6 and 8 and tumor necrosis factor alpha) as mediators of lung injury was assessed. Evidence from studies conducted with animals and human newborns is described. This evidence shows that brief periods of mechanical ventilation is sufficient to induce the release of pro-inflammatory cytokines. Other forms of mechanical and non-invasive ventilation were also analyzed as protective alternatives to conventional mechanical ventilation. It was concluded that non-invasive ventilation, intubation followed by early surfactant administration and quick extubation for nasal continuous positive airway pressure, and strategies that regulate tidal volume and avoid volutrauma (such as volume guarantee ventilation) protect against ventilator-induced lung injury in preterm infants. PMID:24553514

Carvalho, Clarissa Gutierrez; Silveira, Rita C; Procianoy, Renato Soibelmann

2013-01-01

389

On The Valuation of Infiltration towards Meeting Residential Ventilation Needs  

SciTech Connect

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.

Sherman, Max H.

2008-09-01

390