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Sample records for mechanical ventilator care

  1. Characteristics of Mechanical Ventilation Employed in Intensive Care Units: A Multicenter Survey of Hospitals

    PubMed Central

    Oh, Bum Jin; Kim, Young Sam; Kang, Eun Hae; Kim, Chang Ho; Park, Yong Bum; Han, Min Soo; Shin, Cheungsoo

    2008-01-01

    A 1D point-prevalence study was performed to describe the characteristics of conventional mechanical ventilation in intensive care units (ICUs). In addition, a survey was conducted to determine the characteristics of ICUs. A prospective, multicenter study was performed in ICUs at 24 university hospitals. The study population consisted of 223 patients who were receiving mechanical ventilation or had been weaned off mechanical ventilation within the past 24 hr. Common indications for the initiation of mechanical ventilation included acute respiratory failure (66%), acute exacerbation of chronic respiratory failure (15%) (including tuberculosis-destroyed lung [5%]), coma (13%), and neuromuscular disorders (6%). Mechanical ventilation was delivered via an endotracheal tube in 68% of the patients, tracheostomy in 28% and facial mask with noninvasive ventilation (NIV) in 4%. NIV was used in 2 centers. In patients who had undergone tracheostomy, the procedure had been performed 16.9±8.1 days after intubation. Intensivists treated 29% of the patients. A need for additional educational programs regarding clinical practice in the ICU was expressed by 62% of the staff and 42% of the nurses. Tuberculosis-destroyed lung is a common indication for mechanical ventilation in acute exacerbation of chronic respiratory failure, and noninvasive ventilation was used in a limited number of ICUs. PMID:19119434

  2. A student paper: music in critical care setting for clients on mechanical ventilators: a student perspective.

    PubMed

    Ho, Van; Chang, Sue; Olivas, Rosa; Almacen, Catherine; Dimanlig, Marbert; Rodriguez, Heather

    2012-01-01

    This article written by baccalaureate nursing students briefly discusses the use of music therapy in clients on mechanical ventilation in intensive care units. The article explores the possible benefits of music therapy and its use in other aspects of health care. PMID:23042464

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

    PubMed Central

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

    2014-01-01

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

  4. Care of a cardiac pt on mechanical ventilation

    E-print Network

    Kay, Mark A.

    pressure 3. PEEP: Positive end-expiratory pressure 4. PS: Pressure support = Mean airway pressure 5. V: inspiratory or expiratory 3. Tidal volume: volume of air inspired in 1 normal breathnormal breath #12 superimposed breathe) 3. No back up rate (sprinting): PSV, CPAP #12;Ventilator sub-mode 1. Pressure support

  5. Outcomes after long-term acute care. An analysis of 133 mechanically ventilated patients.

    PubMed

    Carson, S S; Bach, P B; Brzozowski, L; Leff, A

    1999-05-01

    Long-term acute-care (LTAC) hospitals are facilities exempt from the Medicare prospective payment system and which provide care to patients suffering from prolonged critical illness. From August 1, 1995 to July 31, 1996, we studied the outcomes of 133 mechanically ventilated patients who were consecutively admitted to a large urban LTAC hospital from intensive care units (ICUs) of acute-care hospitals. Survival and functional status within 1 yr after the index admission were measured, and specific patient variables were used to develop a predictive model for survival at 1 yr. Of the 133 patients studied, 66 (50%) died prior to discharge. Of discharged patients, 70% had been successfully liberated from mechanical ventilation. One year after LTAC hospital admission, 103 (77%) of the patients had expired, typically after spending the majority of their days in acute care or long-term care facilities. Eleven 1-yr survivors (8%) were fully functional, whereas the remainder had significantly reduced functional status. Patients older than 74 yr, and patients older than 64 yr and not functionally independent before admission, had a 95% (confidence interval [CI]: 84% to 99%) 1-yr mortality; patients without these characteristics had a 56% (CI: 41% to 71%) 1-yr mortality (p < 0.001). We demonstrate characteristics predicting the poorest prognoses for patients requiring prolonged mechanical ventilation. These characteristics may be identifiable before transfer to an LTAC hospital. PMID:10228128

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

    PubMed Central

    Rodrigues, Katia Alonso; Machado, Flávia Ribeiro; Chiari, Brasília Maria; Rosseti, Heloísa Baccaro; Lorenzon, Paula; Gonçalves, Maria Inês Rebelo

    2015-01-01

    Objective The aim of the present study was to assess the feasibility of the early implementation of a swallowing rehabilitation program in tracheostomized patients under mechanical ventilation with dysphagia. Methods This prospective study was conducted in the intensive care units of a university hospital. We included hemodynamically stable patients under mechanical ventilation for at least 48 hours following 48 hours of tracheostomy and with an appropriate level of consciousness. The exclusion criteria were previous surgery in the oral cavity, pharynx, larynx and/or esophagus, the presence of degenerative diseases or a past history of oropharyngeal dysphagia. All patients were submitted to a swallowing rehabilitation program. An oropharyngeal structural score, a swallowing functional score and an otorhinolaryngological structural and functional score were determined before and after swallowing therapy. Results We included 14 patients. The mean duration of the rehabilitation program was 12.4 ± 9.4 days, with 5.0 ± 5.2 days under mechanical ventilation. Eleven patients could receive oral feeding while still in the intensive care unit after 4 (2 - 13) days of therapy. All scores significantly improved after therapy. Conclusion In this small group of patients, we demonstrated that the early implementation of a swallowing rehabilitation program is feasible even in patients under mechanical ventilation. PMID:25909315

  7. Conventional mechanical ventilation

    PubMed Central

    Tobias, Joseph D.

    2010-01-01

    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

  8. Infraclavicular axillary vein cannulation using ultrasound in a mechanically ventilated general intensive care population.

    PubMed

    Glen, H; Lang, I; Christie, L

    2015-09-01

    Central venous catheter (CVC) insertion is commonly undertaken in the ICU. The use of ultrasound (US) to facilitate CVC insertion is standard and is supported by guidelines. Because the subclavian vein cannot be insonated where it underlies the clavicle, its use as a CVC site is now less common. The axillary vein, however, can be seen on US just distal to the subclavian vein and placement of a CVC at this site gives a result which is functionally indistinguishable from a subclavian CVC. We evaluated placement of US-guided axillary CVCs in mechanically ventilated intensive care patients. Data were collected for 125 consecutive US-guided axillary CVC procedures in ventilated patients in an adult intensive care setting. All lines were inserted using real-time US guidance with an out-of-plane technique. One hundred and twenty-five procedures occurred in 119 patients. Successful line placement was achieved in 117 out of 125 (94%) procedures. Complications included four procedures that required repeating due to catheter malposition and one arterial puncture. The median number of attempts per procedure was one (IQR 1 to 2). Thirty-nine (31%) patients had a body mass index of 30 or above, 43 (34%) patients had a coagulopathy and 70 (56%) patients had significant ventilator dependence (FiO2 of 0.5 or above, or positive end expiratory pressure 10 cmH20 or above). The technique of US-guided axillary CVC access can be undertaken successfully in ventilated intensive care patients, even in challenging circumstances. Taken together with existing work on the utility and safety of this technique, we suggest that it be adopted more widely in the intensive care population. PMID:26310415

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

    PubMed

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

    2012-01-01

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

  10. Mechanical Ventilation

    MedlinePLUS

    ... body ? To help the lungs get rid of carbon dioxide ? To ease the work of breathing—Some people ... rays and blood drawn to measure oxygen and carbon dioxide (“blood gases”). Members of the health care team ( ...

  11. Impact of Critical Care Nursing on 30-Day Mortality of Mechanically Ventilated Older Adults

    PubMed Central

    Kelly, Deena M.; Kutney-Lee, Ann; McHugh, Matthew D.; Sloane, Douglas M.; Aiken, Linda H.

    2014-01-01

    Objectives The mortality rate for mechanically ventilated older adults in ICUs is high. A robust research literature shows a significant association between nurse staffing, nurses’ education, and the quality of nurse work environments and mortality following common surgical procedures. A distinguishing feature of ICUs is greater investment in nursing care. The objective of this study is to determine the extent to which variation in ICU nursing characteristics—staffing, work environment, education, and experience—is associated with mortality, thus potentially illuminating strategies for improving patient outcomes. Design Multistate, cross-sectional study of hospitals linking nurse survey data from 2006 to 2008 with hospital administrative data and Medicare claims data from the same period. Logistic regression models with robust estimation procedures to account for clustering were used to assess the effect of critical care nursing on 30-day mortality before and after adjusting for patient, hospital, and physician characteristics. Setting Three hundred and three adult acute care hospitals in California, Florida, New Jersey, and Pennsylvania. Patients The patient sample included 55,159 older adults on mechanical ventilation admitted to a study hospital. Interventions None. Measurements and Main Results Patients in critical care units with better nurse work environments experienced 11% lower odds of 30-day mortality than those in worse nurse work environments. Additionally, each 10% point increase in the proportion of ICU nurses with a bachelor’s degree in nursing was associated with a 2% reduction in the odds of 30-day mortality, which implies that the odds on patient deaths in hospitals with 75% nurses with a bachelor’s degree in nursing would be 10% lower than in hospitals with 25% nurses with a bachelor’s degree in nursing. Critical care nurse staffing did not vary substantially across hospitals. Staffing and nurse experience were not associated with mortality after accounting for these other nurse characteristics. Conclusions Patients in hospitals with better critical care nurse work environments and higher proportions of critical care nurses with a bachelor’s degree in nursing experienced significantly lower odds of death. PMID:24368346

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

    PubMed Central

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

    2014-01-01

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

  13. "The death rattle" in the intensive care unit after withdrawal of mechanical ventilation in neurological patients.

    PubMed

    Kompanje, Erwin J O

    2005-01-01

    The noise produced by oscillatory movements of secretions in the oropharynx, hypopharynx, and trachea during inspiration and expiration in unconscious terminal patients is often described as "the death rattle." The secretions are produced by the salivary glands and bronchial mucosa. These patients are usually too weak to expectorate or swallow the migrating secretions. Sputum usually only accumulates in these areas if there is a significant impairment of the cough reflex, as in deep coma or near death. Reported incidence of death rattle in terminal patients varied between 6 and 92%. Death rattle was most commonly reported in patients dying from pulmonary malignancies, primary brain tumors, or brain metastases, and predicts death within 48 hours in 75% of the patients. After withdrawal of artificial ventilation from the intensive care unit, excessive respiratory secretion resulting in a rattling breathing during the last hours of life is not uncommon, especially not in pulmonary and neurological patients. The distressing experience and negative influence in the bereavement process indicates an ethical demand to treat this symptom from the perspective of others merely than that of the patient. PMID:16174877

  14. Mechanical ventilation: introduction for the pharmacy practitioner.

    PubMed

    Cawley, Michael J

    2011-02-01

    Mechanical ventilation is a common therapeutic modality required for the management of patients unable to maintain adequate intrinsic ventilation and oxygenation. Mechanical ventilators can be found within various hospital and nonhospital environments (ie, nursing homes, skilled nursing facilities, and patient's home residence), but these devices generally require the skill of a multidisciplinary health care team to optimize therapeutic outcomes. Unfortunately, pharmacists have been excluded in the discussion of mechanical ventilation since this therapeutic modality may be perceived as irrelevant to drug utilization and the usual scope of practice of a hospital pharmacist. However, the pharmacist provides a crucial role as a member of the multidisciplinary team in the management of the mechanically ventilated patient by verifying accuracy of prescribed medications, providing recommendations of alternative drug selections, monitoring for drug and disease interactions, assisting in the development of institutional weaning protocols, and providing quality assessment of drug utilization. Pharmacists may be intimidated by the introduction of advanced ventilator microprocessor technology, but understanding and integrating ventilator management with the pharmacotherapeutic needs of the patient will ultimately help the pharmacist be a better qualified and respected practitioner. The goal of this article is to assist the pharmacy practitioner with a better understanding of mechanical ventilation and to apply this information to improve delivery of pharmaceutical care. PMID:21507870

  15. A new system for understanding modes of mechanical ventilation.

    PubMed

    Chatburn, R L; Primiano, F P

    2001-06-01

    Numerous ventilation modes and ventilation options have become available as new mechanical ventilators have reached the market. Ventilator manufacturers have no standardized terminology for ventilator modes and ventilation options, and ventilator operator's manuals do not help the clinician compare the modes of ventilators from different manufacturers. This article proposes a standardized system for classifying ventilation modes, based on general engineering principles and a small set of explicit definitions. Though there may be resistance by ventilator manufacturers to a standardized system of ventilation terminology, clinicians and health care equipment purchasers should adopt such a system in the interest of clear communication--the lack of which prevents clinicians from fully understanding the therapies they administer and could compromise the quality of patient care. PMID:11353550

  16. Emergency Department Treatment of the Mechanically Ventilated Patient.

    PubMed

    Spiegel, Rory; Mallemat, Haney

    2016-02-01

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

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

    PubMed

    Slutsky, Arthur S

    2015-05-15

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

  18. [Recommendations for invasive home mechanical ventilation].

    PubMed

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

    2011-02-01

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

  19. Mechanical Ventilation and Bronchopulmonary Dysplasia.

    PubMed

    Keszler, Martin; Sant'Anna, Guilherme

    2015-12-01

    Mechanical ventilation is an important potentially modifiable risk factor for the development of bronchopulmonary dysplasia. Effective use of noninvasive respiratory support reduces the risk of lung injury. Lung volume recruitment and avoidance of excessive tidal volume are key elements of lung-protective ventilation strategies. Avoidance of oxidative stress, less invasive methods of surfactant administration, and high-frequency ventilation are also important factors in lung injury prevention. PMID:26593078

  20. Inhalation therapy in mechanical ventilation

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    2014-01-01

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

  2. Noninvasive ventilation in withdrawal from mechanical ventilation.

    PubMed

    Ferrer, Miquel; Sellares, Jacobo; Torres, Antoni

    2014-08-01

    Patients with chronic airflow obstruction and difficult or prolonged weaning are at increased risk for prolonged invasive mechanical ventilation (IMV). Several randomized controlled trials mainly conducted in patients who had pre-existing lung disease have shown that the use of noninvasive ventilation (NIV) to advance extubation in patients with difficult and prolonged weaning can result in reduced periods of endotracheal intubation, complication rates, and improved survival. Patients in these studies were hemodynamically stable, with a normal level of consciousness, no fever, and a preserved cough reflex. The use of NIV in the management of mixed populations with respiratory failure after extubation, including small proportions of chronic respiratory patients did not show clinical benefits included. By contrast, NIV immediately after extubation is effective in avoiding respiratory failure after extubation and improving survival in patients at risk for this complication, particularly those with chronic respiratory disorders, cardiac comorbidity, and hypercapnic respiratory failure. Finally, both continuous positive airway pressure and NIV can improve clinical outcomes in patients with postoperative acute respiratory failure, particularly abdominal and thoracic surgery. PMID:25111647

  3. Prolonged mechanical ventilation after critical illness.

    PubMed

    Mauri, T; Pivi, S; Bigatello, L M

    2008-06-01

    A significant number of patients that have been critically ill require mechanical ventilation for extended periods of time as they progress towards recovery. Many of these patients can be cared for outside of the Intensive Care Unit in facilities focused on stabilizing the underlying medical problems, managing ventilatory support, and planning for rehabilitation and home care. Although these units have varied administrative structures, they have reported similar encouraging rates of weaning and survival. In a recent study about such a ward at a large academic hospital, it was observed that, although the majority of patients were liberated from the ventilator and returned home with a satisfactory activity level, a significant number of patients did not; these patients eventually died after a protracted hospital stay, mostly after a consensual withdrawal of life support. In the present article, a relevant literature review is presented concerning the outcome of patients undergoing prolonged mechanical ventilation. The main focus of the research was to address how to alleviate the burden of prolonged critical illness on mechanically ventilated patients who may eventually die after a great deal of suffering, and to identify the tangible emotional and financial costs to these patients, their families, and society. PMID:18500202

  4. Mechanical ventilation for severe asthma.

    PubMed

    Leatherman, James

    2015-06-01

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

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

    ERIC Educational Resources Information Center

    Young, Jenny M.; And Others

    1994-01-01

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

  6. Capnography/Capnometry during mechanical ventilation: 2011.

    PubMed

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

    2011-04-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

    Caprotta, Gustavo; Crotti, Patricia Gonzalez; Frydman, Judith

    2011-01-01

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

  9. Respiratory mechanics in mechanically ventilated patients.

    PubMed

    Hess, Dean R

    2014-11-01

    Respiratory mechanics refers to the expression of lung function through measures of pressure and flow. From these measurements, a variety of derived indices can be determined, such as volume, compliance, resistance, and work of breathing. Plateau pressure is a measure of end-inspiratory distending pressure. It has become increasingly appreciated that end-inspiratory transpulmonary pressure (stress) might be a better indicator of the potential for lung injury than plateau pressure alone. This has resulted in a resurgence of interest in the use of esophageal manometry in mechanically ventilated patients. End-expiratory transpulmonary pressure might also be useful to guide the setting of PEEP to counterbalance the collapsing effects of the chest wall. The shape of the pressure-time curve might also be useful to guide the setting of PEEP (stress index). This has focused interest in the roles of stress and strain to assess the potential for lung injury during mechanical ventilation. This paper covers both basic and advanced respiratory mechanics during mechanical ventilation. PMID:25336536

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

    PubMed Central

    Loss, Sérgio Henrique; de Oliveira, Roselaine Pinheiro; Maccari, Juçara Gasparetto; Savi, Augusto; Boniatti, Marcio Manozzo; Hetzel, Márcio Pereira; Dallegrave, Daniele Munaretto; Balzano, Patrícia de Campos; Oliveira, Eubrando Silvestre; Höher, Jorge Amilton; Torelly, André Peretti; Teixeira, Cassiano

    2015-01-01

    Objective The number of patients who require prolonged mechanical ventilation increased during the last decade, which generated a large population of chronically ill patients. This study established the incidence of prolonged mechanical ventilation in four intensive care units and reported different characteristics, hospital outcomes, and the impact of costs and services of prolonged mechanical ventilation patients (mechanical ventilation dependency ? 21 days) compared with non-prolonged mechanical ventilation patients (mechanical ventilation dependency < 21 days). Methods This study was a multicenter cohort study of all patients who were admitted to four intensive care units. The main outcome measures were length of stay in the intensive care unit, hospital, complications during intensive care unit stay, and intensive care unit and hospital mortality. Results There were 5,287 admissions to the intensive care units during study period. Some of these patients (41.5%) needed ventilatory support (n = 2,197), and 218 of the patients met criteria for prolonged mechanical ventilation (9.9%). Some complications developed during intensive care unit stay, such as muscle weakness, pressure ulcers, bacterial nosocomial sepsis, candidemia, pulmonary embolism, and hyperactive delirium, were associated with a significantly higher risk of prolonged mechanical ventilation. Prolonged mechanical ventilation patients had a significant increase in intensive care unit mortality (absolute difference = 14.2%, p < 0.001) and hospital mortality (absolute difference = 19.1%, p < 0.001). The prolonged mechanical ventilation group spent more days in the hospital after intensive care unit discharge (26.9 ± 29.3 versus 10.3 ± 20.4 days, p < 0.001) with higher costs. Conclusion The classification of chronically critically ill patients according to the definition of prolonged mechanical ventilation adopted by our study (mechanical ventilation dependency ? 21 days) identified patients with a high risk for complications during intensive care unit stay, longer intensive care unit and hospital stays, high death rates, and higher costs. PMID:25909310

  11. Telemedicine enabled remote critical care ventilator.

    PubMed

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

    2010-01-01

    Following a critical illness, technology-dependent children on chronic ventilator support require specialized care to facilitate recovery and rehabilitation that minimally impedes social and psychological development. Intervention strategies have been confounded by the need for frequent assessment via physical exam in a relatively immobile patient population. The availability of technology that enables effective, timely, and reliable information transfer between the homecare providers and the attending pulmonologist is likely to decrease the need for transport and hospitalization, and provide a dramatically increased level of comfort for care givers in the home and ultimately the children. A Pulmonetic Systems LTV 1200 ventilator was enabled with a wireless cellular interface to make its settings and performance data real-time accessible over a secure wireless Internet connection. A complete web-browser ventilator interface program was specified, coded, and tested. The live web interface was used to support a formal survey of pediatric pulmonologists to help gauge the potential medical utility of the new remote interface to the ventilator. The survey results were overwhelmingly supportive of the concept, and the pulmonologists listed many varied ways that the data could have utility in their patient populations. PMID:21096563

  12. The basis and basics of mechanical ventilation.

    PubMed

    Bone, R C; Eubanks, D H

    1991-06-01

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

  13. Weaning from prolonged mechanical ventilation.

    PubMed

    Nevins, M L; Epstein, S K

    2001-03-01

    The development of weaning failure and need for PMV is multifactorial in origin, involving disorders of pulmonary mechanics and complications associated with critical illness. The underlying disease process is clearly important when discussing mechanisms of ventilator dependence; interventions therefore must be tailored to individual patients. Unfortunately, the main conclusion that can be drawn from the sum of the studies investigating patients on PMV to date is that an evidence-based approach to weaning is not possible and more research needs to be done. New studies need to incorporate severity-of-illness scores and an assessment of principal and comorbid conditions to allow for comparison of the findings from different centers. The best approach to a patient requiring PMV after exclusion of easily treatable conditions is not known. The literature regarding both acute and chronic cases suggests that a systematic approach to weaning involving the participation of multiple caregivers, including nurses, physicians, and respiratory, physical, and speech therapists facilitates liberation from MV. Although a gradual decrement in ventilator support would seem prudent, Scheinhorn et al have begun to identify a subpopulation of patients who can tolerate an acceleration of the weaning process. Given the known complications associated with MV, it is crucial that further research be performed to identify patients as soon as they are capable of breathing spontaneously. The literature demonstrates through multiple studies that satisfactory patient outcomes are attainable and can be achieved at LTAC facilities in a more cost-effective manner than in an ICU setting. The trend toward the concentration of patients into specialized regional weaning centers should facilitate the research process and continue to improve outcomes in this population. PMID:11315451

  14. [Mechanical ventilation in intensive care units: indications, modalities and complications. Results of a prospective multicenter survey in Tunisia].

    PubMed

    Chelli, Hedi; Besbes, Lamia; Ben Khelil, Jalila; Thabet, Hafedh; Bouhaja, Bechir; Ghedira, Selma; Ben Lakhal, Salh; Bchir, Afef; Gahbiche, Mourad; Bouaziz, Mounir; el Atrous, Souheil; Besbes, Mohamed; Amamou, Mouldi; Ben Ammar, Mohamed Salah; Daoud, Abdelmajid; Bouchoucha, Slah; Abroug, Fekri

    2004-01-01

    The survey was performed during the month of March 1998 and concerned 9 ICUs located in teaching hospitals. To be included each ICU had to MV for more than 12 hours were included in the study and had a 28 day follow-up in the ICU or until hospital discharge. Collected parameters were indications of MV, modalities of MV and of weaning, complication and outcome at hospital discharge. Assist-control ventilation was the most used ventilation modality (69.8%). Weaning of MV was performed in 63% of the study patients and was based on a once-a-day attempt of spontaneous breathing through a T-piece (59.5%) and a combination of intermittent mandatory ventilation with pressure support (IMV-PS: 27%) or pressure support alone (11.2%). Mean length of hospital stay was 19.7 +/- 15.9 days of which 11.6 days were spent in the ICU. Fifty nine patients (54%) were alive at discharge form the ICU of whom 4 ultimately died during their hospital stay. MV practice as well as ICU facilities are not homogenous in Tunisia. Recommendations and guidelines should be built in order to standardize MV practice in Tunisia. PMID:15125351

  15. 46 CFR 154.1200 - Mechanical ventilation system: General.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  16. 46 CFR 154.1200 - Mechanical ventilation system: General.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  17. 46 CFR 154.1200 - Mechanical ventilation system: General.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  18. 46 CFR 154.1200 - Mechanical ventilation system: General.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  19. Healthcare Technology Management (HTM) of mechanical ventilators by clinical engineers.

    PubMed

    Yoshioka, Jun; Nakane, Masaki; Kawamae, Kaneyuki

    2014-01-01

    Mechanical ventilator failures expose patients to unacceptable risks, and maintaining mechanical ventilator safety is an important issue. We examined the usefulness of maintaining mechanical ventilators by clinical engineers (CEs) using a specialized calibrator. These evaluations and the ability to make in-house repairs proved useful for obviating the need to rent ventilators which, in turn, might prove faulty themselves. The CEs' involvement in maintaining mechanical ventilators is desirable, ensures prompt service, and, most importantly, enhances safe management of mechanical ventilators. PMID:25520839

  20. Optimizing Communication in Mechanically Ventilated Patients

    PubMed Central

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

    2014-01-01

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

  1. Case-Mix, Care Processes, and Outcomes in Medically-Ill Patients Receiving Mechanical Ventilation in a Low-Resource Setting from Southern India: A Prospective Clinical Case Series

    PubMed Central

    Karthikeyan, Balasubramanian; Kadhiravan, Tamilarasu; Deepanjali, Surendran; Swaminathan, Rathinam Palamalai

    2015-01-01

    Background Mechanical ventilation is a resource intensive organ support treatment, and historical studies from low-resource settings had reported a high mortality. We aimed to study the outcomes in patients receiving mechanical ventilation in a contemporary low-resource setting. Methods We prospectively studied the characteristics and outcomes (disease-related, mechanical ventilation-related, and process of care-related) in 237 adults mechanically ventilated for a medical illness at a teaching hospital in southern India during February 2011 to August 2012. Vital status of patients discharged from hospital was ascertained on Day 90 or later. Results Mean age of the patients was 40 ± 17 years; 140 (51%) were men. Poisoning and envenomation accounted for 98 (41%) of 237 admissions. In total, 87 (37%) patients died in-hospital; 16 (7%) died after discharge; 115 (49%) were alive at 90-day assessment; and 19 (8%) were lost to follow-up. Weaning was attempted in 171 (72%) patients; most patients (78 of 99 [79%]) failing the first attempt could be weaned off. Prolonged mechanical ventilation was required in 20 (8%) patients. Adherence to head-end elevation and deep vein thrombosis prophylaxis were 164 (69%) and 147 (62%) respectively. Risk of nosocomial infections particularly ventilator-associated pneumonia was high (57.2 per 1,000 ventilator-days). Higher APACHE II score quartiles (adjusted HR [95% CI] quartile 2, 2.65 [1.19–5.89]; quartile 3, 2.98 [1.24–7.15]; quartile 4, 5.78 [2.45–13.60]), and new-onset organ failure (2.98 [1.94–4.56]) were independently associated with the risk of death. Patients with poisoning had higher risk of reintubation (43% vs. 20%; P = 0.001) and ventilator-associated pneumonia (75% vs. 53%; P = 0.001). But, their mortality was significantly lower compared to the rest (24% vs. 44%; P = 0.002). Conclusions The case-mix considerably differs from other settings. Mortality in this low-resource setting is similar to high-resource settings. But, further improvements in care processes and prevention of nosocomial infections are required. PMID:26262995

  2. 46 CFR 154.1200 - Mechanical ventilation system: General.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 5 2011-10-01 2011-10-01 false Mechanical ventilation system: General. 154.1200 Section... Equipment Cargo Area: Mechanical Ventilation System § 154.1200 Mechanical ventilation system: General. (a... cargo handling equipment must have a fixed, exhaust-type mechanical ventilation system. (b)...

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Mechanical ventilation system: Standards. 154.1205... Equipment Cargo Area: Mechanical Ventilation System § 154.1205 Mechanical ventilation system: Standards. (a) Each exhaust type mechanical ventilation system required under § 154.1200 (a) must have ducts...

  5. 46 CFR 154.1205 - Mechanical ventilation system: Standards.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 5 2011-10-01 2011-10-01 false Mechanical ventilation system: Standards. 154.1205... Equipment Cargo Area: Mechanical Ventilation System § 154.1205 Mechanical ventilation system: Standards. (a) Each exhaust type mechanical ventilation system required under § 154.1200 (a) must have ducts...

  6. Sufficiency of care in disasters: ventilation, ventilator triage, and the misconception of guideline-driven treatment.

    PubMed

    Trotter, Griffin

    2010-01-01

    This essay examines the management of ventilatory failure in disaster settings where clinical needs overwhelm available resources. An ethically defensible approach in such settings will adopt a "sufficiency of care" perspective that is: (1) adaptive, (2) resource-driven, and (3) responsive to the values of populations being served. Detailed, generic, antecedently written guidelines for "ventilator triage" or other management issues typically are of limited value, and may even impede ethical disaster response if they result in rescuers' clumsily interpreting events through the lens of the guideline, rather than customizing tactics to the actual context. Especially concerning is the tendency of some expert planners to mistakenly assume that medical treatment of respiratory failure: (1) always requires full-feature mechanical ventilators, (2) will always occur in hospitals, and (3) can be planned in advance without sophisticated public consultation about likely ethical dilemmas. PMID:21313863

  7. Neonatal mechanical ventilation: Indications and outcome

    PubMed Central

    Iqbal, Qazi; Younus, Mir M.; Ahmed, Asif; Ahmad, Ikhlas; Iqbal, Javed; Charoo, Bashir A.; Ali, S Wajid

    2015-01-01

    Background and Aims: Decreasing mortality in sick and ventilated neonates is an endeavor of all neonatologists. To reduce the high mortality in this group of neonates, identification of risk factors is important. This study was undertaken to find out the indications of ventilation and complications in ventilated neonates and also study possible predictors of outcome. Subjects: Age <1-month; mechanically ventilated; not having suspected metabolic disorders or congenital anomalies; excluding postoperative patients. Methods: Neonates consecutively put on mechanical ventilation during the study period (October 2011 to November 2013) enrolled. Primary disease of the neonates along with complications present listed. Clinical and laboratory parameters analyzed to find the predictors of mortality. Results: Total 300 neonates were ventilated. 52% were male. Mean age, weight, and gestational age were 21 ± 62 h, 2320 ± 846.2 g, and 35.2 ± 4.9 weeks, respectively. 130 (43%) neonates died. Respiratory distress syndrome (RDS) (31.1%), sepsis (22.7%), and birth asphyxia (18%) were the most common indications for ventilation. Mortality in ventilated patients with sepsis, pneumonia, RDS or birth asphyxia was 64.7%, 60%, 44.6%, and 33.3%, respectively. Weight <2500 g, gestation <34 weeks, initial pH <7.1, presence of sepsis, apnea, shock, pulmonary hemorrhage, hypoglycemia, neutropenia, and thrombocytopenia were significantly associated with mortality (P < 0.05). Resuscitation at birth, seizures, intra ventricular hemorrhage, pneumothorax, ventilator-associated pneumonia, PO2, or PCO2 did not have a significant association with mortality. On logistic regression, gestation <34 weeks, initial pH <7.1, pulmonary hemorrhage, or shock were independently significant predictors of mortality. Conclusions: Weight <2500 g, gestation <34 weeks, initial arterial pH <7.1, shock, pulmonary hemorrhage, apnea, hypoglycemia, neutropenia, and thrombocytopenia were significant predictors of mortality in ventilated neonates. PMID:26430338

  8. Brazilian recommendations of mechanical ventilation 2013. Part 2

    PubMed Central

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

    2014-01-01

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

  9. Brazilian recommendations of mechanical ventilation 2013. Part I

    PubMed Central

    2014-01-01

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

  10. Brazilian recommendations of mechanical ventilation 2013. Part 2

    PubMed Central

    2014-01-01

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

  11. Brazilian recommendations of mechanical ventilation 2013. Part I

    PubMed Central

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

    2014-01-01

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

  12. [ASSESSMENT OF PULMONARY VENTILATION FUNCTION AT INTENSIVE CARE UNIT PATIENTS].

    PubMed

    Mustafin, R; Bakirov, A

    2015-09-01

    The article presents the functional characteristics of lung tissue in reanimation profile patients with different pathologies with forced ventilation and auxiliary support on the background. The aim of this study was to analyze the dynamics properties of lung tissue in intensive care unit patients with symptoms of severe violations of restrictive lung tissue being on ventilatory support. Results were subjected to analysis of acid-base status and dynamics of the main indicators of the biomechanical properties of the lung in 32 patients with severe concomitant injury (n=21), acute bilateral community-acquired pneumonia (n=7), septic shock (n=4) during the entire period of the respiratory "prosthetics "(before and after the beginning of mechanical ventilation). Using during ventilatory support of patients with initial symptoms of the syndrome of acute lung damage and reduced lung function restrictive positive end-expiratory pressure of 6-10 cm of water column when the conventional (1:2; 1:2.5 at p?0.05) and invert (2:1 at p?0,1) ratio inhale/exhale, relatively low tidal volume (6-8 ml/kg) allows increase the compliance of the lung tissue to 11-29%. Increased expiratory time constant has a direct correlation with the value of airway resistance was due not only to the maintenance of optimal parameters for MVV (mechanical voluntary ventilation), but regular lavage of the tracheobronchial tree, which allows to maintain patency of the lower respiratory tract. The main areas during mechanical ventilation of lungs in patients with a sharp decline in restrictive lung function (ARDS, pneumonia), regardless of the reason it was summoned, optimal value is the observance of the positive end-expiratory pressure, the ratio of inhale/exhale (depending on the degree of hypoxemia), to maintain sufficient blood oxygen saturation and partial pressure of oxygen in the blood plasma. PMID:26355312

  13. Flow measurement in mechanical ventilation: a review.

    PubMed

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

    2015-03-01

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

  14. Air Distribution Effectiveness for Different Mechanical Ventilation

    E-print Network

    LBNL-62700 Air Distribution Effectiveness for Different Mechanical Ventilation Systems Max H, product, or process disclosed, or represents that its use would not infringe privately owned rights. Reference herein to any specific commercial product, process, or service by its trade name, trademark

  15. 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

  16. A nurse's guide to common mechanical ventilation techniques and modes used in infants. Nursing implications.

    PubMed

    Snow, Timothy M; Brandon, Debra H

    2007-02-01

    The need for conventional mechanical ventilation (CMV) is a common one in the neonatal intensive care unit (NICU). The goals of CMV are to facilitate adequate gas exchange, minimize the risk of lung injury/damage, decrease the patient's work of breathing, and optimize the patient's comfort. Although time-cycled, pressure-limited ventilation remains the most common CMV modality, volume-cycled ventilation, assist-control ventilation, pressure-support ventilation, and pressure-control ventilation are sometimes used in the NICU. Pressure-regulated volume control, volume-guaranteed ventilation, volume-assured pressure-support ventilation, and proportional-assist ventilation are emerging hybrid modes of CMV. Although CMV is frequently life saving, it can cause complications if improperly used. Nurses are responsible for the ongoing assessment and care of infants undergoing CMV and are becoming frequently more involved in the weaning process of CMV. This article provides an overview of conventional ventilation, with a focus on common modalities, and ventilation-related nursing interventions. PMID:17536329

  17. Mechanical ventilation in ICUs in Poland: A multi-center point-prevalence study

    PubMed Central

    Kübler, Andrzej; Maciejewski, Dariusz; Adamik, Barbara; Kaczorowska, Ma?gorzata

    2013-01-01

    Background Mechanical ventilation is the primary method of supporting organ function in patients treated in intensive care units (ICUs). Lung damage from mechanical ventilation can be avoided by using the correct ventilation modes. This study was designed to assess the epidemiology and treatment strategies of patients receiving mechanical ventilation in ICUs in Poland. Material/Methods This study was done using a point-prevalence methodology. Questionnaires requesting demographic data, indications for ventilation, variables involved in ventilation, airway access, methods of sedation, and mode of weaning were sent to 148 ICUs. Results Eighty-three ICUs took part in the study. The rate of ventilated patients was 73.6%. The indications for mechanical ventilation were: acute respiratory failure (40%), coma (40%), chronic obstructive pulmonary disease (COPD) exacerbation (14%), and neuromuscular diseases (5%). Patients were ventilated by orotracheal tube (58%), tracheostomy tube (41%), and mask/helmet (1%). The mean tidal volume was 8 ml/kg and positive end-expiratory pressure was commonly used. The mean oxygen concentration was 40%. Synchronized intermittent mandatory ventilation with pressure support was the most frequently used ventilatory mode. Benzodiazepine and opioids were used for sedation in 91% of centers. A systematic testing of the depth of sedation was performed at 48% surveyed ICUs. Ventilation monitoring with biomechanical methods was used at 53% of centers. Conclusions Mechanical ventilation is commonly used in ICUs in Poland. Almost half of the ventilated patients had extrapulmonary indications. Patients were ventilated with low concentrations of oxygen, and positive end-expiratory pressure (PEEP) was commonly employed. PMID:23727991

  18. 42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  19. 42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  20. Decisional responsibility for mechanical ventilation and weaning: an international survey

    PubMed Central

    2011-01-01

    Introduction Optimal management of mechanical ventilation and weaning requires dynamic and collaborative decision making to minimize complications and avoid delays in the transition to extubation. In the absence of collaboration, ventilation decision making may be fragmented, inconsistent, and delayed. Our objective was to describe the professional group with responsibility for key ventilation and weaning decisions and to examine organizational characteristics associated with nurse involvement. Methods A multi-center, cross-sectional, self-administered survey was sent to nurse managers of adult intensive care units (ICUs) in Denmark, Germany, Greece, Italy, Norway, Switzerland, Netherlands and United Kingdom (UK). We summarized data as proportions (95% confidence intervals (CIs)) and calculated odds ratios (OR) to examine ICU organizational variables associated with collaborative decision making. Results Response rates ranged from 39% (UK) to 92% (Switzerland), providing surveys from 586 ICUs. Interprofessional collaboration (nurses and physicians) was the most common approach to initial selection of ventilator settings (63% (95% CI 59 to 66)), determination of extubation readiness (71% (67 to 75)), weaning method (73% (69 to 76)), recognition of weaning failure (84% (81 to 87)) and weaning readiness (85% (82 to 87)), and titration of ventilator settings (88% (86 to 91)). A nurse-to-patient ratio other than 1:1 was associated with decreased interprofessional collaboration during titration of ventilator settings (OR 0.2, 95% CI 0.1 to 0.6), weaning method (0.4 (0.2 to 0.9)), determination of extubation readiness (0.5 (0.2 to 0.9)) and weaning failure (0.4 (0.1 to 1.0)). Use of a weaning protocol was associated with increased collaborative decision making for determining weaning (1.8 (1.0 to 3.3)) and extubation readiness (1.9 (1.2 to 3.0)), and weaning method (1.8 (1.1 to 3.0). Country of ICU location influenced the profile of responsibility for all decisions. Automated weaning modes were used in 55% of ICUs. Conclusions Collaborative decision making for ventilation and weaning was employed in most ICUs in all countries although this was influenced by nurse-to-patient ratio, presence of a protocol, and varied across countries. Potential clinical implications of a lack of collaboration include delayed adaptation of ventilation to changing physiological parameters, and delayed recognition of weaning and extubation readiness resulting in unnecessary prolongation of ventilation. PMID:22169094

  1. Knowledge of Pediatric Critical Care Nurses Regarding Evidence Based Guidelines for Prevention of Ventilator Associated Pneumonia (VAP)

    ERIC Educational Resources Information Center

    Ahmed, Gehan EL Nabawy; Abosamra, Omyma Mostafa

    2015-01-01

    Ventilator associated pneumonia (VAP) is a costly, preventable, and often fatal consequence of medical therapy that increases hospital and intensive care stays in mechanically ventilated patients. The prevention of VAP is primarily the responsibility of the bedside nurse whose knowledge, beliefs, and practices influence the health outcome of ICU…

  2. Two Cases of Pneumatoceles in Mechanically Ventilated Infants

    PubMed Central

    Al-Ghafri, Mohammed; Al-Hanshi, Said; Al-Ismaily, Suad

    2015-01-01

    Pulmonary pneumatocele is a thin-walled, gas-filled space within the lung that usually occurs in association with bacterial pneumonia and is usually transient. The majority of pneumatoceles resolve spontaneously without active intervention, but in some cases they might lead to pneumothorax with subsequent hemodynamic instability. We report two cases presented to the pediatric intensive care unit at the Royal Hospital, Oman with pneumatoceles. The first was a 14-day-old baby who underwent surgical repair of total anomalous pulmonary venous connection (TAPVC) requiring extracorporeal membrane oxygenation (ECMO) support following surgery. He was initially on conventional mechanical ventilation. Seven days after the surgery, he started to develop bilateral pneumatoceles. The pneumatoceles were not regressing and they did not respond to three weeks of conservative management with high-frequency oscillation ventilation (HFOV). He failed four attempts of weaning from HFOV to conventional ventilation. Each time he was developing tachypnea and carbon dioxide retention. Percutaneous intercostal chest drain (ICD) insertion was needed to evacuate one large pneumatocele. Subsequently, he improved and we were able to wean and extubate him. The second case was a two-month-old male admitted with severe respiratory distress secondary to respiratory syncytial virus (RSV) pneumonitis. After intubation, he required a high conventional ventilation setting and within 24 hours he was on HFOV. Conservative management with HFOV was sufficient to treat the pneumatoceles and no further intervention was needed. Our cases demonstrate two different approaches in the management of pneumatoceles in mechanically ventilated children. Each approach was case dependent and could not be used interchangeably. PMID:26366266

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

    PubMed Central

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

    2011-01-01

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

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

    E-print Network

    Lewis, Mark

    THE MECHANICS OF LUNG TISSUE UNDER HIGH-FREQUENCY VENTILATION MARKUS R. OWEN AND MARK A. LEWIS SIAM J. APPL. MATH. c 2001 Society for Industrial and Applied Mathematics Vol. 61, No. 5, pp. 1731­1761 Abstract. High-frequency ventilation is a radical departure from conventional lung ventilation

  5. Update in Mechanical Ventilation, Sedation, and Outcomes 2014.

    PubMed

    Goligher, Ewan C; Douflé, Ghislaine; Fan, Eddy

    2015-06-15

    Novel approaches to the management of acute respiratory distress syndrome include strategies to enhance alveolar liquid clearance, promote epithelial cell growth and recovery after acute lung injury, and individualize ventilator care on the basis of physiological responses. The use of extracorporeal membrane oxygenation (ECMO) is growing rapidly, and centers providing ECMO must strive to meet stringent quality standards such as those set out by the ECMONet working group. Prognostic tools such as the RESP score can assist clinicians in predicting outcomes for patients with severe acute respiratory failure but do not predict whether ECMO will enhance survival. Evidence continues to grow that novel modes of mechanical ventilation such as neurally adjusted ventilatory assist are feasible and improve patient physiology and patient-ventilator interaction; data on clinical outcomes are limited but supportive. Critical illness causes long-term psychological and function sequelae: the risk of a new psychiatric diagnosis and severe physical impairment is significantly increased in the months after discharge from the intensive care unit. These long-term effects might be amenable to changes in sedation practice and increased early mobilization. Daily sedation discontinuation enhances the validity of routine delirium assessment. Many critically ill patients merit assessment by palliative care clinicians; the demand for palliative care services among critically ill patients is expected to grow. Future trials to test therapies for critical illness must ensure that study designs are adequately powered to detect benefit using realistic event rates. Integrating "big data" approaches into treatment decisions and trial designs offers a potential means of individualizing care to enhance outcomes for critically ill patients. PMID:26075422

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

    PubMed

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

    1995-09-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2015-05-01

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

  9. Respiratory Failure and Mechanical Ventilation in the Pregnant Patient.

    PubMed

    Schwaiberger, David; Karcz, Marcin; Menk, Mario; Papadakos, Peter J; Dantoni, Susan E

    2016-01-01

    Fewer than 2% of all peripartal patients need intensive care unit admission. But due to some anatomic and physiologic changes in pregnancy, respiratory failure can be promoted. This article reviews several obstetric and nonobstetric diseases that lead to respiratory failure and the treatment of these. Furthermore, invasive and noninvasive ventilation in pregnancy is discussed and suggestions of medication during ventilation are given. PMID:26600446

  10. 42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... health care professional trained in respiratory therapy (as determined by the State) to an individual who... 42 Public Health 4 2013-10-01 2013-10-01 false Respiratory care for ventilator-dependent... Definitions § 440.185 Respiratory care for ventilator-dependent individuals. (a) “Respiratory care...

  11. 42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... care professional trained in respiratory therapy (as determined by the State) to an individual who— (1... 42 Public Health 4 2011-10-01 2011-10-01 false Respiratory care for ventilator-dependent... Definitions § 440.185 Respiratory care for ventilator-dependent individuals. (a) “Respiratory care...

  12. 42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... health care professional trained in respiratory therapy (as determined by the State) to an individual who... 42 Public Health 4 2012-10-01 2012-10-01 false Respiratory care for ventilator-dependent... Definitions § 440.185 Respiratory care for ventilator-dependent individuals. (a) “Respiratory care...

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

    PubMed Central

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

    2013-01-01

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

  14. Two methods of weaning persons with quadriplegia from mechanical ventilators.

    PubMed

    Peterson, W; Charlifue, W; Gerhart, A; Whiteneck, G

    1994-02-01

    Two commonly-used methods of weaning individuals with quadriplegia from mechanical ventilators were compared. The medical records were reviewed of 52 patients who were injured at the C3 or C4 levels, were ventilator dependent following their injury, and were treated at the participating facilities. The study subjects had a total of 82 separate wean attempts: 26 utilized intermittent mandatory ventilation, 34 used progressive ventilator-free breathing (T-piece weaning) and 22 used either a combination of these approaches or a different approach. With an overall weaning success rate of 83%, this study demonstrated that individuals with C3 and C4 quadriplegia are indeed candidates for ventilator weaning. Comparing the two weaning methods, progressive ventilator-free breathing was found to be successful more often than intermittent mandatory ventilation (67.6% compared to 34.6%). In addition, progressive ventilator-free breathing appeared superior in its ability to provide a more functional alternative to individuals unable to wean completely. PMID:8015852

  15. Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review

    PubMed Central

    Burns, Karen E.A.; Meade, Maureen O.; Premji, Azra; Adhikari, Neill K.J.

    2014-01-01

    Background: Noninvasive ventilation has been studied as a means of reducing complications among patients being weaned from invasive mechanical ventilation. We sought to summarize evidence comparing noninvasive and invasive weaning and their effects on mortality. Methods: We identified relevant randomized and quasirandomized trials through searches of databases, conference proceedings and grey literature. We included trials comparing extubation and immediate application of noninvasive ventilation with continued invasive weaning in adults on mechanical ventilation. Two reviewers each independently screened citations, assessed trial quality and abstracted data. Our primary outcome was mortality. Results: We identified 16 trials involving 994 participants, most of whom had chronic obstructive pulmonary disease (COPD). Compared with invasive weaning, noninvasive weaning significantly reduced mortality (risk ratio [RR] 0.53, 95% confidence interval [CI] 0.36 to 0.80), weaning failures (RR 0.63, 95% CI 0.42 to 0.96), ventilator-associated pneumonia (RR 0.25, 95% CI 0.15 to 0.43), length of stay in the intensive care unit (mean difference [MD] ?5.59 d, 95% CI ?7.90 to ?3.28) and in hospital (MD ?6.04 d, 95% CI ?9.22 to ?2.87), and total duration of mechanical ventilation (MD ?5.64 d, 95% CI ?9.50 to ?1.77). Noninvasive weaning had no significant effect on the duration of ventilation related to weaning, but significantly reduced rates of tracheostomy (RR 0.19, 95% CI 0.08 to 0.47) and reintubation (RR 0.65, 95% CI 0.44 to 0.97). Mortality benefits were significantly greater in trials enrolling patients with COPD than in trials enrolling mixed patient populations (RR 0.36 [95% CI 0.24 to 0.56] v. RR 0.81 [95% CI 0.47 to 1.40]). Interpretation: Noninvasive weaning reduces rates of death and pneumonia without increasing the risk of weaning failure or reintubation. In subgroup analyses, mortality benefits were significantly greater in patients with COPD. PMID:24324020

  16. New strategies in mechanical ventilation for acute lung injury.

    PubMed

    Burchardi, H

    1996-05-01

    In the fluid-filled lungs of early adult respiratory distress syndrome (ARDS) the dependent parts are compressed and atelectatic; whereas, the nondependent areas remain aerated and functional. Ventilating these considerably restricted lungs carries the risk of overinflation and ventilatory-induced lung injury (baro-volutrauma). The consequences for adjusting mechanical ventilation are: 1) reducing tidal volumes in order to avoid alveolar hyperinflation and excessive alveolar pressures; 2) considering permissive hypercapnia if adequate CO2 elimination cannot be maintained; 3) keeping open the unstable alveoli by positive end-expiratory pressure (PEEP) (external or intrinsic). However, the large variations in regional lung compliance make it improbable that an optimal external PEEP level beneficial for the whole lung will be found; 4) using intrinsic PEEP in the inverse ratio ventilation (IRV) mode which varies with differences in regional ventilatory kinetics. No clinical study has yet convincingly demonstrated the benefit of IRV compared to conventional ventilation, controlled clinical long-term trials are not yet available; and 5) using superimposed spontaneous breathing which may be considerably more effective in opening up collapsed alveoli, combined with intentional intrinsic PEEP this is achieved in airway pressure release ventilation (APRV). Other new principles of mechanical ventilation, such as "proportional assist ventilation" or "tracheal gas insufflation" must still be considered as experimental. PMID:8793470

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

    PubMed Central

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

    2014-01-01

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

  18. Using remifentanil in mechanically ventilated rats to provide continuous analgosedation.

    PubMed

    Ismaiel, Nada M; Chankalal, Raymond; Zhou, Juan; Henzler, Dietrich

    2012-01-01

    Remifentanil is a potent synthetic opioid with sedative effects. Intravenous remifentanil provides deep sedation and analgesia in laboratory animals during experimental procedures. We hypothesized that remifentanil would provide effective analgosedation during assisted mechanical ventilation without affecting respiratory mechanics in rats. Five male Sprague- Dawley rats (weight, 400 to 450 g) were assigned to receive assisted mechanical ventilation with continuous positive airway pressure for 5 h. Remifentanil (0.4 ?g/kg/min IV) was delivered for the duration of ventilation. There were no differences between baseline, 1 h, and 5 h of ventilation in the mean arterial pressure, cardiac output, heart rate, and body temperature of all rats. Similarly, no differences were observed in the tidal volume, respiratory rate and minute ventilation, and gas exchange was equal in all rats at all time points. Frequent assessment of sedation by toe pinch documented loss of the pedal withdrawal reflex in all rats. We conclude that continuous remifentanil infusion provides sufficient analgosedation for mechanically ventilated rats without compromising hemodynamics, respiratory function, or gas exchange. PMID:22330869

  19. The Influence of Fluid Overload on the Length of Mechanical Ventilation in Pediatric Congenital Heart Surgery.

    PubMed

    Sampaio, Tatiana Z A L; O'Hearn, Katie; Reddy, Deepti; Menon, Kusum

    2015-12-01

    Fluid overload and prolonged mechanical ventilation lead to worse outcomes in critically ill children. However, the association between these variables in children following congenital heart surgery is unknown. The objectives of this study were to describe the association between fluid overload and duration of mechanical ventilation, oxygen requirement and radiologic findings of pulmonary and chest wall edema. This study is a retrospective chart review of patients who underwent congenital heart surgery between June 2010 and December 2013. Univariate and multivariate associations between maximum cumulative fluid balance and length of mechanical ventilation and OI were tested using the Spearman correlation test and multiple linear regression models, respectively. There were 85 eligible patients. Maximum cumulative fluid balance was associated with duration of mechanical ventilation (adjusted analysis beta coefficient = 0.53, CI 0.38-0.66, P < 0.001), length of stay in the pediatric intensive care unit (Spearman's correlation = 0.45, P < 0.001), and presence of chest wall edema and pleural effusions on chest radiograph (Mann-Whitney test, P = 0.003). Amount of red blood cells transfused and use of nitric oxide were independently associated with increased duration of mechanical ventilation (P = 0.012 and 0.014, respectively). Fluid overload is associated with prolonged duration of mechanical ventilation and PICU length of stay after congenital heart surgery. Fluid overload was also associated with physiological markers of respiratory restriction. A randomized controlled trial of a restrictive versus liberal fluid replacement strategy is necessary in this patient population, but in the meantime, accumulating observational evidence suggests that cautious use of fluid in the postoperative care may be warranted. PMID:26123810

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Frutos-Vivar, Fernando; Esteban, Andrés

    2014-10-01

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

  2. The Association Between Comorbid Illness, Colonization Status, and Acute Hospitalization in Patients Receiving Prolonged Mechanical Ventilation

    PubMed Central

    Verceles, Avelino C; Lechner, Elizabeth J; Halpin, David; Scharf, Steven M

    2015-01-01

    BACKGROUND Long-term acute care (LTAC) hospitals provide specialized care for survivors of critical illness who require prolonged mechanical ventilation. These chronically ill patients often have multiple comorbidities and are colonized with antibiotic-resistant organisms. We investigated the association of comorbidities and colonization status with outcomes in patients requiring prolonged mechanical ventilation in an LTAC facility. We hypothesized that comorbidity burden and colonization with multiple drug resistant organisms would be associated with worse clinical outcomes. METHODS We performed a retrospective, cohort study of 157 mechanically ventilated subjects in an urban LTAC facility admitted from January 2007 to September 2009. Comorbidity burden was documented from pre-admission data using the Charlson Comorbidity Index. Colonization data were obtained from surveillance cultures. Outcomes studied included transfer back to acute care facilities, stay, and ventilator weaning status. RESULTS Within 60 days, 58.6% of subjects were transferred back to an acute care facility. The most common reason for transfer was infection/sepsis (37%). The Charlson Comorbidity Index of subjects transferred to acute care, versus those who were not, was 4.9 ± 3.1 versus 3.6 ± 2.7 (P = .01), an odds ratio of 1.1 for each 1-point increase in Charlson Comorbidity Index (95% CI 1.03–1.71, P = .02). Colonization with acinetobacter was associated with higher incidence of transfer (71% vs 51%, P = .01). The odds ratio for transfer to acute care was 1.3 for each additional organism colonizing a subject (95% CI 1.11–1.53, P = .006). CONCLUSIONS Higher comorbidity burden and colonization status were associated with increased risk of transfer to acute care. Further investigation is needed to clarify this relationship between comorbidity burden and colonization with change in clinical status. PMID:22709565

  3. The Effects of Guided Imagery on Patients Being Weaned from Mechanical Ventilation

    PubMed Central

    Spiva, LeeAnna; Hart, Patricia L.; Gallagher, Erin; McVay, Frank; Garcia, Melida; Malley, Karen; Kadner, Marsha; Segars, Angela; Brakovich, Betsy; Horton, Sonja Y.; Smith, Novlette

    2015-01-01

    The study purpose was to assess the effects of guided imagery on sedation levels, sedative and analgesic volume consumption, and physiological responses of patients being weaned from mechanical ventilation. Forty-two patients were selected from two community acute care hospitals. One hospital served as the comparison group and provided routine care (no intervention) while the other hospital provided the guided imagery intervention. The intervention included two sessions, each lasting 60 minutes, offered during morning weaning trials from mechanical ventilation. Measurements were recorded in groups at baseline and 30- and 60-minute intervals and included vital signs and Richmond Agitation-Sedation Scale (RASS) score. Sedative and analgesic medication volume consumption were recorded 24 hours prior to and after the intervention. The guided imagery group had significantly improved RASS scores and reduced sedative and analgesic volume consumption. During the second session, oxygen saturation levels significantly improved compared to the comparison group. Guided imagery group had 4.88 less days requiring mechanical ventilation and 1.4 reduction in hospital length of stay compared to the comparison group. Guided imagery may be complementary and alternative medicine (CAM) intervention to provide during mechanical ventilation weaning trials. PMID:26640501

  4. Effects of Natural Sounds on Pain: A Randomized Controlled Trial with Patients Receiving Mechanical Ventilation Support.

    PubMed

    Saadatmand, Vahid; Rejeh, Nahid; Heravi-Karimooi, Majideh; Tadrisi, Sayed Davood; Vaismoradi, Mojtaba; Jordan, Sue

    2015-08-01

    Nonpharmacologic pain management in patients receiving mechanical ventilation support in critical care units is under investigated. Natural sounds may help reduce the potentially harmful effects of anxiety and pain in hospitalized patients. The aim of this study was to examine the effect of pleasant, natural sounds on self-reported pain in patients receiving mechanical ventilation support, using a pragmatic parallel-arm, randomized controlled trial. The study was conducted in a general adult intensive care unit of a high-turnover teaching hospital, in Tehran, Iran. Between October 2011 and June 2012, we recruited 60 patients receiving mechanical ventilation support to the intervention (n = 30) and control arms (n = 30) of a pragmatic parallel-group, randomized controlled trial. Participants in both arms wore headphones for 90 minutes. Those in the intervention arm heard pleasant, natural sounds, whereas those in the control arm heard nothing. Outcome measures included the self-reported visual analog scale for pain at baseline; 30, 60, and 90 minutes into the intervention; and 30 minutes post-intervention. All patients approached agreed to participate. The trial arms were similar at baseline. Pain scores in the intervention arm fell and were significantly lower than in the control arm at each time point (p < .05). Administration of pleasant, natural sounds via headphones is a simple, safe, nonpharmacologic nursing intervention that may be used to allay pain for up to 120 minutes in patients receiving mechanical ventilation support. PMID:26092195

  5. Weaning from short-term mechanical ventilation: a review.

    PubMed

    Hanneman, S K; Ingersoll, G L; Knebel, A R; Shekleton, M E; Burns, S M; Clochesy, J M

    1994-11-01

    The purposes of this article are to: identify gaps in the research literature on weaning adult patients from short-term mechanical ventilation, highlight the scientific base for practice guidelines, and suggest future research directions. Data bases from 1989 through June 1993 were reviewed, and relevant research articles were extracted, analyzed, and synthesized within the AACN Third National Study Group framework. Seminal work and other supportive literature also were used in this review. Despite considerable research on predictors and patient responses to weaning from short-term mechanical ventilation, few of the findings can be applied to clinical practice at this time. Less research is available on weaning modes and therapies that facilitate weaning from short-term mechanical ventilation; fruitful research in these areas depends in part on a better understanding of patient responses and accurate weaning predictors. PMID:7834002

  6. Diaphragm weakness in mechanically ventilated critically ill patients

    PubMed Central

    2013-01-01

    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

  7. The predicting ability of serum potassium to assess the duration of mechanical ventilation in critically ill patients

    PubMed Central

    Javdan, Zahra; Talakoub, Reihanak; Honarmand, Azim; Golparvar, Mohammad; Farsani, Enayatolah Yadollahi

    2015-01-01

    Background: No previous study has been done to evaluate the admission serum potassium level as a predictor of morbidity or need for mechanical ventilation. The aim of this study is to determine the predictive ability of serum potassium on admission, in critically ill trauma patients, and to evaluate the relation of the potassium level to organ failure, length of stay, ventilator need, and duration of mechanical ventilation. Materials and Methods: A prospective, observational study was done on 100 patients >16 years old, admitted to the Medical-Surgical Intensive Care Units (ICU), for over one year. Patients were classified into Group A: Patients who required equal or less than five days of mechanical ventilation and Group B: Patients who required more than five days of mechanical ventilation. The total serum potassium concentrations were measured and the Sequential Organ Failure Assessment (SOFA) score was recorded at the time of admission to the ICU, when connected to the ventilator, and then at the time of weaning from the ventilator. Results: There was no significant difference between the Serum K concentrations between the two groups, on admission. However, there were significant difference between the Serum K concentrations at times of receiving and weaning from mechanical ventilation (MV) between the two groups. We found the best cut-off point of 3.45 for serum potassium concentration, to predict the need for longer duration of MV. Conclusion: Development of hypokalemia during an ICU stay is associated with the need for mechanical ventilation. Monitoring of the serum potassium levels may be a good prognostic factor for the requirement of mechanical ventilation. PMID:26322281

  8. Commissioning Trial for Mechanical Ventilation System Installed in Houses 

    E-print Network

    Ohta, I.; Fukushima, A.

    2004-01-01

    FOR MECHANICAL VENTILATION SYSTEM INSTALLED IN HOUSES Isamu Ohta* Akira Fukushima** * Misawa Homes Co., Ltd., 2-4-5 Takaido-Higashi Suginami-ku Tokyo Japan 168-8533 ** Hokkaido Government, 6 Nishi 3Jyou Kita Chuuo-ku Sapporo Japan 060...-8588 Summary Airflow rate of a mechanical ventilation system for houses may not exceed the designed or rated airflow rate because of construction problem and lack of maintenance. According to our survey, half of the houses were enjoying less than 50...

  9. Exhaled Breath Condensate Collection in the Mechanically Ventilated Patient

    PubMed Central

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

    2012-01-01

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

  10. Use of bronchodilators during non-invasive mechanical ventilation.

    PubMed

    Ceriana, P; Navalesi, P; Rampulla, C; Prinianakis, G; Nava, S

    2003-01-01

    Bronchodilators represent one of the most important therapeutic weapons for the treatment of airway obstructive diseases and the inhaled route of administration is very often employed due to the greater drug availability and reduced magnitude of side effects. During acute exhacerbations, it is not unfrequent that the elastic and resistive loads imposed on the ventilatory pump overcome the force sustainable by the respiratory muscles and the patient requires ventilatory assistance, in order to relieve fatigue and to optimize alveolar gas exchange. During these episodes, inhaled bronchodilators, far from being discontinued, sometime must be administered during mechanical ventilation, that, in hypercapnic ventilatory failure can be frequently applied noninvasively with a good rate of success. While in the current literature there are a lot of data about inhaled drug administration during invasive mechanical ventilation, very few data are available on the topic of aerosol therapy during noninvasive mechanical ventilation. With the present paper we want to analyze the rationale, the feasibility and the current data dealing with the administration of inhaled drugs during noninvasive mechanical ventilation. PMID:14635500

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

    PubMed

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

    2015-12-01

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

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

    PubMed Central

    Bach, J. R.

    1992-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  14. A novel simulator for mechanical ventilation in newborns: MEchatronic REspiratory System SImulator for Neonatal Applications.

    PubMed

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

    2015-08-01

    Respiratory problems are among the main causes of mortality for preterm newborns with pulmonary diseases; mechanical ventilation provides standard care, but long-term complications are still largely reported. In this framework, continuous medical education is mandatory to correctly manage assistance devices. However, commercially available neonatal respiratory simulators are rarely suitable for representing anatomical and physiological conditions; a step toward high-fidelity simulation, therefore, is essential for nurses and neonatologists to acquire the practice needed without any risk. An innovative multi-compartmental infant respirator simulator based on a five-lobe model was developed to reproduce different physio-pathological conditions in infants and to simulate many different kinds of clinical scenarios. The work consisted of three phases: (1) a theoretical study and modeling phase, (2) a prototyping phase, and (3) testing of the simulation software during training courses. The neonatal pulmonary simulator produced allows the replication and evaluation of different mechanical ventilation modalities in infants suffering from many different kinds of respiratory physio-pathological conditions. In particular, the system provides variable compliances for each lobe in an independent manner and different resistance levels for the airway branches; moreover, it allows the trainer to simulate both autonomous and mechanically assisted respiratory cycles in newborns. The developed and tested simulator is a significant contribution to the field of medical simulation in neonatology, as it makes it possible to choose the best ventilation strategy and to perform fully aware management of ventilation parameters. PMID:26238790

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

    PubMed

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

    2014-12-01

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

  16. Mechanical ventilation in mass casualty scenarios. Augmenting staff: project XTREME.

    PubMed

    Hanley, Michael E; Bogdan, Gregory M

    2008-02-01

    Disaster preparedness typically includes plans that address the need for surge capacity to manage mass-casualty events. A major concern of disaster preparedness in respiratory therapy focuses on responding to a sudden increase in the volume of patients who require mechanical ventilation. Plans for such disasters must include contingencies to address surge capacity in ventilator inventories and the respiratory therapy staff who will manage the ventilators. Tactics to address these situations include efforts to lower demand by transferring patients to other institutions as well as efforts to augment staffing levels. Staff can be augmented by mobilization of deployable teams of volunteers from outside the region and through exploitation of local resources. The latter includes strategies to recruit local respiratory therapists who are currently in either non-clinical or non-hospital-based positions and policies that optimize existing respiratory therapy resources within an institution by canceling elective surgeries, altering shift structure, and postponing vacations. An alternative approach would employ non-respiratory-therapy staff to assist in the management of patients with respiratory failure. Project XTREME (Cross-Training Respiratory Extenders for Medical Emergencies) is a cross-training program developed to facilitate training of non-respiratory-therapy health professionals to assist in the management of patients who require mechanical ventilation. It includes an interactive digital video disc as well as a competency validation laboratory and is designed to be performed at the time of an emergency. Pilot testing of the program suggests it is effective. PMID:18218149

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

    PubMed

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

    2011-03-01

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

  18. The Use of Noninvasive Ventilation Outside the Intensive Care Unit: A Clinical Case Report

    PubMed Central

    Romano, A; Salvati, A; Romano, R; Mastroberardino, M

    2013-01-01

    Noninvasive Ventilation (NIV) is one of the best weapon at our disposal to treat respiratory failure. The early use of NIV out of the Intensive Care Unit can improve patients’ outcome. A 58-year-old man affected by severe bilateral pneumonia caused by Legionella Pneumophila was treated with Noninvasive Ventilation in extra Intensive Care Unit until the evidence of a marked improvement of clinical and radiological state. PMID:23905082

  19. Ventilation distribution and chest wall mechanics in microgravity

    NASA Technical Reports Server (NTRS)

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

    1997-01-01

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

  20. Racial differences in withdrawal of mechanical ventilation do not alter mortality in neurologically injured patients?

    PubMed Central

    Rubin, Michael A.; Dhar, Rajat; Diringer, Michael N.

    2013-01-01

    Purpose Racial differences in withdrawal of mechanical ventilation (WMV) have been demonstrated among patients with severe neurologic injuries. We ascertained whether such differences might be accounted for by imbalances in socioeconomic status or disease severity, and whether such racial differences impact hospital mortality or result in greater discharge to long-term care facilities. Materials and methods We evaluated WMV among 1885 mechanically ventilated patients with severe neurologic injury (defined as Glasgow Coma Scale <9), excluding those progressing to brain death within the first 48 hours. Results Withdrawal of mechanical ventilation was less likely in nonwhite patients (22% vs 31%, P < .001). Nonwhites were younger and were more likely to have Medicaid or no insurance, live in ZIP codes with low median household incomes, be unmarried, and have greater illness severity; but after adjustment for these variables, racial difference in WMV persisted (odds ratio, 0.56; 95% confidence interval, 0.42–0.76). Nonwhite patients were more likely to die instead with full support or progress to brain death, resulting in equivalent overall hospital mortality (40% vs 42%, P = .44). Among survivors, nonwhites were more likely to be discharged to long-term care facilities (27% vs 17%, P < .001). Conclusions Surrogates of nonwhite neurologically injured patients chose WMV less often even after correcting for socioeconomic status and other confounders. This difference in end-of-life decision making does not appear to alter hospital mortality but may result in more survivors left in a disabled state. PMID:24120091

  1. [Non-invasive positive pressure mechanical ventilation in acute respiratory failure].

    PubMed

    Scala, R

    2000-10-01

    Known for two centuries, positive pressure non invasive mechanical ventilation (VMNPP) has been widely applied in acute respiratory failure (IRA) only in the last ten years. The fact that VMNPP is able to improve gas exchange by avoiding endotracheal intubation and its complications is the most attractive aspect in both general and respiratory intensive care units and in the respiratory ward. Characteristics of VMNPP (interface, ventilator and modality of ventilation), the side where it is performed as well as severity of IRA, underlying disease, and the team's experience are important factors which influence outcome. The addition of VMNPP to conventional medical therapy reduces the need for IE, mortality and hospitalisation in a selected population of BPCO patients in IRA. As there are no available data for comparison between invasive mechanical ventilation (VMI) and VMNPP, the latter has not to be considered as an alternative to VMI but able to prevent it and, even if VMNPP fails, it may be used as a weaning technique. In IRA due to other than BPCO diseases VMNPP seems not to be more effective than standard treatment in avoiding IE but it may give efficient support with fewer complications as compared to VMI. Acute cardiogenic pulmonary edema and "terminal" diseases represent some of the most interesting application fields of VMNPP in non-BPCO patients. According to the latest literature data, in this review history, technique, advantages, limits, indications, nursing and cost of VMNPP are examined. PMID:11194980

  2. Ventilation.

    PubMed

    Turner, W A; Bearg, D W; Brennan, T

    1995-01-01

    This chapter begins with an overview of the history of ventilation guidelines, which has led to the guidelines that are in effect today. Of particular interest is the most recent return in the past 5 years to ventilation rates that more closely reflect a mean or average of the range of guidelines that have existed over the past century. OSHA's and the EPA's recognition of the need to operate ventilation systems in buildings in an accountable manner is also of note. Of even more interest is the resurgence of the concept of minimum mixing and once-through ventilation air that has been pursued in parts of Northern Europe for the past 10 years, and in a school that is being designed with this concept in New Hampshire. In addition, the design concept of equipping office buildings with low pressure drop high efficiency particle filtration to remove fine particles from all of the air that is supplied to the occupants is being used increasingly in the U.S. This chapter also presents an overview of the various types of ventilation systems found in homes and commercial office buildings and the common indoor air quality problems that may be associated with them. It also offers an overview of common HVAC evaluation techniques that can be used to determine if a ventilation system is performing in a manner that makes sense for the use of the space and the needs of the occupants. Are the occupants receiving a reasonable supply of outdoor air? Is the air that they receive of reasonable quality? Are obvious pollutants being exhausted? Ventilation systems have become extremely complex and more difficult to run and maintain over the past 40 years. This trend will continue to drive the need for professionally maintained HVAC equipment that is serviced and run by individuals who are accountable for the quality of the air that the system delivers. PMID:7792680

  3. NanoClusters Enhance Drug Delivery in Mechanical Ventilation

    NASA Astrophysics Data System (ADS)

    Pornputtapitak, Warangkana

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

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

    E-print Network

    Powelson, Stephen K. (Stephen Kirby)

    2010-01-01

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

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

    PubMed Central

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

    2015-01-01

    Objective To evaluate the changes in ventilatory mechanics and hemodynamics that occur in patients dependent on mechanical ventilation who are subjected to a standard respiratory therapy protocol. Methods This experimental and prospective study was performed in two intensive care units, in which patients dependent on mechanical ventilation for more than 48 hours were consecutively enrolled and subjected to an established respiratory physiotherapy protocol. Ventilatory variables (dynamic lung compliance, respiratory system resistance, tidal volume, peak inspiratory pressure, respiratory rate, and oxygen saturation) and hemodynamic variables (heart rate) were measured one hour before (T-1), immediately after (T0) and one hour after (T+1) applying the respiratory physiotherapy protocol. Results During the period of data collection, 104 patients were included in the study. Regarding the ventilatory variables, an increase in dynamic lung compliance (T-1 = 52.3 ± 16.1mL/cmH2O versus T0 = 65.1 ± 19.1mL/cmH2O; p < 0.001), tidal volume (T-1 = 550 ± 134mL versus T0 = 698 ± 155mL; p < 0.001), and peripheral oxygen saturation (T-1 = 96.5 ± 2.29% versus T0 = 98.2 ± 1.62%; p < 0.001) were observed, in addition to a reduction of respiratory system resistance (T-1 = 14.2 ± 4.63cmH2O/L/s versus T0 = 11.0 ± 3.43cmH2O/L/s; p < 0.001), after applying the respiratory physiotherapy protocol. All changes were present in the assessment performed one hour (T+1) after the application of the respiratory physiotherapy protocol. Regarding the hemodynamic variables, an immediate increase in the heart rate after application of the protocol was observed, but that increase was not maintained (T-1 = 88.9 ± 18.7 bpm versus T0 = 93.7 ± 19.2bpm versus T+1 = 88.5 ± 17.1bpm; p < 0.001). Conclusion Respiratory therapy leads to immediate changes in the lung mechanics and hemodynamics of mechanical ventilation-dependent patients, and ventilatory changes are likely to remain for at least one hour. PMID:26340156

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

    PubMed

    Karlsson, Veronika; Lindahl, Berit; Bergbom, Ingegerd

    2012-09-01

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

  7. Clinical presentations as predictors of prolonged mechanical ventilation in Guillain-Barré syndrome in an institution with limited medical resources

    PubMed Central

    Toamad, Umarudee; Kongkamol, Chanon; Setthawatcharawanich, Suwanna; Limapichat, Kitti; Phabphal, Kanitpong; Sathirapanya, Pornchai

    2015-01-01

    INTRODUCTION Severe Guillain-Barré syndrome (GBS) causes ventilatory insufficiency and the need for prolonged artificial ventilation. Under circumstances where medical care for patients with severe GBS is required in a resource-limited institution, identifying initial clinical presentations in GBS patients that can predict respiratory insufficiency and the need for prolonged mechanical ventilation (> 15 days) may be helpful for advanced care planning. METHODS The medical records of patients diagnosed with GBS in a tertiary care and medical teaching hospital from January 2001 to December 2010 were retrospectively reviewed. The demographic data and clinical presentations of the patients were summarised using descriptive statistics. Clinical predictors of respiratory insufficiency and the need for prolonged mechanical ventilation (> 15 days) were identified using univariate logistic regression analysis. RESULTS A total of 55 patients with GBS were included in this study. Mechanical ventilation was needed in 28 (50.9%) patients. Significant clinical predictors for respiratory insufficiency were bulbar muscle weakness (odds ratio [OR] 5.08, 95% confidence interval [CI] 1.31–21.60, p = 0.007) and time to peak limb weakness ? 5 days (OR 0.75, 95% CI 0.62–0.91, p < 0.001). Bulbar muscle weakness (p = 0.006) and time to peak limb weakness ? 5 days (p < 0.001) were also found to be significantly associated with the need for prolonged mechanical ventilation (> 15 days). CONCLUSION Bulbar weakness and time to peak limb weakness ? 5 days were able to predict respiratory insufficiency and the need for prolonged mechanical ventilation in patients with GBS. PMID:26512148

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

    PubMed

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

    2015-01-15

    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

  9. Evaluating ventilator weaning best practice: a long-term acute care hospital system-wide quality initiative.

    PubMed

    O'Bryan, Linda; Von Rueden, Kathryn; Malila, Fern

    2002-11-01

    Long-term acute care (LTAC) hospitals and units are becoming increasingly important to the management of patients who have serious, complex critical illnesses and require mechanical ventilation for extended periods of time. Kindred Healthcare, Inc., a nation-wide system of LTAC hospitals embarked on a quality initiative to establish a Ventilator Management and Weaning Best Practice. The process steps included: measurement of performance of all hospitals in the system using a risk-adjusted methodology to evaluate clinical outcomes, identification of facilities with superior outcomes; structured evaluation of the characteristics, practices, and protocols of these Best Practice hospitals; and utilization of the information gleaned from these hospitals to establish evidence-based LTAC best practice ventilator management guidelines. Key characteristics of the Best Practice LTAC hospitals were: hospital-wide philosophy that "everybody weans"-that is, all disciplines actively participate and all patients are expected to wean; collaborative multidisciplinary plans of care; a consistent and a 24-hour-a-day approach to ventilator management and weaning; daily communication; mutual respect for the contributions of all disciplines to the weaning process; early, aggressive nutrition support and intervention by rehabilitation services; use of 24-hour in-hospital advance practice nurses, hospitalists, or physician assistants; and intervention by physiatrists. PMID:12473919

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

    PubMed

    Kallet, Richard H

    2013-06-01

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

  11. Comparison between a clinical diagnosis method and the surveillance technique of the Center for Disease Control and Prevention for identification of mechanical ventilator-associated pneumonia

    PubMed Central

    Waltrick, Renata; Possamai, Dimitri Sauter; de Aguiar, Fernanda Perito; Dadam, Micheli; de Souza, Valmir João; Ramos, Lucas Rocker; Laurett, Renata da Silva; Fujiwara, Kênia; Caldeira, Milton; Koenig, Álvaro; Westphal, Glauco Adrieno

    2015-01-01

    Objective >To evaluate the agreement between a new epidemiological surveillance method of the Center for Disease Control and Prevention and the clinical pulmonary infection score for mechanical ventilator-associated pneumonia detection. Methods This was a prospective cohort study that evaluated patients in the intensive care units of two hospitals who were intubated for more than 48 hours between August 2013 and June 2014. Patients were evaluated daily by physical therapist using the clinical pulmonary infection score. A nurse independently applied the new surveillance method proposed by the Center for Disease Control and Prevention. The diagnostic agreement between the methods was evaluated. A clinical pulmonary infection score of ? 7 indicated a clinical diagnosis of mechanical ventilator-associated pneumonia, and the association of a clinical pulmonary infection score ? 7 with an isolated semiquantitative culture consisting of ? 104 colony-forming units indicated a definitive diagnosis. Results Of the 801 patients admitted to the intensive care units, 198 required mechanical ventilation. Of these, 168 were intubated for more than 48 hours. A total of 18 (10.7%) cases of mechanical ventilation-associated infectious conditions were identified, 14 (8.3%) of which exhibited possible or probable mechanical ventilatorassociated pneumonia, which represented 35% (14/38) of mechanical ventilator-associated pneumonia cases. The Center for Disease Control and Prevention method identified cases of mechanical ventilator-associated pneumonia with a sensitivity of 0.37, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.84. The differences resulted in discrepancies in the mechanical ventilator-associated pneumonia incidence density (CDC, 5.2/1000 days of mechanical ventilation; clinical pulmonary infection score ? 7, 13.1/1000 days of mechanical ventilation). Conclusion The Center for Disease Control and Prevention method failed to detect mechanical ventilatorassociated pneumonia cases and may not be satisfactory as a surveillance method. PMID:26465248

  12. Systematic study of person-to-person contaminant transport in mechanically ventilated spaces (RP-1458)

    E-print Network

    Chen, Qingyan "Yan"

    Systematic study of person-to-person contaminant transport in mechanically ventilated spaces (RP air distribution design and reduce the infection risk from airborne infectious diseases. This paper provides a systematic study of the effects of ventilation mode, ventilation rate, and person

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

    PubMed

    Turner, J Scott; Pinshow, Berry

    2015-01-15

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

  14. Effects of Acute Administration of Corticosteroids during Mechanical Ventilation on Rat Diaphragm

    PubMed Central

    Maes, Karen; Testelmans, Dries; Cadot, Pascal; DeRuisseau, Keith; Powers, Scott K.; Decramer, Marc; Gayan-Ramirez, Ghislaine

    2008-01-01

    Rationale: Mechanical ventilation is known to induce ventilator-induced diaphragm dysfunction. Patients submitted to mechanical ventilation often receive massive doses of corticosteroids that may cause further deterioration of diaphragm function. Objectives: To examine whether the combination of 24 hours of controlled mechanical ventilation with corticosteroid administration would exacerbate ventilator-induced diaphragm dysfunction. Methods: Rats were randomly assigned to a group submitted to 24 hours of controlled mechanical ventilation receiving an intramuscular injection of saline or 80 mg/kg methylprednisolone, a group submitted to 24 hours of spontaneous breathing receiving saline, or methylprednisolone and a control group. Measurements and Main Results: The diaphragm force–frequency curve was shifted downward in the mechanical ventilation group, but this deleterious effect was prevented when corticosteroids were administered. Diaphragm cross-sectional area of type I fibers was similarly decreased in both mechanical ventilation groups while atrophy of type IIx/b fibers was attenuated after corticosteroid administration. The mechanical ventilation-induced reduction in diaphragm MyoD and myogenin protein expression was attenuated after corticosteroids. Plasma cytokine levels were unchanged while diaphragm lipid hydroperoxides were similarly increased in both mechanical ventilation groups. Diaphragmatic calpain activity was significantly increased in the mechanical ventilation group, but calpain activation was abated with corticosteroid administration. Inverse correlations were found between calpain activity and diaphragm force. Conclusions: A single high dose of methylprednisolone combined with controlled mechanical ventilation protected diaphragm function from the deleterious effects of controlled mechanical ventilation. Inhibition of the calpain system is most likely the mechanism by which corticosteroids induce this protective effect. PMID:18849500

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

    PubMed Central

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

    2007-01-01

    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

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

    NASA Astrophysics Data System (ADS)

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

    2010-04-01

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

  17. Optimal Delivery of Aerosols to Infants During Mechanical Ventilation

    PubMed Central

    Azimi, Mandana; Hindle, Michael

    2014-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  20. Ventilator graphics and respiratory mechanics in the patient with obstructive lung disease.

    PubMed

    Dhand, Rajiv

    2005-02-01

    Obstruction of the large and small airways occurs in several diseases, including asthma, chronic obstructive pulmonary disease, cystic fibrosis, bronchiectasis, and bronchiolitis. This article discusses the role of ventilator waveforms in the context of factors that contribute to the development of respiratory failure and acute respiratory distress in patients with obstructive lung disease. Displays of pressure, flow, and volume, flow-volume loops, and pressure-volume loops are available on most modern ventilators. In mechanically ventilated patients with airway obstruction, ventilator graphics aid in recognizing abnormalities in function, in optimizing ventilator settings to promote patient-ventilator interaction, and in diagnosing complications before overt clinical signs develop. Ventilator waveforms are employed to detect the presence of dynamic hyperinflation and to measure lung mechanics. Various forms of patient-ventilator asynchrony (eg, auto-triggering and delayed or ineffective triggering) can also be detected by waveform analysis. Presence of flow limitation during expiration and excessive airway secretions can be determined from flow-volume loops. Abnormalities in pressure-volume loops occur when the trigger sensitivity is inadequate, with alterations in respiratory compliance, or during patient-ventilator asynchrony. Thus, ventilator waveforms play an important role in management of mechanically-ventilated patients with obstructive lung disease. PMID:15691394

  1. Chronic Obstructive Pulmonary Disease and Ventilator-Associated Pneumonia: An Analysis and Literature Review Into the Intensive Care Unit Exacerbation Progression and Acute Pulmonary Management.

    PubMed

    Toney, Brandon Swain; Lynch-Smith, Donna

    2016-01-01

    The occurrence of ventilator-associated pneumonia (VAP) infections in mechanically ventilated patients has significantly affected how medical providers manage the severe acute pulmonary pathology in chronic obstructive pulmonary disease (COPD) and implement medical interventions to prevent infectious transmission to these patients in the intensive care unit. Severe COPD is present in more than 65 million people worldwide, thereby placing these individuals at an increased risk of intensive care unit admission and VAP contraction. Chronic obstructive pulmonary disease is well known as a risk factor for developing VAP and is related to adverse risk factors such as developing multiple drug-resistant bacteria. Evidence shows that COPD immunosuppression continues to be associated with pulmonary infection, but multiple modalities are available to combat and treat acute exacerbations before decompensation begins, thereby preventing prolonged endotracheal mechanical ventilation. PMID:26627066

  2. Entropy correlates with Richmond Agitation Sedation Scale in mechanically ventilated critically ill patients.

    PubMed

    Sharma, Ankur; Singh, Preet Mohinder; Trikha, Anjan; Rewari, Vimi; Chandralekha

    2014-04-01

    Sedation is routinely used in intensive care units. However due to absence of objective scoring systems like Bispectral Index and entropy our ability to regulate the degree of sedation is limited. This deficiency is further highlighted by the fact that agitation scores used in intensive care units (ICU) have no role in paralyzed patients. The present study compares entropy as a sedation scoring modality with Richmond Agitation Sedation Scale (RASS) in mechanically ventilated, critically ill patients in an ICU. Twenty-seven, mechanically ventilated, critically ill patients of either sex, 16-65 years of age, were studied over a period of 24 h. They received a standard sedation regimen consisting of a bolus dose of propofol 0.5 mg/kg and fentanyl 1 lg/kg followed by infusions of propofol and fentanyl ranging from 1.5 to 5 mg/kg/h and 0.5 to 2.0 lg/kg/h, respectively. Clinically relevant values of RASS for optimal ICU sedation (between 0 and -3) in non-paralyzed patients were compared to corresponding entropy values, to find if any significant correlation exists between the two. These entropy measurements were obtained using the Datex-Ohmeda-M-EntropyTM module. This module is presently not approved by Food and Drug Administration (FDA) for monitoring sedation in ICU. A total of 527 readings were obtained. There was a statistically significant correlation between the state entropy (SE) and RASS [Spearman's rho/rs = 0.334, p\\0.0001]; response entropy (RE) and RASS [Spearman's rho/rs = 0.341, p\\0.0001]). For adequate sedation as judged by a RASS value of 0 to -3, the mean SE was 57.86 ± 16.50 and RE was 67.75 ± 15.65. The present study illustrates that entropy correlates with RASS (between scores 0 and -3) when assessing the level of sedation in mechanically ventilated critically ill patients. PMID:24122077

  3. Developing a readiness assessment tool for weaning patients under mechanical ventilation

    PubMed Central

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

    2014-01-01

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

  4. Post-ICU weaning from mechanical ventilation: the role of long-term facilities.

    PubMed

    Scheinhorn, D J; Chao, D C; Hassenpflug, M S; Gracey, D R

    2001-12-01

    A review of the largest observational studies on post-ICU weaning from prolonged mechanical ventilation yields evidence that more than half of such patients can be successfully liberated from mechanical ventilation. Success is likely to fall within a 3-month window, with late successes and partial ventilator independence still possible thereafter. There is a uniformity of practice in finishing difficult weaning with self-breathing trials of increasing duration. PMID:11742970

  5. Pneumonia in patients who require prolonged mechanical ventilation.

    PubMed

    Rumbak, Mark J

    2005-02-01

    Nosocomial pneumonia is the most important infectious disease in patients who require prolonged mechanical ventilation. Understanding of the etiology helps to prevent ventilator-associated pneumonia (VAP). VAP can develop in four ways: by aspiration, inhalation, hematogenous spread and by contiguous spread. The two most common are aspiration from the oropharyngeal region and inhalation, usually from manipulation of tubing or infected equipment. VAP is prevented by hand-washing, keeping the head of the bed at 45 and, in some cases, by treating the surface bacteria which usually cause VAP. Sputum can be used for the diagnosis of VAP in most of these patients instead of invasive bronchoscopy. However, if the patients are critically ill, then bronchoscopy is used. Treatment in these patients depends on the bacteria. Pseudomonas is treated by two drugs (beta-lactam plus a quinolone or aminoglycoside), Acinetobacteria by ampicillin/sulbactam or carbapenam, extended-spectrum beta-lactam-producing bacteria by carbapenums, and Staphylococcus by vancomycin or linezolid. PMID:15715988

  6. 42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Respiratory care for ventilator-dependent individuals. 440.185 Section 440.185 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL...

  7. Perceptions of Patients and Families who Received a Music Intervention During Mechanical Ventilation

    PubMed Central

    Chlan, Linda; Staugaitis, Abbey

    2015-01-01

    The intensive care unit (ICU) is a technologically-driven environment where critically ill patients and their families have significant physical and emotional experiences. Mechanically ventilated (MV) patients can experience significant distress from anxiety and pain. Music listening is one integrative intervention that has been shown to reduce anxiety as well as other symptoms that contribute to distress in MV patients. This is a report of MV patient and family experiences from a larger research study whose aim was to evaluate levels of anxiety and sedative exposure with use of a patient-directed music intervention. Understanding perceptions of MV patients and families regarding the effectiveness of music listening will guide improvement of their care. PMID:26301046

  8. Liquid ventilation.

    PubMed

    Sarkar, Suman; Paswan, Anil; Prakas, S

    2014-01-01

    Human have lungs to breathe air and they have no gills to breath liquids like fish. When the surface tension at the air-liquid interface of the lung increases as in acute lung injury, scientists started to think about filling the lung with fluid instead of air to reduce the surface tension and facilitate ventilation. Liquid ventilation (LV) is a technique of mechanical ventilation in which the lungs are insufflated with an oxygenated perfluorochemical liquid rather than an oxygen-containing gas mixture. The use of perfluorochemicals, rather than nitrogen as the inert carrier of oxygen and carbon dioxide offers a number of advantages for the treatment of acute lung injury. In addition, there are non-respiratory applications with expanding potential including pulmonary drug delivery and radiographic imaging. It is well-known that respiratory diseases are one of the most common causes of morbidity and mortality in intensive care unit. During the past few years several new modalities of treatment have been introduced. One of them and probably the most fascinating, is of LV. Partial LV, on which much of the existing research has concentrated, requires partial filling of lungs with perfluorocarbons (PFC's) and ventilation with gas tidal volumes using conventional mechanical ventilators. Various physico-chemical properties of PFC's make them the ideal media. It results in a dramatic improvement in lung compliance and oxygenation and decline in mean airway pressure and oxygen requirements. No long-term side-effect reported. PMID:25886321

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

    NASA Astrophysics Data System (ADS)

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

    2012-02-01

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

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

    PubMed

    Guler, Hasan; Ata, Fikret

    2014-09-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    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

    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

  13. AT1 receptor blocker losartan protects against mechanical ventilation-induced diaphragmatic dysfunction.

    PubMed

    Kwon, Oh Sung; Smuder, Ashley J; Wiggs, Michael P; Hall, Stephanie E; Sollanek, Kurt J; Morton, Aaron B; Talbert, Erin E; Toklu, Hale Z; Tumer, Nihal; Powers, Scott K

    2015-11-15

    Mechanical ventilation is a life-saving intervention for patients in respiratory failure. Unfortunately, prolonged ventilator support results in diaphragmatic atrophy and contractile dysfunction leading to diaphragm weakness, which is predicted to contribute to problems in weaning patients from the ventilator. While it is established that ventilator-induced oxidative stress is required for the development of ventilator-induced diaphragm weakness, the signaling pathway(s) that trigger oxidant production remain unknown. However, recent evidence reveals that increased plasma levels of angiotensin II (ANG II) result in oxidative stress and atrophy in limb skeletal muscles. Using a well-established animal model of mechanical ventilation, we tested the hypothesis that increased circulating levels of ANG II are required for both ventilator-induced diaphragmatic oxidative stress and diaphragm weakness. Cause and effect was determined by administering an angiotensin-converting enzyme inhibitor (enalapril) to prevent ventilator-induced increases in plasma ANG II levels, and the ANG II type 1 receptor antagonist (losartan) was provided to prevent the activation of ANG II type 1 receptors. Enalapril prevented the increase in plasma ANG II levels but did not protect against ventilator-induced diaphragmatic oxidative stress or diaphragm weakness. In contrast, losartan attenuated both ventilator-induced oxidative stress and diaphragm weakness. These findings indicate that circulating ANG II is not essential for the development of ventilator-induced diaphragm weakness but that activation of ANG II type 1 receptors appears to be a requirement for ventilator-induced diaphragm weakness. Importantly, these experiments provide the first evidence that the Food and Drug Administration-approved drug losartan may have clinical benefits to protect against ventilator-induced diaphragm weakness in humans. PMID:26359481

  14. High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery

    PubMed Central

    Lara, Thiago Martins; Hajjar, Ludhmila Abrahao; de Almeida, Juliano Pinheiro; Fukushima, Julia Tizue; Barbas, Carmem Silvia Valente; Rodrigues, Adriano Rogerio Baldacin; Nozawa, Emilia; Feltrim, Maria Ignes Zanetti; Almeida, Elisangela; Coimbra, Vera; Osawa, Eduardo; de Moraes Ianotti, Rafael; Leme, Alcino Costa; Jatene, Fabio Biscegli; Auler-Jr., Jose Otavio Costa; Galas, Filomena Regina Barbosa Gomes

    2013-01-01

    OBJECTIVE: The failure to wean from mechanical ventilation is related to worse outcomes after cardiac surgery. The aim of this study was to evaluate whether the serum level of B-type natriuretic peptide is a predictor of weaning failure from mechanical ventilation after cardiac surgery. METHODS: We conducted a prospective, observational cohort study of 101 patients who underwent on-pump coronary artery bypass grafting. B-type natriuretic peptide was measured postoperatively after intensive care unit admission and at the end of a 60-min spontaneous breathing test. The demographic data, hemodynamic and respiratory parameters, fluid balance, need for vasopressor or inotropic support, and length of the intensive care unit and hospital stays were recorded. Weaning failure was considered as either the inability to sustain spontaneous breathing after 60 min or the need for reintubation within 48 h. RESULTS: Of the 101 patients studied, 12 patients failed the weaning trial. There were no differences between the groups in the baseline or intraoperative characteristics, including left ventricular function, EuroSCORE and lengths of the cardiac procedure and cardiopulmonary bypass. The B-type natriuretic peptide levels were significantly higher at intensive care unit admission and at the end of the breathing test in the patients with weaning failure compared with the patients who were successfully weaned. In a multivariate model, a high B-type natriuretic peptide level at the end of a spontaneous breathing trial was the only independent predictor of weaning failure from mechanical ventilation. CONCLUSIONS: A high B-type natriuretic peptide level is a predictive factor for the failure to wean from mechanical ventilation after cardiac surgery. These findings suggest that optimizing ventricular function should be a goal during the perioperative period. PMID:23420154

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...-ferrous material. (3) The impeller and housing made of austenitic stainless steel. (4) The impeller and... fixed or rotating components. (k) Each ventilation intake and exhaust must have a protective metal... duct under paragraph (a) of this section must be at least 10 m (32.8 ft.) from ventilation intakes...

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

    PubMed Central

    Diószeghy, Csaba; Fritúz, Gábor; Gál, János; Varga, Katalin

    2014-01-01

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

  17. 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 ...

  18. 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. ...

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

    PubMed Central

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

    2013-01-01

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

  20. Time course analysis of mechanical ventilation-induced diaphragm contractile muscle dysfunction in the rat

    PubMed Central

    Corpeno, R; Dworkin, B; Cacciani, N; Salah, H; Bergman, H-M; Ravara, B; Vitadello, M; Gorza, L; Gustafson, A-M; Hedström, Y; Petersson, J; Feng, H-Z; Jin, J-P; Iwamoto, H; Yagi, N; Artemenko, K; Bergquist, J; Larsson, L

    2014-01-01

    Controlled mechanical ventilation (CMV) plays a key role in triggering the impaired diaphragm muscle function and the concomitant delayed weaning from the respirator in critically ill intensive care unit (ICU) patients. To date, experimental and clinical studies have primarily focused on early effects on the diaphragm by CMV, or at specific time points. To improve our understanding of the mechanisms underlying the impaired diaphragm muscle function in response to mechanical ventilation, we have performed time-resolved analyses between 6 h and 14 days using an experimental rat ICU model allowing detailed studies of the diaphragm in response to long-term CMV. A rapid and early decline in maximum muscle fibre force and preceding muscle fibre atrophy was observed in the diaphragm in response to CMV, resulting in an 85% reduction in residual diaphragm fibre function after 9–14 days of CMV. A modest loss of contractile proteins was observed and linked to an early activation of the ubiquitin proteasome pathway, myosin:actin ratios were not affected and the transcriptional regulation of myosin isoforms did not show any dramatic changes during the observation period. Furthermore, small angle X-ray diffraction analyses demonstrate that myosin can bind to actin in an ATP-dependent manner even after 9–14 days of exposure to CMV. Thus, quantitative changes in muscle fibre size and contractile proteins are not the dominating factors underlying the dramatic decline in diaphragm muscle function in response to CMV, in contrast to earlier observations in limb muscles. The observed early loss of subsarcolemmal neuronal nitric oxide synthase activity, onset of oxidative stress, intracellular lipid accumulation and post-translational protein modifications strongly argue for significant qualitative changes in contractile proteins causing the severely impaired residual function in diaphragm fibres after long-term mechanical ventilation. For the first time, the present study demonstrates novel changes in the diaphragm structure/function and underlying mechanisms at the gene, protein and cellular levels in response to CMV at a high temporal resolution ranging from 6 h to 14 days. PMID:25015920

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

    SciTech Connect

    Martin, Eric

    2014-01-01

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

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

    SciTech Connect

    Martin, E.

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  4. Mechanical ventilation-induced oxidative stress in the diaphragm.

    PubMed

    Zergeroglu, Murat A; McKenzie, Michael J; Shanely, R Andrew; Van Gammeren, Darin; DeRuisseau, Keith C; Powers, Scott K

    2003-09-01

    Prolonged mechanical ventilation (MV) results in oxidative damage in the diaphragm; however, it is unclear whether this MV-induced oxidative injury occurs rapidly or develops slowly over time. Furthermore, it is unknown whether both soluble (cytosolic) and insoluble (myofibrillar) proteins are equally susceptible to oxidation during MV. These experiments tested two hypotheses: 1). MV-induced oxidative injury in the diaphragm occurs within the first 6 h after the initiation of MV; and 2). MV is associated with oxidative modification of both soluble and insoluble proteins. Adult Sprague-Dawley rats were randomly divided into one of seven experimental groups: 1) control (n = 8); 2) 3-h MV (n = 8); 3). 6-h MV (n = 6); 4). 18-h MV (n = 8); 5). 3-h anesthesia-spontaneous breathing (n = 8); 6). 6-h anesthesia-spontaneous breathing (n = 6); and 7). 18-h anesthesia-spontaneous breathing (n = 8). Markers of oxidative injury in the diaphragm included the measurement of reactive (protein) carbonyl derivatives (RCD) and total lipid hydroperoxides. Three hours of MV did not result in oxidative injury in the diaphragm. In contrast, both 6 and 18 h of MV promoted oxidative injury in the diaphragm, as indicated by increases in both protein RCD and lipid hydroperoxides. Electrophoretic separation of soluble and insoluble proteins indicated that the MV-induced accumulation of RCD was limited to insoluble proteins with molecular masses of approximately 200, 120, 80, and 40 kDa. We conclude that MV results in a rapid onset of oxidative injury in the diaphragm and that insoluble proteins are primary targets of MV-induced protein oxidation. PMID:12777408

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

    SciTech Connect

    Sherman, Max; Logue, Jennifer; Singer, Brett

    2010-06-01

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

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

    PubMed Central

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

    2011-01-01

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

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

    E-print Network

    Lucas, Peter

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

  8. Measured Air Distribution Effectiveness for Residential Mechanical Ventilation Systems

    SciTech Connect

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

    2008-05-01

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

  9. Comparison of Chemical and Mechanical Prophylaxis of Venous Thromboembolism in Nonsurgical Mechanically Ventilated Patients

    PubMed Central

    Gaspard, Dany; Vito, Karen; Schorr, Christa; Hunter, Krystal; Gerber, David

    2015-01-01

    Background. Thromboembolic events are major causes of morbidity, and prevention is important. We aimed to compare chemical prophylaxis (CP) and mechanical prophylaxis (MP) as methods of prevention in nonsurgical patients on mechanical ventilation. Methods. We performed a retrospective study of adult patients admitted to the Cooper University Hospital ICU between 2002 and 2010. Patients on one modality of prophylaxis throughout their stay were included. The CP group comprised 329 patients and the MP group 419 patients. The primary outcome was incidence of thromboembolic events. Results. Acuity measured by APACHE II score was comparable between the two groups (p = 0.215). Univariate analysis showed 1 DVT/no PEs in the CP group and 12 DVTs/1 PE in the MP group (p = 0.005). Overall mortality was 34.3% and 50.6%, respectively. ICU LOS was similar. Hospital LOS was shorter in the MP group. Multivariate analysis showed a significantly higher incidence of events in the MP prophylaxis group (odds ratio 9.9). After excluding patients admitted for bleeding in both groups, repeat analysis showed again increased events in the MP group (odds ratio 2.9) but this result did not reach statistical significance. Conclusion. Chemical methods for DVT/PE prophylaxis seem superior to mechanical prophylaxis in nonsurgical patients on mechanical ventilation and should be used when possible. PMID:26682067

  10. Dexamethasone for treatment of patients mechanically ventilated for lower respiratory tract infection caused by respiratory syncytial virus

    PubMed Central

    van Woensel, J B M; van Aalderen, W M C; de Weerd, W; Jansen, N; van Gestel, J P J; Markhorst, D; van Vught, A J; Bos, A; Kimpen, J

    2003-01-01

    Background: A study was undertaken to evaluate the efficacy of dexamethasone in patients mechanically ventilated for lower respiratory infection caused by respiratory syncytial virus (RSV-LRTI). Methods: In a multicentre randomised controlled trial patients were randomised to receive either intravenous dexamethasone (0.15 mg/kg 6 hourly for 48 hours) or placebo. End points were the duration of mechanical ventilation, length of stay (LOS) in the pediatric intensive care unit (PICU) and in hospital, and the duration of supplemental oxygen administration. Results: Thirty seven patients received dexamethasone and 45 received placebo. There was no significant difference in any of the end points between the two groups. In a post hoc analysis patients were stratified into those with mild gas exchange anomalies (PaO2/FiO2 >200 mm Hg and/or mean airway pressure ? 10 cm H2O, bronchiolitis group) and those with severe gas exchange anomalies (PaO2/FiO2 ?200 mm Hg and mean airway pressure >10 cm H2O, pneumonia group). In the 39 patients with bronchiolitis the duration of mechanical ventilation was 4.3 days shorter in the dexamethasone group than in the placebo group (4.9 v 9.2 days, 95% CI -7.8 to -0.8, p=0.02) and the duration of supplemental oxygen was 3.6 days shorter (7.7 v 11.3 days, 95% CI -8.0 to -0.1, p=0.048). No differences in end points were found in the pneumonia group. Conclusions: Dexamethasone had no beneficial effect in patients mechanically ventilated for RSV-LRTI but was found to have a beneficial effect in patients with bronchiolitis. PMID:12728156

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

    PubMed Central

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

    2013-01-01

    Objective To examine the clinical factors associated with increased opioid dose among mechanically ventilated children in the Pediatric Intensive Care Unit (PICU). Design Prospective, observational study with 100% accrual of eligible patients. Setting Seven PICUs from tertiary-care 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

  12. Adaptive support ventilation: State of the art review

    PubMed Central

    Fernández, Jaime; Miguelena, Dayra; Mulett, Hernando; Godoy, Javier; Martinón-Torres, Federico

    2013-01-01

    Mechanical ventilation is one of the most commonly applied interventions in intensive care units. Despite its life-saving role, it can be a risky procedure for the patient if not applied appropriately. To decrease risks, new ventilator modes continue to be developed in an attempt to improve patient outcomes. Advances in ventilator modes include closed-loop systems that facilitate ventilator manipulation of variables based on measured respiratory parameters. Adaptive support ventilation (ASV) is a positive pressure mode of mechanical ventilation that is closed-loop controlled, and automatically adjust based on the patient's requirements. In order to deliver safe and appropriate patient care, clinicians need to achieve a thorough understanding of this mode, including its effects on underlying respiratory mechanics. This article will discuss ASV while emphasizing appropriate ventilator settings, their advantages and disadvantages, their particular effects on oxygenation and ventilation, and the monitoring priorities for clinicians. PMID:23833471

  13. Successful Use of Venovenous Extracorporeal Membrane Oxygenation for Complicated H1N1 Pneumonia Refractory to Mechanical Ventilation

    PubMed Central

    Patel, Sachit A.; DeMare, Jeffrey S.; Truemper, Edward J.; Deptula, Joseph J.

    2011-01-01

    Abstract: In April 2009, novel H1N1 influenza A pneumonia was initially identified in young adults by the Mexican Health Ministry. Previously healthy patients progressing to multisystem organ failure were common. Worldwide, hospitals reported surges in intensive care admissions during the initial phase of the pandemic. In patients with H1N1 pneumonia refractory to mechanical ventilation, centers were initially reporting low survival rates despite the use of extracorporeal membrane oxygenation (ECMO). The initial poor outcomes and protracted ECMO treatment epochs resulted in centers limiting or withholding the use of ECMO in this population. With respect to children with H1N1 infection there was uncertainty concerning optimal incorporation of ECMO as a therapeutic option. In children with rapidly progressive pneumonia and hypoxia refractory to mechanical ventilation, venovenous (VV) ECMO has been successfully used with survival ranging from 40–60% depending on the etiology. We report the successful use of VV ECMO in two children with confirmed novel H1N1 complicated by bacterial pneumonia or morbid obesity. Our Institutional Review Board waived the need for consent. Prompt initiation of VV ECMO resulted in rapid clinical improvement, radiographic resolution of diffuse consolidation, and return of full neurocognitive function. For children with rapidly progressive respiratory distress on conventional ventilation, VV ECMO can be used to improve outcomes when initiated early in the disease process even in children with a significant co-morbidity. PMID:21848175

  14. A new ventilator for monitoring lung mechanics in small animals.

    PubMed

    Volgyesi, G A; Tremblay, L N; Webster, P; Zamel, N; Slutsky, A S

    2000-08-01

    Researchers investigating the genetic component of various disease states rely increasingly on murine models. We have developed a ventilator to simplify respiratory research in small animals down to murine size. The new ventilator provides constant-flow inflation and tidal volume delivery independent of respiratory parameter changes. The inclusion of end-inspiratory and end-expiratory pauses simplifies the measurement of airway resistance and compliance and allows the detection of dynamic hyperinflation (auto-positive end-expiratory pressure). After bench testing, we performed intravenous methacholine challenge on two strains of mice (A/J and C57bl/bj) known to differ in their responses by using the new ventilator. Dynamic hyperinflation and a decrease in compliance developed during methacholine challenge whenever respiratory rates of 60-120 breaths/min were employed. In contrast, if dynamic hyperinflation was prevented by lengthening expiratory time, (respiratory rate = 20 breaths/min), static compliance remained constant. More importantly, the coefficient of variation of the results decreased when lung volume shifts were prevented. In conclusion, airway challenge studies have greater precision when dynamic hyperinflation is prevented. PMID:10926621

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

    NASA Technical Reports Server (NTRS)

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

    1997-01-01

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

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

    SciTech Connect

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

    2011-07-01

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

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

    PubMed Central

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

    2014-01-01

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

  18. Does postoperative mechanical ventilation predispose to bronchopleural fistula formation in patients undergoing pneumonectomy?

    PubMed

    Toufektzian, Levon; Patris, Vasileios; Sepsas, Evangelos; Konstantinou, Marios

    2015-09-01

    A best evidence topic was written according to a structured protocol. The question addressed was whether postoperative mechanical ventilation has any effect on the incidence of development of bronchopleural fistulas (BPFs) in patients undergoing pneumonectomy. A total of 40 papers were identified using the reported search, of which 8, all retrospective, represented the best evidence to answer the clinical question. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. Of the eight identified papers, six of them reported a statistically significant relationship between postoperative mechanical ventilation and the occurrence of bronchopleural fistula in patients undergoing pneumonectomy (P = 0.027-0.0001). In two of these studies, postoperative mechanical ventilation was identified during multivariate analysis as an independent predictor for the development of BPF after pneumonectomy (odds ratio 15.57 and 33.1), indicating a causal relationship whereas, in the other four reports, statistical significance was the result of univariate analysis. In another study, the difference between these two groups approached but did not reach statistical significance (P = 0.057). Finally, one study reported no association between postoperative mechanical ventilation and the development of post-pneumonectomy BPF (0.16). Apart from mechanical ventilation, pre-existing pleuropulmonary infection was reported by one study as an independent predictor for the development of post-pneumonectomy BPF whereas, in two other studies, its impact approached but did not reach statistical significance. Another study did not find any association between preoperative infection and postoperative BPF occurrence. In conclusion, the majority of the reported studies report a significant relationship between mechanical ventilation after pneumonectomy and the occurrence of BPF. Every effort should be made to achieve extubation at the earliest possible time to withdraw the effects of the continuous barotrauma on the bronchial stump, although its impact cannot be quantified. Performing pneumonectomy in the presence of infectious conditions may contribute to the development of postoperative BPF, but its role is less well defined. PMID:26069338

  19. Mechanical ventilation in patients with chronic obstructive pulmonary disease and bronchial asthma

    PubMed Central

    Ahmed, Syed Moied; Athar, Manazir

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) and bronchial asthma often complicate the surgical patients, leading to post-operative morbidity and mortality. Many authors have tried to predict post-operative pulmonary complications but not specifically in COPD. The aim of this review is to provide recent evidence-based guidelines regarding predictors and ventilatory strategies for mechanical ventilation in COPD and bronchial asthma patients. Using Google search for indexing databases, a search for articles published was performed using various combinations of the following search terms: ‘Predictors’; ‘mechanical ventilation’; COPD’; ‘COPD’; ‘bronchial asthma’; ‘recent strategies’. Additional sources were also identified by exploring the primary reference list. PMID:26556918

  20. Adaptive Support Ventilation (ASV).

    PubMed

    Brunner, J X; Iotti, G A

    2002-05-01

    Adaptive Support Ventilation is a novel ventilation mode, a closed-loop control mode that may switch automatically from a PCV-like behaviour to an SIMV-like or PSV-like behaviour, according to the patient status. The operating principles are based on pressure-controlled SIMV with pressure levels and SIMV rate automatically adjusted according to measured lung mechanics at each breath. ASV provided a safe and effective ventilation in patients with normal lungs, restrective or obstructive diseases. In cardiac surgery tracheal extrubation was faster in ASV patients then in controls. In the early weaning phase of acute ventilatory insufficiency the need of resetting ventilator parameters was decreased, suggesting potential benefit for patient care. PMID:12029247

  1. Respiratory mechanics in the patient who is weaning from the ventilator.

    PubMed

    MacIntyre, Neil R

    2005-02-01

    Ventilator management of the patient recovering from acute respiratory failure must balance competing objectives. On the one hand, aggressive efforts to promptly discontinue support and remove the artificial airway reduce the risk of ventilator-induced lung injury, nosocomial pneumonia, airway trauma from the endotracheal tube, and unnecessary sedation. On the other hand, overly aggressive, premature discontinuation of ventilatory support or removal of the artificial airway can precipitate ventilatory muscle fatigue, gas-exchange failure, and loss of airway protection. To help clinicians balance these concerns, 2 important research projects were undertaken in 1999-2001. The first was a comprehensive evidence-based literature review of the ventilator-discontinuation process, performed by the McMaster University research group on evidence-based medicine. The second was the development (by the American Association for Respiratory Care, American College of Chest Physicians, and Society of Critical Care Medicine) of a set of evidence-based guidelines based on the latter literature review. From those 2 projects, several themes emerged. First, frequent patient-assessment is required to determine whether the patient needs continued ventilatory support, from both the ventilator and the artificial airway. Second, we should continuously re-evaluate the overall medical management of patients who continue to require ventilatory support, to assure that we address all factors contributing to ventilator-dependence. Third, ventilatory support strategies should be aimed at maximizing patient comfort and unloading the respiratory muscles. Fourth, patients who require prolonged ventilatory support beyond the intensive care unit should go to specialized facilities that can provide gradual reduction of support. Fifth, many of these management objectives can be effectively carried out with protocols executed by nonphysicians. PMID:15691396

  2. Linking Ventilation Heterogeneity Quantified via Hyperpolarized 3He MRI to Dynamic Lung Mechanics and Airway Hyperresponsiveness

    PubMed Central

    Lui, Justin K.; Parameswaran, Harikrishnan; Albert, Mitchell S.; Lutchen, Kenneth R.

    2015-01-01

    Advancements in hyperpolarized helium-3 MRI (HP 3He-MRI) have introduced the ability to render and quantify ventilation patterns throughout the anatomic regions of the lung. The goal of this study was to establish how ventilation heterogeneity relates to the dynamic changes in mechanical lung function and airway hyperresponsiveness in asthmatic subjects. In four healthy and nine mild-to-moderate asthmatic subjects, we measured dynamic lung resistance and lung elastance from 0.1 to 8 Hz via a broadband ventilation waveform technique. We quantified ventilation heterogeneity using a recently developed coefficient of variation method from HP 3He-MRI imaging. Dynamic lung mechanics and imaging were performed at baseline, post-challenge, and after a series of five deep inspirations. AHR was measured via the concentration of agonist that elicits a 20% decrease in the subject’s forced expiratory volume in one second compared to baseline (PC20) dose. The ventilation coefficient of variation was correlated to low-frequency lung resistance (R = 0.647, P < 0.0001), the difference between high and low frequency lung resistance (R = 0.668, P < 0.0001), and low-frequency lung elastance (R = 0.547, P = 0.0003). In asthmatic subjects with PC20 values <25 mg/mL, the coefficient of variation at baseline exhibited a strong negative trend (R = -0.798, P = 0.02) to PC20 dose. Our findings were consistent with the notion of peripheral rather than central involvement of ventilation heterogeneity. Also, the degree of AHR appears to be dependent on the degree to which baseline airway constriction creates baseline ventilation heterogeneity. HP 3He-MRI imaging may be a powerful predictor of the degree of AHR and in tracking the efficacy of therapy. PMID:26569412

  3. The implementation of an analgesia-based sedation protocol reduced deep sedation and proved to be safe and feasible in patients on mechanical ventilation

    PubMed Central

    Bugedo, Guillermo; Tobar, Eduardo; Aguirre, Marcia; Gonzalez, Hugo; Godoy, Jorge; Lira, Maria Teresa; Lora, Pilar; Encalada, Eduardo; Hernandez, Antonio; Tomicic, Vinko; Castro, José; Jara, Juan; Andresen, Max; Ugarte, Héctor

    2013-01-01

    Introduction Deep sedation in critically ill patients is associated with a longer duration of mechanical ventilation and a prolonged length of stay in the intensive care unit. Several protocols have been used to improve these outcomes. We implement and evaluate an analgesia-based, goal-directed, nurse-driven sedation protocol used to treat critically ill patients who receive mechanical ventilation. Methods We performed a prospective, two-phase (before-after), non-randomized multicenter study that involved 13 intensive care units in Chile. After an observational phase (observational group, n=155), we designed, implemented and evaluated an analgesia-based, goal-directed, nurse-driven sedation protocol (intervention group, n=132) to treat patients who required mechanical ventilation for more than 48 hours. The primary outcome was to achieve ventilator-free days by day 28. Results The proportion of patients in deep sedation or in a coma decreased from 55.2% to 44.0% in the interventional group. Agitation did not change between the periods and remained approximately 7%. Ventilator-free days to day 28, length of stay in the intensive care unit and mortality were similar in both groups. At one year, post-traumatic stress disorder symptoms in survivors were similar in both groups. Conclusions We designed and implemented an analgesia-based, goal-directed, nurse-driven sedation protocol in Chile. Although there was no improvement in major outcomes, we observed that the present protocol was safe and feasible and that it resulted in decreased periods of deep sedation without increasing agitation. PMID:24213081

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

    PubMed

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

    2015-03-01

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

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

    PubMed Central

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

    2014-01-01

    Background Critical pertussis is characterized by severe respiratory failure, important leukocytosis, pulmonary hypertension, septic shock and encephalopathy. Aim To describe the clinical course of critical pertussis, and identify predictors of death at the time of presentation for medical care. Methodology Retrospective study conducted in 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

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

    PubMed Central

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

    2014-01-01

    Objectives: Reduction of breathing variability is associated with adverse outcome. During mechanical ventilation, the variability of ventilatory pressure is dependent on the ventilatory mode. During neurally adjusted ventilatory assist (NAVA), the support is proportional to electrical activity of the diaphragm (EAdi), which reflects the respiratory center output. The variability of EAdi is, therefore, translated into a similar variability in pressures. Contrastingly, conventional ventilatory modes deliver less variable pressures. The impact of the mode on the 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

  7. Interaction among humoral and neurogenic mechanisms in ventilation control during exercise.

    PubMed

    Ursino, Mauro; Magosso, Elisa

    2004-09-01

    The control of ventilation during exercise is analyzed by a mathematical model. It represents a significant improvement of our previous work, including the effect of potassium on peripheral chemoreceptors, a fast and a slow neurogenic component, and a more accurate description of blood flow control. Moreover, the feedforward contributions (potassium and neurogenic) have been incorporated within a larger model of feedback ventilatory control by central and peripheral chemoreceptors to O2 and CO2 changes, and the interaction among the different mechanisms in ventilation control have been analyzed during moderate (100 W) and severe (300 W) exercise. Results suggest that ventilatory changes during exercise can be mostly ascribed to feedforward neurogenic mechanisms, which ensure quite constant levels of arterial oxygen and CO2 pressure, thus avoiding the involvement of feedback mechanisms. Potassium plays a mild role in ventilation control during steady-state conditions. However, it may have a role in the transient phase after the onset of severe exercise, allowing a faster attainment of the final steady-state ventilation level. In agreement with the physiological literature, the model evidences the presence of three distinct kinetic components in V(E), which ensue from the temporal superimposition (sometimes antagonistic sometimes synergistic) among the several incorporated mechanisms. PMID:15493515

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  11. Mechanical Ventilation for ARDS Patients – For a Better Understanding of the 2012 Surviving Sepsis Campaign Guidelines

    PubMed Central

    Takeuchi, Muneyuki; Tachibana, Kazuya

    2015-01-01

    The mortality rate among patients suffering acute respiratory distress syndrome (ARDS) remains high despite implementation at clinical centers of the lung protective ventilatory strategies recommended by the International Guidelines for Management of Severe Sepsis and Septic Shock, 2012. This suggests that such strategies are still sub-optimal for some ARDS patients. For these patients, tailored use of ventilator settings should be considered, including: further reduction of tidal volumes, administration of neuromuscular blocking agents if the patient’s spontaneous breathing is incompatible with mechanical ventilation, and adjusting positive end-expiratory pressure (PEEP) settings based on transpulmonary pressure levels. PMID:25567337

  12. A comparative study examining the decision-making processes of medical and nursing staff in weaning patients from mechanical ventilation.

    PubMed

    Taylor, Fran

    2006-10-01

    A prolonged period of mechanical ventilation is costly for both the patient, in terms of the risk of complications such as ventilator-acquired pneumonia, and to the health service due to the high cost of maintaining a patient in intensive care. The recognition of the role nurses can play in the weaning process and the desire to try and reduce weaning times led to the introduction of nurse-managed weaning on the intensive care unit which is the focus of this study. This means that both doctors and nurses are now responsible for making decisions about weaning. Flexible guidelines for weaning were devised which still require a large element of individual, clinical decision-making during the process. At every stage in the weaning process clinicians are required to make judgments about patient responses, using these judgments as the basis for their decision-making. This study examined the ways doctors and nurses make these decisions. Semi-structured interviews were conducted with doctors and senior nurses. A grounded theory approach was used to analyse the results and the key themes of Treatment, Balance, Making Progress and The Individual were identified which were found to be linked with particular methods of decision-making. PMID:16406785

  13. Decision-making processes of weaning from mechanical ventilation: a comparative ethnographic insight into the dynamics of the decision-making environment 

    E-print Network

    Kydonaki, Kalliopi

    2011-11-25

    Many critical clinical conditions result in respiratory failure and precipitate the use of mechanical ventilation for their management. A prolonged period of mechanical ventilation is costly for both the patient, in terms ...

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

    PubMed Central

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

    2012-01-01

    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

  15. Assessment of Critical Care Provider’s Application of Preventive Measures for Ventilator-Associated Pneumonia in Intensive Care Units

    PubMed Central

    Amiri-Abchuyeh, Maryam; Gholipour-Baradari, Afshin; Yazdani-Cherati, Jamshid; Nikkhah, Attieh

    2015-01-01

    Background The implementation of guidelines for the prevention of Ventilator-associated pneumonia has been shown to have a significant effect in reducing the incidence of VAP. Objective The aim of the present study was to evaluate the implementation of the preventive strategies for VAP in ICUs of university hospitals of Sari, Iran. Materials and Methods This cross-sectional study was carried out in 600 beds/day in the ICUs of university hospitals of Sari from April to June 2012. Sampling was done by availability technique in patients receiving mechanical ventilation in the ICU. The implementation of the preventive measures was assessed by a standard checklist with previously approved validity and reliability. Results The percentage of implementing each of the measures was as follows: sterile suction, 88.44%; semi-recumbent position, 76.8%; oral hygiene, 58.45%; using heat and moisture exchanges (HMEs), 58%; controlling cuff pressure, 46.8%; hand hygiene, 32.8%; using anti-coagulants, 26.8% and physiotherapy, 25.5%. Closed suction system, continuous drainage of subglottic secretions and kinetic beds were not used at all. Conclusion The overall mean percentage of implementing preventive measures was low and required designing integrated guidelines by considering the conditions of the ICUs in each country, as well as educating and encouraging the staffs to use the recommended guidelines. PMID:26435967

  16. Sampling and analyzing alveolar exhaled breath condensate in mechanically ventilated patients: a feasibility study.

    PubMed

    Vaschetto, Rosanna; Corradi, Massimo; Goldoni, Matteo; Cancelliere, Laura; Pulvirenti, Simone; Fazzini, Ugo; Capuzzi, Fabio; Longhini, Federico; Mutti, Antonio; Corte, Francesco Della; Navalesi, Paolo

    2015-01-01

    Recent studies in spontaneously breathing subjects indicate the possibility of obtaining the alveolar fraction of exhaled breath condensate (aEBC). In critically ill mechanically ventilated patients, in whom microbial colonization of the upper airways is constant, collection of aEBC could considerably add to the ability of monitoring alveolar inflammation. We designed this study to test the feasibility of collecting aEBC in mechanically ventilated critically ill patients through a dedicated apparatus, i.e. a CO2 valve combined with a condenser placed in the expiratory limb of the ventilator circuit. We also aimed to assess the adequacy of the samples obtained by measuring different markers of oxidative stress and inflammation.We enrolled 40 mechanically ventilated patients, 20 with and 20 without acute respiratory distress syndrome (ARDS). Measurements of respiratory mechanics, gas exchange and hemodynamics were obtained with a standard ventilator circuit after 30?min of aEBC collection and after inserting the dedicated collecting apparatus. Data showed that intrinsic positive end-expiratory pressure, peak and plateau pressure, static compliance and airway resistance (Raw) were similar before and after adding the collecting apparatus in both ARDS and controls. Similarly, gas exchange and hemodynamic variables did not change and 30?min collection provided a median aEBC volume of 2.100 and 2.300?ml for ARDS and controls, respectively. aEBC pH showed a trend toward a slight reduction in the ARDS group of patients, as opposed to controls (7.83 (7.62-8.03) versus 7.98 (7.87-8.12), respectively, p??=??0.055)). H2O2 was higher in patients with ARDS, compared to controls (0.09 (0.06-0.12) ?M versus 0.03 (0.01-0.09) ?M, p??=??0.043), while no difference was found in proteins content, 8-isoprostane, 4-hydroxy-2-nonhenal.In conclusion, we demonstrate, in patients receiving controlled mechanical ventilation, that aEBC collection is feasible without detrimental effects on ventilator functioning, respiratory mechanics and gas exchange. In addition, we show that the sample obtained is appropriate for compounds analysis. PMID:26581173

  17. Characteristics and outcome of patients with difficult weaning from mechanical ventilation: an 18 years’ experience of a respiratory intermediate unit attached to a pulmonary department

    PubMed Central

    Tsara, V; Moisiadis, N; Antoniadou, M; Serasli, E

    2015-01-01

    Background: Respiratory dysfunction often persists in post intensive care unit (ICU) patients and intermediate care facilities have been established to ensure the continuous of appropriate care. Methods: The data of patients with difficult weaning from mechanical ventilation admitted to a respiratory intermediate unit (RIU) attached to a pulmonary department of a General Hospital, were retrospectively analyzed. Clinical characteristics, weaning from mechanical ventilation and tracheostomy, ICU readmission and RIU mortality were examined over a period of 18 years (1993- 2010) that was randomly divided into three six-year-periods. Results: A total of 548 patients (age 56.7±17.9 years) [mean ± standard deviation (SD)], of whom 80% with tracheostomy in place and 37.6% with pressure ulcers, were examined. The ICU stay was 30.1±24.7 days (mean ± SD) and increased over time (p<0.05). Patients’ baseline disorders were: chronic respiratory disease (41.3%), chronic cardiovascular diseases (10.6%), neuromuscular disease (22.8%) and miscellaneous (25.3%). The length of RIU stay (22.8±19.5 days) was constant over the examined periods but an increase in age and maintenance of tracheostomy were observed; 80% of patients were liberated from mechanical ventilation and 58.5% from tracheostomy, whereas the RIU mortality was 15%. Conclusion: In their vast majority patients with chronic respiratory failure, who were admitted to RIU,were weaned from mechanical ventilation, although in a substantial percentage the maintenance of tracheostomy was mandatory after discharge. Hippokratia 2015, 19 (1): 37-40. PMID:26435645

  18. A mathematical model of neonatal tidal liquid ventilation integrating airway mechanics and gas transfer phenomena.

    PubMed

    Corno, Chiara; Fiore, Gianfranco Beniamino; Costantino, Maria Laura

    2004-04-01

    Tidal liquid ventilation (TLV) was proposed as an alternative to conventional mechanical ventilation in the case of surfactant-deficiency diseases, particularly for very premature subjects. Although many experimental studies have been conducted up to now, the effects of variations in ventilatory settings, such as frequency and tidal volume, on blood arterialization and lung mechanics have not been studied quantitatively. We developed a mathematical model simulating the breathing processes occurring during neonatal TLV treatments. The model integrates the description of O2 and CO2 transport, from the trachea to pulmonary capillary blood and vice versa, with the description of fluid mechanics within the airways and the saccules (the alveoli precursors). Gas transfer is described with a mono-dimensional model, accounting for convective and diffusive transport through the airways, coupled with a 3-compartment model, simulating gas diffusion between saccules, plasma and red blood cells, and chemical reactions dependent on the concentrations of gases and related chemical species. Mechanic loads on airways are calculated by means of a lumped-parameters approach. The model calculates mechanical stress and gas exchange as a function of the ventilatory settings. The integration of these results sheds light on possible ventilation strategies to allow for optimal management of blood arterialization and lung mechanical load. PMID:15072214

  19. Classification of patients undergoing weaning from mechanical ventilation using the coherence between heart rate variability and respiratory flow signal.

    PubMed

    Arcentales, A; Caminal, P; Diaz, I; Benito, S; Giraldo, B F

    2015-07-01

    Weaning from mechanical ventilation is still one of the most challenging problems in intensive care. Unnecessary delays in discontinuation and weaning trials that are undertaken too early are both undesirable. This study investigated the contribution of spectral signals of heart rate variability (HRV) and respiratory flow, and their coherence to classifying patients on weaning process from mechanical ventilation. A total of 121 candidates for weaning, undergoing spontaneous breathing tests, were analyzed: 73 were successfully weaned (GSucc), 33 failed to maintain spontaneous breathing so were reconnected (GFail), and 15 were extubated after the test but reintubated within 48 h (GRein). The power spectral density and magnitude squared coherence (MSC) of HRV and respiratory flow signals were estimated. Dimensionality reduction was performed using principal component analysis (PCA) and sequential floating feature selection. The patients were classified using a fuzzy K-nearest neighbour method. PCA of the MSC gave the best classification with the highest accuracy of 92% classifying GSucc versus GFail patients, and 86% classifying GSucc versus GRein patients. PCA of the respiratory flow signal gave the best classification between GFail and GRein patients (79% accuracy). These classifiers showed a good balance between sensitivity and specificity. Besides, the spectral coherence between HRV and the respiratory flow signal, in patients on weaning trial process, can contribute to the extubation decision. PMID:26020593

  20. Correlation between central venous pressure and peripheral venous pressure with passive leg raise in patients on mechanical ventilation

    PubMed Central

    Kumar, Dharmendra; Ahmed, Syed Moied; Ali, Shahna; Ray, Utpal; Varshney, Ankur; Doley, Kashmiri

    2015-01-01

    Background: Central venous pressure (CVP) assesses the volume status of patients. However, this technique is not without complications. We, therefore, measured peripheral venous pressure (PVP) to see whether it can replace CVP. Aims: To evaluate the correlation and agreement between CVP and PVP after passive leg raise (PLR) in critically ill patients on mechanical ventilation. Setting and Design: Prospective observational study in Intensive Care Unit. Methods: Fifty critically ill patients on mechanical ventilation were included in the study. CVP and PVP measurements were taken using a water column manometer. Measurements were taken in the supine position and subsequently after a PLR of 45°. Statistical Analysis: Pearson's correlation and Bland–Altman's analysis. Results: This study showed a fair correlation between CVP and PVP after a PLR of 45° (correlation coefficient, r = 0.479; P = 0.0004) when the CVP was <10 cmH2O. However, the correlation was good when the CVP was >10 cmH2O. Bland–Altman analysis showed 95% limits of agreement to be ?2.912–9.472. Conclusion: PVP can replace CVP for guiding fluid therapy in critically ill patients.

  1. Low Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome: A Paradigm Shift in Mechanical Ventilation

    PubMed Central

    Lipes, Jed; Bojmehrani, Azadeh; Lellouche, Francois

    2012-01-01

    Protective ventilation with low tidal volume has been shown to reduce morbidity and mortality in patients suffering from acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Low tidal volume ventilation is associated with particular clinical challenges and is therefore often underutilized as a therapeutic option in clinical practice. Despite some potential difficulties, data have been published examining the application of protective ventilation in patients without lung injury. We will briefly review the physiologic rationale for low tidal volume ventilation and explore the current evidence for protective ventilation in patients without lung injury. In addition, we will explore some of the potential reasons for its underuse and provide strategies to overcome some of the associated clinical challenges. PMID:22536499

  2. Acupressure Improves the Weaning Indices of Tidal Volumes and Rapid Shallow Breathing Index in Stable Coma Patients Receiving Mechanical Ventilation: Randomized Controlled Trial

    PubMed Central

    Maa, Suh-Hwa; Wang, Chiu-Hua; Hsu, Kuang-Hung; Lin, Horng-Chyuan; Yee, Brian; MacDonald, Karen

    2013-01-01

    Background. Acupressure has been shown to improve respiratory parameters. We investigated the effects of acupressure on weaning indices in stable coma patients receiving mechanical ventilation. Methods. Patients were randomly allocated to one of three treatments: standard care with adjunctive acupressure on one (n = 32) or two days (n = 31) and standard care (n = 31). Acupressure in the form of 10 minutes of bilateral stimulation at five acupoints was administered per treatment session. Weaning indices were collected on two days before, right after, and at 0.5?hrs, 1?hr, 1.5?hrs, 2?hrs, 2.5?hrs, 3?hrs, 3.5?hrs, and 4?hrs after the start of treatment. Results. There were statistically significant improvements in tidal volumes and index of rapid shallow breathing in the one-day and two-day adjunctive acupressure study arms compared to the standard care arm immediately after acupressure and persisting until 0.5, 1?hr, and 2?hrs after adjustment for covariates. Conclusions. In the stable ventilated coma patient, adjunctive acupressure contributes to improvements in tidal volumes and the index of rapid shallow breathing, the two indices most critical for weaning patients from mechanical ventilation. These effects tend to be immediate and likely to be sustained for 1 to 2 hours. PMID:23710234

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

    PubMed

    Vandecandelaere, Ilse; Coenye, Tom

    2015-01-01

    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

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

    PubMed

    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

    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

  5. Does the tube-compensation function of two modern mechanical ventilators provide effective work of breathing relief?

    PubMed Central

    Maeda, Yoshiko; Fujino, Yuji; Uchiyama, Akinori; Taenaka, Nobuyuki; Mashimo, Takashi; Nishimura, Masaji

    2003-01-01

    Objective An endotracheal tube (ETT) imposes work of breathing on mechanically ventilated patients. Using a bellows-in-a-box model lung, we compared the tube compensation (TC) performances of the Nellcor Puritan-Bennett 840 ventilator and of the Dräger Evita 4 ventilator. Measurements and results Each ventilator was connected to the model lung. The respiratory rate of the model lung was set at 10 breaths/min with 1 s inspiratory time. Inspiratory flows were 30 or 60 l/min. A full-length 8 mm bore ETT was inserted between the ventilator circuit and the model lung. The TC was set at 0%, 10%, 50%, and 100% for both ventilators. Pressure was monitored at the airway, the trachea, and the pleura, and the data were recorded on a computer for later analysis of the delay time, of the inspiratory trigger pressure, and of the pressure–time product (PTP). The delay time was calculated as the time between the start of inspiration and minimum airway pressure, and the inspiratory trigger pressure was defined as the most negative pressure level. The same measurements were performed under pressure support ventilation of 4 and 8 cmH2O. The PTP increased according to the magnitude of inspiratory flow. Even with 100% TC, neither ventilator could completely compensate for the PTP imposed by the ETT. At 0% TC the PTP tended to be less with the Nellcor Puritan-Bennett 840 ventilator, while at 100% TC the PTP tended to be less with the Dräger Evita 4 ventilator. A small amount of pressure support can be equally effective to reduce the inspiratory effort compared with the TC. Conclusion Although both ventilators provided effective TC, even when set to 100% TC they could not entirely compensate for a ventilator and ETT-imposed work of breathing. The effect of TC is less than that of pressure support ventilation. Physicians should be aware of this when using TC in weaning trials. PMID:12974975

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

    PubMed

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

    2014-12-01

    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

  7. GASTRIC REFLUX IN MECHANICALLY VENTILATED GASTRIC FED ICU PATIENTS

    E-print Network

    Schallom, Marilyn

    2013-08-31

    In the mouth, the digestion of food begins with mechanical breakdown from chewing and initial enzymatic digestion with salivary secretion. Saliva is comprised of a serous and a mucus portion. The serous secretion contains ptyalin an -amylase. Mucus lubricates...

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

    PubMed Central

    2013-01-01

    Background On average 7% of patients admitted to intensive-care units (ICUs) suffer from a potentially preventable ventilator-associated pneumonia (VAP). Our objective was to survey attitudes and practices of ICUs doctors in the field of VAP prevention. Methods A questionnaire was made available online in 6 languages from April, 1st to September 1st, 2012 and disseminated through international and national ICU societies. We investigated reported practices as regards (1) established clinical guidelines for VAP prevention, and (2) measurement of process and outcomes, under the assumption “if you cannot measure it, you cannot improve it”; as well as attitudes towards the implementation of a measurement system. Weighted estimations for Europe were computed based on countries for which at least 10 completed replies were available, using total country population as a weight. Data from other countries were pooled together. Detailed country-specific results are presented in an online additional file. Results A total of 1730 replies were received from 77 countries; 1281 from 16 countries were used to compute weighted European estimates, as follows: care for intubated patients, combined with a measure of compliance to this guideline at least once a year, was reported by 57% of the respondents (95% CI: 54–60) for hand hygiene, 28% (95% CI: 24–33) for systematic daily interruption of sedation and weaning protocol, and 27% (95%: 23–30) for oral care with chlorhexidine. Only 20% (95% CI: 17–22) were able to provide an estimation of outcome data (VAP rate) in their ICU, still 93% (95% CI: 91–94) agreed that “Monitoring of VAP-related measures stimulates quality improvement”. Results for 449 respondents from 61 countries not included in the European estimates are broadly comparable. Conclusions This study shows a low compliance with VAP prevention practices, as reported by ICU doctors in Europe and elsewhere, and identifies priorities for improvement. PMID:23531169

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

    PubMed Central

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

    2015-01-01

    Introduction Patients who require invasive mechanical ventilation (IMV) often represent a sequence of care between the emergency department (ED) and intensive care unit (ICU). Despite being the most populous state, little information exists to define patterns of IMV use within the state of California. Methods We examined data from the masked Patient Discharge Database of California’s Office of Statewide Health Planning and Development from 2000–2009. Adult patients who received IMV during their stay were identified using the International Classification of Diseases 9th Revision and Clinical Modification procedure codes (96.70, 96.71, 96.72). Patients were divided into age strata (18–34yr, 35–64yr, and >65yr). Using descriptive statistics and regression analyses, for IMV discharges during the study period, we quantified the number of ED vs. non-ED based admissions; changes in patient characteristics and clinical outcome; evaluated the marginal costs for IMV; determined predictors for prolonged acute mechanical ventilation (PAMV, i.e. IMV>96hr); and projected the number of IMV discharges and ED-based admissions by year 2020. Results There were 696,634 IMV discharges available for analysis. From 2000–2009, IMV discharges increased by 2.8%/year: n=60,933 (293/100,000 persons) in 2000 to n=79,868 (328/100,000 persons) in 2009. While ED-based admissions grew by 3.8%/year, non-ED-based admissions remained stable (0%). During 2000–2009, fastest growth was noted for 1) the 35–64 year age strata; 2) Hispanics; 3) patients with non-Medicare public insurance; and 4) patients requiring PAMV. Average total patient cost-adjusted charges per hospital discharge increased by 29% from 2000 (from $42,528 to $60,215 in 2014 dollars) along with increases in the number of patients discharged to home and skilled nursing facilities. Higher marginal costs were noted for younger patients (ages 18–34yr), non-whites, and publicly insured patients. Some of the strongest predictors for PAMV were age 35–64 years (OR=1.12; 95% CI [1.09–1.14], p<0.05); non-Whites; and non-Medicare public insurance. Our models suggest that by 2020, IMV discharges will grow to n=153,153 (377 IMV discharges/100,000 persons) with 99,095 admitted through the ED. Conclusion Based on sustained growth over the past decade, by the year 2020, we project a further increase to 153,153 IMV discharges with 99,095 admitted through the ED. Given limited ICU bed capacities, ongoing increases in the number and type of IMV patients have the potential to adversely affect California EDs that often admit patients to ICUs. PMID:26587094

  10. Invasive mechanical ventilation in acute coronary syndromes in the era of percutaneous coronary intervention

    PubMed Central

    Salazar-Mendiguchía, Joel; Lorente-Tordera, Victòria; Sánchez-Salado, José C; González-Costello, José; Moliner-Borja, Pedro; Gómez-Hospital, Joan A; Manito-Lorite, Nicolás; Cequier-Fillat, Ángel

    2013-01-01

    Background: Percutaneous coronary intervention (PCI) improves prognosis in patients with acute coronary syndromes (ACS) reducing ischaemic complications and the development of heart failure, thus potentially changing invasive mechanical ventilation (IMV) requirements. Little information exists about patients with ACS requiring IMV in the current era. We aimed to analyze IMV requirements and characteristics of ACS patients treated under current recommendations (including a high rate of PCI). Methods: Baseline characteristics, indications for IMV, management and in-hospital and mid-term clinical course were analyzed prospectively in a consecutive series of patients with ACS admitted to a tertiary care hospital. Results: We included 1821 patients, of which 106 (5.8%) required IMV. Mean follow-up was 347 days. PCI was performed in 84% of cases. Patients with IMV had more comorbidities, worse left ventricular function and more unstable hemodynamic parameters on admission. In-hospital mortality in patients requiring IMV was 29%. These patients also had higher mid-term mortality (hazard ratio (HR) 6.58; 95% confidence interval (CI) 4.49?9.64; p 0.001). The most common indication for IMV was cardiopulmonary arrest (CA) (65; 61%), followed by pulmonary oedema (27; 26%) and shock (14; 13.2%). Patients with CA were younger, with better hemodynamic parameters at admission, more favourable coronary anatomy and higher rates of PCI. There were no significant differences in overall mortality between the three groups. The main cause of death in CA patients was persistent vegetative state. Conclusions: Mortality in patients with ACS requiring IMV remained high despite a high rate of PCI. Baseline characteristics, management and clinical course were different according to the reason for IMV. The most common cause for IMV requirement was CA. PMID:24222819

  11. 78 FR 54967 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-09

    ...12-150] Rural Health Care Support Mechanism AGENCY: Federal Communications Commission...the universal service support program mechanism; must not use the data except for purposes...administer the Rural Health Care support mechanism (Health Care Connect Fund,...

  12. AUTOPILOT-BT: a system for knowledge and model based mechanical ventilation.

    PubMed

    Lozano, S; Möller, K; Brendle, A; Gottlieb, D; Schumann, S; Stahl, C A; Guttmann, J

    2008-01-01

    A closed-loop system (AUTOPILOT-BT) for the control of mechanical ventilation was designed to: 1) autonomously achieve goals specified by the clinician, 2) optimize the ventilator settings with respect to the underlying disease and 3) automatically adapt to the individual properties and specific disease status of the patient. The current realization focuses on arterial oxygen saturation (SpO(2)), end-tidal CO(2) pressure (P(et)CO(2)), and positive end-expiratory pressure (PEEP) maximizing respiratory system compliance (C(rs)). The "AUTOPILOT-BT" incorporates two different knowledge sources: a fuzzy logic control reflecting expert knowledge and a mathematical model based system that provides individualized patient specific information. A first evaluation test with respect to desired end-tidal-CO(2)-level was accomplished using an experimental setup to simulate three different metabolic CO(2) production rates by means of a physical lung simulator. The outcome of ventilator settings made by the "AUTOPILOT-BT" system was compared to those produced by clinicians. The model based control system proved to be superior to the clinicians as well as to a pure fuzzy logic based control with respect to precision and required settling time into the optimal ventilation state. PMID:18334783

  13. Incidence of ventilator-associated pneumonia in Australasian intensive care units: use of a consensus-developed clinical surveillance checklist in a multisite prospective audit

    PubMed Central

    Elliott, Doug; Elliott, Rosalind; Burrell, Anthony; Harrigan, Peter; Murgo, Margherita; Rolls, Kaye; Sibbritt, David

    2015-01-01

    Objectives With disagreements on diagnostic criteria for ventilator-associated pneumonia (VAP) hampering efforts to monitor incidence and implement preventative strategies, the study objectives were to develop a checklist for clinical surveillance of VAP, and conduct an audit in Australian/New Zealand intensive care units (ICUs) using the checklist. Setting Online survey software was used for checklist development. The prospective audit using the checklist was conducted in 10 ICUs in Australia and New Zealand. Participants Checklist development was conducted with members of a bi-national professional society for critical care physicians using a modified Delphi technique and survey. A 30-day audit of adult patients mechanically ventilated for >72?h. Primary and secondary outcome measures Presence of items on the screening checklist; physician diagnosis of VAP, clinical characteristics, investigations, treatments and patient outcome. Results A VAP checklist was developed with five items: decreasing gas exchange, sputum changes, chest X-ray infiltrates, inflammatory response, microbial growth. Of the 169 participants, 17% (n=29) demonstrated characteristics of VAP using the checklist. A similar proportion had an independent physician diagnosis (n=30), but in a different patient subset (only 17% of cases were identified by both methods). The VAP rate per 1000 mechanical ventilator days for the checklist and clinician diagnosis was 25.9 and 26.7, respectively. The item ‘inflammatory response’ was most associated with the first episode of physician-diagnosed VAP. Conclusions VAP rates using the checklist and physician diagnosis were similar to ranges reported internationally and in Australia. Of note, different patients were identified with VAP by the checklist and physicians. While the checklist items may assist in identifying patients at risk of developing VAP, and demonstrates synergy with the recently developed Centers for Disease Control (CDC) guidelines, decision-making processes by physicians when diagnosing VAP requires further exploration. PMID:26515685

  14. A Simple “Blood-Saving Bundle” Reduces Diagnostic Blood Loss and the Transfusion Rate in Mechanically Ventilated Patients

    PubMed Central

    Riessen, Reimer; Behmenburg, Melanie; Blumenstock, Gunnar; Guenon, Doris; Enkel, Sigrid; Schäfer, Richard; Haap, Michael

    2015-01-01

    Introduction Aim of this study was to reduce blood loss caused by diagnostic blood sampling and to minimize the development of anemia in a high-risk group of mechanically ventilated medical intensive care patients. We therefore implemented a “blood-saving bundle” (BSB) combining a closed-loop arterial blood sampling system, smaller sampling tubes, reduced frequency of blood drawings, and reduced sample numbers. Methods The study included all patients from our medical ICU who were ventilated for more than 72 hours. Exclusion criteria were: acute or chronic anemia on admission, bleeding episode(s) during the ICU stay, or end-of-life therapy. The BSB was introduced in 2009 with training and educational support. Patients treated in 2008, before the introduction of the BSB, served as a control group (n = 41, 617 observation days), and were compared with patients treated in 2010 after the introduction of the BSB (BSB group, n = 50, 559 observation days). Primary endpoints were blood loss per day, and development of anemia. Secondary endpoints were numbers of blood transfusions, number of days on mechanical ventilation, and length of the ICU stay. Results Mean blood loss per ICU day was decreased from 43.3 ml (95% CI: 41.2 to 45.3 ml) in the controls to 15.0 ml (14.3 to 15.7 ml) in the BSB group (P < 0.001). The introduction of a closed-loop arterial blood sampling system was the major contributor to this effect. Mean hemoglobin concentrations showed no significant differences in both groups during the ICU stay. Hemoglobin values <9 g/dl, however, were recorded in 21.2% of observation days in the controls versus 15.4% in the BSB group (P = 0.01). Units of transfused red blood cells per 100 observation days decreased from 7 to 2.3 (P < 0.001). The mean number of ventilation days was 7.1 days (6.1 to 8.3 days) in the controls and 7.5 days (6.6 to 8.5 days) in the BSB group (P = NS). In total, patients in the BSB group stayed in ICU for a mean of 9.9 days (8.6 to 11.3 days), compared to a mean ICU stay of 13.0 days (10.9 to 15.4 days) in the control group (P = 0.014). Due to the longitudinal study design, however, we cannot exclude uncontrolled confounders affecting the transfusion frequency and mean ICU stay. Conclusion Our BSB could be easily implemented and was able to reduce diagnostic blood loss. PMID:26421920

  15. Numerical modeling and analysis of the environment in a mechanically ventilated greenhouse

    NASA Astrophysics Data System (ADS)

    Wu, Fei-qing; Zhang, Li-bin; Xu, Fang; Ai, Qing-lin; Chen, Jiao-liao

    2009-07-01

    Multi-span Greenhouse cooling in summer is always a problem for the greenhouse industry in china, to solve this, the key is to accurately predict the distribution and change of greenhouse environment. At present, the influence of mechanical ventilation about a Venlo-type glass greenhouse on environment has not been reported. The environment model, which takes into account solar radiation, is modeled and the temperature change & distribution is numerically simulated in a mechanically ventilated greenhouse using CFD(Computational Fluid Dynamics),then the velocities and temperatures at key points are measured in a Venlo-type greenhouse. By comparing, the velocity error and the relative error is controlled in 0.08m/s and 7% , respectively. and the temperature error and the relative error is controlled in 2 degrees and 5% expect the individual, respectively. Although the values between simulated and measured have some errors, the curve trend shows that CFD simulation on the mechanical ventilation is effective. It will provide a theoretical basis on greenhouse structure optimization and energy saving in future.

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

    E-print Network

    Utrecht, Universiteit

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

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

    PubMed Central

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

    2015-01-01

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

  18. 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 ...

  19. Using ventilator graphics to identify patient-ventilator asynchrony.

    PubMed

    Nilsestuen, Jon O; Hargett, Kenneth D

    2005-02-01

    Patient-ventilator interaction can be described as the relationship between 2 respiratory pumps: (1) the patient's pulmonary system, which is controlled by the neuromuscular system and influenced by the mechanical characteristics of the lungs and thorax, and (2) the ventilator, which is controlled by the ventilator settings and the function of the flow valve. When the 2 pumps function in synchrony, every phase of the breath is perfectly matched. Anything that upsets the harmony between the 2 pumps results in asynchrony and causes patient discomfort and unnecessarily increases work of breathing. This article discusses asynchrony relative to the 4 phases of a breath and illustrates how asynchrony can be identified with the 3 standard ventilator waveforms: pressure, flow, and volume. The 4 phases of a breath are: (1) The trigger mechanism (ie, initiation of the inspiration), which is influenced by the trigger-sensitivity setting, patient effort, and valve responsiveness. (2) The inspiratory-flow phase. During both volume-controlled and pressure-controlled ventilation the patient's flow demand should be carefully evaluated, using the pressure and flow waveforms. (3) Breath termination (ie, the end of the inspiration). Ideally, the ventilator terminates inspiratory flow in synchrony with the patient's neural timing, but frequently the ventilator terminates inspiration either early or late, relative to the patient's neural timing. During volume-controlled ventilation we can adjust variables that affect inspiratory time (eg, peak flow, tidal volume). During pressure-controlled or pressure-support ventilation we can adjust variables that affect when the inspiration terminates (eg, inspiratory time, expiratory sensitivity). (4) Expiratory phase. Patients with obstructive lung disease are particularly prone to developing intrinsic positive end-expiratory pressure (auto-PEEP) and therefore have difficulty triggering the ventilator. Bedside evaluation for the presence of auto-PEEP should be routinely performed and corrective adjustments made when appropriate. PMID:15691392

  20. Rationale and study design of ViPS – variable pressure support for weaning from mechanical ventilation: study protocol for an international multicenter randomized controlled open trial

    PubMed Central

    2013-01-01

    Background In pressure support ventilation (PSV), a non-variable level of pressure support is delivered by the ventilator when triggered by the patient. In contrast, variable PSV delivers a level of pressure support that varies in a random fashion, introducing more physiological variability to the respiratory pattern. Experimental studies show that variable PSV improves gas exchange, reduces lung inflammation and the mean pressure support, compared to non-variable PSV. Thus, it can theoretically shorten weaning from the mechanical ventilator. Methods/design The ViPS (variable pressure support) trial is an international investigator-initiated multicenter randomized controlled open trial comparing variable vs. non-variable PSV. Adult patients on controlled mechanical ventilation for more than 24 hours who are ready to be weaned are eligible for the study. The randomization sequence is blocked per center and performed using a web-based platform. Patients are randomly assigned to one of the two groups: variable PSV or non-variable PSV. In non-variable PSV, breath-by-breath pressure support is kept constant and targeted to achieve a tidal volume of 6 to 8 ml/kg. In variable PSV, the mean pressure support level over a specific time period is targeted at the same mean tidal volume as non-variable PSV, but individual levels vary randomly breath-by-breath. The primary endpoint of the trial is the time to successful weaning, defined as the time from randomization to successful extubation. Discussion ViPS is the first randomized controlled trial investigating whether variable, compared to non-variable PSV, shortens the duration of weaning from mechanical ventilation in a mixed population of critically ill patients. This trial aims to determine the role of variable PSV in the intensive care unit. Trial registration clinicaltrials.gov NCT01769053 PMID:24176188

  1. Kinetic profiling of in vivo lung cellular inflammatory responses to mechanical ventilation

    PubMed Central

    Woods, Samantha J.; Waite, Alicia A. C.; O'Dea, Kieran P.; Halford, Paul; Takata, Masao

    2015-01-01

    Mechanical ventilation, through overdistension of the lung, induces substantial inflammation that is thought to increase mortality among critically ill patients. The mechanotransduction processes involved in converting lung distension into inflammation during this ventilator-induced lung injury (VILI) remain unclear, although many cell types have been shown to be involved in its pathogenesis. This study aimed to identify the profile of in vivo lung cellular activation that occurs during the initiation of VILI. This was achieved using a flow cytometry-based method to quantify the phosphorylation of several markers (p38, ERK1/2, MAPK-activated protein kinase 2, and NF-?B) of inflammatory pathway activation within individual cell types. Anesthetized C57BL/6 mice were ventilated with low (7 ml/kg), intermediate (30 ml/kg), or high (40 ml/kg) tidal volumes for 1, 5, or 15 min followed by immediate fixing and processing of the lungs. Surprisingly, the pulmonary endothelium was the cell type most responsive to in vivo high-tidal-volume ventilation, demonstrating activation within just 1 min, followed by the alveolar epithelium. Alveolar macrophages were the slowest to respond, although they still demonstrated activation within 5 min. This order of activation was specific to VILI, since intratracheal lipopolysaccharide induced a very different pattern. These results suggest that alveolar macrophages may become activated via a secondary mechanism that occurs subsequent to activation of the parenchyma and that the lung cellular activation mechanism may be different between VILI and lipopolysaccharide. Our data also demonstrate that even very short periods of high stretch can promote inflammatory activation, and, importantly, this injury may be immediately manifested within the pulmonary vasculature. PMID:25770178

  2. Impact of daily bathing with chlorhexidine gluconate on ventilator associated pneumonia in intensive care units: a meta-analysis

    PubMed Central

    Chen, Wensen; Cao, Quan; Li, Songqin; Li, Huifen

    2015-01-01

    Objective Ventilator associated pneumonia (VAP) is the most important nosocomial infection in intensive care units (ICUs). Our objective was to assess whether daily bathing with chlorhexidine gluconate (CHG) would significantly result in the reduction of VAP. Materials and methods Meta-analysis of randomized controlled trials (RCTs) and quasi-experimental studies were conducted. The setting are medical, surgical, trauma, and combined medical-surgical ICUs. The patients are adult. We searched electronic search engine (PubMed), Embase and the Cochrane Central Register database for all published studies related to the application of daily CHG bathing with VAP risk. Results In all, six articles reporting a total of 27,638 ventilator-days met the inclusion criteria; 132 patients in the CHG arm developed a VAP (13,349 ventilator-days), compared with 188 patients in the control arm (14,289 ventilator-days). Daily bathing with CHG was significantly associated with decreased incidence risk of VAP [relative risk (RR): 0.73, 95% confidence interval (CI): 0.57-0.92, I2=0%]. In the subgroup analysis, we found that daily bathing with 2% CHG impregnated cloths or wipes would reduce the incidence risk of VAP among before-and-after studies (pooled RR: 0.73, 95% CI: 0.57-0.93). Conclusions The application of daily bathing with CHG would decrease incidence risk of VAP, which would be an important complementary intervention to barrier precautions. PMID:25973242

  3. Details behind the dots: How different intensive care units used common and contrasting methods to prevent ventilator associated pneumonia

    PubMed Central

    Daniel, Malcolm; Booth, Malcolm; Ellis, Kirsteen; Maher, Shaun; Longmate, Andrew

    2015-01-01

    Care bundles promote delivery of effective care and improve patient outcomes. The understanding of how to improve delivery of care bundles is incomplete. The Scottish Patient Safety Programme is a national collaborative with the aim of improving the delivery of care to patients in acute hospitals in Scotland. Critical care is one of five workstreams in the programme. A programme goal is to reduce incidence of ventilator-associated pneumonia (VAP) to zero or 300 calendar days between events through use of a VAP Prevention bundle. We studied two ICUs participating in this programme. Each ICU had established infection surveillance system prior to the programme starting. Both units had an appreciable incidence of VAP. Initial VAP prevention bundle adherence was low in each ICU (35% and 41%). Comparing time periods before and after 80% bundle VAP prevention bundle adherence was achieved showed a similar reduction in VAP incidence (from 6.9 to 1.0, and from 7.8 to 1.4/1000 ventilation days). When compared each ICU used common and contrasting approaches to accomplish this improvement. We describe the five improvement knowledge systems used to improve bundle adherence to bundle elements in each hospital. The insights gained from these front-line clinical teams can be used as a template for improvement efforts in a variety of other healthcare settings. PMID:26734371

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

    PubMed

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

    2013-03-01

    Autonomous global models based on radial basis functions were obtained from data measured from patients under noninvasive mechanical ventilation. Some of these models, which are discussed in the paper, turn out to have chaotic or quasi-periodic solutions, thus providing a first piece of evidence that the underlying dynamics of the data used to estimate the global models are likely to be chaotic or, at least, have a chaotic component. It is explicitly shown that one of such global models produces attractors characterized by a Horseshoe map, two models produce toroidal chaos, and one model produces a quasi-periodic regime. These topologically inequivalent attractors evidence the individuality of breathing profiles observed in patient under noninvasive ventilation. PMID:23556974

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2012-01-01

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

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

    SciTech Connect

    Baldelli, R.J.; Green, F.H.Y.; Auer, R.N. )

    1993-09-01

    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.

  8. Mechanical ventilation and thoracic artificial lung assistance during mechanical circulatory support with PUCA pump: in silico study.

    PubMed

    De Lazzari, Claudio; Genuini, Igino; Quatember, Bernhard; Fedele, Francesco

    2014-02-01

    Patients assisted with left ventricular assist device (LVAD) may require prolonged mechanical ventilatory assistance secondary to postoperative respiratory failure. The goal of this work is the study of the interdependent effects LVAD like pulsatile catheter (PUCA) pump and mechanical ventilatory support or thoracic artificial lung (TAL), by the hemodynamic point of view, using a numerical simulator of the human cardiovascular system. In the simulator, different circulatory sections are described using lumped parameter models. Lumped parameter models have been designed to describe the hydrodynamic behavior of both PUCA pump and thoracic artificial lung. Ventricular behavior atrial and septum functions were reproduced using variable elastance model. Starting from simulated pathological conditions we studied the effects produced on some hemodynamic variables by simultaneous PUCA pump, thoracic artificial lung or mechanical ventilation assistance. Thoracic artificial lung was applied in parallel or in hybrid mode. The effects of mechanical ventilation have been simulated by changing mean intrathoracic pressure value from -4 mmHg to +5 mmHg. The hemodynamic variables observed during the simulations, in different assisted conditions, were: left and right ventricular end systolic (diastolic) volume, systolic/diastolic aortic pressure, mean pulmonary arterial pressure, left and right mean atrial pressure, mean systemic venous pressure and the total blood flow. Results show that the application of PUCA (without mechanical ventilatory assistance) increases the total blood flow, reduces the left ventricular end systolic volume and increases the diastolic aortic pressure. Parallel TAL assistance increases the right ventricular end diastolic (systolic) volume reduction both when PUCA is switched "ON" and both when PUCA is switched "OFF". By switching "OFF" the PUCA pump, it seems that parallel thoracic artificial lung assistance produces a greater cardiac output (respect to hybrid TAL assistance). Results concerning PUCA and TAL interaction produced by simulations cannot be compared with "in vivo" results since they are not presented in literature. But results concerning the effects produced by LVAD and mechanical ventilation have a trend consistent with those presented in literature. PMID:24332823

  9. The Impact of Dialysis-Requiring Acute Kidney Injury on Long-Term Prognosis of Patients Requiring Prolonged Mechanical Ventilation: Nationwide Population-Based Study

    PubMed Central

    Chao, Chia-Ter; Hou, Chun-Cheng; Wu, Vin-Cent; Lu, Hsin-Ming; Wang, Cheng-Yi; Chen, Likwang; Kao, Tze-Wah

    2012-01-01

    Background Prolonged mechanical ventilation (PMV) is increasingly common worldwide, consuming enormous healthcare resources. Factors that modify PMV outcome are still obscure. Methods We selected patients without preceding mechanical ventilation within the one past year and who developed PMV during index admission in Taiwan's National Health Insurance (NHI) system during 1998–2007 for comparison of mortality and resource use. They were divided into three groups: (1) patients with end-stage renal diseases (ESRD) before the index admission for PMV onset; (2) patients with dialysis-requiring acute kidney injury (AKI-dialysis) during the hospitalization course; and (3) patients without AKI or with non dialysis-requiring AKI during the hospitalization course (non-AKI). We used a random-effects logistic regression model to identify factors associated with mortality. Results Compared with the other two groups, patients with AKI-dialysis had significantly longer mechanical ventilation, more frequent use of vasopressors, longer intensive care unit/hospital stay and higher inpatient expenditures during the index admission. Relative to non-AKI patients, patients with AKI-dialysis had an elevated mortality hazard; the adjusted relative risk ratios were 1.51 (95% confidence interval [CI]:1.46–1.56), 1.27 (95% CI: 1.23–1.32), and 1.10 (95% CI: 1.08–1.12) for mortality rates at discharge, 3 months, and 4 years after PMV, respectively. Patients with AKI-dialysis also consumed significantly higher total in-patient expenditure than the other two patient groups (p<0.001). Conclusions Among patients that need PMV care during an admission, the presence of de novo AKI requiring dialysis significantly increased short and long term mortality, and demand for health care resources. PMID:23251377

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    Yamaguchi, Miku; Suzuki, Machiko

    2013-01-01

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

  12. Review of Residential Ventilation Technologies

    SciTech Connect

    Armin Rudd

    2005-08-30

    This paper reviews current and potential ventilation technologies for residential buildings, including a variety of mechanical systems, natural ventilation, and passive ventilation. with particular emphasis on North American climates and construction.

  13. [Mechanical ventilation in an anesthetic circle system using the lowest tidal volume--studies of 3 anesthesia ventilators in a lung model and an animal experiment].

    PubMed

    Fösel, T; Schirmer, U; Wick, C; Pfenninger, E; Siegler, W; Altemeyer, K H

    1991-11-01

    No anesthesia ventilator attached to a circle system is manufactured for use in neonates. However, a small bellows can be supplied for the following anesthesia ventilators: Spiromat NS 656 (NS), Ventilog 2 (V2) and AV1 (Draeger Co.) We investigated the minimal tidal volume delivered by each of the three ventilators. In addition, we tested the performance of the AV1 in neonatal piglets for manual and controlled ventilation, and in decreased lung compliance. MATERIALS AND METHODS. All circuits were equipped with one CO2 canister (750 ml) and the low-compliance tubes of the "Ulmer Kinder Set" (Ruesch Co.) The circuits were connected to a lung model consisting of a glass cylinder filled with copper wool with a compliance of 3.0 ml/mbar. By using calibrated glass syringes we created a pressure-volume correlation for the entire system, i.e., the lung model, the anesthesia circuit and the ventilator, which was linear for each of the three ventilators. The pressure was measured in the test lung. The pressure increase caused by the tidal volume therefore reflected the actual tidal volume delivered, which was calculated using the pressure-volume correlation. Tidal volumes were determined for varying the fresh gas flow (FGF), the respiratory rate (RR), which was varied between 20 and 60/min and the I:E ratio (IE), which was varied between 1:1 and 1:2. Six newborn piglets aged 2-12 h and with body weight 1000-1300 g were anesthetized, tracheotomized and ventilated with an oxygen-nitrous oxide mixture (FIO2 0.25). The manual ventilation lasted 30 min (period 1) and was followed by mechanical ventilation for 60 min (period 2). Thereafter, a left pneumothorax with constant pressure of 20 mbar and then 40 mbar for 15 min each was created (period 3). A fall in blood pressure was treated with 10 ml colloids in five of the six animals. During the experiment arterial blood pressure in the carotid artery, mean airway pressure at the distal end of the tracheal tube and end-tidal CO2 were continuously recorded. Arterial blood gases were analyzed at the end of each period. RESULTS. The tidal volumes delivered with an identical position of the bellows varied in ventilators NS and V2 with changes in FGF, RR and IE. Decrease in FGF, higher RR and longer expiration resulted in a decrease in the tidal volume. The "smallest" tidal volume delivered by NS varied from 50 ml (FGF 2 l/min, RR 60, IE 1:2) to 188 ml (FGF 4 l/min, RR 20, IE 1:1) and from 11 ml (FGF 2 l/min, RR 60, IE 1:2) to 110 (FGF 4 l/min, RR 20, IE 1:1) in the V2. The AV1 showed a minimal tidal volume of about 5 ml, and no changes in tidal volume attributable to alterations in FGF, RR or IE could be observed. No problems occurred during manual or mechanical ventilation in the piglets. With the experimental decrease in lung compliance no increase in airway pressure was noted, but an increase in arterial pCO2 by 8 mmHg (mean) reflects hypoventilation that was not corrected by the ventilator. DISCUSSION. We believe that the changes in tidal volume in ventilators NS and V2 are caused by adding FGF to the volume delivered by the below during inspiration. Because of the unpredictability of the tidal volumes, these ventilators are not suitable for the use in neonates. The AV1 has a very low systemic compliance which makes it suitable for use in neonatal anesthesia. However, a decrease in lung compliance is not compensated by an increase in airway pressure and leads to hypoventilation. When small tidal volumes are used in patients with low lung compliance, it does not act as expected of a volume-cycled ventilator. PMID:1755533

  14. Mobility interventions to improve outcomes in patients undergoing prolonged mechanical ventilation: a review of the literature.

    PubMed

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

    2008-07-01

    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 (PMV), 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 PMV. 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 (ES), arm exercise, and inspiratory muscle training (IMT). Overall, there is support for the ability of mobility interventions to improve outcomes in patients on PMV but limited evidence of how to best accomplish this goal. Generating more data from multicenter studies and randomized controlled trials is recommended. PMID:18647758

  15. 77 FR 42185 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-18

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

  16. 76 FR 37307 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-27

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

  17. Evidence-based ventilator weaning and discontinuation.

    PubMed

    MacIntyre, Neil R

    2004-07-01

    Ventilator management of a patient who is recovering from acute respiratory failure must balance competing objectives. Discontinuing mechanical ventilation and removing the artificial airway as soon as possible reduces the risk of ventilator-induced lung injury, nosocomial pneumonia, airway trauma from the endotracheal tube, and unnecessary sedation, but premature ventilator-discontinuation or extubation can cause ventilatory muscle fatigue, gas exchange failure, and loss of airway protection. In 1999 the McMaster University Outcomes Research Unit conducted a comprehensive evidence-based review of the literature on ventilator-discontinuation. Using that literature review, the American College of Chest Physicians, the Society of Critical Care Medicine, and the American Association for Respiratory Care created evidence-based guidelines, which include the following principles: 1. Frequent assessment is required to determine whether ventilatory support and the artificial airway are still needed. 2. Patients who continue to require support should be continually re-evaluated to assure that all factors contributing to ventilator dependence are addressed. 3. With patients who continue to require support, the support strategy should maximize patient comfort and provide muscle unloading. 4. Patients who require prolonged ventilatory support beyond the intensive care unit should go to specialized facilities that can provide more gradual support reduction strategies. 5. Ventilator-discontinuation and weaning protocols can be effectively carried out by nonphysician clinicians. PMID:15222913

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

    PubMed Central

    2013-01-01

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

  19. Test-retest reliability of expiratory abdominal compression with a handheld dynamometer in patients with prolonged mechanical ventilation

    PubMed Central

    Morino, Akira; Shida, Masahiro; Tanaka, Masashi; Sato, Kimihiro; Seko, Toshiaki; Ito, Shunsuke; Ogawa, Shunichi; Takahashi, Naoaki

    2015-01-01

    [Purpose] The present study aimed to examine the test-retest reliability of expiratory abdominal compression with a handheld dynamometer in patients with prolonged mechanical ventilation. [Subjects and Methods] We recruited 18 patients with prolonged mechanical ventilation. All patients had impaired consciousness. The mode of the ventilator was synchronized intermittent mandatory ventilation. The abdomen above the navel was vertically compressed using a handheld dynamometer in synchronization with expiration. Expiratory abdominal compression was performed two times. We measured the tidal volume during expiratory abdominal compression. There was an interval of 5 minutes between the first and second measurements. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were performed to examine the test-retest reliability of expiratory abdominal compression with a handheld dynamometer. [Results] The test-retest reliability of expiratory abdominal compression was excellent (ICC(1, 1): 0.987). Bland-Altman analysis showed that there was no fixed bias and no proportional bias. [Conclusion] The findings of this study suggest that expiratory abdominal compression with a handheld dynamometer is reliable and useful for patients with respiratory failure and prolonged mechanical ventilation. PMID:26311946

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

    NASA Astrophysics Data System (ADS)

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

    2002-06-01

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

  1. 47 CFR 54.602 - Health care support mechanism.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Health care support mechanism. 54.602 Section 54.602 Telecommunication FEDERAL...Defined Terms and Eligibility § 54.602 Health care support mechanism. (a) Telecommunications Program. Rural health...

  2. 47 CFR 54.602 - Health care support mechanism.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Health care support mechanism. 54.602 Section 54.602 Telecommunication FEDERAL...Defined Terms and Eligibility § 54.602 Health care support mechanism. (a) Telecommunications Program. Rural health...

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

    PubMed

    Hajizadeh, Negin; Goldfeld, Keith; Crothers, Kristina

    2015-03-01

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

  4. A mobile care system with alert mechanism.

    PubMed

    Lee, Ren-Guey; Chen, Kuei-Chien; Hsiao, Chun-Chieh; Tseng, Chwan-Lu

    2007-09-01

    Hypertension and arrhythmia are chronic diseases, which can be effectively prevented and controlled only if the physiological parameters of the patient are constantly monitored, along with the full support of the health education and professional medical care. In this paper, a role-based intelligent mobile care system with alert mechanism in chronic care environment is proposed and implemented. The roles in our system include patients, physicians, nurses, and healthcare providers. Each of the roles represents a person that uses a mobile device such as a mobile phone to communicate with the server setup in the care center such that he or she can go around without restrictions. For commercial mobile phones with Bluetooth communication capability attached to chronic patients, we have developed physiological signal recognition algorithms that were implemented and built-in in the mobile phone without affecting its original communication functions. It is thus possible to integrate several front-end mobile care devices with Bluetooth communication capability to extract patients' various physiological parameters [such as blood pressure, pulse, saturation of haemoglobin (SpO2), and electrocardiogram (ECG)], to monitor multiple physiological signals without space limit, and to upload important or abnormal physiological information to healthcare center for storage and analysis or transmit the information to physicians and healthcare providers for further processing. Thus, the physiological signal extraction devices only have to deal with signal extraction and wireless transmission. Since they do not have to do signal processing, their form factor can be further reduced to reach the goal of microminiaturization and power saving. An alert management mechanism has been included in back-end healthcare center to initiate various strategies for automatic emergency alerts after receiving emergency messages or after automatically recognizing emergency messages. Within the time intervals in system setting, according to the medical history of a specific patient, our prototype system can inform various healthcare providers in sequence to provide healthcare service with their reply to ensure the accuracy of alert information and the completeness of early warning notification to further improve the healthcare quality. In the end, with the testing results and performance evaluation of our implemented system prototype, we conclude that it is possible to set up a complete intelligent healt care chain with mobile monitoring and healthcare service via the assistance of our system. PMID:17912967

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

    PubMed

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

    2015-09-01

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

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

    PubMed

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

    2015-02-01

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

  7. Ventilation and ventilators.

    PubMed

    Hayes, B

    1982-01-01

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

  8. Deciding about mechanical ventilation in end-stage chronic obstructive pulmonary disease: how respirologists perceive their role

    PubMed Central

    McNeely, P D; Hébert, P C; Dales, R E; O'Connor, A M; Wells, G; McKim, D; Sullivan, K E

    1997-01-01

    OBJECTIVE: To determine when respirologists approach patients with end-stage chronic obstructive pulmonary disease (COPD) to decide about the use of mechanical ventilation, what information they provide to patients and how they provide it. DESIGN: Self-administered national survey. PARTICIPANTS: All Canadian specialists in respiratory medicine; of 401 eligible respirologists, 279 (69.6%) returned a completed questionnaire. OUTCOME MEASURES: Timing and content of doctor-patient discussions regarding mechanical ventilation; physicians' perception of their level of involvement in the decision-making process; and patient and physician characteristics that may influence decisions. RESULTS: Discussions were reported to occur most often at advanced stages of COPD: when the patient's dyspnea was severe (reported by 235 [84.2%] of the respondents) or when the patient's forced expiratory volume in the first second was 30% or less than predicted value (reported by 210 [75.3%]). A total of 120 respondents (43.0%) stated that they discuss mechanical ventilation with 40% or less of their COPD patients before an exacerbation necessitates ventilatory support. Most (154 [55.2%]) described the decision-making process as a collaboration between patient and physician; 83 (29.7%) reported that the patient decides after he or she has considered the physician's opinion. Over half (148 [53.0%]) of the respondents indicated that they occasionally, often or always modify the information provided to patients in order to influence their decision about mechanical ventilation. CONCLUSIONS: Discussions with COPD patients concerning end-of-life decisions about mechanical ventilation are reported to occur in advanced stages of the disease or not at all, with patients' input where possible. Information presented to patients is often modified in order to influence the decision. Future studies should explore ways to involve patients further in the decision-making process and to improve the process for both patients and physicians. PMID:9012718

  9. Patient-directed music therapy reduces anxiety and sedation exposure in mechanically-ventilated patients: a research critique.

    PubMed

    Gullick, Janice G; Kwan, Xiu Xian

    2015-05-01

    This research appraisal, guided by the CASP Randomised Controlled Trial Checklist, critiques a randomised, controlled trial of patient-directed music therapy compared to either noise-cancelling headphones or usual care. This study recruited 373 alert, mechanically-ventilated patients across five intensive care units in the United States. The Music Assessment Tool, administered by a music therapist, facilitated music selection by participants in the intervention group. Anxiety was measured using the VAS-A scale. Sedation exposure was measured by both sedation frequency and by sedation intensity using a daily sedation intensity score. Context for the data was supported by an environmental scan form recording unit activity and by written comments from nurses about the patient's responses to the protocol. Patient-directed music therapy allowed a significant reduction in sedation frequency compared to noise-cancelling headphones and usual care participants. Patient-directed music therapy led to significantly lower anxiety and sedation intensity compared to usual care, but not compared to noise-cancelling headphones. This is a robust study with clear aims and a detailed description of research methods and follow-up. While no participants were lost to follow-up, not all were included in the analysis: 37% did not have the minimum of two anxiety assessments for comparison and 23% were not included in sedation analysis. While some participants utilised the intervention or active control for many hours-per-day, half the music therapy participants listened for 12min or less per day and half of the noise-cancelling headphone participants did not appear to use them. While the results suggest that patient-directed music therapy and noise-cancelling headphones may be useful and cost-effective interventions that lead to an overall improvement in anxiety and sedation exposure, these may appeal to a subset of ICU patients. The self-directed use of music therapy and noise-cancelling headphones means these findings may not transfer to sedated or cognitively-impaired patients. PMID:25818065

  10. The effects of pleural fluid drainage on respiratory function in mechanically ventilated patients after cardiac surgery

    PubMed Central

    Brims, Fraser J H; Davies, Michael G; Elia, Andy; Griffiths, Mark J D

    2015-01-01

    Background Pleural effusions occur commonly after cardiac surgery and the effects of drainage on gas exchange in this population are not well established. We examined pulmonary function indices following drainage of pleural effusions in cardiac surgery patients. Methods We performed a retrospective study examining the effects of pleural fluid drainage on the lung function indices of patients recovering from cardiac surgery requiring mechanical ventilation for more than 7?days. We specifically analysed patients who had pleural fluid removed via an intercostal tube (ICT: drain group) compared with those of a control group (no effusion, no ICT). Results In the drain group, 52 ICTs were sited in 45 patients. The mean (SD) volume of fluid drained was 1180 (634) mL. Indices of oxygenation were significantly worse in the drain group compared with controls prior to drainage. The arterial oxygen tension (PaO2)/fractional inspired oxygen (FiO2) (P/F) ratio improved on day 1 after ICT placement (mean (SD), day 0: 31.01 (8.92) vs 37.18 (10.7); p<0.05) and both the P/F ratio and oxygenation index (OI: kPa/cm?H2O=PaO2/mean airway pressure×FiO2) demonstrated sustained improvement to day 5 (P/F day 5: 39.85 (12.8); OI day 0: 2.88 (1.10) vs day 5: 4.06 (1.73); both p<0.01). The drain group patients were more likely to have an improved mode of ventilation on day 1 compared with controls (p=0.028). Conclusions Pleural effusion after cardiac surgery may impair oxygenation. Drainage of pleural fluid is associated with a rapid and sustained improvement in oxygenation. PMID:26339492

  11. Heterogeneity of cerebral vasoreactivity in preterm infants supported by mechanical ventilation

    SciTech Connect

    Pryds, O.; Greisen, G.; Lou, H.; Friis-Hansen, B. )

    1989-10-01

    The reaction of cerebral blood flow to acute changes in arterial carbon dioxide pressure (PaCO2) and mean arterial blood pressure was determined in 57 preterm infants supported by mechanical ventilation (mean gestational age 30.1 weeks) during the first 48 hours of life. All infants had normal brain sonograms at the time of the investigation. In each infant, global cerebral blood flow was determined by xenon-133 clearance two to five times within a few hours at different levels of PaCO2. Changes in PaCO2 followed adjustments of the ventilator settings. Arterial oxygen pressure was intended to be kept constant, and mean arterial blood pressure fluctuated spontaneously between measurements. The data were analyzed by stepwise multiple regression, with changes in global cerebral blood flow, PaCO2, mean arterial blood pressure, and postnatal age or intracranial hemorrhage used as variables. In infants with persistently normal brain sonograms, the global cerebral blood flow-carbon dioxide reactivity was markedly lower during the first day of life (mean 11.2% to 11.8%/kPa PaCO2) compared with the second day of life (mean 32.6/kPa PaCO2), and pressure-flow autoregulation was preserved. Similarly, global cerebral blood flow-carbon dioxide reactivity and pressure-flow autoregulation were present in infants in whom mild intracranial hemorrhage developed after the study. In contrast, global cerebral blood flow reactivity to changes in PaCO2 and mean arterial blood pressure was absent in infants in whom ultrasonographic signs of severe intracranial hemorrhage subsequently developed. These infants also had about 20% lower global cerebral blood flow before hemorrhage, in comparison with infants whose sonograms were normal, a finding that suggests functional disturbances of cerebral blood flow regulation.

  12. A rational framework for selecting modes of ventilation.

    PubMed

    Mireles-Cabodevila, Eduardo; Hatipo?lu, Umur; Chatburn, Robert L

    2013-02-01

    Mechanical ventilation is a life-saving intervention for respiratory failure and thus has become the cornerstone of the practice of critical care medicine. A mechanical ventilation mode describes the predetermined pattern of patient-ventilator interaction. In recent years there has been a dizzying proliferation of mechanical ventilation modes, driven by technological advances and market pressures, rather than clinical data. The comparison of these modes is hampered by the sheer number of combinations that need to be tested against one another, as well as the lack of a coherent, logical nomenclature that accurately describes a mode. In this paper we propose a logical nomenclature for mechanical ventilation modes, akin to biological taxonomy. Accordingly, the control variable, breath sequence, and targeting schemes for the primary and secondary breaths represent the order, family, genus, and species, respectively, for the described mode. To distinguish unique operational algorithms, a fifth level of distinction, termed variety, is utilized. We posit that such coherent ordering would facilitate comparison and understanding of modes. Next we suggest that the clinical goals of mechanical ventilation may be simplified into 3 broad categories: provision of safe gas exchange; provision of comfort; and promotion of liberation from mechanical ventilation. Safety is achieved via optimization of ventilation-perfusion matching and pressure-volume relationship of the lungs. Comfort is provided by fostering patient-ventilator synchrony. Liberation is promoted by optimization of the weaning experience. Then we follow a paradigm that matches the technological capacity of a particular mode to achieving a specific clinical goal. Finally, we provide the reader with a comparison of existing modes based on these principles. The status quo in mechanical ventilation mode nomenclature impedes communication and comparison of existing mechanical ventilation modes. The proposed model, utilizing a systematic nomenclature, provides a useful framework to address this unmet need. PMID:22710796

  13. Clinical review: Long-term noninvasive ventilation

    PubMed Central

    Robert, Dominique; Argaud, Laurent

    2007-01-01

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

  14. 75 FR 48235 - Rural Health Care Universal Service Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-09

    ... Communications Commission 47 CFR Part 54 Rural Health Care Universal Service Support Mechanism; Proposed Rule #0... COMMUNICATIONS COMMISSION 47 CFR Part 54 Rural Health Care Universal Service Support Mechanism AGENCY: Federal... of health care, and addresses each of the major recommendations in the National Broadband...

  15. 47 CFR 54.602 - Health care support mechanism.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 3 2014-10-01 2014-10-01 false Health care support mechanism. 54.602 Section... (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Defined Terms and Eligibility § 54.602 Health care support mechanism. (a) Telecommunications Program. Rural health...

  16. 47 CFR 54.602 - Health care support mechanism.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 3 2013-10-01 2013-10-01 false Health care support mechanism. 54.602 Section... (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Defined Terms and Eligibility § 54.602 Health care support mechanism. (a) Telecommunications Program. Rural health...

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

    PubMed Central

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

    2013-01-01

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

  18. 78 FR 38606 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-27

    ...12-150] Rural Health Care Support Mechanism AGENCY: Federal Communications Commission...funds for the universal service support mechanisms. On October 1998, the OMB first approved...participation in the universal service support mechanisms. The remittance information...

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

    SciTech Connect

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

    2013-03-15

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-03-01

    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.

  1. 77 FR 42185 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-18

    ... COMMISSION 47 CFR Part 54 Rural Health Care Support Mechanism AGENCY: Federal Communications Commission... support on a limited, interim, fiscally responsible basis for specific Rural Health Care Pilot Program... will preserve transitioning Pilot Program participants' connectivity and the resulting health...

  2. Blood markers of oxidative stress predict weaning failure from mechanical ventilation

    PubMed Central

    Verona, Cléber; Hackenhaar, Fernanda S; Teixeira, Cassiano; Medeiros, Tássia M; Alabarse, Paulo V; Salomon, Tiago B; Shüller, Ártur K; Maccari, Juçara G; Condessa, Robledo Leal; Oliveira, Roselaine P; Rios Vieira, Silvia R; Benfato, Mara S

    2015-01-01

    Patients undergoing mechanical ventilation (MV) often experience respiratory muscle dysfunction, which complicates the weaning process. There is no simple means to predict or diagnose respiratory muscle dysfunction because diagnosis depends on measurements in muscle diaphragmatic fibre. As oxidative stress is a key mechanism contributing to MV-induced respiratory muscle dysfunction, the aim of this study was to determine if differences in blood measures of oxidative stress in patients who had success and failure in a spontaneous breathing trial (SBT) could be used to predict the outcome of MV. This was a prospective analysis of MV-dependent patients (?72 hrs; n = 34) undergoing a standard weaning protocol. Clinical, laboratory and oxidative stress analyses were performed. Measurements were made on blood samples taken at three time-points: immediately before the trial, 30 min. into the trial in weaning success (WS) patients, or immediately before return to MV in weaning failure (WF) patients, and 6 hrs after the trial. We found that blood measures of oxidative stress distinguished patients who would experience WF from patients who would experience WS. Before SBT, WF patients presented higher oxidative damage in lipids and higher antioxidant levels and decreased nitric oxide concentrations. The observed differences in measures between WF and WS patients persisted throughout and after the weaning trial. In conclusion, WF may be predicted based on higher malondialdehyde, higher vitamin C and lower nitric oxide concentration in plasma. PMID:25854285

  3. [Effect of increasing protein ingestion on the nitrogen balance of mechanically ventilated critically ill patients receiving total parenteral nutrition].

    PubMed

    van der Heijden, A; Verbeek, M J; Schreurs, V V; Akkermans, L M; Vos, A

    1993-01-01

    The amount of protein recommended to minimise N loss in critically ill patients receiving total parenteral nutrition (TPN) varies in the literature. Therefore, we studied the effect of increased protein intake on the N balance, administering TPN with either 1.2 g protein/kg/day (low N diet) or 1.8 g protein/kg/day (high N diet). Fifteen mechanically ventilated critically ill patients were studied in a surgical intensive care unit. After at least two days of standard TPN, patients were randomly assigned to either the low or the high N diet. Ten patients were studied on the low N diet and 11 on the high N diet; 6 patients were studied on both diets. Nonprotein energy was supplied according to estimated energy requirements. For five consecutive days, the N balance was measured daily. Total urinary nitrogen (TUN) was analysed using the Kjeldahl method. There was no difference in N balance between the groups. On the low N diet, N balance was -0.113 +/- 0.088 and on the high N diet -0.113 +/- 0.109 g N/kg/day. In patients studied twice, N balance was -0.087 +/- 0.054 and -0.050 +/- 0.060 g N/kd/day respectively. Results of a previous pilot study showed that in 20 similar patients the N balance became 80% less negative (from -5.7 +/- 5.1 to -1.1 +/- 8.2 g N/day) when protein intake was increased from 0.9 to 1.5 g/kg/day. Since these results are consistent with other studies, we conclude that the optimal range of protein supply in this type of critically ill patients is approximately 1.1-1.5 g protein/kg/day. PMID:8334179

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

    PubMed

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

    2014-09-01

    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

  5. Effects of Open and Closed Suctioning Systems on Pain in Newborns Treated with Mechanical Ventilation.

    PubMed

    Acikgoz, Ayfer; Yildiz, Suzan

    2015-10-01

    This experimental study was conducted to compare the effects of open and closed suctioning systems on pain in newborns receiving ventilation support. The study sample consisted of 42 babies (23 female, 16 male) hospitalized in the unit between December 2010 and December 2011 who met the selection criteria established for the study. Using the random sampling method, 20 of the babies were included in the closed suctioning system group and the remaining 22 were analyzed in the open suctioning system group. The data collection tools of the study were intervention monitoring form, data collection form, and documentation of the personal information on the babies; and the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) evaluated the babies' pain responses. The data were evaluated using SPSS 15 software. Most neonates were born preterm (?37 weeks' gestation at birth; 69% [n = 29]). The mean (SD) birth weight, gestational age, and intensive care unit stay were 1.82 kg (1.1 kg), 31.9 (5.3) weeks, and 25.3 (2.9) calendar days, respectively. Results of the study revealed no statistically significant difference between the open suctioning and closed suctioning groups (p = .194). However, the N-PASS pain scores obtained before and during the suctioning processes were significantly different (p < .001). In conclusion, babies seem to experience pain during the suctioning process, according to N-PASS scores, and although not significant statistically, the level of pain felt during open suctioning was observed to be slightly higher compared with closed suctioning. PMID:26163740

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

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

    2014-09-15

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

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

    PubMed

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

    2010-10-01

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

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

    PubMed Central

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

    2014-01-01

    There is clear evidence for the use of a protective ventilation protocol in patients with acute respiratory distress syndrome (ARDS). There is evidence to suggest that protective ventilation is beneficial in patients at risk of ARDS. A protective ventilation strategy was implemented on our intensive care unit in critical care patients who required mechanical ventilation for over 48 h, with and at risk for ARDS. A complete audit cycle was performed over 13 months to assess compliance with a safe ventilation protocol in intensive care. The ARDS network mechanical ventilation protocol was used as the standard for our protective ventilation strategy. This recommends ventilation with a tidal volume (Vt) of 6 ml/kg of ideal body weight (IBW) and plateau airway pressure of ?30 cm H2O. The initial audit failed to meet this standard with Vt's of 9.5 ml/kg of IBW. Following the implementation of a ventilation strategy and an educational program, we demonstrate a significant improvement in practice with Vt's of 6.6 ml/kg of IBW in the re-audit. This highlights the importance of simple interventions and continuous education in maintaining high standards of care. PMID:25425842

  10. Successful weaning from mechanical ventilation in a patient with surfactant protein C deficiency presenting with severe neonatal respiratory distress.

    PubMed

    van Hoorn, Jeroen; Brouwers, Arno; Griese, Matthias; Kramer, Boris

    2014-01-01

    The clinical course and treatment in the first 2.5 years of life of a term-born girl with a severe onset of respiratory symptoms in the neonatal period caused by a p.Cys121Phe/C121F mutation in the gene of surfactant protein C (SFTPC) is described. During the first 9 months of life, she was mechanically ventilated. With methylprednisolone pulse therapy and oral prednisolone, she could eventually gradually be weaned from mechanical ventilation. At the age of 2.5 years, she is in a good clinical condition without any respiratory support and has a normal nutritional status and neurodevelopment. This clinical course with neonatal onset of respiratory insufficiency is remarkable since most patients with SFTPC mutations present with milder respiratory symptoms in the first years of life. PMID:24648475

  11. How to Plan Ventilation Systems.

    ERIC Educational Resources Information Center

    Clarke, John H.

    1963-01-01

    Ventilation systems for factory safety demand careful planning. The increased heat loads and new processes of industry have introduced complex ventilation problems in--(1) ventilation supply, (2) duct work design, (3) space requirements, (4) hood face velocities, (5) discharge stacks, and (6) building eddies. This article describes and diagrams…

  12. Ventilator waveforms.

    PubMed

    Mellema, Matthew S

    2013-08-01

    Ventilator waveforms are graphic representations of changes in pressure, flow, and volume within a ventilator circuit. The changes in these parameters over time may be displayed individually (scalars) or plotted one against another (pressure-volume and flow-volume loops). There are 6 basic shapes of scalar waveforms, but only 3 are functionally distinct (square, ramp, and sine). The pressure scalar is a particularly valuable tool when constant flow (e.g., volume control) modes are employed and an inspiratory pause is added. In this setting, inspection of the pressure waveform can allow determination of static, quasistatic, and dynamic compliance, as well as relative changes in airway resistance. Inspection of the pressure waveform can also help to identify many important aspects of patient drug responses, dyssynchrony, and air trapping (auto positive end-expiratory pressure [auto-PEEP]). Depending on the ventilation mode employed, the shape of the flow waveform may be set by the ventilator operator or may be dependent on patient effort and lung mechanics. Decelerating flow patterns have several important advantages when this option is available. Inspection of flow waveforms is crucial in the recognition of dyssynchrony, setting optimal inspiratory times, evaluating responses to bronchodilators, and the recognition of auto-PEEP. The volume waveform often contains somewhat less useful information than the other 2 scalars, but plays a crucial role in the identification of leaks in the circuit. Pressure-volume loops are particularly useful in setting PEEP and peak inspiratory pressure ranges. Inspection of these loops also often helps in the evaluation of lung mechanics, in the identification of circuit leaks, and in the assessment of patient triggering effort. Flow-volume loops are extremely useful in the identification of leaks and excessive airway secretions as well as alterations in airway resistance. Lastly, serial waveform inspection is crucial to the identification and resolution of patient-ventilator dyssynchrony in many cases. PMID:24183000

  13. 46 CFR 194.10-25 - Ventilation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... CONTROL OF EXPLOSIVES AND OTHER HAZARDOUS MATERIALS Magazines § 194.10-25 Ventilation. (a) Integral magazines. (1) All integral magazines shall be provided with natural or mechanical ventilation....

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

    SciTech Connect

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

    2015-07-01

    Changing the air exchange rate of a home (the sum of the infiltration and mechanical ventilation airflow rates) affects the annual thermal conditioning energy. Large-scale changes to air exchange rates of the housing stock can significantly alter the residential sector’s energy consumption. However, the complexity of existing residential energy models is a barrier to the accurate quantification of the impact of policy changes on a state or national level.

  15. Mechanical ventilation modulates Toll-like receptors 2, 4, and 9 on alveolar macrophages in a ventilator-induced lung injury model

    PubMed Central

    Dai, Huijun; Lin, Fei; Ge, Wanyun; Li, Wei; He, Sheng

    2015-01-01

    Objective To investigate the role of Toll-like receptor 2 (TLR2), TLR4, TLR9 and myeloid differentiation factor 88 (MyD88) on alveolar macrophages in ventilator-induced lung injury (VILI). Methods Male, adult pathogen-free Sprague-Dawley rats weighing 300-350 g were used in this study. Animals were tracheotomized and allowed to breathe spontaneously for 4 h or mechanically ventilated for 4 h with low or high tidal volume (7 or 40 mL/kg). TLR2, TLR4, and TLR9, MyD-88 and NF-?? of alveolar macrophages’ expression under the different ventilation conditions were detected. Pulmonary permeability, lung inflammatory, IL-6 and IL-1? were assessed as well. Results Rats subjected to high tidal volume showed significantly greater pulmonary permeability and lung inflammatory than the control rats. Alveolar macrophages from rats subjected to high tidal volume also showed significantly higher protein expression of TLR2 (0.59±0.049 vs. 0.35±0.036 and 0.36±0.031, both P<0.001), TLR4 (0.845±0.0395 vs. 0.401±0.026 and 0.403±0.020, both P<0.001), TLR9 (0.727±0.074 vs. 0.383±0.039 and 0.367±0.043, both P<0.001), MyD-88 (1.01±0.060 vs. 0.485±0.045 and 0.507±0.046, both P<0.001) and NF-?? (0.776±0.067 vs. 0.448±0.043 and 0.481±0.047, both P<0.001), as well as significantly higher concentrations of IL-6 (7.32±0.24 vs. 2.42±0.13 and 2.44±0.32, both P<0.001) and IL-1? (139.95±9.37 vs. 53.63±5.26 and 53.55±6.63, both P<0.001) than the control and low tidal volume group. Conclusions The overexpression of TLR2, TLR4, and TLR9 on alveolar macrophages and release of pro-inflammatory cytokines play a role in VILI. PMID:25973227

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., whichever is less) as an inpatient in one or more hospitals, NFs, or ICFs/MR; (3) Except for the... ICF/MR and would be eligible to have payment made for inpatient care under the State plan; (4) Has... home does not include a hospital, NF, ICF/MR or other institution as defined in § 435.1010 of...

  17. 76 FR 37280 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-27

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

  18. 76 FR 37307 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-27

    ... COMMISSION 47 CFR Part 54 Rural Health Care Support Mechanism AGENCY: Federal Communications Commission... services under the rural health care program. Grandfathered providers do not currently qualify as ``rural,'' but play a key role in delivering health care services to surrounding regions that do qualify...

  19. 76 FR 37280 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-27

    ... COMMISSION 47 CFR Part 54 Rural Health Care Support Mechanism AGENCY: Federal Communications Commission...) adopts an interim rule permitting health care providers that are located in a ``rural area'' under the... rural health care program prior to July 1, 2005, to continue to be treated as if they are located...

  20. 78 FR 13935 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-01

    ... March 1, 2013 Part II Federal Communications Commission 47 CFR Part 54 Rural Health Care Support... Regulations#0;#0; ] FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 54 Rural Health Care Support Mechanism... Communications Commission reforms its universal service support program for health care, transitioning...

  1. A comparison of the laryngeal mask airway with facemask and oropharyngeal airway for manual ventilation by critical care nurses in children.

    PubMed

    Rechner, J A; Loach, V J; Ali, M T; Barber, V S; Young, J D; Mason, D G

    2007-08-01

    The laryngeal mask airway is included as a first line airway device during adult resuscitation by first responders. However, there is little evidence for its role in paediatric resuscitation. Using anaesthetised children as a model for paediatric cardiopulmonary arrest, we compared the ability of critical care nurses to manually ventilate the anaesthetised child via the laryngeal mask airway compared with the facemask and oropharyngeal airway. The airway devices were inserted in random order and chest expansion was measured using an ultrasound distance transducer. The critical care nurses were able to place the laryngeal mask airway and achieve successful ventilation in 82% of children compared to 70% using the facemask and oropharyngeal airway, although the difference was not statistically significant (p = 0.136). The median time to first successful breath using the laryngeal mask airway was 39 s compared to 25 s using the facemask (p < 0.001). In this group of nurses, we did not show a difference in ventilation via a laryngeal mask airway or facemask, although facemask ventilation was achieved more quickly. PMID:17635426

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

    SciTech Connect

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

    2009-05-01

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

  3. 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

    2011-01-01

    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

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

    PubMed Central

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

    2010-01-01

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

  5. Upper extremity muscle tone and response of tidal volume during manually assisted breathing for patients requiring prolonged mechanical ventilation

    PubMed Central

    Morino, Akira; Shida, Masahiro; Tanaka, Masashi; Sato, Kimihiro; Seko, Toshiaki; Ito, Shunsuke; Ogawa, Shunichi; Yokoi, Yuka; Takahashi, Naoaki

    2015-01-01

    [Purpose] The aim of the present study was to examine, in patients requiring prolonged mechanical ventilation, if the response of tidal volume during manually assisted breathing is dependent upon both upper extremity muscle tone and the pressure intensity of manually assisted breathing. [Subjects] We recruited 13 patients on prolonged mechanical ventilation, and assessed their upper extremity muscle tone using the modified Ashworth scale (MAS). The subjects were assigned to either the low MAS group (MAS?2, n=7) or the high MAS group (MAS?3, n=6). [Methods] The manually assisted breathing technique was applied at a pressure of 2 kgf and 4 kgf. A split-plot ANOVA was performed to compare the tidal volume of each pressure during manually assisted breathing between the low and the high MAS groups. [Results] Statistical analysis showed there were main effects of the upper extremity muscle tone and the pressure intensity of the manually assisted breathing technique. There was no interaction between these factors. [Conclusion] Our findings reveal that the tidal volume during the manually assisted breathing technique for patients with prolonged mechanical ventilation depends upon the patient’s upper extremity muscle tone and the pressure intensity. PMID:26357431

  6. Epigenetic mechanisms and the transgenerational effects of maternal care

    E-print Network

    Champagne, Frances A.

    Review Epigenetic mechanisms and the transgenerational effects of maternal care Frances A generations. However, recent evidence suggests that epigenetic mechanisms are capable of mediating this type 2008 Elsevier Inc. All rights reserved. Keywords: Maternal; Epigenetic; DNA methylation; Estrogen

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

    PubMed Central

    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

    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

  8. 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

  9. A Randomized Trial of Initial Trophic versus Full-Energy Enteral Nutrition in Mechanically Ventilated Patients with Acute Respiratory Failure

    PubMed Central

    Rice, Todd W.; Mogan, Susan; Hays, Margaret A.; Bernard, Gordon R.; Jensen, Gordon L.; Wheeler, Arthur P.

    2011-01-01

    Objective Enteral nutrition is provided to mechanically ventilated patients who cannot eat normally, yet the amount of support needed is unknown. We conducted this randomized, open-label study to test the hypothesis that initial low-volume (i.e. trophic) enteral nutrition would decrease episodes of gastrointestinal intolerance/complications and improve outcomes as compared to initial full-energy enteral nutrition in patients with acute respiratory failure. Design Randomized, open-label study Patients 200 Patients with acute respiratory failure expected to require mechanical ventilation for at least 72 hours Interventions Patients were randomized to receive either initial trophic (10 ml/hr) or full-energy enteral nutrition for the initial 6 days of ventilation. Measurements and Main Results The primary outcome measure was ventilator-free days to day 28. Baseline characteristics were similar between the 98 patients randomized to trophic and the 102 patients randomized to full-energy nutrition. At enrollment, patients had a mean APACHE II score of 26.9, PaO2/FiO2 of 182 and 38% were in shock. Both groups received similar duration of enteral nutrition (5.5 vs. 5.1 days; P=0.51). The trophic group received an average of 15 ± 11% of goal calories daily through day 6 compared to 74.8 ± 38.5% (P<0.001) for the full-energy group. Both groups had a median of 23.0 ventilator-free (P=0.90) and 21.0 ICU-free days (P=0.64). Mortality to hospital discharge was 22.4% for trophic vs. 19.6% for full-energy (P=0.62). In the first 6 days, the trophic group had trends for less diarrhea (19 vs. 24% of feeding days; P=0.08) and significantly fewer episodes of elevated gastric residual volumes (2 vs. 8% of feeding days; P<0.001). Conclusions Initial trophic enteral nutrition resulted in similar clinical outcomes in mechanically ventilated patients with acute respiratory failure as early full-energy enteral nutrition but with fewer episodes of gastrointestinal intolerance. PMID:21242788

  10. 46 CFR 194.10-25 - Ventilation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  11. 46 CFR 194.10-25 - Ventilation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  12. 46 CFR 194.10-25 - Ventilation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  13. 46 CFR 194.10-25 - Ventilation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  14. 46 CFR 194.10-25 - Ventilation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

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

    PubMed Central

    2013-01-01

    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

  16. [Optimising speech during artificial ventilation].

    PubMed

    Gonzalez-Bermejo, J; Prigent, H

    2005-09-01

    Speech is an essential component of quality of life for patients treated with long term mechanical ventilation. Therefore trying to improve phonation should always sought by physicians treating these patients. We review the different tools and techniques available in order to restore speech for patients with home mechanical ventilation whether ventilation is done continuously or not. PMID:16294188

  17. A versatile mechanical ventilator (DIGIT) with high flow stability and a programmable inspiratory phase flow pattern.

    PubMed

    Grianti, F; Montecchia, F; Di Bari, L; Baldassarri, M

    1996-11-01

    The paper describes the general characteristics of a newly developed nonconstant-flow generator for automatic ventilation of the lungs. It is known that the application of very high pressure to high internal resistance leads to a very stable flow, in that the flow itself is unaffected by external load (patient) variations. The stability of the flow means that the inspiratory process can be controlled by means of the ventilated volume, thus extending DIGIT utilization to high resistance patients. The modulation of the flow is implemented via a digital electromechanical system, which allows the ventilator functions to be accurately programmed. The desired flow waveform is obtained by means of a series of pneumatic valves, the apertures of which are digitally controlled. The design is innovative in that it allows the flow waveform in each of the ten digitalized time steps into which each inspiratory phase is divided to be both programmed and controlled. Other ventilators commercially available and currently in use do not have this functional capability, as they are all designed to model the integral flow of the inspiratory waveform without being able to modify the subunit time steps of a single inspiratory phase. The paper also discusses the results of fundamental tests concerning the performance characteristics of the ventilator. PMID:9214824

  18. Central Fan Integrated Ventilation Systems

    SciTech Connect

    2009-05-12

    This information sheet describes one example of a ventilation system design, a central fan integrated supply (CFIS) system, a mechanical ventilation and pollutant source control to ensure that there is reasonable indoor air quality inside the house.

  19. Development of an Outdoor Temperature Based Control Algorithm for Residential Mechanical Ventilation Control

    SciTech Connect

    Less, Brennan; Walker, Iain; Tang, Yihuan

    2014-08-01

    The Incremental Ventilation Energy (IVE) model developed in this study combines the output of simple air exchange models with a limited set of housing characteristics to estimate the associated change in energy demand of homes. The IVE model was designed specifically to enable modellers to use existing databases of housing characteristics to determine the impact of ventilation policy change on a population scale. The IVE model estimates of energy change when applied to US homes with limited parameterisation are shown to be comparable to the estimates of a well-validated, complex residential energy model.

  20. Perioperative lung protective ventilation in obese patients.

    PubMed

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F; Repine, John E

    2015-01-01

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increasing, and facing these challenges is common in the operating rooms and critical care units worldwide. In this review we summarize the existing literature which supports the following recommendations for the perioperative ventilation in obese patients: (1) the use of protective ventilation with low tidal volumes (approximately 8 mL/kg, calculated based on predicted -not actual- body weight) to avoid volutrauma; (2) a focus on lung recruitment by utilizing PEEP (8-15 cmH2O) in addition to recruitment maneuvers during the intraoperative period, as well as incentivized deep breathing and noninvasive ventilation early in the postoperative period, to avoid atelectasis, hypoxemia and atelectrauma; and (3) a judicious oxygen use (ideally less than 0.8) to avoid hypoxemia but also possible reabsorption atelectasis. Obesity poses an additional challenge for achieving adequate protective ventilation during one-lung ventilation, but different lung isolation techniques have been adequately performed in obese patients by experienced providers. Postoperative efforts should be directed to avoid hypoventilation, atelectasis and hypoxemia. Further studies are needed to better define optimum protective ventilation strategies and analyze their impact on the perioperative outcomes of surgical patients with obesity. PMID:25907273

  1. Pulmonary and Systemic Pharmacokinetics of Colistin Following a Single Dose of Nebulized Colistimethate in Mechanically Ventilated Neonates.

    PubMed

    Nakwan, Narongsak; Lertpichaluk, Pichaya; Chokephaibulkit, Kulkanya; Villani, Paola; Regazzi, Mario; Imberti, Roberto

    2015-09-01

    The purpose of this study was to evaluate the pulmonary and systemic pharmacokinetics of colistin following a single dose of nebulized colistimethate sodium (CMS) in mechanically ventilated neonates. We administered a single dose of nebulized CMS (approximately 120,000 IU/kg of CMS, equivalent to 4 mg/kg colistin base activity) to 6 ventilated neonates with ventilator-associated pneumonia. The median gestational age was 39 weeks (range, 32-39 weeks). Mean (±SD) tracheal aspirate colistin maximum concentration (Cmax), area under the concentration-time curve (AUC0-24) and t1/2 were 24.0 ± 8.2 ?g/mL, 147.6 ± 53.5 ?g·hours/mL and 9.8 ± 5.5 hours, respectively. The plasma concentrations of colistin were low. In neonates, a single nebulized dose of CMS (120,000 IU) resulted in high local concentrations for at least 12 hours and low systemic concentrations of colistin. Twice daily nebulization might be more appropriate. PMID:26065861

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

    SciTech Connect

    Logue, Jennifer M.; Turner, William J. N.; Walker, Iain S.; Singer, Brett C.

    2015-01-19

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

  3. Safe mechanical ventilation in patients without acute respiratory distress syndrome (ARDS).

    PubMed

    Pannu, S R; Hubmayr, R D

    2015-09-01

    Insights into the pathogenesis of lung deformation injury inspired a benchmark clinical trial, which demonstrated that reducing tidal volumes compared to previous norms was associated with improved patient survival in acute respiratory distress syndrome (ARDS). Since many critically ill patients without ARDS possess ventilator associated lung injury (VALI) risk factors, there is no need to expose them to tidal volumes that are larger than would be needed to achieve acceptable blood gas tensions. In the following perspective we will argue that lung protection from deformation injury should guide ventilator management in all patients, irrespective of the presence of ARDS. That is not to say that all lung diseases share the same VALI risk, but we contend that adopting a low tidal ventilation strategy is a simple and safe starting point in most instances. We will review studies in the medical and surgical literature that have addressed "lung protective ventilation" in patients without ARDS and summarize them with a focus on tidal volume, positive end expiratory pressure and oxygen supplementation settings. In addition, we will briefly discuss under what circumstance one might consider deviating from a conventional approach. PMID:25598293

  4. Simultaneous monitoring of intratidal compliance and resistance in mechanically ventilated piglets: A feasibility study in two different study groups.

    PubMed

    Buehler, Sarah; Schumann, Stefan; Vimláti, László; Lichtwarck-Aschoff, Michael; Guttmann, Josef

    2015-12-01

    Compliance measures the force counteracting parenchymal lung distension. In mechanical ventilation, intratidal compliance-volume (C(V))-profiles therefore change depending on PEEP, tidal volume (VT), and underlying mechanical lung properties. Resistance counteracts gas flow through the airways. Due to anatomical linking between parenchyma and airways, intratidal resistance-volume (R(V))-profiles are hypothesised to change in a non-linear way as well. We analysed respiratory system mechanics in fifteen piglets with lavage-induced lung injury and nine healthy piglets ventilated at different PEEP/VT-settings. In healthy lungs, R(V)-profiles remained mostly constant and linear at all PEEP-settings whereas the shape of the C(V)-profiles showed an increase toward a maximum followed by a decrease (small PEEP) or volume-dependent decrease (large PEEP). In the lavage group, a large drop in resistance at small volumes and slow decrease toward larger volumes was found for small PEEP/VT-settings where C(V)-profiles revealed a volume-dependent increase (small PEEP) or a decrease (large PEEP and large VT). R(V)-profiles depend characteristically on PEEP, VT, and possibly whether lungs are healthy or not. Curved R(V)-profiles might indicate pathological changes in the underlying mechanical lung properties and/or might be a sign of derecruitment. PMID:26275684

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

    PubMed Central

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

    2013-01-01

    Controlled mechanical ventilation (CMV) is known to result in rapid and severe diaphragmatic dysfunction, but the recovery response of the diaphragm to normal function after CMV is unknown. Therefore, we examined the time course of diaphragm function recovery in an animal model of CMV. Healthy rats were submitted to CMV for 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

  6. Evaluation of the Effect of Nebulized N-Acetylcysteine on Respiratory Secretions in Mechanically Ventilated Patients: Randomized Clinical Trial

    PubMed Central

    Masoompour, Seyed Masoom; Anushiravani, Amir; Tafaroj Norouz, Amir

    2015-01-01

    Background The purpose of our study was to evaluate an inexpensive and available method to reduce mucous impactions in mechanically ventilated patients. Methods This randomized clinical trial was conducted on 40 mechanically ventilated patients aged 15-90 years. The patients were randomly allocated into two arms; 20 cases and 20 controls. The cases received N-acetylcysteine via their nebulizers, and the control group received normal saline three times a day for one day. We measured the density of respiratory secretion, plateau and peak airway pressures, and O2 saturation at baseline, 12 and 24 hours later. Results Although the mean secretion density was significantly lower in the NAC group (F (1, 38)=8.61, P=0.006), but a repeated measures ANOVA with a Greenhouse-Geisser correction determined that the effect of NAC on mean secretion density did not differ significantly between time points (F (1, 38)=3.08, P=0.087). NAC increased O2 saturation significantly between time points (F (1.92, 73.1)=4.6, P=0.014). The plateau airway pressures were relatively stable throughout the study in the normal saline and NAC groups (F (1.95, 37.1)=0.67, P=0.513). The peak airway pressure did not change significantly during the study in the normal saline and NAC groups (F (1.52, 56.4)=0.91, P=0.384). Conclusion Considering the limitations of the study, nebulized NAC in mechanically ventilated patients was not effective more than normal saline nebulization in reducing the density of mucous plugs. The peak and plateau airway pressures were relatively stable throughout the study in both groups. Trial Registration Number: IRCT201104276312N1. PMID:26170516

  7. 78 FR 38606 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-27

    ... COMMISSION 47 CFR Part 54 Rural Health Care Support Mechanism AGENCY: Federal Communications Commission... Form. This announcement is consistent with the Universal Service--Rural Health Care Program, Report and... published at 78 FR 13936, March 1, 2013, are effective June 27, 2013. FOR FURTHER INFORMATION CONTACT:...

  8. 78 FR 54967 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-09

    ... COMMISSION 47 CFR Part 54 Rural Health Care Support Mechanism AGENCY: Federal Communications Commission... information collection associated with the Commission's Universal Service--Rural Health Care Program, Report..., 54.647, 54.648(b), and 54.675(d), published at 78 FR 13936, March 1, 2013, are effective September...

  9. Need for Mechanical Ventilation in Pediatric Scald Burns: Why it Happens and Why it Matters.

    PubMed

    Mosier, Michael J; Peter, Tony; Gamelli, Richard L

    2016-01-01

    Scald burns are the most common thermal injury among children. A small subset of pediatric scald burns are complicated by the need for mechanical ventilation (MV). Studies suggest that 4 to 5% of pediatric scald burns will require MV, and these patients tend to be younger with larger burns. Identifying why pediatric patients with scald burns require MV has remained unclear, and few studies have sought to elucidate possible mechanisms. After institutional review board approval, a retrospective review of all pediatric patients with scald burns admitted to the Burn Center between 2010 and 2013 was conducted. Variables collected included age, sex, weight, height, race, ethnicity, socioeconomic status or type of insurance, hospital length of stay, burn size and location, Department of Child and Family Services (DCFS) involvement, time to intubation from admission, reason for intubation, need for MV, duration of MV, need for operative intervention, 24-hour and 48-hour total fluid intake and urine output, glucose levels, infectious complications, comorbidities, and mortality. Patients who required MV were then compared with those who did not require MV to identify statistically significant differences between groups. The MV patients (n = 6) and nonventilated patients (n = 339) did not show significant differences in regards to gender, body mass index, ethnicity, and type of insurance; however, MV patients were younger and had larger burns. The mean age of MV patients was 8.2 + 5.0 months compared with 40.7 + 45.2 months for non-MV (P = .002). The mean percentage of TBSA burn in MV patients was 17.3 + 9.0% compared with 4.5 + 3.9% for non-MV (P < .001). Burn location was significant, and 66.6% of MV patients had burns on the face or neck compared with 23.6% of non-MV (P = .015). MV patients were more likely to have been victims of child abuse, as DCFS was involved in 67% of MV patients vs 28% of non-MV patients (P = .036). Fifty percent of patients requiring MV had either a preceding upper respiratory infection, diagnosis of asthma, or congenital defects, compared with 6% of non-MV patients (P = .004). MV patients received more fluids for 48 hours compared with non-MV patients (2275.7 vs 1332.3 ml, P = .013) and had a higher 48-hour urine output (2.34 vs 1.34 ml/kg/hr, P = .013). Pediatric scald burns that require MV have an increased mortality risk and length of stay. MV patients were younger with larger burns. They received more fluids than non-MV patients, and child abuse, asthma, and stress hyperglycemia within the first 72 hours of injury were common among MV patients. Importantly, burn size and previous history of asthma were found to be independent predictors of the need for MV. PMID:26284637

  10. Computer simulation allows goal-oriented mechanical ventilation in acute respiratory distress syndrome

    PubMed Central

    Uttman, Leif; Ögren, Helena; Niklason, Lisbet; Drefeldt, Björn; Jonson, Björn

    2007-01-01

    Introduction To prevent further lung damage in patients with acute respiratory distress syndrome (ARDS), it is important to avoid overdistension and cyclic opening and closing of atelectatic alveoli. Previous studies have demonstrated protective effects of using low tidal volume (VT), moderate positive end-expiratory pressure and low airway pressure. Aspiration of dead space (ASPIDS) allows a reduction in VT by eliminating dead space in the tracheal tube and tubing. We hypothesized that, by applying goal-orientated ventilation based on iterative computer simulation, VT can be reduced at high respiratory rate and much further reduced during ASPIDS without compromising gas exchange or causing high airway pressure. Methods ARDS was induced in eight pigs by surfactant perturbation and ventilator-induced lung injury. Ventilator resetting guided by computer simulation was then performed, aiming at minimal VT, plateau pressure 30 cmH2O and isocapnia, first by only increasing respiratory rate and then by using ASPIDS as well. Results VT decreased from 7.2 ± 0.5 ml/kg to 6.6 ± 0.5 ml/kg as respiratory rate increased from 40 to 64 ± 6 breaths/min, and to 4.0 ± 0.4 ml/kg when ASPIDS was used at 80 ± 6 breaths/min. Measured values of arterial carbon dioxide tension were close to predicted values. Without ASPIDS, total positive end-expiratory pressure and plateau pressure were slightly higher than predicted, and with ASPIDS they were lower than predicted. Conclusion In principle, computer simulation may be used in goal-oriented ventilation in ARDS. Further studies are needed to investigate potential benefits and limitations over extended study periods. PMID:17352801

  11. Air compressor battery duration with mechanical ventilation in a field anesthesia machine.

    PubMed

    Szpisjak, Dale F; Giberman, Anthony A

    2015-05-01

    Compressed air to power field anesthesia machine ventilators may be supplied by air compressor with battery backup. This study determined the battery duration when the compPAC ventilator's air compressor was powered by NiCd battery to ventilate the Vent Aid Training Test Lung modeling high (HC = 0.100 L/cm H2O) and low (LC = 0.020 L/cm H2O) pulmonary compliance. Target tidal volumes (VT) were 500, 750, and 1,000 mL. Respiratory rate = 10 bpm, inspiratory-to-expiratory time ratio = 1:2, and fresh gas flow = 1 L/min air. N = 5 in each group. Control limits were determined from the first 150 minutes of battery power for each run and lower control limit = mean VT - 3SD. Battery depletion occurred when VT was below the lower control limit. Battery duration ranged from 185.8 (±3.2) minutes in the LC-1000 group to 233.3 (±3.6) minutes in the HC-750 group. Battery duration of the LC-1000 group was less than all others (p = 0.027). The differences among the non-LC-1000 groups were not clinically significant. PMID:25939102

  12. Invasive Mechanical Ventilation in California Over 2000-2009: Implications for Emergency Medicine

    E-print Network

    2015-01-01

    cost of an intensive care unit day: the contribution ofcare hospital Skilled nursing facilities In-hospital death Other Unknown Daysday. The masked PDD contains information on all patient discharges from non-federal, acute-care

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2014-01-01

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

  15. Blunt Chest Trauma in Mice after Cigarette Smoke-Exposure: Effects of Mechanical Ventilation with 100 % O2

    PubMed Central

    Wagner, Katja; Gröger, Michael; McCook, Oscar; Scheuerle, Angelika; Asfar, Pierre; Stahl, Bettina; Huber-Lang, Markus; Ignatius, Anita; Jung, Birgit; Duechs, Matthias; Möller, Peter; Georgieff, Michael; Calzia, Enrico; Radermacher, Peter; Wagner, Florian

    2015-01-01

    Cigarette smoking (CS) aggravates post-traumatic acute lung injury and increases ventilator-induced lung injury due to more severe tissue inflammation and apoptosis. Hyper-inflammation after chest trauma is due to the physical damage, the drop in alveolar PO2, and the consecutive hypoxemia and tissue hypoxia. Therefore, we tested the hypotheses that 1) CS exposure prior to blunt chest trauma causes more severe post-traumatic inflammation and thereby aggravates lung injury, and that 2) hyperoxia may attenuate this effect. Immediately after blast wave-induced blunt chest trauma, mice (n=32) with or without 3-4 weeks of CS exposure underwent 4 hours of pressure-controlled, thoraco-pulmonary compliance-titrated, lung-protective mechanical ventilation with air or 100 % O2. Hemodynamics, lung mechanics, gas exchange, and acid-base status were measured together with blood and tissue cytokine and chemokine concentrations, heme oxygenase-1 (HO-1), activated caspase-3, and hypoxia-inducible factor 1-? (HIF-1?) expression, nuclear factor-?B (NF-?B) activation, nitrotyrosine formation, purinergic receptor 2X4 (P2XR4) and 2X7 (P2XR7) expression, and histological scoring. CS exposure prior to chest trauma lead to higher pulmonary compliance and lower PaO2 and Horovitz-index, associated with increased tissue IL-18 and blood MCP-1 concentrations, a 2-4-fold higher inflammatory cell infiltration, and more pronounced alveolar membrane thickening. This effect coincided with increased activated caspase-3, nitrotyrosine, P2XR4, and P2XR7 expression, NF-?B activation, and reduced HIF-1? expression. Hyperoxia did not further affect lung mechanics, gas exchange, pulmonary and systemic cytokine and chemokine concentrations, or histological scoring, except for some patchy alveolar edema in CS exposed mice. However, hyperoxia attenuated tissue HIF-1?, nitrotyrosine, P2XR7, and P2XR4 expression, while it increased HO-1 formation in CS exposed mice. Overall, CS exposure aggravated post-traumatic inflammation, nitrosative stress and thereby organ dysfunction and injury; short-term, lung-protective, hyperoxic mechanical ventilation have no major beneficial effect despite attenuation of nitrosative stress, possibly due to compensation of by regional alveolar hypoxia and/or consecutive hypoxemia, resulting in down-regulation of HIF-1? expression. PMID:26225825

  16. Ventilative cooling

    E-print Network

    Graça, Guilherme Carrilho da, 1972-

    1999-01-01

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

  17. Automatic classification of interference patterns in driven event series: application to single sympathetic neuron discharge forced by mechanical ventilation.

    PubMed

    Porta, A; Montano, N; Furlan, R; Cogliati, C; Guzzetti, S; Gnecchi-Ruscone, T; Malliani, A; Chang, H-S; Staras, K; Gilbey, M P

    2004-10-01

    This study proposes a method for the automatic classification of nonlinear interactions between a strictly periodical event series modelling the activity of an exogenous oscillator working at a fixed and well-known rate and an event series modelling the activity of a self-sustained oscillator forced by the exogenous one. The method is based on a combination of several well-known tools (probability density function of the cyclic relative phase, probability density function of the count of forced events per forcing cycle, conditional entropy of the cyclic relative phase sequence and a surrogate data approach). Classification is reached via a sequence of easily applicable decision rules, thus rendering classification virtually user-independent and fully reproducible. The method classifies four types of dynamics: full uncoupling, quasiperiodicity, phase locking and aperiodicity. In the case of phase locking, the coupling ratio (i.e. n: m) and the strength of the coupling are calculated. The method, validated on simulations of simple and complex phase-locking dynamics corrupted by different levels of noise, is applied to data derived from one anesthetized and artificially ventilated rat to classify the nonlinear interactions between mechanical ventilation and: (1) the discharges of two (contemporaneously recorded) single postganglionic sympathetic neurons innervating the caudal ventral artery in the tail and (2) arterial blood pressure. Under central apnea, the activity of the underlying sympathetic oscillators is perturbed by means of five different lung inflation rates (0.58, 0.64, 0.76, 0.95, 1.99 Hz). While ventilation and arterial pressure are fully uncoupled, ventilation is capable of phase locking sympathetic discharges, thus producing 40% of phase-locked patterns (one case of 2:5, 1:1, 3:2 and 2:2) and 40% of aperiodic dynamics. In the case of phase-locked patterns, the coupling strength is low, thus demonstrating that this pattern is sliding. Non-stationary interactions are observed in 20% of cases. The two discharges behave differently, suggesting the presence of a population of sympathetic oscillators working at different frequencies. PMID:15378378

  18. Mechanisms of gas transport during ventilation by high-frequency oscillation.

    PubMed

    Chang, H K

    1984-03-01

    Ventilation by high-frequency oscillation (HFO) presents some difficulties in understanding exactly how gas is transported in the lung. However, at a qualitative level, five modes of transport may be identified: 1) direct alveolar ventilation in the lung units situated near the airway opening; 2) bulk convective mixing in the conducting airways as a result of recirculation of air among units of inhomogeneous time constants; 3) convective transport of gases as a result of the asymmetry between inspiratory and expiratory velocity profiles; 4) longitudinal dispersion caused by the interaction between axial velocities and radial transports due to turbulent eddies and/or secondary swirling motions; and 5) molecular diffusion near the alveolocapillary membrane. These modes of transport are not mutually exclusive and certainly interact. It is therefore difficult to make quantitative predictions about the overall rate of transport. Qualitatively, it may now be stated with confidence that convective transport in the tracheobronchial tree is very important during HFO as in normal breathing and that increasing tidal volume is more effective than increasing frequency in improving gas exchange during HFO. To optimize the gas transport efficiency of HFO, future research should focus on identifying the rate-limiting mode of transport for a given set of geometric and dynamic conditions. PMID:6368498

  19. Adaptive lung ventilation.

    PubMed

    Linton, D M

    2001-09-01

    Adaptive lung ventilation (ALV) is a method of closed-loop mechanical ventilation analogous to modern closed-loop technology in aviation such as the autopilot and automatic landing system. The algorithm of the controller of ALV is designed to automatically provide pressure-controlled synchronized intermittent mandatory ventilation (P-SIMV) and weaning as individually required in any clinical situation. The synchronized pressure limited breaths constantly adapt to the patient requirements to encourage optimal alveolar ventilation with minimal adverse physiological disturbance and timely weaning. The ease of application, efficiency, and safety of the first ALV controllers have been demonstrated in lung models, in patients with normal lungs undergoing general anesthesia, in patients requiring unusual positioning, in transition to and from one-lung anesthesia, and in long-term ventilation of patients with various lung pathologies and in weaning patients who have restrictive or obstructive pulmonary disease. Prospective comparative studies of ALV versus other currently used manually selected modes of mechanical ventilation, such as the one reported in this article, should confirm the safety and identify the benefits of this form of advanced closed-loop mechanical ventilation technology. PMID:11517031

  20. Effect of Tracheostomy on Weaning Parameters in Difficult-to-Wean Mechanically Ventilated Patients: A Prospective Observational Study

    PubMed Central

    Lim, Chor-Kuan; Ruan, Sheng-Yuan; Lin, Feng-Ching; Wu, Chao-Ling; Chang, Hou-Tai; Jerng, Jih-Shuin; Wu, Huey-Dong; Yu, Chong-Jen

    2015-01-01

    Background and Objective Weaning parameters are commonly measured through an endotracheal tube in mechanically ventilated patients recovering from acute respiratory failure, however this practice has rarely been evaluated in tracheostomized patients. This study aimed to investigate changes in weaning parameters measured before and after tracheostomy, and to explore whether the data measured after tracheostomy were associated with weaning outcomes in difficult-to-wean patients. Methods In a two-year study period, we enrolled orotracheally intubated patients who were prepared for tracheostomy due to difficult weaning. Weaning parameters were measured before and after the conversion to tracheostomy and compared, and the post-tracheostomy data were tested for associations with weaning outcomes. Results A total of 86 patients were included. After tracheostomy, maximum inspiratory pressure (mean difference (?) = 4.4, 95% CI, 2.7 to 6.1, P<0.001), maximum expiratory pressure (? = 5.4, 95% CI, 2.9 to 8.0, P<0.001) and tidal volume (? = 33.7, 95% CI, 9.0 to 58.5, P<0.008) significantly increased, and rapid shallow breathing index (? = -14.6, 95% CI, -25.4 to -3.7, P<0.009) and airway resistance (? = -4.9, 95% CI, -5.8 to -4.0, P<0.001) significantly decreased. The patients who were successfully weaned within 90 days of the initiation of mechanical ventilation had greater increments in maximum inspiratory pressure (5.9 vs. 2.4, P = 0.04) and maximum expiratory pressure (8.0 vs. 2.0, P = 0.02) after tracheostomy than those who were unsuccessfully weaned. Conclusions In conclusion, the conversion from endotracheal tube to tracheostomy significantly improved the measured values of weaning parameters in difficult-to-wean patients who subsequently weaned successfully from the mechanical ventilator. The change was significant only for airway resistance in patients who failed weaning. Trial Registration ClinicalTrials.gov NCT01312142 PMID:26379127

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

    SciTech Connect

    Sherman, Max H.; Walker, Iain S.

    2011-04-01

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

  2. Neurally adjusted ventilator assist in very low birth weight infants: Current status.

    PubMed

    Narchi, Hassib; Chedid, Fares

    2015-06-26

    Continuous improvements in perinatal care have resulted in increased survival of premature infants. Their immature lungs are prone to injury with mechanical ventilation and this may develop into chronic lung disease (CLD) or bronchopulmonary dysplasia. Strategies to minimize the risk of lung injury have been developed and include improved antenatal management (education, regionalization, steroids, and antibiotics), exogenous surfactant administration and reduction of barotrauma by using exclusive or early noninvasive ventilatory support. The most frequently used mode of assisted ventilation is pressure support ventilation that may lead to patient-ventilator asynchrony that is associated with poor outcome. Ventilator-induced diaphragmatic dysfunction or disuse atrophy of diaphragm fibers may also occur. This has led to the development of new ventilation modes including neurally adjusted ventilatory assist (NAVA). This ventilation mode is controlled by electrodes embedded within a nasogastric catheter which detect the electrical diaphragmatic activity (Edi) and transmit it to trigger the ventilator in synchrony with the patient's own respiratory efforts. This permits the patient to control peak inspiratory pressure, mean airway pressure and tidal volume. Back up pressure control (PC) is provided when there is no Edi signal and no pneumatic trigger. Compared with standard conventional ventilation, NAVA improves blood gas regulation with lower peak inspiratory pressure and oxygen requirements in preterm infants. NAVA is safe mode of ventilation. The majority of studies have shown no significant adverse events in neonates ventilated with NAVA nor a difference in the rate of intraventricular hemorrhage, pneumothorax, or necrotizing enterocolitis when compared to conventional ventilation. Future large size randomized controlled trials should be established to compare NAVA with volume targeted and pressure controlled ventilation in newborns with mature respiratory drive. Most previous studies and trials were not sufficiently large and did not include long-term patient oriented outcomes. Multicenter, randomized, outcome trials are needed to determine whether NAVA is effective in avoiding intubation, facilitating extubation, decreasing time of ventilation, reducing the incidence of CLD, decreasing length of stay, and improving long-term outcomes such as the duration of ventilation, length of hospital stay, rate of pneumothorax, CLD and other major complications of prematurity. In order to prevent barotrauma, next generations of NAVA equipment for neonatal use should enable automatic setting of ventilator parameters in the backup PC mode based on the values generated by NAVA. They should also include an upper limit to the inspiratory time as in conventional ventilation. The manufacturers of Edi catheters should produce smaller sizes available for extreme low birth weight infants. Newly developed ventilators should also include leak compensation and high frequency ventilation. A peripheral flow sensor is also essential to the proper delivery of all modes of conventional ventilation as well as NAVA. PMID:26140273

  3. Neurally adjusted ventilator assist in very low birth weight infants: Current status

    PubMed Central

    Narchi, Hassib; Chedid, Fares

    2015-01-01

    Continuous improvements in perinatal care have resulted in increased survival of premature infants. Their immature lungs are prone to injury with mechanical ventilation and this may develop into chronic lung disease (CLD) or bronchopulmonary dysplasia. Strategies to minimize the risk of lung injury have been developed and include improved antenatal management (education, regionalization, steroids, and antibiotics), exogenous surfactant administration and reduction of barotrauma by using exclusive or early noninvasive ventilatory support. The most frequently used mode of assisted ventilation is pressure support ventilation that may lead to patient-ventilator asynchrony that is associated with poor outcome. Ventilator-induced diaphragmatic dysfunction or disuse atrophy of diaphragm fibers may also occur. This has led to the development of new ventilation modes including neurally adjusted ventilatory assist (NAVA). This ventilation mode is controlled by electrodes embedded within a nasogastric catheter which detect the electrical diaphragmatic activity (Edi) and transmit it to trigger the ventilator in synchrony with the patient’s own respiratory efforts. This permits the patient to control peak inspiratory pressure, mean airway pressure and tidal volume. Back up pressure control (PC) is provided when there is no Edi signal and no pneumatic trigger. Compared with standard conventional ventilation, NAVA improves blood gas regulation with lower peak inspiratory pressure and oxygen requirements in preterm infants. NAVA is safe mode of ventilation. The majority of studies have shown no significant adverse events in neonates ventilated with NAVA nor a difference in the rate of intraventricular hemorrhage, pneumothorax, or necrotizing enterocolitis when compared to conventional ventilation. Future large size randomized controlled trials should be established to compare NAVA with volume targeted and pressure controlled ventilation in newborns with mature respiratory drive. Most previous studies and trials were not sufficiently large and did not include long-term patient oriented outcomes. Multicenter, randomized, outcome trials are needed to determine whether NAVA is effective in avoiding intubation, facilitating extubation, decreasing time of ventilation, reducing the incidence of CLD, decreasing length of stay, and improving long-term outcomes such as the duration of ventilation, length of hospital stay, rate of pneumothorax, CLD and other major complications of prematurity. In order to prevent barotrauma, next generations of NAVA equipment for neonatal use should enable automatic setting of ventilator parameters in the backup PC mode based on the values generated by NAVA. They should also include an upper limit to the inspiratory time as in conventional ventilation. The manufacturers of Edi catheters should produce smaller sizes available for extreme low birth weight infants. Newly developed ventilators should also include leak compensation and high frequency ventilation. A peripheral flow sensor is also essential to the proper delivery of all modes of conventional ventilation as well as NAVA. PMID:26140273

  4. Industrial ventilation

    NASA Astrophysics Data System (ADS)

    Goodfellow, H. D.

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

  5. Fuzzy logic assisted control of inspired oxygen in ventilated newborn infants.

    PubMed Central

    Sun, Y.; Kohane, I.; Stark, A. R.

    1994-01-01

    The control of oxygen delivery to mechanically ventilated newborn infants is a time intensive process that must balance adequate tissue oxygenation against possible toxic effects of oxygen exposure. Investigation in computer assisted control of mechanical ventilation is increasing, although very few studies involve newborn infants. We have implemented a fuzzy controller for the adjustment of inspired oxygen concentration (FIO2) in ventilated newborns. The controller utilizes rules produced by neonatologists, and operates in real-time. A clinical trial of this controller is currently taking place in the neonatal intensive care unit (NICU) of Children's Hospital, Boston, MA. PMID:7950026

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

    PubMed Central

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

    2014-01-01

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

  7. A 2015 Update on Ventilator-Associated Pneumonia: New Insights on Its Prevention, Diagnosis, and Treatment.

    PubMed

    Waters, Braden; Muscedere, John

    2015-08-01

    Ventilator-associated pneumonia (VAP), an infection of the lower respiratory tract which occurs in association with mechanical ventilation, is one of the most common causes of nosocomial infection in the intensive care unit (ICU). VAP causes significant morbidity and mortality in critically ill patients including increased duration of mechanical ventilation, ICU stay and hospitalization. Current knowledge for its prevention, diagnosis and management is therefore important clinically and is the basis for this review. We discuss recent changes in VAP surveillance nomenclature incorporating ventilator-associated conditions and ventilator-associated events, terms recently proposed by the Centers for Disease Control. To the extent possible, we rely predominantly on data from randomized control trials (RCTs) and meta-analyses. PMID:26115700

  8. Oral Chlorhexidine Use to Prevent Ventilator-Associated Pneumonia in Adults: Review of the Current Literature.

    PubMed

    Zuckerman, Lisa M

    2016-01-01

    Ventilator-associated pneumonia (VAP) describes pneumonia in patients requiring mechanical ventilation that was not present prior to intubation. Ventilator-associated pneumonia concurrently increases patient mortality, hospital length of stay, and health care costs. Ventilator-associated pneumonia also contributes to patient morbidity, which is challenging the progression of patient care in intensive care units throughout the United States. Through critique of current literature, suitable interventions for intensive care unit implementation to prevent VAP are clearly identified. Oral health was shown in this literature to greatly contribute to the development or prevention of VAP; it can be compromised by critical illness and mechanical ventilation while being influenced by nursing care. Oral health is managed by proper oral care using oral chlorhexidine in order to decrease oral bacteria and potential oropharynx colonization. The previously mentioned literature review demonstrates a decrease in VAP rates with the use of such oral interventions as chlorhexidine. These research results will support and influence patient care practices considering nursing and medicine are driven by evidence rather than experience to prevent avoidable patient harm. PMID:26627070

  9. Closed loop control of oxgenation and ventilation.

    PubMed

    Johannigman, Jay; Branson, Richard D; Muskat, Peter; Barnes, Stephen L; Beck, George

    2007-07-01

    Closed loop control of oxygenation and ventilation during mechanical ventilatory support is essential for remote medical care in an austere environment. Closed loop control allows for expert systems to provide the current standard of care in the absence of on-site expertise. Ventilation may be controlled by simple systems incorporating patient height or by advanced systems incorporating measurements of end-tidal carbon dioxide (ETCO2) and pulmonary impedance. Oxygenation may be controlled by adjustments of inspired oxygen concentrations (FIO2) and positive end-expiratory pressure (PEEP) using pulse oximetry (SpO2) as the input. Control of oxygenation can prevent hypoxemia and has the potential to reduce oxygen requirements. A double closed loop system of oxygenation control including control of FIO2 via SpO2 and control of oxygen generation by a portable oxygen generator (POG) based on FIO2 and minute ventilation (VE) promises safety and efficiency. Remote control of ventilation and oxygenation is possible using existing technology. PMID:18372690

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

    ERIC Educational Resources Information Center

    Hawkinson, Laura E.

    2011-01-01

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

  11. Prophylactic Antibiotics May Improve Outcome in Patients With Severe Burns Requiring Mechanical Ventilation: Propensity Score Analysis of a Japanese Nationwide Database

    PubMed Central

    Tagami, Takashi; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

    2016-01-01

    Background.?The use of prophylactic antibiotics for severe burns in general settings remains controversial and is not suggested by recent guidelines owing to lack of evidence for efficacy. We examined the hypothesis that prophylactic systemic antibiotic therapy may reduce mortality in patients with severe burns. Methods.?We identified 2893 severe burns patients (burn index ?10) treated at 583 hospitals between July 2010 and March 2013 using the Japanese diagnosis procedure combination inpatient database. We categorized the patients according to whether they received mechanical ventilation within 2 days after admission (n = 692) or not (n = 2201). We further divided the patients into those with and without prophylactic antibiotics and generated 232 and 526 propensity score–matched pairs, respectively. We evaluated 28-day all-cause in-hospital mortality. Results.?Among the mechanically ventilated patients, significant differences in 28-day in-hospital mortality existed between control and prophylaxis groups in both unmatched (control vs prophylaxis; 48.6% vs 38.3%; difference, 10.2%; 95% confidence interval [95% CI], 2.7 to 17.7) and propensity score–matched groups (47.0% vs 36.6%; difference, 10.3%; 95% CI, 1.4 to 19.3). Among patients without mechanical ventilation, there was no significant difference in 28-day in-hospital mortality between the 2 groups in both the unmatched (control vs prophylaxis; 7.0% vs 5.8%; difference, 1.2%; 95% CI, ?1.2 to 3.5) and propensity-matched groups (5.1% vs 4.2%; difference, 0.9%; 95% CI, ?1.6 to 3.5). Conclusions.?Prophylactic antibiotics use may result in improved 28-day in-hospital mortality in mechanically ventilated patients with severe burns but not in those who do not receive mechanical ventilation.

  12. 46 CFR 185.352 - Ventilation of gasoline machinery spaces.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...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,...

  13. 46 CFR 127.260 - Ventilation for accommodations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  14. 46 CFR 185.352 - Ventilation of gasoline machinery spaces.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...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,...

  15. 24 CFR 3280.710 - Venting, ventilation and combustion air.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 2013-04-01 false Venting, ventilation and combustion air. 3280.710 ...Burning Systems § 3280.710 Venting, ventilation and combustion air. (a) The venting...instructions. Gravity or mechanical ventilation shall be installed within a...

  16. 24 CFR 3280.710 - Venting, ventilation and combustion air.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 2010-04-01 false Venting, ventilation and combustion air. 3280.710 ...Burning Systems § 3280.710 Venting, ventilation and combustion air. (a) The venting...instructions. Gravity or mechanical ventilation shall be installed within a...

  17. 46 CFR 127.260 - Ventilation for accommodations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  18. 24 CFR 3280.710 - Venting, ventilation and combustion air.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 2012-04-01 false Venting, ventilation and combustion air. 3280.710 ...Burning Systems § 3280.710 Venting, ventilation and combustion air. (a) The venting...instructions. Gravity or mechanical ventilation shall be installed within a...

  19. 46 CFR 127.260 - Ventilation for accommodations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 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,...

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...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,...

  2. 24 CFR 3280.710 - Venting, ventilation and combustion air.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 2011-04-01 false Venting, ventilation and combustion air. 3280.710 ...Burning Systems § 3280.710 Venting, ventilation and combustion air. (a) The venting...instructions. Gravity or mechanical ventilation shall be installed within a...

  3. 24 CFR 3280.710 - Venting, ventilation and combustion air.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 2014-04-01 false Venting, ventilation and combustion air. 3280.710 ...Burning Systems § 3280.710 Venting, ventilation and combustion air. (a) The venting...instructions. Gravity or mechanical ventilation shall be installed within a...

  4. 46 CFR 127.260 - Ventilation for accommodations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  5. 46 CFR 185.352 - Ventilation of gasoline machinery spaces.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...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,...

  6. 46 CFR 127.260 - Ventilation for accommodations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  7. Caregiver suctioning education for Japanese patients with an invasive home ventilator.

    PubMed

    Imaiso, Junko; Yamauchi, Toyoaki

    2009-12-01

    In Japan, more people require care activities at home. In particular, patients with an invasive mechanical ventilator in the home require extensive care by family caregivers. Collaboration between their nurses and paid caregivers in the provision of care activities, especially tracheal suctioning, is necessary. This three-round Delphi study identifies the essential items required by nurses to instruct the paid caregivers in how to carry out tracheal suctioning on patients with an invasive mechanical ventilator in the home. By the final round, three competencies were found to be important by the home-visit nurses and paid caregivers: the anticipation of risk, the manner of handling an emergency situation, and the observation of a patient's breathing. The Delphi technique was used to obtain consensus between the home-visit nurses and the paid caregivers regarding the essential knowledge, skills, and attitudes required to carry out tracheal suctioning for patients with an invasive mechanical ventilator in the home. PMID:19909452

  8. Heat shock protein 70 secretion by neonatal tracheal tissue during mechanical ventilation: association with indices of tissue function and modeling

    PubMed Central

    Chong, Euming; Dysart, Kevin C.; Chidekel, Aaron; Locke, Robert; Shaffer, Thomas H.; Miller, Thomas L.

    2009-01-01

    Mechanical ventilation (MV) of the neonatal airway alters mechanical properties and activates tissue-modeling pathways. Heat shock protein (HSP70) is a marker of tissue injury and modulates inflammation, which may influence subsequent pulmonary tissue modeling by matrix metalloproteinases (MMPs). HSP70 secretion is up regulated in MV airway tissues and associated with changes in airway elasticity and secretion of MMPs. Proximal tracheal segments were isolated in 13 newborn lambs and were either MV for 4 hr or SHAM. At baseline and hourly, tracheal segments were flushed and tracheal elasticity was determined. Tracheal wash fluid was assayed for HSP70 by ELISA and for MMPs by substrate zymography. HSP70 secretion increased from baseline to a peak at 1 hr in both groups (p<0.01), greater in the MV group (p<0.05), and returned to baseline values by 2 hr. This response was in contrast to the progressive decrease in tracheal elasticity (p<0.05). The HSP70 elevation pattern was noted in MMP-2, but beyond 1 hr, MMP-2 returned to baseline values in MV group but remained elevated in SHAM (p<0.05). HSP70 secretion is associated with the degree of biophysical tracheal injury as well as the time course of MMP-2 secretion by tracheal tissues. PMID:19127221

  9. Noninvasive Mechanical Ventilation in Helicopter Emergency Medical Services Saves Time and Oxygen and Improves Patient and Mission Safety: A Pilot Study.

    PubMed

    Garrote, Jose Ignacio; Aylagas, Diego; Gutierrez, Jose M; Sinisterra, Juan A; Gowran, Brian Mc; Medina, Alberto; Díaz-Tendero, Javier; Gómez-Calcerrada, Pablo; Crespo, Ricardo

    2015-01-01

    Noninvasive mechanical ventilation (NIMV) is used increasingly in patients with severe respiratory distress and has clear benefits over standard medical therapy (SMT) in terms of patient safety. NIMV is particularly useful in cardiogenic acute pulmonary edema and in exacerbations of chronic obstructive pulmonary disease, both of which are frequent reasons for an emergency medical services dispatch. Early use of NIMV avoids complications in these patients in many cases. To date, the use of noninvasive positive-pressure ventilation in the air medical environment has been minimally researched. We evaluated NIMV versus SMT in the helicopter emergency medical services environment in patients with cardiogenic acute pulmonary edema and exacerbated chronic obstructive pulmonary disease. The parameters assessed were stabilization time, tolerance, safety, clinical response, and oxygen consumption. Bilevel noninvasive positive-pressure ventilation was the ventilatory mode used for all patients. The technique of NIMV in medical air transport is useful, easy to operate, and safe. It offers increased patient safety, reducing the need for invasive mechanical ventilation and its complications; better intervention times (35.8 minutes [NIMV] vs. 57.65 minutes [SMT], P < .05); improvement in aircraft operability; and a reduction in oxygen consumption (6.2 L/min vs. 9.8 L/min, P < .05), contributing to mission operability and safety. PMID:26206548

  10. 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, 2013 CFR

    2013-07-01

    ... ADMINISTRATION, DEPARTMENT OF LABOR METAL AND 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... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Mechanical ventilation (I-A, I-B, I-C, II-A,...

  11. 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

    2011-07-01

    ... ADMINISTRATION, DEPARTMENT OF LABOR METAL AND 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... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Mechanical ventilation (I-A, I-B, I-C, II-A,...

  12. 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, 2014 CFR

    2014-07-01

    ... ADMINISTRATION, DEPARTMENT OF LABOR METAL AND 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... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Mechanical ventilation (I-A, I-B, I-C, II-A,...

  13. 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

    2010-07-01

    ... ADMINISTRATION, DEPARTMENT OF LABOR METAL AND 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... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Mechanical ventilation (I-A, I-B, I-C, II-A,...

  14. 30 CFR 57.22201 - Mechanical ventilation (I-A, I-B, I-C, II-A, II-B, III, IV, V-A, and V-B mines).

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... ADMINISTRATION, DEPARTMENT OF LABOR METAL AND 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... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Mechanical ventilation (I-A, I-B, I-C, II-A,...

  15. Ventilation Model

    SciTech Connect

    H. Yang

    1999-11-04

    The purpose of this analysis and model report (AMR) for the Ventilation Model is to analyze the effects of pre-closure continuous ventilation in the Engineered Barrier System (EBS) emplacement drifts and provide heat removal data to support EBS design. It will also provide input data (initial conditions, and time varying boundary conditions) for the EBS post-closure performance assessment and the EBS Water Distribution and Removal Process Model. The objective of the analysis is to develop, describe, and apply calculation methods and models that can be used to predict thermal conditions within emplacement drifts under forced ventilation during the pre-closure period. The scope of this analysis includes: (1) Provide a general description of effects and heat transfer process of emplacement drift ventilation. (2) Develop a modeling approach to simulate the impacts of pre-closure ventilation on the thermal conditions in emplacement drifts. (3) Identify and document inputs to be used for modeling emplacement ventilation. (4) Perform calculations of temperatures and heat removal in the emplacement drift. (5) Address general considerations of the effect of water/moisture removal by ventilation on the repository thermal conditions. The numerical modeling in this document will be limited to heat-only modeling and calculations. Only a preliminary assessment of the heat/moisture ventilation effects and modeling method will be performed in this revision. Modeling of moisture effects on heat removal and emplacement drift temperature may be performed in the future.

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

    PubMed Central

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

    2012-01-01

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

  17. Findings of the International Nosocomial Infection Control Consortium (INICC), Part II: Impact of a multidimensional strategy to reduce ventilator-associated pneumonia in neonatal intensive care units in 10 developing countries.

    PubMed

    Rosenthal, Victor D; Rodríguez-Calderón, Maria E; Rodríguez-Ferrer, Marena; Singhal, Tanu; Pawar, Mandakini; Sobreyra-Oropeza, Martha; Barkat, Amina; Atencio-Espinoza, Teodora; Berba, Regina; Navoa-Ng, J A; Dueñas, Lourdes; Ben-Jaballah, Nejla; Ozdemir, Davut; Ersoz, Gulden; Aygun, Canan

    2012-07-01

    Design.?Before-after prospective surveillance study to assess the efficacy of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control program to reduce the rate of occurrence of ventilator-associated pneumonia (VAP). Setting.?Neonatal intensive care units (NICUs) of INICC member hospitals from 15 cities in the following 10 developing countries: Argentina, Colombia, El Salvador, India, Mexico, Morocco, Peru, Philippines, Tunisia, and Turkey. Patients.?NICU inpatients. Methods.?VAP rates were determined during a first period of active surveillance without the implementation of the multidimensional approach (phase 1) to be then compared with VAP rates after implementation of the INICC multidimensional infection control program (phase 2), which included the following practices: a bundle of infection control interventions, education, outcome surveillance, process surveillance, feedback on VAP rates, and performance feedback on infection control practices. This study was conducted by infection control professionals who applied National Health Safety Network (NHSN) definitions for healthcare-associated infections and INICC surveillance methodology. Results.?During phase 1, we recorded 3,153 mechanical ventilation (MV)-days, and during phase 2, after the implementation of the bundle of interventions, we recorded 15,981 MV-days. The VAP rate was 17.8 cases per 1,000 MV-days during phase 1 and 12.0 cases per 1,000 MV-days during phase 2 (relative risk, 0.67 [95% confidence interval, 0.50-0.91]; [Formula: see text]), indicating a 33% reduction in VAP rate. Conclusions.?Our results demonstrate that an implementation of the INICC multidimensional infection control program was associated with a significant reduction in VAP rate in NICUs in developing countries. PMID:22669232

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

    SciTech Connect

    Huang, Chien-Sheng; Division of Thoracic Surgery, Department of Surgery, Taipei-Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan ; Kawamura, Tomohiro; Peng, Ximei; Tochigi, Naobumi; Shigemura, Norihisa; Billiar, Timothy R.; Nakao, Atsunori; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA ; Toyoda, Yoshiya

    2011-05-06

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

  19. Evaluation of a decision aid for making choices about intubation and mechanical ventilation in chronic obstructive pulmonary disease.

    PubMed

    Wilson, Keith G; Aaron, Shawn D; Vandemheen, Katherine L; Hébert, Paul C; McKim, Douglas A; Fiset, Valerie; Graham, Ian D; Sevigny, Elyse; O'Connor, Annette M

    2005-04-01

    To assist patients with chronic obstructive pulmonary disease (COPD) in advance planning for life-threatening exacerbations, we developed a structured decision aid that describes the process, risks, and outcomes of intubation and mechanical ventilation (MV). Thirty-three patients with severe COPD took part in a before-after evaluation study. At baseline, only two participants (6%) reported that they had already made an advance decision about MV. After reviewing the decision aid, 31 participants (94%) reported that they had made a choice, which in 23 cases (74% of those deciding) was to forego MV. These choices were associated with more accurate expectations of MV outcome, and reduced decisional conflict. Qualitatively, participants who would accept MV emphasized their wish to prolong life, whereas those who would forego MV were more influenced by the burdens of treatment and the perception of a poor long-term outcome. However, there was evidence that 24% of participants did not completely comprehend the decision aid and 27% found the experience to be stressful. These findings indicate that a decision aid for MV helps patients plan for life-threatening exacerbations, and may be a useful adjunct to counseling for some patients with severe COPD. PMID:15797156

  20. Non invasive ventilation.

    PubMed

    Sidhu, U S; Simonds, A K

    2000-04-01

    Non-invasive ventilation refers to the technique of providing ventilatory support to a patient without an endo/orotracheal airway. It is a promising and rapidly upcoming new technique and is being used as first line therapy in a wide variety of conditions causing respiratory failure. The major indications for its use include respiratory failure due to a variety of causes (chest wall abnormalities, neuromuscular disease, COPD), weaning and stabilization of cardio-respiratory status before and after surgery. Patients who are candidates for this modality usually have a hypercapnic respiratory failure but are able to protect the airway and cooperate with treatment. The biggest advantage of the technique is its simplicity and avoidance of complications of intubation like trauma, infection and delayed complications like tracheal stenosis. Patient comfort is significantly improved and important functions like speech, swallowing and cough are preserved. Several purpose built ventilators are available for use including pressure preset and volume present machines, each of which have their own advantages and disadvantages in clinical practice. A range of patient interfaces is available. The initiation of non-invasive ventilation is much easier as compared to invasive ventilation and can be done for most patients in an intermediary care unit thereby cutting down treatment costs and saving precious intensive care beds. Titration of ventilatory parameters can usually be done using simple tests like oxymetry and blood gases. Several technique related problems like skin pressure sores, nasal symptoms and abdominal distension can be managed with simple measures. Non invasive ventilation has got a special and evolving role in management of COPD, both in acute exacerbations and chronic respiratory failure. In short, the advantages of this form of ventilation are numerous and physicians must familiarize themselves with this new technique, facilities for which should be available in all hospitals admitting patients with respiratory failure. PMID:11273177

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

    PubMed Central

    2014-01-01

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

  2. Pretest Predictions for Ventilation Tests

    SciTech Connect

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

    2007-01-17

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

  3. Ventilation Model

    SciTech Connect

    V. Chipman

    2002-10-05

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

  4. Noninvasive ventilation in acute respiratory failure

    PubMed Central

    Mas, Arantxa; Masip, Josep

    2014-01-01

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

  5. Precalcitonin and C-reactive protein as markers in response to antibiotic treatment in ventilator-associated pneumonia in intensive care unit-hospitalized patients

    PubMed Central

    Kiaei, Babak Ali; Ghiasi, Farzin; Moradi, Daryoush

    2015-01-01

    Background: Pneumonia due to ventilator is a prevalent nosocomial infection associated with high morbidity and mortality. This study aimed to determine the change in serum levels of precalcitonin (PCT) and C-reactive protein (CRP) in response to antibiotic treatment in patients hospitalized in intense care unit (ICU) suffering from ventilator-associated pneumonia (VAP). Materials and Methods: This is an analytical and descriptive study performed in 2013 in Ayatollah Kashani Medical Training Center, Isfahan, Iran. The statistical sample includes patients hospitalized in ICU in 2013 suffering from VAP. In this study, 50 patients suffering from VAP were selected, and PCT and CRP levels were measured in them before antibiotic therapy and every 48 h until the end of therapy. The collected data were analyzed by SPSS software. Results: CRP and PCT levels were high before the beginning of antibiotic therapy in all patients suffering from VAP and their CRP level had an increasing trend until 4 days after the beginning of therapy; however, from the 4th day, it turned into decreasing trend. PCT serum level was higher than normal before the treatment and until 48 h after the therapy, and then it was found to have a decreasing trend. According to variance analysis test with repetition of observations, the mean level of mentioned markers had a meaningful difference before the beginning of antibiotic therapy until the end of antibiotic therapy (P < 0.001). Conclusion: CRP and PCT serum levels can be used as an instrument for determining the effect of antibiotic therapy in patients with VAP. PMID:26682206

  6. 46 CFR 168.15-50 - Ventilation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  7. 9 CFR 91.21 - Ventilation.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

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

  8. 46 CFR 168.15-50 - Ventilation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  9. 9 CFR 91.21 - Ventilation.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  10. 46 CFR 168.15-50 - Ventilation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  11. 46 CFR 168.15-50 - Ventilation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  12. 9 CFR 91.21 - Ventilation.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  13. 9 CFR 91.21 - Ventilation.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

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

  14. 9 CFR 91.21 - Ventilation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  15. Heat recovery ventilators in multifamily residences in the Arctic

    SciTech Connect

    Ninomura, P.T.; Bhargava, R.

    1995-12-31

    Heat recovery ventilators (HRVs) have been utilized in the design of new residential units in Kotzebue, Alaska. This project will provide 50 new residential units for US Public Health Service health care professionals who will be working in a new hospital in Kotzebue. Kotzebue is located just north of the Arctic Circle on the coast of the Arctic Ocean. The ASHRAE 99% design winter condition is {minus}38 F. The prolonged and severe winter conditions warrant construction designed to limit infiltration to the minimum that current construction techniques will allow. Consequently, adequate ventilation can be best ensured by mechanical ventilation provisions. Individual HRVs are provided to ensure compliance with ASHRAE Standard 62-1989. The residential units are heated by a hydronic baseboard fin-tube system. The HRVs provide supply air to the occupiable areas and obtain the exhaust air from the kitchen and bathroom(s).

  16. Liquid ventilation: it's not science fiction anymore.

    PubMed

    Norris, M K; Fuhrman, B P; Leach, C L

    1994-08-01

    Liquid ventilation is, by all initial considerations, an unconventional concept. Decades of research, however, have found that by using perfluorocarbons, which are capable of holding high concentrations of critical gases such as oxygen and carbon dioxide, gas exchange optimal enough to support life is possible with no known toxic effects. The earliest method of liquid ventilation, tidal liquid breathing, involved infusion and active removal of tidal volumes of perfluorocarbons by a liquid ventilator for gas exchange. Recently, a new method of partial liquid breathing, called perfluorocarbon-associated gas exchange, makes the process of liquid ventilation simpler by using conventional gas ventilators. Current research is showing great promise in the use of liquid ventilation for patients with pulmonary pathology. Critical care nurses should become knowledgeable of this new mode of ventilation and be prepared to meet the special needs of this unique population. PMID:7780839

  17. 30 CFR 77.1911 - Ventilation of slopes and shafts.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  18. 30 CFR 77.1911 - Ventilation of slopes and shafts.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 2014-07-01 false Ventilation of slopes and shafts. 77.1911...Slope and Shaft Sinking § 77.1911 Ventilation of slopes and shafts. (a) All...shafts shall be ventilated by mechanical ventilation equipment during development....

  19. Short-Term Prognosis of Mechanically Ventilated Patients With Guillain-Barré Syndrome Is Worsened by Corticosteroids as an Add-On Therapy.

    PubMed

    Wu, Xiujuan; Zhang, Bing; Li, Chunrong; Shen, Donghui; Liu, Kangding; Zhu, Jie; Zhang, Hong-Liang

    2015-10-01

    Intravenous immunoglobulin (IVIg) has been proven most effective in treating Guillain-Barré syndrome (GBS). Corticosteroids as an add-on therapy have been prescribed in severe GBS cases. However, the efficacy of intravenous corticosteroids combined with IVIg in dealing with severe GBS remains unclear. We explored the therapeutic effects of different therapeutic regimens on the short-term prognosis of GBS patients, especially the severe cases.We retrospectively analyzed the clinical data of 527 adult patients with GBS who were prescribed to different treatments from 2003 to 2014. The therapeutic effect of a treatment was evaluated by the improvement of Hughes Functional Grading Scale (HFGS) and Medical Research Council (MRC) sum score.With comparable incidence of infectious complications (P?>?0.05), more mechanically ventilated patients were found improvement after IVIg treatment than combination IVIg with intravenous corticosteroids (MRC: 97% vs. 72.4%, P?mechanical ventilation, incidence of infectious complications (P?>?0.05) and ratio of patients who were improved after IVIg were insignificantly different from the combination therapy (MRC: 89.6% vs. 86.5%; HFGS: 69.6% vs. 61.5%; both P?>?0.05), even if the intravenous corticosteroids were initiated within 7 days after onset (P?>?0.05). In addition, supportive treatment was sufficient for patients who were able to walk with help (HFGS?=?3) and mildly affected (HFGS??3), while corticosteroids are detrimental for short-term prognosis in mechanically ventilated patients when used in combination with IVIg. Further prospective and randomized studies are warranted to validate this finding. PMID:26512609

  20. Numerical study of variable lung ventilation strategies

    E-print Network

    Yadav, Reena; Hiremath, Kirankumar; Bagler, Ganesh

    2015-01-01

    Mechanical ventilation is used for patients with a variety of lung diseases. Traditionally, ventilators have been designed to monotonously deliver equal sized breaths. While it may seem intuitive that lungs may benefit from unvarying and stable ventilation pressure strategy, recently it has been reported that variable lung ventilation is advantageous. In this study, we analyze the mean tidal volume in response to different `variable ventilation pressure' strategies. We found that uniformly distributed variability in pressure gives the best tidal volume as compared to that of normal, scale- free, log normal and linear distributions.

  1. [A case of ventilation disorder and poor oxygenation after changing position from prone to supine].

    PubMed

    Yamaguchi, Satoshi; Hirakawa, Kei; Kitamura, Jiro

    2013-01-01

    A 68-year-old obese woman (BMI 35) underwent posterior lumbar interbody fusion in prone position. Immediately after changing position postoperatively from prone to supine, severe ventilation disorder and poor oxygenation occured. Chest X-ray showed severe atelectasis. Poor oxygenation was suspected to be the result of the atelectasis by the pressure of massive abdominal fatty tissue to the diaphragm. Ventilation disorder was suspected of the bronchospasm associated with inadequate anesthesia. We ventilated her manually with a bag in Fowler position for twenty minutes, and then mechanically by pressure controlled ventilation. She recovered gradually. It is concluded that in obese patients undergoing operation in prone position, changing position should be done very carefully during adequate anesthesia, understanding respiratory physiology in positioning and considering the effect of the abdominal fatty tissue to the diaphragm. PMID:23431901

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

    PubMed Central

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

    2007-01-01

    Catastrophic disasters, particularly a pandemic of influenza, may force difficult allocation decisions when demand for mechanical ventilation greatly exceeds available resources. These situations demand integrated incident management responses on the part of the health care facility and community, including resource management, provider liability protection, community education and information, and health care facility decision-making processes designed to allocate resources as justly as possible. If inadequate resources are available despite optimal incident management, a process that is evidence-based and as objective as possible should be used to allocate ventilators. The process and decision tools should be codified pre-event by the local and regional healthcare entities, public health agencies, and the community. A proposed decision tool uses predictive scoring systems, disease-specific prognostic factors, response to current mechanical ventilation, duration of current and expected therapies, and underlying disease states to guide decisions about which patients will receive mechanical ventilation. Although research in the specifics of the decision tools remains nascent, critical care physicians are urged to work with their health care facilities, public health agencies, and communities to ensure that a just and clinically sound systematic approach to these situations is in place prior to their occurrence. PMID:17601354

  3. [Respiratory function monitoring in a child on mechanical respiratory ventilation. 2: compliance, resistance, dynamic hyperinflation, pulmonary dead-space, work of breathing].

    PubMed

    López-Herce Cid, J

    2003-09-01

    Several parameters can be used to study respiratory mechanics in children on mechanical ventilation. Compliance is a measure of the distensibility of the respiratory system. In mechanical ventilation two measures of compliance can be used. Static compliance (pulmonary distensibility) can be measured in volume modes by the application of an inspiratory pause with the respiratory system at rest (sedated patients without inspiratory effort). Dynamic compliance does not require an inspiratory pause and the respiratory system need not be at rest. Compliance can be calculated numerically or expressed graphically in the volume-pressure curve. Many respirators can calculate inspiratory and expiratory airway resistance (including endotracheal tube resistance). Several measures can be used to detect dynamic hyperinflation (intrinsic PEEP, auto-PEEP, trapped air volume) after application of an expiratory pause. The latest respirators can perform these measurements almost automatically. Work of breathing and respiratory effort can also be analyzed by measuring several parameters (pressure-time product, imposed work of breathing, P 0.1, maximum inspiratory pressure). However, these measures have not yet been standardized in children. PMID:14598802

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

    PubMed Central

    2011-01-01

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

  5. Anemia in the long-term ventilator-dependent patient with respiratory failure.

    PubMed

    Silver, Michael R

    2005-11-01

    Anemia occurs in virtually all critically ill patients receiving long-term mechanical ventilation and has been associated with increased mortality and poor outcomes. Allogeneic RBC transfusions are routinely administered to critically ill anemic patients, especially during lengthy stays in ICUs or in long-term acute care facilities. Although RBC transfusions are a physiologically rational approach to raising hemoglobin levels, they may increase the risk of complications and have been associated with higher mortality in critically ill patients. Treatment with epoetin alfa, an erythropoiesis-stimulating agent, as a means of reducing transfusion requirements has been studied in the critically ill and in patients receiving long-term mechanical ventilation. Promising results have been reported, including a potential survival benefit, although larger and more definitive studies are needed in order to establish whether raising hemoglobin levels affects clinical outcomes in patients receiving mechanical ventilation. PMID:16306055

  6. Comparison of changes in tidal volume associated with expiratory rib cage compression and expiratory abdominal compression in patients on prolonged mechanical ventilation

    PubMed Central

    Morino, Akira; Shida, Masahiro; Tanaka, Masashi; Sato, Kimihiro; Seko, Toshiaki; Ito, Shunsuke; Ogawa, Shunichi; Takahashi, Naoaki

    2015-01-01

    [Purpose] This study was designed to compare and clarify the relationship between expiratory rib cage compression and expiratory abdominal compression in patients on prolonged mechanical ventilation, with a focus on tidal volume. [Subjects and Methods] The subjects were 18 patients on prolonged mechanical ventilation, who had undergone tracheostomy. Each patient received expiratory rib cage compression and expiratory abdominal compression; the order of implementation was randomized. Subjects were positioned in a 30° lateral recumbent position, and a 2-kgf compression was applied. For expiratory rib cage compression, the rib cage was compressed unilaterally; for expiratory abdominal compression, the area directly above the navel was compressed. Tidal volume values were the actual measured values divided by body weight. [Results] Tidal volume values were as follows: at rest, 7.2 ± 1.7?mL/kg; during expiratory rib cage compression, 8.3 ± 2.1?mL/kg; during expiratory abdominal compression, 9.1 ± 2.2?mL/kg. There was a significant difference between the tidal volume during expiratory abdominal compression and that at rest. The tidal volume in expiratory rib cage compression was strongly correlated with that in expiratory abdominal compression. [Conclusion] These results indicate that expiratory abdominal compression may be an effective alternative to the manual breathing assist procedure. PMID:26311963

  7. Results of the Evaluation Study DeAL Decentralized Facade Integrated Ventilation Systems 

    E-print Network

    Mahler, B.; Himmler, R.

    2008-01-01

    Most office buildings in Germany have either no mechanical ventilation system or a centralized ventilation system with fresh and exhaust air supply. Within the last 10 years some projects using decentralized ventilation systems (DVS) came up. Common...

  8. Night ventilation control strategies in office buildings

    SciTech Connect

    Wang, Zhaojun; Yi, Lingli; Gao, Fusheng

    2009-10-15

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

  9. Clinical Verification of A Clinical Decision Support System for Ventilator Weaning

    PubMed Central

    2013-01-01

    Background Weaning is typically regarded as a process of discontinuing mechanical ventilation in the daily practice of an intensive care unit (ICU). Among the ICU patients, 39%-40% need mechanical ventilator for sustaining their lives. The predictive rate of successful weaning achieved only 35-60% for decisions made by physicians. Clinical decision support systems (CDSSs) are promising in enhancing diagnostic performance and improve healthcare quality in clinical setting. To our knowledge, a prospective study has never been conducted to verify the effectiveness of the CDSS in ventilator weaning before. In this study, the CDSS capable of predicting weaning outcome and reducing duration of ventilator support for patients has been verified. Methods A total of 380 patients admitted to the respiratory care center of the hospital were randomly assigned to either control or study group. In the control group, patients were weaned with traditional weaning method, while in the study group, patients were weaned with CDSS monitored by physicians. After excluding the patients who transferred to other hospitals, refused further treatments, or expired the admission period, data of 168 and 144 patients in the study and control groups, respectively, were used for analysis. Results The results show that a sensitivity of 87.7% has been achieved, which is significantly higher (p<0.01) than the weaning determined by physicians (sensitivity: 61.4%). Furthermore, the days using mechanical ventilator for the study group (38.41 ± 3.35) is significantly (p<0.001) shorter than the control group (43.69 ± 14.89), with a decrease of 5.2 days in average, resulting in a saving of healthcare cost of NT$45,000 (US$1,500) per patient in the current Taiwanese National Health Insurance setting. Conclusions The CDSS is demonstrated to be effective in identifying the earliest time of ventilator weaning for patients to resume and sustain spontaneous breathing, thereby avoiding unnecessary prolonged ventilator use and decreasing healthcare cost. PMID:24565021

  10. Study of natural ventilation in buildings with large eddy simulation

    E-print Network

    Jiang, Yi, 1972-

    2002-01-01

    With the discovery of many economic, environmental, and health problems in sealed and mechanically ventilated buildings, the concept of natural ventilation has been revived. "Buildings that breathe" have become more and ...

  11. Modeling buoyancy-driven airflow in ventilation shafts

    E-print Network

    Ray, Stephen D. (Stephen Douglas)

    2012-01-01

    Naturally ventilated buildings can significantly reduce the required energy for cooling and ventilating buildings by drawing in outdoor air using non-mechanical forces. Buoyancy-driven systems are common in naturally ...

  12. [Mechanical ventilation and pulmonary vascular resistance: comparison of IPPV, CPPV, CPAP, and PSV in decompensated chronic obstructive bronchopneumopathy with pulmonary hypertension].

    PubMed

    Rubini, F; Fonzo, R; Dipino, G

    1989-11-01

    Alterations of pulmonary vascular resistance were studied using four different methods of mechanical ventilation. A Servo Ventilator 900 C respirator was used for three of these techniques (IPPV, CPPV and PSV); CPAP was performed using a continuous-flow system because of the latter's advantages compared to demand-flow systems. Five patients (aged 64-75) affected by BPCO uncompensation and pulmonary hypertension (PAP 40 +/- 8 mmHg) were included in the study. A complete hemodynamic test was performed in each patient for each of the methods used by inserting a Swan-Ganz catheter through the right-hand internal jugular vein; intrapleural pressure were also measured using an esophageal balloon. The results of the study revealed a low level of tolerance to CPAP. Of the other methods, PSV was found to be particularly useful since it produced significant constant reductions of PVR and increased levels of CO compared to other techniques. These positive hemodynamic effects may be explained by the pattern of intrapleural pressures and the possibility of "self-adjustment" which this method allows. PMID:2699013

  13. Improved Performance With Ventilation

    NASA Astrophysics Data System (ADS)

    Kawakami, Ellison; Lee, Seung Jae; Karn, Ashish; Hong, Jiarong; Arndt, Roger

    2013-11-01

    Drag reduction and/or speed augmentation of marine vehicles by means of supercavitation is a topic of great interest. During the initial launch of a supercavitating vehicle, ventilation is required to supply an artificial cavity until conditions at which a natural supercavity can be sustained are reached. Various aspects of the flow physics of a supercavitating vehicle have been under investigation for several years at Saint Anthony Falls Laboratory. Both steady flow and simulated flow below a wave train have been studied. Using a high speed camera and the proper software, it is possible to synchronize cavity dimensions with pressure measurements taken inside the cavity to permit an in-depth study of unsteadiness. It was found that flow unsteadiness caused a decrease in the overall length of the supercavity while having only a minimal effect on the maximum diameter. Results regarding supercavity shape, ventilation demand, cavitation parameters and closure methods are reviewed in light of new studies that focused on various closure mechanisms. Drag reduction and/or speed augmentation of marine vehicles by means of supercavitation is a topic of great interest. During the initial launch of a supercavitating vehicle, ventilation is required to supply an artificial cavity until conditions at which a natural supercavity can be sustained are reached. Various aspects of the flow physics of a supercavitating vehicle have been under investigation for several years at Saint Anthony Falls Laboratory. Both steady flow and simulated flow below a wave train have been studied. Using a high speed camera and the proper software, it is possible to synchronize cavity dimensions with pressure measurements taken inside the cavity to permit an in-depth study of unsteadiness. It was found that flow unsteadiness caused a decrease in the overall length of the supercavity while having only a minimal effect on the maximum diameter. Results regarding supercavity shape, ventilation demand, cavitation parameters and closure methods are reviewed in light of new studies that focused on various closure mechanisms. Sponsored by ONR.

  14. 75 FR 48235 - Rural Health Care Universal Service Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-09

    ...as a result of broadband access, the type of health IT applications...and provide reasonable support for the type of health care providers that will...connection supported by such funds, and the type and frequency of utilization of...

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

    PubMed Central

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

    2008-01-01

    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

  16. Development of a Residential Integrated Ventilation Controller

    SciTech Connect

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

    2011-12-01

    The goal of this study was to develop a Residential Integrated Ventilation Controller (RIVEC) to reduce the energy impact of required mechanical ventilation by 20percent, maintain or improve indoor air quality and provide demand response benefits. This represents potential energy savings of about 140 GWh of electricity and 83 million therms of natural gas as well as proportional peak savings in California. The RIVEC controller is intended to meet the 2008 Title 24 requirements for residential ventilation as well as taking into account the issues of outdoor conditions, other ventilation devices (including economizers), peak demand concerns and occupant preferences. The controller is designed to manage all the residential ventilation systems that are currently available. A key innovation in this controller is the ability to implement the concept of efficacy and intermittent ventilation which allows time shifting of ventilation. Using this approach ventilation can be shifted away from times of high cost or high outdoor pollution towards times when it is cheaper and more effective. Simulations, based on the ones used to develop the new residential ventilation requirements for the California Buildings Energy code, were used to further define the specific criteria and strategies needed for the controller. These simulations provide estimates of the energy, peak power and contaminant improvement possible for different California climates for the various ventilation systems. Results from a field test of the prototype controller corroborate the predicted performance.

  17. An intelligent control system for ventilators.

    PubMed

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

    1998-10-01

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

  18. The JAK–STAT Pathway Is Critical in Ventilator-Induced Diaphragm Dysfunction

    PubMed Central

    Tang, Huibin; Smith, Ira J; Hussain, Sabah NA; Goldberg, Peter; Lee, Myung; Sugiarto, Sista; Godinez, Guillermo L; Singh, Baljit K; Payan, Donald G; Rando, Thomas A; Kinsella, Todd M; Shrager, Joseph B

    2014-01-01

    Mechanical ventilation (MV) is one of the lynchpins of modern intensive-care medicine and is life saving in many critically ill patients. Continuous ventilator support, however, results in ventilation-induced diaphragm dysfunction (VIDD) that likely prolongs patients’ need for MV and thereby leads to major associated complications and avoidable intensive care unit (ICU) deaths. Oxidative stress is a key pathogenic event in the development of VIDD, but its regulation remains largely undefined. We report here that the JAK–STAT pathway is activated in MV in the human diaphragm, as evidenced by significantly increased phosphorylation of JAK and STAT. Blockage of the JAK–STAT pathway by a JAK inhibitor in a rat MV model prevents diaphragm muscle contractile dysfunction (by ~85%, p < 0.01). We further demonstrate that activated STAT3 compromises mitochondrial function and induces oxidative stress in vivo, and, interestingly, that oxidative stress also activates JAK–STAT. Inhibition of JAK–STAT prevents oxidative stress-induced protein oxidation and polyubiquitination and recovers mitochondrial function in cultured muscle cells. Therefore, in ventilated diaphragm muscle, activation of JAK–STAT is critical in regulating oxidative stress and is thereby central to the downstream pathogenesis of clinical VIDD. These findings establish the molecular basis for the therapeutic promise of JAK–STAT inhibitors in ventilated ICU patients. PMID:25286450

  19. VENTILATION NEEDS DURING CONSTRUCTION

    SciTech Connect

    C.R. Gorrell

    1998-07-23

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

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

    E-print Network

    Zimmerman, Julia C

    2011-01-01

    As part of the development of a point of care complete blood count device, I designed a single use lancet integrated with a blood collection mechanism and interface and successfully tested a prototype. High speed video was ...

  1. Epigenetic mechanisms mediating the long-term effects of maternal care on development

    E-print Network

    Champagne, Frances A.

    Review Epigenetic mechanisms mediating the long-term effects of maternal care on development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 596 5. Implications of the study of epigenetics for psychiatry abuse and neglect has been demonstrated to increase rates of diabetes and cardiovascular disease (Baten

  2. 78 FR 13935 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-01

    ...about whether or under what circumstances a SNF might qualify as a health care provider...Skilled Nursing Facilities Pilot Program (SNF Pilot) will focus on determining how we...million annually. We expect to implement this SNF Pilot in Funding Year 2014. We...

  3. Energy Impact of Residential Ventilation Norms in the United States

    E-print Network

    by the American Society of Heating, Refrigerating and Air- conditioning Engineers (ASHRAE). This standard does mechanical ventilation approaches that are 62.2 compliant for a variety of climates. These results separate the energy needed to ventilate from the energy needed to condition the ventilation air, from the energy

  4. Infiltration in ASHRAE's Residential Ventilation Standards

    SciTech Connect

    Sherman, Max

    2008-10-01

    The purpose of ventilation is to dilute or remove indoor contaminants that an occupant could be exposed to. It can be provided by mechanical or natural means. ASHRAE Standards including standards 62, 119, and 136 have all considered the contribution of infiltration in various ways, using methods and data from 20 years ago. The vast majority of homes in the United States and indeed the world are ventilated through natural means such as infiltration caused by air leakage. Newer homes in the western world are tight and require mechanical ventilation. As we seek to provide acceptable indoor air quality at minimum energy cost, it is important to neither over-ventilate norunder-ventilate. Thus, it becomes critically important to correctly evaluate the contribution infiltration makes to both energy consumption and equivalent ventilation. ASHRAE Standard 62.2 specifies how much mechanical ventilation is considered necessary to provide acceptable indoor air quality, but that standard is weak on how infiltration can contribute towards meeting the total requirement. In the past ASHRAE Standard 136 was used to do this, but new theoretical approaches and expanded weather data have made that standard out of date. This article will describe how to properly treat infiltration as an equivalent ventilation approach and then use new data and these new approaches to demonstrate how these calculations might be done both in general and to update Standard 136.

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

    PubMed Central

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

    2012-01-01

    BACKGROUND: Early withdrawal of invasive mechanical ventilation (IMV) followed by noninvasive MV (NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with acute respiratory failure (ARF). Using pulmonary infection control window (PIC window) as the switch point for transferring from invasive to noninvasive MV, the time for early extubation can be more accurately judged, and therapy efficacy can be improved. This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy (FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV. METHODS: Since July 2006 to January 2011, 106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization. Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used (group A, n=54) or not (group B, n=52) during sequential weaning from invasive to noninvasive MV. In group A, for sputum suction and bronchoalveolar lavage (BAL), a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube, which was accompanied with uninterrupted use of a ventilator. After achieving PIC window, patients of both groups changed to NIMV mode, and weaned from ventilation. The following listed indices were used to compare between the groups after treatment: 1) the occurrence time of PIC, the duration of MV, the length of ICU stay, the success rate of weaning from MV for the first time, the rate of reventilation and the occurrence rate of ventilator-associated pneumonia (VAP); 2) the convenience and safety of FOB manipulation. The results were compared using Student’s t test and the Chi-square test. RESULTS: The occurrence time of PIC was (5.01±1.49) d, (5.87±1.87) d in groups A and B, respectively (P<0.05); the duration of MV was (6.98±1.84) d, (8.69±2.41) d in groups A and B, respectively (P<0.01); the length of ICU stay was (9.25±1.84) d, (11.10±2.63) d in groups A and B, respectively (P<0.01); the success rate of weaning for the first time was 96.30%, 76.92% in groups A and B, respectively (P<0.01); the rate of reventilation was 5.56%, 19.23% in groups A and B, respectively (P<0.05); and the occurrence rate of VAP was 3.70%, 23.07% in groups A and B, respectively (P<0.01). Moreover, it was easy and safe to manipulate FOB, and no side effect was observed. CONCLUSIONS: The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU. It can decrease the duration of MV and the length of ICU stay, increase the success rate from weaning MV for the first time, reduce the rate of reventilation and the occurrence rate of VAP. In addition, such a method is convenient and safe in patients of this kind. PMID:25215035

  6. [Periodic nocturnal ventilation using an Emerson chest respirator as an alternative to permanent tracheostomy with positive pressure ventilation in patients with idiopathic scoliosis and severe global respiratory insufficiency].

    PubMed

    Pfister, M; Keller, R

    1988-09-24

    Sustained success was achieved in treating a 40-year-old patient who had had severe progressive thoracic kyphoscoliosis since childhood and developed cardiorespiratory failure with terminal alveolar hypoventilation and hypoxemia due to acute pulmonary infection. On emergency admission to this hospital mechanically controlled ventilation by tracheostomy tube produced a remarkable improvement in cardiorespiratory function. Weakness of the respiratory muscles made complete disconnection from ventilatory support impossible. Instead of positive pressure ventilation by tracheostomy tube with resultant patient invalidity, nighttime external negative pressure ventilation with an Emerson chest respirator was started leaving the patient free for daytime activity. This type of ventilation is a simple, effective and well tolerated long-term treatment at low cost. The patient has been using it nightly at home for over 6 months and no problems have arisen. These findings show that intensive care is indicated in patients with severe thoracic kyphoscoliosis and cardiorespiratory failure since long-term treatment of terminal hypoventilation and cardiorespiratory failure is possible with a cheap and simple nocturnal ventilation system. PMID:3055274

  7. Fracture ventilation by surface winds

    NASA Astrophysics Data System (ADS)

    Nachshon, U.; Dragila, M. I.; Weisbrod, N.

    2011-12-01

    Gas exchange between the Earth subsurface and the atmosphere is an important mechanism, affecting hydrological, agricultural and environmental processes. From a hydrological aspect, water vapor transport is the most important process related to Earth-atmosphere gas exchange. In respect to agriculture, gas transport in the upper soil profile is important for soil aeration. From an environmental aspect, emission of volatile radionuclides, such as 3H, 14C and Rd from radioactive waste disposal facilities; volatile organic components from industrial sources and Rn from natural sources, all found in the upper vadose zone, can greatly affect public health when emissions occur in populated areas. Thus, it is vital to better understand gas exchange processes between the Earth's upper crust and atmosphere. Four major mechanisms are known to transfer gases between ground surface and atmosphere: (1) Diffusion; (2) Pressure gradients between ground pores and atmosphere due to changes in barometric pressure; (3) Density-driven gas flow in respond to thermal gradients in the ground; and (4) Winds above the ground surface. Herein, the wind ventilation mechanism is studied. Whereas the wind's impact on ground ventilation was explored in several studies, the physical mechanisms governing this process were hardly quantified or characterized. In this work the physical properties of fracture ventilation due to wind blowing along land surface were explored and quantified. Both field measurements and Hele-Shaw experiments under controlled conditions in the laboratory were used to study this process. It was found that winds in the range of 0.3 m/s result in fracture ventilation down to a depth of 0.2 m. As wind velocity increases, the depth of the ventilation inside the fracture increases respectively, in a linear manner. In addition, the fracture aperture also affects the depth of ventilation, which grows as fracture aperture increases. For the maximal examined aperture of 2 cm and wind velocity of 1.25 m/s, fracture ventilation was deeper than 0.45 m. This study sheds new light on fracture ventilation, showing that moderate winds may increase evaporation and gas exchange between fractured media and the atmosphere. Even though wind impact is limited to the top 0.5 m below the ground surface, it is an important process as most of the biological activities, as well as important hydrological processes occur in this region. Wind effect should be considered when modeling mass and energy balances between the Earth upper crust and atmosphere.

  8. Prolonged weaning: from the intensive care unit to home.

    PubMed

    Navalesi, P; Frigerio, P; Patzlaff, A; Häußermann, S; Henseke, P; Kubitschek, M

    2014-01-01

    Weaning is the process of withdrawing mechanical ventilation which starts with the first spontaneous breathing trial (SBT). Based on the degree of difficulty and duration, weaning is classified as simple, difficult and prolonged. Prolonged weaning, which includes patients who fail 3 SBTs or are still on mechanical ventilation 7 days after the first SBT, affects a relatively small fraction of mechanically ventilated ICU patients but these, however, requires disproportionate resources. There are several potential causes which can lead to prolonged weaning. It is nonetheless important to understand the problem from the point of view of each individual patient in order to adopt appropriate treatment and define precise prognosis. An otherwise stable patient who remains on mechanical ventilation will be considered for transfer to a specialized weaning unit (SWU). Though there is not a precise definition, SWU can be considered as highly specialized and protected environments for patients requiring mechanical ventilation despite resolution of the acute disorder. Proper staffing, well defined short-term and long-term goals, attention to psychological and social problems represent key determinants of SWU success. Some patients cannot be weaned, either partly or entirely, and may require long-term home mechanical ventilation. In these cases the logistics relating to caregivers and the equipment must be carefully considered and addressed. PMID:24975297

  9. Improving Ventilator-Associated Event Surveillance in the National Healthcare Safety Network and Addressing Knowledge Gaps: Update and Review

    PubMed Central

    Magill, Shelley; Rhodes, Barry; Klompas, Michael

    2015-01-01

    Purpose of review The Centers for Disease Control and Prevention (CDC) recently transitioned from ventilator-associated pneumonia surveillance to ventilator-associated event (VAE) surveillance in adult inpatient settings. Since the transition, several modifications have been made to improve surveillance methods, and there is a growing body of data regarding the epidemiology, risk factors, and preventability of VAEs. Recent findings The VAE surveillance definition algorithm is based on objective criteria and includes three tiers: Ventilator-Associated Conditions, Infection-related Ventilator-Associated Complications, and Possible and Probable VAP. VAE surveillance expands the purview of surveillance beyond pneumonia alone to include additional complications of mechanical ventilation. Most VAEs are caused by pneumonia, pulmonary edema, atelectasis, and/or acute respiratory distress syndrome. VAEs are associated with adverse outcomes including prolonged mechanical ventilation, longer intensive care and hospital lengths-of-stay, and higher mortality rates. Studies to date suggest that minimizing sedation and optimizing fluid management can reduce VAE rates. Summary We review CDC’s recent updates on VAE surveillance definitions, methods, and tools, and provide an overview of the growing evidence base for VAE as a patient safety measure. Further work is needed to affirm and extend current knowledge about how best to prevent VAEs. PMID:24945615

  10. Midlevel ventilation's constraint on tropical cyclone intensity

    E-print Network

    Tang, Brian Hong-An

    2010-01-01

    Midlevel ventilation, or the flux of low-entropy air into the inner core of a tropical cyclone (TC), is a hypothesized mechanism by which environmental vertical wind shear can constrain a TC's intensity. An idealized ...

  11. Midlevel Ventilation's Constraint on Tropical Cyclone Intensity

    E-print Network

    Tang, Brian Hong-An

    Midlevel ventilation, or the flux of low-entropy air into the inner core of a tropical cyclone (TC), is a hypothesized mechanism by which environmental vertical wind shear can constrain a tropical cyclone’s intensity. An ...

  12. VENTILATION MODEL REPORT

    SciTech Connect

    V. Chipman

    2002-10-31

    The purpose of the Ventilation Model is to simulate the heat transfer processes in and around waste emplacement drifts during periods of forced ventilation. The model evaluates the effects of emplacement drift ventilation on the thermal conditions in the emplacement drifts and surrounding rock mass, and calculates the heat removal by ventilation as a measure of the viability of ventilation to delay the onset of peak repository temperature and reduce its magnitude. The heat removal by ventilation is temporally and spatially dependent, and is expressed as the fraction of heat carried away by the ventilation air compared to the fraction of heat produced by radionuclide decay. One minus the heat removal is called the wall heat fraction, or the remaining amount of heat that is transferred via conduction to the surrounding rock mass. Downstream models, such as the ''Multiscale Thermohydrologic Model'' (BSC 2001), use the wall heat fractions as outputted from the Ventilation Model to initialize their postclosure analyses.

  13. VENTILATION TECHNOLOGY SYSTEMS ANALYSIS

    EPA Science Inventory

    The report gives results of a project to develop a systems analysis of ventilation technology and provide a state-of-the-art assessment of ventilation and indoor air quality (IAQ) research needs. (NOTE: Ventilation technology is defined as the hardware necessary to bring outdoor ...

  14. Contaminants in Naturally Ventilated

    E-print Network

    Politècnica de Catalunya, Universitat

    a natural ventilation/flushing Volcanic Magma Chambers Deep Ocean Recirculation Basins Lakes Buildings (My;Displacement Ventilation An air distribution system in which incoming air originates at floor level and risesContaminants in Naturally Ventilated Closed Spaces Diogo Bolster #12;Outline Motivation Modelling

  15. Ventilator weaning outcomes in chronic respiratory failure in children.

    PubMed

    O'Brien, Jane E; Dumas, Helene M; Haley, Stephen M; Ladenheim, Barbara; Mast, Joelle; Burke, Sharon A; Birnkrant, David J; Whitford, Kathleen; Palazzo, Regina; Neufeld, Jacob A; Kharasch, Virginia S

    2007-06-01

    The purpose of this study was to describe mechanical ventilation weaning outcomes for children with chronic respiratory failure discharged from one of six post-acute rehabilitation facilities. Demographic, clinical and outcome data were collected from the medical record. Forty-four children were included in this prospective series; 20 (45%) were weaned off the ventilator at discharge. Children required significantly lower levels of ventilatory support at discharge than admission. Hourly use on the ventilator decreased from admission to discharge for the full cohort and for the subgroup who required a ventilator at discharge. Seventy-five percent of the children discharged with a ventilator had a portable unit. We conclude that nearly half of the children using mechanical ventilation achieve weaning during a postacute rehabilitation admission, whereas others have positive outcomes in severity, hours off the ventilator or portability of equipment. PMID:17473631

  16. On The Valuation of Infiltration towards Meeting Residential Ventilation Needs

    SciTech Connect

    Sherman, Max H.

    2008-09-01

    The purpose of ventilation is dilute or remove indoor contaminants that an occupant is exposed to. It can be provided by mechanical or natural means. In most homes, especially existing homes, infiltration provides the dominant fraction of the ventilation. As we seek to provide acceptable indoor air quality at minimum energy cost, it is important to neither over-ventilate nor under-ventilate. Thus, it becomes critically important to correctly evaluate the contribution infiltration makes to both energy consumption and equivalent ventilation. ASHRAE Standards including standards 62, 119, and 136 have all considered the contribution of infiltration in various ways, using methods and data from 20 years ago.

  17. The Clinical Impact of Ventilator-Associated Events: A Prospective Multi-Center Surveillance Study.

    PubMed

    Zhu, Shichao; Cai, Lin; Ma, Chunhua; Zeng, Hongmei; Guo, Hua; Mao, Xiaoqing; Zeng, Chenghui; Li, Xiaohong; Zhao, Hua; Liu, Yongfang; Liu, Shilian; Sun, Juhua; Zhang, Ling; Peng, Tingyong; Dong, Mina; Chen, Liping; Zong, Zhiyong

    2015-12-01

    OBJECTIVE The Centers for Disease Control and Prevention (CDC) has developed an approach to ventilator-associated events (VAE) surveillance. Using these methods, this study was performed to investigate VAE incidences and to test whether VAEs are associated with poorer outcomes in China. DESIGN A 4-month, prospective multicenter surveillance study between April and July 2013. SETTING Our study included 15 adult intensive care units (ICUs) of 15 hospitals in China. PATIENTS Patients admitted to ICUs during the study period METHODS Patients on mechanical ventilation (MV) were monitored for VAEs: ventilator-associated conditions (VACs), infection-related ventilator-associated complications (IVACs), and possible or probable ventilator-associated pneumonia (VAP). Patients with and without VACs were compared with regard to duration of MV, ICU length of stay (LOS), overall hospital LOS, and mortality rate. RESULTS During the study period, 2,356 of the 5,256 patients admitted to ICUs received MV for 8,438 ventilator days. Of these patients, 636 were on MV >2 days. VACs were identified in 94 cases (4.0%; 11.1 cases per 1,000 ventilator days), including 31 patients with IVACs and 16 with possible VAP but none with probable VAP. Compared with patients without VACs, patients with VACs had longer ICU LOS (by 6.2 days), longer duration on MV (by 7.7 days), and higher hospital mortality rate (50.0% vs 27.3%). The mortality rate attributable to VACs was 11.7%. Compared with those with VACs alone, patients with IVACs had longer duration on MV and increased ICU LOS but no higher mortality rates. CONCLUSIONS In China, surveillance of VACs and IVACs is able to identify MV patients with poorer outcomes. However, surveillance of possible and probable VAP can be problematic. Infect. Control Hosp. Epidemiol. 2015;36(12):1388-1395. PMID:26310838

  18. DEMAND CONTROLLED VENTILATION AND CLASSROOM VENTILATION

    SciTech Connect

    Fisk, William J.; Mendell, Mark J.; Davies, Molly; Eliseeva, Ekaterina; Faulkner, David; Hong, Tienzen; Sullivan, Douglas P.

    2014-01-06

    This document summarizes a research effort on demand controlled ventilation and classroom ventilation. The research on demand controlled ventilation included field studies and building energy modeling. Major findings included: ? The single-location carbon dioxide sensors widely used for demand controlled ventilation frequently have large errors and will fail to effectively control ventilation rates (VRs).? Multi-location carbon dioxide measurement systems with more expensive sensors connected to multi-location sampling systems may measure carbon dioxide more accurately.? Currently-available optical people counting systems work well much of the time but have large counting errors in some situations. ? In meeting rooms, measurements of carbon dioxide at return-air grilles appear to be a better choice than wall-mounted sensors.? In California, demand controlled ventilation in general office spaces is projected to save significant energy and be cost effective only if typical VRs without demand controlled ventilation are very high relative to VRs in codes. Based on the research, several recommendations were developed for demand controlled ventilation specifications in the California Title 24 Building Energy Efficiency Standards.The research on classroom ventilation collected data over two years on California elementary school classrooms to investigate associations between VRs and student illness absence (IA). Major findings included: ? Median classroom VRs in all studied climate zones were below the California guideline, and 40percent lower in portable than permanent buildings.? Overall, one additional L/s per person of VR was associated with 1.6percent less IA. ? Increasing average VRs in California K-12 classrooms from the current average to the required level is estimated to decrease IA by 3.4percent, increasing State attendance-based funding to school districts by $33M, with $6.2 M in increased energy costs. Further VR increases would provide additional benefits.? Confirming these findings in intervention studies is recommended. ? Energy costs of heating/cooling unoccupied classrooms statewide are modest, but a large portion occurs in relatively few classrooms.

  19. Using a Ventilation Controller to Optimize Residential Passive Ventilation For Energy and Indoor Air Quality

    SciTech Connect

    Turner, William; Walker, Iain

    2014-08-01

    One way to reduce the energy impact of providing residential ventilation is to use passive and hybrid systems. However, these passive and hybrid (sometimes called mixed-mode) systems must still meet chronic and acute health standards for ventilation. This study uses a computer simulation approach to examine the energy and indoor air quality (IAQ) implications of passive and hybrid ventilation systems, in 16 California climate zones. Both uncontrolled and flow controlled passive stacks are assessed. A new hybrid ventilation system is outlined that uses an intelligent ventilation controller to minimise energy use, while ensuring chronic and acute IAQ standards are met. ASHRAE Standard 62.2-2010 – the United States standard for residential ventilation - is used as the chronic standard, and exposure limits for PM2.5, formaldehyde and NO2 are used as the acute standards.The results show that controlled passive ventilation and hybrid ventilation can be used in homes to provide equivalent IAQ to continuous mechanical ventilation, for less use of energy.

  20. Long-term acute care hospitals.

    PubMed

    Munoz-Price, L Silvia

    2009-08-01

    Long-term acute care hospitals (LTACHs) are health care facilities that admit complex patients with acute care needs (eg, mechanical ventilator weaning, administration of intravenous antibiotics, and complex wound care) for a mean duration of stay of 25 days. LTACHs are different than nursing homes and were initially created in the 1990s in an effort to decrease Medicare costs by facilitating prompt discharge from intensive care units of patients with difficulty weaning mechanical ventilation; however, current admission diagnoses are quite broad. Patients admitted to these facilities have multiple comorbidities and are at risk for colonization with multidrug-resistant organisms. LTACH patients have been shown to have high rates of hospital-acquired infections, including central vascular catheter-associated bloodstream infection and ventilator-associated pneumonia. In addition, LTACHs have been implicated in various regional outbreaks of multidrug-resistant organisms. This review summarizes the limited amount of scientific literature on LTACHs while highlighting their infection control problems, as well as the role LTACHs play on regional outbreaks. PMID:19548836

  1. Validating and improving CT ventilation imaging by correlating with ventilation 4D-PET/CT using {sup 68}Ga-labeled nanoparticles

    SciTech Connect

    Kipritidis, John Keall, Paul J.; Siva, Shankar; Hofman, Michael S.; Callahan, Jason; Hicks, Rodney J.

    2014-01-15

    Purpose: CT ventilation imaging is a novel functional lung imaging modality based on deformable image registration. The authors present the first validation study of CT ventilation using positron emission tomography with{sup 68}Ga-labeled nanoparticles (PET-Galligas). The authors quantify this agreement for different CT ventilation metrics and PET reconstruction parameters. Methods: PET-Galligas ventilation scans were acquired for 12 lung cancer patients using a four-dimensional (4D) PET/CT scanner. CT ventilation images were then produced by applying B-spline deformable image registration between the respiratory correlated phases of the 4D-CT. The authors test four ventilation metrics, two existing and two modified. The two existing metrics model mechanical ventilation (alveolar air-flow) based on Hounsfield unit (HU) change (V{sub HU}) or Jacobian determinant of deformation (V{sub Jac}). The two modified metrics incorporate a voxel-wise tissue-density scaling (?V{sub HU} and ?V{sub Jac}) and were hypothesized to better model the physiological ventilation. In order to assess the impact of PET image quality, comparisons were performed using both standard and respiratory-gated PET images with the former exhibiting better signal. Different median filtering kernels (?{sub m} = 0 or 3 mm) were also applied to all images. As in previous studies, similarity metrics included the Spearman correlation coefficient r within the segmented lung volumes, and Dice coefficient d{sub 20} for the (0 ? 20)th functional percentile volumes. Results: The best agreement between CT and PET ventilation was obtained comparing standard PET images to the density-scaled HU metric (?V{sub HU}) with ?{sub m} = 3 mm. This leads to correlation values in the ranges 0.22 ? r ? 0.76 and 0.38 ? d{sub 20} ? 0.68, with r{sup ¯}=0.42±0.16 and d{sup ¯}{sub 20}=0.52±0.09 averaged over the 12 patients. Compared to Jacobian-based metrics, HU-based metrics lead to statistically significant improvements in r{sup ¯} and d{sup ¯}{sub 20} (p < 0.05), with density scaled metrics also showing higher r{sup ¯} than for unscaled versions (p < 0.02). r{sup ¯} and d{sup ¯}{sub 20} were also sensitive to image quality, with statistically significant improvements using standard (as opposed to gated) PET images and with application of median filtering. Conclusions: The use of modified CT ventilation metrics, in conjunction with PET-Galligas and careful application of image filtering has resulted in improved correlation compared to earlier studies using nuclear medicine ventilation. However, CT ventilation and PET-Galligas do not always provide the same functional information. The authors have demonstrated that the agreement can improve for CT ventilation metrics incorporating a tissue density scaling, and also with increasing PET image quality. CT ventilation imaging has clear potential for imaging regional air volume change in the lung, and further development is warranted.

  2. Review of Residential Ventilation Technologies

    SciTech Connect

    Russell, Marion L.; Sherman, Max H.; Rudd, Armin

    2005-03-01

    This paper reviews current and potential ventilation technologies for residential buildings in North America and a few in Europe. The major technologies reviewed include a variety of mechanical systems, natural ventilation, and passive ventilation. Key parameters that are related to each system include operating costs, installation costs, ventilation rates, heat recovery potential. It also examines related issues such as infiltration, duct systems, filtration options, noise, and construction issues. This report describes a wide variety of systems currently on the market that can be used to meet ASHRAE standard 62.2. While these systems generally fall into the categories of supply, exhaust or balanced, the specifics of each system are driven by concerns that extend beyond those in the standard and are discussed. Some of these systems go beyond the current standard by providing additional features (such as air distribution or pressurization control). The market will decide the immediate value of such features, but ASHRAE may wish to consider modifications to the standard in the future.

  3. The effect of market reforms and new public management mechanisms on the Swiss health care system.

    PubMed

    Moresi-Izzo, Stefania; Bankauskaite, Vaida; Gericke, Christian A

    2010-01-01

    In 1996, the Federal Law on Health Insurance (LAMal) was adopted in order to contain costs in Swiss health care. At the same time, the reform aimed to maintain or even improve solidarity and encourage institutional reform through new public management (NPM) and market mechanisms. More freedom in contractual conditions between insurers and providers and a clearer distinction of responsibilities between federal and regional (cantonal) authorities were stipulated to achieve efficiency, effectiveness, and transparency. The focus of this paper is an analysis of the effects of market reforms and NPM mechanisms introduced with the LAMal on the cost-containment, quality of care and equity objectives in the Swiss health care system. PMID:20540084

  4. Predicting reintubation, prolonged mechanical ventilation and death in post-coronary artery bypass graft surgery: a comparison between artificial neural networks and logistic regression models

    PubMed Central

    Mendes, Renata G.; de Souza, César R.; Machado, Maurício N.; Correa, Paulo R.; Di Thommazo-Luporini, Luciana; Arena, Ross; Myers, Jonathan; Pizzolato, Ednaldo B.

    2015-01-01

    Introduction In coronary artery bypass (CABG) surgery, the common complications are the need for reintubation, prolonged mechanical ventilation (PMV) and death. Thus, a reliable model for the prognostic evaluation of those particular outcomes is a worthwhile pursuit. The existence of such a system would lead to better resource planning, cost reductions and an increased ability to guide preventive strategies. The aim of this study was to compare different methods – logistic regression (LR) and artificial neural networks (ANNs) – in accomplishing this goal. Material and methods Subjects undergoing CABG (n = 1315) were divided into training (n = 1053) and validation (n = 262) groups. The set of independent variables consisted of age, gender, weight, height, body mass index, diabetes, creatinine level, cardiopulmonary bypass, presence of preserved ventricular function, moderate and severe ventricular dysfunction and total number of grafts. The PMV was also an input for the prediction of death. The ability of ANN to discriminate outcomes was assessed using receiver-operating characteristic (ROC) analysis and the results were compared using a multivariate LR. Results The ROC curve areas for LR and ANN models, respectively, were: for reintubation 0.62 (CI: 0.50–0.75) and 0.65 (CI: 0.53–0.77); for PMV 0.67 (CI: 0.57–0.78) and 0.72 (CI: 0.64–0.81); and for death 0.86 (CI: 0.79–0.93) and 0.85 (CI: 0.80–0.91). No differences were observed between models. Conclusions The ANN has similar discriminating power in predicting reintubation, PMV and death outcomes. Thus, both models may be applicable as a predictor for these outcomes in subjects undergoing CABG. PMID:26322087

  5. Ventilation Model Report

    SciTech Connect

    V. Chipman; J. Case

    2002-12-20

    The purpose of the Ventilation Model is to simulate the heat transfer processes in and around waste emplacement drifts during periods of forced ventilation. The model evaluates the effects of emplacement drift ventilation on the thermal conditions in the emplacement drifts and surrounding rock mass, and calculates the heat removal by ventilation as a measure of the viability of ventilation to delay the onset of peak repository temperature and reduce its magnitude. The heat removal by ventilation is temporally and spatially dependent, and is expressed as the fraction of heat carried away by the ventilation air compared to the fraction of heat produced by radionuclide decay. One minus the heat removal is called the wall heat fraction, or the remaining amount of heat that is transferred via conduction to the surrounding rock mass. Downstream models, such as the ''Multiscale Thermohydrologic Model'' (BSC 2001), use the wall heat fractions as outputted from the Ventilation Model to initialize their post-closure analyses. The Ventilation Model report was initially developed to analyze the effects of preclosure continuous ventilation in the Engineered Barrier System (EBS) emplacement drifts, and to provide heat removal data to support EBS design. Revision 00 of the Ventilation Model included documentation of the modeling results from the ANSYS-based heat transfer model. Revision 01 ICN 01 included the results of the unqualified software code MULTIFLUX to assess the influence of moisture on the ventilation efficiency. The purposes of Revision 02 of the Ventilation Model are: (1) To validate the conceptual model for preclosure ventilation of emplacement drifts and verify its numerical application in accordance with new procedural requirements as outlined in AP-SIII-10Q, Models (Section 7.0). (2) To satisfy technical issues posed in KTI agreement RDTME 3.14 (Reamer and Williams 2001a). Specifically to demonstrate, with respect to the ANSYS ventilation model, the adequacy of the discretization (Section 6.2.3.1), and the downstream applicability of the model results (i.e. wall heat fractions) to initialize post-closure thermal models (Section 6.6). (3) To satisfy the remainder of KTI agreement TEF 2.07 (Reamer and Williams 2001b). Specifically to provide the results of post-test ANSYS modeling of the Atlas Facility forced convection tests (Section 7.1.2). This portion of the model report also serves as a validation exercise per AP-SIII.10Q, Models, for the ANSYS ventilation model. (4) To asses the impacts of moisture on the ventilation efficiency.

  6. [INTENSIVE CARE OF COMPLICATED ACUTE PORPHYRIA].

    PubMed

    Yatskovi, K V; Gorodetskiy, V M; Shulutko, E M; Glukhova, T E; Pusqtovoit, Ya S

    2015-01-01

    The experience of anesthesia and intensive care departments of Hematological center Russia for intensive care management in 13 patients with acute porphyria, from 1996 till 2013 was summarized ion this pape4: Main causes of life-threatening complications of acute porphyria and its frequency were revealed Advantages of mechanical lung ventilation in respiratory failure, algorithms of clinical nutrition, correction of water-electrolyte disorders were represented. Importance of kinesiotherapy in successful treatment in these category of patients was revealed. It is shown that the whole complex of intensive care methods with the specific pathogenetical therapy brings success in 84,6 % of patients. PMID:26596031

  7. Protective garment ventilation system

    NASA Technical Reports Server (NTRS)

    Lang, R. (inventor)

    1970-01-01

    A method and apparatus for ventilating a protective garment, space suit system, and/or pressure suits to maintain a comfortable and nontoxic atmosphere within is described. The direction of flow of a ventilating and purging gas in portions of the garment may be reversed in order to compensate for changes in environment and activity of the wearer. The entire flow of the ventilating gas can also be directed first to the helmet associated with the garment.

  8. [Epigenetic mechanisms of the influence of maternal care on off spring development].

    PubMed

    Dang, Yong-Hui; Yan, Chun-Xia; Chen, Teng

    2011-09-01

    It has been demonstrated that the social environment early in life has a long lasting effect on the physical and psychological health of the human body. However, understanding of the relationship between early life experiences, such as maternal care behavior, and life-long cognitive and emotional health can only rely on the studies on animal models. In this paper, we summarized the maternal care effects on both defensive responses to stress and reproductive behavior in rat, and explored the possible underlying epigenetic mechanisms for these effects. Based on this model, we further investigated the significance of such epigenetic effects on human mental health. PMID:21951791

  9. Outcomes for patients with lung cancer admitted to intensive care units

    PubMed Central

    Müller, Alice Mânica; Gazzana, Marcelo Basso; Silva, Denise Rossato

    2013-01-01

    Objective This study aimed to evaluate the outcomes for patients with lung cancer admitted to intensive care units and assess their clinical and demographic profiles. Methods Retrospective, analytical, observational study, wherein the outcomes for patients diagnosed with lung cancer admitted to the intensive care unit of university hospital from January 2010 until February 2011 were evaluated. Results Thirty-four patients' medical records were included. Twenty-six (76.5%) patients received some type of ventilatory support, of whom 21 (61.8%) used invasive mechanical ventilation and 11 (32.4%) used noninvasive ventilation at some point during their stay at the intensive care unit. Regarding mortality, 12 (35.3%) patients died during hospitalization at the intensive care unit, totaling 15 (44.1%) deaths during the entire hospitalization period; 19 (55.9%) patients were discharged from the hospital. The analysis of the variables showed that the patients who died had remained on invasive mechanical ventilation for a longer period 5.0 (0.25 to 15.0) days than the survivors (1.0 (0 to 1.0) days) (p=0.033) and underwent dialysis during their stay at the intensive care unit (p=0.014). Conclusions The mortality of patients with lung cancer admitted to the intensive care unit is associated with the time spent on invasive mechanical ventilation and the need for dialysis. PMID:23887754

  10. Pulmonary ventilation/perfusion scan

    MedlinePLUS

    V/Q scan; Ventilation/perfusion scan; Lung ventilation/perfusion scan ... A pulmonary ventilation/perfusion scan is actually two tests. They may be done separately or together. During the perfusion scan, a ...

  11. Monitoring in the Intensive Care

    PubMed Central

    Kipnis, Eric; Ramsingh, Davinder; Bhargava, Maneesh; Dincer, Erhan; Cannesson, Maxime; Broccard, Alain; Vallet, Benoit; Bendjelid, Karim; Thibault, Ronan

    2012-01-01

    In critical care, the monitoring is essential to the daily care of ICU patients, as the optimization of patient's hemodynamic, ventilation, temperature, nutrition, and metabolism is the key to improve patients' survival. Indeed, the decisive endpoint is the supply of oxygen to tissues according to their metabolic needs in order to fuel mitochondrial respiration and, therefore, life. In this sense, both oxygenation and perfusion must be monitored in the implementation of any resuscitation strategy. The emerging concept has been the enhancement of macrocirculation through sequential optimization of heart function and then judging the adequacy of perfusion/oxygenation on specific parameters in a strategy which was aptly coined “goal directed therapy.” On the other hand, the maintenance of normal temperature is critical and should be regularly monitored. Regarding respiratory monitoring of ventilated ICU patients, it includes serial assessment of gas exchange, of respiratory system mechanics, and of patients' readiness for liberation from invasive positive pressure ventilation. Also, the monitoring of nutritional and metabolic care should allow controlling nutrients delivery, adequation between energy needs and delivery, and blood glucose. The present paper will describe the physiological basis, interpretation of, and clinical use of the major endpoints of perfusion/oxygenation adequacy and of temperature, respiratory, nutritional, and metabolic monitorings. PMID:22970356

  12. Methodology for the evaluation of natural ventilation in buildings using a reduced-scale air model

    E-print Network

    Walker, Christine E. (Christine Elaine)

    2006-01-01

    Commercial office buildings predominantly are designed to be ventilated and cooled using mechanical systems. In temperate climates, passive ventilation and cooling techniques can be utilized to reduce energy consumption ...

  13. [Artificial ventilation of preterm and term infants (author's transl)].

    PubMed

    Frisch, H; Schabel, F; Zieglauer, H; Haffner, B; Haberfellner, H

    1978-01-01

    One of the first aims of the neonatal care unit of the Paediatric Department of the University of Innsbruck (Austria) consists in taking care of dangerously ill children of Tyrol including the neighbouring federal states and the alpine part of Italy (South Tyrol). From SUMMER 1974 to the end of October 1976 1342 preterm and term infants were treated. 142 of these children died (mortality rate 10.5%). In 94 patients, i. e. 6.9% mechanical ventilation was necessary. 39 of these children, i. e. 41.5% survived. Two indications of artifical ventilation were predominant: Hyaline membrane syndrome in 59 children (survival rate 49%) and apnoe in 22 children (survival rate 27%). Electroencephalography was performed in 39 children during the neonatal period. 34 of these children were severely ill (gestational age of 24 to 37 weeks), 5 children were born at term nevertheless moribund. 18 of the 23 dead children of this group showed severe alterations in electroencephalography. The cause of death of 10 of these children was cerebral bleeding as verified by autopsy. 8 of the 16 surviving children showed a regular psychomotoric development, 5 children of this group had a normal electroencephalogram. PMID:341041

  14. European Home Mechanical Ventilation Registry

    ClinicalTrials.gov

    2014-12-08

    Pulmonary Disease, Chronic Obstructive; Amyotrophic Lateral Sclerosis; Spinal Cord Injury; Muscular Dystrophies; Obesity Hypoventilation Syndrome; Kyphoscoliosis; Congenital Central Hypoventilation Syndrome; Duchenne Muscular Dystrophy; Myopathies; Myotonic Dystrophy

  15. Alternative approaches to ventilator-associated pneumonia prevention.

    PubMed

    Berra, L; Sampson, J; Fumagalli, J; Panigada, M; Kolobow, T

    2011-03-01

    Ventilator-associated pneumonia (VAP), which develops in patients receiving mechanical ventilation, is the most common nosocomial infection in patients with acute respiratory failure. The major mechanism of lower respiratory tract colonization is aspiration of bacteria-colonized secretions from the oropharynx into the lower airways. The hydrostatic pressure of the secretions that collect in the subglottic space, which is the area above the endotracheal tube (ETT) cuff, or aerosolization of bacteria from the secretions collected within the respiratory tubing may facilitate the leakage into the lower airways. Ideally, the elimination of the mechanisms responsible for aspiration would decrease the incidence of VAP. Several preventive measures have been tested in clinical trials with little success.Here we present the results of our efforts to develop novel approaches for the prevention of VAP. Specifically, we found that keeping ventilated patients in a lateral position, which eliminates gravitational forces, is feasible and possibly advantageous. Additionally, several novel medical devices have been recently developed to prevent bacterial biofilm formation from the ETT and breathing tubing. These devices include coated ETTs, mucus shavers and mucus slurpers. Prevention of ETT bacterial colonization showed decreased bacterial colonization of the respiratory circuit and of the lower respiratory tract in laboratory studies and clinical trials. Future large studies should be designed to test the hypothesis that VAP can be prevented with these novel strategies. While there is a current focus on the use of respiratory devices to prevent biofilm formation and microaspiration, it is important to remember that lower respiratory tract colonization is multifactorial. Prevention of VAP cannot be achieved solely by eliminating bacterial biofilm on respiratory devices, and more comprehensive care of the intubated patient needs to be implemented. PMID:21150848

  16. Ventilator-associated pneumonia in children after cardiac surgery.

    PubMed

    Shaath, Ghassan A; Jijeh, Abdulraouf; Faruqui, Fawaz; Bullard, Lily; Mehmood, Akhter; Kabbani, Mohamed S

    2014-04-01

    Ventilator-associated pneumonia (VAP) is a nosocomially acquired infection that has a significant burden on intensive care units (ICUs). We investigated the incidence of VAP in children after cardiac surgery and its impact on morbidity and mortality. A prospective cross-sectional review was performed in the postoperative cardiac patients in pediatric cardiac intensive care unit (PCICU) patients from March 2010 until the end of September 2010. The patients were divided into two groups: the VAP group and the non-VAP group, Demographic data and perioperative risk variables were collected for all patients. One hundred thirty-seven patients were recruited, 65 (48%) female and 72 (52%) male. VAP occurred in 9 patients (6.6%). Average body weights in the VAP and non-VAP groups were 5.9 ± 1.24 and 7.3 ± 0.52 kg, respectively. In our PCICU, the mechanical ventilation (MV) use ratio was 26% with a VAP-density rate of 29/1000 ventilator days. Univariate analyses showed that the risk variables to develop VAP are as follows: prolonged cardiopulmonary bypass (CPB) time, use of total parenteral nutrition (TPN), and prolonged ICU stay (p < 0.002 for all). Thirty-three percent of VAP patients had Gram-negative bacilli (GNB). VAP Patients require more MV hours, longer stay, and more inhaled nitric oxide. Mortality in the VAP group was 11% and in the non-VAP group was 0.7 % (p = 0.28). VAP incidence is high in children after cardiac surgery mainly by GNB. VAP increases with longer CPB time, administration of TPN, and longer PCICU stay. VAP increases morbidity in postoperative cardiac patients. PMID:24259009

  17. The VICI-trial: high frequency oscillation versus conventional mechanical ventilation in newborns with congenital diaphragmatic hernia: an international multicentre randomized controlled trial

    PubMed Central

    2011-01-01

    Background Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly of the diaphragm resulting in pulmonary hypoplasia and pulmonary hypertension. It is associated with a high risk of mortality and pulmonary morbidity. Previous retrospective studies have reported high frequency oscillatory ventilation (HFO) to reduce pulmonary morbidity in infants with CDH, while others indicated HFO to be associated with worse outcome. We therefore aimed to develop a randomized controlled trial to compare initial ventilatory treatment with high-frequency oscillation and conventional ventilation in infants with CDH. Methods/design This trial is designed as a multicentre trial in which 400 infants (200 in each arm) will be included. Primary outcome measures are BPD, described as oxygen dependency by day 28 according to the definition of Jobe and Bancalari, and/or mortality by day 28. All liveborn infants with CDH born at a gestational age of over 34 weeks and no other severe congenital anomalies are eligible for inclusion. Parental informed consent is asked antenatally and the allocated ventilation mode starts within two hours after birth. Laboratory samples of blood, urine and tracheal aspirate are taken at the first day of life, day 3, day 7, day 14 and day 28 to evaluate laboratory markers for ventilator-induced lung injury and pulmonary hypertension. Discussion To date, randomized clinical trials are lacking in the field of CDH. The VICI-trial, as the first randomized clinical trial in the field of CDH, may provide further insight in ventilation strategies in CDH patient. This may hopefully prevent mortality and morbidity. Trial registration Netherlands Trial Register (NTR): NTR1310 PMID:22047542

  18. Multifamily Ventilation Retrofit Strategies

    SciTech Connect

    Ueno, K.; Lstiburek, J.; Bergey, D.

    2012-12-01

    In multifamily buildings, central ventilation systems often have poor performance, overventilating some portions of the building (causing excess energy use), while simultaneously underventilating other portions (causing diminished indoor air quality). BSC and Innova Services Corporation performed a series of field tests at a mid-rise test building undergoing a major energy audit and retrofit, which included ventilation system upgrades.

  19. Guide to Home Ventilation

    SciTech Connect

    2010-10-01

    A fact sheet from the U.S. Department of Energy's Office of Energy Efficiency and Renewable Energy: Ventilation refers to the exchange of indoor and outdoor air. Without proper ventilation, an otherwise insulated and airtight house will seal in harmful pollutants, such as carbon monoxide, and moisture that can damage a house.

  20. Home Ventilator Guide

    MedlinePLUS

    ... High FiO 2 , Ventilation not started/stopped, Circuit fault, Low/High PEEP, Pressure line disconnected H, O ... High FiO 2 , Ventilation not started/stopped, Circuit fault, Low/High PEEP, Pressure line disconnected H, O ...

  1. Summary of human responses to ventilation

    E-print Network

    Seppanen, Olli A.; Fisk, William J.

    2004-01-01

    Ventilation Mechanical exhaust O Simple mechanical, with humidification Recirculation*Recirculation * Y/N 7 Smoking Number of Symptoms with signicantly higher prevalences in assessment^^ none Natural Ventilationventilation rate, n f = the removal rate of infectious particles by filtration , equal to the product of the recirculation

  2. A comparative study of teaching clinical guideline for prevention of ventilator-associated pneumonia in two ways: face-to-face and workshop training on the knowledge and practice of nurses in the intensive care unit

    PubMed Central

    YAZDANI, MAJID; SABETIAN, GOLNAR; RA'OFI, SHAHIN; ROUDGARI, AMIR; FEIZI, MONIREH

    2015-01-01

    Introduction Ventilator-associated pneumonia (VAP) is one of the most popular nosocomial infections in the intensive care units and the nurse's role in preventing it is very important. The aim of this study was to compare the effect of two methods of face to face training and work- shop clinical guidelines in prevention of VAP. Methods In this experimental randomized clinical trial, the knowledge and practice of nurses in ICUs were studied in two groups: face to face training (35 nurses) and workshops (40 nurses) by using clinical guidelines in prevention of VAP in one of the hospitals of Shiraz University of Medical Sciences. The level of knowledge and practice in each group was assessed by self-report questionnaire, knowledge questionnaire and also direct observation of practice, before and after training. Data were analyzed with descriptive statistics, paired t-test, independent t-test, McNemar test, Fisher’s exact, sign and Chi-square test, using SPSS 14. Results This study demonstrated that both methods of face to face training and workshop were very effective. The incidence of inappropriate pressure of cuff in the tracheal tubes and tracheostomy tubes was significantly reduced after training (p=0.001). But, by comparison of these two methods and the relationship between the variables revealed that no significant difference was found between the two groups of face to face training and workshop. Conclusion Training the nurses is highly effective in preventing VAP, particularly for appropriate cuff pressure, suctioning and disinfecting hands. PMID:25927070

  3. A pilot prospective study on closed loop controlled ventilation and oxygenation in ventilated children during the weaning phase

    PubMed Central

    2012-01-01

    Introduction The present study is a pilot prospective safety evaluation of a new closed loop computerised protocol on ventilation and oxygenation in stable, spontaneously breathing children weighing more than 7 kg, during the weaning phase of mechanical ventilation. Methods Mechanically ventilated children ready to start the weaning process were ventilated for five periods of 60 minutes in the following order: pressure support ventilation, adaptive support ventilation (ASV), ASV plus a ventilation controller (ASV-CO2), ASV-CO2 plus an oxygenation controller (ASV-CO2-O2) and pressure support ventilation again. Based on breath-by-breath analysis, the percentage of time with normal ventilation as defined by a respiratory rate between 10 and 40 breaths/minute, tidal volume > 5 ml/kg predicted body weight and end-tidal CO2 between 25 and 55 mmHg was determined. The number of manipulations and changes on the ventilator were also recorded. Results Fifteen children, median aged 45 months, were investigated. No adverse event and no premature protocol termination were reported. ASV-CO2 and ASV-CO2-O2 kept the patients within normal ventilation for, respectively, 94% (91 to 96%) and 94% (87 to 96%) of the time. The tidal volume, respiratory rate, peak inspiratory airway pressure and minute ventilation were equivalent for all modalities, although there were more automatic setting changes in ASV-CO2 and ASV-CO2-O2. Positive end-expiratory pressure modifications by ASV-CO2-O2 require further investigation. Conclusion Over the short study period and in this specific population, ASV-CO2 and ASV-CO2-O2 were safe and kept the patient under normal ventilation most of the time. Further research is needed, especially for positive end-expiratory pressure modifications by ASV-CO2-O2. Trial registration ClinicalTrials.gov: NCT01095406 PMID:22591622

  4. Why we ventilate our houses - An historical look

    SciTech Connect

    Matson, Nance E.; Sherman, Max H.

    2004-05-14

    The knowledge of how to ventilate buildings, and how much ventilation is necessary for human health and comfort, has evolved over centuries of trial and error. Humans and animals have developed successful solutions to the problems of regulating temperature and removing air pollutants through the use of ventilation. These solutions include ingenious construction methods, such as engineered passive ventilation (termite mounds and passive stacks), mechanical means (wing-powered, fans), and an evolving effort to identify problems and develop solutions. Ventilation can do more than help prevent building occupants from getting sick; it can provide an improved indoor environment. Codes and standards provide minimum legal requirements for ventilation, but the need for ventilation goes beyond code minima. In this paper we will look at indoor air pollutant sources over time, the evolution of ventilation strategies, current residential ventilation codes and standards (e.g., recently approved ASHRAE Standard 62.2), and briefly discuss ways in which we can go beyond the standards to optimize residential ventilation, reduce indoor air quality problems, and provide corresponding social and economic benefit.

  5. Confined space ventilation by shipyard welders: observed use and effectiveness.

    PubMed

    Pouzou, Jane G; Warner, Chris; Neitzel, Richard L; Croteau, Gerry A; Yost, Michael G; Seixas, Noah S

    2015-01-01

    Shipbuilding involves intensive welding activities within enclosed and confined spaces, and although ventilation is commonly used in the industry, its use and effectiveness has not been adequately documented. Workers engaged in welding in enclosed or confined spaces in two shipyards were observed for their use of ventilation and monitored for their exposure to particulate matter. The type of ventilation in use, its placement and face velocity, the movement of air within the space, and other ventilation-related parameters were recorded, along with task characteristics such as the type of welding, the welder's position, and the configuration of the space. Mechanical ventilation was present in about two-thirds of the 65 welding scenarios observed, with exhaust ventilation used predominantly in one shipyard and supply blowers predominantly in the other. Welders were observed working in apparent dead-spaces within the room in 53% of the cases, even where ventilation was in use. Respiratory protection was common in the two shipyards, observed in use in 77 and 100% of the cases. Welding method, the proximity of the welder's head to the fume, and air mixing were found to be significantly associated with the welder's exposure, while other characteristics of dilution ventilation did not produce appreciable differences in exposure level. These parameters associated with exposure reduction can be assessed subjectively and are thus good candidates for training on effective ventilation use during hot work in confined spaces. Ventilation used in confined space welding is often inadequate for controlling exposure to welding fume. PMID:25245587

  6. Experimental Investigation of Ventilation of a Surface Piercing Hydrofoil

    NASA Astrophysics Data System (ADS)

    Harwood, Casey; Miguel Montero, Francisco; Young, Yin Lu; Ceccio, Steven

    2013-11-01

    Bodies that pierce a liquid free-surface are prone to entrainment of atmospheric and/or vaporous gases. This process, called ventilation, can occur suddenly and violently, drastically altering hydrodynamic response. Experiments have been conducted at the free-surface towing-tank in the University of Michigan Marine Hydrodynamics Laboratory to investigate fully attached, partially ventilated, and fully ventilated flows around a canonical surface-piercing hydrofoil. The objectives of the work are: (i) to gain a broad and improved understanding of the physics of ventilation, (ii) to classify the physical mechanisms by which ventilation inception and washout may occur and quantify the conditions required for each mechanism and (iii) to quantify the effects of ventilation on global hydrodynamic responses, including the six force and moment components. Experimental data and high-speed video will be used to illustrate the impact of ventilation on hydrodynamic loads, pressures, and flow structures. The completion of this study is expected to contribute significantly toward a comprehensive understanding of ventilation physics, and toward an improved ability to design safe and controllable ventilated lifting surfaces for use in propulsion, energy harvesting, and turbomachinery. Supported by: The Office of Naval Research (ONR) (Grant No. N00014-09-1-1204); the National Research Foundation of Korea (NRF) (GCRC-SOP Grant No. 2012-0004783); the National Science Foundation Graduate Student Research Fellowship (Grant No. DGE 1256260).

  7. 46 CFR 185.352 - Ventilation of gasoline machinery spaces.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 7 2012-10-01 2012-10-01 false Ventilation of gasoline machinery spaces. 185.352... machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space, required by... sufficient to insure at least one complete change of air in the space served....

  8. 46 CFR 185.352 - Ventilation of gasoline machinery spaces.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 7 2013-10-01 2013-10-01 false Ventilation of gasoline machinery spaces. 185.352... machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space, required by... sufficient to insure at least one complete change of air in the space served....

  9. Optimal decision making in ventilation control Andrew Kusiak*, Mingyang Li

    E-print Network

    Kusiak, Andrew

    Optimal decision making in ventilation control Andrew Kusiak*, Mingyang Li Department of Mechanical and Industrial Engineering, 3131 Seamans Center, The University of Iowa, Iowa City, IA 52242-1527, USA a r t i c Accepted 24 July 2009 Available online 15 August 2009 Keywords: Ventilation Air quality Multi

  10. 46 CFR 185.352 - Ventilation of gasoline machinery spaces.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Ventilation of gasoline machinery spaces. 185.352... machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space, required by... sufficient to insure at least one complete change of air in the space served....

  11. Lung Ventilation/Perfusion Scan

    MedlinePLUS

    ... the NHLBI on Twitter. What Is a Lung Ventilation/Perfusion Scan? A lung ventilation/perfusion scan, or VQ scan, is a test ... A VQ scan involves two types of scans: ventilation and perfusion. The ventilation scan shows where air ...

  12. Ventilating Air-Conditioner

    NASA Technical Reports Server (NTRS)

    Dinh, Khanh

    1994-01-01

    Air-conditioner provides ventilation designed to be used alone or incorporated into cooling or heating system operates efficiently only by recirculating stale air within building. Energy needed to operate overall ventilating cooling or heating system slightly greater than operating nonventilating cooling or heating system. Helps to preserve energy efficiency while satisfying need for increased forced ventilation to prevent accumulation of undesired gases like radon and formaldehyde. Provides fresh treated air to variety of confined spaces: hospital surgeries, laboratories, clean rooms, and printing shops and other places where solvents used. In mobile homes and portable classrooms, eliminates irritant chemicals exuded by carpets, panels, and other materials, ensuring healthy indoor environment for occupants.

  13. Recommended Ventilation Strategies for Energy-Efficient Production Homes

    SciTech Connect

    Roberson, J.; Brown, R.; Koomey, J.; Warner, J.; Greenberg, S.

    1998-12-01

    This report evaluates residential ventilation systems for the U.S. Environmental Protection Agency's (EPA's) ENERGY STAR{reg_sign} Homes program and recommends mechanical ventilation strategies for new, low-infiltration, energy-efficient, single-family, ENERGY STAR production (site-built tract) homes in four climates: cold, mixed (cold and hot), hot humid, and hot arid. Our group in the Energy Analysis Department at Lawrence Berkeley National Lab compared residential ventilation strategies in four climates according to three criteria: total annualized costs (the sum of annualized capital cost and annual operating cost), predominant indoor pressure induced by the ventilation system, and distribution of ventilation air within the home. The mechanical ventilation systems modeled deliver 0.35 air changes per hour continuously, regardless of actual infiltration or occupant window-opening behavior. Based on the assumptions and analysis described in this report, we recommend independently ducted multi-port supply ventilation in all climates except cold because this strategy provides the safety and health benefits of positive indoor pressure as well as the ability to dehumidify and filter ventilation air. In cold climates, we recommend that multi-port supply ventilation be balanced by a single-port exhaust ventilation fan, and that builders offer balanced heat-recovery ventilation to buyers as an optional upgrade. For builders who continue to install forced-air integrated supply ventilation, we recommend ensuring ducts are airtight or in conditioned space, installing a control that automatically operates the forced-air fan 15-20 minutes during each hour that the fan does not operate for heating or cooling, and offering ICM forced-air fans to home buyers as an upgrade.

  14. Why We Ventilate

    SciTech Connect

    Logue, Jennifer M.; Sherman, Max H.; Price, Phil N.; Singer, Brett C.

    2011-09-01

    It is widely accepted that ventilation is critical for providing good indoor air quality (IAQ) in homes. However, the definition of"good" IAQ, and the most effective, energy efficient methods for delivering it are still matters of research and debate. This paper presents the results of work done at the Lawrence Berkeley National Lab to identify the air pollutants that drive the need for ventilation as part of a larger effort to develop a health-based ventilation standard. First, we present results of a hazard analysis that identified the pollutants that most commonly reach concentrations in homes that exceed health-based standards or guidelines for chronic or acute exposures. Second, we present results of an impact assessment that identified the air pollutants that cause the most harm to the U.S. population from chronic inhalation in residences. Lastly, we describe the implications of our findings for developing effective ventilation standards.

  15. Frequency and management of respiratory incidents in invasive home ventilation.

    PubMed

    Stieglitz, Sven; George, Sandhya; Priegnitz, Christina; Hagmeyer, Lars; Randerath, Winfried

    2013-08-01

    There has been a rise in the number of patients requiring long-term ventilation, both in the in-hospital and the out-of-hospital setting. Despite this, little is known about the subsequent clinical course of these patients following hospital discharge. The purpose of this study was to determine the frequency and management of respiratory incidents in patients with invasive out-of-hospital ventilation living in a nursing home allied to a weaning centre. We evaluated retrospectively the protocols that are used to monitor the patients over a period of 2 months. The average time from hospital discharge was 386 ± 330 days. Of the total 17 patients, 9 (53%) patients remained free from any respiratory incidents, while the remaining 8 (47%) patients were responsible for a total of 95 respiratory incidents. Patients that suffered respiratory incidents had been ventilated at home for an average of 194 days, while the others were receiving out-of-hospital ventilation for an average of 557 days. Desaturation (17), dyspnoea (17) and reduced general condition (10) were the most common respiratory incidents. Also, the use of an Ambu bag (bag valve mask; 17), request for a pneumologist review (12) and replacement of the tracheal cannula (7) were the most common interventions. Respiratory incidents are common in invasive home mechanical ventilation, and so home mechanical ventilation needed to be organized safely. Being allied to a weaning centre helps to organize invasive home mechanical ventilation in a safe manner over the long-term ventilation. PMID:23897929

  16. Measure Guideline: Selecting Ventilation Systems for Existing Homes

    SciTech Connect

    Aldrich, R.

    2014-02-01

    This document addresses adding -or improving - mechanical ventilation systems to existing homes. The purpose of ventilation is to remove contaminants from homes, and this report discusses where, when, and how much ventilation is appropriate in a home, including some discussion of relevant codes and standards. Advantages, disadvantages, and approximate costs of various system types are presented along with general guidelines for implementing the systems in homes. CARB intends for this document to be useful to decision makers and contractors implementing ventilation systems in homes. Choosing the "best" system is not always straightforward; selecting a system involves balancing performance, efficiency, cost, required maintenance, and several other factors. It is the intent of this document to assist contractors in making more informed decisions when selecting systems. Ventilation is an integral part of a high-performance home. With more air-sealed envelopes, a mechanical means of removing contaminants is critical for indoor environmental quality and building durability.

  17. 14 CFR 25.831 - Ventilation.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Design and Construction Ventilation and Heating § 25.831 Ventilation... probable failures or malfunctioning of the ventilating, heating, pressurization, or other systems...

  18. 14 CFR 25.831 - Ventilation.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Design and Construction Ventilation and Heating § 25.831 Ventilation... probable failures or malfunctioning of the ventilating, heating, pressurization, or other systems...

  19. 14 CFR 25.831 - Ventilation.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Design and Construction Ventilation and Heating § 25.831 Ventilation... probable failures or malfunctioning of the ventilating, heating, pressurization, or other systems...

  20. 14 CFR 25.831 - Ventilation.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Design and Construction Ventilation and Heating § 25.831 Ventilation... probable failures or malfunctioning of the ventilating, heating, pressurization, or other systems...

  1. 14 CFR 25.831 - Ventilation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Design and Construction Ventilation and Heating § 25.831 Ventilation... probable failures or malfunctioning of the ventilating, heating, pressurization, or other systems...

  2. Quebec's Child Care Services: What Are the Mechanisms Influencing Children's Behaviors across Quantity, Type, and Quality of Care Experienced?

    ERIC Educational Resources Information Center

    Lemay, Lise; Bigras, Nathalie; Bouchard, Caroline

    2015-01-01

    The objective of this study was to examine how quantity, type, and quality of care interact in predicting externalizing and internalizing behaviors of 36-month-old children attending Quebec's educational child care from their first years of life. To do so, the authors examined two hypothesized models: (1) a mediation model where quantity, type,…

  3. Thermoregulation and ventilation of termite mounds

    NASA Astrophysics Data System (ADS)

    Korb, Judith

    2003-05-01

    Some of the most sophisticated of all animal-built structures are the mounds of African termites of the subfamily Macrotermitinae, the fungus-growing termites. They have long been studied as fascinating textbook examples of thermoregulation or ventilation of animal buildings. However, little research has been designed to provide critical tests of these paradigms, derived from a very small number of original papers. Here I review results from recent studies on Macrotermes bellicosus that considered the interdependence of ambient temperature, thermoregulation, ventilation and mound architecture, and that question some of the fundamental paradigms of termite mounds. M. bellicosus achieves thermal homeostasis within the mound, but ambient temperature has an influence too. In colonies in comparably cool habitats, mound architecture is adapted to reduce the loss of metabolically produced heat to the environment. While this has no negative consequences in small colonies, it produces a trade-off with gas exchange in large colonies, resulting in suboptimally low nest temperatures and increased CO2 concentrations. Along with the alteration in mound architecture, the gas exchange/ventilation mechanism also changes. While mounds in the thermally appropriate savannah have a very efficient circular ventilation during the day, the ventilation in the cooler forest is a less efficient upward movement of air, with gas exchange restricted by reduced surface exchange area. These results, together with other recent findings, question entrenched ideas such as the thermosiphon-ventilation mechanism or the assumption that mounds function to dissipate internally produced heat. Models trying to explain the proximate mechanisms of mound building, or building elements, are discussed.

  4. Effect of Nebulized Colistin on the Ventilator Circuit: a Prospective Pilot Case- Control Study from a Single Cancer Center

    PubMed Central

    Ghonimat, Iyad M; Nazer, Lama H; Aqel, Flsteen; Mohammad, Mohammad K; Hawari, Feras I; Le, Jennifer

    2015-01-01

    Nebulized colistin (NC) is used for the treatment of pneumonia due to multidrug- resistant Gram-negative bacteria. In this one-year case-control study, our objective was to evaluate the effect of NC on the ventilator circuit (VC) components. The case group consisted of 25 mechanically-ventilated patients who received NC for the treatment of nosocomial pneumonia while the control group was 25 mechanically-ventilated patients who did not receive NC. Respiratory therapists inspected the VC every 4 hrs and whenever a ventilator alarm was reported. The VC component was changed if the alarm did not subside after necessary measures were performed. Patients from both groups were treated at the adult medical/surgical intensive care unit at King Hussein Cancer Center. In the case group, 22 (88%) patients required changing at least one of the circuit components (flow sensor, exhalation membrane, or nebulizer kit). The median number of changes (range) per patient of the flow sensor, exhalation membrane, and nebulizer kit were: 2 (1–3), 2 (1–6), and 1 (1–2), respectively. Large amounts of white crystals, which resembled the colistin powder, were reported on the replaced VC components. The flow sensor was changed in 2 control patients, but white crystals were absent. Crystals obtained from one case subject were confirmed to be colistin by chromatographic mass spectroscopy. Further studies are needed to evaluate the effect of crystal formation on the efficacy of NC and clinical outcomes. PMID:25960860

  5. Nebulised colistin for ventilator-associated pneumonia prevention.

    PubMed

    Karvouniaris, Marios; Makris, Demosthenes; Zygoulis, Paris; Triantaris, Apostolos; Xitsas, Stelios; Mantzarlis, Konstantinos; Petinaki, Efthimia; Zakynthinos, Epaminondas

    2015-12-01

    We evaluated whether prophylactic nebulised colistin could reduce ventilator-associated pneumonia (VAP) rates in an intensive care unit (ICU) setting with prevalent multidrug-resistant (MDR) bacteria.We used a single-centre, two-arm, randomised, open-label, controlled trial in a 12-bed ICU in the University Hospital of Larissa, Greece. Patient inclusion criteria included mechanical ventilation of >48?h. The two arms consisted of prophylaxis with 500?000?U colistin (Col group) or normal saline (NS group), thrice daily, for the first 10 ICU days or until extubation. The primary outcome of the study was the 30-day VAP incidence.In total, 168 patients entered the study. VAP incidence was not different between Col and NS group patients (14 (16.7%) versus 25 (29.8%), respectively, p=0.07). Regarding the secondary outcomes, the intervention resulted in a lower VAP incidence density rate (11.4 versus 25.6, respectively, p<0.01), and less Gram-negative bacteria-VAP (p=0.03) and MDR-VAP (p=0.04). Among VAP patients (n=39), prophylaxis with inhaled colistin improved ICU survival (p=0.016). There was no evidence of increased resistance to colistin or multidrug resistance.Our findings suggest that nebulised colistin had no significant effect on VAP incidence. PMID:26405294

  6. Informal payments and the quality of health care: Mechanisms revealed by Tanzanian health workers.

    PubMed

    Mæstad, Ottar; Mwisongo, Aziza

    2011-02-01

    Informal payments for health services are common in many transitional and developing countries. The aim of this paper is to investigate the nature of informal payments in the health sector of Tanzania and to identify mechanisms through which informal payments may affect the quality of health care. Our focus is on the effect of informal payments on health worker behaviours, in particular the interpersonal dynamics among health workers at their workplaces. We organised eight focus groups with 58 health workers representing different cadres and levels of care in one rural and one urban district in Tanzania. We found that health workers at all levels receive informal payments in a number of different contexts. Health workers sometimes share the payments received, but only partially, and more rarely within the cadre than across cadres. Our findings indicate that health workers are involved in 'rent-seeking' activities, such as creating artificial shortages and deliberately lowering the quality of service, in order to extract extra payments from patients or to bargain for a higher share of the payments received by their colleagues. The discussions revealed that many health workers think that the distribution of informal payments is grossly unfair. The findings suggest that informal payments can impact negatively on the quality of health care through rent-seeking behaviours and through frustrations created by the unfair allocation of payments. Interestingly, the presence of corruption may also induce non-corrupt workers to reduce the quality of care. Positive impacts can occur because informal payments may induce health workers to increase their efforts, and maybe more so if there is competition among health workers about receiving the payments. Moreover, informal payments add to health workers' incomes and might thus contribute to retention of health workers within the health sector. PMID:20709420

  7. Computational fluid dynamics in ventilation: Practical approach

    NASA Astrophysics Data System (ADS)

    Fontaine, J. R.

    The potential of computation fluid dynamics (CFD) for conceiving ventilation systems is shown through the simulation of five practical cases. The following examples are considered: capture of pollutants on a surface treating tank equipped with a unilateral suction slot in the presence of a disturbing air draft opposed to suction; dispersion of solid aerosols inside fume cupboards; performances comparison of two general ventilation systems in a silkscreen printing workshop; ventilation of a large open painting area; and oil fog removal inside a mechanical engineering workshop. Whereas the two first problems are analyzed through two dimensional numerical simulations, the three other cases require three dimensional modeling. For the surface treating tank case, numerical results are compared to laboratory experiment data. All simulations are carried out using EOL, a CFD software specially devised to deal with air quality problems in industrial ventilated premises. It contains many analysis tools to interpret the results in terms familiar to the industrial hygienist. Much experimental work has been engaged to validate the predictions of EOL for ventilation flows.

  8. Increased Natural Ventilation Flow Rates through Ventilation Shafts

    E-print Network

    Ray, Stephen D.

    Buoyancy-driven natural ventilation in ventilation shafts is investigated with a small scale physical experiment within a duct and CFD simulations of an office building. For a fixed exhaust opening, smaller shafts lead to ...

  9. Barriers to Improved Ventilation in Production Housing: Preprint

    SciTech Connect

    Barley, C. D.

    2002-04-01

    In addressing the goals of energy-efficiency and indoor air quality (IAQ) in homes, industry teams in the U.S. Department of Energy's Building America program are installing mechanical ventilation systems in tight homes.

  10. Natural ventilation in buildings : modeling, control and optimization

    E-print Network

    Ip Kiun Chong, Karine

    2014-01-01

    Natural ventilation in buildings has the potential to reduce the energy consumption usually associated with mechanical cooling while maintaining thermal comfort and air quality. It is important to know how building parameters, ...

  11. Natural ventilation possibilities for buildings in the United States

    E-print Network

    Dean, Brian N. (Brian Nathan), 1974-

    2001-01-01

    In the United States, many of the commercial buildings built in the last few decades are completely mechanically air conditioned, without the capability to use natural ventilation. This habit has occurred in building designs ...

  12. 4. VENTILATION FAN SHOWING RELATIVE POSITION IN THE AIR TUNNEL. ...

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

    4. VENTILATION FAN SHOWING RELATIVE POSITION IN THE AIR TUNNEL. - Hot Springs National Park, Bathhouse Row, Ozark Bathhouse: Mechanical & Piping Systems, State Highway 7, 1 mile north of U.S. Highway 70, Hot Springs, Garland County, AR

  13. [Protracted respiratory insufficiency - epidemiology and network on respiratory weaning after prolonged ventilation].

    PubMed

    Schönhofer, B; Pfeifer, M; Köhler, D

    2010-09-01

    The prevalence of difficult or prolonged weaning from the ventilator is increasing due to a growing number of multi-morbid, elderly and pulmonary deficient patients being mechanically ventilated. Intensive care units (ICU) tend to refer difficult to wean patients to specialised weaning facilities. A survey of 38 centres - performed in 2006 - included a total number of 2718 patients with difficult or prolonged weaning. Almost three quarters of the patients were transferred to a weaning centre from an external ICU. The weaning success rate was 66.3?%. After weaning in 31.9?% of the patients, home mechanical ventilation was started. The overall hospital mortality rate was 20.8?%. Recently the task force "WeanNet" - a network of weaning units - was founded under the auspices of the German Thoracic Society. The main aim of WeanNet is to improve cooperation among the weaning centres and the quality of patient management. Important tools of WeanNet are (i) the register of weaning patients and (ii) accreditation of the weaning centres. To develop the register an intensive cooperation between the task force and the Institute for Lung Research (ILF) was necessary. The finished register is now logistically run by ILF. In less than 1 year after the official start, already 70 weaning units with ca. 3000 patients are registered. In future "WeanNet", in particular in terms of the register and the accreditation, will stand for the quality of weaning centres in Germany. PMID:20827645

  14. N-Acetylcysteine Inhibits Ventilation-Induced Collagen Accumulation in the Rat Lung.

    PubMed

    Chen, Chuanxi; Guan, Xiangdong; Quinn, Deborah A; Ouyang, Bin

    2015-01-01

    Mechanical ventilation is the most important life supportive therapy for patients with acute respiratory distress syndrome (ARDS). However, increasing evidence from clinical studies suggests that mechanical ventilation can cause lung fibrosis, which may significantly contribute to morbidity and mortality. Recent studies also found fibroproliferation occurred in early stage of ARDS with poor outcome. We have hypothesized that mechanical ventilation-induced lung injury may be a major contributor to lung fibrosis, and antioxidant could be a potential therapeutic agent for the treatment to mechanic ventilation induced fibroproliferation. We therefore used Sprague-Dawley rats that were ventilated with large tidal volume (20 ml/kg) or low tidal volume (7 ml/kg). We analyzed the time course of collagen level in the lung and the effect of N-acetylcysteine (NAC), a thiol antioxidant, on mechanical ventilation-induced collagen accumulation. In addition, normal human lung fibroblasts (NHLF) were exposed to mechanical stretch, which mimics ventilator-induced lung inflation, to evaluate the collagen secretion in culture medium. We found that ventilation-induced collagen accumulation occurred even after 2-hour ventilation. Pretreatment with NAC (140 mg/kg) inhibited collagen accumulation in lungs of rats ventilated with large tidal volume. Moreover, mechanical stretch caused the accumulation of collagen in the culture medium of NHLF, the magnitude of which was decreased with the pretreatment with NAC (1 mM). These results indicate that mechanical ventilation can induce collagen accumulation within 2 hours. NAC alleviated the collagen accumulation induced by mechanical ventilation with high tidal volume. Therefore, NAC can be considered as a good candidate in preventing ventilation-induced lung fibrosis. PMID:26156407

  15. Contracts, Vouchers, and Child Care Subsidy Stability: A Preliminary Look at Associations between Subsidy Payment Mechanism and Stability of Subsidy Receipt

    ERIC Educational Resources Information Center

    Holod, Aleksandra; Johnson, Anna D.; Martin, Anne; Gardner, Margo; Brooks-Gunn, Jeanne

    2012-01-01

    Background: The federal child care subsidy program, funded through the Child Care and Development Fund (CCDF), is the nation's largest public investment in early child care. However, little is known about whether and how subsidy payment mechanisms relate to the stability of subsidy receipt or the stability of children's care arrangements.…

  16. Gas exchange and intrapulmonary distribution of ventilation during continuous-flow ventilation

    SciTech Connect

    Vettermann, J.; Brusasco, V.; Rehder, K.

    1988-05-01

    In 12 anesthetized paralyzed dogs, pulmonary gas exchange and intrapulmonary inspired gas distribution were compared between continuous-flow ventilation (CFV) and conventional mechanical ventilation (CMV). Nine dogs were studied while they were lying supine, and three dogs were studied while they were lying prone. A single-lumen catheter for tracheal insufflation and a double-lumen catheter for bilateral endobronchial insufflation (inspired O2 fraction = 0.4; inspired minute ventilation = 1.7 +/- 0.3 (SD) 1.kg-1.min-1) were evaluated. Intrapulmonary gas distribution was assessed from regional 133Xe clearances. In dogs lying supine, CO2 elimination was more efficient with endobronchial insufflation than with tracheal insufflation, but the alveolar-arterial O2 partial pressure difference was larger during CFV than during CMV, regardless of the type of insufflation. By contrast, endobronchial insufflation maintained both arterial PCO2 and alveolar-arterial O2 partial pressure difference at significantly lower levels in dogs lying prone than in dogs lying supine. In dogs lying supine, the dependent lung was preferentially ventilated during CMV but not during CFV. In dogs lying prone, gas distribution was uniform with both modes of ventilation. The alveolar-arterial O2 partial pressure difference during CFV in dogs lying supine was negatively correlated with the reduced ventilation of the dependent lung, which suggests that increased ventilation-perfusion mismatching was responsible for the increase in alveolar-arterial O2 partial pressure difference. The more efficient oxygenation during CFV in dogs lying prone suggests a more efficient matching of ventilation to perfusion, presumably because the distribution of blood flow is also nearly uniform.

  17. Ventilation technologies scoping study

    SciTech Connect

    Walker, Iain S.; Sherman, Max H.

    2003-09-30

    This document presents the findings of a scoping study commissioned by the Public Interest Energy Research (PIER) program of the California Energy Commission to determine what research is necessary to develop new residential ventilation requirements for California. This study is one of three companion efforts needed to complete the job of determining the needs of California, determining residential ventilation requirements, and determining appropriate ventilation technologies to meet these needs and requirements in an energy efficient manner. Rather than providing research results, this scoping study identifies important research questions along with the level of effort necessary to address these questions and the costs, risks, and benefits of pursuing alternative research questions. In approaching these questions and level of effort, feasibility and timing were important considerations. The Commission has specified Summer 2005 as the latest date for completing this research in time to update the 2008 version of California's Energy Code (Title 24).

  18. Brain-lung crosstalk: Implications for neurocritical care patients

    PubMed Central

    Mrozek, Ségolène; Constantin, Jean-Michel; Geeraerts, Thomas

    2015-01-01

    Major pulmonary disorders may occur after brain injuries as ventilator-associated pneumonia, acute respiratory distress syndrome or neurogenic pulmonary edema. They are key points for the management of brain-injured patients because respiratory failure and mechanical ventilation seem to be a risk factor for increased mortality, poor neurological outcome and longer intensive care unit or hospital length of stay. Brain and lung strongly interact via complex pathways from the brain to the lung but also from the lung to the brain. Several hypotheses have been proposed with a particular interest for the recently described “double hit” model. Ventilator setting in brain-injured patients with lung injuries has been poorly studied and intensivists are often fearful to use some parts of protective ventilation in patients with brain injury. This review aims to describe the epidemiology and pathophysiology of lung injuries in brain-injured patients, but also the impact of different modalities of mechanical ventilation on the brain in the context of acute brain injury. PMID:26261769

  19. Natural ventilation generates building form

    E-print Network

    Chen, Shaw-Bing

    1996-01-01

    Natural ventilation is an efficient design strategy for thermal comfort in hot and humid climates. The building forms can generate different pressures and temperatures to induce natural ventilation. This thesis develops a ...

  20. Innovative Energy Efficient Industrial Ventilation 

    E-print Network

    Litomisky, A.

    2005-01-01

    This paper was written to describe an innovative “on-demand” industrial ventilation system for woodworking, metalworking, food processing, pharmaceutical, chemical, and other industries. Having analyzed existing industrial ventilation in 130...

  1. Ventilation flow: Submerged

    NASA Technical Reports Server (NTRS)

    Hutchinson, D.

    1985-01-01

    The ventilation system on a submarine is discussed. When the submarine is submerged. The ventilation system provides a conditioned atmosphere in the ship with complete isolation from the outside. A conditioned atmosphere includes not only filtration and temperature and humidity control, but also air purification (removal of potentially harmful quantities of impurities and comtaminants) and revitalization (addition of vital life support oxygen). Carbon dioxide removal, the oxygen system, air conditioning, carbon monoxide removal, hydrogen removal, and atmosphere monitoring systems are among the topics discussed.

  2. Cancer Pain: A Critical Review of Mechanism-based Classification and Physical Therapy Management in Palliative Care

    PubMed Central

    Kumar, Senthil P

    2011-01-01

    Mechanism-based classification and physical therapy management of pain is essential to effectively manage painful symptoms in patients attending palliative care. The objective of this review is to provide a detailed review of mechanism-based classification and physical therapy management of patients with cancer pain. Cancer pain can be classified based upon pain symptoms, pain mechanisms and pain syndromes. Classification based upon mechanisms not only addresses the underlying pathophysiology but also provides us with an understanding behind patient's symptoms and treatment responses. Existing evidence suggests that the five mechanisms – central sensitization, peripheral sensitization, sympathetically maintained pain, nociceptive and cognitive-affective – operate in patients with cancer pain. Summary of studies showing evidence for physical therapy treatment methods for cancer pain follows with suggested therapeutic implications. Effective palliative physical therapy care using a mechanism-based classification model should be tailored to suit each patient's findings, using a biopsychosocial model of pain. PMID:21976851

  3. High Burden of Palliative Needs among Older Intensive Care Unit Survivors Transferred to Post–Acute Care Facilities. A Single-Center Study

    PubMed Central

    Wunsch, Hannah; Reyfman, Paul A.; Narain, Wazim R.; Blinderman, Craig D.; Schluger, Neil W.; Reid, M. Cary; Maurer, Mathew S.; Goldstein, Nathan; Lederer, David J.; Bach, Peter

    2013-01-01

    Rationale: Adults with chronic critical illness (tracheostomy after ? 10 d of mechanical ventilation) have a high burden of palliative needs, but little is known about the actual use and potential need of palliative care services for the larger population of older intensive care unit (ICU) survivors discharged to post–acute care facilities. Objectives: To determine whether older ICU survivors discharged to post–acute care facilities have potentially unmet palliative care needs. Methods: We examined electronic records from a 1-year cohort of 228 consecutive adults ? 65 years of age who had their first medical-ICU admission in 2009 at a single tertiary-care medical center and survived to discharge to a post–acute care facility (excluding hospice). Use of palliative care services was defined as having received a palliative care consultation. Potential palliative care needs were defined as patient characteristics suggestive of physical or psychological symptom distress or anticipated poor prognosis. We examined the prevalence of potential palliative needs and 6-month mortality. Measurements and Main Results: The median age was 78 years (interquartile range, 71–84 yr), and 54% received mechanical ventilation for a median of 7 days (interquartile range, 3–16 d). Six subjects (2.6%) received a palliative care consultation during the hospitalization. However, 88% had at least one potential palliative care need; 22% had chronic wounds, 37% were discharged on supplemental oxygen, 17% received chaplaincy services, 23% preferred to not be resuscitated, and 8% were designated “comfort care.” The 6-month mortality was 40%. Conclusions: Older ICU survivors from a single center who required postacute facility care had a high burden of palliative care needs and a high 6-month mortality. The in-hospital postcritical acute care period should be targeted for palliative care assessment and intervention. PMID:23987743

  4. RESIDENTIAL VENTILATION AND ENERGY CHARACTERISTICS*

    E-print Network

    RESIDENTIAL VENTILATION AND ENERGY CHARACTERISTICS* Max Sherman Nance Matson Energy Performance Berkeley, California The role of ventilation in the housing stock is to provide fresh air and to dilute to provide this ventilation service, either directly for moving the air or indirectly for conditioning

  5. RESIDENTIAL VENTILATION STUDY

    EPA Science Inventory

    This project evaluated the effectiveness, first costs and operational costs of various types of residential ventilation systems in three different climates in the U.S. The Agency, through its Energy Star Program, recommends that builders construct homes that are energy efficient ...

  6. Measure Guideline: Ventilation Cooling

    SciTech Connect

    Springer, D.; Dakin, B.; German, A.

    2012-04-01

    The purpose of this measure guideline on ventilation cooling is to provide information on a cost-effective solution for reducing cooling system energy and demand in homes located in hot-dry and cold-dry climates. This guideline provides a prescriptive approach that outlines qualification criteria, selection considerations, and design and installation procedures.

  7. Space station ventilation study

    NASA Technical Reports Server (NTRS)

    Colombo, G. V.; Allen, G. E.

    1972-01-01

    A ventilation system design and selection method which is applicable to any manned vehicle were developed. The method was used to generate design options for the NASA 33-foot diameter space station, all of which meet the ventilation system design requirements. System characteristics such as weight, volume, and power were normalized to dollar costs for each option. Total system costs for the various options ranged from a worst case $8 million to a group of four which were all approximately $2 million. A system design was then chosen from the $2 million group and is presented in detail. A ventilation system layout was designed for the MSFC space station mockup which provided comfortable, efficient ventilation of the mockup. A conditioned air distribution system design for the 14-foot diameter modular space station, using the same techniques, is also presented. The tradeoff study resulted in the selection of a system which costs $1.9 million, as compared to the alternate configuration which would have cost $2.6 million.

  8. How to minimise ventilator-induced lung injury in transplanted lungs: The role of protective ventilation and other strategies.

    PubMed

    Soluri-Martins, Andre; Sutherasan, Yuda; Silva, Pedro L; Pelosi, Paolo; Rocco, Patricia R M

    2015-12-01

    Lung transplantation is the treatment of choice for end-stage pulmonary diseases. In order to avoid or reduce pulmonary and systemic complications, mechanical ventilator settings have an important role in each stage of lung transplantation. In this respect, the use of mechanical ventilation with a tidal volume of 6 to 8?ml?kg predicted body weight, positive end-expiratory pressure of 6 to 8?cmH2O and a plateau pressure lower than 30?cmH2O has been suggested for the donor during surgery, and for the recipient both during and after surgery. For the present review, we systematically searched the PubMed database for articles published from 2000 to 2014 using the following keywords: lung transplantation, protective mechanical ventilation, lung donor, extracorporeal membrane oxygenation, recruitment manoeuvres, extracorporeal CO2 removal and noninvasive ventilation. PMID:26148171

  9. Alcohol-based hand rub and ventilator-associated pneumonia after elective neurosurgery: An interventional study

    PubMed Central

    Saramma, P. P.; Krishnakumar, K.; Dash, P. K.; Sarma, P. S.

    2011-01-01

    Background: Interventional studies on the effect of alcohol-based hand rub on ventilator-associated pneumonia (VAP) among neurosurgical patients are scarce. Aim: To observe the effect of alcohol-based hand rub on tracheobronchial colonization and VAP after elective neurosurgical procedures. Materials and Methods: An interventional study using a “before–after” design in a tertiary care center in Kerala. Two 9-month study periods were compared; between these periods, an infection control protocol incorporating an alcohol-based hand rub was implemented for a period of 3 months and continued thereafter. Consecutive patients who required mechanical ventilation after neurosurgery between January and September 2006 and 2007, respectively, were included. Outcome measures included VAP rate, tracheobronchial colonization rate, profile of microorganisms and patient survival. Results: A total of 352 patients were on mechanical ventilator for a varying period of 1–125 days. The patients in the control and intervention groups were similar with regard to sex, age and type of neurosurgery. Tracheobronchial colonization was seen in 86 (48.6%) of 177 in the control group and 73 (41.7%) of 175 among the intervention group (P = 0.195). The VAP rates in the control and intervention groups were 14.03 and 6.48 per 1000 ventilator days (P = 0.08). The predominant organisms causing VAP and tracheobronchial colonization were Klebsiella and Pseudomonas aeruginosa, respectively, in both groups. Patient survival rates were 87.6% (control) and 92% (intervention). Conclusion: Clinical results indicated a better outcome, showing a reduction in tracheobronchial colonization rate and VAP rate, although this was not statistically significant. PMID:22346030

  10. Contaminated Ventilator Air Flow Sensor Linked to Bacillus cereus Colonization of Newborns

    PubMed Central

    Gee, Jay E.; Hoffmaster, Alex R.; Manian, Farrin; Butler, Cindy; Byrd, David; Schildknecht, Stephanie; Hauser, Lina Chavez; Duncan, Mary; Ferrett, Rhonda; Evans, Dana; Talley, Crystal

    2013-01-01

    We investigated Bacillus cereus–positive tracheal aspirates from infants on ventilators in a neonatal intensive care unit. Multilocus sequence typing determined a genetic match between strains isolated from samples from a case-patient and from the air flow sensor in the ventilator. Changing the sterilization method for sensors to steam autoclaving stopped transmission. PMID:23647973

  11. Contaminated ventilator air flow sensor linked to Bacillus cereus colonization of newborns.

    PubMed

    Turabelidze, George; Gee, Jay E; Hoffmaster, Alex R; Manian, Farrin; Butler, Cindy; Byrd, David; Schildknecht, Stephanie; Hauser, Lina Chavez; Duncan, Mary; Ferrett, Rhonda; Evans, Dana; Talley, Crystal

    2013-05-01

    We investigated Bacillus cereus-positive tracheal aspirates from infants on ventilators in a neonatal intensive care unit. Multilocus sequence typing determined a genetic match between strains isolated from samples from a case-patient and from the air flow sensor in the ventilator. Changing the sterilization method for sensors to steam autoclaving stopped transmission. PMID:23647973

  12. Using modeling to inform patient-centered care choices at the end of life

    PubMed Central

    Hajizadeh, Negin; Crothers, Kristina; Braithwaite, R Scott

    2014-01-01

    Aim Advance directives are often under-informed due to a lack of disease-specific prognostic information. Without well-informed advance directives patients may receive default care that is incongruent with their preferences. We aimed to further inform advance care planning in patients with severe chronic obstructive pulmonary disease by estimating outcomes with alternative advance directives. Methods We designed a Markov microsimulation model estimating outcomes for patients choosing between the Full Code advance directive (permitting invasive mechanical ventilation), and the Do Not Intubate directive (only permitting noninvasive ventilation). Results Our model estimates Full Code patients have marginally increased one-year survival after admission for severe respiratory failure, but are more likely to be residing in a nursing home and have frequent rehospitalizations for respiratory failure. Conclusion Patients with severe chronic obstructive pulmonary disease may consider these potential tradeoffs between survival, rehospitalizations and institutionalization when making informed advance care plans and end-of-life decisions. We highlight outcomes research needs for variables most influential to the model’s outcomes, including the risk of complications of invasive mechanical ventilation and failing noninvasive mechanical ventilation. PMID:24236746

  13. Ventilation and infiltration in high-rise apartment buildings

    SciTech Connect

    Diamond, R.C.; Feustel, H.E.; Dickerhoff, D.J.

    1996-03-01

    Air flow, air leakage measurements and numerical simulations were made on a 13-story apartment building to characterize the ventilation rates for the individual apartments. Parametric simulations were performed for specific conditions, e.g., height, orientation, outside temperature and wind speed. Our analysis of the air flow simulations suggest that the ventilation to the individual units varies considerably. With the mechanical ventilation system disabled and no wind, units at the lower level of the building have adequate ventilation only on days with high temperature differences, while units on higher floors have no ventilation at all. Units facing the windward side will be over-ventilated when the building experiences wind directions between west and north. At the same time, leeward apartments did not experience any fresh air-because, in these cases, air flows enter the apartments from the corridor and exit through the exhaust shafts and the cracks in the facade. Even with the mechanical ventilation system operating, we found wide variation in the air flows to the individual apartments. In addition to the specific case presented here, these findings have more general implications for energy retrofits and health and comfort of occupants in high-rise apartment buildings.

  14. High-volume hemofiltration and prone ventilation in subarachnoid hemorrhage complicated by severe acute respiratory distress syndrome and refractory septic shock

    PubMed Central

    Cornejo, Rodrigo; Romero, Carlos; Ugalde, Diego; Bustos, Patricio; Diaz, Gonzalo; Galvez, Ricardo; Llanos, Osvaldo; Tobar, Eduardo

    2014-01-01

    We report the successful treatment of two patients with aneurismal subarachnoid hemorrhage complicated by severe respiratory failure and refractory septic shock using simultaneous prone position ventilation and high-volume hemofiltration. These rescue therapies allowed the patients to overcome the critical situation without associated complications and with no detrimental effects on the intracranial and cerebral perfusion pressures. Prone position ventilation is now an accepted therapy for severe acute respiratory distress syndrome, and high-volume hemofiltration is a non-conventional hemodynamic support that has several potential mechanisms for improving septic shock. In this manuscript, we briefly review these therapies and the related evidence. When other conventional treatments are insufficient for providing safe limits of oxygenation and perfusion as part of basic neuroprotective care in subarachnoid hemorrhage patients, these rescue therapies should be considered on a case-by-case basis by an experienced critical care team. PMID:25028955

  15. Perceptions and Attitudes of Health Professionals in Kenya on National Health Care Resource Allocation Mechanisms: A Structural Equation Modeling

    PubMed Central

    Owili, Patrick Opiyo; Hsu, Yi-Hsin Elsa; Chern, Jin-Yuan; Chiu, Chiung-Hsuan Megan; Wang, Bill; Huang, Kuo-Cherh; Muga, Miriam Adoyo

    2015-01-01

    Background Health care resource allocation is key towards attaining equity in the health system. However, health professionals’ perceived impact and attitude towards health care resource allocation in Sub-Saharan Africa is unknown; furthermore, they occupy a position which makes them notice the impact of different policies in their health system. This study explored perceptions and attitudes of health professionals in Kenya on health care resource allocation mechanism. Method We conducted a survey of a representative sample of 341 health professionals in Moi Teaching and Referral Hospital from February to April 2012, consisting of over 3000 employees. We assessed health professionals’ perceived impact and attitudes on health care resource allocation mechanism in Kenya. We used structural equation modeling and applied a Confirmatory Factor Analysis using Robust Maximum Likelihood estimation procedure to test the hypothesized model. Results We found that the allocation mechanism was negatively associated with their perceived positive impact (-1.04, p < .001), health professionals’ satisfaction (-0.24, p < .01), and professionals’ attitudes (-1.55, p < .001) while it was positively associated with perceived negative impact (1.14, p < .001). Perceived positive impact of the allocation mechanism was negatively associated with their overall satisfaction (-0.08) and attitude (-0.98) at p < .001, respectively. Furthermore, overall satisfaction was negatively associated with attitude (-1.10, p <.001). On the other hand, perceived negative impact of the allocation was positively associated with overall satisfaction (0.29, p <.001) but was not associated with attitude. Conclusion The result suggests that health care resource allocation mechanism has a negative effect towards perceptions, attitudes and overall satisfaction of health professionals who are at the frontline in health care. These findings can serve as a crucial reference for policymakers as the Kenyan health system move towards devolving the system of governance. PMID:26039053

  16. ASHRAE and residential ventilation

    SciTech Connect

    Sherman, Max H.

    2003-10-01

    In the last quarter of a century, the western world has become increasingly aware of environmental threats to health and safety. During this period, people psychologically retreated away from outdoors hazards such as pesticides, smog, lead, oil spills, and dioxin to the seeming security of their homes. However, the indoor environment may not be healthier than the outdoor environment, as has become more apparent over the past few years with issues such as mold, formaldehyde, and sick-building syndrome. While the built human environment has changed substantially over the past 10,000 years, human biology has not; poor indoor air quality creates health risks and can be uncomfortable. The human race has found, over time, that it is essential to manage the indoor environments of their homes. ASHRAE has long been in the business of ventilation, but most of the focus of that effort has been in the area of commercial and institutional buildings. Residential ventilation was traditionally not a major concern because it was felt that, between operable windows and envelope leakage, people were getting enough outside air in their homes. In the quarter of a century since the first oil shock, houses have gotten much more energy efficient. At the same time, the kinds of materials and functions in houses changed in character in response to people's needs. People became more environmentally conscious and aware not only about the resources they were consuming but about the environment in which they lived. All of these factors contributed to an increasing level of public concern about residential indoor air quality and ventilation. Where once there was an easy feeling about the residential indoor environment, there is now a desire to define levels of acceptability and performance. Many institutions--both public and private--have interests in Indoor Air Quality (IAQ), but ASHRAE, as the professional society that has had ventilation as part of its mission for over 100 years, is the logical place to provide leadership. This leadership has been demonstrated most recently by the publication of the first nationally recognized standard on ventilation in homes, ASHRAE Standard 62.2-2003, which builds on work that has been part of ASHRAE for many years and will presumably continue. Homeowners and occupants, which includes virtually all of us, will benefit from the application of Standard 62.2 and use of the top ten list. This activity is exactly the kind of benefit to society that the founders of ASHRAE envisioned and is consistent with ASHRAE's mission and vision. ASHRAE members should be proud of their Society for taking leadership in residential ventilation.

  17. Oral Care in Trauma Patients Admitted to the ICU: Viewpoints of ICU Nurses

    PubMed Central

    Javadinia, Seyed Alireza; Kuchi, Zahra; Saadatju, Alireza; Tabasi, Mohsen; Adib-Hajbaghery, Mohsen

    2014-01-01

    Background: Many patients with severe traumatic injuries are admitted to intensive care units (ICU). These patients usually require prolonged mechanical ventilation. These interventions require oral intubation and leave the mouth open which consequently impairs the natural antimicrobial activity in the mouth and airways. These patients are also prone to ventilator-associated pneumonia (VAP). Evidence shows that paying attention to oral hygiene in patients under mechanical ventilation is important in helping to prevent VAP. Objectives: The present study was conducted to assess the viewpoints and performance of ICU nurses at Birjand hospitals towards oral care of patients under mechanical ventilation. Patients and Methods: A cross-sectional study was conducted at ICUs of Imam-Reza and Vali-Asr hospitals, Birjand, Iran. Sampling was done through a census in which 53 ICU nurses participated. Descriptive statistics, Kolmogorov-Smirnov test, Mann-Whitney U tests and Kendall's correlation coefficient were used to analyze the data. Results: A total of 53 nurses participated in this study. Most of the nurses had been trained to provide oral care during their university education. According to the participants' opinions, oral care with an average score of 5.72 ranked second among the 10 nursing care domains. The most frequent oral care provided was oral suctioning, normal saline irrigation, and chlorhexidine rinse with 95%, 90%, and 81.3% frequency, respectively. Conclusions: Nurses participating in this study considered oral care to be of prime importance. Most of the participants although trained in this area felt the need for continuing training courses. PMID:25032148

  18. Measure Guideline: Selecting Ventilation Systems for Existing Homes

    SciTech Connect

    Aldrich, R.

    2014-02-01

    This report, developed by Building America research team CARB, addresses adding or improving mechanical ventilation systems to existing homes. The goal of this report is to assist decision makers and contractors in making informed decisions when selecting ventilation systems for homes. With more air-sealed envelopes, a mechanical means of removing contaminants is critical for indoor environmental quality and building durability. The purpose of ventilation is to remove contaminants from homes, and this report discusses where, when, and how much ventilation is appropriate in a home, including examination of relevant codes and standards. Choosing the "best" system is not always straightforward; selecting a system involves balancing performance, efficiency, cost, required maintenance, and several other factors.

  19. Modeling particle loss in ventilation ducts

    NASA Astrophysics Data System (ADS)

    Sippola, Mark R.; Nazaroff, William W.

    Empirical equations were developed and applied to predict losses of 0.01-100 ?m airborne particles making a single pass through 120 different ventilation duct runs typical of those found in mid-sized office buildings. For all duct runs, losses were negligible for submicron particles and nearly complete for particles larger than 50 ?m. The 50th percentile cut-point diameters were 15 ?m in supply runs and 25 ?m in return runs. Losses in supply duct runs were higher than in return duct runs, mostly because internal insulation was present in portions of supply duct runs, but absent from return duct runs. Single-pass equations for particle loss in duct runs were combined with models for predicting ventilation system filtration efficiency and particle deposition to indoor surfaces to evaluate the fates of particles of indoor and outdoor origin in an archetypal mechanically ventilated building. Results suggest that duct losses are a minor influence for determining indoor concentrations for most particle sizes. Losses in ducts were of a comparable magnitude to indoor surface losses for most particle sizes. For outdoor air drawn into an unfiltered ventilation system, most particles smaller than 1 ?m are exhausted from the building. Large particles deposit within the building, mostly in supply ducts or on indoor surfaces. When filters are present, most particles are either filtered or exhausted. The fates of particles generated indoors follow similar trends as outdoor particles drawn into the building.

  20. Modeling particle loss in ventilation ducts

    SciTech Connect

    Sippola, Mark R.; Nazaroff, William W.

    2003-04-01

    Empirical equations were developed and applied to predict losses of 0.01-100 {micro}m airborne particles making a single pass through 120 different ventilation duct runs typical of those found in mid-sized office buildings. For all duct runs, losses were negligible for submicron particles and nearly complete for particles larger than 50 {micro}m. The 50th percentile cut-point diameters were 15 {micro}m in supply runs and 25 {micro}m in return runs. Losses in supply duct runs were higher than in return duct runs, mostly because internal insulation was present in portions of supply duct runs, but absent from return duct runs. Single-pass equations for particle loss in duct runs were combined with models for predicting ventilation system filtration efficiency and particle deposition to indoor surfaces to evaluate the fates of particles of indoor and outdoor origin in an archetypal mechanically ventilated building. Results suggest that duct losses are a minor influence for determining indoor concentrations for most particle sizes. Losses in ducts were of a comparable magnitude to indoor surface losses for most particle sizes. For outdoor air drawn into an unfiltered ventilation system, most particles smaller than 1 {micro}m are exhausted from the building. Large particles deposit within the building, mostly in supply ducts or on indoor surfaces. When filters are present, most particles are either filtered or exhausted. The fates of particles generated indoors follow similar trends as outdoor particles drawn into the building.

  1. Bicarbonate versus acetate hemodialysis in ventilated patients.

    PubMed

    van Geelen, J A; Woittiez, A J; Schalekamp, M A

    1987-09-01

    Hemodynamic tolerance to bicarbonate versus acetate hemodialysis was studied in seven ventilated, critically ill patients, suffering from acute renal failure. Both kinds of hemodialysis were carried out with a recirculating dialysate delivery system and a relatively low blood flow (180 ml/min). Each patient underwent two hemodialysis procedures, one with bicarbonate and one with acetate, lasting for four hours. Ultrafiltration rates were kept below 250 ml/h and only biocompatible membranes with a relatively small surface area (Biospal 2400, Hospal, France) were used. Despite the mild hemodialysis conditions, hypotensive episodes with a mean blood pressure below 70 mmHg were observed in 3 out of 7 bicarbonate sessions and 4 out of 7 acetate sessions. Thus, we could not demonstrate a hemodynamic advantage of bicarbonate hemodialysis in this group of ventilated patients. This contrasts with other studies conducted in non-ventilated patients. Prevention of hypoxemia by mechanical ventilation and control of vascular tone by the use of vasoactive drugs may be of more clinical relevance than the kind of hemodialysis procedure that is used. PMID:3117466

  2. Harnessing natural ventilation benefits.

    PubMed

    O'Leary, John

    2013-04-01

    Making sure that a healthcare establishment has a good supply of clean fresh air is an important factor in keeping patients, staff, and visitors, free from the negative effects of CO2 and other contaminants. John O'Leary of Trend Controls, a major international supplier of building energy management solutions (BEMS), examines the growing use of natural ventilation, and the health, energy-saving, and financial benefits, that it offers. PMID:23678661

  3. Ventilation Air Preconditioning Systems 

    E-print Network

    Khattar, M.; Brandemuehl, M. J.

    1996-01-01

    , maintaining excellent control of temperature and humidity within each zone. Filter racks are 4" deep to accommodate a wide range of highefficiency filters. Tempering Outside Air in Winter In winter, the recirculation air can be heated rather than cooled...-cooled refrigeration racks. Simulation of the WalMart superstore application of these units showed a potential cost savings of 22.6% over conventional WAC&R systems. Zero-ODP Refrigerant The ventilation chiller uses R-407C, an environmentally acceptable...

  4. Asynchrony and cyclic variability in pressure support noninvasive ventilation.

    PubMed

    Achour, Linda; Letellier, Christophe; Cuvelier, Antoine; Vérin, Eric; Muir, Jean-François

    2007-09-01

    Noninvasive mechanical ventilation is an effective procedure to manage patients with acute or chronic respiratory failure. Most ventilators act as flow generators that assist spontaneous respiratory cycles by delivering inspiratory and expiratory pressures. This allows the patient to improve alveolar ventilation and subsequent pulmonary gas exchanges. The interaction between the patient and his ventilator are therefore crucial for tolerance and acceptability and part of this interaction is the facility to trigger the ventilator at the beginning of the inspiration. This is directly related to patients' discomfort which is not quantified today. Phase portraits reconstructed from the airflow and first-return maps built on the total breath duration were used to investigate the quality of the patient-ventilator interaction. Phase synchronization can be identified from phase portrait and the breath-to-breath variability is well characterized by return maps. This paper is a first step in the direction of automatically estimating the comfort from measurements and not from a necessarily subjective answer given by the patient. These tools could be helpful for the physicians to set the ventilator parameters. PMID:17258187

  5. Outcomes of Children With Severe Bronchopulmonary Dysplasia Who Were Ventilator Dependent at Home

    PubMed Central

    Carroll, Aaron E.; Davis, Stephanie D.; Swigonski, Nancy L.; Ackerman, Veda L.

    2013-01-01

    OBJECTIVE: To describe the incidence and outcomes of children with chronic respiratory failure secondary to severe bronchopulmonary dysplasia (BPD) on chronic positive pressure ventilation (PPV) via tracheostomy at home. METHODS: We retrospectively reviewed medical charts of patients with severe BPD who were PPV dependent at home and who were enrolled in a university-affiliated home ventilator program between 1984 and 2010. We excluded patients with other comorbidities that could contribute to the development of chronic respiratory failure. We reported the incidence of these children in Indiana and cumulative incidences of survival, liberation from PPV, and decannulation. RESULTS: Over 27 years, 628 children were cared for in our home ventilator program. Of these, 102 patients met inclusion criteria: 83 (81.4%) were alive and 19 (18.6%) were deceased. Sixty-nine patients (67.6%) were liberated from PPV, and 97.1% of them were weaned before their fifth birthday, with a median age at liberation of 24 months (interquartile range, 19–33). Similarly, 60 patients (58.8%) were decannulated, of which 96.7% completed this process before their sixth birthday, with a median age at decannulation of 37.5 months (interquartile range, 31.5–45). The incidence of children with chronic respiratory failure secondary to BPD who were PPV-dependent at home in Indiana was 1.23 per 100?000 live births in 1984 and increased to 4.77 per 100?000 live births in 2010. CONCLUSIONS: Although extreme prematurity associated with severe BPD necessitating PPV at home carries significant risks of morbidity and mortality, successful liberation from mechanical ventilation and decannulation are likely to occur. PMID:23918888

  6. Reflections on pediatric high-frequency oscillatory ventilation from a physiologic perspective.

    PubMed

    Kneyber, Martin C J; van Heerde, Marc; Markhorst, Dick G

    2012-09-01

    Mechanical ventilation using low tidal volumes has become universally accepted to prevent ventilator-induced lung injury. High-frequency oscillatory ventilation (HFOV) allows pulmonary gas exchange using very small tidal volume (1-2 mL/kg) with concomitant decreased risk of atelectrauma. However, its use in pediatric critical care varies between only 3% and 30% of all ventilated children. This might be explained by the fact that the beneficial effect of HFOV on patient outcome has not been ascertained. Alternatively, in contrast with present recommendations, one can ask if HFOV has been employed in its most optimal fashion related especially to the indications for and timing of HFOV, as well as to using the best oscillator settings. The first was addressed in one small randomized study showing that early use of HFOV, instead of rescue use, was associated with improved survival. From a physiologic perspective, the oscillator settings could be refined. Lung volume is the main determinant of oxygenation in diffuse alveolar disease, suggesting using an open-lung strategy by recruitment maneuvers, although this is in practice not custom. Using such an approach, the patient can be oscillated on the deflation limb of the pressure-volume (P-V) curve, allowing less pressure required to maintain a certain amount of lung volume. Gas exchange is determined by the frequency and the oscillatory power setting, controlling the magnitude of the membrane displacement. Experimental work as well as preliminary human data have shown that it is possible to achieve the smallest tidal volume with concomitant adequate gas exchange when oscillating at high frequency and high fixed power setting. Future studies are needed to validate these novel approaches and to evaluate their effect on patient outcome. PMID:22348243

  7. Intensive Care Utilization for Hematopoietic Cell Transplant Recipients.

    PubMed

    Jenkins, Patricia; Johnston, Laura J; Pickham, David; Chang, Beverly; Rizk, Norman; Tierney, D Kathryn

    2015-11-01

    Blood and marrow transplantation (BMT) is a potentially curative therapy for a number of malignant and nonmalignant diseases. Multiple variables, including age, comorbid conditions, disease, disease stage, prior therapies, degree of donor-recipient matching, type of transplantation, and dose intensity of the preparative regimen, affect both morbidity and mortality. Despite tremendous gains in supportive care, BMT remains a high-risk medical therapy. A critically ill BMT recipient may require transfer to an intensive care unit (ICU) and the specialized medical and nursing care that can be provided, such as mechanical ventilation and vasopressor support. Mortality for BMT recipients requiring care in an ICU is high. This paper will describe the experience of the Stanford Blood and Marrow Transplant Program in developing and implementing guidelines to maximize the benefit of intensive care for critically ill BMT recipients. PMID:26238809

  8. Non-invasive ventilation in cardiac surgery: a concise review.

    PubMed

    Cabrini, L; Plumari, V P; Nobile, L; Olper, L; Pasin, L; Bocchino, S; Landoni, G; Beretta, L; Zangrillo, A

    2013-01-01

    Mild to severe respiratory dysfunction is still a common issue after cardiac surgery. Postoperative respiratory complications are associated with prolonged hospitalization and worse survival. In this high-risk surgery, non-invasive ventilation could have relevant positive effects. The present narrative concise review aims to summarize available data on the role of non-invasive ventilation before and after cardiac surgery. Non-invasive ventilation exerts its main effects on the pulmonary and on the cardiovascular systems.  Non-invasive ventilation can be applied to prevent acute respiratory failure; it can also be prescribed as a curative tool to treat an established postoperative acute respiratory failure. Non-invasive ventilation could also be applied to wean patients from mechanical ventilation. When applied as a preventive tool, the main scope is the prevention of pneumonia by resolving or preventing atelectasis. So far, limited (but encouraging) data are available: its routine use in all patients to prevent postoperative acute respiratory failure cannot be recommended. Non-invasive ventilation to treat postoperative acute respiratory failure has been evaluated more extensively. A failure rate from 10 to 55% was reported. Safety appears preserved, with no relevant hemodynamic complication reported. Non-invasive ventilation has also been applied during percutaneous aortic valve implant in patients unable to lie supine due to severe respiratory limitation and orthopnea. In conclusion, non-invasive ventilation has the potential to be very useful before and after cardiac surgery. So far, results are promising but available data are limited. Training and experience are essential to obtain positive results and to avoid complications. PMID:24364004

  9. 14 CFR 252.9 - Ventilation systems.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...2010-01-01 2010-01-01 false Ventilation systems. 252.9 Section 252...SMOKING ABOARD AIRCRAFT § 252.9 Ventilation systems. Air carriers shall prohibit smoking whenever the ventilation system is not fully...

  10. 24 CFR 3285.505 - Crawlspace ventilation.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...2014-04-01 false Crawlspace ventilation. 3285.505 Section 3285.505...Features § 3285.505 Crawlspace ventilation. (a) A crawlspace with skirting must be provided with ventilation openings. The minimum net area...

  11. 46 CFR 194.20-5 - Ventilation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Ventilation. 194.20-5 Section 194...or Storerooms § 194.20-5 Ventilation. (a) Chemical storerooms shall be equipped with a power ventilation system of exhaust type. The...

  12. 30 CFR 57.8520 - Ventilation plan.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...2013-07-01 2013-07-01 false Ventilation plan. 57.8520 Section 57.8520...STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Ventilation Underground Only § 57.8520 Ventilation plan. A plan of the mine...

  13. 30 CFR 57.8520 - Ventilation plan.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2011-07-01 2011-07-01 false Ventilation plan. 57.8520 Section 57.8520...STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Ventilation Underground Only § 57.8520 Ventilation plan. A plan of the mine...

  14. 46 CFR 194.20-5 - Ventilation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Ventilation. 194.20-5 Section 194...or Storerooms § 194.20-5 Ventilation. (a) Chemical storerooms shall be equipped with a power ventilation system of exhaust type. The...

  15. 30 CFR 57.8520 - Ventilation plan.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2012-07-01 2012-07-01 false Ventilation plan. 57.8520 Section 57.8520...STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Ventilation Underground Only § 57.8520 Ventilation plan. A plan of the mine...

  16. 14 CFR 252.9 - Ventilation systems.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...2014-01-01 2014-01-01 false Ventilation systems. 252.9 Section 252...SMOKING ABOARD AIRCRAFT § 252.9 Ventilation systems. Air carriers shall prohibit smoking whenever the ventilation system is not fully...

  17. 14 CFR 252.9 - Ventilation systems.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...2012-01-01 2012-01-01 false Ventilation systems. 252.9 Section 252...SMOKING ABOARD AIRCRAFT § 252.9 Ventilation systems. Air carriers shall prohibit smoking whenever the ventilation system is not fully...

  18. 30 CFR 57.8520 - Ventilation plan.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 2010-07-01 false Ventilation plan. 57.8520 Section 57.8520...STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Ventilation Underground Only § 57.8520 Ventilation plan. A plan of the mine...

  19. 24 CFR 3285.505 - Crawlspace ventilation.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...2011-04-01 false Crawlspace ventilation. 3285.505 Section 3285.505...Features § 3285.505 Crawlspace ventilation. (a) A crawlspace with skirting must be provided with ventilation openings. The minimum net area...

  20. 46 CFR 194.20-5 - Ventilation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 2012-10-01 false Ventilation. 194.20-5 Section 194...or Storerooms § 194.20-5 Ventilation. (a) Chemical storerooms shall be equipped with a power ventilation system of exhaust type. The...