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1

Respiratory care year in review 2010: part 2. Invasive mechanical ventilation, noninvasive ventilation, pediatric mechanical ventilation, aerosol therapy.  

PubMed

The purpose of this paper is to review the recent literature related to invasive mechanical ventilation, NIV, pediatric mechanical ventilation, and aerosol therapy. Topics covered related to invasive mechanical ventilation topics include the role of PEEP in providing lung protection during mechanical ventilation, unconventional modes for severe hypoxemia, and strategies to improve patient-ventilator interactions. Topics covered related to NIV include real-life NIV use, NIV and extubation failure, and NIV and pandemics. For pediatric mechanical ventilation, the topics addressed are NIV, invasive respiratory support, and inhaled nitric oxide. Topics covered related to aerosol therapy include short-acting ?-adrenergic agents, long-acting ?-adrenergic agents, long-acting antimuscarinic agents, inhaled corticosteroid therapy, phosphodiesterase type 4 (PDE4) inhibitors, long-acting ?-adrenergic plus inhaled corticosteroid, long-acting antimuscarinic plus inhaled corticosteroid, nebulized hypertonic saline, inhaled mannitol, and inhaled antibiotic therapy. These topics were chosen and reviewed in a manner that is most likely to have interest to the readers of Respiratory Care. PMID:21669105

Macintyre, Neil R; Nava, Stefano; Diblasi, Robert M; Restrepo, Ruben D; Hess, Dean R

2011-05-01

2

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

3

Conventional mechanical ventilation.  

PubMed

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

2010-05-01

4

Mechanical ventilator - infants  

MedlinePLUS

Ventilator - infants; Respirator - infants ... WHY IS A MECHANICAL VENTILATOR USED? A ventilator is used to provide breathing support for ill or immature babies. Sick or premature babies are often ...

5

Mechanical ventilation and clinical practice heterogeneity in intensive care units: a multicenter case-vignette study  

PubMed Central

Background Observational studies on mechanical ventilation (MV) show practice variations across ICUs. We sought to determine, with a case-vignette study, the heterogeneity of processes of care in ICUs focusing on mechanical ventilation procedures, and whether organizational patterns or physician characteristics influence practice variations. Methods We conducted a cross-sectional multicenter study using the case-vignette methodology. Descriptive analyses were calculated for each organizational pattern and respondent characteristics. An Index of Qualitative Variation (IQV, from 0, no heterogeneity, to a maximum of 1) was calculated. Results Forty ICUs from France (N?=?33) and Switzerland (N?=?7) participated; 396 physicians answered our case-vignettes. There was major heterogeneity of management processes related to MV within and across centers (mean IQV per center 0.51, SD 0.09). We observed the lowest variability (mean IQV per question?ventilation of acute respiratory distress syndrome and the use of the semirecumbent position. We observed a high variability (mean IQV per question?>?0.6) for questions related to management of endotracheal tube or suctioning, management of sedation and analgesia, and respect of autonomy. Heterogeneity was independent of respondent characteristics and of the presence of written procedures. There was a correlation between the processes associated with the highest variability (mean IQV per question?>?0.6) and the annual volume of ICU admission (r?=?0.32 (0.01 to 0.58)) and MV (r?=?0.38 (0.07 to 0.63)). Within ICUs there was a large heterogeneity regarding knowledge of a local written procedure. Conclusions Large clinical practice variations were found among ICUs. High volume centers were more likely to have heterogeneous practices. The presence of a local written procedure or respondent characteristics did not influence practice variation. PMID:24484902

2014-01-01

6

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

7

Home mechanical ventilation and specialised health care in the community: Between a rock and a hard place  

PubMed Central

Background Home mechanical ventilation probably represents the most advanced and complicated type of medical treatment provisioned outside a hospital setting. The aim of this study was both to explore the challenges experienced by health care professionals in community health care services when caring for patients dependent on home mechanical ventilation, continual care and highly advanced technology, and their proposed solutions to these challenges. Methods Using qualitative research methods, a grounded theory influenced approach was used to explore the respondents' experiences and proposed solutions. A total of 34 multidisciplinary respondents from five different communities in Norway were recruited for five focus groups. Results The core category in our findings was what health care professionals in community health care services experience as "between a rock and a hard place," when working with hospitals, family members, and patients. We further identified four subcategories, "to be a guest in the patient's home," "to be accepted or not," "who decides," and "how much can we take." The main background for these challenges seems to stem from patients living and receiving care in their private homes, which often leads to conflicts with family members. These challenges can have a negative effect on both the community health caregivers' work environment and the community health service's provision of professional care. Conclusions This study has identified that care of individuals with complex needs and dependent on home mechanical ventilation presents a wide range of immense challenges for community health care services. The results of this study point towards a need to define the roles of family caregivers and health care professionals and also to find solutions to improve their collaboration. The need to improve the work environment for caregivers directly involved in home-care also exists. The study also shows the need for more dialogue concerning eligibility requirements, rights, and limitations of patients in the provision and use of ventilatory support in private homes. PMID:21605365

2011-01-01

8

Inpatient Health Care Utilization for Children Dependent on Long-term Mechanical Ventilation  

PubMed Central

OBJECTIVE: The objective was to describe the characteristics of pediatric discharges associated with long-term mechanical ventilation (LTMV) compared with those with complex chronic conditions (CCCs), and evaluate trends over time in health care utilization for the discharges associated with LTMV. METHODS: The Kids' Inpatient Database, compiled by the Agency for Healthcare Research and Quality, was used. Routine newborn care was excluded. Discharges associated with LTMV were identified by using the International Classification of Diseases, Ninth Revision, code v46.1x and compared with discharges associated with CCCs in 2006 using simple regression and ?2 analyses. Trends in LTMV-associated discharges from 2000 to 2006 were assessed using variance-weighted least squares regression. RESULTS: In 2006, there were an estimated 7812 discharges associated with LTMV. Compared with discharges for children with CCCs, LTMV discharges had significantly higher mortality, longer lengths of stay, higher mean charges, more emergency department admissions, and more discharges to long-term care. From 2000 to 2006, there was a 55% increase in the number of LTMV discharges and a concurrent 70% increase in aggregate hospital charges. The majority of LTMV discharges occurred in children 4 years old and younger, and ?50% of the aggregate charges were for children younger than 1 year. CONCLUSIONS: Discharges for children associated with LTMV require substantively greater inpatient resource use than other children with CCCs. As the number of discharges and associated aggregate charges increase over time, additional research must examine patterns of care for specific clinical subgroups of LTMV, especially children aged 4 years and younger. PMID:21576303

Gebremariam, Achamyeleh; Clark, Sarah J.; Shanley, Thomas P.; Davis, Matthew M.

2011-01-01

9

Clinical review: Liberation from mechanical ventilation  

PubMed Central

Mechanical ventilation is the defining event of intensive care unit (ICU) management. Although it is a life saving intervention in patients with acute respiratory failure and other disease entities, a major goal of critical care clinicians should be to liberate patients from mechanical ventilation as early as possible to avoid the multitude of complications and risks associated with prolonged unnecessary mechanical ventilation, including ventilator induced lung injury, ventilator associated pneumonia, increased length of ICU and hospital stay, and increased cost of care delivery. This review highlights the recent developments in assessing and testing for readiness of liberation from mechanical ventilation, the etiology of weaning failure, the value of weaning protocols, and a simple practical approach for liberation from mechanical ventilation. PMID:18710593

El-Khatib, Mohamad F; Bou-Khalil, Pierre

2008-01-01

10

Tracheostomy in mechanical ventilation.  

PubMed

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

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

2014-08-01

11

A randomised, controlled trial of conventional versus automated weaning from mechanical ventilation using SmartCare™\\/PS  

Microsoft Academic Search

Objective  Preliminary assessment of an automated weaning system (SmartCare™\\/PS) compared to usual management of weaning from mechanical\\u000a ventilation performed in the absence of formal protocols.\\u000a \\u000a \\u000a \\u000a Design and setting  A randomised, controlled pilot study in one Australian intensive care unit.\\u000a \\u000a \\u000a \\u000a Patients  A total of 102 patients were equally divided between SmartCare\\/PS and Control.\\u000a \\u000a \\u000a \\u000a Interventions  The automated system titrated pressure support, conducted a spontaneous breathing trial

Louise Rose; Jeffrey J. Presneill; Linda Johnston; John F. Cade

2008-01-01

12

Nurse and patient interaction behaviors' effects on nursing care quality for mechanically ventilated older adults in the ICU.  

PubMed

The study purposes were to (a) describe interaction behaviors and factors that may effect communication and (b) explore associations between interaction behaviors and nursing care quality indicators among 38 mechanically ventilated patients (age ?60 years) and their intensive care unit nurses (n = 24). Behaviors were measured by rating videorecorded observations from the Study of Patient-Nurse Effectiveness with Communication Strategies (SPEACS). Characteristics and quality indicators were obtained from the SPEACS dataset and medical chart abstraction. All positive behaviors occurred at least once. Significant (p < 0.05) associations were observed between (a) positive nurse and positive patient behaviors, (b) patient unaided augmentative and alternative communication (AAC) strategies and positive nurse behaviors, (c) individual patient unaided AAC strategies and individual nurse positive behaviors, (d) positive nurse behaviors and pain management, and (e) positive patient behaviors and sedation level. Findings provide evidence that nurse and patient behaviors effect communication and may be associated with nursing care quality. PMID:24496114

Nilsen, Marci L; Sereika, Susan M; Hoffman, Leslie A; Barnato, Amber; Donovan, Heidi; Happ, Mary Beth

2014-01-01

13

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

PubMed Central

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

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

2015-01-01

14

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

15

Volume Assessment in Mechanically Ventilated Critical Care Patients Using Bioimpedance Vectorial Analysis, Brain Natriuretic Peptide, and Central Venous Pressure  

PubMed Central

Purpose. Strategies for volume assessment of critically ill patients are limited, yet early goal-directed therapy improves outcomes. Central venous pressure (CVP), Bioimpedance Vectorial Analysis (BIVA), and brain natriuretic peptide (BNP) are potentially useful tools. We studied the utility of these measures, alone and in combination, to predict changing oxygenation. Methods. Thirty-four mechanically ventilated patients, 26 of whom had data beyond the first study day, were studied. Relationships were assessed between CVP, BIVA, BNP, and oxygenation index (O2I) in a cross-sectional (baseline) and longitudinal fashion using both univariate and multivariable modeling. Results. At baseline, CVP and O2I were positively correlated (R = 0.39; P = .021), while CVP and BIVA were weakly correlated (R = ?0.38; P = .025). The association between slopes of variables over time was negligible, with the exception of BNP, whose slope was correlated with O2I (R = 0.40; P = .044). Comparing tertiles of CVP, BIVA, and BNP slopes with the slope of O2I revealed only modest agreement between BNP and O2I (kappa = 0.25; P = .067). In a regression model, only BNP was significantly associated with O2I; however, this was strengthened by including CVP in the model. Conclusions. BNP seems to be a valuable noninvasive measure of volume status in critical care and should be assessed in a prospective manner. PMID:21151535

House, Andrew A.; Haapio, Mikko; Lentini, Paolo; Bobek, Ilona; de Cal, Massimo; Cruz, Dinna N.; Virzì, Grazia M.; Carraro, Rizzieri; Gallo, Giampiero; Piccinni, Pasquale; Ronco, Claudio

2011-01-01

16

Biomarker circadian rhythm profiles in critically ill mechanically ventilated patients  

Microsoft Academic Search

Objective: To explore the natural trajectory of core body temperature (CBT) and cortisol (CORT) circadian rhythms in mechanically ventilated intensive care unit (MV ICU) patients. ^ Design: Prospective, observational, time-series pilot study. ^ Setting: Medical-surgical and pulmonary ICUs in a tertiary care hospital. ^ Sample: Nine (F = 3, M = 6) adults who were mechanically ventilated within 12 hrs

Mary Anne Vincent

2011-01-01

17

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

18

The impact of ventilator-associated pneumonia on the Canadian health care systemB  

Microsoft Academic Search

Introduction: Ventilator-associated pneumonia (VAP) is a cause of morbidity and mortality in critically ill patients. It is associated with increased health care costs and duration of mechanical ventilation. Using published data and information from public health care providers, we sought to determine the impact of VAP on the Canadian health care system. Methods: Ventilator-associated pneumonia incidence, attributable mortality, and intensive

John G. Muscedere; Claudio M. Martin; Daren K. Heyland

19

Pitfalls of mechanical ventilation in Thailand.  

PubMed

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

Bunburaphong, Thananchai

2014-01-01

20

Basics of mechanical ventilation for dogs and cats.  

PubMed

Respiratory failure may occur due to hypoventilation or hypoxemia. Regardless of the cause, emergent anesthesia and intubation, accompanied by positive pressure ventilation, may be necessary and life saving. Long-term mechanical ventilation requires some specialized equipment and knowledge; however, short-term ventilation can be accomplished without the use of an intensive care unit ventilator, and can provide oxygen supplementation and carbon dioxide removal in critical patients. PMID:23747268

Hopper, Kate; Powell, Lisa L

2013-07-01

21

Duodenogastroesophageal reflux and esophageal mucosal injury in mechanically ventilated patients  

Microsoft Academic Search

Background & Aims: Esophagitis has been reported to be the most frequent cause of upper gastrointestinal bleeding in intensive care patients. The mechanisms causing esophagitis are unclear. The aim of this study was to measure esophageal acid and bile reflux and to examine the relationship between reflux and mucosal injury in mechanically ventilated patients. Methods: Twenty-five critically ill, mechanically ventilated

Alexander Wilmer; Jan Tack; Eric Frans; Hilde Dits; Steven Vanderschueren; Anemie Gevers; Hesmann Bobbaers

1999-01-01

22

[Monitoring of patients receiving mechanical ventilation].  

PubMed

Patients undergoing mechanical ventilation are usually treated in the intensive care unit. Monitoring of these patients is challenging for all members of the medical staff. Understanding the aetiology of respiratory failure as well as the pathophysiological principles is essential for appropriate monitoring and treatment. Besides observation of clinical signs, different monitoring methods have become available including invasive and non-invasive diagnostic tools. Furthermore, knowledge about oxygen supply and oxygen consumption as well as respiratory muscle capacities and workload is important. The current article presents an overview of these issues and evaluates different diagnostic tools to monitor ventilator-dependent patients. PMID:25006972

Storre, J H; Dellweg, D

2014-08-01

23

Not-So-Trivial Pursuit: Mechanical Ventilation Risk Reduction  

PubMed Central

As many as half of critically ill patients require mechanical ventilation. In this article, a program of research focused on reduction of risk associated with mechanical ventilation is reviewed. Airway management practices can have profound effects on outcomes in these patients. How patients are suctioned, types of processes used, effects of suctioning in patients with lung injury, and open versus closed suctioning systems all have been examined to determine best practices. Pneumonia is a common complication of mechanical ventilation (ventilator-associated pneumonia), and use of higher backrest elevations reduces risk of pneumonia, although compliance with such recommendations varies. The studies reviewed here describe backrest elevation practices, factors that affect backrest elevation, and the effect of backrest elevation on ventilator-associated pneumonia. Oral care strategies also have been investigated to determine their effect on ventilator-associated pneumonia. Oral care practices are reported to hold a low care priority, vary widely across care providers, and differ in intubated versus nonintubated patients. However, in several studies, oral applications of chlorhexidine have reduced the occurrence of ventilator-associated pneumonia. Although ventilator patients require sedation, sedation is associated with significant risks. The overall goals of sedation are to provide physiological stability, to maintain ventilator synchrony, and to ensure patients' comfort–although methods to evaluate achievement of these goals are limited. Reducing risks associated with mechanical ventilation in critically ill patients is a complex and interdisciplinary process. Our understanding of the risks associated with mechanical ventilation is constantly changing, but care of these patients must be based on the best evidence. PMID:19556408

Grap, Mary Jo

2013-01-01

24

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

25

Humidification during Mechanical Ventilation in the Adult Patient  

PubMed Central

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

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

2014-01-01

26

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

PubMed Central

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

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

2013-01-01

27

Early mobilization of LVAD recipients who require prolonged mechanical ventilation.  

PubMed

Early mobilization and aggressive physical therapy are essential in patients who receive left ventricular assist devices (LVADs) due to long-term, end-stage heart failure. Some of these patients remain ventilator dependent for quite some time after device implantation. We report our regimen of mobilization with the aid of a portable ventilator, in patients with cardiac cachexia and LVAD implantation. Further, we describe the specific physical therapy interventions used in an LVAD patient who required prolonged mechanical ventilation after device implantation. The patient was critically ill for 5 weeks before the surgery and was ventilator dependent for 48 days postoperatively. There were significant functional gains during the period of prolonged mechanical ventilation. The patient was able to walk up to 600 feet by the time he was weaned from the ventilator and transferred out of the intensive care unit. He underwent successful heart transplantation 6 weeks after being weaned from the ventilator We believe that improving the mobility of LVAD patients who require mechanical ventilation has the potential both to facilitate ventilator weaning and to improve the outcomes of transplantation. PMID:16878612

Perme, Christiane S; Southard, Robert E; Joyce, David L; Noon, George P; Loebe, Matthias

2006-01-01

28

A taxonomy for mechanical ventilation: 10 fundamental maxims.  

PubMed

The American Association for Respiratory Care has declared a benchmark for competency in mechanical ventilation that includes the ability to "apply to practice all ventilation modes currently available on all invasive and noninvasive mechanical ventilators." This level of competency presupposes the ability to identify, classify, compare, and contrast all modes of ventilation. Unfortunately, current educational paradigms do not supply the tools to achieve such goals. To fill this gap, we expand and refine a previously described taxonomy for classifying modes of ventilation and explain how it can be understood in terms of 10 fundamental constructs of ventilator technology: (1) defining a breath, (2) defining an assisted breath, (3) specifying the means of assisting breaths based on control variables specified by the equation of motion, (4) classifying breaths in terms of how inspiration is started and stopped, (5) identifying ventilator-initiated versus patient-initiated start and stop events, (6) defining spontaneous and mandatory breaths, (7) defining breath sequences (8), combining control variables and breath sequences into ventilatory patterns, (9) describing targeting schemes, and (10) constructing a formal taxonomy for modes of ventilation composed of control variable, breath sequence, and targeting schemes. Having established the theoretical basis of the taxonomy, we demonstrate a step-by-step procedure to classify any mode on any mechanical ventilator. PMID:25118309

Chatburn, Robert L; El-Khatib, Mohamad; Mireles-Cabodevila, Eduardo

2014-11-01

29

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

PubMed

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

Thomas, P J

2015-01-01

30

46 CFR 154.1200 - Mechanical ventilation system: General.  

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

2014-10-01

31

46 CFR 154.1200 - Mechanical ventilation system: General.  

Code of Federal Regulations, 2012 CFR

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

2012-10-01

32

46 CFR 154.1200 - Mechanical ventilation system: General.  

Code of Federal Regulations, 2013 CFR

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

2013-10-01

33

An evidence-based oral care protocol to decrease ventilator-associated pneumonia.  

PubMed

The purpose of this study was to examine the impact of 0.12% chlorhexidine rinses and an oral care protocol on ventilator-associated pneumonia rates. A quasi-experimental preintervention-postintervention design was used. The sample included all patients admitted to critical care and on mechanical ventilation at any time during the study period. Data were collected 6 months before and 12 months after intervention. Ventilator-associated pneumonia rates were reduced from 4.3 to 1.86 per 1000 ventilator-days during the study period, with an estimated cost avoidance of $700,000 to $798,000. PMID:22874549

Cuccio, Lisa; Cerullo, Ellen; Paradis, Heidi; Padula, Cynthia; Rivet, Cindy; Steeves, Susan; Lynch, Judy

2012-01-01

34

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

35

Reproducibility of regional lung ventilation distribution determined by electrical impedance tomography during mechanical ventilation  

Microsoft Academic Search

Electrical impedance tomography (EIT) has the potential to become a new tool for bedside monitoring of regional lung ventilation. The aim of our study was to assess the reproducibility of regional lung ventilation distribution determined by EIT during mechanical ventilation under identical ventilator settings. The experiments were performed on 10 anaesthetized supine pigs ventilated in a volume-controlled mode. EIT measurements

I Frerichs; G Schmitz; S Pulletz; G Zick; J Scholz; N Weiler

2007-01-01

36

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

Code of Federal Regulations, 2013 CFR

...2013-10-01 false Respiratory care for ventilator-dependent individuals. 440.185... § 440.185 Respiratory care for ventilator-dependent individuals. (a) “Respiratory care for ventilator-dependent individuals”...

2013-10-01

37

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

Code of Federal Regulations, 2012 CFR

...2012-10-01 false Respiratory care for ventilator-dependent individuals. 440.185... § 440.185 Respiratory care for ventilator-dependent individuals. (a) “Respiratory care for ventilator-dependent individuals”...

2012-10-01

38

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

Code of Federal Regulations, 2011 CFR

...2011-10-01 false Respiratory care for ventilator-dependent individuals. 440.185... § 440.185 Respiratory care for ventilator-dependent individuals. (a) “Respiratory care for ventilator-dependent individuals”...

2011-10-01

39

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

40

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:25410835

2014-01-01

41

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:25028944

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

2014-01-01

42

Benchmarking mechanical ventilation services in teaching hospitals.  

PubMed

The purpose of this investigation was to examine the technical efficiency of mechanical ventilation nonsurgery (DRG 475) among University Hospital Consortium (UHC) hospitals that consists of volunteer, teaching hospitals across the nation. The data for this study was retrieved from the 1997 UHC database that includes charge and discharge information for 69 hospitals. Data on 7961 patients classified with mechanical ventilation were aggregated to the hospital level. We retained data from a total of 62 hospitals, the other seven hospitals had missing data. The research questions were (1) Do UHC hospitals differ significantly in their efficiencies in the treatment of mechanically ventilated patients? (2) What inputs and outputs contribute most to the inefficiencies associated with mechanical ventilation? Of the 62 hospitals analyzed using data envelopment analysis technique, 10 were considered efficient and 52 were inefficient as compared to their benchmark peers. Efficient and inefficient hospitals did significantly differ between the transferred output variable and between the respiratory, laboratory, and radiology input variables. All inputs demonstrated excessive resource utilization among inefficient hospitals as compared to efficient hospitals. A total reduction of about $19 million dollars in ancillary services would need to occur for inefficient hospitals to approach the frontier of efficient hospitals. This study demonstrates that mechanical ventilation is costly, yet the specified ancillary services are capable of being reduced yielding technical efficiency as demonstrated by 10 efficient hospitals. PMID:12018609

O'Neal, Pamela V; Ozcan, Yasar A; Ma, Yanqiang

2002-06-01

43

THE EFFECT OF A COMPREHENSIVE ORAL CARE PROTOCOL ON PATIENTS AT RISK FOR VENTILATOR-ASSOCIATED PNEUMONIA  

Microsoft Academic Search

Mechanically ventilated patients are at the highest risk for the second most common nosocomial infection, pneumonia. This retrospective study evaluates the impact of a compre- hensive oral care protocol on the ventilator-associated pneumonia (VAP) rate in adult ICU patients. The oral care procedure addresses three recognized VAP risk factors: (1) oropharyngeal colonization, (2) oral secretions that can migrate to the

Bonnie Schleder; Kathleen Stott; Robert C Lloyd

44

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

Microsoft Academic Search

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

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

2009-01-01

45

Air Distribution Effectiveness for Different Mechanical Ventilation  

E-print Network

LBNL-62700 Air Distribution Effectiveness for Different Mechanical Ventilation Systems Max H Orlando Lawrence Berkeley National Laboratory is an equal opportunity employer. #12;1 Air Distribution depending on the effectiveness of their air distribution systems and the location of sources and occupants

46

THE MECHANICS OF LUNG TISSUE UNDER HIGH-FREQUENCY VENTILATION  

E-print Network

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

47

THE MECHANICS OF LUNG TISSUE UNDER HIGH-FREQUENCY VENTILATION  

E-print Network

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

Lewis, Mark

48

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

49

Louisiana's Ventilator Assisted Care Program: Case Management Services to Link Tertiary with Community-Based Care.  

ERIC Educational Resources Information Center

The Ventilator Assisted Care Program provides centralized case management services to ventilator-using youths and their families in Louisiana. Case managers develop individualized, comprehensive plans to be implemented locally using community resources; plans are based on needs identified by tertiary care providers and family members and are…

Kirkhart, Kathryn A.; And Others

1988-01-01

50

Mechanical ventilation during long-range air transport.  

PubMed

Mechanical ventilation during long-range aeromedical transport presents significant challenges. Patient, crew member, and equipment are placed in an environment with reduced barometric pressure, noise, vibration, and limited space, oxygen, electrical power, and access to imaging technology. It is the transport team's responsibility to provide care in this environment, which approximates that given in the ICU as closely as possible. This is achieved through careful preparation and planning. Preparation starts with training of the personnel and selection of optimal equipment. Planning needs to consider the patient's physiologic reserve, available supplies of oxygen and electrical power, and the crew's ability to sustain high performance for the duration of the mission. PMID:12184657

Beninati, William; Jones, Kevin D

2002-03-01

51

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

52

Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit.  

PubMed

Ventilator-associated pneumonia (VAP) is a preventable secondary consequence of intubation and mechanical ventilation. VAP is pneumonia that develops in an intubated patient after 48 hours or more of mechanical ventilator support. Mechanically ventilated patients in neurologic and other intensive care units (ICUs) are at an increased risk of VAP due to factors such as decreased level of consciousness; dry, open mouth; and microaspiration of secretions. VAP can be prevented by initiating interventions from the Institute of Healthcare Improvement's VAP bundle, including (a) elevating the head of the bed of ventilated patients to 30 degrees, (b) preventing venous thromboembolism through use of sequential compression devices or anticoagulation, (c) administering gastric acid histamine2 blockers, (d) practicing good hand hygiene, (e) initiating early mobilization, and (f) performing daily sedation interruption at 10 am to evaluate neurologic status. The one intervention not included in the IHI bundle is oral hygiene. The purpose of this project is to support the premise that oral care, including timed toothbrushing, combined with the VAP bundle can mitigate and prevent the occurrence of VAP. Our project specifically addressed timed oral care of mechanically ventilated patients on a 24-bed stroke, neurologic, and medical ICU. Patients were randomized into a control group that performed usual oral care or an intervention group that brushed teeth every 8 hours. The results were immediate and startling, as the VAP rate dropped to zero within a week of beginning the every-8-hours toothbrushing regimen in the intervention group. The study was so successful that the control group was dropped after 6 months, and all intubated patients' teeth were brushed every 8 hours, maintaining the zero rate until the end of the study. PMID:18856250

Fields, Lorraine B

2008-10-01

53

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

PubMed

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

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

1995-09-01

54

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

Code of Federal Regulations, 2010 CFR

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

2010-10-01

55

Effect of mechanical ventilation waveforms on airway wall shear.  

PubMed

Better understanding of airway wall shear stress/strain rate is very important in order to prevent inflammation in patients undergoing mechanical ventilation due to respiratory problems in intensive-care medicine. The objective of this study was to investigate the role of mechanical ventilation waveforms on airway wall shear/strain rate using computational fluid dynamics analysis. Six different waveforms were considered to investigate the airway wall shear stress (WSS) from fluid dynamics analysis for the airway geometry of two-to-three generations. The simulation results showed that Original with Sine Inhale Waveform (OSIW) produced the highest WSS value and the Near True Sine Waveform produced the lowest WSS value. Also, the Original with Sine Inhale Waveform and the Short Sine Inhale with Long Sine Exhale Waveform (SSILSEW) produced a higher shear strain rate in comparison to the Original Waveform (OW). These results, combined with optimization, suggest that it is possible to develop a set of mechanical ventilation waveform strategies to avoid inflammation in the lung. PMID:25385315

Pidaparti, Ramana M; Swanson, John

2015-01-01

56

Automatic detection of AutoPEEP during controlled mechanical ventilation  

PubMed Central

Background Dynamic hyperinflation, hereafter called AutoPEEP (auto-positive end expiratory pressure) with some slight language abuse, is a frequent deleterious phenomenon in patients undergoing mechanical ventilation. Although not readily quantifiable, AutoPEEP can be recognized on the expiratory portion of the flow waveform. If expiratory flow does not return to zero before the next inspiration, AutoPEEP is present. This simple detection however requires the eye of an expert clinician at the patient’s bedside. An automatic detection of AutoPEEP should be helpful to optimize care. Methods In this paper, a platform for automatic detection of AutoPEEP based on the flow signal available on most of recent mechanical ventilators is introduced. The detection algorithms are developed on the basis of robust non-parametric hypothesis testings that require no prior information on the signal distribution. In particular, two detectors are proposed: one is based on SNT (Signal Norm Testing) and the other is an extension of SNT in the sequential framework. The performance assessment was carried out on a respiratory system analog and ex-vivo on various retrospectively acquired patient curves. Results The experiment results have shown that the proposed algorithm provides relevant AutoPEEP detection on both simulated and real data. The analysis of clinical data has shown that the proposed detectors can be used to automatically detect AutoPEEP with an accuracy of 93% and a recall (sensitivity) of 90%. Conclusions The proposed platform provides an automatic early detection of AutoPEEP. Such functionality can be integrated in the currently used mechanical ventilator for continuous monitoring of the patient-ventilator interface and, therefore, alleviate the clinician task. PMID:22715924

2012-01-01

57

Effects of bronchoalveolar lavage volume on arterial oxygenation in mechanically ventilated patients with pneumonia  

Microsoft Academic Search

Objective: To assess the effect of bronchoalveolar lavage (BAL) volume on arterial oxygenation in critically ill patients with pneumonia. Design: Randomized clinical comparison. Setting: Six-bed respiratory intensive care unit of a 850-bed tertiary care university hospital. Patients: Thirty-seven intubated and mechanically ventilated patients with clinical suspicion of pneumonia. Interventions: Bronchoscopically guided protected specimen brush (PSB) followed by either a \\

Torsten T. Bauer; Antoni Torres; Santiago Ewig; Carmen Hernández; Juan Miguel Sanchez-Nieto; Antoni Xaubet; Carlos Agustí; Roberto Rodriguez-Roisin

2001-01-01

58

The fluid mechanics of natural ventilation  

Microsoft Academic Search

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

Paul Linden

1999-01-01

59

Home mechanical ventilation for amyotrophic lateral sclerosis: nasal compared to tracheostomy-intermittent positive pressure ventilation  

Microsoft Academic Search

People with amyotrophic lateral sclerosis (ALS) usually die from respiratory failure unless they use mechanical ventilation (MV). Many die of respiratory failure without being adequately informed about the available options, such as MV, that can provide symptomatic relief and prolong survival. The traditional method of MV used for persons with ALS has been tracheostomy-intermittent positive pressure ventilation (IPPV). However, the

Pamela A. Cazzolli; Edward A. Oppenheimer

1996-01-01

60

Very Low Birth Weight Infant Necessitating Nissen Fundoplication for Weaning off the Mechanical Ventilator  

PubMed Central

Gastro-esophageal reflux (GER) is one of the common problems of neonatal intensive care units. Although this condition does not always need to be treated, it occasionally causes clinically serious consequences. Initial management is medical; however, in some cases surgery might be required. A premature neonate with birth weight of 1370 grams was managed in our ICU. The patient was mechanical ventilator dependent due to GER. The patient needed Nissen fundoplication for successfully weaning off the ventilator. PMID:25057468

Köksal, Nilgün; Özkan, Hilal; Do?an, Pelin; Ba?c?, Onur; Do?ruyol, Hasan; Gürp?nar, Arif

2014-01-01

61

A care bundle approach for prevention of ventilator-associated pneumonia.  

PubMed

Implementation of care bundles for prevention of ventilator-associated pneumonia (VAP) and its impact on patient outcomes requires validation with long-term follow-up. A collaborative multi-centre cohort study was conducted in five Spanish adult intensive-care units. A care bundle approach based on five measures was implemented after a 3-month baseline period, and compliance, VAP rates, intensive-care unit length of stay (ICU LOS) and duration of mechanical ventilation were prospectively recorded for 16 months. There were 149 patients in the baseline period and 885 after the intervention. Compliance with all measures after intervention was <30% (264/885). In spite of this, VAP incidence decreased from 15.5% (23/149) to 11.7% (104/885), after the intervention (p <0.05). This reduction was significantly associated with hand hygiene (OR = 0.35), intra-cuff pressure control (OR = 0.21), oral hygiene (OR = 0.23) and sedation control (OR = 0.51). Use of the care bundle was associated with an incidence risk ratio of VAP of 0.78 (95% CI 0.15-0.99). We documented a reduction of median ICU LOS (from 10 to 6 days) and duration of mechanical ventilation (from 8 to 4 days) for patients with full bundle compliance (intervention period). Efforts on VAP prevention and outcome improvement should focus on achieving higher compliance in hand and oral hygiene, sedation protocols and intracuff pressure control. PMID:22439889

Rello, J; Afonso, E; Lisboa, T; Ricart, M; Balsera, B; Rovira, A; Valles, J; Diaz, E

2013-04-01

62

Heliox Improves Carbon Dioxide Removal during Lung Protective Mechanical Ventilation  

PubMed Central

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

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

2014-01-01

63

Oral Care Reduces Incidence of Ventilator-Associated Pneumonia in ICU Populations  

Microsoft Academic Search

Objective  To examine whether oral care contributes to preventing ventilator-associated pneumonia (VAP) in ICU patients.\\u000a \\u000a \\u000a \\u000a Design  Nonrandomized trial with historical controls.\\u000a \\u000a \\u000a \\u000a Setting  A medical-surgical ICU in a university hospital.\\u000a \\u000a \\u000a \\u000a Patients  1,666 mechanically ventilated patients admitted to the ICU.\\u000a \\u000a \\u000a \\u000a Intervention  Oral care was provided to 1,252 patients who were admitted to the ICU during period between January 1997 and December 2002\\u000a (oral care group), while 414 patients who

Hideo Mori; Hiroyuki Hirasawa; Shigeto Oda; Hidetoshi Shiga; Kenichi Matsuda; Masataka Nakamura

2006-01-01

64

The effects of an oral care practice on incidence of pneumonia among ventilator patients in ICUs of selected hospitals in Isfahan, 2010  

PubMed Central

Background: Oral care plays an inevitable role in health and well-being of patients in intensive care units (ICUs). Poor oral care causes colonization of respiratory pathogens and secondary respiratory infections. Ventilator-associated pneumonia occurs in patients on mechanical ventilation for more than 48 hours. It results in prolonged duration of mechanical ventilation, mortality and health expenses. The present study aimed to review the effects of an oral care practice on the incidence of ventilator-associated pneumonia in patients on mechanical ventilation admitted in ICUs. Materials and Methods: This was a clinical trial study conducted in the ICUs of selected hospitals in Isfahan during 2010. We randomly divided 54 patients into the intervention and control groups. Intubation was performed during the 48 hours before the study. The intervention group received an oral care practice along with brushing and the control group received routine oral care twice daily. The incidence of ventilator-associated pneumonia was diagnosed through clinical pulmonary infection score (CPIS). Findings: The two groups were compared in terms of underlying criteria (APACHE-II). The incidence of ventilator-associated pneumonia did not statistically differ between the intervention and control groups (37% vs. 48.1%; p = 0.41). Conclusions: The results of the present study showed that brushing and standard oral care practice had no effects on ventilator-associated pneumonia. Therefore, the incidence of such complication might be affected by many different factors. PMID:23833615

Khalifehzadeh, Asghar; Parizade, Ahmad; Hosseini, Abbas; Yousefi, Hojatollah

2012-01-01

65

Critical pertussis in a young infant requiring mechanical ventilation.  

PubMed

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

66

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

67

Reproducibility of Blind Protected Bronchoalveolar Lavage in Mechanically Ventilated Children  

Microsoft Academic Search

Blind protected bronchoalveolar lavage (BAL) could be an interest- ing tool in the diagnosis of ventilator-associated pneumonia in in- tubated children, but its reproducibility has never been evaluated. This study evaluates the reproducibility, feasibility, and safety of blind protected BAL in mechanically ventilated children. Two blind protected BAL were done, at a 2-hour interval, in 30 patients. The reproducibility of

France Gauvin; Jacques Lacroix; Marie-Claude Guertin; François Proulx; Catherine Ann Farrell; Albert Moghrabi; Pierre Lebel; Clément Dassa

68

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.

69

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

PubMed Central

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

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

2014-01-01

70

Intensive Care Med . Author manuscript Comparison of patient-ventilator interfaces based on their computerized  

E-print Network

Intensive Care Med . Author manuscript Page /1 8 Comparison of patient-ventilator interfaces based.louis@inserm.fr > Abstract Purpose Non-invasive ventilation is largely used to treat acute and chronic respiratory failure. This ventilation encounters a non negligible rate of failure related to the used interface/mask, but the reasons

Boyer, Edmond

71

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

72

Estimation of energy requirements for mechanically ventilated, critically ill patients using nutritional status  

Microsoft Academic Search

BACKGROUND: There is very little information on what is considered an adequate energy intake for mechanically ventilated, critically ill patients. The purpose of the present study was to determine this energy requirement by making use of patients' nutritional status. METHODS: The study was conducted in a multidisciplinary intensive care unit of Taichung Veterans General Hospital, Taiwan. Patients were hemodynamically stable

Mee-Nin Kan; Han-Hsin Chang; Woei-Fen Sheu; Chien-Hsiang Cheng; Bor-Jen Lee; Yi-Chia Huang

2003-01-01

73

Sedation and weaning from mechanical ventilation: time for ‘best practice’ to catch up with new realities?  

PubMed Central

Delivery of sedation in anticipation of weaning of adult patients from prolonged mechanical ventilation is an arena of critical care medicine where opinion-based practice is currently hard to avoid because robust evidence is lacking. We offer some views on this subject, hoping to stimulate debate among colleagues. PMID:25473522

2014-01-01

74

The Impact of Mechanical Ventilation on Immature Airway Smooth Muscle: Functional, Structural, Histological, and Molecular Correlates  

Microsoft Academic Search

Preterm infants exposed to mechanical ventilation often develop airway dysfunction and bronchopulmonary dysplasia. The mechanisms of mechanical ventilation-induced airway injury are currently unknown. This study correlates the age-related effects of mechanical ventilation on airway function with structural alterations at the tissue, cellular, ultrastructural, and molecular levels. Mechanically ventilated and nonventilated tracheal rings were obtained from premature and newborn lambs. In

Aaron B. Cullen; Peter H. Cooke; Steven P. Driska; Marla R. Wolfson; Thomas H. Shaffer

2006-01-01

75

A Bench Study of Intensive Care Unit Ventilators: New versus Old and Turbine-Based versus Compressed Gas-Based Ventilators  

E-print Network

1 A Bench Study of Intensive Care Unit Ventilators: New versus Old and Turbine-Based versus Compressed Gas-Based Ventilators Arnaud W. Thille,1 MD; Aissam Lyazidi,1 Biomed Eng MS; Jean-Christophe M commercially available, new-generation, intensive-care-unit (ICU) ventilators regarding trigger function

Paris-Sud XI, Université de

76

Clinical Characteristics and Immediate-Outcome of Children Mechanically Ventilated in PICU of Pakistan  

PubMed Central

Back ground and Objective: Mechanical Ventilation (MV) is frequently used as one of the most frequent life-supportive technology in Pediatric Intensive Care Units (PICUs). Very little data is available from Asian countries like Pakistan regarding use of MV in PICUs. Our objective was to assess the frequency, indications and immediate-outcomes in mechanically ventilated pediatric patients in tertiary-care center of developing country. Methods: Retrospective cohort study of critically ill pediatric patients admitted in PICU of Aga Khan University Hospital, who required MV for more than 24-hour over two-year period. Results: A total of 605 patients were admitted to PICU, 307 (50.7%) patients required MV support for >24hr. The median age was 3 years (IQR 6 month to 6 yr 2 months), and male was 59.6% (183/307). Common indications for MV was neurological illness 35.8%, followed by respiratory diseases in 20.8% patients and cardiac diseases in 13%; and 30.3 % patients were ventilated for other reasons. The median length of MV was 2.1 days. 9.4% developed complications and atelectasis (4.6%) was the most common. The mortality rate of children mechanically ventilated was 30.3% as compared to the overall mortality rate of in PICU was 16.3%. The long duration (> 10 days) and cardiogenic shock were identified as independent risk factor associated with increased mortality. Conclusion: About half of PICU admission required mechanical ventilation for more than 24 hours. The neurological illness was the most common reason for ventilation. The low incidence of complication rate and relatively high mortality in cardiac cases and long duration of mechanical ventilation were noted in our cohort. PMID:25225500

Mukhtar, Beenish; Siddiqui, Naveedur R.; Haque, Anwarul

2014-01-01

77

Impact of an infection control program on rates of ventilator-associated pneumonia in intensive care units in 2 Argentinean hospitals  

Microsoft Academic Search

Background: Hospitalized, critically ill patients have a significant risk of developing nosocomial infection. Most episodes of nosocomial pneumonia occur in patients undergoing mechanical ventilation (MV). Objective: To ascertain the effect of an infection control program on rates of ventilator-associated pneumonia (VAP) in intensive care units (ICUs) in Argentina. Methods: All adult patients who received MV for at least 24 hours

Victor D. Rosenthal; Sandra Guzman; Christopher Crnich

78

Oral care and ventilator-associated pneumonia: an integrated review of the literature.  

PubMed

The purpose of this study was to review evidence-based research studies specific to oral care in critical care and its relationship to ventilator-associated pneumonia. Twenty articles were analyzed. Results showed a pattern of 4 themes: (1) oral care practices, (2) deviation from practices, (3) interventions, and (4) documentation. Results are varied across the articles reviewed, although some pattern of essential oral care was revealed as crucial to the prevention of ventilator-associated pneumonia. PMID:23571198

Parsons, Susan; Lee, Carla A; Strickert, Debbie; Trumpp, Margaret

2013-01-01

79

A new method of securing the airway for differential lung ventilation in intensive care.  

PubMed

Differential lung ventilation to achieve optimised ventilation for each lung is a procedure rarely used in the intensive care unit, to treat select cases of severe unilateral lung disease in intensive care. However, existing techniques both for securing the airway and ventilating the lungs are challenging and have complications. We present the use of differential lung ventilation in the intensive care setting, securing the airway with a technique not previously described, using endotracheal tubes inserted through a tracheotomy and orally. In the course of 1 month, we treated three patients with unilateral atelectatic and consolidated lungs by differential lung ventilation. The left lung was ventilated through an endotracheal tube inserted into the left main stem bronchus through a tracheotomy. The right lung was ventilated through an endotracheal tube with the cuff positioned immediately under the vocal cord. In patient 1, the diseased lung remained consolidated after 24 h of differential lung ventilation. In the two other patients, the diseased lungs responded to differential lung ventilation by increased compliance and radiographic increased aeration. Differential ventilation of the lungs with this novel technique is feasible and may increase the likelihood of successful treatment of atelectatic lungs refractory to conventional ventilator strategies. PMID:24588330

Skjeflo, G W; Dybwik, K

2014-04-01

80

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

E-print Network

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

Matsumoto, Katsumi

81

Ventilator-associated pneumonia risk decreased by use of oral moisture gel in oral health care.  

PubMed

Although oral health care has a preventive effect against ventilator-associated pneumonia (VAP), the most effective method of oral health care in this respect remains to be established. The objective of this single-center, randomized, controlled trial was to investigate the relationship between VAP and various methods of oral health care. All patients included in the study (n=142) were on mechanical ventilation with oral intubation at the intensive care unit of the Tokyo Dental College Ichikawa General Hospital. They were divided into two groups, one receiving standard oral health care (Standard group), and the other receiving oral health care using an oral moisture gel instead of water (Gel group). After removal of the intubation tube, biofilm on cuff of the tube was stained with a disclosing agent to determine the contamination level. Factors investigated included sex, age, number of remaining teeth, intubation time, fever ?38.5°C, VAP, cuff contamination level, and time required for one oral health care session. No VAP occurred in either group during the study period. The level of cuff contamination was significantly lower in the Gel group than the Standard group, and the time required for one session of oral health care was shorter (p<0.001). Multivariate analysis revealed use of the oral moisture gel as a factor affecting cuff contamination level. Use of an oral moisture gel decreased invasion of the pharynx by bacteria and contaminants together with biofilm formation on the intubation tube cuff. These results suggest that oral health care using an oral moisture gel is effective in preventing cuff contamination. PMID:24965954

Takeyasu, Yoshihiro; Yamane, Gen-Yuki; Tonogi, Morio; Watanabe, Yutaka; Nishikubo, Shuichi; Serita, Ryohei; Imura, Kumiko

2014-01-01

82

Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: a prospective cohort study  

Microsoft Academic Search

INTRODUCTION: Post-traumatic stress disorder (PTSD) has been identified in a significant portion of intensive care unit (ICU) survivors. We sought to identify factors associated with PTSD symptoms in patients following critical illness requiring mechanical ventilation. METHODS: Forty-three patients who were mechanically ventilated in the medical and coronary ICUs of a university-based medical center were prospectively followed during their ICU admission

Timothy D Girard; Ayumi K Shintani; James C Jackson; Sharon M Gordon; Brenda T Pun; Melinda S Henderson; Robert S Dittus; Gordon R Bernard; E Wesley Ely

2007-01-01

83

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

PubMed Central

BACKGROUND Respiratory failure after acute spinal cord injury (SCI) is well recognized, but data defining which patients need long-term ventilator support, and criteria for weaning and extubation are lacking. We hypothesized that many patients with SCI, even those with cervical SCI, can be successfully managed without long-term mechanical ventilation and its associated morbidity. METHODS Under the auspices of the Western Trauma Association Multi-Center Trials Group, a retrospective study of patients with SCI at 14 major trauma centers was conducted. Comprehensive injury, demographic, and outcome data on patients with acute SCI was compiled. The primary outcome variable was the need for mechanical ventilation at discharge. Secondary outcomes included the use of tracheostomy, and development of acute lung injury (ALI) and ventilator-associated pneumonia (VAP). RESULTS 360 patients had SCI requiring mechanical ventilation. Sixteen patients were excluded for death within the first 2 days of hospitalization. Of the 344 patients included, 222 (64.5%) had cervical SCI. Notably, 62.6% of patients with cervical SCI were ventilator-free by discharge. 149 patients (43.3%) underwent tracheostomy and 53.7% of them were successfully weaned from the ventilator, compared to an 85.6% success rate among those with no tracheostomy (p<0.05). Patients who underwent tracheostomy had significantly higher rates of VAP (61.1% vs 20.5%, p<0.05) and ALI (12.8% vs 3.6%, p<0.05), and fewer ventilator free days (1 vs. 24 p<0.05). When controlled for injury severity, thoracic injury, and respiratory comorbidities, tracheostomy after cervical SCI was an independent predictor of ventilator dependence with an associated 14-fold higher likelihood of prolonged mechanical ventilation (OR 14.1, CI 2.78–71.67, p<0.05). DISCUSSION While many patients with SCI require short-term mechanical ventilation, the majority can be successfully weaned prior to discharge. In patients with SCI tracheostomy is associated with major morbidity and its use, especially among patients with cervical SCI, deserves further study. LEVEL OF EVIDENCE Level III, care-management/prognostic PMID:24256682

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

2013-01-01

84

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

85

STATE OF CALIFORNIA MECHANICAL VENTILATION AND REHEAT  

E-print Network

or equal to H, or use Transfer Air (column N) to make up the difference. J Design fan supply cfm (Fan CFM'D V.A. Max of D or G Design Ventilation Air cfm 50% of Design Zone Supply cfm B x 0.4 cfm/ft² Max of Columns H, J, K, 300 cfm Design minimum Air setpoint Transfer Air 15 15 15 15 15 15 15 15 15 15 15 15

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

Decreasing ventilator-associated pneumonia in the intensive care unit: a sustainable comprehensive quality improvement program.  

PubMed

An intensive care unit implemented an oral care bundle to decrease ventilator-associated pneumonia (VAP). A retrospective analysis comparing like time periods revealed the VAP rate per 1,000 ventilator-days dropped significantly from 10.5 to 0 (P = .016). The oral care bundle remains in place as of end of May 2011 and has proven to be a sustainable method for VAP prevention. PMID:22386154

Heck, Kara

2012-11-01

88

Diaphragm weakness in mechanically ventilated critically ill patients  

PubMed Central

Introduction Studies indicate that mechanically ventilated patients develop significant diaphragm muscle weakness, but the etiology of weakness and its clinical impact remain incompletely understood. We assessed diaphragm strength in mechanically ventilated medical ICU patients, correlated the development of diaphragm weakness with multiple clinical parameters, and examined the relationship between the level of diaphragm weakness and patient outcomes. Methods Transdiaphragmatic twitch pressure (PdiTw) in response to bilateral magnetic stimulation of the phrenic nerves was measured. Diaphragm weakness was correlated with the presence of infection, blood urea nitrogen, albumin, and glucose levels. The relationship of diaphragm strength to patient outcomes, including mortality and the duration of mechanical ventilation for successfully weaned patients, was also assessed. Results We found that infection is a major risk factor for diaphragm weakness in mechanically ventilated medical ICU patients. Outcomes for patients with severe diaphragm weakness (PdiTw <10 cmH2O) were poor, with a markedly increased mortality (49%) compared to patients with PdiTw ?10 cmH2O (7% mortality, P = 0.022). In addition, survivors with PdiTw <10 cmH2O required a significantly longer duration of mechanical ventilation (12.3 ± 1.7 days) than those with PdiTw ?10 cmH2O (5.5 ± 2.0 days, P = 0.016). Conclusions Infection is a major cause of severe diaphragm weakness in mechanically ventilated patients. Moreover, diaphragm weakness is an important determinant of poor outcomes in this patient population. PMID:23786764

2013-01-01

89

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

90

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

91

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

92

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

93

Computational tool for modeling and simulation of mechanically ventilated patients.  

PubMed

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

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

2010-01-01

94

Respiratory phase locking during mechanical ventilation in anesthetized human subjects  

E-print Network

Respiratory phase locking during mechanical ventilation in anesthetized human subjects CARL GRAVES, Canada GRAVES, CARL, LEON GLASS, DONALD LAPORTA, ROGER MELOCHE, AND ALEX GRASSINO.Respiratory phase of these results. entrainment; respiratory reflexes; control of breathing PERIODIC INPUTS HAVE POWERFUL effects

Glass, Leon

95

Rapid Disuse Atrophy of Diaphragm Fibers in Mechanically Ventilated Humans  

Microsoft Academic Search

Background The combination of complete diaphragm inactivity and mechanical ventilation (for more than 18 hours) elicits disuse atrophy of myofibers in animals. We hypothe- sized that the same may also occur in the human diaphragm. Methods We obtained biopsy specimens from the costal diaphragms of 14 brain-dead organ donors before organ harvest (case subjects) and compared them with intraoperative biopsy

Sanford Levine; Taitan Nguyen; Nyali Taylor; Michael E. Friscia; Murat T. Budak; Pamela Rothenberg; Jianliang Zhu; Rajeev Sachdeva; Seema Sonnad; Larry R. Kaiser; Neal A. Rubinstein; Scott K. Powers; Joseph B. Shrager

2010-01-01

96

NATURAL HISTORY OF DENTAL PLAQUE ACCUMULATION IN MECHANICALLY VENTILATED ADULTS: A DESCRIPTIVE CORRELATIONAL STUDY  

PubMed Central

Summary Objective The purpose of this study was to describe the pattern of dental plaque accumulation in mechanically ventilated adults. Accumulation of dental plaque and bacterial colonization of the oropharynx is associated with a number of systemic diseases including ventilator associated pneumonia. Research Methodology/Design Data were collected from mechanically ventilated critically ill adults (n=137), enrolled within 24 hours of intubation. Dental plaque, counts of decayed, missing and filled teeth and systemic antibiotic use was assessed on study days 1, 3, 5 and 7. Dental plaque averages per study day, tooth type and tooth location were analyzed. Setting Medical Respiratory, Surgical Trauma and Neuroscience ICU’s of a large tertiary care center in the southeast United States. Results Plaque: All surfaces > 60% plaque coverage from day 1 to day 7; Molars and Premolars contained greatest plaque average >70%. Systemic antibiotic use on day 1 had no significant effect on plaque accumulation on day 3 (p=0.73). Conclusions Patients arrive in critical care units with preexisting oral hygiene issues. Dental plaque tends to accumulate in the posterior teeth (molars and premolars) that may be hard for nurses to visualize and reach; this problem may be exacerbated by endotracheal tubes and other equipment. Knowing accumulation trends of plaque will guide the development of effective oral care protocols. PMID:22014582

Jones, Deborah J.; Munro, Cindy L.; Grap, Mary Jo

2011-01-01

97

A theory for phase locking of respiration in cats to a mechanical ventilator  

E-print Network

A theory for phase locking of respiration in cats to a mechanical ventilator G. A. PETRILLO to a mechanical ventilator. Am. J. Physiol. 246 (Regulatory Integrative Comp. Physiol. 15): R31l- R320, 1984,-A mathematical model describing the Hering- Breuer reflexes in mechanically ventilated cats is developed

Glass, Leon

98

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

E-print Network

Recent studies have documented the lung ventilation mechanics of aquatic salamanders (Brainerd et of the lungs. In the present study, we document the ventilation mechanics of adult (post- metamorphic, lung ventilation mechanisms may be classified as either two-stroke or four- stroke buccal pumps

Brainerd, Elizabeth

99

Complementary home mechanical ventilation techniques. SEPAR Year 2014.  

PubMed

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

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

2014-12-01

100

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

PubMed

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

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

2011-03-01

101

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

Microsoft Academic Search

Introduction  Patients triaged to tertiary care centers frequently undergo rotary-wing transport and may be exposed to additional risk for\\u000a adverse events. The incidence of physiologic adverse events and their predisposing factors in mechanically ventilated patients\\u000a undergoing aeromedical transport are unknown.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We performed a retrospective review of flight records of all interfacility, rotary-wing transports to a tertiary care, university\\u000a hospital during 2001

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

2008-01-01

102

Ventilation distribution and chest wall mechanics in microgravity  

NASA Technical Reports Server (NTRS)

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

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

1997-01-01

103

NanoClusters Enhance Drug Delivery in Mechanical Ventilation  

NASA Astrophysics Data System (ADS)

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

Pornputtapitak, Warangkana

104

Patient Machine Interface for the Control of Mechanical Ventilation Devices  

PubMed Central

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

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

2013-01-01

105

Airway humidification with a heat and moisture exchanger in mechanically ventilated neonates  

Microsoft Academic Search

Objective  We set out to evaluate the efficacy of passive inspiratory gas conditioning in mechanically ventilated neonates and compared\\u000a it with that of a heated humidifier (HH).\\u000a \\u000a \\u000a \\u000a Design  Prospective, randomized, controlled study.\\u000a \\u000a \\u000a \\u000a Setting  Neonatal and pediatric intensive care unit.\\u000a \\u000a \\u000a \\u000a Patients  Fourteen mechanically ventilated neonates nursed in incubators.\\u000a \\u000a \\u000a \\u000a Interventions  The HH was set to deliver a temperature of 37?°C and an absolute humidity of 40?mgH2O\\/l at the incubator

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

2007-01-01

106

Acute respiratory distress syndrome in combat casualties: military medicine and advances in mechanical ventilation.  

PubMed

Military medicine has made numerous enduring contributions to the advancement of pulmonary medicine. Acute respiratory distress syndrome was first recognized as a complication in battlefield casualties in World War I and continued to play a significant role in the treatment of casualties through the Vietnam War. Innovative surgeons during World War II devised methods to assist their patients with positive pressure breathing. This concept was later adopted and applied to the development of mechanical ventilation in the late 1940s and early 1950s. The continued treatment of acute respiratory distress syndrome in combat casualties by military physicians has provided a major impetus for advances in modern mechanical ventilation and intensive care unit medicine. PMID:17153538

Morris, Michael James

2006-11-01

107

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

E-print Network

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

Dojat, Michel

108

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

E-print Network

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

109

Critical care bug team: A multidisciplinary team approach to reducing ventilator-associated pneumonia  

Microsoft Academic Search

Background: Ventilator-associated pneumonia rates in the medical-surgical intensive care unit first exceeded the 90th percentile in September 1997 and were significantly (P < .05) higher than National Nosocomial Infections Surveillance System pooled mean data. In January 1998, a multidisciplinary “Critical Care Bug Team” was developed by the Infection Control Committee to review 1997 National Nosocomial Infections Surveillance System data for

Judy Kaye; Vivian Ashline; Deborah Erickson; Kathy Zeiler; Dawn Gavigan; Lisa Gannon; Patricia Wynne; Janice Cooper; William Kittle; Kailash Sharma; Jared Morton

2000-01-01

110

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

111

Home mechanical ventilation: A Canadian Thoracic Society clinical practice guideline  

PubMed Central

Increasing numbers of patients are surviving episodes of prolonged mechanical ventilation or benefitting from the recent availability of user-friendly noninvasive ventilators. Although many publications pertaining to specific aspects of home mechanical ventilation (HMV) exist, very few comprehensive guidelines that bring together all of the current literature on patients at risk for or using mechanical ventilatory support are available. The Canadian Thoracic Society HMV Guideline Committee has reviewed the available English literature on topics related to HMV in adults, and completed a detailed guideline that will help standardize and improve the assessment and management of individuals requiring noninvasive or invasive HMV. The guideline provides a disease-specific review of illnesses including amyotrophic lateral sclerosis, spinal cord injury, muscular dystrophies, myotonic dystrophy, kyphoscoliosis, post-polio syndrome, central hypoventilation syndrome, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease as well as important common themes such as airway clearance and the process of transition to home. The guidelines have been extensively reviewed by international experts, allied health professionals and target audiences. They will be updated on a regular basis to incorporate any new information. PMID:22059178

McKim, Douglas A; Road, Jeremy; Avendano, Monica; Abdool, Steve; Côté, Fabien; Duguid, Nigel; Fraser, Janet; Maltais, François; Morrison, Debra L; O’Connell, Colleen; Petrof, Basil J; Rimmer, Karen; Skomro, Robert

2011-01-01

112

Home mechanical ventilation: a Canadian Thoracic Society clinical practice guideline.  

PubMed

Increasing numbers of patients are surviving episodes of prolonged mechanical ventilation or benefitting from the recent availability of userfriendly noninvasive ventilators. Although many publications pertaining to specific aspects of home mechanical ventilation (HMV) exist, very few comprehensive guidelines that bring together all of the current literature on patients at risk for or using mechanical ventilatory support are available. The Canadian Thoracic Society HMV Guideline Committee has reviewed the available English literature on topics related to HMV in adults, and completed a detailed guideline that will help standardize and improve the assessment and management of individuals requiring noninvasive or invasive HMV. The guideline provides a disease-specific review of illnesses including amyotrophic lateral sclerosis, spinal cord injury, muscular dystrophies, myotonic dystrophy, kyphoscoliosis, post-polio syndrome, central hypoventilation syndrome, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease as well as important common themes such as airway clearance and the process of transition to home. The guidelines have been extensively reviewed by international experts, allied health professionals and target audiences. They will be updated on a regular basis to incorporate any new information. PMID:22059178

McKim, Douglas A; Road, Jeremy; Avendano, Monica; Abdool, Steve; Cote, Fabien; Duguid, Nigel; Fraser, Janet; Maltais, Fracois; Morrison, Debra L; O'Connell, Colleen; Petrof, Basil J; Rimmer, Karen; Skomro, Robert

2011-01-01

113

Mechanical ventilation modulates TLR4 and IRAK3 in a non-infectious, ventilator-induced lung injury model  

Microsoft Academic Search

BACKGROUND: Previous experimental studies have shown that injurious mechanical ventilation has a direct effect on pulmonary and systemic immune responses. How these responses are propagated or attenuated is a matter of speculation. The goal of this study was to determine the contribution of mechanical ventilation in the regulation of Toll-like receptor (TLR) signaling and interleukin-1 receptor associated kinase-3 (IRAK-3) during

Jesús Villar; Nuria E Cabrera; Milena Casula; Carlos Flores; Francisco Valladares; Lucio Díaz-Flores; Mercedes Muros; Arthur S Slutsky; Robert M Kacmarek

2010-01-01

114

Ventilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients  

PubMed Central

Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection among pediatric intensive care unit (ICU) patients. Empiric therapy for VAP accounts for approximately 50% of antibiotic use in pediatric ICUs. VAP is associated with an excess of 3 days of mechanical ventilation among pediatric cardiothoracic surgery patients. The attributable mortality and excess length of ICU stay for patients with VAP have not been defined in matched case control studies. VAP is associated with an estimated $30,000 in attributable cost. Surveillance for VAP is complex and usually performed using clinical definitions established by the CDC. Invasive testing via bronchoalveolar lavage increases the sensitivity and specificity of the diagnosis. The pathogenesis in children is poorly understood, but several prospective cohort studies suggest that aspiration and immunodeficiency are risk factors. Educational interventions and efforts to improve adherence to hand hygiene for children have been associated with decreased VAP rates. Studies of antibiotic cycling in pediatric patients have not consistently shown this measure to prevent colonization with multidrug-resistant gram-negative rods. More consistent and precise approaches to the diagnosis of pediatric VAP are needed to better define the attributable morbidity and mortality, pathophysiology, and appropriate interventions to prevent this disease. PMID:17630332

Foglia, Elizabeth; Meier, Mary Dawn; Elward, Alexis

2007-01-01

115

Mechanical Ventilation Weaning in Inclusion Body Myositis: Feasibility of Isokinetic Inspiratory Muscle Training as an Adjunct Therapy  

PubMed Central

Inclusion body myositis is a rare myopathy associated with a high rate of respiratory complications. This condition usually requires prolonged mechanical ventilation and prolonged intensive care stay. The unsuccessful weaning is mainly related to respiratory muscle weakness that does not promptly respond to immunosuppressive therapy. We are reporting a case of a patient in whom the use of an inspiratory muscle-training program which started after a two-week period of mechanical ventilation was associated with a successful weaning in one week and hospital discharge after 2 subsequent weeks. PMID:25147743

Campos, Josué Felipe; Daher, Leandro Possidente; Ventura, Alex; do Prado, Pollyana Zamborlini; Brasil, Daniele; Mendonça, Debora; Lugon, Jocemir Ronaldo

2014-01-01

116

The effect of neuromuscular blockade on oxygen consumption in sedated and mechanically ventilated pediatric patients after cardiac surgery  

Microsoft Academic Search

Objective  To measure the effect of intense neuromuscular blockade (NMB) on oxygen consumption (VO2) in deeply sedated and mechanically ventilated children on the first day after complex congenital cardiac surgery.\\u000a \\u000a \\u000a \\u000a Design  Prospective clinical interventional study.\\u000a \\u000a \\u000a \\u000a Setting  Pediatric intensive care unit of an university medical centre.\\u000a \\u000a \\u000a \\u000a Measurements and results  Nine mechanically ventilated and sedated children (weight 2.8–8.7 kg) were included. All children were treated with vasoactive

J. Lemson; J. J. Driessen; J. G. van der Hoeven

2008-01-01

117

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

PubMed Central

Introduction Mechanical ventilation (MV) of mice is increasingly required in experimental studies, but the conditions that allow stable ventilation of mice over several hours have not yet been fully defined. In addition, most previous studies documented vital parameters and lung mechanics only incompletely. The aim of the present study was to establish experimental conditions that keep these parameters within their physiological range over a period of 6 h. For this purpose, we also examined the effects of frequent short recruitment manoeuvres (RM) in healthy mice. Methods Mice were ventilated at low tidal volume VT?=?8 mL/kg or high tidal volume VT?=?16 mL/kg and a positive end-expiratory pressure (PEEP) of 2 or 6 cmH2O. RM were performed every 5 min, 60 min or not at all. Lung mechanics were followed by the forced oscillation technique. Blood pressure (BP), electrocardiogram (ECG), heart frequency (HF), oxygen saturation and body temperature were monitored. Blood gases, neutrophil-recruitment, microvascular permeability and pro-inflammatory cytokines in bronchoalveolar lavage (BAL) and blood serum as well as histopathology of the lung were examined. Results MV with repetitive RM every 5 min resulted in stable respiratory mechanics. Ventilation without RM worsened lung mechanics due to alveolar collapse, leading to impaired gas exchange. HF and BP were affected by anaesthesia, but not by ventilation. Microvascular permeability was highest in atelectatic lungs, whereas neutrophil-recruitment and structural changes were strongest in lungs ventilated with high tidal volume. The cytokines IL-6 and KC, but neither TNF nor IP-10, were elevated in the BAL and serum of all ventilated mice and were reduced by recurrent RM. Lung mechanics, oxygenation and pulmonary inflammation were improved by increased PEEP. Conclusions Recurrent RM maintain lung mechanics in their physiological range during low tidal volume ventilation of healthy mice by preventing atelectasis and reduce the development of pulmonary inflammation. PMID:21935418

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

2011-01-01

118

Fatal pneumomediastinum associated with use of noninvasive mechanical ventilation  

PubMed Central

We present a case of fatal pneumomediastinum in a patient with acute respiratory failure caused by acute exacerbated chronic obstructive pulmonary disease (AECOPD) and interstitial lung disease (ILD) precipitated by noninvasive mechanical ventilation (NIMV). To our knowledge, this is the first case reported in the literature. NIMV is very useful to treat acute respiratory failure due to AECOPD improving survival and avoiding endotracheal intubation. Use of NIMV in end stage ILD is not standardized and efficacy is to be proven. No data are reported to manage patient with concomitant COPD and ILD. Pathophysiological mechanisms underlying this fatal complication are explained and suggestions to treat this subgroup of patients discussed. PMID:25530859

Ruggeri, Paolo; Girbino, Giuseppe

2014-01-01

119

Equation Discovery for Model Identification in Respiratory Mechanics of the Mechanically Ventilated Human Lung  

NASA Astrophysics Data System (ADS)

Lung protective ventilation strategies reduce the risk of ventilator associated lung injury. To develop such strategies, knowledge about mechanical properties of the mechanically ventilated human lung is essential. This study was designed to develop an equation discovery system to identify mathematical models of the respiratory system in time-series data obtained from mechanically ventilated patients. Two techniques were combined: (i) the usage of declarative bias to reduce search space complexity and inherently providing the processing of background knowledge. (ii) A newly developed heuristic for traversing the hypothesis space with a greedy, randomized strategy analogical to the GSAT algorithm. In 96.8% of all runs the applied equation discovery system was capable to detect the well-established equation of motion model of the respiratory system in the provided data. We see the potential of this semi-automatic approach to detect more complex mathematical descriptions of the respiratory system from respiratory data.

Ganzert, Steven; Guttmann, Josef; Steinmann, Daniel; Kramer, Stefan

120

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

121

Pleural liquid and kinetic friction coefficient of mesothelium after mechanical ventilation.  

PubMed

Volume and protein concentration of pleural liquid in anesthetized rabbits after 1 or 3h of mechanical ventilation, with alveolar pressure equal to atmospheric at end expiration, were compared to those occurring after spontaneous breathing. Moreover, coefficient of kinetic friction between samples of visceral and parietal pleura, obtained after spontaneous or mechanical ventilation, sliding in vitro at physiological velocity under physiological load, was determined. Volume of pleural liquid after mechanical ventilation was similar to that previously found during spontaneous ventilation. This finding is contrary to expectation of Moriondo et al. (2005), based on measurement of lymphatic and interstitial pressure. Protein concentration of pleural liquid after mechanical ventilation was also similar to that occurring after spontaneous ventilation. Coefficient of kinetic friction after mechanical ventilation was 0.023±0.001, similar to that obtained after spontaneous breathing. PMID:25447684

Bodega, Francesca; Sironi, Chiara; Porta, Cristina; Zocchi, Luciano; Agostoni, Emilio

2015-01-15

122

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

123

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

PubMed

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

Kallet, Richard H

2013-06-01

124

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

PubMed

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

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

2014-12-01

125

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

126

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

E-print Network

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

127

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

128

Prolongation of hospital stay and extra costs due to ventilator-associated pneumonia in an intensive care unit  

Microsoft Academic Search

A prospective cohort study was performed to determine the prolongation of stay and the extra costs incurred due to the occurrence of ventilator-associated pneumonia in intensive care unit patients. Over a 16-month period a sample of 270 consecutive adult patients from a large university anesthesiological intensive care unit requiring ventilation therapy for more than 24 hours was analyzed. A matching

I. Kappstein; G. Schulgen; U. Beyer; K. Geiger; M. Schumacher; F. D. Daschner

1992-01-01

129

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

130

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

PubMed

Controlled mechanical ventilation (CMV) is associated with the development of diaphragm atrophy and contractile dysfunction, and respiratory muscle weakness is thought to contribute significantly to delayed weaning of patients. Therefore, therapeutic strategies for preventing these processes may have clinical benefit. The aim of the current study was to investigate the role of the Janus kinase (JAK)/signal transducer and activator of transcription 3 (STAT3) signaling pathway in CMV-mediated diaphragm wasting and weakness in rats. CMV-induced diaphragm atrophy and contractile dysfunction coincided with marked increases in STAT3 phosphorylation on both tyrosine 705 (Tyr705) and serine 727 (Ser727). STAT3 activation was accompanied by its translocation into mitochondria within diaphragm muscle and mitochondrial dysfunction. Inhibition of JAK signaling during CMV prevented phosphorylation of both target sites on STAT3, eliminated the accumulation of phosphorylated STAT3 within the mitochondria, and reversed the pathologic alterations in mitochondrial function, reduced oxidative stress in the diaphragm, and maintained normal diaphragm contractility. In addition, JAK inhibition during CMV blunted the activation of key proteolytic pathways in the diaphragm, as well as diaphragm atrophy. These findings implicate JAK/STAT3 signaling in the development of diaphragm muscle atrophy and dysfunction during CMV and suggest that the delayed extubation times associated with CMV can be prevented by inhibition of Janus kinase signaling.-Smith, I. J., Godinez, G. L., Singh, B. K., McCaughey, K. M., Alcantara, R. R., Gururaja, T., Ho, M. S., Nguyen, H. N., Friera, A. M., White, K. A., McLaughlin, J. R., Hansen, D., Romero, J. M., Baltgalvis, K. A., Claypool, M. D., Li, W., Lang, W., Yam, G. C., Gelman, M. S., Ding, R., Yung, S. L., Creger, D. P., Chen, Y., Singh, R., Smuder, A. J., Wiggs, M. P., Kwon, O.-S., Sollanek, K. J., Powers, S. K., Masuda, E. S., Taylor, V. C., Payan, D. G., Kinoshita, T., Kinsella, T. M. Inhibition of Janus kinase signaling during controlled mechanical ventilation prevents ventilation-induced diaphragm dysfunction. PMID:24671708

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

2014-07-01

131

[Pneumomediastinum: an aspect of pulmonary barotrauma during mechanical ventilation of acute respiratory distress syndrome].  

PubMed

Mechanical ventilation is a fundamental treatment of acute respiratory distress syndrome (ARDS). Despite compliance with the recommendations of protective mechanical ventilation, it can results in serious complications including the pulmonary barotrauma. This is often manifested by a pneumothorax. This observation describes an unusual aspect of barotrauma which is pneumomediastinum. The authors also point out the role of chest imaging in the management of mechanical ventilation during ARDS. PMID:24646783

Aissaoui, Y; En-Nafaa, I; Chkoura, K; Boughalem, M; Kamili, N Drissi

2014-06-01

132

Ventilator-Associated Pneumonia in Pediatric Intensive Care Unit Patients: Risk Factors and Outcomes  

Microsoft Academic Search

Objectives. To determine the rates, risk factors, and outcomes of ventilator-associated pneumo- nia in pediatric intensive care unit (PICU) patients. Methods. A prospective cohort study was conducted at the St Louis Children's Hospital PICU on all patients who were admitted to the PICU from September 1, 1999, to May 31, 2000, except those who died within 24 hours, were >18

Alexis M. Elward; David K. Warren; Victoria J. Fraser

2009-01-01

133

The efficacy of the COMFORT scale in assessing optimal sedation in critically ill children requiring mechanical ventilation.  

PubMed

Sedation is often necessary to optimize care for critically ill children requiring mechanical ventilation. If too light or too deep, however, sedation can cause significant adverse reactions, making it important to assess the degree of sedation and maintain its optimal level. We evaluated the efficacy of the COMFORT scale in assessing optimal sedation in critically ill children requiring mechanical ventilation. We compared 12 month data in 21 patients (intervention group), for whom we used the pediatric intensive care unit (PICU) sedation protocol of Asan Medical Center (Seoul, Korea) and the COMFORT scale to maintain optimal sedation, with the data in 20 patients (control group) assessed before using the sedation protocol and the COMPORT scale. Compared with the control group, the intervention group showed significant decreases in the total usage of sedatives and analgesics, the duration of mechanical ventilation (11.0 days vs. 12.5 days) and PICU stay (15.0 days vs. 19.5 days), and the development of withdrawal symptoms (1 case vs. 7 cases). The total duration of sedation (8.0 days vs. 11.5 days) also tended to decrease. These findings suggest that application of protocol-based sedation with the COMPORT scale may benefit children requiring mechanical ventilation. PMID:17728512

Jin, Hyun Seung; Yum, Mi Sun; Kim, Seoung Lan; Shin, Hye Young; Lee, Eun Hee; Ha, Eun Ju; Hong, Soo Jong; Park, Seong Jong

2007-08-01

134

Prevention of ventilator-associated pneumonia: Current practice in Canadian intensive care units  

Microsoft Academic Search

Objective: To evaluate the current use of strategies to prevent ventilator-associated pneumonia (VAP) and to identify interventions to target for quality-improvement initiatives. Design: Cross-sectional national survey. Setting: Canadian intensive care units (ICUs) with at least 8 beds. Patients: Seven hundred and two patients in 66 ICUs in 10 provinces in Canada. Interventions: None. Measurements and Results: The Canadian Critical Care

Daren K. Heyland; Deborah J. Cook; Peter M. Dodek

2002-01-01

135

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

136

Mechanical ventilation, diaphragm weakness and weaning: a rehabilitation perspective.  

PubMed

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 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 potential VIDD treatments have 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

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

2013-11-01

137

New perspectives on the evolution of lung ventilation mechanisms in vertebrates  

E-print Network

New perspectives on the evolution of lung ventilation mechanisms in vertebrates 11 E.L. Brainerd. In the traditional view of vertebrate lung ventilation mechanisms, air-breathing fishes and amphibians breathe exhibits a mechanism that is intermediate between buccal pumping and aspiration breathing; all lung

Brainerd, Elizabeth

138

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

139

Round table March 2005, Brussels The ventilator of tomorrow  

E-print Network

Round table ­ March 2005, Brussels The ventilator of tomorrow Laurent Brochard, MD, Michel Dojat (France) Tél. 01.49.81.25.45 e-mail : laurent.brochard@hmn.aphp.fr #12;The ventilator of our dreams does this ventilator. Technology is very present in the intensive care unit. The field of mechanical ventilation has

Dojat, Michel

140

Ventilator-Associated Pneumonia: A Review  

Microsoft Academic Search

Ventilator-associated pneumonia is the most frequent intensive care unit (ICU)-related infection in patients requiring mechanical ventilation. In contrast to other ICU-related infections, which have a low mortality rate, the mortality rate for ventilator-associated pneumonia ranges from 20% to 50%. These clinically significant infections prolong duration of mechanical ventilation and ICU length of stay, underscoring the financial burden these infections impose

Kimberly A. Davis

2006-01-01

141

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

142

Anaesthesia ventilators.  

PubMed

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

Jain, Rajnish K; Swaminathan, Srinivasan

2013-09-01

143

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

PubMed

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

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

2014-08-01

144

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

145

Use of propofol to facilitate extubation in mechanically ventilated children: A case for pediatric trials  

Microsoft Academic Search

Background: Sedatives are frequently used to facilitate mechanical ventilation of critically ill pediatric patients. Many of these drugs are used in children before appropriate clinical pharmacology and efficacy\\/safety trials are performed in the targeted pediatric population.Objective: This study assesses the prescribing patterns and clinical utility of propofol as a sedative before anticipated extubation in mechanically ventilated pediatric patients in the

Mark L. Glover; Jeffrey L. Blumer; Michael D. Reed

2002-01-01

146

Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease  

Microsoft Academic Search

INTRODUCTION: Mechanical ventilation (MV) with high tidal volumes may induce or aggravate lung injury in critical ill patients. We compared the effects of a protective versus a conventional ventilatory strategy, on systemic and lung production of tumor necrosis factor-? (TNF-?) and interleukin-8 (IL-8) in patients without lung disease. METHODS: Patients without lung disease and submitted to mechanical ventilation admitted to

Roselaine Pinheiro de Oliveira; Marcio Pereira Hetzel; Mauro dos Anjos Silva; Daniele Dallegrave; Gilberto Friedman

2010-01-01

147

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

148

Early and small changes in serum creatinine concentrations are associated with mortality in mechanically ventilated patients.  

PubMed

Emerging evidence suggests that minor changes in serum creatinine concentrations are associated with increased hospital mortality rates. However, whether serum creatinine concentration (SCr) on admission and its change are associated with an increased mortality rate in mechanically ventilated patients is not known. We have conducted an international, prospective, observational cohort study enrolling adult intensive care unit patients under mechanical ventilation (MV). Recursive partitioning was used to determine the values of SCr at the start of MV (SCr0) and the change in SCr ([DeltaSCr] defined as the maximal difference between the value at start of MV [day 0] and the value on MV day 2 at 8:00 am) that best discriminate mortality. In-hospital mortality, adjusted by a proportional hazards model, was the primary outcome variable. A total of 2,807 patients were included; median age was 59 years and median Simplified Acute Physiology Score II was 44. All-cause in-hospital mortality was 44%. The variable that best discriminated outcome was a SCr0 greater than 1.40 mg/dL (mortality, 57% vs. 36% for patients with SCr0 mechanically ventilated patients. PMID:20634655

Nin, Nicolás; Lombardi, Raúl; Frutos-Vivar, Fernando; Esteban, Andrés; Lorente, José A; Ferguson, Niall D; Hurtado, Javier; Apezteguia, Carlos; Brochard, Laurent; Schortgen, Fréderique; Raymondos, Konstantinos; Tomicic, Vinko; Soto, Luis; González, Marco; Nightingale, Peter; Abroug, Fekri; Pelosi, Paolo; Arabi, Yaseen; Moreno, Rui; Anzueto, Antonio

2010-08-01

149

Improved Oral Hygiene in Adult Critical Care Patients Reduces the Incidence of Ventilator-Associated Pneumonia  

Microsoft Academic Search

over 90% receiving invasive mechanical ventilation. In one zone of the ICU, an intervention, designed to improve oral hygiene and aid protocol compliance, was commenced. The intervention included 8 hourly OP cleaning, toothbrushing, suctioning of the OP and hypopharynx, moisturization of lips and mucous membranes, instillation of cetylpyridium chloride antiseptic oral rinse (4). Hardware aiding this intervention included single use

Blakley S; Lavery GG; Trainor D; Thompson I; Smyth E

2008-01-01

150

Effects of three approaches to standardized oral hygiene to reduce bacterial colonization and ventilator associated pneumonia in mechanically ventilated patients: A randomised control trial  

Microsoft Academic Search

BackgroundVentilator associated pneumonia remains an important concern in the intensive care unit (ICU). An increasing body of evidence shows that mortality and morbidity can be reduced by implementing a range of preventive strategies, including optimizing oral hygiene.

A. M. Berry; P. M. Davidson; J. Masters; K. Rolls; R. Ollerton

2011-01-01

151

STATE OF CALIFORNIA INDOOR AIR QUALITY AND MECHANICAL VENTILATION  

E-print Network

for each additional person. (Eq. 4.1a) Qfan = 0.01Afloor + 7.5(Nbr + 1) Where: Afloor = conditioned floor flow rate, (cfm) Enter Eq 4.1a Calculation: Afloor = Nbr = Qfan = Delivered Ventilation: The effective to intermittent systems. (Eq. 4.2) Qf = Qr / (f) Where: Qr = ventilation air requirement from Eq. 4.1a (above) f

152

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

153

Heat stress protects against mechanical ventilation-induced diaphragmatic atrophy.  

PubMed

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

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

2014-09-01

154

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

NASA Astrophysics Data System (ADS)

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

Vanrhein, Timothy; Banerjee, Arindam

2010-11-01

155

Reduced mite allergen levels in dwellings with mechanical exhaust and supply ventilation.  

PubMed

Seventy similar bungalows constructed between 1968 and 1970 in the same suburban area of Stockholm were investigated regarding the content of house dust mite allergen, absolute indoor humidity, type of ventilation and basement construction. Houses with mechanical exhaust and supply ventilation had an indoor humidity above 7 g/kg less often than houses without this type of ventilation (Odds ratio 0.1, 95% confidence interval 0.0-0.2). Furthermore, only five of the 24 houses with exhaust and supply ventilation contained mattress dust mite allergen concentrations exceeding the median value (98.5 ng/g) compared with 30 of 46 hours which did not have such ventilation (odds ratio = 0.1, C.I. 0.0-0.5). Houses with both natural ventilation and crawl space basement harboured significantly less mattress mite allergen than houses having the same type of ventilation, but with a concrete slab basement. In a cold temperature climate, type of building construction and ventilation seem to be important for the occurrence of house dust mite allergens in dwellings. Our results indicate that modern energy-efficient houses should be equipped with mechanical exhaust and supply ventilation to reduce indoor air humidity during the dry winter months and the risk of mite infestation. PMID:8187025

Wickman, M; Emenius, G; Egmar, A C; Axelsson, G; Pershagen, G

1994-02-01

156

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

157

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

158

Influence of mechanical ventilation and pulmonary disease on pulmonary artery pressure monitoring.  

PubMed Central

Mechanical ventilation and respiratory disease impose both theoretical and practical limitations on the interpretation of hemodynamic measurements. To properly interpret such information a thorough understanding of the circulatory changes associated with normal breathing, mechanical ventilation and respiratory disease is vital. There are a variety of factors involved in patients with obstructive lung disease and those receiving mechanical ventilation that complicate the usual interpretation of hemodynamic data obtained from flow-directed catheters. An awareness of the potential pitfalls of hemodynamic monitoring in such situations is important in the efficient use of the hemodynamic data obtained. PMID:387199

King, E G

1979-01-01

159

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

PubMed Central

Background Nosocomial and ventilator-associated pneumonia (VAP) are causes of significant morbidity and mortality in hospitalized patients. We analyzed a) the incidence and the outcome of pneumonias caused by different pathogens in the intensive care unit (ICU) of a medium-sized twenty-four bed community hospital and b) the incidence of complications of such pneumonias requiring surgical intervention such as thoracotomy and decortication. Results We retrospectively reviewed the charts of patients diagnosed with nosocomial and ventilator-associated pneumonia in our ICU. Their bronchoalveolar lavage (BAL) and sputum cultures, antibiograms, and other clinical characteristics, including complications and need for tracheostomy, thoracotomy and decortication were studied. In a span of one year (2011–12), 43 patients were diagnosed with nosocomial pneumonia in our ICU. The median simplified acute physiology score (SAPS II) was 39. One or more gram negative organisms as the causative agents were present in 85% of microbiologic samples. The three most prevalent gram negatives were Stenotrophomonas maltophilia (34%), Pseudomonas aeurginosa (40%), and Acinetobacter baumannii (32%). Twenty eight percent of bronchoalveolar samples contained Staphylococcus aureus. Eight three percent of patients required mechanical ventilation postoperatively and 37% underwent tracheostony. Thirty five percent underwent thoracotomy and decortication because of further complications such as empyema and non-resolving parapneumonic effusions. A. baumannii, Klebsiella pneumonia extended spectrum beta lactam (ESBL) and P. aeurginosa had the highest prevalence of multi drug resistance (MDR). Fifteen patients required surgical intervention. Mortality from pneumonia was 37% and from surgery was 2%. Conclusion Nosocomial pneumonias, in particular the ones that were caused by gram negative drug resistant organisms and their ensuing complications which required thoracotomy and decortication, were the cause of significant morbidity in our intensive care unit. Preventative and more intensive and novel infection control interventions in reducing the incidence of nosocomial pneumonias are strongly emphasized. PMID:24725655

2014-01-01

160

Predictors of Prolonged Mechanical Ventilation after Open Heart Surgery  

PubMed Central

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

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

2014-01-01

161

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

162

Stomach as a source of colonization of the respiratory tract during mechanical ventilation: association with ventilator-associated pneumonia  

Microsoft Academic Search

The aetiopathogenesis of ventilator-associated pneumonia (VAP) requires abnormal oropharyngeal and gastric colonization and the further aspira- tion of their contents to the lower airways. VAP develops easily if aspiration or inoculation of microorganisms occur in patients with artificial airways, in whom mechanical, cellular and\\/or humoral defences are altered. Well-known risk factors for gastric colonization include: alterations in gastric juice secretion;

A. Torres; M. El-Ebiary; N. Soler; C. Montón; N. Fàbregas; C. Hernández

1996-01-01

163

Development and pilot testing of a decision aid for surrogates of patients with prolonged mechanical ventilation  

PubMed Central

Objective Shared decision making is inadequate in intensive care units (ICUs). Decision aids can improve decision making quality, though their role in an ICU setting is unclear. We aimed to develop and pilot test a decision aid for shared decision makers of patients undergoing prolonged mechanical ventilation. Setting ICUs at three medical centers. Subjects 53 surrogate decision makers and 58 physicians. Design and interventions We developed the decision aid using defined methodological guidelines. After an iterative revision process, formative cognitive testing was performed among surrogate-physician dyads. Next, we compared the decision aid to usual care control in a prospective, before/after design study. Measurements and main results Primary outcomes were physician-surrogate discordance for expected patient survival, comprehension of relevant medical information, and the quality of communication. Compared to control, the intervention group had lower surrogate-physician discordance (7 [10] vs 43 [21]), greater comprehension (11.4 [0.7] vs 6.1 [3.7]), and improved quality of communication (8.7 [1.3] vs 8.4 [1.3]) (all p<0.05) post-intervention. Hospital costs were lower in the intervention group ($110,609 vs $178,618; p=0.044); mortality did not differ by group (38% vs 50%, p=0.95). 94% of surrogates and 100% of physicians reported that the decision aid was useful in decision making. Conclusion We developed a prolonged mechanical ventilation decision aid that is feasible, acceptable, and associated with both improved decision making quality and less resource utilization. Further evaluation using a randomized controlled trial design is needed to evaluate the decision aid's effect on long-term patient and surrogate outcomes. PMID:22635048

Cox, Christopher E.; Lewis, Carmen L.; Hanson, Laura C.; Hough, Catherine L.; Kahn, Jeremy M.; White, Douglas B.; Song, Mi-Kyung; Tulsky, James A.; Carson, Shannon S.

2013-01-01

164

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

Microsoft Academic Search

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

Bronagh Blackwood; Fiona Alderdice; Karen Burns; Chris Cardwell; Gavin Lavery; Peter O’Halloran

2011-01-01

165

Secondary plastic closure of gastroschisis is associated with a lower incidence of mechanical ventilation.  

PubMed

Introduction?Nonsurgical closure after primary silo placement, secondary plastic closure (SPC), has been used as an alternative to secondary surgical closure (SSC) in gastroschisis. The benefits described were closure without formal surgical procedure, cosmetic aspect, and minimization of intra-abdominal pressures. This study compared requirements for mechanical ventilation and general anesthesia, nutritional care, and outcomes between SPC and SSC. Patients and Methods?We included patients with primary staged-silo reduction with a 1-year minimum follow-up. SPC was performed at bedside with sedation using a nonadherent dressing. SSC was performed in operating room under general anesthesia using standard surgical techniques. Results?This retrospective study included 64 patients, 23 SPC and 41 SSC. The characteristics of the two groups were comparable. Mechanical ventilation was used for 15 SPC and 41 SSC (p?=?0.0001) with a comparable median duration (5.5 and 6.0 days, not significant [NS]). General anesthesia was required for 9 SPC and 41 SSC (p?care unit (24 and 23.5 days) and overall hospital LOS (37 and 36 days) were not statistically different between SPC and SSC patients without complications, respectively. These data were comparable for SPC and SSC patients with complications. Five SPC and six SSC developed an umbilical hernia (NS); two patients in each group required a surgical repair (NS). Conclusion?Plastic closure of gastroschisis after primary silo reduction is simple, safe, reproducible, and associated with a significant lower incidence of mechanical ventilation. Nutritional management and length of hospital stay were similar to conventional surgical closure for patients. Plastic closure allows nonoperative management without general anesthesia at patient's bedside, in comparison with surgical closure that must be performed under general anesthesia in the operating room. Plastic closure does not appear to be associated with more umbilical hernias in this retrospective study. PMID:25526605

Dariel, Anne; Poocharoen, Wannisa; de Silva, Nicole; Pleasants, Hazel; Gerstle, Justin Ted

2015-02-01

166

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

E-print Network

of Mechanical Ventilator Settings for Pulmonary Disease States Anup Das, Prathyush P. Menon, Jonathan G. Hardman, and Declan G. Bates Abstract--The selection of mechanical ventilator settings that ensure adequate oxygenation and carbon dioxide clearance while minimizing the risk of ventilator-associated lung injury (VALI

Davies, Christopher

167

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

PubMed Central

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

Schonhofer, B.; Kohler, D.

2000-01-01

168

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

Technology Transfer Automated Retrieval System (TEKTRAN)

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

169

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

EPA Science Inventory

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

170

Perception of non-invasive ventilation in adult Swiss intensive care units.  

PubMed

The real utilisation scenario of non-invasive ventilation (NIV) in Swiss ICUs has never been reported. Using a survey methodology, we developed a questionnaire sent to the directors of the 79 adult ICUs to identify the perceived pattern of NIV utilisation. We obtained a response rate of 62%. The overall utilisation rate for NIV was 26% of all mechanical ventilations, but we found significant differences in the utilisation rates among different linguistic areas, ranging from 20% in the German part to 48% in the French part (p <0.01). NIV was mainly indicated for the acute exacerbations of COPD (AeCOPD), acute cardiogenic pulmonary edema (ACPE) and acute respiratory failure (ARF) in selected do-not-intubate patients. In ACPE, CPAP was much less used than bi-level ventilation and was still applied in AeCOPD. The first line interface was a facial mask (81%) and the preferred type of ventilator was an ICU machine with an NIV module (69%). The perceived use of NIV is generally high in Switzerland, but regional variations are remarkable. The indications of NIV use are in accordance with international guidelines. A high percentage of units consider selected do-not-intubate conditions as an important additional indication. PMID:22481224

Salvadè, Igor; Domenighetti, Guido; Jolliet, Philippe; Maggiorini, Marco; Rothen, Hans-Ueli

2012-01-01

171

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

172

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

173

Recent advances in mechanical ventilation in patients without acute respiratory distress syndrome  

PubMed Central

While being an essential part of general anesthesia for surgery and at times even a life-saving intervention in critically ill patients, mechanical ventilation has a strong potential to cause harm. Certain ventilation strategies could prevent, at least to some extent, the injury caused by this intervention. One essential element of so-called ‘lung-protective’ ventilation is the use of lower tidal volumes. It is uncertain whether higher levels of positive end-expiratory pressures have lung-protective properties as well. There are indications that too high oxygen fractions of inspired air, or too high blood oxygen targets, are harmful. Circumstantial evidence further suggests that spontaneous modes of ventilation are to be preferred over controlled ventilation to prevent harm to respiratory muscle. Finally, the use of restrictive sedation strategies in critically ill patients indirectly prevents ventilation-induced injury, as daily spontaneous awakening and breathing trials and bolus instead of continuous sedation are associated with shorter duration of ventilation and shorten the exposure to the injurious effects of ventilation. PMID:25580269

Filho, Roberto R.; Rocha, Leonardo L.; Schultz, Marcus J.

2014-01-01

174

Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients  

Microsoft Academic Search

INTRODUCTION: Delirium occurs in most ventilated patients and is independently associated with more deaths, longer stay, and higher cost. Guidelines recommend monitoring of delirium in all intensive care unit (ICU) patients, though few data exist in non-ventilated patients. The study objective was to determine the relationship between delirium and outcomes among non-ventilated ICU patients. METHOD: A prospective cohort investigation of

Jason WW Thomason; Ayumi Shintani; Josh F Peterson; Brenda T Pun; James C Jackson; E Wesley Ely

2005-01-01

175

Total liquid ventilation provides superior respiratory support to conventional mechanical ventilation in a large animal model of severe respiratory failure.  

PubMed

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 mm Hg, 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

176

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

E-print Network

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

Lucas, Peter

177

Continuous versus intermittent administration of piperacillin–tazobactam in intensive care unit patients with ventilator-associated pneumonia  

PubMed Central

Background and Aims: Ventilator-associated pneumonia (VAP) is one of the most common Intensive Care Unit (ICU)-acquired infection. The aim of this study was to compare the clinical outcome of continuous and intermittent administration of piperacillin–tazobactam by serial measurements of the Clinical Pulmonary Infection Score (CPIS). Subjects and Methods: Groups were designed as parallel and the study was designed as quasi-experimental and conducted at a semi-closed ICU between September 2008 and May 2010. Patients received 3.375 g (piperacillin 3 g/tazobactam 0.375 g) either through intermittent infusion every 6 h for 30 min [Intermittent Infusion (II) group; n = 30] or through continuous infusion every 8 h for 4 h [Continuous Infusion (CI) group; n = 31]. CPIS was used to assess the clinical diagnosis and outcome of VAP patients. Results: Sex, age, Acute Physiology and Chronic Health Evaluation II II score on ICU admission, diagnosis and underlying disease of VAP patients were not significantly different in the CI (n = 31) and II (n = 30) groups. Duration of mechanical ventilation, length of stay, total number of antibiotics used per patient and duration of piperacillin/tazobactam treatment were similar in both groups. Mortality rates of VAP patients were similar between both groups during hospitalization. Conclusion: There was no significant difference in clinical outcomes of patients receiving piperacillin–tazobactam via CI or II when measured by serial CPIS score. PMID:23188954

Fahimi, Fanak; Ghafari, Somayeh; Jamaati, Hamidreza; Baniasadi, Shadi; Tabarsi, Payam; Najafi, Arvin; Akhzarmehr, Arnavaz; Hashemian, Seyed Mohammad Reza

2012-01-01

178

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

179

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

180

Intravenous immunoglobulin vs plasma exchange in treatment of mechanically ventilated adults with Guillain-Barré syndrome  

PubMed Central

Introduction The aim of the study is to compare efficacy of IvIg versus PE in treatment of mechanically ventilation adults with GBS in intensive care unit. Methods It is a prospective, non randomized study, realized in a medical ICU from 2006 to 2010. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 4 PE during 10-14 days). We collected demographic characteristics, clinical and therapeutic aspects and outcome. Statistical analysis used: The quantitative variables are expressed on mean ± standard derivation and compared by Student test. The statistic analysis has been based on SPSS for windows. P < 0.05 is considered as significant. Results Forty-one patients (21 in group 1 and 20 in group 2) were enrolled. The mean age was 37.4 ± 9.2 years, with a masculine predominance (75.4%). Electromyogram in all patients found acute inflammatory demyelinating polyradiculoneuropathy in 80.5% of patients. The mean length of hospitalization was 45.3 ± 9.2 days. The length of hospitalization of the IvIg group is less long than PE group (p = 0.03). The weaning of the MV was more precocious in IvIg group than PE group (p = 0.01). Also, the beginning of motility recuperation was precocious at IvIg group than PE group (p = 0.04). Conclusion Our work reveals a meaningful difference for the MV weaning and precocious recovery in IvIg group compared to PE group. PMID:25368724

Charra, Boubaker; Hachimi, Abdelhamid; Benslama, Abdellatif; Motaouakkil, Said

2014-01-01

181

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

182

Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and  

Microsoft Academic Search

Objective To evaluate the effect of oral decontamination on the incidence of ventilator associated pneumonia and mortality in mechanically ventilated adults. Design Systematic review and meta-analysis. Data sources Medline, Embase, CINAHL, the Cochrane Library, trials registers, reference lists, conference proceedings, and investigators in the specialty. Review methods Two independent reviewers screened studiesforinclusion,assessedtrialquality,andextracted data. Eligible trials were randomised controlled trials enrolling

Ee Yuee Chan; Annie Ruest; Maureen O Meade; Deborah J Cook

2007-01-01

183

Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis  

Microsoft Academic Search

Objective To evaluate the effect of oral decontamination on the incidence of ventilator associated pneumonia and mortality in mechanically ventilated adults.Design Systematic review and meta-analysis.Data sources Medline, Embase, CINAHL, the Cochrane Library, trials registers, reference lists, conference proceedings, and investigators in the specialty.Review methods Two independent reviewers screened studies for inclusion, assessed trial quality, and extracted data. Eligible trials were

Ee Yuee Chan; Annie Ruest; Maureen O Meade; Deborah J Cook

2007-01-01

184

Continuous infusion of ketamine in mechanically ventilated children with refractory bronchospasm  

Microsoft Academic Search

Objective: To determine whether ketamine infusion to me- chanically ventilated children with refractory bronchospasm is benefi- cial. Design: Retrospective chart review. Setting: Pediatric intensive care unit (PICU) of a children's hospital. Patients: Seventeen patients, ages ranging from 5 months to 17 years (mean 6-+ 5.7 years), were admitted to our PICU over a 3-year period and received ketamine infusion dur-

M. Z. Youssef-Ahmed; P. Silver; L. Nimkoff; M. Sagy

1996-01-01

185

Test of 20 similar intensive care ventilators in daily use conditions —evaluation of accuracy and performances  

Microsoft Academic Search

Infrequent control, aging of components, may compromise the accuracy of ICU ventilators. In order to assess the reliability of ventilators during their clinical use, we bench tested a group of 20 CPU1 ventilators (Ohmeda) sampled at random in several ICU units. We found major leaks in 5 ventilators, attributable to the disposable tubings used in these systems. Mean error in

L. Beydon; N. Liu; J. Hassapopoulos; F. Rua; F. Bonnet; A. Harf; Ph. Duvaldestin

1992-01-01

186

Measurement of tracheal temperature is not a reliable index of total respiratory heat loss in mechanically ventilated patients  

PubMed Central

Background: Minimizing total respiratory heat loss is an important goal during mechanical ventilation. The aim of the present study was to evaluate whether changes in tracheal temperature (a clinical parameter that is easy to measure) are reliable indices of total respiratory heat loss in mechanically ventilated patients. Method: Total respiratory heat loss was measured, with three different methods of inspired gas conditioning, in 10 sedated patients. The study was randomized and of a crossover design. Each patient was ventilated for three consecutive 24-h periods with a heated humidifier (HH), a hydrophobic heat-moisture exchanger (HME) and a hygroscopic HME. Total respiratory heat loss and tracheal temperature were simultaneously obtained in each patient. Measurements were obtained during each 24-h study period after 45 min, and 6 and 24 h. Results: Total respiratory heat loss varied from 51 to 52 cal/min with the HH, from 100 to 108 cal/min with the hydrophobic HME, and from 92 to 102 cal/min with the hygroscopic HME (P < 0.01). Simultaneous measurements of maximal tracheal temperatures revealed no significant differences between the HH (35.7-35.9°C) and either HME (hydrophobic 35.3-35.4°C, hygroscopic 36.2-36.3°C). Conclusion: In intensive care unit (ICU) mechanically ventilated patients, total respiratory heat loss was twice as much with either hydrophobic or hydroscopic HME than with the HH. This suggests that a much greater amount of heat was extracted from the respiratory tract by the HMEs than by the HH. Tracheal temperature, although simple to measure in ICU patients, does not appear to be a reliable estimate of total respiratory heat loss. PMID:11178222

Thomachot, Laurent; Viviand, Xavier; Lagier, Pierre; Marc Dejode, Jean; Albanèse, Jacques; Martin, Claude

2001-01-01

187

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

SciTech Connect

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

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

2011-07-01

188

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

NASA Technical Reports Server (NTRS)

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

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

1997-01-01

189

GASTRIC REFLUX IN MECHANICALLY VENTILATED GASTRIC FED ICU PATIENTS  

E-print Network

Association of Critical Care Nurses (AACN) American Society for Parenteral and Enteral Nutrition (ASPEN) Body Mass Index (BMI) Centers for Disease Control (CDC) Electronic Medical Record (EMR) Enzyme-Linked Immunosorbent Assay (ELISA... of Critical Care Nurses (AACN),22 3) American Society for Parenteral and Enteral Nutrition (ASPEN),1 4) Canadian Critical Care Trials Group,23 and 5) a joint guideline from ASPEN and the Society of Critical Care Medicine (SCCM).24 Conversely, risk...

Schallom, Marilyn

2013-08-31

190

Ventilator management protocols in pediatrics.  

PubMed

Management of mechanical ventilation is a complex process with outcomes affected by multiple patient and caregiver variable. Well-constructed protocols represent the synthesis of best available evidence regarding ventilator management. In adults, protocols improve important outcomes such as duration of mechanical ventilation, length of stay, and complication rates; however, protocols are not uniformly successful. In pediatrics, the available evidence does not suggest that ventilator management protocols should be adopted routinely, which may be due to pediatric-specific attributes such as a generally shorter weaning duration. Evidence suggests support for protocols to carefully titrate sedation. In addition, daily assessment of SBTs improves patient outcomes and should be more uniformly adopted in pediatrics. Ventilator-related outcomes may be affected by other confounding factors such as nutrition and fluid balance. Specific subpopulations, such as children who have congenital heart disease, may present opportunities for focused use of ventilator management protocols. Protocolized ventilation has an important place in trials of new therapeutic strategies such as surfactant or proning. It is hoped that future research will further define the appropriate use of protocols in the general PICU population. Although specific protocols cannot be routinely recommended, a multidisciplinary team approach to synthesizing available literature and determining best practice is a useful model. This approach will foster "team ownership" of ventilator management by all involved, thus engendering the best possible outcomes for critically ill children who require mechanical ventilation. PMID:16952800

Graham, Alan S; Kirby, Aileen L

2006-09-01

191

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

192

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

PubMed Central

Mechanical ventilation (MV) is a life-saving measure and supportive modality utilized to treat patients experiencing respiratory failure. Patients experience pain, discomfort, and anxiety as a result of being mechanically ventilated. Music listening is a non-pharmacological intervention used to manage these psychophysiological symptoms associated with mechanical ventilation. The purpose of this secondary analysis was to examine music preferences of 107 MV patients enrolled in a randomized clinical trial that implemented a patient-directed music listening protocol to help manage the psychophysiological symptom of anxiety. Music data presented includes the music genres and instrumentation patients identified as their preferred music. Genres preferred include: classical, jazz, rock, country, and oldies. Instrumentation preferred include: piano, voice, guitar, music with nature sounds, and orchestral music. Analysis of three patients’ preferred music received throughout the course of the study is illustrated to demonstrate the complexity of assessing MV patients and the need for an ongoing assessment process. PMID:21154376

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

2014-01-01

193

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

PubMed Central

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

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

2014-01-01

194

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

PubMed

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

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

2015-01-01

195

Quality of life of patients treated by home mechanical ventilation due to restrictive ventilatory disorders.  

PubMed

The quality of life of patients with hypoventilation and home mechanical ventilation (HMV) has not been well described. Modern quality of life assessment techniques were therefore introduced in a cross-sectional study of patients treated with HMV. The aim was to study various aspects of the patient's quality of life and relate them to the underlying diseases, blood gases and the type of ventilatory connection. The study comprised 39 patients, most of them ventilated only during the night (n = 35). Nasal ventilation predominated (n = 29). Patients treated with HMV reported satisfactory levels of both psychosocial functioning and mental well-being that compared well with a general population group. Their quality of sleep was generally good. The quality of life measures were mainly influenced by the patients' underlying disease. Patients with scoliosis expressed in almost all instances the best quality of life. The quality of life of patients with ventilation by tracheostomy was reported to be at least as good as that of patients with nasal ventilation. The global quality of life estimation was mainly determined by the mental state of the patients and their sleep quality and only to a minor extent by physical handicaps. In conclusion, the patients treated with HMV reported good psychosocial functioning and mental well-being, in spite of severe physical limitations and dependence on regular nocturnal ventilation. PMID:8029509

Pehrsson, K; Olofson, J; Larsson, S; Sullivan, M

1994-01-01

196

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 Simões; Vieira, Silvia Regina Rios

2014-01-01

197

Ventilator associated pneumonia  

PubMed Central

Hospital acquired or nosocomial infections continue to be an important cause of morbidity and mortality. The critically ill patient is at particular risk of developing intensive care unit acquired infection, with the lungs being especially vulnerable. Nosocomial bacterial pneumonia occurring after two days of mechanical ventilation is referred to as ventilator associated pneumonia, and is the most common nosocomial infection seen in the intensive care unit. Intubation of the trachea and mechanical ventilation is associated with a 7?fold to 21?fold increase in the incidence of pneumonia and up to 28% of patients receiving mechanical ventilation will develop this complication. Its development is associated with an attributable increase in morbidity and mortality. The establishment of an accurate diagnosis of ventilator associated pneumonia remains problematic and as yet there is still no accepted “gold standard” for diagnosis. The responsible pathogens vary according to case mix, local resistance patterns, and methodology of sampling. However, there is general agreement that rapid initiation of appropriate antimicrobial therapy improves outcome. PMID:16517798

Hunter, J D

2006-01-01

198

Commissioning Trial for Mechanical Ventilation System Installed in Houses  

E-print Network

Performance recovery of a central ventilation system in a house 0 5 10 15 20 25 30 35 S upply 1 S up ply 2 S upp ly 3 S upply 4 S upply 5 0 20 40 60 80 100 120 S uppl y (t o t a l ) ? A ft e r 4 y e a r s w i thout an y m ai ntenance ?Insect... decreased to 54.1% of the ideal airflow volume. Fig. 5 Relation between pressure drop coefficient and opening rate 0 50 100 150 200 250 Id e a l E x h a u s t fi l te r s t u ffe d m3/h 100% 54. 1% Fig. 6 Foul...

Ohta, I.; Fukushima, A.

2004-01-01

199

Prediction of mortality from respiratory distress among long-term mechanically ventilated patients.  

PubMed

With the advent of inexpensive storage, pervasive networking, and wireless devices, it is now possible to store a large proportion of the medical data that is collected in the intensive care unit (ICU). These data sets can be used as valuable resources for developing and validating predictive analytics. In this report, we focus on the problem of prediction of mortality from respiratory distress among long-term mechanically ventilated patients using data from the publicly-available MIMIC-II database. Rather than only reporting p-values for univariate or multivariate regression, as in previous work, we seek to generate sparsest possible model that will predict mortality. We find that the presence of severe sepsis is highly associated with mortality. We also find that variables related to respiration rate have more predictive accuracy than variables related to oxygenation status. Ultimately, we have developed a model which predicts mortality from respiratory distress in the ICU with a cross-validated area-under-the-curve (AUC) of approximately 0.74. Four methodologies are utilized for model dimensionality-reduction: univariate logistic regression, multivariate logistic regression, decision trees, and penalized logistic regression. PMID:25570736

Boverman, Gregory; Genc, Sahika

2014-08-01

200

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

PubMed Central

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

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

2014-01-01

201

Children and Young People Requiring Home Assisted Ventilation in the South of England: Incidence, Receipt of Care Support and Components of the Care Package  

ERIC Educational Resources Information Center

The study found an increasing number of ventilator dependent children and young people living at home. Almost three quarters of the sample had a physical disability as a result of or in addition to their primary diagnosis. There was wide variation in the amount of paid care supporting these families which appeared unrelated to the level of…

While, Alison E.; Cockett, Andrea M.; Lewis, Samantha

2004-01-01

202

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

PubMed

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

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

2013-01-15

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

Care of a cardiac pt on mechanical ventilation  

E-print Network

#12;#12;Indications for intubation · Work of breathing · Upper airway obstruction · Actual pressure 3. PEEP: Positive end-expiratory pressure 4. PS: Pressure support = Mean airway pressure 5. V or potential decrease in airway· Actual or potential decrease in airway protection · Hypoxemia despite max non

Kay, Mark A.

205

Factors associated with swallowing assessment after oral endotracheal intubation and mechanical ventilation for acute lung injury.  

PubMed

Rationale: Endotracheal intubation is associated with post-extubation swallowing dysfunction, but no guidelines exist for post-extubation swallowing assessments. Objectives: We evaluated the prevalence, patient demographic and clinical factors, and intensive care unit (ICU) and hospital organizational factors associated with swallowing assessment after oral endotracheal intubation and mechanical ventilation in patients with acute lung injury. Methods: This is a secondary analysis of a prospective cohort study that evaluates 178 eligible patients with ALI who were mechanically ventilated via oral endotracheal tube, recruited from 13 ICUs at 4 teaching hospitals in Baltimore, MD. Patient demographic and clinical factors, type of ICU, and hospital study site were evaluated for their association with completion of a swallowing assessment both in ICU and after ICU before hospital discharge. Factors significantly associated with a swallow assessment were evaluated in a multivariable logistic regression model. Measurements and Main Results: Before hospital discharge, 79 (44%) patients completed a swallowing assessment: 59 (75%) initiated in ICU, 20 (25%) initiated on hospital ward. Female sex (Odds Ratio [OR]=2.01; 95% confidence interval [95%CI]=1.03, 3.97), orotracheal intubation duration (OR=1.13 per day; 95%CI=1.05, 1.22), and hospital study site (site 3 OR=2.41; 95%CI=1.00, 5.78) were independently associated with swallowing assessment. Although hospital site 3 had a 2-fold increase in swallowing assessments in the ICU, there was no significant difference between hospitals in the frequency of swallowing assessments completed after ICU discharge (p=0.287) and in the proportion of patients failing a swallowing assessment conducted in the ICU (p=0.468) or on the ward (p=0.746). Conclusions: In this multi-site prospective study, female sex, intubation duration, and hospital site were associated with post-extubation swallowing assessment. These results demonstrate variability in practice patterns between institutions and highlight the need to determine the appropriate timing and indications for swallowing assessment and to more fully understanding swallowing dysfunction after intubation. PMID:25387319

Brodsky, Martin B; González-Fernández, Marlís; Mendez-Tellez, Pedro A; Shanholtz, Carl; Palmer, Jeffrey B; Needham, Dale M

2014-11-11

206

PETCO2 measurement and feature extraction of capnogram signals for extubation outcomes from mechanical ventilation.  

PubMed

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

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

2015-02-01

207

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

PubMed Central

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

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

2014-01-01

208

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

209

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

210

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

E-print Network

Lung ventilation in vertebrates is accomplished by diverse respiratory pump mechanisms. Amniotes into the lungs. Air-breathing fishes and amphibians, in contrast, use a buccal pump (pulse pump) in which the mouth cavity expands to fill with fresh air and then compresses to pump air into the lungs (Gans, 1970b

Brainerd, Elizabeth

211

Mobility Interventions to Improve Outcomes in Patients Undergoing Prolonged Mechanical Ventilation: A Review of the Literature  

PubMed Central

Survivors of critical illness often undergo an extended recovery trajectory. Reduced functional ability is one of several adverse outcomes of prolonged bed rest and mechanical ventilation during critical illness. Skeletal muscle weakness is known to be one of the major phenomena that account for reduced functional ability. Although skeletal muscle weakness is evident after prolonged mechanical ventilation, few studies have tested the benefits of various types of mobility interventions in this population. The purpose of this article is to review the published research on improving mobility outcomes in patients undergoing prolonged mechanical ventilation. For this review, published studies were retrieved from MEDLINE, PubMed, CINAHL, and the Cochrane Database of Systematic Reviews from January 1990 to July 2007. A total of 10 relevant articles were selected that examined the effect of whole body physical therapy, electrical stimulation, arm exercise and inspiratory muscle training. Overall, there is support for the ability of mobility interventions to improve outcomes in patients on prolonged mechanical ventilation but limited evidence of how to best accomplish this goal. Generating more data from multicenter studies and randomized controlled trials is recommended. PMID:18647758

Choi, JiYeon; Tasota, Frederick J.; Hoffman, Leslie A.

2009-01-01

212

Human versus Computer Controlled Selection of Ventilator Settings: An Evaluation of Adaptive Support Ventilation and Mid-Frequency Ventilation  

PubMed Central

Background. There are modes of mechanical ventilation that can select ventilator settings with computer controlled algorithms (targeting schemes). Two examples are adaptive support ventilation (ASV) and mid-frequency ventilation (MFV). We studied how different clinician-chosen ventilator settings are from these computer algorithms under different scenarios. Methods. A survey of critical care clinicians provided reference ventilator settings for a 70?kg paralyzed patient in five clinical/physiological scenarios. The survey-derived values for minute ventilation and minute alveolar ventilation were used as goals for ASV and MFV, respectively. A lung simulator programmed with each scenario's respiratory system characteristics was ventilated using the clinician, ASV, and MFV settings. Results. Tidal volumes ranged from 6.1 to 8.3?mL/kg for the clinician, 6.7 to 11.9?mL/kg for ASV, and 3.5 to 9.9?mL/kg for MFV. Inspiratory pressures were lower for ASV and MFV. Clinician-selected tidal volumes were similar to the ASV settings for all scenarios except for asthma, in which the tidal volumes were larger for ASV and MFV. MFV delivered the same alveolar minute ventilation with higher end expiratory and lower end inspiratory volumes. Conclusions. There are differences and similarities among initial ventilator settings selected by humans and computers for various clinical scenarios. The ventilation outcomes are the result of the lung physiological characteristics and their interaction with the targeting scheme. PMID:23119152

Mireles-Cabodevila, Eduardo; Diaz-Guzman, Enrique; Arroliga, Alejandro C.; Chatburn, Robert L.

2012-01-01

213

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

PubMed Central

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

2013-01-01

214

Post-traumatic stress disorder after weaning from prolonged mechanical ventilation  

Microsoft Academic Search

Purpose  Weaning from prolonged mechanical ventilation may be associated with mental discomfort. It is not known whether such discomfort\\u000a is linked with the development of post-traumatic stress disorder (PTSD). Accordingly, we investigated whether PTSD occurs\\u000a in patients after weaning from prolonged ventilation. We also determined whether administering a questionnaire would identify\\u000a patients at risk for developing PTSD.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A prospective longitudinal study

Amal Jubran; Gerald Lawm; Lisa A. Duffner; Eileen G. Collins; Dorothy M. Lanuza; Leslie A. Hoffman; Martin J. Tobin

2010-01-01

215

A survey on oral care practices for ventilator-assisted patients in intensive care units in 3A hospitals of mainland China.  

PubMed

Oral hygiene is a critical element of patient care, particularly among patients who need ventilator-assisted equipment. The objective of this study was to explore the current status of oral care practices, attitudes, education and knowledge among intensive care unit (ICU) nurses caring for ventilator-assisted patients in 3A hospitals in mainland China. To achieve this aim, an 18-item self-assessment questionnaire was mailed to head ICU nurses in 189 Grade 3A hospitals. Additional data were collected through in-person interviews at 38 ICUs throughout Sichuan, Shanxi, Jiangsu provinces, as well as Chongqing and Beijing. We found that most ICUs conducted oral examinations at patient admission, and that this care was largely provided by nurses. The most common oral care methods were foam swabs and mouth rinse containing antibiotics or disinfectants. Although the majority of ICUs provided continuing training for oral care, and most training was conducted by head nurses, the content and scope of training were not consistent among the hospitals in the study. The most popular sources of oral care knowledge were academic journals, Internet and professional books. Overall, it is clear that an evidence-based oral care standard manual is urgently needed for oral practice in ICUs in mainland China. PMID:24689526

Qu, Xing; Xie, Huixu; Zhang, Qi; Zhou, Xuedong; Shi, Zongdao

2014-04-01

216

Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: a prospective cohort study  

PubMed Central

Introduction Post-traumatic stress disorder (PTSD) has been identified in a significant portion of intensive care unit (ICU) survivors. We sought to identify factors associated with PTSD symptoms in patients following critical illness requiring mechanical ventilation. Methods Forty-three patients who were mechanically ventilated in the medical and coronary ICUs of a university-based medical center were prospectively followed during their ICU admission for delirium with the Confusion Assessment Method for the ICU. Additionally, demographic data were obtained and severity of illness was measured with the APACHE II (Acute Physiology and Chronic Health Evaluation II) score. Six months after discharge, patients were screened for PTSD symptoms by means of the Post-Traumatic Stress Syndrome 10-Questions Inventory (PTSS-10). Multiple linear regression was used to assess the association of potential risk factors with PTSS-10 scores. Results At follow-up, six (14%) patients had high levels of PTSD symptoms. On multivariable analysis, women had higher PTSS-10 scores than men by a margin of 7.36 points (95% confidence interval [CI] 1.62 to 13.11; p = 0.02). Also, high levels of PTSD symptoms were less likely to occur in older patients, with symptoms declining after age 50 (p = 0.04). Finally, although causation cannot be assumed, the total dose of lorazepam received during the ICU stay was associated with PTSD symptoms; for every 10-mg increase in cumulative lorazepam dose, PTSS-10 score increased by 0.39 (95% CI 0.17 to 0.61; p = 0.04). No significant relationship was noted between severity of illness and PTSD symptoms or duration of delirium and PTSD symptoms. Conclusion High levels of PTSD symptoms occurred in 14% of patients six months following critical illness necessitating mechanical ventilation, and these symptoms were most likely to occur in female patients and those receiving high doses of lorazepam. High levels of PTSD symptoms were less likely to occur in older patients. PMID:17316452

Girard, Timothy D; Shintani, Ayumi K; Jackson, James C; Gordon, Sharon M; Pun, Brenda T; Henderson, Melinda S; Dittus, Robert S; Bernard, Gordon R; Ely, E Wesley

2007-01-01

217

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

218

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

219

Inhaled antibiotic therapy for ventilator-associated tracheobronchitis and ventilator-associated pneumonia: an Update  

Microsoft Academic Search

Ventilator-associated pneumonia (VAP) remains a leading cause of morbidity and mortality in mechanically-ventilated patients\\u000a in the Intensive Care Unit (ICU). Ventilator-associated tracheobronchitis (VAT) was previously believed to be an intermediate\\u000a stage between colonization of the lower respiratory tract and VAP. More recent data, however, suggest that VAT may be a separate\\u000a entity that increases morbidity and mortality, independently of the

Tareq Abu-Salah; Rajiv Dhand

220

Microbial composition and antibiotic resistance of biofilms recovered from endotracheal tubes of mechanically ventilated patients.  

PubMed

In critically ill patients, breathing is impaired and mechanical ventilation, using an endotracheal tube (ET) connected to a ventilator, is necessary. Although mechanical ventilation is a life-saving procedure, it is not without risk. Because of several reasons, a biofilm often forms at the distal end of the ET and this biofilm is a persistent source of bacteria which can infect the lungs, causing ventilator-associated pneumonia (VAP). There is a link between the microbial flora of ET biofilms and the microorganisms involved in the onset of VAP. Culture dependent and independent techniques were already used to identify the microbial flora of ET biofilms and also, the antibiotic resistance of microorganisms obtained from ET biofilms was determined. The ESKAPE pathogens play a dominant role in the onset of VAP and these organisms were frequently identified in ET biofilms. Also, antibiotic resistant microorganisms were frequently present in ET biofilms. Members of the normal oral flora were also identified in ET biofilms but it is thought that these organisms initiate ET biofilm formation and are not directly involved in the development of VAP. PMID:25366226

Vandecandelaere, Ilse; Coenye, Tom

2015-01-01

221

Interactive effects of mechanical ventilation, inhaled nitric oxide and oxidative stress in acute lung injury.  

PubMed

To compare conventional mechanical ventilation (CMV) and high-frequency oscillatory ventilation (HFOV), with/without inhaled nitric oxide (iNO), for oxygenation, inflammation, antioxidant/oxidative stress status, and DNA damage in a model of acute lung injury (ALI). Lung injury was induced by tracheal infusion of warm saline. Rabbits were ventilated at [Formula: see text] 1.0 and randomly assigned to one of five groups. Overall antioxidant defense/oxidative stress was assessed by total antioxidant performance assay, and DNA damage by comet assay. Ventilatory and hemodynamic parameters were recorded every 30min for 4h. ALI groups showed worse oxygenation than controls after lung injury. After 4h of mechanical ventilation, HFOV groups presented significant improvements in oxygenation. HFOV with and without iNO, and CMV with iNO showed significantly increased antioxidant defense and reduced DNA damage than CMV without iNO. Inhaled nitric oxide did not beneficially affect HFOV in relation to antioxidant defense/oxidative stress and pulmonary DNA damage. Overall, lung injury was reduced using HFOV or CMV with iNO. PMID:24148688

Ronchi, Carlos Fernando; Ferreira, Ana Lucia Anjos; Campos, Fabio Joly; Kurokawa, Cilmery Suemi; Carpi, Mario Ferreira; Moraes, Marcos Aurélio; Bonatto, Rossano Cesar; Yeum, Kyung-Jin; Fioretto, Jose Roberto

2014-01-01

222

Mechanical ventilation drives pneumococcal pneumonia into lung injury and sepsis in mice: protection by adrenomedullin  

PubMed Central

Introduction Ventilator-induced lung injury (VILI) contributes to morbidity and mortality in acute respiratory distress syndrome (ARDS). Particularly pre-injured lungs are susceptible to VILI despite protective ventilation. In a previous study, the endogenous peptide adrenomedullin (AM) protected murine lungs from VILI. We hypothesized that mechanical ventilation (MV) contributes to lung injury and sepsis in pneumonia, and that AM may reduce lung injury and multiple organ failure in ventilated mice with pneumococcal pneumonia. Methods We analyzed in mice the impact of MV in established pneumonia on lung injury, inflammation, bacterial burden, hemodynamics and extrapulmonary organ injury, and assessed the therapeutic potential of AM by starting treatment at intubation. Results In pneumococcal pneumonia, MV increased lung permeability, and worsened lung mechanics and oxygenation failure. MV dramatically increased lung and blood cytokines but not lung leukocyte counts in pneumonia. MV induced systemic leukocytopenia and liver, gut and kidney injury in mice with pneumonia. Lung and blood bacterial burden was not affected by MV pneumonia and MV increased lung AM expression, whereas receptor activity modifying protein (RAMP) 1–3 expression was increased in pneumonia and reduced by MV. Infusion of AM protected against MV-induced lung injury (66% reduction of pulmonary permeability p?mechanically ventilated individuals with severe pneumonia. PMID:24731244

2014-01-01

223

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

224

Monitoring of intratidal lung mechanics: a Graphical User Interface for a model-based decision support system for PEEP-titration in mechanical ventilation.  

PubMed

In mechanical ventilation, a careful setting of the ventilation parameters in accordance with the current individual state of the lung is crucial to minimize ventilator induced lung injury. Positive end-expiratory pressure (PEEP) has to be set to prevent collapse of the alveoli, however at the same time overdistension should be avoided. Classic approaches of analyzing static respiratory system mechanics fail in particular if lung injury already prevails. A new approach of analyzing dynamic respiratory system mechanics to set PEEP uses the intratidal, volume-dependent compliance which is believed to stay relatively constant during one breath only if neither atelectasis nor overdistension occurs. To test the success of this dynamic approach systematically at bedside or in an animal study, automation of the computing steps is necessary. A decision support system for optimizing PEEP in form of a Graphical User Interface (GUI) was targeted. Respiratory system mechanics were analyzed using the gliding SLICE method. The resulting shapes of the intratidal compliance-volume curve were classified into one of six categories, each associated with a PEEP-suggestion. The GUI should include a graphical representation of the results as well as a quality check to judge the reliability of the suggestion. The implementation of a user-friendly GUI was successfully realized. The agreement between modelled and measured pressure data [expressed as root-mean-square (RMS)] tested during the implementation phase with real respiratory data from two patient studies was below 0.2 mbar for data taken in volume controlled mode and below 0.4 mbar for data taken in pressure controlled mode except for two cases with RMS < 0.6 mbar. Visual inspections showed, that good and medium quality data could be reliably identified. The new GUI allows visualization of intratidal compliance-volume curves on a breath-by-breath basis. The automatic categorisation of curve shape into one of six shape-categories provides the rational decision-making model for PEEP-titration. PMID:24549460

Buehler, S; Lozano-Zahonero, S; Schumann, S; Guttmann, J

2014-12-01

225

Prevention of ventilator-associated pneumonia.  

PubMed

Ventilator-associated pneumonia is the commonest, yet mostly preventable, infection in mechanically ventilated patients. Successful control of ventilator-associated pneumonia can save hospitalisation cost, and is possible by using a multidisciplinary clinical and administrative approach. The ventilator-associated pneumonia rate should be expressed as the number of ventilator-associated pneumonia days per 1000 ventilator days to take into account the device-utilisation duration for meaningful comparison. Various strategies address the issue, including general infection control measures, body positioning, intubation and mechanical ventilation, oral and gastro-intestinal tract, endotracheal tube, airway pressure, cuff pressure, selective digestive and/or oropharyngeal decontamination, and probiotic or early antibiotic treatment, as well as overall administration at a policy level. The rationale and controversy of these approaches are discussed in this article. The authors suggest that all units treating mechanically ventilated patients should have a ventilator-associated pneumonia prevention protocol in place, and ventilator-associated pneumonia should be seriously considered as a key performance indicator in local intensive care units. PMID:25593193

Lau, A Cw; So, H M; Tang, S L; Yeung, A; Lam, S M; Yan, W W

2015-02-01

226

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

PubMed Central

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

Gandhi, Anuradha M; Patel, Prakruti P

2014-01-01

227

Comparison of INSURE method with conventional mechanical ventilation after surfactant administration in preterm infants with respiratory distress syndrome: therapeutic challenge.  

PubMed

Administration of endotracheal surfactant is potentially the main treatment for neonates suffering from RDS (Respiratory Distress Syndrome), which is followed by mechanical ventilation. Late and severe complications may develop as a consequence of using mechanical ventilation. In this study, conventional methods for treatment of RDS are compared with surfactant administration, use of mechanical ventilation for a brief period and NCPAP (Nasal Continuous Positive Airway Pressure), (INSURE method ((Intubation, Surfactant administration and extubation)). A randomized clinical trial study was performed, including all newborn infants with diagnosed RDS and a gestational age of 35 weeks or less, who were admitted in NICU of Valiasr hospital. The patients were then divided randomly into two CMV (Conventional Mechanical Ventilation) and INSURE groups. Surfactant administration and consequent long-term mechanical ventilation were done in the first group (CMV group). In the second group (INSURE group), surfactant was administered followed by a short-term period of mechanical ventilation. The infants were then extubated, and NCPAP was embedded. The comparison included crucial duration of mechanical ventilation and oxygen therapy, IVH (Intraventricular Hemorrhage), PDA (Patent Ductus Arteriosus), air-leak syndromes, BPD (Broncho-Pulmonary Dysplasia) and mortality rate. The need for mechanical ventilation in 5th day of admission was 43% decreased (P=0.005) in INSURE group in comparison to CMV group. A decline (P=0.01) in the incidence of IVH and PDA was also achieved. Pneumothorax, chronic pulmonary disease and mortality rates, were not significantly different among two groups. (P=0.25, P=0.14, P=0.25, respectively). This study indicated that INSURE method in the treatment of RDS decreases the need for mechanical ventilation and oxygen-therapy in preterm neonates. Moreover, relevant complications as IVH and PDA were observed to be reduced. Thus, it seems rationale to perform this method as the initial treatment for neonates with mild to moderate RDS. PMID:25149882

Nayeri, Fatemeh Sadat; Esmaeilnia Shirvani, Tahereh; Aminnezhad, Majid; Amini, Elaheh; Dalili, Hossein; Moghimpour Bijani, Faezeh

2014-01-01

228

Ventilator-driven xenon ventilation studies  

SciTech Connect

A modification of a common commerical Xe-133 ventilation device is described for mechanically assisted ventilation imaging. The patient's standard ventilator serves as the power source controlling the ventilator rate and volume during the xenon study, but the gases in the two systems are not intermixed. This avoids contamination of the ventilator with radioactive xenon. Supplemental oxygen and positive end-expiratory pressure (PEEP) are provided if needed. The system can be converted quickly for conventional studies with spontaneous respiration.

Chilcoat, R.T.; Thomas, F.D.; Gerson, J.I.

1984-07-01

229

Nutrition assessment: the reproducibility of Subjective Global Assessment in patients requiring mechanical ventilation  

PubMed Central

Background/Objective The detection of malnutrition in the intensive care unit (ICU) is critical to appropriately address its contribution on outcomes. The primary objective of this investigation was to determine if nutritional status could be reliably classified using Subjective Global Assessment (SGA) in mechanically ventilated (MV) patients. Subjects/Methods Fifty-seven patients requiring MV greater than 48 hours in a university-affiliated medical ICU were evaluated in this cross-sectional study over a 3 month period. Nutritional status was categorized independently by two Registered Dietitians using SGA. Frequencies, means (± standard deviations), Chi square and T tests were used to describe the population characteristics; agreement between raters was evaluated using the ? statistic. Results On admission, the average patient was 50.4 (± 14.2) years of age, overweight (body mass index: 29.0 ± 9.2), had an APACHE II score of 24 (± 10) and respiratory failure. Fifty percent (n=29) of patients were categorized as malnourished. Agreement between raters was 95% prior to consensus, reflecting near perfect agreement (? =0.90) and excellent reliability. Patients categorized as malnourished were more often admitted to the hospital floor prior to the ICU (n=32; 56%), reported decreased dietary intake (69% vs. 46%, p=0.02) and exhibited signs of muscle wasting (45% vs. 7%, p<0.001, respectively) and fat loss (52% vs. 7%, p<0.001, respectively) on physical exam when compared to normally nourished individuals. Conclusions SGA can serve as a reliable nutrition assessment technique for detecting malnutrition in patients requiring MV. Its routine use should be incorporated into future studies and clinical practice. PMID:20700137

Peterson, Sarah J.; Gurka, David P.; Braunschweig, Carol A.

2010-01-01

230

Adaptation of a Communication Interaction Behavior Instrument for use in Mechanically Ventilated, Nonvocal Older Adults  

PubMed Central

Background Valid and reliable instruments are needed to measure communication interaction behaviors between nurses and mechanically ventilated (MV) intensive care unit (ICU) patients who are without oral speech. Objectives To refine and evaluate preliminary validity and reliability of a Communication Interaction Behavior Instrument (CIBI) adapted for use with nonvocal, MV ICU patients. Methods Raters observed nurse-patient communication interactions using a checklist of nurse and patient behaviors, categorized as positive and negative behaviors. We used 3-minute video-recorded observations of 5 MV ICU adults (<60 years) and their nurses to establish preliminary inter-rater reliability and confirm appropriateness of definitions (4 observations per dyad, N=20). Based on expert input and reliability results, the behaviors and item definitions on the CIBI were revised. The revised tool was then tested in a larger sample of 38 MV ICU patients (?60 years) and their nurses (4 observations per dyad, N=152) to determine inter-rater reliability. Results For preliminary testing, percent agreement for individual items ranged from 60–100% for nurse behaviors and 20–100% for patient behaviors across the 5 pilot cases. Based on these results, 11 definitions were modified and 4 items were dropped. Using the revised 29-item instrument, percent agreement improved for nurse behaviors (73–100%) and patient behaviors (68–100%). Kappa coefficients ranged from 0.13–1.00, with lower coefficients for patient behaviors. Conclusion Preliminary results suggest that the revised CIBI has good face validity and demonstrates good inter-rater reliability for many of the behaviors but further refinement is needed. The use of dual raters with adjudication of discrepancies is the recommended method of administration for the revised CIBI. PMID:24335909

Nilsen, Marci; Happ, Mary Beth; Donovan, Heidi; Barnato, Amber; Hoffman, Leslie; Sereika, Susan M.

2014-01-01

231

Severe and early quadriceps weakness in mechanically ventilated patients  

E-print Network

%) Hypothyroid 3 (23%) Dyslipidemia 8 (62%) Diabetes mellitus 4 (31%) Risk factor for polyneuropathy Mechanical (46%) Neuromuscular blocker 5 (38%) Risk factors, mean 3 ± 1 Duration of hospitalization before Cardiac surgery ICU 9 (69%) Respiratory ICU 4 (31%) Comorbidities COPD 8 (62%) Hypertension 11 (85

Boyer, Edmond

232

Effects of surfactant depletion on regional pulmonary metabolic activity during mechanical ventilation  

PubMed Central

Inflammation during mechanical ventilation is thought to depend on regional mechanical stress. This can be produced by concentration of stresses and cyclic recruitment in low-aeration dependent lung. Positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) allows for noninvasive assessment of regional metabolic activity, an index of neutrophilic inflammation. We tested the hypothesis that, during mechanical ventilation, surfactant-depleted low-aeration lung regions present increased regional 18F-FDG uptake suggestive of in vivo increased regional metabolic activity and inflammation. Sheep underwent unilateral saline lung lavage and were ventilated supine for 4 h (positive end-expiratory pressure = 10 cmH2O, tidal volume adjusted to plateau pressure = 30 cmH2O). We used PET scans of injected 13N-nitrogen to compute regional perfusion and ventilation and injected 18F-FDG to calculate 18F-FDG uptake rate. Regional aeration was quantified with transmission scans. Whole lung 18F-FDG uptake was approximately two times higher in lavaged than in nonlavaged lungs (2.9 ± 0.6 vs. 1.5 ± 0.3 10?3/min; P < 0.05). The increased 18F-FDG uptake was topographically heterogeneous and highest in dependent low-aeration regions (gas fraction 10–50%, P < 0.001), even after correction for lung density and wet-to-dry lung ratios. 18F-FDG uptake in low-aeration regions of lavaged lungs was higher than that in low-aeration regions of nonlavaged lungs (P < 0.05). This occurred despite lower perfusion and ventilation to dependent regions in lavaged than nonlavaged lungs (P < 0.001). In contrast, 18F-FDG uptake in normally aerated regions was low and similar between lungs. Surfactant depletion produces increased and heterogeneously distributed pulmonary 18F-FDG uptake after 4 h of supine mechanical ventilation. Metabolic activity is highest in poorly aerated dependent regions, suggesting local increased inflammation. PMID:21799132

de Prost, Nicolas; Costa, Eduardo L.; Wellman, Tyler; Musch, Guido; Winkler, Tilo; Tucci, Mauro R.; Harris, R. Scott; Venegas, Jose G.

2011-01-01

233

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

234

Mild Endotoxemia during Mechanical Ventilation Produces Spatially Heterogeneous Pulmonary Neutrophilic Inflammation in Sheep  

PubMed Central

Background There is limited information on the regional inflammatory effects of mechanical ventilation and endotoxemia on the production of acute lung injury. Measurement of 18F-fluorodeoxyglucose (18F-FDG) uptake with Positron Emission Tomography allows for the regional, in vivo and non-invasive, assessment of neutrophilic inflammation. We tested whether mild endotoxemia combined with large tidal volume mechanical ventilation bounded by pressures within clinically acceptable limits could yield measurable and anatomically localized neutrophilic inflammation. Methods Sheep were mechanically ventilated with plateau pressures=30–32 cmH2O and positive end-expiratory pressure=0 for 2h. Six sheep received IV endotoxin (10 ng.kg?1.min?1) while 6 did not (controls), in sequentially performed studies. We imaged with Positron Emission Tomography the intrapulmonary kinetics of infused 13N-nitrogen and 18F-FDG to compute regional perfusion and 18F-FDG uptake. Transmission scans were used to assess aeration. Results Mean gas fraction and perfusion distribution were similar between groups. In contrast, a significant increase in 18F-FDG uptake was observed in all lung regions of the endotoxin group. In this group, 18F-FDG uptake in middle and dorsal regions was significantly larger than that in ventral regions. Multivariate analysis showed that 18F-FDG uptake was associated with regional aeration (p<0.01) and perfusion (p<0.01). Conclusions Mild short-term endotoxemia in the presence of heterogeneous lung aeration and mechanical ventilation with pressures within clinically acceptable limits produces marked spatially heterogeneous increases in pulmonary neutrophilic inflammation. The dependence of inflammation on aeration and perfusion suggests a multifactorial basis for that finding. 18F-FDG uptake may be a sensitive marker of pulmonary neutrophilic inflammation in the studied conditions. PMID:20179503

Costa, Eduardo L.V.; Musch, Guido; Winkler, Tilo; Schroeder, Tobias; Harris, R. Scott; Jones, Hazel A; Venegas, Jose G.; Vidal Melo, Marcos F.

2009-01-01

235

A closed-loop mechanical ventilation controller with explicit objective functions  

Microsoft Academic Search

A closed-loop lung ventilation controller was designed, aiming to: 1) track a desired end-tidal CO2 pressure (PetCO2), 2) find the positive end-expiratory pressure (PEEP) of minimum estimated respiratory system elastance (Ers,e), and 3) follow objective functions conjectured to reduce lung injury. After numerical simulations, tests were performed in six paralyzed piglets. Respiratory mechanics parameters were estimated by the recursive least

Frederico C. Jandre; Alexandre V. Pino; Ivanir Lacorte; J. H. S. Neves; A. Giannella-Neto

2004-01-01

236

Coronary haemo-dynamics and myocardial metabolism during weaning from mechanical ventilation in cardiac surgical patients  

Microsoft Academic Search

The present clinical study was undertaken to assess the alterations in myocardial metabolism and coronary haemodynamics during\\u000a weaning from mechanical ventilation in postoperative cardiac surgical patients. Global and regional myocardial blood flow\\u000a and metabolism were assessed using a dual port coronary sinus-great cardiac vein thermodilution catheter in 17 patients who\\u000a had undergone coronary revascularization and who were being weaned from

Steven Elia; Peter Liu; Alan Hilgenberg; Charrisios Skourtis; Demetrios Lappas

1991-01-01

237

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

E-print Network

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

Utrecht, Universiteit

238

Daily sedative interruption versus intermittent sedation in mechanically ventilated critically ill patients: a randomized trial  

PubMed Central

Background Daily sedative interruption and intermittent sedation are effective in abbreviating the time on mechanical ventilation. Whether one is superior to the other has not yet been determined. Our aim was to compare daily interruption and intermittent sedation during the mechanical ventilation period in a low nurse staffing ICU. Methods Adult patients expected to need mechanical ventilation for more than 24 hours were randomly assigned, in a single center, either to daily interruption of continuous sedative and opioid infusion or to intermittent sedation. In both cases, our goal was to maintain a Sedation Agitation Scale (SAS) level of 3 or 4; that is patients should be calm, easily arousable or awakened with verbal stimuli or gentle shaking. Primary outcome was ventilator-free days in 28 days. Secondary outcomes were ICU and hospital mortality, incidence of delirium, nurse workload, self-extubation and psychological distress six months after ICU discharge. Results A total of 60 patients were included. There were no differences in the ventilator-free days in 28 days between daily interruption and intermittent sedation (median: 24 versus 25 days, P?=?0.160). There were also no differences in ICU mortality (40 versus 23.3%, P?=?0.165), hospital mortality (43.3 versus 30%, P?=?0.284), incidence of delirium (30 versus 40%, P?=?0.472), self-extubation (3.3 versus 6.7%, P?=?0.514), and psychological stress six months after ICU discharge. Also, the nurse workload was not different between groups, but it was reduced on day 5 compared to day 1 in both groups (Nurse Activity Score (NAS) in the intermittent sedation group was 54 on day 1 versus 39 on day 5, P?ventilator-free days in 28 days between both groups. Intermittent sedation was associated with lower sedative and opioid doses. Trial registration ClinicalTrials.gov Identifier: NCT00824239. PMID:24900938

2014-01-01

239

Mechanical ventilation alone, and in the presence of sepsis, impair protein metabolism in the diaphragm of neonatal pigs  

Technology Transfer Automated Retrieval System (TEKTRAN)

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

240

Drug-resistant ventilator associated pneumonia in a tertiary care hospital in Saudi Arabia  

PubMed Central

BACKGROUND: There is a wide geographic and temporal variability of bacterial resistance among microbial causes of ventilator-associated pneumonia (VAP). The contribution of multi-drug resistant (MDR) pathogens to the VAP etiology in Saudi Arabia was never studied. We sought to examine the extent of multiple-drug resistance among common microbial causes of VAP. MATERIALS AND METHODS: We conducted a retrospective susceptibility study in the adult intensive care unit (ICU) of King Abdulaziz Medical City, Riyadh, Saudi Arabia. Susceptibility results of isolates from patients diagnosed with VAP between October 2004 and June 2009 were examined. The US National Healthcare Safety Network definition of MDR was adopted. RESULTS: A total of 248 isolates including 9 different pathogens were included. Acinetobacter spp. was highly (60-89%) resistant to all tested antimicrobials, including carbapenems (three- and four-class MDR prevalence were 86% and 69%, respectively). Pseudomonas aeruginosa was moderately (13-31%) resistant to all tested antimicrobials, including antipseudomonal penicillins (three- and four-class MDR prevalence were 13% and 10%, respectively). With an exception of ampicillin (fully resistant), Klebsiella spp. had low (0-13%) resistance to other tested antimicrobials with no detected MDR. Staphylococcus aureus was fully susceptible to vancomycin with 42% resistance to oxacillin. There were significant increasing trends of MDR Acinetobacter spp. however not P. aeruginosa during the study. Resistant pathogens were associated with worse profile of ICU patients but not patients’ outcomes. CONCLUSION: Acinetobacter in the current study was an increasingly resistant VAP-associated pathogen more than seen in many parts of the world. The current finding may impact local choice of initial empiric antibiotics. PMID:24791174

Balkhy, Hanan H.; El-Saed, Aiman; Maghraby, Rana; Al-Dorzi, Hasan M.; Khan, Raymond; Rishu, Asgar H.; Arabi, Yaseen M.

2014-01-01

241

Simulation of swallowing dysfunction and mechanical ventilation after a Montgomery T-tube insertion.  

PubMed

The Montgomery T-tube is used as a combined tracheal stent and airway after laryngotracheoplasty, to keep the lumen open and prevent mucosal laceration from scarring. It is valuable in the management of upper and mid-tracheal lesions, while invaluable in long and multisegmental stenting lesions. Numerical simulations based on real-patient-tracheal geometry, experimental tissue characterization, and previous numerical estimation of the physiological swallowing force are performed to estimate the consequences of Montgomery T-tube implantation on swallowing and assisted ventilation: structural analysis of swallowing is performed to evaluate patient swallowing capacity, and computational fluid dynamics simulation is carried out to analyze related mechanical ventilation. With an inserted Montgomery T-tube, vertical displacement (Z-axis) reaches 8.01 mm, whereas in the Y-axis, it reaches 6.63 mm. The maximal principal stress obtained during swallowing was 1.6 MPa surrounding the hole and in the upper contact with the tracheal wall. Fluid flow simulation of the mechanical ventilation revealed positive pressure for both inhalation and exhalation, being higher for inspiration. The muscular deflections, considerable during normal breathing, are nonphysiological, and this aspect results in a constant overload of the tracheal muscle. During swallowing, the trachea ascends producing a nonhomogeneous elongation. This movement can be compromised when prosthesis is inserted, which explains the high incidence of glottis close inefficiency. Fluid simulations showed that nonphysiological pressure is established inside the trachea due to mechanical ventilation. This may lead to an overload of the tracheal muscle, explaining several related problems as muscle thinning or decrease in contractile function. PMID:24963870

Trabelsi, O; Malvè, M; Mena Tobar, A; Doblaré, M

2015-11-01

242

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

PubMed Central

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

Hernández-Jiménez, Claudia; García-Torrentera, Rogelio; Olmos-Zúñiga, J. Raúl; Jasso-Victoria, Rogelio; Gaxiola-Gaxiola, Miguel O.; Baltazares-Lipp, Matilde; Gutiérrez-González, Luis H.

2014-01-01

243

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

244

Meeting Residential Ventilation Standards  

E-print Network

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

245

78 FR 13935 - Rural Health Care Support Mechanism  

Federal Register 2010, 2011, 2012, 2013

...47 CFR Part 54 Rural Health Care Support Mechanism; Final Rule Federal...02-60; FCC 12-150] Rural Health Care Support Mechanism AGENCY: Federal Communications...universal service support program for health care, transitioning its existing Internet...

2013-03-01

246

Recurrence plots and Shannon entropy for a dynamical analysis of asynchronisms in noninvasive mechanical ventilation  

NASA Astrophysics Data System (ADS)

Recurrence plots were introduced to quantify the recurrence properties of chaotic dynamics. Hereafter, the recurrence quantification analysis was introduced to transform graphical interpretations into statistical analysis. In this spirit, a new definition for the Shannon entropy was recently introduced in order to have a measure correlated with the largest Lyapunov exponent. Recurrence plots and this Shannon entropy are thus used for the analysis of the dynamics underlying patient assisted with a mechanical noninvasive ventilation. The quality of the assistance strongly depends on the quality of the interactions between the patient and his ventilator which are crucial for tolerance and acceptability. Recurrence plots provide a global view of these interactions and the Shannon entropy is shown to be a measure of the rate of asynchronisms as well as the breathing rhythm.

Rabarimanantsoa, H.; Achour, L.; Letellier, C.; Cuvelier, A.; Muir, J.-F.

2007-03-01

247

Ventilator Associated Pneumonia (VAP)  

E-print Network

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

Connor, Ed

248

Heuristics to determine ventilation times of ICU patients from the MIMIC-II database.  

PubMed

Mechanical ventilation is an important life support tool for patients in intensive care units (ICU). For various research purposes related to patient hemodynamic and cardiopulmonary monitoring, it is important to know when a patient is on a ventilator. Unfortunately, the widely used MIMIC-II database contains results from user charted data, where the user did not always store ventilation on and off times explicitly and accurately. The resulting ventilation-related data are subject to error. Therefore, there are no simple rules to define ventilation times retrospectively for this dataset. Hence, we designed a simple set of rules to determine the ventilation times using multiple sources of mechanical ventilator-related settings and physiological measurements by expert heuristics. The rules worked well in comparison with nursing notes regarding ventilation events. We conclude that our rule sets for determining ventilation times may be useful in assisting with MIMIC-II database analysis. PMID:21096039

Cao, Hanqing; Lee, K P; Ennett, Colleen M; Eshelman, Larry; Nielsen, Larry; Saeed, Mohammed; Gross, Brian

2010-01-01

249

Comparison of intravenous immunoglobulin and plasma exchange in treatment of mechanically ventilated children with Guillain Barré syndrome: a randomized study  

PubMed Central

Introduction Respiratory failure is a life threatening complication of Guillain Barré syndrome (GBS). There is no consensus on the specific treatment for this subset of children with GBS. Methods This was a prospective randomized study to compare the outcome of intravenous immunoglobulin (IVIG) and plasma exchange (PE) treatment in children with GBS requiring mechanical ventilation. Forty-one children with GBS requiring endotracheal mechanical ventilation (MV) within 14 days from disease onset were included. The ages of the children ranged from 49 to 143 months. Randomly, 20 children received a five-day course of IVIG (0.4 g/kg/day) and 21 children received a five-day course of one volume PE daily. Lumbar puncture (LP) was performed in 36 patients (18 in each group). Results Both groups had comparable age (p = 0.764), weight (p = 0.764), duration of illness prior to MV (p = 0.854), preceding diarrhea (p = 0.751), cranial nerve involvement (p = 0.756), muscle power using Medical Research Council (MRC) sum score (p = 0.266) and cerebrospinal fluid (CSF) protein (p = 0.606). Children in the PE group had a shorter period of MV (median 11 days, IQR 11.0 to 13.0) compared to IVIG group (median 13 days, IQR 11.3 to 14.5) with p = 0.037. Those in the PE group had a tendency for a shorter Pediatric Intensive Care Unit (PICU) stay (p = 0.094). A total of 20/21 (95.2%) and 18/20 (90%) children in the PE and IVIG groups respectively could walk unaided within four weeks after PICU discharge (p = 0.606). There was a negative correlation between CSF protein and duration of mechanical ventilation in the PE group (p = 0.037), but not in the IVIG group (p = 0.132). Conclusions In children with GBS requiring MV, PE is superior to IVIG regarding the duration of MV but not PICU stay or the short term neurological outcome. The negative correlation between CSF protein values and duration of MV in PE group requires further evaluation of its clinical usefulness. Trial Registration Clinicaltrials.gov Identifier NCT01306578 PMID:21745374

2011-01-01

250

Prolonged mechanical ventilation in critically ill patients: epidemiology, outcomes and modelling the potential cost consequences of establishing a regional weaning unit  

PubMed Central

Introduction The number of patients requiring prolonged mechanical ventilation (PMV) is likely to increase. Transferring patients to specialised weaning units may improve outcomes and reduce costs. The aim of this study was to establish the incidence and outcomes of PMV in a UK administrative health care region without a dedicated weaning unit, and model the potential impact of establishing a dedicated weaning unit. Methods A retrospective cohort study was undertaken using a database of admissions to three intensive care units (ICU) in a UK region from 2002 to 2006. Using a 21 day cut-off to define PMV, incidence was calculated using all ICU admissions and ventilated ICU admissions as denominators. Outcomes for the PMV cohort (mortality and hospital resource use) were compared with the non-PMV cohort. Length of ICU stay beyond 21 days was used to model the effect of establishing a weaning unit in terms of unit occupancy rates, admission refusal rates, and healthcare costs. Results Out of 8290 ICU admission episodes, 7848 were included in the analysis. Mechanical ventilation was required during 5552 admission episodes, of which 349 required PMV. The incidence of PMV was 4.4 per 100 ICU admissions, and 6.3 per 100 ventilated ICU admissions. PMV patients used 29.1% of all general ICU bed days, spent longer in hospital after ICU discharge than non-PMV patients (median 17 vs 7 days, P < 0.001) and had higher hospital mortality (40.3% vs 33.8%, P = 0.02). For the region, in which about 70 PMV patients were treated each year, a weaning unit with a capacity of three beds appeared most cost efficient, resulting in an occupancy rate of 73%, admission refusal rate at 21 days of 36%, and potential cost saving of £344,000 (€418,000) using UK healthcare tariffs. Conclusions One in every sixteen ventilated patients requires PMV in our region and this group use a substantial amount of health care resource. Establishing a weaning unit would potentially reduce acute bed occupancy by 8-10% and could reduce overall treatment costs. Restructuring the current configuration of critical care services to introduce weaning units should be considered if the expected increase in PMV incidence occurs. PMID:21439086

2011-01-01

251

Mechanical Ventilation  

MedlinePLUS

... cannot talk because the tube passes between the vocal cords into the windpipe. They also cannot eat by ... done with a very severe lung illness. Muscle paralysis is stopped as soon as possible and before ...

252

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

253

Prevalence of ventilator-associated pneumonia in a university hospital and prognosis for the patients affected  

Microsoft Academic Search

Objective: To determine the prevalence of ventilator-associated pneumonia in an intensive care unit, as well as to identify related factors and characterize patient evolution. Methods: This study evaluated 278 patients on mechanical ventilation for more than 24 hours in a university hospital. Results: Ventilator-associated pneumonia developed in 38.1% of the patients, translating to 35.7 cases\\/1000 ventilator-days: 45.3% were caused by

MÁRCIO MARTINS DE QUEIROZ; JOSÉ RODOLFO ROCCO

2006-01-01

254

Clinical spectrum of ventilator-associated pneumonia caused by methicillin-sensitive Staphylococcus aureus  

Microsoft Academic Search

The incidence of tracheal colonization and its association with ventilator-associated pneumonia caused by methicillin-sensitiveStaphylococcus aureus (MSSA) was studied prospectively in 530 consecutively admitted mechanically ventilated patients in a general intensive care unit. Furthermore, the clinical spectrum, outcome, and microbiological results of 27 cases of staphylococcal ventilator-associated pneumonia (SVAP) were examined. Ventilator-associated pneumonia was diagnosed by protected specimen brush and\\/or bronchoalveolar

D. Bergmans; M. Bonten; C. Gaillard; P. de Leeuw; F. van Tiel; E. Stobberingh; S. van der Geest

1996-01-01

255

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

PubMed Central

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

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

2015-01-01

256

Ventilator-driven xenon ventilation studies  

SciTech Connect

A modification of a common commercial Xe-133 ventilation device is described for mechanically assisted ventilation imaging. The patient's standard ventilator serves as the power source controlling the ventilatory rate and volume during the xenon study, but the gases in the two systems are not intermixed. This avoids contamination of the ventilator with radioactive xenon. Supplemental oxygen and positive end-expiratory pressure (PEEP) are provided if needed. The system can be converted quickly for conventional studies with spontaneous respiration.

Chilcoat, R.T.; Thomas, F.D.; Gerson, J.I.

1984-07-01

257

Real-time noninvasive estimation of intrapleural pressure in mechanically ventilated patients: a feasibility study.  

PubMed

A method for real-time noninvasive estimation of intrapleural pressure in mechanically ventilated patients is proposed. The method employs a simple first-order lung mechanics model that is fitted in real-time to flow and pressure signals acquired non-invasively at the opening of the patient airways, in order to estimate lung resistance (RL), lung compliance (CL) and intrapleural pressure (Ppl) continuously in time. Estimation is achieved by minimizing the sum of squared residuals between measured and model predicted airway pressure using a modified Recursive Least Squares (RLS) approach. Particularly, two different RLS algorithms, namely the conventional RLS with Exponential Forgetting (EF-RLS) and the RLS with Vector-type Forgetting Factor (VFF-RLS), are considered in this study and their performances are first evaluated using simulated data. Simulations suggest that the conventional EF-RLS algorithm is not suitable for our purposes, whereas the VFF-RLS method provides satisfactory results. The potential of the VFF-RLS based method is then proved on experimental data collected from a mechanically ventilated pig. Results show that the method provides continuous estimated lung resistance and compliance in normal physiological ranges and pleural pressure in good agreement with invasive esophageal pressure measurements. PMID:24110910

Albanese, Antonio; Karamolegkos, Nikolaos; Haider, Syed W; Seiver, Adam; Chbat, Nicolas W

2013-01-01

258

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

PubMed Central

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

2014-01-01

259

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. PMID:25414899

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

2014-01-01

260

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

261

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

262

Recovery of Diaphragm Function following Mechanical Ventilation in a Rodent Model  

PubMed Central

Background Mechanical ventilation (MV) induces diaphragmatic muscle fiber atrophy and contractile dysfunction (ventilator induced diaphragmatic dysfunction, VIDD). It is unknown how rapidly diaphragm muscle recovers from VIDD once spontaneous breathing is restored. We hypothesized that following extubation, the return to voluntary breathing would restore diaphragm muscle fiber size and contractile function using an established rodent model. Methods Following 12 hours of MV, animals were either euthanized or, after full wake up, extubated and returned to voluntary breathing for 12 hours or 24 hours. Acutely euthanized animals served as controls (each n?=?8/group). Diaphragmatic contractility, fiber size, protease activation, and biomarkers of oxidative damage in the diaphragm were assessed. Results 12 hours of MV induced VIDD. Compared to controls diaphragm contractility remained significantly depressed at 12 h after extubation but rebounded at 24 h to near control levels. Diaphragmatic levels of oxidized proteins were significantly elevated after MV (p?=?0.002) and normalized at 24 hours after extubation. Conclusions These findings indicate that diaphragm recovery from VIDD, as indexed by fiber size and contractile properties, returns to near control levels within 24 hours after returning to spontaneous breathing. Besides the down-regulation of proteolytic pathways and oxidative stress at 24 hours after extubation further repairing mechanisms have to be determined. PMID:24475293

Bruells, Christian S.; Bergs, Ingmar; Rossaint, Rolf; Du, Jun; Bleilevens, Christian; Goetzenich, Andreas; Weis, Joachim; Wiggs, Michael P.; Powers, Scott K.; Hein, Marc

2014-01-01

263

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

PubMed Central

Background Lung derecruitment is common during general anesthesia. Mechanical ventilation with physiological tidal volumes could magnify derecruitment, and produce lung dysfunction and inflammation. We used Positron Emission Tomography to study the process of derecruitment in normal lungs ventilated for 16 h, and the corresponding changes in regional lung perfusion and inflammation. Methods Six anesthetized supine sheep were ventilated with VT = 8mL/kg and positive end-expiratory pressure = 0. Transmission scans were obtained at 2-h intervals to assess regional aeration. Emission scans were acquired at baseline and after 16 h for the tracers: (a) 18F-fluorodeoxyglucose to evaluate lung inflammation, and (b) 13NN to calculate regional perfusion and shunt fraction. Results Gas fraction decreased from baseline to 16 h in dorsal (0.31 ± 0.13 to 0.14 ± 0.12, P < 0.01) but not ventral regions (0.61 ± 0.03 to 0.63 ± 0.07, P = NS), with time constants of 1.5-44.6 h. Whereas the vertical distribution of relative perfusion did not change from baseline to 16 h, shunt increased in dorsal regions (0.34 ± 0.23 to 0.63 ± 0.35, P < 0.01). The average pulmonary net 18F-fluorodeoxyglucose uptake rate in six regions of interest along the ventral-dorsal direction increased from 3.4 ± 1.4·10-3min-1 at baseline to 4.1 ± 1.5·10-3min-1 after 16 h (P < 0.01), and the corresponding average regions of interest 18F-fluorodeoxyglucose phosphorylation rate increased from 2.0 ± 0.2·10-2min-1 to 2.5 ± 0.2·10-2min-1 (P < 0.01). Conclusions In normal lungs mechanically ventilated without positive end-expiratory pressure, loss of aeration occurs continuously for several hours and is preferentially localized to dorsal regions. Progressive lung derecruitment was associated with increased regional shunt, implying an insufficient hypoxic pulmonary vasoconstriction. The increased pulmonary net uptake and phosphorylation rates of 18F-fluorodeoxyglucose suggest incipient inflammation in these initially normal lungs. PMID:23535501

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

2014-01-01

264

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

265

SIMV: An Application of Mathematical Modeling in Ventilator Management  

PubMed Central

SIMV (simulation and modeling of ventilation) is a quantitative system for the mathematical modeling and simulation of pulmonary function. SIMV has been developed as a part of a project designed to assist physicians managing patients who are in the intensive care unit and who require mechanical ventilation. SIMV provides predictions about a patient's pulmonary function, estimates the patient's physiologic parameters, and optimizes the patient's respiratory status by adjusting the controls of the ventilator. These three tasks are accomplished using standard numerical techniques, which are kept separate from SIMV's domain representation. SIMV communicates with other components of the ventilator-management project through probability distributions of shared physiologic parameters.

Thomsen, George; Sheiner, Lewis

1989-01-01

266

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

267

A European care bundle for prevention of ventilator-associated pneumonia  

Microsoft Academic Search

Background  One recent approach to facilitating guideline implementation involves the use of care bundles.\\u000a \\u000a \\u000a \\u000a Methods  This document presents a care bundle package addressing VAP prevention in an attempt to promote guideline-compliant practices.\\u000a Uniquely, the development of these care bundles used a formalised methodology to assess the supporting data, based on multi-criteria\\u000a decision analysis.\\u000a \\u000a \\u000a \\u000a \\u000a Results  The resulting VAP care bundles for prevention were: non-ventilatory

Jordi Rello; Hartmut Lode; Giuseppe Cornaglia; Robert Masterton

2010-01-01

268

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

PubMed

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

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

2013-09-01

269

National trends in hospital outcomes among patients with Guillain-Barré syndrome requiring mechanical ventilation.  

PubMed

Several new treatments have been introduced for Guillain-Barré syndrome over the last decade. To assess the impact of these new strategies on outcomes and hospitalization charges among patients with Guillain-Barré syndrome requiring mechanical ventilation, we compared pertinent variables between nationally representative data derived from 1992 and 2002. Compared with patients admitted in 1992, the patients admitted in 2002 showed an increase in hospital charges ($168,600 versus $116,300, P = 0.007), longer hospitalization (52.6 +/- 23.3 versus 40.3 +/- 36.3 days, P = 0.017), and greater in-hospital mortality (11.1% versus 7.6%, P = 0.003). Thus, improvements in therapeutic strategies over that decade are not reflected in mortality, length of hospitalization, or hospital charges in the current study. This outcome may be more reflective of changing patterns of hospitalization rather than relatively futility of new treatments. PMID:18772698

Souayah, Nizar; Nasar, Abu; Suri, M Fareed K; Qureshi, Adnan I

2008-09-01

270

Isoflurane sedation for patients undergoing mechanical ventilation: metabolism to inorganic fluoride and renal effects.  

PubMed

The metabolism and renal effects of isoflurane sedation were studied for 24 h in patients undergoing mechanical ventilation. Forty-six patients admitted to our intensive therapy unit were allocated randomly to receive either 0.1-0.6% isoflurane or midazolam 0.01-0.2 mg kg-1 h-1 for sedation. In 26 patients sedated with isoflurane, plasma inorganic fluoride increased from a mean concentration of 4.03 mumol litre-1 to 13.57 mumol litre-1 12 h after stopping sedation. Plasma inorganic fluoride concentrations in 20 patients sedated with midazolam were unchanged from baseline values (mean 5.32 mumol litre-1). Serum electrolyte, urea and creatinine concentrations, and urine output rates during and after sedation in patients who received isoflurane were similar to those who received midazolam. We conclude that, following isoflurane sedation for up to 24 h, metabolism to inorganic fluoride is insufficient to cause clinical renal dysfunction. PMID:2317417

Kong, K L; Tyler, J E; Willatts, S M; Prys-Roberts, C

1990-02-01

271

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

272

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

273

Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation. An experimental study.  

PubMed

We explored the pulmonary effects of continuous mechanical ventilation (MV) at a peak inspiratory pressure of 50 cm H2O in healthy, paralyzed, and anesthetized adult sheep during a period of 48 h. The 9 control sheep (Group A) were ventilated with 40% oxygen at a tidal volume of about 10 ml/kg and a peak inspiratory pressure of 15 to 20 cm H2O. All these animals remained stable throughout the 48 h of MV with no change in lung function. The 7 sheep in Group B were ventilated with 40% oxygen using a pressure-controlled ventilator at 50 cm H2O peak inspiratory pressure, at a VT of 50 to 70 ml/kg. All sheep in Group B developed severe respiratory failure and died or were killed within 2 to 35 h, and showed parenchymal consolidation at autopsy. The 9 sheep in Group C were ventilated as in Group B, except that 3.8% CO2 was added to the inspired gases: the Group C animals deteriorated more slowly, with little change in PaO2 but with a severely reduced FRC, VT, total static lung compliance, and grossly abnormal lungs at autopsy. We conclude that in this model, mechanical ventilation at peak airway pressure of 50 cm H2O will lead to progressive impairment in pulmonary mechanics, lung function, acute respiratory failure, and alveolar cellular dysfunction, as demonstrated by highly abnormal minimal surface tension values of saline lung lavage fluid in both study groups. PMID:3544984

Kolobow, T; Moretti, M P; Fumagalli, R; Mascheroni, D; Prato, P; Chen, V; Joris, M

1987-02-01

274

Nosocomial maxillary sinusitis during mechanical ventilation: A prospective comparison of orotracheal versus the nasotracheal route for intubation  

Microsoft Academic Search

Nosocomial maxillary sinusitis during mechanical ventilation may cause life-threatening complications in ICU patients. The aim of this prospective study was to compare the incidence of maxillary sinusitis according to the route of intubation. 111 consecutive adult patients (mean age: 53, mean SAPS: 12) were randomly assigned to receive either orotracheal (n=53) or nasotracheal (n=58) intubation. All had a nasogastric feeding

F. Salord; P. Gaussorgues; J. Marti-Flich; M. Sirodot; C. Allimant; D. Lyonnet; D. Robert

1990-01-01

275

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

E-print Network

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

Paris-Sud XI, Université de

276

75 FR 48235 - Rural Health Care Universal Service Support Mechanism  

Federal Register 2010, 2011, 2012, 2013

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

2010-08-09

277

Ventilator-associated pneumonia, liver disease and oral chlorhexldine.  

PubMed

As part of the ventilator care bundle, the Department of Health (DH) in the U.K. recommends the use of chlorhexidine (CHX) for oral care to prevent the occurrence of ventilator-associated pneumonia (VAP) in all mechanically ventilated patients. Due to the heterogenous nature of this population, however, it is important to consider whether such recommendations are also relevant to specific critical care patient population groups. This article reviews the available scientific evidence on the use of CHX in the prevention of VAP, with a focus on critically ill mechanically ventilated patients who have liver dysfunction. Findings will be discussed with reference to the wider research literature in order to make recommendations for future practice. PMID:24261090

Oshodi, Titilayo O; Bench, Suzanne

278

The application of mechanical aerosol delivery systems in an in vitro model of mechanically ventilated neonates.  

PubMed

Delivery of medication to the neonatal lung using current methods is inefficient. Aerosols offer one way to improve delivery to small airways. In this in vitro work, aerosol delivery by using a micropump or a rotary valve has been evaluated in a model of the neonatal setting with a pressurised metered dose inhaler plus spacer outside of the inspiratory limb. Drug depositions were assessed by spectrophotometric analyses. Drug lung deposition was increased by adjusting the rotary valve for co-ordination between the inhalation and aerosol delivery, but this intermittent mode decreased the aerosol delivery by using the micropump. Also, decreasing the volume of spacer decreased drug deposition in test lungs by using the micropump system. At the optimum conditions, the rotary valve aerosol delivery system delivered 3.68±0.91% of the Qvar nominal dose to the test lungs, and this was 2.34±0.01% for the micropump system. In conclusion, the rotary valve aerosol delivery system provided higher amounts of drug particles to the test lungs compared to the micropump system. The advantages of these methods were that the humidity in the ventilation circuit did not affect the aerosol particles in the spacer. Further optimisation is required to improve aerosol deposition in the test lungs. The article has also a short section of recent patents relevant to aerosol delivery. PMID:24021087

Ehtezazi, Touraj; Turner, Mark A

2013-12-01

279

REVIEW Open Access Ventilator-induced lung injury: historical  

E-print Network

REVIEW Open Access Ventilator-induced lung injury: historical perspectives and clinical Mechanical ventilation can produce lung physiological and morphological alterations termed ventilator to mechanically ventilated patients, and thus of the stress applied to their lungs, unambiguously contributed

Paris-Sud XI, Université de

280

Rural health care support mechanism. Final rule.  

PubMed

In this document, the Federal Communications Commission reforms its universal service support program for health care, transitioning its existing Internet Access and Rural Health Care Pilot programs into a new, efficient Healthcare Connect Fund. This Fund will expand health care provider access to broadband, especially in rural areas, and encourage the creation of state and regional broadband health care networks. Access to broadband for medical providers saves lives while lowering health care costs and improving patient experiences. PMID:23476995

2013-03-01

281

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

SciTech Connect

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

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

2013-03-15

282

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

PubMed

In this work, a simple and low-cost air flow sensor, based on a novel fiber-optic sensing technique has been developed for monitoring air flows rates supplied by a neonatal ventilator to support infants in intensive care units. The device is based on a fiber optic sensing technique allowing (a) the immunity to light intensity variations independent by measurand and (b) the reduction of typical shortcomings affecting all biomedical fields (electromagnetic interference and patient electrical safety). The sensing principle is based on the measurement of transversal displacement of an emitting fiber-optic cantilever due to action of air flow acting on it; the fiber tip displacement is measured by means of a photodiode linear array, placed in front of the entrance face of the emitting optical fiber in order to detect its light intensity profile. As the measurement system is based on a detection of the illumination pattern, and not on an intensity modulation technique, it results less sensitive to light intensity fluctuation independent by measurand than intensity-based sensors. The considered technique is here adopted in order to develop two different configurations for an air flow sensor suitable for the measurement of air flow rates typically occurring during mechanical ventilation of newborns: a mono-directional and a bi-directional transducer have been proposed. A mathematical model for the air flow sensor is here proposed and a static calibration of two different arrangements has been performed: a measurement range up to 3.00 × 10(-4) m(3)?s (18.0 l?min) for the mono-directional sensor and a measurement range of ±3.00 × 10(-4) m(3)?s (±18.0 l?min) for the bi-directional sensor are experimentally evaluated, according to the air flow rates normally encountered during tidal breathing of infants with a mass lower than 10 kg. Experimental data of static calibration result in accordance with the proposed theoretical model: for the mono-directional configuration, the coefficient of determination r(2) is equal to 0.997; for the bi-directional configuration, the coefficient of determination r(2) is equal to 0.990 for positive flows (inspiration) and 0.988 for negative flows (expiration). Measurement uncertainty ?Q of air flow rate has been evaluated by means of the propagation of distributions and the percentage error in the arrangement of bi-directional sensor ranges from a minimum of about 0.5% at -18.0 l?min to a maximum of about 9% at -12.0 l?min. PMID:23556844

Battista, L; Sciuto, S A; Scorza, A

2013-03-01

283

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

NASA Astrophysics Data System (ADS)

In this work, a simple and low-cost air flow sensor, based on a novel fiber-optic sensing technique has been developed for monitoring air flows rates supplied by a neonatal ventilator to support infants in intensive care units. The device is based on a fiber optic sensing technique allowing (a) the immunity to light intensity variations independent by measurand and (b) the reduction of typical shortcomings affecting all biomedical fields (electromagnetic interference and patient electrical safety). The sensing principle is based on the measurement of transversal displacement of an emitting fiber-optic cantilever due to action of air flow acting on it; the fiber tip displacement is measured by means of a photodiode linear array, placed in front of the entrance face of the emitting optical fiber in order to detect its light intensity profile. As the measurement system is based on a detection of the illumination pattern, and not on an intensity modulation technique, it results less sensitive to light intensity fluctuation independent by measurand than intensity-based sensors. The considered technique is here adopted in order to develop two different configurations for an air flow sensor suitable for the measurement of air flow rates typically occurring during mechanical ventilation of newborns: a mono-directional and a bi-directional transducer have been proposed. A mathematical model for the air flow sensor is here proposed and a static calibration of two different arrangements has been performed: a measurement range up to 3.00 × 10-4 m3/s (18.0 l/min) for the mono-directional sensor and a measurement range of ±3.00 × 10-4 m3/s (±18.0 l/min) for the bi-directional sensor are experimentally evaluated, according to the air flow rates normally encountered during tidal breathing of infants with a mass lower than 10 kg. Experimental data of static calibration result in accordance with the proposed theoretical model: for the mono-directional configuration, the coefficient of determination r2 is equal to 0.997; for the bi-directional configuration, the coefficient of determination r2 is equal to 0.990 for positive flows (inspiration) and 0.988 for negative flows (expiration). Measurement uncertainty ?Q of air flow rate has been evaluated by means of the propagation of distributions and the percentage error in the arrangement of bi-directional sensor ranges from a minimum of about 0.5% at -18.0 l/min to a maximum of about 9% at -12.0 l/min.

Battista, L.; Sciuto, S. A.; Scorza, A.

2013-03-01

284

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

PubMed Central

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

2014-01-01

285

Association between mechanical ventilation and neurodevelopmental disorders in a nationwide cohort of extremely low birth weight infants.  

PubMed

Mechanical ventilation for preterm infants independently contributes to poor neurodevelopmental performance. However, few studies have investigated the association between the duration of mechanical ventilation and the risk for various developmental disorders in extremely low birth weight (ELBW) (<1000g) infants. Using a large nationwide database, we did a 10-year retrospective follow-up study to explore the effect of mechanical ventilation on the incidence of cerebral palsy (CP), autism spectrum disorder (ASD), intellectual disability (ID), and attention-deficit/hyperactivity disorder (ADHD) in ELBW infants born between 1998 and 2001. Seven hundred twenty-eight ELBW infants without diagnoses of brain insults or focal brain lesions in the initial hospital stay were identified and divided into three groups (days on ventilator: ?2, 3-14, ?15 days). After adjusting for demographic and medical factors, the infants in the ?15 days group had higher risks for CP (adjusted hazard ratio: 2.66; 95% confidence interval: 1.50-4.59; p<0.001) and ADHD (adjusted hazard ratio: 1.95; 95% confidence interval: 1.02-3.76; p<0.05), than did infants in the ?2 days group. The risk for ASD or ID was not significantly different between the three groups. We conclude that mechanical ventilation for ?15 days increased the risk for CP and ADHD in ELBW infants even without significant neonatal brain damage. Developing a brain-protective respiratory support strategy in response to real-time cerebral hemodynamic and oxygenation changes has the potential to improve neurodevelopmental outcomes in ELBW infants. PMID:24769371

Tsai, Wen-Hui; Hwang, Yea-Shwu; Hung, Te-Yu; Weng, Shih-Feng; Lin, Shio-Jean; Chang, Wen-Tsan

2014-07-01

286

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

Microsoft Academic Search

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

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

1992-01-01

287

Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses  

Microsoft Academic Search

Objective  To determine intensive care nurses' knowledge of evidence-based guidelines for the prevention of ventilator-associated pneumonia\\u000a (VAP).\\u000a \\u000a \\u000a \\u000a Design  A survey using a validated multiple-choice questionnaire, developed to evaluate nurses' knowledge of VAP prevention. The questionnaire\\u000a was distributed and collected during the annual congress of the Flemish Society for Critical Care Nurses (Ghent, November\\u000a 2005). Demographic data included were gender, years of intensive care experience,

Stijn I. Blot; Sonia Labeau; Dominique Vandijck; Paul Van Aken; Brigitte Claes

2007-01-01

288

47 CFR 54.602 - Health care support mechanism.  

...support mechanism. (a) Telecommunications Program. Rural health care providers may request support for the difference, if any, between the urban and rural rates for telecommunications services, subject to...

2014-10-01

289

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

290

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

PubMed Central

Aim Providing consistent levels of oxygen saturation (SpO2) for infants in neonatal intensive care units is not easy. This study explored how effectively the Auto-Mixer® algorithm automatically adjusted fraction of inspired oxygen (FiO2) levels to maintain SpO2 within an intended range in extremely low birth weight infants receiving supplemental oxygen without mechanical ventilation. Methods Twenty extremely low birth weight infants were randomly assigned to the Auto-Mixer® group or the manual intervention group and studied for 12 h. The SpO2 target was 85–93%, and the outcomes were the percentage of time SpO2 was within target, SpO2 variability, SpO2 >95%, oxygen received and manual interventions. Results The percentage of time within intended SpO2 was 58 ± 4% in the Auto-Mixer® group and 33.7 ± 4.7% in the manual group, SpO2 >95% was 26.5% vs 54.8%, average SpO2 and FiO2 were 89.8% vs 92.2% and 37% vs 44.1%, and manual interventions were 0 vs 80 (p < 0.05). Brief periods of SpO2 < 85% occurred more frequently in the Auto-Mixer® group. Conclusion The Auto-Mixer® effectively increased the percentage of time that SpO2 was within the intended target range and decreased the time with high SpO2 in spontaneously breathing extremely low birth weight infants receiving supplemental oxygen. PMID:24813808

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

2014-01-01

291

Post-traumatic stress symptoms in Guillain-Barré syndrome patients after prolonged mechanical ventilation in ICU: a preliminary report.  

PubMed

Thirty percent of Guillain-Barré syndrome (GBS) patients require mechanical ventilation (MV) in intensive care unit (ICU). Post-traumatic stress disorder (PTSD) is found in ICU survivors, and the traumatic aspects of intubation and MV have been previously reported as risk factors for PTSD after ICU. Our objective was to determine long-term PTSD or post-traumatic stress symptoms (PTSS) in GBS patients after prolonged MV in ICU. We assessed GBS patients who had MV for more than 2?months. PTSD was assessed using Horowitz Impact of Event Scale (IES), IES-Revisited (IES-R), and the Post-traumatic CheckList Scale; functional outcome using Rankin and Barthel scales; quality of life (QoL) using Nottingham Health Profile (NHP) and 36-Item Short Form Health Survey (SF-36) and depression using Hospital Anxiety and Depression Scale (HAD) and Beck questionnaire. Thirteen patients could be identified and analyzed. They had only mild disability. They were neither anxious nor depressed with an anxiety HAD at 5 (4-11.5), a depression HAD at 1 (0-3.5) and a Beck at 1 (0-5). QoL was mildly decreased in our population with a NHP at 78.5 (12.8-178.8) and mild decreased SF-36. Compared with the French population, the SF-36 sub-categories were, however, not statistically different. Twenty-two percentage of our 13 patients had PTSD and PTSS with a Horowitz IES at 12 (2-29), and an IES-R at 16 (2-34.5). Although severe GBS patients requiring prolonged MV had good functional recovery and no difference in QoL, they had a high incidence of PTSS. PMID:25403788

Le Guennec, Loïc; Brisset, Marion; Viala, Karine; Essardy, Fatiha; Maisonobe, Thierry; Rohaut, Benjamin; Demeret, Sophie; Bolgert, Francis; Weiss, Nicolas

2014-09-01

292

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

Microsoft Academic Search

Diagnosing ventilator-associated pneumonia in mechanically ventilated patients in intensive care units is seen as a clinical challenge. The difficulty in diagnosing ventilator-associated pneumonia stems from the lack of a simple yet accurate diagnostic test. To assist clinicians in diagnosing and treating patients with pneumonia, a decision-theoretic network had been designed with the help of domain experts. A major limitation of

Theodore Charitos; Linda C. Van Der Gaag; Stefan Visscher; Karin A. M. Schurink; Peter J. F. Lucas

2009-01-01

293

Two-way analysis for detecting factors affecting ventilator-associated pneumonia  

Microsoft Academic Search

The “clinically required ventilation period” for assessing ventilator-associated pneumonia (VAP) has not been studied because\\u000a this period could not be clinically predicted. We addressed this problem using both rate analysis and failure-time analysis.\\u000a A total of 325 patients who had received mechanical ventilatory support in the intensive care unit of a university hospital\\u000a were reviewed. The total ventilation period and

Takahiro Takuma; Hisashi Shoji; Koichiro Yoshida; Yoshihito Niki

294

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

295

Consultation system for determining the patients' readiness for weaning from long-term mechanical ventilation.  

PubMed

Determining the readiness of the patient for weaning from long-term mechanical ventilation with high degree of accuracy is a prerequisite for successful weaning attempt. A computer system for the determination of the moment for beginning the weaning process is proposed and realized as a program package WeaningMV. It is designed on the basis of four classification methods: stepwise discriminant analysis, stepwise logistic regression; intuitionistic fuzzy Voronoi diagrams and non-pulmonary weaning index, applied to 17 features (variables). The system is designed and preliminary tested on 151 patients with features in two classes "not ready for weaning" and "ready for weaning" and it has a high degree for sensitivity (0.99) and specificity (0.89). After the application of the system in the everyday physician's practice a set of 72 patients has been examined. For that set the sensitivity is 0.92 and the specificity 0.88. The system consults the medical team on the basis of objective processing of the information contained in the data and is suitable for use in the clinical practice as well as in the training of the respective specialists. PMID:20233635

Hadjitodorov, Stefan; Todorova, Lyudmila

2010-10-01

296

A closed-loop mechanical ventilation controller with explicit objective functions.  

PubMed

A closed-loop lung ventilation controller was designed, aiming to: 1) track a desired end-tidal CO2 pressure (Pet CO2), 2) find the positive end-expiratory pressure (PEEP) of minimum estimated respiratory system elastance (Ers,e), and 3) follow objective functions conjectured to reduce lung injury. After numerical simulations, tests were performed in six paralyzed piglets. Respiratory mechanics parameters were estimated by the recursive least squares (RLS) method. The controller incorporated a modified PI controller for Pet CO2 and a gradient descent method for PEEP. In each animal, three automated PEEP control runs were performed, as well as a manual PEEP titration of Ers,e and a multiple PetCO2 step change trial. Overall performance indexes were obtained from PEEP control, such as minimum Ers,e (37.0 +/- 4.5 cmH2O x L(-1)), time to reach the minimum Ers,e (235 +/- 182 s) and associated PEEP (6.5 +/- 1.0 cmH2O), and from Pet CO2 control, such as rise time (53 +/- 22 s), absolute overshoot/undershoot of PetCO2 (3 +/- 1 mmHg), and settling time (145 +/- 72 s). The resulting CO2 controller dynamics approximate physiological responses, and results from PEEP control were similar to those obtained by manual titration. Multiple dependencies linking the involved variables are discussed. The present controller can help to implement and evaluate objective functions that meet clinical goals. PMID:15132509

Jandre, Frederico C; Pino, Alexandre V; Lacorte, Ivanir; Neves, João Henrique S; Giannella-Neto, Antonio

2004-05-01

297

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

298

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

299

Appropriateness and delay to initiate therapy in ventilator-associated pneumonia  

Microsoft Academic Search

Inappropriate therapy (IT) and delayed initiation of appropriate therapy (DIAT) result in inadequate therapy in patients with ventilator-associated pneumonia (VAP). The aim of the current study was to assess the impact of DIAT in VAP. A total of 76 mechanically ventilated patients with bacteriologically confirmed VAP were prospectively evaluated in the intensive care unit of six hospitals in Buenos Aires,

C. M. Luna; P. Aruj; M. S. Niederman; J. Garzon; D. Violi; A. Prignoni; F. Rõ ´

2006-01-01

300

Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation  

PubMed Central

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

2014-01-01

301

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

302

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

303

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; Fogaça Kawaguchi, Yurika Maria; Sayuri Hirota, Adriana; Fu, Carolina; Tanaka, Clarice; Caruso, Pedro; Park, Marcelo; Ribeiro Carvalho, Carlos Roberto

2013-01-01

304

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

PubMed

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

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

2014-01-15

305

Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis  

PubMed Central

Background: Mechanical ventilation in the prone position is used to improve oxygenation and to mitigate the harmful effects of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). We sought to determine the effect of prone positioning on mortality among patients with ARDS receiving protective lung ventilation. Methods: We searched electronic databases and conference proceedings to identify relevant randomized controlled trials (RCTs) published through August 2013. We included RCTs that compared prone and supine positioning during mechanical ventilation in patients with ARDS. We assessed risk of bias and obtained data on all-cause mortality (determined at hospital discharge or, if unavailable, after longest follow-up period). We used random-effects models for the pooled analyses. Results: We identified 11 RCTs (n = 2341) that met our inclusion criteria. In the 6 trials (n = 1016) that used a protective ventilation strategy with reduced tidal volumes, prone positioning significantly reduced mortality (risk ratio 0.74, 95% confidence interval 0.59–0.95; I2 = 29%) compared with supine positioning. The mortality benefit remained in several sensitivity analyses. The overall quality of evidence was high. The risk of bias was low in all of the trials except one, which was small. Statistical heterogeneity was low (I2 < 50%) for most of the clinical and physiologic outcomes. Interpretation: Our analysis of high-quality evidence showed that use of the prone position during mechanical ventilation improved survival among patients with ARDS who received protective lung ventilation. PMID:24863923

Sud, Sachin; Friedrich, Jan O.; Adhikari, Neill K. J.; Taccone, Paolo; Mancebo, Jordi; Polli, Federico; Latini, Roberto; Pesenti, Antonio; Curley, Martha A.Q.; Fernandez, Rafael; Chan, Ming-Cheng; Beuret, Pascal; Voggenreiter, Gregor; Sud, Maneesh; Tognoni, Gianni; Gattinoni, Luciano; Guérin, Claude

2014-01-01

306

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

307

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

Microsoft Academic Search

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

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

2001-01-01

308

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

309

Non-invasive ventilation in acute respiratory failure.  

PubMed

One of the cornerstones of critical care medicine is support of the failing respiratory system. The 2 major components of managing respiratory failure are the acute intervention and the weaning process. Many of the studies to determine the optimal methods of ventilation and weaning have focused on non-invasive positive-pressure ventilation as an alternative to invasive ventilation, with various causes of acute respiratory failure. Non-invasive ventilation refers to the provision of ventilatory support to the lungs, without the use of an endotracheal airway. It has emerged as an important tool in the treatment of acute respiratory failure. Non-invasive positive ventilation has undergone a remarkable evolution over the past decades and is assuming an important role in the management of both acute and chronic respiratory failure. There is improvement in gas exchange, relief of respiratory muscle fatigue, and clinical outcome with reduced morbidity and mortality. Nevertheless, contraindications and failures need to be identified early, as delaying endotracheal intubation is associated with increased morbidity and mortality. Furthermore, although it is common practice to give intubation and mechanical ventilation, complications can result from the intubation process (damage to local tissue) and during the course of ventilation (pneumonia and sinusitis associated with ventilators), prolonging stay in intensive care, length of hospital stay and mortality in selected patients. PMID:24760814

Singh, Gurmeet; Pitoyo, Ceva W

2014-01-01

310

Lower tidal volume at initiation of mechanical ventilation may reduce progression to acute respiratory distress syndrome: a systematic review  

PubMed Central

Introduction The most appropriate tidal volume in patients without acute respiratory distress syndrome (ARDS) is controversial and has not been rigorously examined. Our objective was to determine whether a mechanical ventilation strategy using lower tidal volume is associated with a decreased incidence of progression to ARDS when compared with a higher tidal volume strategy. Methods A systematic search of MEDLINE, EMBASE, CINAHL, the Cochrane Library, conference proceedings, and clinical trial registration was performed with a comprehensive strategy. Studies providing information on mechanically ventilated patients without ARDS at the time of initiation of mechanical ventilation, and in which tidal volume was independently studied as a predictor variable for outcome, were included. The primary outcome was progression to ARDS. Results The search yielded 1,704 studies, of which 13 were included in the final analysis. One randomized controlled trial was found; the remaining 12 studies were observational. The patient cohorts were significantly heterogeneous in composition and baseline risk for developing ARDS; therefore, a meta-analysis of the data was not performed. The majority of the studies (n = 8) showed a decrease in progression to ARDS with a lower tidal volume strategy. ARDS developed early in the course of illness (5 hours to 3.7 days). The development of ARDS was associated with increased mortality, lengths of stay, mechanical ventilation duration, and nonpulmonary organ failure. Conclusions In mechanically ventilated patients without ARDS at the time of endotracheal intubation, the majority of data favors lower tidal volume to reduce progression to ARDS. However, due to significant heterogeneity in the data, no definitive recommendations can be made. Further randomized controlled trials examining the role of lower tidal volumes in patients without ARDS, controlling for ARDS risk, are needed. 2013 Fuller et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. PMID:23331507

2013-01-01

311

Inhibiting Lung Elastase Activity Enables Lung Growth in Mechanically Ventilated Newborn Mice  

PubMed Central

Rationale: Mechanical ventilation with O2-rich gas (MV-O2) offers life-saving treatment for respiratory failure, but also promotes lung injury. We previously reported that MV-O2 of newborn mice increased lung elastase activity, causing elastin degradation and redistribution of elastic fibers from septal tips to alveolar walls. These changes were associated with transforming growth factor (TGF)-? activation and increased apoptosis leading to defective alveolarization and lung growth arrest, as seen in neonatal chronic lung disease. Objectives: To determine if intratracheal treatment of newborn mice with the serine elastase inhibitor elafin would prevent MV-O2–induced lung elastin degradation and the ensuing cascade of events causing lung growth arrest. Methods: Five-day-old mice were treated via tracheotomy with recombinant human elafin or vehicle (lactated-Ringer solution), followed by MV with 40% O2 for 8–24 hours; control animals breathed 40% O2 without MV. At study's end, lungs were harvested to assess key variables noted below. Measurements and Main Results: MV-O2 of vehicle-treated pups increased lung elastase and matrix metalloproteinase-9 activity when compared with unventilated control animals, causing elastin degradation (urine desmosine doubled), TGF-? activation (pSmad-2 tripled), and apoptosis (cleaved-caspase-3 increased 10-fold). Quantitative lung histology showed larger and fewer alveoli, greater inflammation, and scattered elastic fibers. Elafin blocked these MV-O2–induced changes. Conclusions: Intratracheal elafin, by blocking lung protease activity, prevented MV-O2–induced elastin degradation, TGF-? activation, apoptosis, and dispersion of matrix elastin, and attenuated lung structural abnormalities noted in vehicle-treated mice after 24 hours of MV-O2. These findings suggest that elastin breakdown contributes to defective lung growth in response to MV-O2 and might be targeted therapeutically to prevent MV-O2–induced lung injury. PMID:21562133

Hilgendorff, Anne; Parai, Kakoli; Ertsey, Robert; Jain, Noopur; Navarro, Edwin F.; Peterson, Joanna L.; Tamosiuniene, Rasa; Nicolls, Mark R.; Starcher, Barry C.; Rabinovitch, Marlene

2011-01-01

312

Prostacyclin concentrations and transitional circulation in preterm infants requiring mechanical ventilation  

PubMed Central

AIM—To describe the association between early postnatal prostacyclin concentrations in preterm infants; echocardiographic measurements of ductal diameter and ventricular output and clinical outcomes of intraventricular haemorrhage (IVH) and patent ductus arteriosus (PDA).?METHODS—Forty nine preterm infants born before 30 weeks of gestational age (median birthweight 980 g, median gestational age 27 weeks) underwent echocardiographic studies at 5, 12, 24 and 48 hours of postnatal age. Measurements included ventricular outputs and the ductal shunt diameter as a measure of the shunt size. Simultaneous measurements of blood pressures, mean airway pressure and inspired fraction of oxygen (FIO2) were recorded. A blood sample for the prostacyclin metabolite 6-ketoprostaglandin F1-alpha (6KPGF1?) was taken at the 5 and 24 hour echocardiogram.?Results—The mean 6KPGF1? concentrations were higher than adult concentrations at 5 (515 pg/ml) and 24 (255 pg/ml) hours. There was no association with gestational age. Raised 6KPGF1? concentrations were related to increased need for mechanical ventilation and severity of respiratory disease. At 5 hours, increased 6KPGF1? concentrations were associated with larger PDA and at 24 hours with larger PDA and higher left ventricular output. Infants with higher 6KPGF1? concentrations were more likely to develop clinically significant PDA. There was no association between early measurements of 6KPGF1? and IVH.?CONCLUSIONS—Early postnatal prostacyclin concentrations are markedly raised in preterm infants, particularly in those with more severe lung disease. Raised 6KPGF1? concentrations were associated with an increased ductal diameter and subsequent PDA, but not IVH.?? PMID:10325809

Kluckow, M.; Evans, N.; Leslie, G.; Rowe, J.

1999-01-01

313

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

PubMed

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

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

2014-06-01

314

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

E-print Network

on the ventilator data and the temperature sensor inside the EIT system; 2) an algorithm to automatically validate over long periods of time. Prolonged comparisons of EIT measurements against reference techniques over timeline of all events. The temperature inside the EIT system is also similarly recorded to account for any

Adler, Andy

315

Assisted ventilation as an aid to exercise training: a mechanical doping?  

Microsoft Academic Search

xercise training as a part of multidisciplinary pulmon- ary rehabilitation can improve both exercise tolerance and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD) (1). The following physiological changes contribute to these improve- ments: reduction of lactic acidosis; minute ventilation and heart rate for a given work rate; and enhanced activity of mitochondrial enzymes and capillary

N. Ambrosino

2006-01-01

316

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

317

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

318

A Review of Documented Oral Care Practices in an Intensive Care Unit  

Microsoft Academic Search

Oral care is recognized as an essential component of care for critically ill patients and nursing documentation provides evidence of this process. This study examined the practice and frequency of oral care among mechanically ventilated and nonventilated patients. A retrospective record review was conducted of patients admitted to an intensive care unit (ICU) between July 1, 2007 and December 31,

Linda K. Goss; Mary-Beth Coty; John A. Myers

2011-01-01

319

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

320

Prevalência e prognóstico dos pacientes com pneumonia associada à ventilação mecânica em um hospital universitário* Prevalence of ventilator-associated pneumonia in a university hospital and prognosis for the patients affected  

Microsoft Academic Search

Objective: To determine the prevalence of ventilator-associated pneumonia in an intensive care unit, as well as to identify related factors and characterize patient evolution. Methods: This study evaluated 278 patients on mechanical ventilation for more than 24 hours in a university hospital. Results: Ventilator-associated pneumonia developed in 38.1% of the patients, translating to 35.7 cases\\/1000 ventilator- days: 45.3% were caused

MÁRCIO MARTINS DE QUEIROZ; JOSÉ RODOLFO ROCCO

2006-01-01

321

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

322

Dispersion of Expiratory Droplets in a General Hospital Ward with Ceiling Mixing Type Mechanical Ventilation System  

Microsoft Academic Search

This study investigated the dispersion characteristics of polydispersed droplets in a general hospital ward equipped with ceiling-mixing type ventilation system. Injections of water test droplets containing non-volatile content were produced. The injections simulate human coughs with a similar droplet size distribution (peak size at 12 ? m) and airflow rate (0.4 L\\/s). The dispersion of test droplets was measured in-situ

M. P. Wan; C. Y. H. Chao; Y. D. Ng; G. N. Sze To; W. C. Yu

2007-01-01

323

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

324

Imaging of the three-dimensional alveolar structure and the alveolar mechanics of a ventilated and perfused isolated rabbit lung with Fourier domain optical coherence tomography  

NASA Astrophysics Data System (ADS)

In this feasibility study, Fourier domain optical coherence tomography (FDOCT) is used for visualizing the 3-D structure of fixated lung parenchyma and to capture real-time cross sectional images of the subpleural alveolar mechanics in a ventilated and perfused isolated rabbit lung. The compact and modular setup of the FDOCT system allows us to image the first 500 µm of subpleural lung parenchyma with a 3-D resolution of 16×16×8 µm (in air). During mechanical ventilation, real-time cross sectional FDOCT images visualize the inflation and deflation of alveoli and alveolar sacks (acini) in successive images of end-inspiratory and end-expiratory phase. The FDOCT imaging shows the relation of local alveolar mechanics to the setting of tidal volume (VT), peak airway pressure, and positive end-expiratory pressure (PEEP). Application of PEEP leads to persistent recruitment of alveoli and acini in the end-expiratory phase, compared to ventilation without PEEP where alveolar collapse and reinflation are observed. The imaging of alveolar mechanics by FDOCT will help to determine the amount of mechanical stress put on the alveolar walls during tidal ventilation, which is a key factor in understanding the development of ventilator induced lung injury (VILI).

Popp, Alexander; Wendel, Martina; Knels, Lilla; Koch, T.; Koch, Edmund

2006-01-01

325

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

326

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

327

21 CFR 868.5955 - Intermittent mandatory ventilation attachment.  

Code of Federal Regulations, 2011 CFR

... (a) Identification. An intermittent mandatory ventilation (IMV) attachment is a device attached to a mechanical ventilator that allows spontaneous breathing by a patient while providing mechanical ventilation at a preset rate. (b)...

2011-04-01

328

21 CFR 868.5955 - Intermittent mandatory ventilation attachment.  

... (a) Identification. An intermittent mandatory ventilation (IMV) attachment is a device attached to a mechanical ventilator that allows spontaneous breathing by a patient while providing mechanical ventilation at a preset rate. (b)...

2014-04-01

329

21 CFR 868.5955 - Intermittent mandatory ventilation attachment.  

Code of Federal Regulations, 2012 CFR

... (a) Identification. An intermittent mandatory ventilation (IMV) attachment is a device attached to a mechanical ventilator that allows spontaneous breathing by a patient while providing mechanical ventilation at a preset rate. (b)...

2012-04-01

330

21 CFR 868.5955 - Intermittent mandatory ventilation attachment.  

Code of Federal Regulations, 2013 CFR

... (a) Identification. An intermittent mandatory ventilation (IMV) attachment is a device attached to a mechanical ventilator that allows spontaneous breathing by a patient while providing mechanical ventilation at a preset rate. (b)...

2013-04-01

331

21 CFR 868.5955 - Intermittent mandatory ventilation attachment.  

Code of Federal Regulations, 2010 CFR

... (a) Identification. An intermittent mandatory ventilation (IMV) attachment is a device attached to a mechanical ventilator that allows spontaneous breathing by a patient while providing mechanical ventilation at a preset rate. (b)...

2010-04-01

332

Noisy Ventilation Improves Lung Function  

NASA Astrophysics Data System (ADS)

It has been shown that mechanical ventilation in the setting of acute lung injury may propagate additional injury within the lung and numerous studies have been carried out to determine the optimal method of minimizing ventilator induced lung injury while still maintaining life-sustaining gas exchange. We have found that noise added to tidal volume and frequency, called noisy ventilation, during mechanical ventilation improves both lung mechanics and oxygenation in a rodent model of acute lung injury. Additionally, the standard deviation of the noise appears to be directly related to the magnitude of improvements seen with this ventilation modality in a manner similar to stochastic resonance. Furthermore, healthy guinea pigs that underwent with noisy ventilation exhibited increased surfactant content and reduced plasma proteins than their conventionally ventilated counterparts within the alveolar space of the lung. This suggests that not only did noisy ventilation induce endogenous surfactant release, but also served to reduce ventilator induced lung injury in this animal model. In conclusion, noisy ventilation improves blood oxygenation during acute lung injury and also serves to enhance lung function and reduce ventilator induced lung injury in healthy lungs.

Suki, Béla; Arold, Stephen P.; Alencar, Adriano; Lutchen, Kenneth R.; Ingenito, Edward P.

2003-05-01

333

Concept of Operations for Triage of Mechanical Ventilation in an Epidemic  

Microsoft Academic Search

The recent outbreak of severe acute respiratory syndrome and the growing potential of an influenza pan- demic force us to consider the fact that despite great advances in critical care medicine, we lack the capacity to provide intensive care to the large number of patients that may be generated in an epidemic or multisite bioterrorism event. Because many epidemic and

John L. Hick; Daniel T. O'Laughlin

2006-01-01

334

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

PubMed Central

Introduction The aim of this study was to validate an automated, objective and standardized algorithm for quantifying and displaying patient-ventilator interaction. Methods Using a new method to detect patient-ventilator synchrony, the present study re-analyzed previously acquired and published data from 24 mechanically ventilated adult patients (Colombo et al., Crit Care Med. 2011 Nov;39(11):2452–7). Patient-ventilator interactions were evaluated by comparing ventilator pressure and diaphragm electrical activity (EAdi) waveforms, recorded during pressure support ventilation. The EAdi and ventilator pressure waveforms were analyzed for their timings (manually and automatically determined), and the error between the two waveforms was quantified. A new index of patient-ventilator interaction (NeuroSync index), which is standardized and automated, was validated and compared to manual analysis and previously published indices of asynchrony. Results The comparison of manual and automated detection methods produced high test-retest and inter-rater reliability (Intraclass correlation coefficient = 0.95). The NeuroSync index increased the sensitivity of detecting dyssynchronies, compared to previously published indices, which were found to only detect asynchronies. Conclusion The present study introduces an automated method and the NeuroSync index to determine patient-ventilator interaction with a more sensitive analysis method than those previously described. A dashboard-style of graphical display allows a rapid overview of patient-ventilator interaction and breathing pattern at the bedside. PMID:24131701

2013-01-01

335

Randomised crossover study of pressure and volume non-invasive ventilation in chest wall deformity  

PubMed Central

Background: Non-invasive ventilation is an established treatment for chronic respiratory failure due to chest wall deformity. There are few data available to inform the choice between volume and pressure ventilators. The aim of this study was to compare pressure and volume targeted ventilation in terms of diurnal arterial blood gas tensions, lung volumes, hypercapnic ventilatory responses, sleep quality, and effect on daytime function and health status when ventilators were carefully set to provide the same minute ventilation. Methods: Thirteen patients with chest wall deformity underwent a 4 week single blind randomised crossover study using the Breas PV403 ventilator in either pressure or volume mode with assessments made at the end of each 4 week period. Results: Minute ventilation at night was less than that set during the day with greater leakage for both modes of ventilation. There was more leakage with pressure than volume ventilation (13.8 (1.9) v 5.9 (1.0) l/min, p = 0.01). There were no significant differences in sleep quality, daytime arterial blood gas tensions, lung mechanics, ventilatory drive, health status or daytime functioning. Conclusions: These data suggest that pressure and volume ventilation are equivalent in terms of the effect on nocturnal and daytime physiology, and resulting daytime function and health status. PMID:16085730

Tuggey, J; Elliott, M

2005-01-01

336

Ventilator associated pneumonia and infection control  

PubMed Central

Ventilator associated pneumonia (VAP) is the leading cause of morbidity and mortality in intensive care units. The incidence of VAP varies from 7% to 70% in different studies and the mortality rates are 20–75% according to the study population. Aspiration of colonized pathogenic microorganisms on the oropharynx and gastrointestinal tract is the main route for the development of VAP. On the other hand, the major risk factor for VAP is intubation and the duration of mechanical ventilation. Diagnosis remains difficult, and studies showed the importance of early initiation of appropriate antibiotic for prognosis. VAP causes extra length of stay in hospital and intensive care units and increases hospital cost. Consequently, infection control policies are more rational and will save money. PMID:16600048

Alp, Emine; Voss, Andreas

2006-01-01

337

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

PubMed Central

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

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

2014-01-01

338

Prolonged sedation requiring mechanical ventilation and continuous flumazenil infusion after routine doses of clorazepam for alcohol withdrawal syndrome.  

PubMed

We report the cases of two patients who developed prolonged sedation after routine doses of clorazepam for alcohol withdrawal syndrome. They required prolonged mechanical ventilation (10 days for both patients) followed by continuous flumazenil infusion (16 days for one patient and 3 days for the other) to avoid reintubation. In the two patients, nordazepam accumulation (main active metabolite of clorazepam) was demonstrated as the cause of the coma. This accumulation could be attributed, in one case, to impaired hepatic cytochrome P 450 3A4 activity. Caution is required when prescribing benzodiazepines to alcoholic patients and the use of benzodiazepine which do not undergo hepatic oxidation by cytochrome P 450 such as oxazepam or lorazepam is suggested. PMID:10660854

Guglielminotti, J; Maury, E; Alzieu, M; Delhotal Landes, B; Becquemont, L; Guidet, B; Offenstadt, G

1999-12-01

339

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

340

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

PubMed Central

Background Pressure support ventilation from a bilevel device is a standard technique for non-invasive home ventilation. A bench study was designed to compare the performance and patient-ventilator synchronization of 7 bilevel ventilators, in the presence of system leaks. Material/Methods Ventilators were connected to a Hans Rudolph Series 1101 lung simulator (compliance, 50 mL/cmH2O; expiratory resistance, 20 cmH2O/L/s; respiratory rate, 15 breaths/min; inspiratory time, 1.0 s). All ventilators were set at 15 cmH2O pressure support and 5 cmH2O positive end-expiratory pressure. Tests were conducted at 2 system leaks (12–15 and 25–28 L/min). The performance characteristics and patient-ventilator asynchrony were assessed, including flow, airway pressure, time, and workload. Results The Breas Vivo30 could not synchronize with the simulator (frequent auto-triggering) at a leak of 25–28 L/min, but provided stable assisted ventilation when the leak was 12–15 L/min. Missed efforts and back-up ventilation occurred for the Weinmann VENTImotion and Airox Smartair Plus, requiring adjustment of trigger effort. All ventilators had a short trigger delay time (<200 ms), but significant differences between devices were found in triggering workload, pressurization appearance, tidal volume, and peak inspiratory flow. Premature cycling was frequent when the inspiratory termination criteria were at the highest sensitivity. Cycling synchronization was considerably improved by modifying expiratory triggering sensitivity settings, when available. Conclusions Performance and triggering workload varied significantly between bilevel ventilators, possibly due to software algorithm differences. Adjusting the cycling criteria settings can alter the shape of the inspiratory phase and peak expiratory flow, and improve patient-ventilator synchrony. PMID:25619202

Chen, Yuqing; Cheng, Kewen; Zhou, Xin

2015-01-01

341

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

Microsoft Academic Search

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

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

1999-01-01

342

46 CFR 127.260 - Ventilation for accommodations.  

Code of Federal Regulations, 2011 CFR

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

2011-10-01

343

46 CFR 127.260 - Ventilation for accommodations.  

Code of Federal Regulations, 2013 CFR

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

2013-10-01

344

46 CFR 127.260 - Ventilation for accommodations.  

Code of Federal Regulations, 2012 CFR

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

2012-10-01

345

46 CFR 127.260 - Ventilation for accommodations.  

Code of Federal Regulations, 2010 CFR

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

2010-10-01

346

46 CFR 185.352 - Ventilation of gasoline machinery spaces.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Ventilation of gasoline machinery spaces...Operating Requirements § 185.352 Ventilation of gasoline machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space,...

2011-10-01

347

46 CFR 185.352 - Ventilation of gasoline machinery spaces.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Ventilation of gasoline machinery spaces...Operating Requirements § 185.352 Ventilation of gasoline machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space,...

2010-10-01

348

46 CFR 185.352 - Ventilation of gasoline machinery spaces.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 2012-10-01 false Ventilation of gasoline machinery spaces...Operating Requirements § 185.352 Ventilation of gasoline machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space,...

2012-10-01

349

46 CFR 185.352 - Ventilation of gasoline machinery spaces.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Ventilation of gasoline machinery spaces...Operating Requirements § 185.352 Ventilation of gasoline machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space,...

2013-10-01

350

[Less ventilator-associated pneumonia after oral decontamination with chlorhexidine; a randomised trial  

Microsoft Academic Search

OBJECTIVE: To determine the effect of oral decontamination with either chlorhexidine (CHX, 2%) or the combination chlorhexidine-colistin (CHX-COL, 2%-2%) on the frequency and the time to onset of ventilator-associated pneumonia in Intensive Care patients. DESIGN: Double blind, placebo-controlled, multicentre, randomised trial. METHODS: Consecutive ICU patients needing at least 48 h of mechanical ventilation were enrolled in a randomized trial with

M. Koeman; A. J. A. M. van der Ven; E. Hak; J. C. Joore; H. A. Kaasjager; AM de Smet; G. Ramsay; T. P. J. Dormans; L. P. H. J. Aarts; E. E. de Bel; W. N. Hustinx; I. van de Tweel; I. M. Hoepelman; M. J. M. Bonten

2008-01-01

351

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

352

Mechanical ventilation of critically ill newborns on scheduled flights of commercial passenger aircraft.  

PubMed

Transport of critically sick neonates of any gestation on scheduled commercial passenger aircraft is practical, safe, and cost effective. There is no disruption to boarding or egress of passengers and no seats need be removed or rearranged. Civil Aviation and Federal Aviation Authority regulations are obeyed. Power supply modifications and strengthening of the transport incubator are necessary. Other standard neonatal intensive care equipment can be used in battery mode. Replacement of an endotracheal tube in-flight is not difficult. PMID:3985909

Johnson, R A; Blackler, A D; Lill, B R; Evans, G B

1985-03-01

353

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

Microsoft Academic Search

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

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

1999-01-01

354

JAMA Patient Page: Ventilator-Associated Pneumonia  

MedlinePLUS

... of the American Medical Association JAMA PATIENT PAGE Ventilator-Associated Pneumonia V entilator-associated pneumonia , defined as ... and life-threatening infection. Because individuals who contract ventilator-associated pneumonia are already critically ill (requiring mechanical ...

355

46 CFR 194.10-25 - Ventilation.  

Code of Federal Regulations, 2010 CFR

...MATERIALS Magazines § 194.10-25 Ventilation. (a) Integral magazines. (1) All integral magazines shall be provided with natural or mechanical ventilation. Design calculations shall be submitted demonstrating that the system...

2010-10-01

356

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

PubMed Central

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

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

2014-01-01

357

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

PubMed Central

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

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

2011-01-01

358

Clinical review: Long-term noninvasive ventilation  

Microsoft Academic Search

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

Dominique Robert; Laurent Argaud

2007-01-01

359

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

...NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Safety Standards for Methane in Metal and Nonmetal Mines Ventilation § 57.22201 Mechanical ventilation (I-A, I-B, I-C, II-A,...

2010-07-01

360

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

...NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Safety Standards for Methane in Metal and Nonmetal Mines Ventilation § 57.22201 Mechanical ventilation (I-A, I-B, I-C, II-A,...

2011-07-01

361

Interactive Simulation System for Artificial Ventilation on the Internet: Virtual Ventilator  

Microsoft Academic Search

Objective. To develop an interactive simulation system “virtual ventilator” that demonstrates the dynamics of pressure and flow in the respiratory system under the combination of spontaneous breathing, ventilation modes, and ventilator options. The simulation system was designed to be used by unexperienced health care professionals as a self-training tool. Methods. The system consists of a simulation controller and three modules:

Akihiro Takeuchi; Tadashi Abe; Minoru Hirose; Koichi Kamioka; Atsushi Hamada; Noriaki Ikeda

2004-01-01

362

Inadvertent tracheobronchial placement of feeding tube in a mechanically ventilated patient.  

PubMed

Nasogastric (NG) tube misplacement into the airways is a rare complication. The presence of a cuffed endotracheal or tracheostomic tube often gives primary care providers a false sense of security. This report presents a case of inadvertent NG tube insertion into the right lower lobe bronchus of a 79-year-old patient with advanced chronic obstructive pulmonary disease, resulting in pneumonia and septic shock. In this report, the literature is reviewed, the influence of tube size on complications is compared, and the reliability of different methods to verify correct tube position is discussed. We conclude that a cuffed tracheostomic tube does not prevent advancement of a large-bore feeding tube into the tracheobronchial system. If any doubt exists regarding proper tube position, a chest radiograph should be obtained prior to initiation of feeding. PMID:18653401

Wang, Po-Chien; Tseng, Guan-Ying; Yang, Hsiao-Bai; Chou, Kuo-Chih; Chen, Chung-Hua

2008-07-01

363

Pretest Predictions for Ventilation Tests  

SciTech Connect

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

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

2007-01-17

364

Ventilation Model  

SciTech Connect

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

V. Chipman

2002-10-05

365

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

366

Lung and chest wall mechanics in ventilated patients with end stage idiopathic pulmonary fibrosis  

Microsoft Academic Search

BACKGROUNDIdiopathic pulmonary fibrosis is an inflammatory disease which leads to chronic ventilatory insufficiency and is characterised by a reduction in pulmonary static and dynamic volumes. It has been suggested that lung elastance may also be abnormally increased, particularly in end stage disease, but this has not been systematically tested. The aim of this study was to assess the respiratory mechanics

Stefano Nava; Fiorenzo Rubini

1999-01-01

367

[Technical requirements for buying a heat and humidity exchanger for ventilation during anesthesia. French Society of Anesthesia and Intensive Care].  

PubMed

To prevent cross infection and to improve the management of anaesthetic circuits, the French society of anesthesia and intensive care recommended the use of heat and moisture exchange filter (HMEF). Buying a HMEF needs a procedure with different steps and a product request form must delineate precise needed requirements of the device. In the absence of standardized methods to assess filtration performance, required specifications are established from both manufacturer data and scientific published studies. Proposed purchasing method and criteria help the health care workers at the time of final decision for objective comparison between the different devices on the market. PMID:10976373

Hajjar, J; Loctin, H; Goullet, D

2000-08-01

368

Noninvasive ventilation in acute respiratory failure  

PubMed Central

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

Mas, Arantxa; Masip, Josep

2014-01-01

369

Measuring Residential Ventilation System Airflows: Part 1 Laboratory  

E-print Network

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

370

9 CFR 91.21 - Ventilation.  

Code of Federal Regulations, 2011 CFR

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

2011-01-01

371

46 CFR 168.15-50 - Ventilation.  

Code of Federal Regulations, 2013 CFR

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

2013-10-01

372

9 CFR 91.21 - Ventilation.  

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

2014-01-01

373

9 CFR 91.21 - Ventilation.  

Code of Federal Regulations, 2010 CFR

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

2010-01-01

374

9 CFR 91.21 - Ventilation.  

Code of Federal Regulations, 2012 CFR

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

2012-01-01

375

9 CFR 91.21 - Ventilation.  

Code of Federal Regulations, 2013 CFR

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

2013-01-01

376

46 CFR 168.15-50 - Ventilation.  

Code of Federal Regulations, 2010 CFR

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

2010-10-01

377

46 CFR 168.15-50 - Ventilation.  

Code of Federal Regulations, 2011 CFR

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

2011-10-01

378

Ventilator-induced diaphragm dysfunction: cause and effect.  

PubMed

Mechanical ventilation (MV) is used clinically to maintain gas exchange in patients that require assistance in maintaining adequate alveolar ventilation. Common indications for MV include respiratory failure, heart failure, drug overdose, and surgery. Although MV can be a life-saving intervention for patients suffering from respiratory failure, prolonged MV can promote diaphragmatic atrophy and contractile dysfunction, which is referred to as ventilator-induced diaphragm dysfunction (VIDD). This is significant because VIDD is thought to contribute to problems in weaning patients from the ventilator. Extended time on the ventilator increases health care costs and greatly increases patient morbidity and mortality. Research reveals that only 18-24 h of MV is sufficient to develop VIDD in both laboratory animals and humans. Studies using animal models reveal that MV-induced diaphragmatic atrophy occurs due to increased diaphragmatic protein breakdown and decreased protein synthesis. Recent investigations have identified calpain, caspase-3, autophagy, and the ubiquitin-proteasome system as key proteases that participate in MV-induced diaphragmatic proteolysis. The challenge for the future is to define the MV-induced signaling pathways that promote the loss of diaphragm protein and depress diaphragm contractility. Indeed, forthcoming studies that delineate the signaling mechanisms responsible for VIDD will provide the knowledge necessary for the development of a pharmacological approach that can prevent VIDD and reduce the incidence of weaning problems. PMID:23842681

Powers, Scott K; Wiggs, Michael P; Sollanek, Kurt J; Smuder, Ashley J

2013-09-01

379

Rotation and Restricted Use of Antibiotics in a Medical Intensive Care Unit Impact on the Incidence of Ventilator-associated Pneumonia Caused by Antibiotic-resistant Gram-negative Bacteria  

Microsoft Academic Search

To test the hypothesis that a new program of antibiotic strategy control can minimize the incidence of ventilator-associated pneu- monia (VAP) caused by potentially antibiotic-resistant microor- ganisms, we performed a prospective before-after study in 3,455 patients admitted to a single intensive care unit over a 4-yr period. Regarding the bacterial ecology and the increasing antimicrobial resistance in our medical intensive

DIDIER GRUSON; GILLES HILBERT; FREDERIC VARGAS; RUDDY VALENTINO; CECILE BEBEAR; ANNIE ALLERY; CHRISTIANE BEBEAR; GEORGES GBIKPI-BENISSAN; JEAN-PIERRE CARDINAUD

380

Backrest position in prevention of pressure ulcers and ventilator-associated pneumonia: Conflicting recommendations  

PubMed Central

Pressure ulcers and ventilator-associated pneumonia (VAP) are both common in acute and critical care settings and are considerable sources of morbidity, mortality, and health care costs. To prevent pressure ulcers, guidelines limit bed backrest elevation to less than 30 degrees, whereas recommendations to reduce VAP include use of backrest elevations of 30 degrees or more. Although a variety of risk factors beyond patient position have been identified for both pressure ulcers and VAP, this article will focus on summarizing the major evidence for each of these apparently conflicting positioning strategies and discuss implications for practice in managing mechanically ventilated patients with risk factors for both pressure ulcers and VAP. PMID:22819601

Burk, Ruth Srednicki; Jo Grap, Mary

2013-01-01

381

Respiratory response and inspiratory effort during pressure support ventilation in COPD patients  

Microsoft Academic Search

Objective: Pressure Sup- port Ventilation (PSV) is now wide- ly used in the process of weaning patients from mechanical ventila- tion. The aim of this study was to evaluate the effects of various levels of PS on respiratory pattern and diaphragmatic efforts in patients affected by chronic obstructive pul- monary disease (COPD). Setting: Intermediate intensive care unit. Patients.\\

S. Nava; C. Bruschi; F. Rubini; A. Palo; G. Iotti; A. Braschi

1995-01-01

382

Blind and bronchoscopic sampling methods in suspected ventilator-associated pneumonia  

Microsoft Academic Search

Objective: To compare four sampling methods: blind tra- cheal aspirate (blind TA), blind pro- tected telescoping catheter (blind PTC), bronchoscopic PTC and bron- choscopic bronchoalveolar lavage (bronchoscopic BAL), for diagnosis of ventilator-associated pneumonia (VAP). Design: Prospective multi- centre study. Setting: Five intensive care units in France. Patients: Sixty- three patients with mechanical venti- lation for more than 48 h, no

Hervé Mentec; Laetitia May-Michelangeli; Antoine Rabbat; Emmanuelle Varon; Françoise Turdu; Gérard Bleichner

2004-01-01

383

30 CFR 77.1911 - Ventilation of slopes and shafts.  

Code of Federal Regulations, 2011 CFR

...2011-07-01 2011-07-01 false Ventilation of slopes and shafts. 77.1911...Slope and Shaft Sinking § 77.1911 Ventilation of slopes and shafts. (a) All...shafts shall be ventilated by mechanical ventilation equipment during development....

2011-07-01

384

30 CFR 77.1911 - Ventilation of slopes and shafts.  

Code of Federal Regulations, 2013 CFR

...2013-07-01 2013-07-01 false Ventilation of slopes and shafts. 77.1911...Slope and Shaft Sinking § 77.1911 Ventilation of slopes and shafts. (a) All...shafts shall be ventilated by mechanical ventilation equipment during development....

2013-07-01

385

30 CFR 77.1911 - Ventilation of slopes and shafts.  

Code of Federal Regulations, 2012 CFR

...2012-07-01 2012-07-01 false Ventilation of slopes and shafts. 77.1911...Slope and Shaft Sinking § 77.1911 Ventilation of slopes and shafts. (a) All...shafts shall be ventilated by mechanical ventilation equipment during development....

2012-07-01

386

[Ventilator-induced diaphragm dysfunction : clinically relevant problem].  

PubMed

Mechanical ventilation is a life-saving intervention for patients with respiratory failure or during deep sedation. During continuous mandatory ventilation the diaphragm remains inactive, which activates pathophysiological cascades leading to a loss of contractile force and muscle mass (collectively referred to as ventilator-induced diaphragm dysfunction, VIDD). In contrast to peripheral skeletal muscles this process is rapid and develops after as little as 12 h and has a profound influence on weaning patients from mechanical ventilation as well as increased incidences of morbidity and mortality. In recent years, animal experiments have revealed pathophysiological mechanisms which have been confirmed in humans. One major mechanism is the mitochondrial generation of reactive oxygen species that have been shown to damage contractile proteins and facilitate protease activation. Besides atrophy due to inactivity, drug interactions can induce further muscle atrophy. Data from animal research concerning the influence of corticosteroids emphasize a dose-dependent influence on diaphragm atrophy and function although the clinical interpretation in intensive care patients (ICU) patients might be difficult. Levosimendan has also been proven to increase diaphragm contractile forces in humans which may prove to be helpful for patients experiencing difficult weaning. Additionally, antioxidant drugs that scavenge reactive oxygen species have been demonstrated to protect the diaphragm from VIDD in several animal studies. The translation of these drugs into the IUC setting might protect patients from VIDD and facilitate the weaning process. PMID:24306096

Bruells, C S; Marx, G; Rossaint, R

2014-01-01

387

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

388

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

389

The influence of different mechanical ventilator settings of peak inspiratory pressure on stroke volume variation in pediatric cardiac surgery patients  

PubMed Central

Background The usefulness of dynamic parameters derived by heart-lung interaction for fluid responsiveness in pediatric patients has been revealed. However, the effects of peak inspiratory pressure (PIP) that could affect the absolute values and the accuracy in pediatric patients have not been well established. Methods Participants were 30 pediatric patients who underwent ventricular septal defect repair. After completion of surgical procedure and sternum closure, mean arterial blood pressure, heart rate, central venous pressure, cardiac output, cardiac index and stroke volume variation (SVV) were measured at PIP 10 cmH2O (PIP10), at PIP 15 cmH2O (PIP15), at PIP 20 cmH2O (PIP20) and at PIP 25 cmH2O (PIP25). Results SVV at PIP15 was larger than that at PIP10 (13.7 ± 2.9% at PIP10 vs 14.7 ± 2.5% at PIP15, P < 0.001) and SVV at PIP20 was larger than that at PIP10 and PIP15 (13.7 ± 2.9% at PIP10 vs 15.4 ± 2.5% at PIP20, P < 0.001; 14.7 ± 2.5% at PIP15 vs 15.4 ± 2.5% at PIP20, P < 0.001) and SVV at PIP25 was larger than that at PIP10 and PIP15 and PIP20 (13.7 ± 2.9% at PIP10 vs 17.4 ± 2.4% at PIP25, P < 0.001; 14.7 ± 2.5% at PIP15 vs 17.4 ± 2.4% at PIP25, P < 0.001; 15.4 ± 2.5% at PIP20 vs 17.4 ± 2.4% at PIP25, P < 0.001). Conclusions SVV is affected by different levels of PIP in same patient and under same volume status. This finding must be taken into consideration when SVV is used to predict fluid responsiveness in mechanically ventilated pediatric patients. PMID:24910727

Kang, Woon-Seok; Kim, Jae Yun; Woo, Nam Sik

2014-01-01

390

CHLORHEXIDINE, TOOTHBRUSHING, AND PREVENTING VENTILATOR-ASSOCIATED PNEUMONIA IN CRITICALLY ILL ADULTS  

PubMed Central

Background Ventilator-associated pneumonia is associated with increased morbidity and mortality. Objective To examine the effects of mechanical (toothbrushing), pharmacological (topical oral chlorhexidine), and combination (toothbrushing plus chlorhexidine) oral care on the development of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation. Methods Critically ill adults in 3 intensive care units were enrolled within 24 hours of intubation in a randomized controlled clinical trial with a 2 × 2 factorial design. Patients with a clinical diagnosis of pneumonia at the time of intubation and edentulous patients were excluded. Patients (n = 547) were randomly assigned to 1 of 4 treatments: 0.12% solution chlorhexidine oral swab twice daily, toothbrushing thrice daily, both toothbrushing and chlorhexidine, or control (usual care). Ventilator-associated pneumonia was determined by using the Clinical Pulmonary Infection Score (CPIS). Results The 4 groups did not differ significantly in clinical characteristics. At day 3 analysis, 249 patients remained in the study. Among patients without pneumonia at baseline, pneumonia developed in 24% (CPIS ?6) by day 3 in those treated with chlorhexidine. When data on all patients were analyzed together, mixed models analysis indicated no effect of either chlorhexidine (P = .29) or toothbrushing (P = .95). However, chlorhexidine significantly reduced the incidence of pneumonia on day 3 (CPIS ?6) among patients who had CPIS <6 at baseline (P = .006). Toothbrushing had no effect on CPIS and did not enhance the effect of chlorhexidine. Conclusions Chlorhexidine, but not toothbrushing, reduced early ventilator-associated pneumonia in patients without pneumonia at baseline. PMID:19723863

Munro, Cindy L.; Grap, Mary Jo; Jones, Deborah J.; McClish, Donna K.; Sessler, Curtis N.

2013-01-01

391

Ventilation shaft to increase effectiveness of natural ventilation.  

E-print Network

??Ventilation shafts can aid natural ventilation in buildings. Natural ventilation provides ventilation for occupants that can provide thermal comfort conditions. This study attempts to increase… (more)

Nagory, Abhay

2012-01-01

392

Outreach Education to Improve Quality of Rural ICU Care Results of a Randomized Trial  

Microsoft Academic Search

This study tests whether an outreach educational program tailored to institutional specific patient care practices would improve the quality of care delivered to mechanically ventilated intensive care unit (ICU) patients in rural hospitals. The study was conducted as a randomized control trial using 20 rural Iowa hospitals as the unit of analysis. Twelve randomly selected hospitals received an outreach educational

MICHAEL S. HENDRYX; JOHN F. FIESELMANN; M. JEANNE BOCK; DOUGLAS S. WAKEFIELD; CHARLES M. HELMS; SUZANNE E. BENTLER

393

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

PubMed Central

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

Garg, Shalabh; Sinha, Sunil

2013-01-01

394

Fertility and Child Care Arrangements as Mechanisms of Status Articulation.  

ERIC Educational Resources Information Center

Examined the relationship among employment preferences, child care arrangements of mothers of young children, and fertility expectations. Findings indicated that future fertility expectations were influenced by: (1) whether mothers wanted to be employed, given adequate child care, and (2) by whether they currently used regular child care. (Author)

Powers, Mary G.; Salvo, Joseph J.

1982-01-01

395

Early tracheal stenosis causing extubation failure and prolonged ventilator dependency.  

PubMed

Postintubation stenosis is the most frequent cause of benign tracheal stenosis and may cause reintubation and delay in weaning of intensive care unit patients. This case study describes typical patients with tracheal stenosis and the management of these patients. Five patients requiring reintubation and mechanical ventilation due to early intubation-related stenosis are discussed. Stridor developed in three cases after extubation. In these cases, bronchoscopy revealed tracheal stenosis. Dilatation and silicone stent placement were performed using rigid bronchoscopy. The other two patients were on ventilators when they were admitted to the intensive care unit and their stenoses were also treated by rigid bronchoscopy. Hypercapnia and hypoxia resolved after intervention in three cases. Of the remaining two patients, one had the tracheostomy closed and in the other patient ventilation was stopped but the tracheostomy was maintained. Tracheal stenosis developing in the subglottic region after extubation, especially after exposure to cuff pressure, may lead to reintubation. A tracheostomy may hinder the diagnosis of progressive stenosis and may lead to unnecessary maintenance of ventilator treatment. Early intubation-related tracheal stenosis should therefore be considered in cases of weaning or extubation failure and prompt appropriate investigation and treatment. PMID:23362899

Dalar, L; Schuurmans, M M; Eryuksel, E; Karasulu, L; Kosar, A F; Altin, S

2013-01-01

396

A comparison of volume control and pressure-regulated volume control ventilation in acute respiratory failure  

PubMed Central

Background: The aim of this study was to test the hypothesis that a new mode of ventilation (pressure-regulated volume control; PRVC) is associated with improvements in respiratory mechanics and outcome when compared with conventional volume control (VC) ventilation in patients with acute respiratory failure. We conducted a randomised, prospective, open, cross over trial on 44 patients with acute respiratory failure in the general intensive care unit of a university hospital. After a stabilization period of 8 h, a cross over trial of 2 × 2 h was conducted. Apart from the PRVC/VC mode, ventilator settings were comparable. The following parameters were recorded for each patient: days on ventilator, failure in the assigned mode of ventilation (peak inspiratory pressure > 50 cmH2O) and survival. Results: In the crossover trial, peak inspiratory pressure was significantly lower using PRVC than with VC (20 cmH2O vs 24 cmH2O, P < 0.0001). No other statistically significant differences were found. Conclusions: Peak inspiratory pressure was significantly lower during PRVC ventilation than during VC ventilation, and thus PRVC may be superior to VC in certain patients. However, in this small group of patients, we could not demonstrate that PRVC improved outcome. PMID:11056699

Guldager, Henrik; Nielsen, Soeren L; Carl, Peder; Soerensen, Mogens B

1997-01-01

397

Lung Function and Organ Dysfunctions in 178 Patients Requiring Mechanical Ventilation During The 2009 Influenza A (H1N1) Pandemic  

PubMed Central

Introduction Most cases of the 2009 influenza A (H1N1) infection are self-limited, but occasionally the disease evolves to a severe condition needing hospitalization. Here we describe the evolution of the respiratory compromise, ventilatory management and laboratory variables of patients with diffuse viral pneumonitis caused by pandemic 2009 influenza A (H1N1) admitted to the ICU. Method This was a multicenter, prospective inception cohort study including adult patients with acute respiratory failure requiring mechanical ventilation (MV) admitted to 20 ICUs in Argentina between June and September of 2009 during the influenza A (H1N1) pandemic. In a standard case-report form, we collected epidemiological characteristics, results of real-time reverse-transcriptase--polymerase-chain-reaction viral diagnostic tests, oxygenation variables, acid-base status, respiratory mechanics, ventilation management and laboratory tests. Variables were recorded on ICU admission and at days 3, 7 and 10. Results During the study period 178 patients with diffuse viral pneumonitis requiring MV were admitted. They were 44 ± 15 years of age, with Acute Physiology And Chronic Health Evaluation II (APACHE II) scores of 18 ± 7, and most frequent comorbidities were obesity (26%), previous respiratory disease (24%) and immunosuppression (16%). Non-invasive ventilation (NIV) was applied in 49 (28%) patients on admission, but 94% were later intubated. Acute respiratory distress syndrome (ARDS) was present throughout the entire ICU stay in the whole group (mean PaO2/FIO2 170 ± 25). Tidal-volumes used were 7.8 to 8.1 ml/kg (ideal body weight), plateau pressures always remained < 30 cmH2O, without differences between survivors and non-survivors; and mean positive end-expiratory pressure (PEEP) levels used were between 8 to 12 cm H2O. Rescue therapies, like recruitment maneuvers (8 to 35%), prone positioning (12 to 24%) and tracheal gas insufflation (3%) were frequently applied. At all time points, pH, platelet count, lactate dehydrogenase assay (LDH) and Sequential Organ Failure Assessment (SOFA) differed significantly between survivors and non-survivors. Lack of recovery of platelet count and persistence of leukocytosis were characteristic of non-survivors. Mortality was high (46%); and length of MV was 10 (6 to 17) days. Conclusions These patients had severe, hypoxemic respiratory failure compatible with ARDS that persisted over time, frequently requiring rescue therapies to support oxygenation. NIV use is not warranted, given its high failure rate. Death and evolution to prolonged mechanical ventilation were common outcomes. Persistence of thrombocytopenia, acidosis and leukocytosis, and high LDH levels found in non-survivors during the course of the disease might be novel prognostic findings. PMID:21849039

2011-01-01

398

A review of documented oral care practices in an intensive care unit.  

PubMed

Oral care is recognized as an essential component of care for critically ill patients and nursing documentation provides evidence of this process. This study examined the practice and frequency of oral care among mechanically ventilated and nonventilated patients. A retrospective record review was conducted of patients admitted to an intensive care unit (ICU) between July 1, 2007 and December 31, 2007. Data were analyzed using bivariate and multivariate analyses to determine the variables related to patients receiving oral care. Frequency of oral care documentation was found to be performed, on average, every 3.17 to 3.51 hr with a range of 1 to 8 hr suggesting inconsistencies in nursing practice. This study found that although oral care is a Center for Disease Control and Prevention (CDC) recommendation for the prevention of hospital-associated infections like ventilator-associated pneumonia (VAP), indication of documentation of the specifics are lacking in the patients' medical record. PMID:21191094

Goss, Linda K; Coty, Mary-Beth; Myers, John A

2011-05-01

399

Night ventilation control strategies in office buildings  

SciTech Connect

In moderate climates night ventilation is an effective and energy-efficient approach to improve the indoor thermal environment for office buildings during the summer months, especially for heavyweight construction. However, is night ventilation a suitable strategy for office buildings with lightweight construction located in cold climates? In order to answer this question, the whole energy-consumption analysis software EnergyPlus was used to simulate the indoor thermal environment and energy consumption in typical office buildings with night mechanical ventilation in three cities in northern China. The summer outdoor climate data was analyzed, and three typical design days were chosen. The most important factors influencing night ventilation performance such as ventilation rates, ventilation duration, building mass and climatic conditions were evaluated. When night ventilation operation time is closer to active cooling time, the efficiency of night ventilation is higher. With night ventilation rate of 10 ach, the mean radiant temperature of the indoor surface decreased by up to 3.9 C. The longer the duration of operation, the more efficient the night ventilation strategy becomes. The control strategies for three locations are given in the paper. Based on the optimized strategies, the operation consumption and fees are calculated. The results show that more energy is saved in office buildings cooled by a night ventilation system in northern China than ones that do not employ this strategy. (author)

Wang, Zhaojun; Yi, Lingli; Gao, Fusheng [School of Municipal and Environmental Engineering, Harbin Institute of Technology, Harbin 150090 (China)

2009-10-15

400

Crankcase ventilator  

SciTech Connect

This patent describes a crankcase ventilator. It comprises: a conduct adapted to be attached to crankcase and a suction means for drawing air containing vapors from the crankcase through the conduit, a temperature sensitive element adapted to be placed in thermal contact with the crankcase, means for continuously varying the rate at which the suction means draws the air containing vapors from the crankcase according to temperature, and means connecting the varying means to the temperature sensitive element for causing the suction means to draw a greater volume of air from the crankcase when the crankcase is hot than when the crankcase is cold.

Pickering, J.J.

1989-11-14

401

Oral hygiene is an important factor for prevention of ventilator-associated pneumonia.  

PubMed

Inadequate oral hygiene in intensive care units (ICUs) has been recognized as a critical issue, for it is an important risk factor for ventilator associated pneumonia (VAP). VAP is an aspiration pneumonia that occurs in mechanically ventilated patients, mostly caused by bacteria colonizing the oral cavity and dental plaque. It is the second most common nosocomial infection and the leading cause of complications and death in mechanically ventilated patients. It has been suggested that improvement of oral hygiene in ICU patients could lead to a reduced incidence of VAP. Although diverse oral care measures for ICU patients have been proposed in the literature, there is no evidence that could identify the most efficient ones. Although there are several evidence-based protocols, oral care measures are still performed inconsistently and differ greatly between individual ICUs. This paper lists the oral care measures most commonly performed in ICUs, indicating their advantages and disadvantages. Brushing with regular toothbrush and rinsing with chlorhexidine are considered optimal measures of oral hygiene in critically ill patients. To date, there is no definitive agreement about the most effective oral care protocol, but evidence demonstrates that consistent performance of oral care may lower the incidence of VAP in critically ill patients. PMID:24974668

Par, Matej; Badovinac, Ana; Plancak, Darije

2014-03-01

402

Ventilator-associated pneumonia: a review.  

PubMed

Ventilator-associated pneumonia (VAP) is the most common infection seen in intensive care units (ICUs); it accounts for one-fourth of the infections occurring in critically ill patients and is the reason for half of antibiotic prescriptions in mechanically ventilated patients. In addition to being a financial burden on ICUs, it continues to contribute significantly to the morbidity and mortality of ICU patients, with an estimated attributable mortality rate of 8% to 15%. While the pathophysiology of VAP remains relatively unchanged, diagnostic techniques and preventive measures are constantly evolving. The focus of this article is on recent trends in VAP epidemiology, modifiable risk factors, diagnostic techniques, challenges in management, and current data on the prevention of VAP. Important messages that the reader should take away include: 1) There is no gold standard for the diagnosis of VAP; whenever VAP is suspected, if feasible, a quantitative culture should be obtained by invasive or noninvasive methods (whichever is more readily available before initiation of antibiotics); 2) Suspicion based on clinical features should prompt the initiation of a broad spectrum of antibiotics depending on suspected pathogens; 3) Close attention should be paid to de-escalation of antibiotics once microbiological results become available or as the patient starts responding clinically; the ideal duration of treatment should be 8 days instead of the conventional 10 to 14 days, except in situations where Pseudomonas may be suspected or the patient's comorbidities dictate otherwise; and 4) Prevention remains the key to reducing the burden of VAP. We promote the proven preventive measures of using noninvasive ventilation when possible, semirecumbent patient positioning, continuous aspiration of subglottic secretions, and oral chlorhexidine washes along with stress ulcer prophylaxis only after careful assessment of the risks versus benefits. PMID:22406885

Ashraf, Madiha; Ostrosky-Zeichner, Luis

2012-02-01

403

Condensation of humidified air in the inflation line of a polyurethane cuff precludes correct continuous pressure monitoring during mechanical ventilation.  

PubMed

Within continuously controlled limits of cuff pressure, an endotracheal tube cuff made of polyurethane (PU) prevents secretion inflow better than a conventional polyvinylchloride cuff. However, the temperature difference between ventilator gas and the air inside a PU cuff produces condensation droplets that accumulate in the cuff inflation canal. We investigated whether condensation influenced continuous cuff pressure monitoring. A PU-cuffed tube was placed into an artificial trachea and connected to a ventilator and test lung. An additional line was inserted at the distal cuff end to directly measure pressure inside the cuff. Methylene blue instillation via the inflation line mimicked condensation. Inspiratory (Pinsp) and expiratory (Pexp) pressures were continuously recorded. Six consecutive experiments were performed comparing pressures at baseline (T0) and at 24 h (T24). Shortly after dye instillation, pressures recorded at the inflation canal became permanently fixed at 25 cmH2O. In contrast, pressures measured directly in the cuff progressively decreased (mean Pinsp 30 ± 3 vs. 20 ± 2 cmH2O and mean Pexp 25 ± 0 vs. 12 ± 2 cmH2O, T0 vs. T24, both P < 0.05). Thus, condensation in the inflation line of a PU-cuffed tube renders continuous cuff pressure monitoring unreliable, thereby increasing the risk for microaspiration. PMID:24854520

Spapen, Herbert; Moeyersons, Walter; Stiers, Wim; Desmet, Geert; Suys, Emiel

2014-12-01

404

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

405

Bedside calculation of energy expenditure does not guarantee adequate caloric prescription in long-term mechanically ventilated critically ill patients: a quality control study.  

PubMed

Nutrition is essential in critically ill patients, but translating caloric prescriptions into adequate caloric intake remains challenging. Caloric prescriptions (P), effective intake (I), and caloric needs (N), calculated with modified Harris-Benedict formulas, were recorded during seven consecutive days in ventilated patients. Adequacy of prescription was estimated by P/N ratio. I/P ratio assessed accuracy of translating a prescription into administered feeding. I/N ratio compared delivered calories with theoretical caloric needs. Fifty patients were prospectively studied in a mixed medicosurgical ICU in a teaching hospital. Basal and total energy expenditure were, respectively, 1361 ± 171 kcal/d and 1649 ± 233 kcal/d. P and I attained 1536 ± 602 kcal/d and 1424 ± 572 kcal/d, respectively. 24.6% prescriptions were accurate, and 24.3% calories were correctly administered. Excessive calories were prescribed in 35.4% of patients, 27.4% being overfed. Caloric needs were underestimated in 40% prescriptions, with 48.3% patients underfed. Calculating caloric requirements by a modified standard formula covered energy needs in only 25% of long-term mechanically ventilated patients, leaving many over- or underfed. Nutritional imbalance mainly resulted from incorrect prescription. Failure of "simple" calculations to direct caloric prescription in these patients suggests systematic use of more reliable methods, for example, indirect calorimetry. PMID:22675272

De Waele, Elisabeth; Spapen, Herbert; Honoré, P M; Mattens, Sabrina; Rose, Thomas; Huyghens, Luc

2012-01-01

406

47 CFR 54.602 - Health care support mechanism.  

Code of Federal Regulations, 2013 CFR

...Telecommunications Program.” (b) Healthcare Connect Fund. Eligible health care...This support is referred to as the “Healthcare Connect Fund.” (c) Allocation...the Telecommunications Program or the Healthcare Connect Fund must be...

2013-10-01

407

Rural health care support mechanism. Final rule; denial of petition for reconsideration.  

PubMed

In this document, the Commission modifies its rules to improve the effectiveness of the rural health care support mechanism, which provides discounts to rural health care providers to access modern telecommunications for medical and health maintenance purposes. Because participation in the rural health care support mechanism has not met the Commission's initial projections, the Commission amends its rules to improve the program, increase participation by rural health care providers, and ensure that the benefits of the program continue to be distributed in a fair and equitable manner. In addition, the Commission denies Mobile Satellite Ventures Subsidiary's petition for reconsideration of the 1997 Universal Service Order. PMID:14976975

2003-12-24

408

Natural ventilation in buildings: measurement in a wind tunnel and numerical simulation with large-eddy simulation  

Microsoft Academic Search

Natural ventilation in buildings can create a comfortable and healthy indoor environment, and can save energy compared to mechanical ventilation systems. In building design the prediction of ventilation can be difficult; cases of wind-driven single-sided ventilation, where the effects of turbulence dominate, are particularly problematic to simulate. In order to investigate the mechanism of natural ventilation driven by wind force,

Yi Jiang; Donald Alexander; Huw Jenkins; Rob Arthur; Qingyan Chen

2003-01-01

409

Jet Nebulization of Prostaglandin E1 During Neonatal Mechanical Ventilation: Stability, Emitted Dose and Aerosol Particle Size  

PubMed Central

Background We have previously reported the safety of aerosolized PGE1 in neonatal hypoxemic respiratory failure. The aim of this study is to characterize the physicochemical properties of PGE1 solution, stability, emitted dose and the aerodynamic particle size distribution (APSD) of PGE1 aerosol in a neonatal ventilator circuit. Methods PGE1 was diluted in normal saline and physicochemical properties of the solution characterized. Chemical stability and emitted dose were evaluated during jet nebulization in a neonatal conventional (CMV) or high frequency (HFV) ventilator circuit by a High Performance Liquid Chromatography - Mass Spectrometry method. The APSD of the PGE1 aerosol was evaluated with a six-stage cascade impactor during CMV. Results PGE1 solution in normal saline had a low viscosity (0.9818 cP) and surface tension (60.8 mN/m) making it suitable for aerosolization. Little or no degradation of PGE1 was observed in samples from aerosol condensates, the PGE1 solution infused over 24 h, or the residual solution in the nebulizer. The emitted dose of PGE1 following jet nebulization was 32–40% during CMV and 0.1% during HFV. The PGE1 aerosol had a mass median aerodynamic diameter of 1.4 µm and geometric standard deviation of 2.9 with 90% of particles being < 4.0 µm in size. Conclusion Nebulization of PGE1 during neonatal CMV or HFV is efficient and results in rapid nebulization without altering the chemical structure. On the basis of the physicochemical properties of PGE1 solution and the APSD of the PGE1 aerosol, one can predict predominantly alveolar deposition of aerosolized PGE1. PMID:17997106

Sood, Beena G.; Peterson, Jennifer; Malian, Monica; Galli, Robert; Geisor-Walter, Maria; McKinnon, Jon; Sharp, Jody; Maddipati, Krishna Rao

2008-01-01

410

Oral care and pulmonary infection - the importance of plaque scoring  

PubMed Central

Improving the quality of oral hygiene is recognised as an important counter measure for reducing the incidence of ventilator-associated pneumonia amongst critically ill patients. Toothbrushing physically disrupts the dental plaque that acts as a reservoir for pulmonary infection and therefore has the potential to reduce the incidence of ventilator-associated pneumonia. Gu and colleagues performed a systematic review and meta-analysis of oral hygiene with and without a toothbrush and found no difference in the incidence of pneumonia in mechanically ventilated patients. The diagnosis of ventilator-associated pneumonia is prone to bias and future studies of oral care interventions should focus on measures of oral cleanliness such as plaque and gingival scores. Once the optimal strategy for oral hygiene is defined in the critically ill, larger studies focussing on ventilator-associated pneumonia or mortality can be conducted. PMID:23302185

2013-01-01

411

Oral care and pulmonary infection - the importance of plaque scoring.  

PubMed

Improving the quality of oral hygiene is recognised as an important counter measure for reducing the incidence of ventilator-associated pneumonia amongst critically ill patients. Toothbrushing physically disrupts the dental plaque that acts as a reservoir for pulmonary infection and therefore has the potential to reduce the incidence of ventilator-associated pneumonia. Gu and colleagues performed a systematic review and meta-analysis of oral hygiene with and without a toothbrush and found no difference in the incidence of pneumonia in mechanically ventilated patients. The diagnosis of ventilator-associated pneumonia is prone to bias and future studies of oral care interventions should focus on measures of oral cleanliness such as plaque and gingival scores. Once the optimal strategy for oral hygiene is defined in the critically ill, larger studies focussing on ventilator-associated pneumonia or mortality can be conducted. PMID:23302185

Wise, Matt P; Williams, David W

2013-01-01

412

Ventilation of sheep and goat barns.  

PubMed

Good ventilation is an important part of any livestock housing system. It may be accomplished by either natural or mechanical means. Generally, except for buildings that must be kept at warm, nonfluctuating temperatures, naturally ventilated cold housing is satisfactory for sheep and goats provided it is dry and draft-free in pen and resting areas, and air exchange is taking place at a rate high enough to remove moisture, gases, and airborne disease organisms from the building. Understanding the importance of site location, building orientation, and principles of ventilation design increases the likelihood of successful barn ventilation. PMID:2245366

Collins, E R

1990-11-01

413

Effect of intubation and mechanical ventilation on exhaled nitric oxide in preterm infants with and without bronchopulmonary dysplasia measured at a median postmenstrual age of 49 weeks  

PubMed Central

Background Exhaled nitric oxide (eNO) is a marker of established airway inflammation in adults and children, but conflicting results have been reported in preterm infants when postnatal eNO is measured during tidal breathing. This study investigated the extent to which intubation and mechanical ventilation (MV) affect eNO and NO production (V’NO) in preterm infants with and without bronchopulmonary dysplasia (BPD). Patients and methods A total of 176 very low birth weight (VLBW) infants (birth weight <1500 g), including 74 (42%) with and 102 (58%) without BPD, were examined at a median postmenstrual age of 49 weeks. Of the 176 infants, 84 (48%) did not require MV, 47 (27%) required MV for <7 days and 45 (26%) required MV for ?7 days. Exhaled NO and tidal breathing parameters were measured in sleeping infants during tidal breathing, respiratory mechanics were assessed by occlusion tests, and arterialized capillary blood gas was analyzed. Results eNO was significantly correlated with tidal breathing parameters, while V’NO was correlated with growth parameters, including age and body length (p?ventilated infants. In contrast, eNO and V’NO did not differ significantly in non-ventilated infants and those receiving MV for ?7 days. Multivariate analysis showed that independent on the duration of MV eNO (p?=?0.003) and V’NO (p?=?0.018) were significantly increased in BPD infants comparable with the effects of intubation and MV on eNO (p?=?0.002) and V’NO (p?=?0.017). Conclusions Preterm infants with BPD show only weak postnatal increases in eNO and V’NO, but these changes may be obscured by the distinct influences of breathing pattern and invasive respiratory support. This limits the diagnostic value of postnatal eNO measurements in the follow-up of BPD infants. PMID:24957096

2014-01-01

414

Effects of prolonged mechanical ventilation with a closed suction system on endotracheal tube resistance and its reversibility by a closed suction cleaning system.  

PubMed

The study objective was to evaluate endotracheal tubes (ETT) from extubated adult patients and compare them to new, unused, size-matched control tubes for changes in inspiratory resistance (Rinsp) and peak inspiratory pressure (PIP) before and immediately after suctioning with the Airway Medix Closed Suction System (AMCSS) (Biovo Technologies, 2013 Tel Aviv, Israel). Sixteen ETTs were recovered from predominantly medical patients who had required intubation and mechanical ventilation for more than 12 hours. ETTs were evaluated within 4.5 hours of extubation. Readings were taken during square wave flow, at rates of 40 and 60 l/minute. Cleaning of extubated ETTs using the AMCSS was able to restore them to almost original conditions in terms of Rinsp and PIP. The examined ETTs included tubes of various sizes ranging from internal diameter (ID) 7 to 8.5 mm and intubation periods ranging from 12 hours to 21 days. The mean Rinsp for the used and uncleaned ETTs was equivalent to 275% of the Rinsp of sized-matched new and unused ETTs. For 8 mm ID ETTs this was comparable to a measured Rinsp of a 5 mm tube. Following a single cleaning episode with the AMCSS, Rinsp decreased, regaining an effective ETT ID of a 7.5 to 8 mm tube. A single suctioning episode with this device resulted in a significant reduction in Rinsp, virtually restoring original flow variable values. The AMCSS represents a novel technology in closed suction systems, designed to achieve more effective inner lumen cleaning in prolonged mechanical ventilation. PMID:24180713

Adi, N A; Tomer, N T; Bergman, G B; Kishinevsky, E K; Wyncoll, D W

2013-11-01

415

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

416

Rural health care support mechanism. Final rule; petition for reconsideration.  

PubMed

In this document, the Commission grants American Telemedicine Association's (ATA) Petition for Reconsideration in part and extends for three years the Commission's prior determination to grandfather those health care providers who were eligible under the Commission's definition of "rural" prior to the Second Report and Order. PMID:18464349

2008-04-10

417

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