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1

Weaning from mechanical ventilation in pediatric intensive care patients  

Microsoft Academic Search

Objective: The development of weaning predictors in mechanically ventilated children has not been sufficiently investigated. The purpose\\u000a of this study was to evaluate the accuracy of some weaning indices in predicting weaning failure. Design: Prospective, interventional study. Setting: University-affiliated children's hospital with a 19-bed intensive care unit. Patients: 84 consecutive infants and children requiring mechanical ventilation for at least 48

J. A. Farias; I. Alía; A. Esteban; A. N. Golubicki; F. A. Olazarri

1998-01-01

2

Respiratory Care year in review 2012: invasive mechanical ventilation, noninvasive ventilation, and cystic fibrosis.  

PubMed

For the busy clinician, educator, or manager, it is becoming an increasing challenge to filter the literature to what is relevant to one's practice and then update one's practice based on the current evidence. The purpose of this paper is to review the recent literature related to invasive mechanical ventilation, noninvasive ventilation, and cystic fibrosis. These topics were chosen and reviewed in a manner that is most likely to have interest to the readers of Respiratory Care. PMID:23564873

Kallet, Richard H; Volsko, Teresa A; Hess, Dean R

2013-04-01

3

Analysis of trials comparing High Frequency Ventilation with Conventional Mechanical Ventilation : Clinical Epidemiology in Intensive Care  

Microsoft Academic Search

An abundance of experimental and clinical evidence indicates that mechanical ventilation can cause ventilator induced lung damage (VILI). Primary mechanisms leading to VILI are volutrauma, i.e. use of large tidal volumes resulting in over-distension, and atelectotrauma, i.e. repetitive closing and opening of alveoli, causing shear stress. Ideally, mechanical ventilation should supply enough airway pressure, even in the end-expiratory phase of

C. W. Bollen

2006-01-01

4

How is Mechanical Ventilation Employed in a Pediatric Intensive Care Unit in Brazil?  

PubMed Central

OBJECTIVE: to investigate the relationship between mechanical ventilation and mortality and the practice of mechanical ventilation applied in children admitted to a high-complexity pediatric intensive care unit in the city of São Paulo, Brazil. DESIGN: Prospective cohort study of all consecutive patients admitted to a Brazilian high-complexity PICU who were placed on mechanical ventilation for 24 hours or more, between October 1st, 2005 and March 31st, 2006. RESULTS: Of the 241 patients admitted, 86 (35.7%) received mechanical ventilation for 24 hours or more. Of these, 49 met inclusion criteria and were thus eligible to participate in the study. Of the 49 patients studied, 45 had chronic functional status. The median age of participants was 32 months and the median length of mechanical ventilation use was 6.5 days. The major indication for mechanical ventilation was acute respiratory failure, usually associated with severe sepsis / septic shock. Pressure ventilation modes were the standard ones. An overall 10.37% incidence of Acute Respiratory Distress Syndrome was found, in addition to tidal volumes > 8 ml/kg, as well as normo- or hypocapnia. A total of 17 children died. Risk factors for mortality within 28 days of admission were initial inspiratory pressure, pH, PaO2/FiO2 ratio, oxygenation index and also oxygenation index at 48 hours of mechanical ventilation. Initial inspiratory pressure was also a predictor of mechanical ventilation for periods longer than 7 days. CONCLUSION: Of the admitted children, 35.7% received mechanical ventilation for 24 h or more. Pressure ventilation modes were standard. Of the children studied, 91% had chronic functional status. There was a high incidence of Acute Respiratory Distress Syndrome, but a lung-protective strategy was not fully implemented. Inspiratory pressure at the beginning of mechanical ventilation was a predictor of mortality within 28 days and of a longer course of mechanical ventilation.

da Silva, Dafne Cardoso Bourguignon; Shibata, Audrey Rie Ogawa; Farias, Julio A; Troster, Eduardo Juan

2009-01-01

5

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

PubMed Central

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

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

2013-01-01

6

Respiratory function monitoring during mechanical ventilation in pediatric intensive care unit  

Microsoft Academic Search

Noninvasive monitoring of lung function during mechanical ventilation has been used to study disease processes causing respiratory\\u000a failure. Pediatric pulmonary function monitoring during mechanical ventilation in the pediatric intensive care unit in patient\\u000a with respiratory failure is becoming more common in western countries. The article describes a review of principles and methods\\u000a of respiratory function monitoring in the pediatric age

Praveen Khilnani

1998-01-01

7

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

Microsoft Academic Search

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

ANDRÉS ESTEBAN; ANTONIO ANZUETO; FEDERICO GORDO; DAVID CIDE; ROSANNE GOLDWASER; GUILLERMO BUGEDO; CARLOS RODRIGO; JORGE PIMENTEL; GUILLERMO RAIMONDI; MARTIN J. TOBIN; Fraga Filho; Asociación Española

8

Evaluation by polymerase chain reaction of cytomegalovirus reactivation in intensive care patients under mechanical ventilation  

Microsoft Academic Search

Objective: The study was undertaken to determine if critically ill patients under mechanical ventila- tion could reactivate latent cytomega- lovirus (CMV) in either lung or blood. Design: Prospective study in critically ill patients. Setting: The study was performed in a nmltidisciplinary intensive care unit in a university hospital. Patients: 23 non-immunocompro - mised, mechanically ventilated pa- tients who were anti-CMV

F. Stéphan; F. Clergue; D. Méhari; S. Ricci; A. Fajac; J.-F. Bernaudin

1996-01-01

9

Conventional mechanical ventilation.  

PubMed

Mechanical ventilation has become a very common and well-accepted practice in modern intensive care units. The use of the mechanical ventilator has progressed from being a support system during surgery and for acutely ill patients to being used in both moderate and long-term life support in patients with inadequate ventilation. The sophistication of modern ventilators and the ability of trained respiratory therapists and nursing personnel have permitted this technology to explode. This is occurring at a time when there are still many controversies about the relative benefits and modes of action of conventional ventilation. As newer techniques are developed, it is mandatory that the application of these techniques be tempered with controlled clinical trials, documenting their effectiveness. The beneficial effects of new modalities must be documented as mechanical ventilation expands from use in the intensive care unit to use in standard medical wards and the patient's home. In these latter two settings, the vigilance of an intensive care unit is absent and the simplest method will be preferable. The requirement to demonstrate efficacy of new techniques with adequate studies is especially necessary now as the economics of health delivery have come under increasing scrutiny. Even more important than new technologies may be the efficacy of prolonged mechanical ventilation. A recent study by Spicher and White evaluated the outcome in 250 patients ventilated for 10 days or more at the Hershey Medical Center (Pennsylvania State University). The mortality, morbidity, and disability in patients in this study population requiring prolonged ventilation were extremely high. As these studies have pointed out, further evaluations of predictors of meaningful survival are necessary to avoid unnecessary human suffering and to best use limited resources. PMID:3280230

Grum, C M; Chauncey, J B

1988-03-01

10

Liberation of neurosurgical patients from mechanical ventilation and tracheostomy in neurocritical care.  

PubMed

Neurosurgical patients commonly require mechanical ventilation and monitoring in a neurocritical care unit. There are only few studies that specifically address the process of liberation from mechanical ventilation in this population. Patients who remain ventilator or artificial airway dependent receive a tracheostomy. The appropriate timing for the procedure is not well defined and may be different among an inhomogeneous population of critically ill patients. In this article, we review the general principles of liberation and the current literature as it pertains to neurosurgical patients with primary brain injury. The criteria for "readiness of extubation" include a combination of neurologic assessment, hemodynamic, and respiratory parameters. Future studies are required to better assess indicators for extubation readiness, evaluate the predictors of extubation failure in brain-injured patients, and define the most appropriate timing for a tracheostomy. PMID:22033050

Lazaridis, Christos; DeSantis, Stacia M; McLawhorn, Marc; Krishna, Vibhor

2011-10-26

11

Conventional mechanical ventilation  

PubMed Central

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

Tobias, Joseph D.

2010-01-01

12

Noninvasive ventilation after intubation and mechanical ventilation  

Microsoft Academic Search

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

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

2002-01-01

13

Variability in usual care mechanical ventilation for pediatric ALI: the potential benefit of a lung protective computer protocol  

PubMed Central

Purpose Although pediatric intensivists claim to embrace lung protective ventilation for ALI, ventilator management is variable. We describe ventilator changes clinicians made for children with hypoxemic respiratory failure, and evaluate the potential acceptability of a pediatric ventilation protocol. Methods Retrospective cohort study; tertiary care PICU, 1/2000–7/2007. We included mechanically ventilated children with PaO2/FiO2 (P/F) ratio <300. We assessed variability in ventilator management by evaluating actual changes to ventilator settings after an arterial blood gas (ABG). We evaluated the potential acceptability of a pediatric mechanical ventilation protocol we adapted from NIH/NHLBI ARDS Network protocols by comparing actual practice changes in ventilator settings to changes that would have been recommended by the protocol. Results 2,719 ABGs from 402 patients were associated with 6,017 ventilator settings. Clinicians infrequently decreased FiO2, even when the PaO2 was high (>68 mmHg). The protocol would have recommended more positive end expiratory pressure (PEEP) than was used in actual practice 42% of the time in the mid PaO2 range (55 to 68 mmHg) and 67% of the time in the low PaO2 range (<55 mmHg). Clinicians often made no change to either peak inspiratory pressure (PIP) or ventilator rate (VR) when the protocol would have recommended a change, even when the pH was >7.45 with PIP ? 35 cm H2O. Conclusions There may be lost opportunities to minimize potentially injurious ventilator settings for children with ALI. A reproducible pediatric mechanical ventilation protocol could prompt clinicians to make ventilator changes that are consistent with lung protective ventilation.

Khemani, Robinder G.; Sward, Katherine; Morris, Alan; Dean, J. Michael; Newth, Christopher JL

2013-01-01

14

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

PubMed

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

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

2012-06-01

15

Brain-lung crosstalk in critical care: how protective mechanical ventilation can affect the brain homeostasis.  

PubMed

The maintenance of brain homeostasis against multiple internal and external challenges occurring during the acute phase of acute brain injury may be influenced by critical care management, especially in its respiratory, hemodynamic and metabolic components. The occurrence of acute lung injury represents the most frequent extracranial complication after brain injury and deserves special attention in daily practice as optimal ventilatory strategy for patients with acute brain and lung injury are potentially in conflict. Protecting the lung while protecting the brain is thus a new target in the modern neurointensive care. This article discusses the essentials of brain-lung crosstalk and focuses on how mechanical ventilation may exert an active role in the process of maintaining or treatening brain homeostasis after acute brain injury, highlighting the following points: 1) the role of inflammation as common pathomechanism of both acute lung and brain injury; 2) the recognition of ventilatory induced lung injury as determinant of systemic inflammation affecting distal organs, included the brain; 3) the possible implication of protective mechanical ventilation strategy on the patient with an acute brain injury as an undiscovered area of research in both experimental and clinical settings. PMID:23254163

Mazzeo, A T; Fanelli, V; Mascia, L

2012-12-20

16

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

PubMed Central

Background We evaluated the clinical outcomes and prognostic factors of patients requiring prolonged mechanical ventilation (PMV), defined as ventilator care for ?21 days, who were admitted to the medical intensive care unit (ICU) of a university hospital in Korea. Methods During the study period, a total of 2,644 patients were admitted to the medical ICU, and 136 patients (5.1%) were enrolled between 2005 and 2010. Results The mean age of the patients was 61.3±14.5 years, and 94 (69.1%) were male. The ICU and six-month cumulative mortality rates were 45.6 and 58.8%, respectively. There were 96 patients with tracheostomy placement after admission and their mean period from admission to the day of tracheostomy was 21.3±8.4 days. Sixty-three patients (46.3%) were successfully weaned from ventilator care. Of the ICU survivors (n=74), 34 patients (45.9%) were transferred to other hospitals (not university hospitals). Two variables (thrombocytopenia [hazard ratio (HR), 1.964; 95% confidence interval (CI), 1.225~3.148; p=0.005] and the requirement for vasopressors [HR, 1.822; 95% CI, 1.111~2.986; p=0.017] on day 21) were found to be independent factors of survival on based on the Cox proportional hazard model. Conclusion We found that patients requiring PMV had high six-month cumulative mortality rates, and that two clinical variables (measured on day 21), thrombocytopenia and requirement for vasopressors, may be associated with prognostic indicators.

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

2012-01-01

17

Prolonged mechanical ventilation in a respiratory-care setting: a comparison of outcome between tracheostomized and translaryngeal intubated patients  

Microsoft Academic Search

INTRODUCTION: Mechanical ventilation of patients may be accomplished by either translaryngeal intubation or tracheostomy. Although numerous intensive care unit (ICU) studies have compared various outcomes between the two techniques, no definitive consensus indicates that tracheostomy is superior. Comparable studies have not been performed in a respiratory care center (RCC) setting. METHODS: This was a retrospective observational study of 985 tracheostomy

Yao-Kuang Wu; Ying-Huang Tsai; Chou-Chin Lan; Chun-Yao Huang; Chih-Hsin Lee; Kuo-Chin Kao; Jui-Ying Fu

2010-01-01

18

[Complications of mechanical ventilation].  

PubMed

Mechanical ventilation of the lungs, as an important therapeutic measure, cannot be avoided in critically ill patients. However, when machines take over some of vital functions there is always a risk of complications and accidents. Complications associated with mechanical ventilation can be divided into:1) airway-associated complications; 2) complications in the response of patients to mechanical ventilation; and 3) complications related to the patient's response to the device for mechanical ventilation. Complications of artificial airway may be related to intubation and extubation or the endotracheal tube. Complications of mechanical ventilation, which arise because of the patient's response to mechanical ventilation, may primarily cause significant side effects to the lungs. During the last two decades it was concluded that mechanical ventilation can worsen or cause acute lung injury. Mechanical ventilation may increase the alveolar/capillary permeability by overdistension of the lungs (volutrauma), it can exacerbate lung damage due to the recruitment/derecruitment of collapsed alveoli (atelectrauma) and may cause subtle damages due to the activation of inflammatory processes (biotrauma). Complications caused by mechanical ventilation, beside those involving the lungs, can also have significant effects on other organs and organic systems, and can be a significant factor contributing to the increase of morbidity and mortality in critically ill of mechanically ventilated patients. Complications are fortunately rare and do not occur in every patient, but due to their seriousness and severity they require extensive knowledge, experience and responsibility by healthcare workers. PMID:22070009

Draškovi?, Biljana; Raki?, Goran

19

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

PubMed Central

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

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

2010-01-01

20

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

PubMed Central

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

McPherson, Christopher

2012-01-01

21

Patients with haematological malignancies requiring invasive mechanical ventilation: differences between survivors and non-survivors in intensive care unit  

Microsoft Academic Search

Background: Mortality of patients with haematological malig- nancies requiring intensive therapy is high. We wanted to establish reasons for intensive care unit (ICU) admis- sion and treatment as well as outcome in subjects who required invasive mechanical ventilation. We were also interested in differences between ICU survivors and non-survivors at the moment of admission. Patients and methods: Forty patients (21

Radoslaw Owczuk; Magdalena A. Wujtewicz; Wioletta Sawicka; Anna Wadrzyk; Maria Wujtewicz

2005-01-01

22

Clinical review: Liberation from mechanical ventilation  

PubMed Central

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

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

2008-01-01

23

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

PubMed Central

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

2011-01-01

24

Mechanical ventilation for the home  

Microsoft Academic Search

A ventilation system gives occupants control over a home`s air change rate and thermal control. This article discussed the option available today for good mechanical ventilation. Topic covered include ventilation codes; types of ventilation; ventilation approaches (fan types, heat recovery ventilation); avoid backdrafting; meeting outdoor air requirements; sizing fans; ducts and terminal devices; timers and other controls. 3 tabs.

1996-01-01

25

Equipment needs for noninvasive mechanical ventilation  

Microsoft Academic Search

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

B. Schonhofer; S. Sortor-Leger

2002-01-01

26

A “little bit illegal”? Withholding and withdrawing of mechanical ventilation in the eyes of German intensive care physicians  

Microsoft Academic Search

Research questions and background  This study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical\\u000a ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty\\u000a in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word

Sabine Beck; Andreas van de Loo; Stella Reiter-Theil

2008-01-01

27

Being the lifeline: The parent experience of caring for a child with neuromuscular disease on home mechanical ventilation  

Microsoft Academic Search

We describe the experience of parents caring for children with neuromuscular disease (NMD) on home mechanical ventilation (HMV). Data was obtained from semi-structured interviews and analyzed using a phenomenological framework. Fifteen families including 19 parents of children with DMD (n=3), SMA (n=5), and other NMD (n=7) participated. The central theme of these parents’ experience was being the “lifeline” for their

Jean K. Mah; Jennifer E. Thannhauser; Deborah A. McNeil; Deborah Dewey

2008-01-01

28

Mechanical ventilation of the premature neonate.  

PubMed

Although the trend in the neonatal intensive care unit is to use noninvasive ventilation whenever possible, invasive ventilation is still often necessary for supporting pre-term neonates with lung disease. Many different ventilation modes and ventilation strategies are available to assist with the optimization of mechanical ventilation and prevention of ventilator-induced lung injury. Patient-triggered ventilation is favored over machine-triggered forms of invasive ventilation for improving gas exchange and patient-ventilator interaction. However, no studies have shown that patient-triggered ventilation improves mortality or morbidity in premature neonates. A promising new form of patient-triggered ventilation, neurally adjusted ventilatory assist (NAVA), was recently FDA approved for invasive and noninvasive ventilation. Clinical trials are underway to evaluate outcomes in neonates who receive NAVA. New evidence suggests that volume-targeted ventilation modes (ie, volume control or pressure control with adaptive targeting) may provide better lung protection than traditional pressure control modes. Several volume-targeted modes that provide accurate tidal volume delivery in the face of a large endotracheal tube leak were recently introduced to the clinical setting. There is ongoing debate about whether neonates should be managed invasively with high-frequency ventilation or conventional ventilation at birth. The majority of clinical trials performed to date have compared high-frequency ventilation to pressure control modes. Future trials with premature neonates should compare high-frequency ventilation to conventional ventilation with volume-targeted modes. Over the last decade many new promising approaches to lung-protective ventilation have evolved. The key to protecting the neonatal lung during mechanical ventilation is optimizing lung volume and limiting excessive lung expansion, by applying appropriate PEEP and using shorter inspiratory time, smaller tidal volume (4-6 mL/kg), and permissive hypercapnia. This paper reviews new and established neonatal ventilation modes and strategies and evaluates their impact on neonatal outcomes. PMID:21944682

Brown, Melissa K; DiBlasi, Robert M

2011-09-01

29

[Noninvasive ventilation in intensive care].  

PubMed

Non-invasive ventilation has been in use for many years to provide long-term home ventilatory support to patients with chronic respiratory failure. In recent years, it has emerged on the intensive care scene as a means of avoiding intubation in acute respiratory failure. The results of several studies indicate that such an approach can lead to a reduction in mortality and duration of hospital stay compared to conventional mechanical ventilation with endotracheal intubation. The purpose of this article is to explore the various ventilatory techniques available, the choice of respirator and ventilatory mode in various clinical conditions, and to discuss some of the logistics involved in the optimal use of this technique. PMID:9064754

Jolliet, P; Sommer-Buhler, J; Abajo, B; Chevrolet, J C

1997-01-25

30

Diurnal sedative changes during intensive care: impact on liberation from mechanical ventilation and delirium  

PubMed Central

Objective To determine whether benzodiazepine and propofol doses are increased at night and whether daytime and nighttime sedative doses are associated with delirium, coma, and delayed liberation from mechanical ventilation. Design Single-center, prospective cohort study nested within the Awakening and Breathing Controlled randomized trial Setting Saint Thomas Hospital in Nashville, TN from 2004–2006 Patients Adult patients receiving mechanical ventilation for greater than 12 hours with continuous recording of hourly sedation dosing Interventions We measured hourly doses of benzodiazepine and propofol exposure during the daytime (7am–11pm) and nighttime (11pm–7am) for five days. We quantified nighttime dose increases by subtracting the average hourly daytime dose on the preceding day from subsequent average hourly nighttime dose. We used multivariable logistic regression to determine if daytime and nighttime dose increases were independently associated with delirium, coma, and delayed liberation from mechanical ventilation. Measurements and main results Among 140 patients, the median APACHE II score was 27 [IQR: 22, 33]. Among those receiving the sedatives, benzodiazepine and propofol doses were increased at night on 40% and 41% of patient-days, respectively. Of 485 patient-days, delirium was present on 160 (33%) and coma on 206 (42%). In adjusted models, greater daytime benzodiazepine dose was independently associated with failed SBT and extubation, and subsequent delirium (p<0.02 for all). Nighttime increase in benzodiazepine dose was associated with failed SBT (p<0.01) and delirium (p=0.05). Daytime propofol dose was marginally associated with subsequent delirium (p=0.06). Conclusions Nearly half of mechanically ventilated ICU patients received greater doses of sedation at night, a practice associated with failed SBTs, coma, and delirium. Over the first five days in our study, patients spent 75% of their time in coma or delirium, outcomes that may be reduced by efforts to decrease sedative exposure during both daytime and nighttime hours in the ICU.

Seymour, Christopher W.; Pandharipande, Pratik P.; Koestner, Tyler; Hudson, Leonard D.; Thompson, Jennifer L.; Shintani, Ayumi K.; Ely, E. Wesley; Girard, Timothy D.

2012-01-01

31

Difficult weaning from mechanical ventilation  

Microsoft Academic Search

Difficult weaning is fortunately a rare occurrence in mechanically ventilated patients in ICU. When faced with this problem,\\u000a a vast number of factors must be carefully considered simultaneously: physiological adjustment, technical problems (tubing,\\u000a circuit resistances, ...) [13]. The most promising approach to difficult weaning to date centers on the respiratory muscle\\u000a function which represents the most common factor allowing weaning

J. C. Chevrolet

1990-01-01

32

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

Microsoft Academic Search

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

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

2008-01-01

33

Nontraditional modes of mechanical ventilation: progress or distraction?  

PubMed

As technology continues to develop, a wide range of novel and nontraditional modes of mechanical ventilation have become available for the management of critically ill patients. Proportional assist ventilation, neurally adjusted ventilatory assist and adaptive support ventilation are three novel modes of ventilation, which attempt to optimize patient-ventilator synchrony. Improved interactions between patient and ventilator may be important in improving clinical outcomes. Another important priority for mechanically ventilated patients is lung protection, and nontraditional modes of ventilation that may be implemented to minimize ventilator-associated lung injury include airway pressure release ventilation and high-frequency ventilation. Novel and nontraditional modes of ventilation may represent important tools in the critical care environment; however, continued investigation is needed to determine the overall impact of these various approaches on outcomes for mechanically ventilated patients. PMID:22788942

Turner, David A; Rehder, Kyle J; Cheifetz, Ira M

2012-06-01

34

Neuroanesthesia and Intensive Care A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation  

Microsoft Academic Search

\\u000a Abstract\\u000a Purpose  To summarize the evidence comparing noninvasive positive pressure ventilation (NPPV) and invasive positive pressure ventilation\\u000a (IPPV) weaning on mortality, ventilator associated pneumonia and the total duration of mechanical ventilation among invasively\\u000a ventilated adults with respiratory failure.\\u000a \\u000a \\u000a \\u000a Source  Meta-analysis of randomized and quasi-randomized studies comparing early extubation with immediate application of NPPV to\\u000a IPPV weaning. We selected randomized studies that 1)

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

2006-01-01

35

Patient-ventilator asynchrony during assisted mechanical ventilation  

Microsoft Academic Search

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

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

2006-01-01

36

[Mechanical ventilation in pediatrics (III). Weaning, complications and other types of ventilation. High-frequency ventilation].  

PubMed

In the era of lung-protective ventilation strategies, high frequency oscillatory ventilation (HFOV) has attracted renewed interest and its use has dramatically increased in neonatal and pediatric intensive care units. HFOV is able to reduce ventilator-induced lung injury by limiting the incidence of volutrauma, atelectrauma, barotrauma and biotrauma. During HFOV, adequate oxygenation and ventilation is achieved by using low tidal volumes and small pressure swings at supraphysiologic frequencies. Unlike other high-frequency ventilation modes, HFOV has an active expiration phase. HFOV constitutes a safe and successful ventilation mode for managing pediatric patients with respiratory insufficiency refractory to optimized conventional mechanical ventilation and provides better results when initiated early. However, the elective use of HFOV requires further studies to identify its benefits over conventional modes of mechanical ventilation and to support its routine use as a first line therapy. In the present article, the Respiratory Working Group of the Spanish Society Pediatric Critical Care reviews the main issues in the pediatric application of HFOV. In addition, a general practical protocol and specific management strategies, as well as the monitoring, patient care and other special features of the use of HFOV in the pediatric setting, are discussed. PMID:14562843

Martinón-Torres, F; Ibarra de la Rosa, I; Fernández Sanmartín, M; García Menor, E; Marinón Sánchez, J M

2003-08-01

37

Recent updates in mechanical ventilation  

PubMed Central

Recently, several studies have been performed to better outline the pathophysiology of acute respiratory failure and evaluate the therapeutic profile of different modes of ventilation and ventilator settings. Here we briefly report those we consider most relevant for daily intensive care unit clinical practice.

Bergamaschi, Valentina

2009-01-01

38

Characteristics and outcome of mechanically ventilated patients with 2009 H1N1 influenza in Bosnia and Herzegovina and Serbia: impact of newly established multidisciplinary intensive care units  

PubMed Central

Aim To describe characteristics and outcome of mechanically ventilated patients admitted to three newly established intensive care units (ICU) in Bosnia-Herzegovina and Serbia for 2009 H1N1 influenza infection. Methods The retrospective observational study included all mechanically ventilated adult patients of three university-affiliated hospitals between November 1, 2009 and March 1 2010 who had 2009 H1N1 influenza infection confirmed by real-time reverse transcriptase-polymerase-chain-reaction (RT-PCR) from nasopharyngeal swab specimens and respiratory secretions. Results The study included 50 patients, 31 male (62%), aged 43?±?13 years. Median time from hospital to ICU admission was 1 day (range 1-2). Sixteen patients (30%) presented with one or more chronic medical condition: 8 (16%) with chronic lung disease, 5 (10%) with chronic heart failure, and 3 (6%) with diabetes mellitus. Thirty-two (64%) were obese. Forty-eight patients (96%) experienced acute respiratory distress syndrome (ARDS), 28 (56%) septic shock, and 27 (54%) multiorgan failure. Forty-five patients (90%) were intubated and mechanically ventilated, 5 received non-invasive mechanical ventilation, 7 (14%) high-frequency oscillatory ventilation, and 7 (14%) renal replacement therapy. The median duration of mechanical ventilation was 7 (4-14) days. Hospital mortality was 52%.

Kojicic, Marija; Kovacevic, Pedja; Bajramovic, Nermina; Batranovic, Uros; Vidovic, Jadranka; Aganovic, Kenana; Gavrilovic, Srdjan; Zlojutro, Biljana; Thiery, Guillaume

2012-01-01

39

Invasive fungal infection among hematopoietic stem cell transplantation patients with mechanical ventilation in the intensive care unit  

PubMed Central

Background Invasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT) patientsThe purpose of this study was to assess the characteristics and outcomes of HSCT patients with IFIs who are undergoing MV at a single institution in Taiwan. Methods We performed an observational retrospective analysis of IFIs in HSCT patients undergoing mechanical ventilation (MV) in an intensive care unit (ICU) from the year 2000 to 2009. The characteristics of these HSCT patients and risk factors related to IFIs were evaluated. The status of discharge, length of ICU stay, date of death and cause of death were also recorded. Results There were 326 HSCT patients at the Linkou Chang-Gung Memorial Hospital (Taipei, Taiwan) during the study period. Sixty of these patients (18%) were transferred to the ICU and placed on mechanical ventilators. A total of 20 of these 60 patients (33%) had IFIs. Multivariate analysis indicated that independent risk factors for IFI were admission to an ICU more than 40 days after HSCT, graft versus host disease (GVHD), and high dose corticosteroid (p < 0.01 for all). The overall ICU mortality rate was 88% (53 of 60 patients), and was not significantly different for patients with IFIs (85%) and those without IFIs (90%, p = 0.676). Conclusion There was a high incidence of IFIs in HSCT patients requiring MV in the ICU in our study cohort. The independent risk factors for IFI are ICU admission more than 40 days after HSCT, GVHD, and use of high-dose corticosteroid.

2012-01-01

40

Intensive care and non-invasive mechanical ventilation in kyphoscoliosis: are new perspectives still needed?  

PubMed

Non-invasive ventilation (NIV) assists breathing and thus improves oxygenation in patients with Kyphoscoliosis. The benefits of short- and long-term intermittent nocturnal in such patients have been reported previously (improvement of vital capacity, total lung capacity, muscle strength, daytime oxygenation, exercise capacity, and pulmonary hypertension). We review this important study reporting patients with kyphoscoliosis and acute respiratory failure along with their long-term outcomes. We believe that this letter may provide important information regarding the prognosis and efficacy of NIV. PMID:23647687

Esquinas, Antonio M; Matsuoka, Yoshinori; Ad?güzel, Nalan; Karakurt, Zuhal

2013-05-07

41

Intensive care and non-invasive mechanical ventilation in kyphoscoliosis: are new perspectives still needed?  

PubMed Central

Non-invasive ventilation (NIV) assists breathing and thus improves oxygenation in patients with Kyphoscoliosis. The benefits of short- and long-term intermittent nocturnal in such patients have been reported previously (improvement of vital capacity, total lung capacity, muscle strength, daytime oxygenation, exercise capacity, and pulmonary hypertension). We review this important study reporting patients with kyphoscoliosis and acute respiratory failure along with their long-term outcomes. We believe that this letter may provide important information regarding the prognosis and efficacy of NIV.

2013-01-01

42

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

PubMed Central

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

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

2013-01-01

43

Mechanical Ventilation: Past and Present 1 1 Critical Care is coordinated by Joseph Varon, MD, of the Methodist Hospital and Baylor College of Medicine, Houston, Texas  

Microsoft Academic Search

Emergency physicians commonly manage patients with acute respiratory failure who require assisted mechanical ventilation. Several different modes of positive pressure mechanical ventilation can be used to manage these patients when they present to the emergency department. These modes of ventilation have evolved over the last three decades. A comprehensive review of the most important historical moments in mechanical ventilation as

Karen Chen; George L Sternbach; Robert E Fromm; Joseph Varon

1998-01-01

44

Secretion management in the mechanically ventilated patient.  

PubMed

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

Branson, Richard D

2007-10-01

45

Current issues in home mechanical ventilation.  

PubMed

As modern health care continues to evolve, we expect and are seeing that more sophisticated medical care will be provided outside the traditional acute care environments. Advances in home medical technology, economic pressures, health-care consumerism, and societal changes are all factors playing a role in this evolution. Medically fragile and technology-dependent individuals who were once limited to care in acute and subacute institutional settings are now frequently cared for at home, most often by their immediate family members. Mechanical ventilation has found its way into the patient's home such that physicians and other providers must be prepared for the challenges associated with managing the conditions of complex, ventilator-dependent individuals outside of the walls, controls, and safety of the institutional setting. With little published science and recognized standards of practice, there are fewer rules to guide clinicians through this process. Experience has shown, however, that successful home management of ventilator-dependent individuals can be traced to a smooth and collaborative discharge from the hospital to home. Reimbursement and coverage issues must also be well understood to avoid the aggravation of denials and challenges for necessary equipment and assistance. Once home, a streamlined, patient-centered process supported by effective communication between all care providers can result in a safe and appropriate long-term home ventilation success story. PMID:17699139

Lewarski, Joseph S; Gay, Peter C

2007-08-01

46

Noninvasive Home Mechanical Ventilation in Elderly Patients  

Microsoft Academic Search

Study Objective: To determine the short- and long-term benefits of noninvasive home mechanical ventilation (NIHMV) in patients aged 65 and older who were eligible for this treatment. Design and Setting: This retrospective, comparative, longitudinal study was carried out in a tertiary care hospital in Barcelona (Spain). Patients and Methods: The study included all patients in whom NIHMV with a nasal

Astrid Crespo; Xavier Muñoz; Ferran Torres; Sergi Martí; Jaume Ferrer; Ferran Morell

2010-01-01

47

Positive pressure mechanical ventilation  

Microsoft Academic Search

Andreas Wesele Vesalius documented the first known attempt at assisted ventilation in 1555. He observed, ''An opening must be attempted in the trunk of the trachea, into which a tube of reed or cane should be put; you will then blow into this, so that the lung may rise again and the animal take in air.'' Though primitive, this formed

Bhargavi Gali; Deepi G. Goyal

2003-01-01

48

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

Microsoft Academic Search

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

Sofia Almerud; Kerstin Petersson

2003-01-01

49

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

PubMed Central

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

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

2011-01-01

50

Basics of mechanical ventilation for dogs and cats.  

PubMed

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

Hopper, Kate; Powell, Lisa L

2013-04-29

51

Outcome of mechanical ventilation in Central Africa.  

PubMed Central

The outcome of mechanical ventilation is reported in a prospective series of 200 patients managed in an intensive care unit in Zambia. Fifty two patients survived (26%), and 46 patients were subsequently discharged from hospital (23%). Ten patients died in whom a complication of ventilation was a factor. Patients not expected to survive by the authors had a 96.3% mortality whereas patients with a chance of survival had a mortality rate of 58.8%. Two diagnostic groups were found to have a high mortality: head injury (85.1%) and non-traumatic coma (76.4%). This series is compared with similar series from developed countries and recommendations are made for the institution of mechanical ventilation in the developing world.

Sinclair, J. R.; Watters, D. A.; Davison, M.

1988-01-01

52

Anxiety and Agitation in Mechanically Ventilated Patients  

PubMed Central

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

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

2013-01-01

53

Novel modes of mechanical ventilation.  

PubMed

The overarching goal of positive pressure mechanical ventilation is to provide adequate gas exchange support while not causing harm. Indeed, positive pressure mechanical ventilators are only support technologies, not therapeutic technologies. As such they cannot be expected to "cure" disease; they can only "buy time" for other therapies (including the patient's own defenses) to work.Conventional approaches to positive pressure ventilation involve applying ventilatory patterns mimicking normal ones through either masks or artificial airways. This is usually done with modes of support incorporating assist/control breath-triggering mechanisms, gas delivery patterns governed by either a set flow or pressure, and breath cycling based on either a set volume, a set inspiratory time, or a set flow. Often this support includes positive end-expiratory pressure and supplemental oxygen. In recent decades several novel or unconventional approaches to providing mechanical ventilatory support have been introduced. For these to be considered of value, however, it would seem reasonable that they address important clinical challenges and be shown to improve important clinical outcomes (e.g., mortality, duration of ventilation, sedation needs, complications). This article focuses on challenges facing clinicians in providing mechanical ventilatory support and assesses several novel approaches introduced over the last 2 decades in the context of these challenges. PMID:23934718

Al-Hegelan, Mashael; MacIntyre, Neil R

2013-08-11

54

Effectiveness of Medical Resident Education in Mechanical Ventilation  

Microsoft Academic Search

Specific methods of mechanical ventilation management reduce 3), and reduce costs and ICU complications (3) for the nearly mortality and lower health care costs. However, in the face of a 1.5 million U.S. patients who require mechanical ventilation predicted deficit of intensivists, it is unclear whether residency pro- each year (4). Critically ill patients with acute respiratory grams are training

Christopher E. Cox; Shannon S. Carson; E. Wesley Ely; Joseph A. Govert; Joanne M. Garrett; Roy G. Brower; David G. Morris; Edward Abraham; Vincent Donnabella; Antoinette Spevetz; Jesse B. Hall

2003-01-01

55

Cardiovascular Effects of Mechanical Ventilation  

Microsoft Academic Search

Objective: To review the cardiovascular effects of spontaneous breathing and mechanical ventilation in healthy and pathological states. Data sources: A review of articles published in peer-reviewed journals from 1966 to 1998 and identified through a MEDLINE search on cardiopulmonary interaction. Summary of review: Respiration has a hydraulic influence upon cardiovascular function. Pulmonary and cardiac pathology alter this interaction. Spontaneous inspiration

G. J. DUKE

1999-01-01

56

Ethical challenges in home mechanical ventilation: A secondary analysis  

PubMed Central

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

Dybwik, Knut; Nielsen, Erik Waage; Brinchmann, Berit St?re

2012-01-01

57

Mechanical ventilators as vehicles of infection.  

PubMed

Twenty-five patients from the intensive care unit who had been subjected to tracheostomy and require mechanical respiration were studied. Data are presented concerning the bacteriological controls performed on the tracheal exudates, various parts of the ventilators (Engström Model 200 and Bennett PR-2), and the Wright spirometer. The germs found were mainly pseudomonas, enterobacteriaceae germs and bacteria from the acinetobacter group. There was a high incidence of infection in the tracheostomies of these patients. We found a cause and effect relationship between the contaminating bacteria isolated from the cannula and the bacteria isolated from the tracheal exudates in the case of pseudomonas aeruginosa. However, this was not found to be the case where enterobacteriaceae were concerned. Acinetobacter calcoaceticus were isolated almost exclusively in the ventilators. The study calls attention to the need for rigorous disinfection of ventilators to prevent hospital cross infections. PMID:811072

Perea, E J; Criado, A; Moreno, M; Avello, F

1975-01-01

58

Genetic relationships between Candida albicans strains isolated from dental plaque, trachea, and bronchoalveolar lavage fluid from mechanically ventilated intensive care unit patients  

PubMed Central

Candida albicans often resides in the oral cavity of healthy humans as a harmless commensal organism. This opportunistic fungus can cause significant disease in critically ill patients, such as those undergoing mechanical ventilation in the intensive care unit (ICU) having compromised local airway defense mechanisms. The goal of this study was to determine the intra- and inter-patient genetic relationship between strains of C. albicans recovered from dental plaque, tracheal secretions, and the lower airway by bronchoalveolar lavage of patients undergoing mechanical ventilation. Three pulsed-field gel electrophoresis (PFGE) typing methods were used to determine the genetic relatedness of the C. albicans strains, including electrophoretic karyotyping (EK) and restriction endonuclease analysis of the genome using SfiI (REAG-S) and BssHII (REAG-B). The C. albicans isolates from dental plaque and tracheo-bronchial sites from the same patient were genetically indistinguishable and retained over time, whereas strains from different patients usually separated into different genotypes. Among the three methods, REAG-B proved to be the most discriminatory method to differentiate isolates. The finding of genetically similar strains from the oral and tracheo-bronchial sites from the same patient supports the notion that the oral cavity may serve as an important source for C. albicans spread to the trachea and lung of mechanically ventilated patients.

Heo, Seok-Mo; Sung, Robert S.; Scannapieco, Frank A.; Haase, Elaine M.

2011-01-01

59

[Mechanical ventilation of acute lung injury].  

PubMed

Acute lung injury (ALI) is of paramount importance for modern intensive care since it is one of the most frequent conditions necessitating admission to an ICU. ALI is characterised by severe life threatening hypoxemia which is based on ventilation perfusion mismatching within the lung. This is mostly resulting from atelectasis formation due to primary or secondary inflammation of lung tissue. Many studies showed that this inflammatory process is not restricted to the respiratory system but might result in non pulmonary organ failure and hemodynamic compromise as well. Mechanical ventilation is considered the hallmark treatment for ALI patients aimed to recruit lung tissue and thereby reverse hypoxemia without causing additional lung injury potentially resulting from overdistention or cycling collapse during expiration. Scientific evidence shows us that prevention of ventilator induced lung injury by protective ventilation with reduced tidal volumes is resulting in better clinical outcomes. Moreover, different technologies and adjunctive therapies have been suggested based on their pathophysiology. All these treatment options will be summarized in this article. Given the clear evidence for protective ventilation and bearing in mind that clinical application of this easy concept is still not widespread we will focus on this aspect. PMID:17455139

Kuhlen, R; Dembinski, R

2007-04-01

60

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

ERIC Educational Resources Information Center

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

Young, Jenny M.; And Others

1994-01-01

61

Invasive home mechanical ventilation, mainly focused on neuromuscular disorders  

PubMed Central

Introduction and background Invasive home mechanical ventilation is used for patients with chronic respiratory insufficiency. This elaborate and technology-dependent ventilation is carried out via an artificial airway (tracheal cannula) to the trachea. Exact numbers about the incidence of home mechanical ventilation are not available. Patients with neuromuscular diseases represent a large portion of it. Research questions Specific research questions are formulated and answered concerning the dimensions of medicine/nursing, economics, social, ethical and legal aspects. Beyond the technical aspect of the invasive home, mechanical ventilation, medical questions also deal with the patient’s symptoms and clinical signs as well as the frequency of complications. Economic questions pertain to the composition of costs and the differences to other ways of homecare concerning costs and quality of care. Questions regarding social aspects consider the health-related quality of life of patients and caregivers. Additionally, the ethical aspects connected to the decision of home mechanical ventilation are viewed. Finally, legal aspects of financing invasive home mechanical ventilation are discussed. Methods Based on a systematic literature search in 2008 in a total of 31 relevant databases current literature is viewed and selected by means of fixed criteria. Randomized controlled studies, systematic reviews and HTA reports (health technology assessment), clinical studies with patient numbers above ten, health-economic evaluations, primary studies with particular cost analyses and quality-of-life studies related to the research questions are included in the analysis. Results and discussion Invasive mechanical ventilation may improve symptoms of hypoventilation, as the analysis of the literature shows. An increase in life expectancy is likely, but for ethical reasons it is not confirmed by premium-quality studies. Complications (e. g. pneumonia) are rare. Mobile home ventilators are available for the implementation of the ventilation. Their technical performance however, differs regrettably. Studies comparing the economic aspects of ventilation in a hospital to outpatient ventilation, describe home ventilation as a more cost-effective alternative to in-patient care in an intensive care unit, however, more expensive in comparison to a noninvasive (via mask) ventilation. Higher expenses arise due to the necessary equipment and the high expenditure of time for the partial 24-hour care of the affected patients through highly qualified personnel. However, none of the studies applies to the German provisionary conditions. The calculated costs strongly depend on national medical fees and wages of caregivers, which barely allows a transmission of the results. The results of quality-of-life studies are mostly qualitative. The patient’s quality of life using mechanical ventilation is predominantly considered well. Caregivers of ventilated patients report positive as well as negative ratings. Regarding the ethical questions, it was researched which aspects of ventilation implementation will have to be considered. From a legal point of view the financing of home ventilation, especially invasive mechanical ventilation, requiring specialised technical nursing is regulated in the code of social law (Sozialgesetzbuch V). The absorption of costs is distributed to different insurance carriers, who often, due to cost pressures within the health care system, insurance carriers, who consider others and not themselves as responsible. Therefore in practice, the necessity to enforce a claim of cost absorption often arises in order to exercise the basic right of free choice of location. Conclusion Positive effects of the invasive mechanical ventilation (overall survival and symptomatic) are highly probable based on the analysed literature, although with a low level of evidence. An establishment of a home ventilation registry and health care research to ascertain valid data to improve outpatient structures is necessary. Gathering specific German dat

Geiseler, Jens; Karg, Ortrud; Borger, Sandra; Becker, Kurt; Zimolong, Andreas

2010-01-01

62

[Mechanical ventilation in pediatrics (III). Weaning, complications and other types of ventilation. Compications of mechanical ventilation].  

PubMed

Mechanical ventilation can produce multiple complications. The most important acute complications are mechanical problems (respirator failure, problems with the connections and circuit, incorrect parameters or alarms), problems in the airway (disconnection, extubation, mal-positioning of the endotracheal tube, leaks, nose erosions, obstruction of the endotracheal tube due to secretions or kinking, mainstem bronchus intubation, bronchospasm, postextubation croup), pulmonary complications (ventilator-induced lung injury with barotrauma, volutrauma and biotrauma), hemodynamic complications, nosocomial infections (tracheobronchitis, pneumonia, otitis, sinusitis), failure of adjustment of the respirator to the patient, and nutritional complications. The most important chronic problems are subglottal stenosis, chronic pulmonary injury, and psychological alterations. PMID:14562840

Reina Ferragut, C; López-Herce, J

2003-08-01

63

Mechanical Ventilation and the Kidney  

PubMed Central

Acute lung injury (ALI) and acute kidney injury (AKI) are complications often encountered in the setting of critical illness. Both forms of end-organ injury commonly occur in similar settings of systemic inflammatory response syndrome, shock, and evolving multiple organ dysfunction. Recent elucidation of the pathobiology of critical illness has led to a more basic mechanistic understanding of the complex interplay between injured organs in patients with multiple organ dysfunction syndrome; this has been aptly called ‘the slippery slope of critical illness’ [Kidney Int Suppl 1998;66:S25–S33]. Distant organ effects of apparently isolated injuries to the lungs, gut, and kidneys have all been discovered in recent years. In this article, we will review the harmful bidirectional interaction between ALI and AKI, which appears to be a common clinical syndrome with routine clinical implications. We will review the current understanding of lung-kidney interactions from both perspectives, including the renal effects of ALI and mechanical ventilation, and the pulmonary sequelae of AKI. In this review of the emerging evidence of deleterious bidirectional organ cross talk between lung and kidney, we will focus on the role of ventilator-induced kidney injury in the pathogenesis of AKI in patients with ALI.

Koyner, Jay L.; Murray, Patrick T.

2010-01-01

64

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

PubMed Central

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

2011-01-01

65

Acute lung injury and acute respiratory distress syndrome requiring tracheal intubation and mechanical ventilation in the intensive care unit: impact on managing uncertainty for patient-centered communication.  

PubMed

A case of acute lung injury (ALI) progressing to acute respiratory distress syndrome (ARDS) requiring tracheal intubation and mechanical ventilation (ETMV) is presented. The palliative medicine service was asked to address concerns expressed by the patient's spouse reflecting uncertainty regarding outcome expectations. Acknowledging and confronting the uncertainties of a critical illness is an essential component of patient-centered communication. Addressing and managing uncertainty for the case scenario requires consideration of both short- and long-term outcomes including mortality, ventilator independence, and adverse effects on quality of life for survivors. In this paper, ALI/ARDS requiring ETMV in the ICU was used as a focal point for preparing a prognostic assessment incorporating these issues. This assessment was based on a review of recently published literature regarding mortality and ventilator independence of survivors for adult patients receiving ETMV for ALI/ARDS in the ICU. In the studies reviewed, long-term survival reported at 60 days to 1 year was 50-73% with greater than 84% of the survivors in each study breathing independently. Selected articles discussing outcomes other than mortality or recovery of respiratory function, particularly quality of life implications for ALI/ARDS survivors, were also reviewed. A case of of ALI/ARDS requiring ETMV in the ICU is used to illustrate the situation of an incapacitated critically ill patient where the outcome is uncertain. Patient-centered communication should acknowledge and address this uncertainty. Managing uncertainty consists of effectively expressing a carefully formulated prognostic assessment and using sound communication principles to alleviate the distress associated with the uncertain outcome probabilities. PMID:23015728

Johnson, Robert F; Gustin, Jillian

2012-09-25

66

Daytime mechanical ventilation in chronic respiratory insufficiency  

Microsoft Academic Search

Chronic respiratory insufficiency (CRI) is associated with nocturnal hypoventilation. Treatment with noninvasive mechanical ventilation (NIMV) per- formed overnight relieves symptoms of hypoventilation and improves daytime blood gases in CRI. In order to test whether the efficacy of NIMV depends on it being applied during sleep, we conducted a prospective case-controlled study comparing daytime mechanical ventilation (dMV) in awake patients with

B. Schönhofer; M. Geibel; M. Sonneborn; P. Haidl; D. Köhler

1997-01-01

67

[Lung damage due to mechanical ventilation].  

PubMed

Mechanical ventilation in both children and adults is still associated with development of lung injury, both short term and long term. In particular, ventilation with high tidal volumes and low positive end-expiratory pressures (PEEP) contributes significantly to development of lung injury. Suggested preventive measures consist of limiting peak inflation pressures, preventing high tidal volumes, and applying high PEEP to prevent alveolar collapse. Recent studies have demonstrated that mechanical ventilation, via stretch of lung tissue, results in an inflammatory reaction in the lungs. This is known as biotrauma. The degree of inflammation depends on the ventilator settings and mode of ventilation. This inflammatory reaction may not be limited to the lungs but, via inflammatory mediators, may cause multiple organ dysfunction as well. Future research needs to be concentrated on how to modify this ventilator induced inflammatory reaction in order to prevent lung injury as well as systemic injury. PMID:10086125

Plötz, F B; van Vught, A J

1999-01-16

68

Recent advances in mechanical ventilation  

Microsoft Academic Search

Important advances have been made over the past decade towards understanding the optimal approach to ventilating patients with acute respiratory failure. Evidence now supports the use of noninvasive positive pressure ventilation in selected patients with hypercapnic respiratory failure and chronic obstructive pulmonary disease, cardiogenic pulmonary edema, and for facilitating the discontinuation of ventilatory support in patients with chronic pulmonary disease.

Carolyn S. Calfee; Michael A. Matthay

2005-01-01

69

46 CFR 154.1205 - Mechanical ventilation system: Standards.  

Code of Federal Regulations, 2010 CFR

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

2010-10-01

70

High frequency oscillatory ventilation compared with conventional mechanical ventilation in adult respiratory distress syndrome: a randomized controlled trial [ISRCTN24242669  

Microsoft Academic Search

INTRODUCTION: To compare the safety and efficacy of high frequency oscillatory ventilation (HFOV) with conventional mechanical ventilation (CV) for early intervention in adult respiratory distress syndrome (ARDS), a multi-centre randomized trial in four intensive care units was conducted. METHODS: Patients with ARDS were randomized to receive either HFOV or CV. In both treatment arms a priority was given to maintain

Casper W Bollen; Gijs Th J van Well; Tony Sherry; Richard J Beale; Sanjoy Shah; George Findlay; Mehran Monchi; Jean-Daniel Chiche; Norbert Weiler; Cuno SPM Uiterwaal; Adrianus J van Vught

2005-01-01

71

Simulations for Mechanical Ventilation in Children: Review and Future Prospects  

PubMed Central

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

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

2013-01-01

72

Simulations for mechanical ventilation in children: review and future prospects.  

PubMed

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

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

2013-03-07

73

Humidification of inspired gases during mechanical ventilation.  

PubMed

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

Gross, J L; Park, G R

2012-01-23

74

Shut-off mechanism for ventilation hose  

DOEpatents

A shut-off mechanism to provide automatic closure of a ventilation hose when the operation of drawing air through the hose is terminated. The mechanism includes a tube of light gauge metal inside of which are mounted a plurality of louver doors positioned in the closed position due to gravity when the ventilation unit is not operational. When the unit is operational, air flowing into the unit maintains the doors in the open position. 5 figs.

Huyett, J.D.; Meskanick, G.R.

1989-12-07

75

The soaring mechanic ventilator utilization under a universal health insurance in Taiwan  

Microsoft Academic Search

ObjectivesThe use of mechanic ventilators (MVs) is increasing in many countries. Taiwan's Bureau of National Health Insurance (NHI) launched a new payment program in 2000 to encourage integrated care for mechanically ventilated patients and to reduce the heavy utilization of high-cost intensive care unit. This study examines the trend in MV usage in Taiwan.

Shou-Hsia Cheng; I-Shiow Jan; Pin-Chun Liu

2008-01-01

76

Variability in mean duration of mechanical ventilation among community hospitals.  

PubMed

We explored intensive care units' mean ventilator-days per patient as a possible objective alternative to ventilator-associated pneumonia rates for assessing quality of care for ventilated patients. Mean ventilator-days per patient varied 4-fold within a network of community hospitals despite adjusting for multiple patient and hospital factors. Further assessment of this metric is warranted. PMID:22561723

Klompas, Michael; Kleinman, Ken P; Karcz, Anita

2012-04-24

77

[Non-invasive mechanical ventilation in COPD].  

PubMed

Non-invasive mechanical ventilation is the preferred method for the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). Primary contraindications and stopping criteria must be regarded to avoid delaying endotracheal intubation. The primary interface is usually a nasal-oral mask. Cautious sedation can facilitate non-invasive ventilation in some patients. Under certain circumstances non-invasive ventilation may enable successful extubation in COPD patients with prolonged weaning. COPD patients can also benefit from preventive non-invasive ventilation in order to avoid re-intubation after a planned extubation. Domiciliary nocturnal non-invasive ventilation is an option for some patients with COPD in chronic hypercapnic respiratory failure. This treatment should be established in a specialised unit. PMID:22415450

Funk, G-C

2012-03-15

78

Hospital Volume and the Outcomes of Mechanical Ventilation  

Microsoft Academic Search

Background An increased volume of patients is associated with improved survival in numerous high-risk medical and surgical conditions. The relationship between the number of patients admitted (hospital volume) and outcome among patients with critical ill- nesses is unknown. Methods We analyzed data from 20,241 nonsurgical patients receiving mechanical ventilation at 37 acute care hospitals in the Acute Physiology and Chronic

Jeremy M. Kahn; Christopher H. Goss; Patrick J. Heagerty; Andrew A. Kramer; Chelsea R. O'Brien; Gordon D. Rubenfeld

2006-01-01

79

State of the art in conventional mechanical ventilation  

Microsoft Academic Search

Despite a shift to noninvasive respiratory support, mechanical ventilation remains an essential tool in the care of critically ill neonates. The availability of a variety of technologically advanced devices with a host of available modes and confusing terminology presents a daunting challenge to the practicing neonatologist. Many of the available modes have not been adequately evaluated in newborn infants and

M Keszler

2009-01-01

80

Non-invasive mechanical ventilation in status asthmaticus  

Microsoft Academic Search

Objective: To evaluate our clinical experience with the use of non-invasive mechanical ventilation (NIMV) in patients with an acute asthmatic attack. Design: Seven-year period retrospective observational study. Setting: General intensive care department (ICU) of a county hospital. Patients: From 1992 to 1998, we documented clinical data, gas exchange and outcome of every asthmatic patient admitted to our ICU because of

M. M. Fernández; A. Villagrá; L. Blanch; R. Fernández

2001-01-01

81

Optimization of mechanical ventilator settings for pulmonary disease states.  

PubMed

The selection of mechanical ventilator settings that ensure adequate oxygenation and carbon dioxide clearance while minimizing the risk of ventilator-associated lung injury (VALI) is a significant challenge for intensive-care clinicians. Current guidelines are largely based on previous experience combined with recommendations from a limited number of in vivo studies whose data are typically more applicable to populations than to individuals suffering from particular diseases of the lung. By combining validated computational models of pulmonary pathophysiology with global optimization algorithms, we generate in silico experiments to examine current practice and uncover optimal combinations of ventilator settings for individual patient and disease states. Formulating the problem as a multiobjective, multivariable constrained optimization problem, we compute settings of tidal volume, ventilation rate, inspiratory/expiratory ratio, positive end-expiratory pressure and inspired fraction of oxygen that optimally manage the tradeoffs between ensuring adequate oxygenation and carbon dioxide clearance and minimizing the risk of VALI for different pulmonary disease scenarios. PMID:23322759

Das, Anup; Menon, Prathyush P; Hardman, Jonathan G; Bates, Declan G

2013-01-11

82

Negative pressure ventilation versus conventional mechanical ventilation in the treatment of acute respiratory failure in COPD patients  

Microsoft Academic Search

This case-control study was aimed to evaluate the effectiveness of nega- tive pressure ventilation (NPV) versus conventional mechanical ventilation (CMV) for the treatment of acute respiratory failure (ARF) in patients with chronic obstructive pulmonary disease (COPD) admitted to a respiratory intermediate intensive care unit (RIICU) and four general intensive care units (ICU). Twenty-six COPD patients in ARF admitted in 1994-95

A. Corrado; M. Gorini; R. Ginanni; C. Pelagatti; G. Villella; U. Buoncristiano; F. Guidi; E. Pagni; A. Peris; E. De Paola

1998-01-01

83

Prospective Study To Evaluate Mechanical Ventilator-Associated Pneumonia Rate in Intensive Care Units in a Peruvian Public Hospital: Benchmark with NNIS American Rates  

Microsoft Academic Search

OBJECTIVES: To measure the incidence of mechanical ventilator-associated pneumonia (VAP) in ICU in Peru and to compare with NNIS rates.METHODS: We performed a prospective nosocomial infection surveillance study during 3 months in one Peruvian ICUs of one public hospital. Nosocomial pneumonias were identified using the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance system (NNIS) definitions. Definitions: Criterion

L. Cuellar Ponce de Leon; R. Rosales

2004-01-01

84

Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients  

Microsoft Academic Search

Introduction  The aim of this study was to investigate whether in-hospital mortality was associated with the administered fraction of oxygen\\u000a in inspired air (FiO2) and achieved arterial partial pressure of oxygen (PaO2).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  This was a retrospective, observational study on data from the first 24 h after admission from 36,307 consecutive patients\\u000a admitted to 50 Dutch intensive care units (ICUs) and treated

Evert de Jonge; Linda Peelen; Peter J Keijzers; Hans Joore; Dylan de Lange; Peter HJ van der Voort; Robert J Bosman; Ruud AL de Waal; Ronald Wesselink; Nicolette F de Keizer

2008-01-01

85

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

PubMed

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

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

86

Injurious mechanical ventilation affects neuronal activation in ventilated rats  

Microsoft Academic Search

Introduction  Survivors of critical illness often have significant long-term brain dysfunction, and routine clinical procedures like mechanical\\u000a ventilation (MV) may affect long-term brain outcome. We aimed to investigate the effect of the increase of tidal volume (Vt)\\u000a on brain activation in a rat model.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Male Sprague Dawley rats were randomized to three groups: 1) Basal: anesthetized unventilated animals, 2) low Vt

Elisa María Quilez; Gemma Fuster; Jesús Villar; Carlos Flores; Octavi Martí-Sistac; Lluís Blanch; Josefina López-Aguilar

2011-01-01

87

Antibiotic resistance and virulence properties of Pseudomonas aeruginosastrains from mechanically ventilated patients with pneumonia in intensive care units: comparison with imipenem-resistant extra-respiratory tract isolates from uninfected patients  

Microsoft Academic Search

We investigated the epidemiology of antibiotic resistance and virulence properties among Pseudomonas aeruginosaclinical isolates col- lected in 1999 from patients hospitalized in the intensive care units of the centre hospitalier d'Orléans, in France. We compared the totality of the strains from mechanically ventilated patients with pneumonia (33 non-duplicate isolates, group 1) to 15 randomly chosen, imipenem- resistant, extra-respiratory tract isolates,

Patrick Di Martino; Hélène Gagnière; Hugues Berry; Laurent Bret

88

Antibiotic resistance and virulence properties of Pseudomonas aeruginosa strains from mechanically ventilated patients with pneumonia in intensive care units: comparison with imipenem-resistant extra-respiratory tract isolates from uninfected patients  

Microsoft Academic Search

We investigated the epidemiology of antibiotic resistance and virulence properties among Pseudomonas aeruginosa clinical isolates collected in 1999 from patients hospitalized in the intensive care units of the centre hospitalier d’Orléans, in France. We compared the totality of the strains from mechanically ventilated patients with pneumonia (33 non-duplicate isolates, group 1) to 15 randomly chosen, imipenem-resistant, extra-respiratory tract isolates, collected

Patrick Di Martino; Hélène Gagnière; Hugues Berry; Laurent Bret

2002-01-01

89

Frequency of hypoxic events in patients on a mechanical ventilator  

PubMed Central

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

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

2013-01-01

90

Facial mask noninvasive mechanical ventilation reduces the incidence of nosocomial pneumonia  

Microsoft Academic Search

Objective: To evaluate the impact of noninvasive positive pressure mechanical ventilation (NPPV) on ventilator-associated pneumonia\\u000a (VAP). Design: Prospective observational study. Setting: Medical intensive care unit (ICU) of a university teaching hospital. Patients: Cohort of 320 consecutive patients staying in the ICU more than 2 days and mechanically ventilated for ? 1 day. Measurements and results: VAP was diagnosed when, satisfying

C. Guérin; R. Girard; C. Chemorin; R. De Varax; G. Fournier

1997-01-01

91

Nosocomial pneumonia in mechanically ventilated patients, a prospective randomised evaluation of the Stericath closed suctioning system  

Microsoft Academic Search

Objective: To compare the ventilator-associated pneumonia (VAP) incidence rates in mechanically ventilated patients according to the\\u000a type of endotracheal suctioning (closed versus open). Setting: The Neurosurgery Intensive Care Unit of the Grenoble University Hospital, France. Design: A prospective randomised study performed after a 6-month period of nursing personnel training. Patients: One hundred four consecutive patients needing mechanical ventilation for more

P. Combes; B. Fauvage; C. Oleyer

2000-01-01

92

A Medical Student Workshop in Mechanical Ventilation.  

ERIC Educational Resources Information Center

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

And Others; Kushins, Lawrence G.

1980-01-01

93

Noninvasive mechanical ventilation in acute respiratory failure  

Microsoft Academic Search

Mechanical ventilation (MV) has been indicated in the treatment of acute respiratory failure (ARF) if conservative treatment fails. Invasive MV is asso- ciated to a variety of complications. The recent innovations of noninvasive methods of MV (NMV) avoid the complications of invasive MV, whilst ensuring a similar degree of efficacy. A review of the literature from 1989 to 1995 shows

N. Ambrosino

1996-01-01

94

A Medical Student Workshop in Mechanical Ventilation.  

ERIC Educational Resources Information Center

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

And Others; Kushins, Lawrence G.

1980-01-01

95

JAMA Patient Page: Mechanical Ventilation  

MedlinePLUS

... produce unconsciousness to ensure the patient’s comfort. In emergency situations (such as cardiac arrest or during cardiopulmonary ... like all other mechanical devices, can malfunction. Sophisticated alarms and system checks are built into the machines ...

96

Failed Weaning from Mechanical Ventilation and Cardiac Dysfunction  

PubMed Central

Failure to transition patient from controlled mechanical ventilation to spontaneous breathing trials (SBTs) in a timely fashion is associated with significant morbidity and mortality in the intensive care unit. In addition, weaning failures are common in patients with limited cardiac reserves. Recent advances in cardiac echocardiography and laboratory measurement of serum biomarkers to assess hemodynamic response to SBT may provide additional information to guide clinicians to predict weaning outcome.

Porhomayon, Jahan; Papadakos, Peter; Nader, Nader D.

2012-01-01

97

Nonassociative Learning Promotes Respiratory Entrainment to Mechanical Ventilation  

PubMed Central

Background Patient-ventilator synchrony is a major concern in critical care and is influenced by phasic lung-volume feedback control of the respiratory rhythm. Routine clinical application of positive end-expiratory pressure (PEEP) introduces a tonic input which, if unopposed, might disrupt respiratory-ventilator entrainment through sustained activation of the vagally-mediated Hering-Breuer reflex. We suggest that this potential adverse effect may be averted by two differentiator forms of nonassociative learning (habituation and desensitization) of the Hering-Breuer reflex via pontomedullary pathways. Methodology/Principal Findings We tested these hypotheses in 17 urethane-anesthetized adult Sprague-Dawley rats under controlled mechanical ventilation. Without PEEP, phrenic discharge was entrained 1?1 to the ventilator rhythm. Application of PEEP momentarily dampened the entrainment to higher ratios but this effect was gradually adapted by nonassociative learning. Bilateral electrolytic lesions of the pneumotaxic center weakened the adaptation to PEEP, whereas sustained stimulation of the pneumotaxic center weakened the entrainment independent of PEEP. In all cases, entrainment was abolished after vagotomy. Conclusions/Significance Our results demonstrate an important functional role for pneumotaxic desensitization and extra-pontine habituation of the Hering-Breuer reflex elicited by lung inflation: acting as buffers or high-pass filters against tonic vagal volume input, these differentiator forms of nonassociative learning help to restore respiratory-ventilator entrainment in the face of PEEP. Such central sites-specific habituation and desensitization of the Hering-Breuer reflex provide a useful experimental model of nonassociative learning in mammals that is of particular significance in understanding respiratory rhythmogenesis and coupled-oscillator entrainment mechanisms, and in the clinical management of mechanical ventilation in respiratory failure.

Poon, Chi-Sang

2007-01-01

98

Ventilator-associated pneumonia: the importance of oral care in intubated adults.  

PubMed

Ventilator-associated pneumonia (VAP) occurs within 24 hours of intubation and mechanical ventilation. Health care costs related to increased patient mortality, extended length of stay, and patient well-being make treatment of VAP a priority in all health care settings. The Institute for Healthcare Improvements has developed the Ventilator Bundle as a group of interventions linked to ventilator care with demonstrated outcome improvements; removal of subglottic secretions is one of these recommendations. Dental plaque and bacterial colonization of pathogens is directly related to microaspiration of bacteria into the lungs. A moist environment in the mouth maintains normal oropharyngeal bacteria, preventing overgrowth of pathogenic bacteria. Frequent oral care to include twice-a-day brushing of the teeth found a 69% reduction in respiratory tract infections. PMID:20827066

Stonecypher, Karen

99

[Researches on the mechanical ventilation trigger way].  

PubMed

A mechanical ventilation trigger way is set forth and a technical analysis on the pressure trigger way and flow trigger way is made in this paper. And it is pointed out that the PEEPi's influence on the human organism is the reason for the latter two kinds of trigger ways' notable differences in the measured values of the inspiration time and breath work. PMID:18581882

Li, Zhen-Hua

2008-03-01

100

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

Microsoft Academic Search

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

Bonnie Schleder; Kathleen Stott; Robert C Lloyd

101

Injurious mechanical ventilation affects neuronal activation in ventilated rats  

PubMed Central

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

2011-01-01

102

Epidemiology of Mechanical Ventilation: Analysis of the SAPS 3 Database  

Microsoft Academic Search

Objective  To evaluate current practice of mechanical ventilation in the ICU and the characteristics and outcomes of patients receiving\\u000a it.\\u000a \\u000a \\u000a \\u000a Design  Pre-planned sub-study of a multicenter, multinational cohort study (SAPS 3).\\u000a \\u000a \\u000a \\u000a Patients  13,322 patients admitted to 299 intensive care units (ICUs) from 35 countries.\\u000a \\u000a \\u000a \\u000a Interventions  None.\\u000a \\u000a \\u000a \\u000a Main measurements and results  Patients were divided into three groups: no mechanical ventilation (MV), noninvasive MV (NIV), and invasive

Philipp G. H. Metnitz; Barbara Metnitz; Rui P. Moreno; Peter Bauer; Lorenzo Del Sorbo; Christoph Hoermann; Susana Afonso de Carvalho; V. Marco Ranieri

2009-01-01

103

Fast track anesthesia for liver transplantation reduces postoperative ventilation time but not intensive care unit stay  

Microsoft Academic Search

Fast tracking is an approach to health care delivery that emphasizes the efficient use of resources. This investigation was designed to determine whether shorter-acting drugs and different drug administration practices reduce the length of time for which patients require mechanical ventilation and intensive care after liver transplantation. After obtaining Institutional Review Board approval and informed consent, we randomized 80 consecutive

James Y. Findlay; Christopher J. Jankowski; Gurinder M. Vasdev; Robert C. Chantigian; Bhargavi Gali; Gerard S. Kamath; Mark T. Keegan; Brian A. Hall; Keith A. Jones; Christopher M. Burkle; David J. Plevak

2002-01-01

104

Depressive Disorders during Weaning from Prolonged Mechanical Ventilation  

PubMed Central

Purpose Patients who require mechanical ventilation are at risk of emotional stress because of total dependence on a machine for breathing. The stress may negatively impact ventilator weaning and survival. The purpose of this study was to determine whether depressive disorders in patients being weaned from prolonged mechanical ventilation are linked to weaning failure and decreased survival. Methods A prospective study of 478 consecutive patients transferred to a long-term acute care hospital for weaning from prolonged ventilation was undertaken. A clinical psychologist conducted a psychiatric interview to assess for the presence of depressive disorders. Results Of the 478 patients, 142 had persistent coma or delirium and were unable to be evaluated for depressive disorders. Of the remaining 336 patients, 142 (42%) were diagnosed with depressive disorders. In multivariate analysis, co-morbidity score (odds ratio [OR], 1.23, p=0.007), functional dependence before the acute illness (OR, 1.70, p=0.03), and history of psychiatric disorders (OR, 3.04, p=0.0001) were independent predictors of depressive disorders. The rate of weaning failure was higher in patients with depressive disorders than in those without such disorders (61% versus 33%, p=0.0001), as was mortality (24% versus 10%, p=0.0008). The presence of depressive disorders was independently associated with mortality (OR, 4.3; p=0.0002); age (OR, 1.06; p=0.001) and co-morbidity score (OR, 1.24; p=0.02) also predicted mortality. Conclusion Depressive disorders were diagnosed in 42% of patients who are being weaned from prolonged ventilation. Patients with depressive disorders were more likely to experience weaning failure and death.

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

2010-01-01

105

Imposed Work of Breathing and Breathing Comfort of Nonintubated Volunteers Breathing with Three Portable Ventilators and a Critical Care Ventilator.  

National Technical Information Service (NTIS)

In spontaneous breathing modes, past laboratory work using a lung model indicated portable ventilators as compared to critical care ventilators may increase inspiratory work of breathing. The purpose of this study was to assess the imposed inspiratory wor...

P. N. Austin

2001-01-01

106

Evaluation of the user-friendliness of 11 home mechanical ventilators.  

PubMed

The home ventilator market has grown in size and complexity. The aim of this study was to determine if common home ventilators are user-friendly for trained intensive care unit (ICU) physicians. Eleven ventilator models were tested by 13 ICU physicians without practical experience in home mechanical ventilation. Six tests were defined (start-up, unlocking, mode and setting recognition, mode change, pressure setting and alarm). For each test, the physicians were timed and their performance compared with a reference time established by a technician. The physicians also had to rate their global assessment of each machine on a visual analogue scale. The start-up test was the only test for which there was no significant difference between the physicians and the technician, except for two ventilators. The physicians were slower than the technician to unlock the ventilator and change the ventilatory mode, with some complete failures during these tests and heterogeneous results between physicians and between ventilators. Mistakes occurred in close to 50% of cases during the ventilatory mode and settings recognition test. The mean time for the most rapid of the physicians for all the tests was 58+/-53 s, compared with 15+/-9 s for the technician. In conclusion, trained intensive care unit physicians perform poorly when confronted with home mechanical ventilators without specific prior training. Therefore, it is hypothesised that the user-friendliness of home ventilators for other categories of users might be questionable. PMID:16481386

Gonzalez-Bermejo, J; Laplanche, V; Husseini, F E; Duguet, A; Derenne, J-P; Similowski, T

2006-02-15

107

Effects of mechanical ventilation on diaphragm function and biology  

Microsoft Academic Search

ABSTRACT: The pathophysiological mechanisms,of weaning,from,mechanical ventilation are not fully known, but there is accumulating evidence that mechanical ventilation induces inspiratory muscle dysfunction. Recently, several animal models have provided potential mechanisms for mecha- nical ventilation-induced effects on muscle function. In patients, weaning difficulties are associated with inspiratory muscle,weakness,and,reduced,endurance,capacity. Animal,studies demonstrated,that diaphragm,force was,already,decreased,after 12 h of controlled mechanical,ventilation and this worsened,with time

G. Gayan-Ramirez; M. Decramer

2002-01-01

108

Cisapride decreases gastric content aspiration in mechanically ventilated patients  

Microsoft Academic Search

OBJECTIVE: To determine the effect of the prokinetic agent cisapride in the\\u0009\\u0009\\u0009\\u0009prevention of aspiration of gastric contents. DESIGN: A prospective randomized two-period crossover study. SETTING: Fourteen-bed polyvalent intensive care unit in a University\\u0009\\u0009\\u0009\\u0009Hospital. PATIENTS: Eighteen intubated, mechanically ventilated patients who were\\u0009\\u0009\\u0009\\u0009seated in a semirecumbent position were studied. METHOD: Tc-99 m sulfur colloid (80 megabecquerels) was administered via

John Pneumatikos; Basil Koulouras; Christ Frangides; Dian Goe; George Nakos

1999-01-01

109

Physiologic Determinants of Ventilator Dependence in Long-term Mechanically Ventilated Patients  

Microsoft Academic Search

To investigate the pathophysiologic mechanisms of ventilator de- pendence, we took physiologic measurements in 28 patients with COPD and 11 postcardiac surgery (PCS) patients receiving long- term mechanical ventilation during a spontaneous breathing trial, and in 20 stable, spontaneously breathing patients matched for age and disease. After 40 6 14 min of spontaneous breathing, 20 of 28 patients with COPD

ANDREA PURRO; LORENZO APPENDINI; ANDREA DE GAETANO; MARTA GUDJONSDOTTIR; CLAUDIO F. DONNER; ANDREA ROSSI

2000-01-01

110

Mechanical ventilation: past lessons and the near future.  

PubMed

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

Marini, John J

2013-03-12

111

Measurement of cardiac output by transesophageal echocardiography in mechanically ventilated patients  

Microsoft Academic Search

Objective: The determination of basal cardiac output (CO) and of its variations during different therapeutic interventions liable to\\u000a increase or decrease it in mechanically ventilated patients using transesophageal echocardiography (TEE). Design: To compare CO measurements simultaneously obtained by transmitral single-plane TEE and thermodilution. Setting: Medical intensive care unit. Patients: Twenty-two consecutive mechanically ventilated patients hospitalized for various medical conditions were

P. Estagnasié; K. Djedaini; L. Mier; F. Coste; D. Dreyfuss

1997-01-01

112

Heliumoxygen reduces work of breathing in mechanically ventilated patients with chronic obstructive pulmonary disease  

Microsoft Academic Search

ObjectiveTo evaluate whether helium-oxygen mixture reduces inspiratory work of breathing (WOB) in sedated, paralyzed, and mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).Design and settingOpen, prospective, randomized, crossover study in the medical intensive care unit in a university hospital.Patients and participants23 patients admitted for acute exacerbation of COPD and mechanically ventilated.MeasurementsTotal WOB (WOBt), elastic WOB (WOBel),

Marc Gainnier; Jean-Michel Arnal; Patrick Gerbeaux; Stéphane Donati; Laurent Papazian; Jean-Marie Sainty

2003-01-01

113

Carbon dioxide mandatory ventilation (CO2MV): A new method for weaning from mechanical ventilation  

Microsoft Academic Search

Summary  We describe a new technique specially designed for weaning from mechanical ventilation: carbon dioxide mandatory ventilation\\u000a (CO2MV). CO2MV is based on feedback between end tidal expired partial pressure of carbon dioxide and ventilatory mode, controlled\\u000a or spontaneous. In order to evaluate its real interest we performed a randomized prospective study, CO2MV vs Intermittent\\u000a Mandatory Ventilation (IMV) and T. Tube Method

C. Chopin; M. C. Chambrin; J. Mangalaboyi; P. Lestavel; F. Fourrier

1989-01-01

114

Incidence and Risk Factors for Ventilator-Associated Pneumonia in 4 Multidisciplinary Intensive Care Units in Athens, Greece  

Microsoft Academic Search

INTRODUCTION: Ventilator-associated pneumonia (VAP) is the most common nosocomial infec- tion among intensive care unit (ICU) patients. OBJECTIVE: Prospectively identify the factors associated with development of VAP and examine the incidence of VAP. SUBJECTS: Over a 6-month period we had 175 patients who required mechanical ventilation for longer than 24 hours. RESULTS: VAP occurred in 56 patients (32%). Stepwise logistic

Eleni Apostolopoulou; Petros Bakakos; Theophanis Katostaras; Leonides Gregorakos

2003-01-01

115

Current status of mechanical ventilation decision support systems: a review  

Microsoft Academic Search

Objectives of computerized decision support systems for mechanical ventilation are discussed. Questions considered are: Why\\u000a is computerized decision support for mechanical ventilation important? What parameter(s) should be optimized? What are the\\u000a differences between a single attribute and a multiattribute value function used for optimization? How is it possible to achieve\\u000a optimization in clinical practice with existing ventilators? How does one

Robert Rudowski; Thomas D. East; Reed M. Gardner

1996-01-01

116

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

PubMed Central

Objective To evaluate the effect of oral decontamination on the incidence of ventilator associated pneumonia and mortality in mechanically ventilated adults. Design Systematic review and meta-analysis. Data sources Medline, Embase, CINAHL, the Cochrane Library, trials registers, reference lists, conference proceedings, and investigators in the specialty. Review methods Two independent reviewers screened studies for inclusion, assessed trial quality, and extracted data. Eligible trials were randomised controlled trials enrolling mechanically ventilated adults that compared the effects of daily oral application of antibiotics or antiseptics with no prophylaxis. Results 11 trials totalling 3242 patients met the inclusion criteria. Among four trials with 1098 patients, oral application of antibiotics did not significantly reduce the incidence of ventilator associated pneumonia (relative risk 0.69, 95% confidence interval 0.41 to 1.18). In seven trials with 2144 patients, however, oral application of antiseptics significantly reduced the incidence of ventilator associated pneumonia (0.56, 0.39 to 0.81). When the results of the 11 trials were pooled, rates of ventilator associated pneumonia were lower among patients receiving either method of oral decontamination (0.61, 0.45 to 0.82). Mortality was not influenced by prophylaxis with either antibiotics (0.94, 0.73 to 1.21) or antiseptics (0.96, 0.69 to 1.33) nor was duration of mechanical ventilation or stay in the intensive care unit. Conclusions Oral decontamination of mechanically ventilated adults using antiseptics is associated with a lower risk of ventilator associated pneumonia. Neither antiseptic nor antibiotic oral decontamination reduced mortality or duration of mechanical ventilation or stay in the intensive care unit.

Ruest, Annie; Meade, Maureen O; Cook, Deborah J

2007-01-01

117

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

PubMed Central

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

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

2011-01-01

118

Weaning from tracheotomy in long-term mechanically ventilated patients: feasibility of a decisional flowchart and clinical outcome  

Microsoft Academic Search

Objective. To assess the feasibility of following a decisional flowchart to decide whether to remove tracheotomy in long-term mechanically ventilated patients. Design and setting. Prospective study in a respiratory intensive care unit, with beds dedicated to weaning from prolonged mechanical ventilation Patients and participants. 108 tracheotomized patients with respiratory failure of different causes (chronic obstructive pulmonary disease, postsurgical complications, recovery

Piero Ceriana; Annalisa Carlucci; Paolo Navalesi; Ciro Rampulla; Monica Delmastro; GianCarlo Piaggi; Elisa De Mattia; Stefano Nava

2003-01-01

119

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

PubMed Central

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

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

2005-01-01

120

Evolution of Mechanical Ventilation in Response to Clinical Research  

Microsoft Academic Search

Rationale: Recent literature in mechanical ventilation includes strong evidence from randomized trials. Little information is available regarding the influence of these trials on usual clinical practice. Objectives: To describe current mechanical ventilation practices and to assess the influence of interval randomized trials when compared with findings from a 1998 cohort. Methods: A prospective international observational cohort study, with a nested

Andres Esteban; Niall D. Ferguson; Maureen O. Meade; Fernando Frutos-Vivar; Carlos Apezteguia; Laurent Brochard; Konstantinos Raymondos; Nicolas Nin; Javier Hurtado; Vinko Tomicic; Marco Gonzalez

121

Trolox Attenuates Mechanical Ventilation-induced Diaphragmatic Dysfunction and Proteolysis  

Microsoft Academic Search

Prolonged mechanical ventilation results in diaphragmatic oxida- tive injury, elevated proteolysis, fiber atrophy, and reduced force- generating capacity. We tested the hypothesis that antioxidant infusion during mechanical ventilation would function as an antioxi- dant to maintain redox balance within diaphragm muscle fibers and therefore prevent oxidative stress and subsequent proteolysis and contractile dysfunction. Sprague-Dawley rats were anesthe- tized, tracheostomized, and

Jenna L. Betters; David S. Criswell; R. Andrew Shanely; Darin Van Gammeren; Darin Falk; Keith C. DeRuisseau; Melissa Deering; Tossaporn Yimlamai; Scott K. Powers

2004-01-01

122

The mechanisms involved in the natural ventilation of greenhouses  

Microsoft Academic Search

Although natural ventilation is one of the major mechanisms that controls the greenhouse climate, our understanding of the underlying processes remains insufficient to allow accurate prediction of the rates of such exchanges.This paper deals with the physical mechanisms involved in natural ventilation of a greenhouse equipped with continuous lateral windows, and uses the following experimental procedures: •• air exchange rate

T. Boulard; J. F. Meneses; M. Mermier; G. Papadakis

1996-01-01

123

Invited review: mechanisms of ventilator-induced lung injury: a perspective.  

PubMed

Despite advances in critical care, the mortality rate in patients with acute lung injury remains high. Furthermore, most patients who die do so from multisystem organ failure. It has been postulated that ventilator-induced lung injury plays a key role in determining the negative clinical outcome of patients exposed to mechanical ventilation. How mechanical ventilation exerts its detrimental effect is as of yet unknown, but it appears that overdistension of lung units or shear forces generated during repetitive opening and closing of atelectatic lung units exacerbates, or even initiates, significant lung injury and inflammation. The term "biotrauma" has recently been elaborated to describe the process by which stress produced by mechanical ventilation leads to the upregulation of an inflammatory response. For mechanical ventilation to exert its deleterious effect, cells are required to sense mechanical forces and activate intracellular signaling pathways able to communicate the information to its interior. This information must then be integrated in the nucleus, and an appropriate response must be generated to implement and/or modulate its response and that of neighboring cells. In this review, we present a perspective on ventilator-induced lung injury with a focus on mechanisms and clinical implications. We highlight some of the most recent findings, which we believe contribute to the generation and propagation of ventilator-induced lung injury, placing a special emphasis on their implication for future research and clinical therapies. PMID:11007607

Dos Santos, C C; Slutsky, A S

2000-10-01

124

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

Microsoft Academic Search

Background  A considerable number of patients admitted to the intensive care unit (ICU) die following withdrawal of mechanical ventilation.\\u000a After discontinuation of ventilation without proper preparation, excessive respiratory secretion is common, resulting in a\\u000a ‘death rattle’. Post-extubation stridor can give rise to the relatives’ perception that the patient is choking and suffering.\\u000a Existing protocols lack adequate anticipatory preparation to respond to

E. J. O. Kompanje; B. van der Hoven; J. Bakker

2008-01-01

125

Mechanical ventilation strategies and inflammatory responses to cardiac surgery: a prospective randomized clinical trial  

Microsoft Academic Search

Objective  To examine whether postoperative mechanical ventilation with lower tidal volumes (VT) has protective effects on inflammatory responses induced by cardiopulmonary bypass (CPB) surgery in smokers and nonsmokers.Design and setting  Prospective, randomized, controlled clinical trial in the intensive care unit of a university hospital.Patients and participants  We examined 44 patients (22 smokers, 22 nonsmokers) immediately after uncomplicated CPB surgery.Interventions  Ventilation was applied for 6 h

Hermann Wrigge; Ulrike Uhlig; Georg Baumgarten; Jan Menzenbach; Jörg Zinserling; Martin Ernst; Daniel Drömann; Armin Welz; Stefan Uhlig; Christian Putensen

2005-01-01

126

Noninvasive mechanical ventilation may be useful in treating patients who fail weaning from invasive mechanical ventilation: a randomized clinical trial  

Microsoft Academic Search

INTRODUCTION: The use of noninvasive positive-pressure mechanical ventilation (NPPV) has been investigated in several acute respiratory failure situations. Questions remain about its benefits when used in weaning patients from invasive mechanical ventilation (IMV). The objective of this study was to evaluate the use of bi-level NPPV for patients who fail weaning from IMV. METHODS: This experimental randomized clinical trial followed

Cristiane E Trevisan; Silvia R Vieira

2008-01-01

127

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

Microsoft Academic Search

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

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

2000-01-01

128

Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study  

PubMed Central

Introduction Respiratory muscle weakness is an important risk factor for delayed weaning. Animal data show that mechanical ventilation itself can cause atrophy and weakness of the diaphragm, called ventilator-induced diaphragmatic dysfunction (VIDD). Transdiaphragmatic pressure after magnetic stimulation (TwPdi BAMPS) allows evaluation of diaphragm strength. We aimed to evaluate the repeatability of TwPdi BAMPS in critically ill, mechanically ventilated patients and to describe the relation between TwPdi and the duration of mechanical ventilation. Methods This was a prospective observational study in critically ill and mechanically ventilated patients, admitted to the medical intensive care unit of a university hospital. Nineteen measurements were made in a total of 10 patients at various intervals after starting mechanical ventilation. In seven patients, measurements were made on two or more occasions, with a minimum interval of 24 hours. Results The TwPdi was 11.5 ± 3.9 cm H2O (mean ± SD), indicating severe respiratory muscle weakness. The between-occasion coefficient of variation of TwPdi was 9.7%, comparable with data from healthy volunteers. Increasing duration of mechanical ventilation was associated with a logarithmic decline in TwPdi (R = 0.69; P = 0.038). This association was also found for cumulative time on pressure control (R = 0.71; P = 0.03) and pressure-support ventilation (P = 0.05; R = 0.66) separately, as well as for cumulative dose of propofol (R = 0.66; P = 0.05) and piritramide (R = 0.79; P = 0.01). Conclusions Duration of mechanical ventilation is associated with a logarithmic decline in diaphragmatic force, which is compatible with the concept of VIDD. The observed decline may also be due to other potentially contributing factors such as sedatives/analgesics, sepsis, or others.

2010-01-01

129

Ventilator-dependent children and the health services system. Unmet needs and coordination of care.  

PubMed

Rationale: Children dependent on mechanical ventilation are a vulnerable population by virtue of their chronic disability and are therefore at increased risk for health disparities and access barriers. The present study is the first, to our knowledge, to conduct a large-scale survey of caregivers of ventilator-dependent children to develop a comprehensive socio-demographic profile. Objectives: To describe the demographic and health status profile of ventilator-dependent children, to identify the types of unmet needs families caring for a child on a ventilator face, and to determine the correlates of access to care coordination. Methods: A survey was administered to 122 parents whose children attended a pediatric home ventilator clinic at a large tertiary Midwestern medical center (84% of the clinic population). Measurements and Main Results: Half of the patient population had severe functional limitations, and 70% had one or more comorbidities. One quarter of caregivers reported current financial struggles, and 16% screened positive for a probable depressive disorder. More than half of families reported unmet needs for care, most frequently therapeutic services and skilled nursing care. Of those reporting an unmet need for skilled nursing care, lack of adequate staffing was the main barrier (71.1%). Financial struggles and a probable caregiver depressive disorder were significantly associated with an unmet need for care coordination. Conclusions: This is the first large-scale quantitative study to investigate the themes of unmet need and care coordination within this vulnerable population. The results suggest these families face barriers accessing therapeutic and skilled nursing services, and caregiver mental health and financial struggles may be important points of intervention for service providers through the inclusion of multidisciplinary care teams and the strengthening of social services referral networks. PMID:23987826

Hefner, Jennifer L; Tsai, Wan Chong

2013-10-01

130

Oral hygiene regimes for mechanically ventilated patients that use chlorhexidine reduce ventilator-associated pneumonia.  

PubMed

Data sourcesThe Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, LILACS, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan Fang Database, OpenGrey and ClinicalTrials.gov databases were searched. Reference lists of identified articles were also scanned for relevant papers. There were no language restrictions.Study selectionRandomised controlled trials (RCTs) evaluating OHC in the form of mouthwashes, swabs, toothbrushing or in combination in critically ill patients receiving mechanical ventilation were included.Data extraction and synthesisData extraction was carried out independently by two reviewers. Study authors were contracted for additional information. Random-effects meta-analyses were performed where data could be pooled.ResultsThirty-five RCTs (5374 participants) were included. Five trials (14%) were assessed at low risk of bias, 17 studies (49%) were at high risk of bias and 13 studies (37%) were assessed at unclear risk of bias in at least one domain. There were four main comparisons; chlorhexidine (CHX mouthrinse or gel) versus placebo/usual care, toothbrushing versus no toothbrushing, powered versus manual toothbrushing and comparisons of oral care solutions.Seventeen RCTs (2402 participants, two at high, 11 at unclear and four at low risk of bias) provide moderate quality evidence that CHX mouthrinse or gel, as part of OHC, compared to placebo or usual care is associated with a reduction in VAP (OR 0.60, 95% confidence intervals (CI) 0.47 to 0.77, P < 0.001, I(2) = 21%) A number needed to treat (NNT) of 15 (95% CI 10 to 34). There is no evidence of a difference between CHX and placebo/usual care in the outcomes of mortality, duration of mechanical ventilation or duration of ICU stay. There was insufficient evidence to determine whether there is a difference between CHX and placebo/usual care in the outcomes of duration of use of systemic antibiotics, oral health indices, microbiological cultures, caregivers' preferences or cost. Only three studies reported any adverse effects, and these were mild with similar frequency in CHX and control groups.Three trials in children found no evidence of a difference between OHC with CHX and placebo, and there was insufficient evidence to determine the effect of other outcomes. Four RCTs (828 participants, low quality evidence) compared to OHC without toothbrushing (± CHX), and for the outcome of VAP no evidence of a difference was found (OR 0.69, 95% CI 0.36 to 1.29, P = 0.24, I(2) = 64%). There was insufficient evidence to determine the effect of other outcomes.Only one trial compared use of a powered toothbrush with a manual toothbrush, providing insufficient evidence to determine the effect on any of the outcomes of this review.A range of other oral care solutions were compared. There is some weak evidence that povidone iodine mouthrinse is more effective than saline in reducing VAP (OR 0.35, 95% CI 0.19 to 0.65, P = 0.0009, I(2) = 53%) (two studies, 206 participants, high risk of bias). Due to the variation in comparisons and outcomes among the trials in this group there is insufficient evidence concerning the effects of other oral care solutions on the outcomes of this review.ConclusionsEffective OHC is important for ventilated patients in intensive care. OHC that includes either chlorhexidine mouthwash or gel is associated with a 40% reduction in the odds of developing ventilator-associated pneumonia in critically ill adults. However, there is no evidence of a difference in the outcomes of mortality, duration of mechanical ventilation or duration of ICU stay. There is no evidence that OHC including both CHX and toothbrushing is different from OHC with CHX alone, and some weak evidence to suggest that povidone iodine mouthrinse is more effective than saline in reducing VAP. There is insufficient evidence to determine whether powered toothbrushing or other oral care solutions are effective in reducing VAP. PMID:24071682

Richards, Derek

2013-09-01

131

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

Microsoft Academic Search

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

Ulf E. Kongsgaard; Nina K. Meidell

1999-01-01

132

Continuous epidural infusion for postoperative mechanical ventilation  

Microsoft Academic Search

We evaluated in analgesic and sedative effects of continuous epidural infusion of two analgesic regimens in ventilated patients\\u000a following esophagectomy. Fortysix patients, divided into two treatment groups, received postoperative continuous epidural\\u000a infusion of morphine, or that of a combination of bupivacaine and morphine. Assessments were made with the following indices:\\u000a pain relief score, somnolence score, patient ventilator coordination score, and

Shinichi Sakura; Mariko Sumi; Yoji Saito; Jyunken Koh; Makoto Asano; Akio Tanaka; Yoshihiro Kosaka

1990-01-01

133

Outcome of patients with acute myeloid leukemia and pulmonary infiltrates requiring invasive mechanical ventilation—a retrospective analysis  

Microsoft Academic Search

Purpose: To assess the prognosis of patients with acute myeloid leukemia (AML) and pulmonary infiltrates requiring mechanical ventilation.Design: A retrospective cohort study.Setting: A medical intensive care unit (ICU) in an academic tertiary care center.Patients and Methods: We identified 30 consecutive patients with acute myeloid leukemia and pulmonary infiltrates who received invasive mechanical ventilation and compared clinical and laboratory parameters between

Christian Rabe; Ulrich Mey; Michael Paashaus; Annemarie Musch; Selcuk Tasci; Axel Glasmacher; Ingo G. H Schmidt-Wolf; Tilman Sauerbruch; Franz Ludwig Dumoulin

2004-01-01

134

Noninvasive mechanical ventilation as a palliative treatment of acute respiratory failure in patients with end-stage solid cancer  

Microsoft Academic Search

Noninvasive ventilation (NIV) is widely used in the treatment of acute respiratory failure (ARF), but not in patients with end-stage solid cancer in whom any form of mechanical ventilation tends to be avoided. In a prospective study, we investigated the use of NIV in 23 patients with solid malignancies receiving palliative care and who were affected by severe hypoxic or

Annamaria Cuomo; Monica Delmastro; Piero Ceriana; Stefano Nava; Giorgio Conti; Massimo Antonelli; Emanuele Iacobone

2004-01-01

135

Activation of human macrophages by mechanical ventilation in vitro.  

PubMed

Positive-pressure mechanical ventilation supports gas exchange in patients with respiratory failure but is also responsible for significant lung injury. In this study, we have developed an in vitro model in which isolated lung cells can be submitted to a prolonged cyclic pressure-stretching strain resembling that of conventional mechanical ventilation. In this model, cells cultured on a Silastic membrane were elongated up to 7% of their initial diameter, corresponding to a 12% increase in cell surface. The lung macrophage was identified as the main cellular source for critical inflammatory mediators such as tumor necrosis factor-alpha, the chemokines interleukin (IL)-8 and -6, and matrix metalloproteinase-9 in this model system of mechanical ventilation. These mediators were measured in supernatants from ventilated alveolar macrophages, monocyte-derived macrophages, and promonocytic THP-1 cells. Nuclear factor-kappaB was found to be activated in ventilated macrophages. Synergistic proinflammatory effects of mechanical stress and molecules such as bacterial endotoxin were observed, suggesting that mechanical ventilation might be particularly deleterious in preinjured or infected lungs. Dexamethasone prevented IL-8 and tumor necrosis factor-alpha secretion in ventilated macrophages. Mechanical ventilation induced low levels of IL-8 secretion by alveolar type II-like cells. Other lung cell types such as endothelial cells, bronchial cells, and fibroblasts failed to produce IL-8 in response to a prolonged cyclic pressure-stretching load. This model is of particular value for exploring physical stress-induced signaling pathways, as well as for testing the effects of novel ventilatory strategies or adjunctive substances aimed at modulating cell activation induced by mechanical ventilation. PMID:9843840

Pugin, J; Dunn, I; Jolliet, P; Tassaux, D; Magnenat, J L; Nicod, L P; Chevrolet, J C

1998-12-01

136

Fast track anesthesia for liver transplantation reduces postoperative ventilation time but not intensive care unit stay.  

PubMed

Fast tracking is an approach to health care delivery that emphasizes the efficient use of resources. This investigation was designed to determine whether shorter-acting drugs and different drug administration practices reduce the length of time for which patients require mechanical ventilation and intensive care after liver transplantation. After obtaining Institutional Review Board approval and informed consent, we randomized 80 consecutive patients (>17 years) undergoing liver transplantation to receive either our traditional anesthetic (thiopental, pancuronium, 50 microg/kg fentanyl), or fast track anesthetic (propofol, cisatracurium, 20 microg/kg fentanyl). The patients were weaned to extubation in the intensive care unit after an established clinical protocol. Measured data included the occurrence of intraoperative hypotension, intraoperative hypertension, intraoperative tachycardia, the length of postoperative mechanical ventilation, length of intensive care unit stay, and episodes of reintubation. Seventy-eight patients remained in the study through the investigation (two died intraoperatively). Operating time; amount of intraoperative red blood cells transfused; lowest body temperature achieved; and minutes of intraoperative hypotension, hypertension, and tachycardia were not different between the traditional and fast track patient groups. Postoperative ventilation time was greater in the patients who received the traditional anesthetic; mean. 1,081 minutes (median, 855) versus mean, 553.5 minutes (median, 390) (P <.001). However, there was no difference in length of intensive care unit stay. Five patients required reintubation (two patients given the traditional anesthetic, three given the fast track anesthetic). We conclude that a fast track approach to anesthetic care reduces the requirement for postoperative mechanical ventilation, but does not reduce intensive care unit stay after liver transplantation. PMID:12149758

Findlay, James Y; Jankowski, Christopher J; Vasdev, Gurinder M; Chantigian, Robert C; Gali, Bhargavi; Kamath, Gerard S; Keegan, Mark T; Hall, Brian A; Jones, Keith A; Burkle, Christopher M; Plevak, David J

2002-08-01

137

Lumican Expression in Diaphragm Induced by Mechanical Ventilation  

PubMed Central

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

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

2011-01-01

138

Erythropoietin response in critically ill mechanically ventilated patients: a prospective observational study  

PubMed Central

Introduction Anemia is a common problem in critically ill patients. The etiology of anemia of critical illness is often determined to be multifactorial in the clinical setting, but the pathophysiology remains to be elucidated. Erythropoietin (EPO) is an endogenous glycoprotein hormone that serves as the primary stimulus for erythropoiesis. Recent evidence has demonstrated a blunted EPO response as a factor contributing to anemia of critical illness in specific subsets of patients. Critically ill patients requiring mechanical ventilation who exhibit anemia have not been the subject of previous studies. Our goal was to evaluate the erythropoietic response to anemia in the critically ill mechanically ventilated patient. Methods A prospective observational study was undertaken in the medical intensive care unit of a tertiary care, military hospital. Twenty patients admitted to the medical intensive care unit requiring mechanical ventilation for at least 72 hours were enrolled as study patients. EPO levels and complete blood count were measured 72 hours after admission and initiation of mechanical ventilation. Admission clinical and demographic data were recorded, and patients were followed for the duration of mechanical ventilation. Twenty patients diagnosed with iron deficiency anemia in the outpatient setting were enrolled as a control population. Control patients had baseline complete blood count and iron panel recorded by primary care physicians. EPO levels were measured at the time of enrollment in conjunction with complete blood count. Results The mean EPO level for the control population was 60.9 mU/ml. The mean EPO level in the mechanically ventilated patient group was 28.7 mU/ml, which was significantly less than in the control group (P = 0.035). The mean hemoglobin value was not significantly different between groups (10.6 g/dl in mechanically ventilated patients versus 10.2 g/dl in control patients; P > 0.05). Conclusion Mechanically ventilated patients demonstrate a blunted EPO response to anemia. Further study of therapies directed at treating anemia of critical illness and evaluating its potential impact on mechanical ventilation outcomes and mortality is warranted.

DeAngelo, Alan J; Bell, David G; Quinn, Michael W; Long, Deborah Ebert; Ouellette, Daniel R

2005-01-01

139

Determinants of weaning success in patients with prolonged mechanical ventilation  

PubMed Central

Introduction Physiological determinants of weaning success and failure are usually studied in ventilator-supported patients, comparing those who failed a trial of spontaneous breathing with those who tolerated such a trial and were successfully extubated. A major limitation of these studies was that the two groups may be not comparable concerning the severity of the underlying disease and the presence of comorbidities. In this physiological study, we assessed the determinants of weaning success in patients acting as their own control, once they are eventually liberated from the ventilator. Methods In 30 stable tracheotomised ventilator-dependent patients admitted to a weaning center inside a respiratory intensive care unit, we recorded the breathing pattern, respiratory mechanics, inspiratory muscle function, and tension-time index of diaphragm (TTdi = Pdisw/Pdimax [that is, tidal transdiaphragmatic pressure over maximum transdiaphragmatic pressure] × Ti/Ttot [that is, the inspiratory time over the total breath duration]) at the time of weaning failure (T0). The measurements were repeated in all the patients (T1) either during a successful weaning trial (successful weaning [SW] group, n = 16) or 5 weeks later, in the case of repeated weaning failure (failed weaning [FW] group, n = 14). Results Compared to T0, in the FW group at T1, significant differences were observed only for a reduction in spontaneous breathing frequency and in TTdi (0.21 ± 0.122 versus 0.14 ± 0.054, P = 0.008). SW patients showed a significant increase in Pdimax (34.9 ± 18.9 cm H2O versus 43.0 ± 20.0, P = 0.02) and decrease in Pdisw/Pdimax (36.0% ± 15.8% versus 23.1% ± 7.9%, P = 0.004). Conclusions The recovery of an inadequate inspiratory muscle force could be the major determinant of 'late' weaning success, since this allows the patients to breathe far below the diaphragm fatigue threshold.

Carlucci, Annalisa; Ceriana, Piero; Prinianakis, Georgios; Fanfulla, Francesco; Colombo, Roberto; Nava, Stefano

2009-01-01

140

A prospective randomized comparison of conventional mechanical ventilation and very early high frequency oscillatory ventilation in extremely premature newborns with respiratory distress syndrome  

Microsoft Academic Search

Objective: To compare the effectiveness and safety of very early high-frequency oscillatory ventilation (HFOV) with conventional mechanical\\u000a ventilation (CMV) in treatment of the respiratory distress syndrome (RDS) and to evaluate their impact on the incidence of\\u000a chronic pulmonary disease and early and late morbidity of very low-birthweight neonates. Design: A prospective randomized clinical trial. Setting: Tertiary neonatal intensive care unit

R. Plavka; P. Kopecký; V. Sebro?; P. Švihovec; B. Zlatohlávková; V. Januš

1999-01-01

141

High-Frequency Oscillatory Ventilation, Partial Liquid Ventilation, or Conventional Mechanical Ventilation in NewbornPiglets with Saline Lavage-Induced Acute Lung Injury  

Microsoft Academic Search

It has been reported that, in diseased lungs, either partial liquid ventilation (PLV) or high-frequency oscillatory ventilation (HFOV) can improve oxygenation better and with less lung injury than conventional mechanical ventilation (CMV). This study was intended as a preclinical comparison between the effects of HFOV, PLV and CMV on gas exchange, lung mechanics and histology. Fifteen anesthetized newborn piglets, with

Pieter L. J. Degraeuwe; Frederik B. J. M. Thunnissen; Gijs D. Vos; Carlos E. Blanco

1999-01-01

142

Noninvasive Mechanical Ventilation in Valencia, Spain: From Theory to Practice  

Microsoft Academic Search

ObjectiveTo obtain representative data on the type, frequency of use, and availability of resources for noninvasive mechanical ventilation (NIV) in hospitals (acute respiratory failure) and at home (chronic respiratory failure).

Eusebi Chiner; Mónica Llompart; Miguel Ángel Martínez-García; Estrella Fernández-Fabrellas; Rafael Navarro; Ángela Cervera

2009-01-01

143

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

PubMed Central

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

2012-01-01

144

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

PubMed

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

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

2012-03-22

145

Effects of a Clinical Trial on Mechanical Ventilation Practices in Patients with Acute Lung Injury  

Microsoft Academic Search

Rationale: In a clinical trial by the Acute Respiratory Distress Syn- drome Network (ARDSNet), mechanical ventilation with tidal volumes of 6 ml\\/kg decreased mortality from acute lung injury. However, interpretations of these results generated controversy and it was unclear if this trial would change usual-care practices. Objectives: First, to determine if clinical practices at ARDSNet hospi- tals changed after the

William Checkley; Roy Brower; Anna Korpak; B. Taylor Thompson

146

Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation  

Microsoft Academic Search

Objective: A closed suction system (CS) maintains connection with the mechanical ventilator during tracheal suctioning and is claimed to limit loss in lung volume and oxygenation. We compared changes in lung volume, oxygenation, airway pressure and hemodynamics during endotracheal suctioning performed with CS and with an open suction system (OS). Design: Prospective, randomized study. Setting: Intensive care unit in a

Maurizio Cereda; Federico Villa; Enrico Colombo; Gianluca Greco; Mirco Nacoti; Antonio Pesenti

2001-01-01

147

Mechanisms of ventilator-induced lung injury in premature infants.  

PubMed

Mechanical ventilation in premature infants may injure the lungs or exacerbate the pre-existing condition that led to the need for mechanical ventilation. Ventilator-induced lung injury (VILI) may be associated with alveolar structural damage, pulmonary oedema, inflammation, and fibrosis. This injury is not uniform and is associated with surfactant dysfunction. Recovery from VILI includes clearance of pulmonary oedema and alveolar structural repair. Mechanisms of VILI include high airway pressure (barotrauma), large gas volumes (volutrauma), alveolar collapse and re-expansion (atelectotrauma), and increased inflammation (biotrauma). Injury to the lung may lead to other organ dysfunction. The premature lung is more susceptible to VILI, and lung injury may exacerbate the disturbance of lung development that occurs after birth. Therapies targeting specific processes in lung injury, and which complement the protective ventilator management strategies to avoid atelectotrauma and lung overdistension are an area of active research. PMID:12464497

Attar, Mohammad Ali; Donn, Steven M

2002-10-01

148

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

Microsoft Academic Search

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

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

2006-01-01

149

Leakage estimation using Kalman filtering in noninvasive mechanical ventilation.  

PubMed

Noninvasive mechanical ventilation is today often used to assist patient with chronic respiratory failure. One of the main reasons evoked to explain asynchrony events, discomfort, unwillingness to be treated, etc., is the occurrence of nonintentional leaks in the ventilation circuit, which are difficult to account for because they are not measured. This paper describes a solution to the problem of variable leakage estimation based on a Kalman filter driven by airflow and the pressure signals, both of which are available in the ventilation circuit. The filter was validated by showing that based on the attained leakage estimates, practically all the untriggered cycles can be explained. PMID:23221796

Rodrigues, G G; Freitas, U S; Bounoiare, D; Aguirre, L A; Letellier, C

2012-12-03

150

Calibration of seven ICU ventilators for mechanical ventilation with helium-oxygen mixtures.  

PubMed

The study evaluated seven intensive care unit (ICU) ventilators (Veolar FT, Galileo, Evita 2, Evita 4, Servo 900C, Servo 300, Nellcor Puritan Bennett 7200 Series) with helium-oxygen (HeO2), using a lung model, to develop correction factors for the safe use of HeO2. A 70:28 helium-O2 mixture (heliox) replaced air and combined with O2 (HeO2). Theoretical impact of HeO2 on inspiratory valves and gas mixing was computed. True fraction of inspired oxygen (FIO2del) was compared with fraction of inspired oxygen (FIO2) set on the ventilator (FIO2set). True tidal volume (VTdel) was compared with VT set on the ventilator (VTset) in volume control and with control VTdel at FIO2 1.0 in pressure control. FIO2del minimally exceeded FIO2set ( FIO2set by 125%). In volume control, with the Veolar FT, Galileo, Evita 2, and Servo 900C, VTdel > VTset, with the 7200 Series VTdel < VTset (linear relationship, magnitude of discrepancy inversely related to FIO2set). With the Evita 4, VTdel > VTset (nonlinear relationship), whereas with the Servo 300 VTdel = VTset. In pressure control, VTdel was identical to control measurements, except with the 7200 Series (ventilator malfunction). Correction factors were developed that can be applied to most ventilators. PMID:10390375

Tassaux, D; Jolliet, P; Thouret, J M; Roeseler, J; Dorne, R; Chevrolet, J C

1999-07-01

151

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

PubMed Central

Even if the performance of a given ventilator has been evaluated in the laboratory under very well controlled conditions, inappropriate maintenance and lack of long-term stability and accuracy of the ventilator sensors may lead to ventilation errors in actual clinical practice. The aim of this study was to evaluate the actual performances of ventilators during clinical routines. A resistance (7.69 cmH2O/L/s) – elastance (100 mL/cmH2O) test lung equipped with pressure, flow, and oxygen concentration sensors was connected to the Y-piece of all the mechanical ventilators available for patients in four intensive care units (ICUs; n = 66). Ventilators were set to volume-controlled ventilation with tidal volume = 600 mL, respiratory rate = 20 breaths/minute, positive end-expiratory pressure (PEEP) = 8 cmH2O, and oxygen fraction = 0.5. The signals from the sensors were recorded to compute the ventilation parameters. The average ± standard deviation and range (min–max) of the ventilatory parameters were the following: inspired tidal volume = 607 ± 36 (530–723) mL, expired tidal volume = 608 ± 36 (530–728) mL, peak pressure = 20.8 ± 2.3 (17.2–25.9) cmH2O, respiratory rate = 20.09 ± 0.35 (19.5–21.6) breaths/minute, PEEP = 8.43 ± 0.57 (7.26–10.8) cmH2O, oxygen fraction = 0.49 ± 0.014 (0.41–0.53). The more error-prone parameters were the ones related to the measure of flow. In several cases, the actual delivered mechanical ventilation was considerably different from the set one, suggesting the need for improving quality control procedures for these machines.

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

2012-01-01

152

Changes in pulmonary mechanics after fiberoptic bronchoalveolar lavage in mechanically ventilated patients  

Microsoft Academic Search

Objective: We prospectively assessed the impact of bronchoalveolar lavage (BAL) on respiratory mechanics in critically ill, mechanically\\u000a ventilated patients. Study design: Mechanically ventilated patients underwent BAL of one lung segment using 5 ? 20 ml of sterile, physiologic saline with a\\u000a temperature of 25–28 ?C. The fractional inspired oxygen was increased to 1.0, but ventilator settings were otherwise left\\u000a unchanged.

U. Klein; W. Karzai; P. Zimmermann; U. Hannemann; U. Koschel; J. X. Brunner; H. Remde

1998-01-01

153

High frequency oscillatory ventilation compared with conventional mechanical ventilation in adult respiratory distress syndrome: a randomized controlled trial [ISRCTN24242669  

PubMed Central

Introduction To compare the safety and efficacy of high frequency oscillatory ventilation (HFOV) with conventional mechanical ventilation (CV) for early intervention in adult respiratory distress syndrome (ARDS), a multi-centre randomized trial in four intensive care units was conducted. Methods Patients with ARDS were randomized to receive either HFOV or CV. In both treatment arms a priority was given to maintain lung volume while minimizing peak pressures. CV ventilation strategy was aimed at reducing tidal volumes. In the HFOV group, an open lung strategy was used. Respiratory and circulatory parameters were recorded and clinical outcome was determined at 30 days of follow up. Results The study was prematurely stopped. Thirty-seven patients received HFOV and 24 patients CV (average APACHE II score 21 and 20, oxygenation index 25 and 18 and duration of mechanical ventilation prior to randomization 2.1 and 1.5 days, respectively). There were no statistically significant differences in survival without supplemental oxygen or on ventilator, mortality, therapy failure, or crossover. Adjustment by a priori defined baseline characteristics showed an odds ratio of 0.80 (95% CI 0.22–2.97) for survival without oxygen or on ventilator, and an odds ratio for mortality of 1.15 (95% CI 0.43–3.10) for HFOV compared with CV. The response of the oxygenation index (OI) to treatment did not differentiate between survival and death. In the HFOV group the OI response was significantly higher than in the CV group between the first and the second day. A post hoc analysis suggested that there was a relatively better treatment effect of HFOV compared with CV in patients with a higher baseline OI. Conclusion No significant differences were observed, but this trial only had power to detect major differences in survival without oxygen or on ventilator. In patients with ARDS and higher baseline OI, however, there might be a treatment benefit of HFOV over CV. More research is needed to establish the efficacy of HFOV in the treatment of ARDS. We suggest that future studies are designed to allow for informative analysis in patients with higher OI.

Bollen, Casper W; van Well, Gijs Th J; Sherry, Tony; Beale, Richard J; Shah, Sanjoy; Findlay, George; Monchi, Mehran; Chiche, Jean-Daniel; Weiler, Norbert; Uiterwaal, Cuno SPM; van Vught, Adrianus J

2005-01-01

154

Mechanical ventilation and lung infection in the genesis of air-space enlargement  

Microsoft Academic Search

INTRODUCTION: Air-space enlargement may result from mechanical ventilation and\\/or lung infection. The aim of this study was to assess how mechanical ventilation and lung infection influence the genesis of bronchiolar and alveolar distention. METHODS: Four groups of piglets were studied: non-ventilated-non-inoculated (controls, n = 5), non-ventilated-inoculated (n = 6), ventilated-non-inoculated (n = 6), and ventilated-inoculated (n = 8) piglets. The

Alfonso Sartorius; Qin Lu; Silvia Vieira; Marc Tonnellier; Gilles Lenaour; Ivan Goldstein; Jean-Jacques Rouby

2007-01-01

155

Ontological based clinical decision support system (CDSS) for weaning ventilator in Intensive Care Unit (ICU)  

Microsoft Academic Search

Weaning from mechanical ventilation is a process of discontinuation or withdrawal from mechanical ventilation and it can be referred as the transition from ventilatory support to spontaneous breathing. The aim of this process is to reduce the support given by the mechanical ventilation as soon as possible to minimize mortality and morbidity, the use of resources and the costs of

Farahidayah Bt. Mahmud; Maryati Mohd Yusof; Azman Naoh Shahrul

2011-01-01

156

Calibration of Seven ICU Ventilators for Mechanical Ventilation with HeliumOxygen Mixtures  

Microsoft Academic Search

The study evaluated seven intensive care unit (ICU) ventilators (Veolar FT, Galileo, Evita 2, Evita 4, Servo 900C, Servo 300, Nellcor Puritan Bennett 7200 Series) with helium-oxygen (HeO 2 ), using a lung model, to develop correction factors for the safe use of HeO 2 . A 70:28 helium-O 2 mixture (he- liox) replaced air and combined with O 2

DIDIER TASSAUX; PHILIPPE JOLLIET; JEAN-MARC THOURET; JEAN ROESELER; RENÉ DORNE; JEAN-CLAUDE CHEVROLET

157

Increased use of noninvasive ventilation in French intensive care units  

Microsoft Academic Search

Objectives  A prospective survey of French intensive care units (ICUs) in 1997 showed \\u000amoderate and variable use of noninvasive ventilation (NIV). This study \\u000aexamined changes in NIV use in French ICUs after the intervening 5?years.Settings  Patients were enrolled in a prospective survey in 70 French ICUs.Methods  Three-week survey, with prospective inclusion of all patients requiring \\u000aventilatory support.Measurements and results  Overall 1,076 patients received ventilatory support (55%

Alexandre Demoule; Emmanuelle Girou; Jean-Christophe Richard; Solenne Taillé; Laurent Brochard

2006-01-01

158

Sleep quality in mechanically ventilated patients: comparison between NAVA and PSV modes  

PubMed Central

Background Mechanical ventilation seems to occupy a major source in alteration in the quality and quantity of sleep among patients in intensive care. Quality of sleep is negatively affected with frequent patient-ventilator asynchronies and more specifically with modes of ventilation. The quality of sleep among ventilated patients seems to be related in part to the alteration between the capacities of the ventilator to meet patient demand. The objective of this study was to compare the impact of two modes of ventilation and patient-ventilator interaction on sleep architecture. Methods Prospective, comparative crossover study in 14 conscious, nonsedated, mechanically ventilated adults, during weaning in a university hospital medical intensive care unit. Patients were successively ventilated in a random ordered cross-over sequence with neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV). Sleep polysomnography was performed during four 4-hour periods, two with each mode in random order. Results The tracings of the flow, airway pressure, and electrical activity of the diaphragm were used to diagnose central apneas and ineffective efforts. The main abnormalities were a low percentage of rapid eye movement (REM) sleep, for a median (25th-75th percentiles) of 11.5% (range, 8-20%) of total sleep, and a highly fragmented sleep with 25 arousals and awakenings per hour of sleep. Proportions of REM sleep duration were different in the two ventilatory modes (4.5% (range, 3-11%) in PSV and 16.5% (range, 13-29%) during NAVA (p = 0.001)), as well as the fragmentation index, with 40 ± 20 arousals and awakenings per hour in PSV and 16 ± 9 during NAVA (p = 0.001). There were large differences in ineffective efforts (24 ± 23 per hour of sleep in PSV, and 0 during NAVA) and episodes of central apnea (10.5 ± 11 in PSV vs. 0 during NAVA). Minute ventilation was similar in both modes. Conclusions NAVA improves the quality of sleep over PSV in terms of REM sleep, fragmentation index, and ineffective efforts in a nonsedated adult population.

2011-01-01

159

Oxygenation index predicts mortality in pediatric stem cell transplant recipients requiring mechanical ventilation.  

PubMed

The mortality in the ICU for pediatric HSCT recipients remains high. Early pulmonary complications continue to be an obstacle to the survival. We hypothesize OI is a predictor for mortality in critically ill pediatric HSCT recipients. Retrospective review of pediatric HSCT recipients between 2002 and 2010 who required intensive care during the same hospital admission as their transplant. Twenty-eight patients accounted for 31 ICU admissions. Twenty-six (84%) admissions required mechanical ventilation. Ten (38%) mechanically ventilated admissions were placed on HFOV. Mortality of those mechanically ventilated was 70%. An OI ? 20 at any point during ventilation was associated with 94% mortality, while an OI ? 25 had 100% mortality. There was a significant association between maximum OI at any point during mechanical ventilation and ICU mortality, with the odds of dying increasing by 13% for each unit increase of max OI (OR = 1.13, 95% CI = 1.01-1.26, p = 0.03). An OI of 20 had a sensitivity of 0.89 and specificity of 0.83 for predicting mortality. OI has a strong association with ICU mortality among pediatric stem cell recipients. PMID:22708708

Rowan, Courtney M; Hege, Kerry M; Speicher, Richard H; Goodman, Michael; Perkins, Susan M; Slaven, James E; Westenkirchner, David F; Haut, Paul R; Nitu, Mara E

2012-06-18

160

[ARDS and mechanical ventilation--"primum nil nocere"].  

PubMed

Present evidence demonstrates that mechanical ventilation in patients with adult respiratory distress syndrome (ARDS) contributes to the ongoing pulmonary damage, a condition known as "ventilator lung". Data from various animal studies indicate that volume, rather than pressure, is probably the main culprit. Accordingly, clinicians should use tidal volumes smaller than those usually recommended. This approach leads to hypercapnia (i.e. so-called "permissive hypercapnia"), which seems to have very few adverse effects and might even be beneficial. Moreover, there is an added risk of atelectasis, which can be prevented by the application of positive end-expiratory pressure (PEEP). The present study reviews the pathophysiological mechanisms by which mechanical ventilation is injurious to the lung, and attempts to outline an approach aimed at minimizing such damage. PMID:8211022

Jolliet, P; Thorens, J B; Chevrolet, J C

1993-09-11

161

[Young's syndrome in the adult age: home treatment with a mechanical device of intrapulmonary percusive ventilation].  

PubMed

We studied a man with bronchiectasis, chronic sinopulmonary infections and obstructive azoospermia diagnosed of Young's syndrome in the adult age. The patient was treated at home by a mechanical system of respiratory care based in intrapulmonary percussive ventilation (Percussionaire) reaching a significant clinical and functional improvement. Our case enhanced the importance to make a proper history of fertility in patients with bronchiectasis in order to establish the diagnostic. We review different methods of respiratory mechanical assistance in patients with bronchiectasis. PMID:18198952

Ruescas Escolano, E; Chiner Vives, E; Andreu Rodríguez, A L; Camarasa Escrig, A; Llombart Cantó, M; Sancho Chust, J

2007-09-01

162

Highly conserved transcriptional responses to mechanical ventilation of the lung  

PubMed Central

Cross-species analysis of microarray data has shown improved discriminating power between healthy and diseased states. Computational approaches have proven effective in deciphering the complexity of human disease by identifying upstream regulatory elements and the transcription factors that interact with them. Here we used both methods to identify highly conserved transcriptional responses during mechanical ventilation, an important therapeutic treatment that has injurious side effects. We generated control and ventilated whole lung samples from the premature baboon model of bronchopulmonary dysplasia (BPD), processed them for microarray, and combined them with existing whole lung oligonucleotide microarray data from 85 additional control samples from mouse, rat, and human and 19 additional ventilated samples from mouse and rat. Of the 2,531 orthologs shared by all 114 samples, 60 were modulated by mechanical ventilation [false discovery rate (FDR)-adjusted q value (qFDR) = 0.005, ANOVA]. These included transcripts encoding the transcription factors ATF3 and FOS. Because of compelling known roles for these transcription factors, we used computational methods to predict their targets in the premature baboon model of BPD, which included elastin (ELN), gastrin-releasing polypeptide (GRP), and connective tissue growth factor (CTGF). This approach identified highly conserved transcriptional responses to mechanical ventilation and may facilitate identification of therapeutic targets to reduce the side effects of this valuable treatment.

Kompass, Kenneth S.; Deslee, Gaetan; Moore, Carla; McCurnin, Donald

2010-01-01

163

Weaning From Mechanical Ventilation in Paediatrics. State of the Art.  

PubMed

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

Valenzuela, Jorge; Araneda, Patricio; Cruces, Pablo

2013-03-28

164

Monitored arterial and end-tidal carbon dioxide during in-flight mechanical ventilation  

Microsoft Academic Search

Introduction: Mechanical ventilation with monitored arterial carbon dioxide tension is necessary for optimum pulmonary support and hemodynamic stability. Ongoing monitoring is necessary to ensure adequate ventilation parameters. The prospective study purpose was to (1) compare mechanical ventilation to historic manual ventilation, (2) evaluate the effectiveness of institutional tidal volume parameters, (3) determine the effect of institutional tidal volume manipulation on

Cheryl J. Erler; William F. Rutherford; Angela Fiege; David R. Nelson; Ann Stahl

1996-01-01

165

Emergency department length of stay for patients requiring mechanical ventilation: a prospective observational study  

PubMed Central

Background Recommendations for acceptable emergency department (ED) length of stay (LOS) vary internationally with???8?h generally considered acceptable. Protracted ED LOS may place critically ill patients requiring mechanical ventilation at increased risk of adverse events as most EDs are not resourced for longitudinal delivery of critical care. Our objective was to quantify the ED LOS for mechanically ventilated patients (invasive and/or non-invasive ventilation [NIV]) and to explore patient and system level predictors of prolonged ED LOS. Additionally, we aimed to describe delivery and monitoring of ventilation in the ED. Methods Prospective observational study of ED LOS for all patients receiving mechanical ventilation at four metropolitan EDs in Toronto, Canada over two six-month periods in 2009 and 2010. Results We identified 618 mechanically ventilated patients which represented 0.5% (95% CI 0.4%–0.5%) of all ED visits. Of these, 484 (78.3%) received invasive ventilation, 118 (19.1%) received NIV; 16 received both during the ED stay. Median Kaplan-Meier estimated duration of ED stay for all patients was 6.4?h (IQR 2.8–14.6). Patients with trauma diagnoses had a shorter median (IQR) LOS, 2.5?h (1.3–5.1), compared to ventilated patients with non-trauma diagnoses, 8.5?h (3.3–14.0) (p <0.001). Patients requiring NIV had a longer ED stay (16.6?h, 8.2–27.9) compared to those receiving invasive ventilation exclusively (4.6?h, 2.2–11.1) and patients receiving both (15.4?h, 6.4–32.6) (p <0.001). Longer ED LOS was associated with ED site and lower priority triage scores. Shorter ED LOS was associated with intubation at another ED prior to transfer. Conclusions While patients requiring mechanical ventilation represent a small proportion of overall ED visits these critically ill patients frequently experienced prolonged ED stay especially those treated with NIV, assigned lower priority triage scores at ED presentation, and non-trauma patients.

2012-01-01

166

Survival in a recent cohort of mechanically ventilated pediatric allogeneic hematopoietic stem cell transplantation recipients.  

PubMed

There is ongoing discussion whether survival improved for children requiring mechanical ventilation after hematopoietic stem cell transplantation (HSCT). We reviewed the outcomes of 150 children who received an allogeneic HSCT between January 1999 and April 2007, in a pediatric university hospital in The Netherlands. Thirty-five of the 150 patients received mechanical ventilation on 38 occasions. None of the recorded risk factors was significantly associated with the requirement of mechanical ventilation. Sixteen admissions resulted in death in the intensive care unit (ICU), giving a case fatality rate of 42% (95% confidence interval 26%-58%). ICU mortality was associated with multiorgan failure on the second day of admission and with the use of high frequency oscillatory ventilation. Patients had higher pediatric risk of mortality scores than in previous studies, reflecting higher acuity of illness on admission to the ICU. Six-month survival in patients discharged from the ICU was 82%. Compared to previous studies, we found an improvement in ICU survival and survival 6 months after ICU discharge in a recent cohort of ventilated children after allogeneic HSCT, even though our patients were more severely ill. Our results are promising, but they need to be confirmed in larger, preferably multicenter, studies. PMID:19041061

van Gestel, Josephus P J; Bollen, Casper W; Bierings, Marc B; Boelens, Jaap Jan; Wulffraat, Nico M; van Vught, Adrianus J

2008-12-01

167

Exhaled Breath Condensate Collection in the Mechanically Ventilated Patient  

PubMed Central

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

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

2012-01-01

168

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

Microsoft Academic Search

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

Victor D. Rosenthal; Sandra Guzman; Christopher Crnich

169

Effects of increasing compliance with minimal sedation on duration of mechanical ventilation: a quality improvement intervention  

PubMed Central

Introduction In the past two decades, healthcare adopted industrial strategies for process measurement and control. In the industry model, care is taken to avoid minimal deviations from a standard. In healthcare there is scarce data to support that a similar strategy can lead to better outcomes. Briefly, when compliance is high, further attempts to improve uptake of a process are seldom made. Our intensive care unit (ICU) improved the compliance with minimizing sedation from a high baseline of 80.4% (95% CI: 66.9 to 90.2) to 96.2% (95% CI: 95.2 to 97.0) 12 months after a quality improvement initiative. We sought to measure whether this minute improvement in compliance led to a reduction in duration of mechanical ventilation. Methods We collected data on compliance with the process during 12 months. A trained data collector abstracted data from charts every other day. Our database contains data for length of mechanical ventilation, mortality, type of admission, and acute physiology and chronic health evaluation (APACHE) II scores for the 12 months before and after the process improvement. To control for secular trends we used an interrupted-time series with adjustment for auto-correlation. We calculated the expected length of mechanical ventilation on each month by the end of the intervention period, and calculated the fitted value for the post-intervention months. Results We included 1556 patients. There was an immediate effect of the intervention (regression coefficient = -0.129, P value < 0.001) and the secular trend was a determinant of length of mechanical ventilation (regression coefficient = 0.010, P value = 0.004). The trend post-intervention was not significant (regression coefficient = 0.004, P value = 0.380). The relative change in the length of mechanical ventilation was 14.5% (IQR 13.8% to 15.8%) and the total expected decrease in mechanical ventilation days was 502.7 days (95% CI 300.9 to 729.1) over one year. Conclusions In a system already working at high levels of compliance, outcomes can still be improved. Our intervention was successful in reducing the length of mechanical ventilation. ICUs should have a process of quality assurance in place to provide constant monitoring of key quality of care processes and correct deviations from the proposed standard.

2012-01-01

170

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

Microsoft Academic Search

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

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

171

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

Microsoft Academic Search

INTRODUCTION: This randomised, open-label, multicentre study compared the safety and efficacy of an analgesia-based sedation regime using remifentanil with a conventional hypnotic-based sedation regime in critically ill patients requiring prolonged mechanical ventilation for up to 10 days. METHODS: One hundred and five randomised patients received either a remifentanil-based sedation regime (initial dose 6 to 9 ?g kg-1 h-1 (0.1 to

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

2005-01-01

172

Computational tool for modeling and simulation of mechanically ventilated patients.  

PubMed

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

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

2010-01-01

173

Use of bronchodilators during non-invasive mechanical ventilation  

Microsoft Academic Search

Use of bronchodilators during non-invasive mechanical ventilation. P. Ceriana, P. Navalesi, C. Rampulla, G. Prinianakis, S. Nava. Bronchodilators represent one of the most important therapeutic weapons for the treatment of airway obstruc- tive 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 ex- hacerbations,

P. Ceriana; P. Navalesi; C. Rampulla; G. Prinianakis; S. Nav

174

Palliative Noninvasive Mechanical Ventilation in Patients with Hematological Malignancies  

Microsoft Academic Search

\\u000a Treatment with noninvasive ventilation (NIV) is feasible and effective in cancer patients. However, virtually no data are\\u000a available on the role for NIV as a component of palliative care for patients with hematological malignancies. NIV can be used\\u000a in patients with reversible causes of acute respiratory failure for whom potentially life-extending treatments are available.\\u000a In patients with treatment-limitation decisions, NIV

Anne-Pascale Meert; Thierry Berghmans; Jean-Paul Sculier

175

Reinstitution of Mechanical Ventilation within 14 Days as a Poor Predictor in Prolonged Mechanical Ventilation Patients following Successful Weaning  

PubMed Central

Although many parameters were investigated about weaning and mortality in critical patients in intensive units, no studies have yet investigated predictors in prolonged mechanical ventilation (PMV) patients following successful weaning. A cohort of 142 consecutive PMV patients with successful weaning in our respiratory care center was enrolled in this study. Successful weaning is defined as a patient having smooth respiration for more than 5 days after weaning. The results showed as follows: twenty-seven patients (19%) had the reinstitution within 14 days, and 115 patients (81%) had the reinstitution beyond 14 days. Renal disease RIFLE-LE was associated with the reinstitution within 14 days (P = 0.006). One year mortality rates showed significant difference between the two groups (85.2% in the reinstitution within 14 days group versus 53.1% in the reinstitution beyond 14 days; P < 0.001). Kaplan-Meier analysis showed that age ?70 years (P = 0.04), ESRD (P = 0.02), and the reinstitution within 14 days (P < 0.001) were associated with one-year mortality. Cox proportional hazards regression model showed that only the reinstitution within 14 days was the independent predictor for mortality (P < 0.001). In conclusion, the reinstitution within 14 days was a poor predictor for PMV patients after successful weaning.

Tu, Mei-Lien; Tseng, Ching-Wan; Tsai, Yuh Chyn; Wang, Chin-Chou; Tseng, Chia-Cheng; Lin, Meng-Chih; Fang, Wen-Feng; Chen, Yung-Che; Liu, Shih-Feng

2012-01-01

176

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

Microsoft Academic Search

Rationale and Objectives: Duration of weaning from mechanical ven- tilation may be reduced by the use of a systematic approach. We assessed whether a closed-loop knowledge-based algorithm intro- duced in a ventilator to act as a computer-driven weaning protocol can improve patient outcomes as compared with usual care. Methods and Measurements: We conducted a multicenter random- ized controlled study with

François Lellouche; Jordi Mancebo; Philippe Jolliet; Jean Roeseler; Fréderique Schortgen; Michel Dojat; Belen Cabello; Lila Bouadma; Pablo Rodriguez; Salvatore Maggiore; Marc Reynaert; Stefan Mersmann; Laurent Brochard

2006-01-01

177

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

PubMed

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

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

2010-11-11

178

Weaning Preterm Infants from Mechanical Ventilation  

Microsoft Academic Search

Mechanical ventilatory support is required by a large number of neonates in respiratory failure. However, its use in preterm infants is frequently associated with acute complications and long-term respiratory sequelae. Therefore, it is recommended to avoid or limit the exposure to ventilatory support. This is a review of existing practices and novel strategies to achieve weaning of ventilatory support in

Eduardo Bancalari; Nelson Claure

2008-01-01

179

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

PubMed Central

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

2011-01-01

180

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

PubMed

Improvement of gas exchange through closer matching of regional ventilation (V) and lung perfusion (Q) with the application of positive end-expiratory pressure (PEEP) was evaluated in vivo in six mechanically ventilated preterm lambs (107-126 days/145 days gestation). Changes in V and Q were determined from in vivo scintigraphic measurements in four lung regions with inhaled radioactive 81mKr, and infused 81mKr/dextrose and/or [99mTc]MAA as PEEP was applied at 2, 4, and 6 cm H2O in each animal. Dynamic compliance varied between 0.02 and 0.40 ml/cm H2O, which was consistent with surfactant deficiency. As PEEP was increased, the regional distribution of Q shifted from the rostral to the caudal lung regions (p less than 0.02 to less than 0.05), while that of V remained unchanged. Regional V/Q matching improved together with a trend towards improvement of arterial blood gases as PEEP was increased from 2 to 4 cm H2O. Pulmonary scintigraphy offers a noninvasive methodology for the quantitative assessment of regional V and Q matching in preterm lambs and may be clinically applicable to ventilated neonates. PMID:2666596

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

1989-08-01

181

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

SciTech Connect

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

Schlessel, J.S.; Susskind, H.; Joel, D.D.; Bossuyt, A.; Harrold, W.H.; Zanzi, I.; Chanana, A.D. (Cornell Univ. Medical College, Manhasset, NY (USA))

1989-08-01

182

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

PubMed Central

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

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

2011-01-01

183

Improved prognosis of infants mechanically ventilated for hyaline membrane disease  

PubMed Central

The results of mechanical ventilation for severe hyaline membrane disease (HMD), and the changes in technique which took place, during the 6-year period 1967-72 are described. A pilot study of the effect of hydrocortisone among the most severely affected infants showed no benefit. After the introduction at the beginning of 1970 of a regimen for ventilating the infants at low peak airway pressures, slow respiratory frequencies, and high inspiration: expiration ratios, there was a sudden increase in survival rate which was largely accounted for by a reduction in the incidence of bronchopulmonary dysplasia. Evidence is presented that in infants with HMD mechanical factors are more important than oxygen toxicity in the pathogenesis of this condition.

Reynolds, E. O. R.; Taghizadeh, A.

1974-01-01

184

Effect of spontaneous breathing on ventilator-induced lung injury in mechanically ventilated healthy rabbits: a randomized, controlled, experimental study  

PubMed Central

Introduction Ventilator-induced lung injury (VILI), one of the most serious complications of mechanical ventilation (MV), can impact patients' clinical prognoses. Compared to control ventilation, preserving spontaneous breathing can improve many physiological features in ventilated patients, such as gas distribution, cardiac performance, and ventilation-perfusion matching. However, the effect of spontaneous breathing on VILI is unknown. The goal of this study was to compare the effects of spontaneous breathing and control ventilation on lung injury in mechanically-ventilated healthy rabbits. Methods Sixteen healthy New Zealand white rabbits were randomly placed into a spontaneous breathing group (SB Group) and a control ventilation group (CV Group). Both groups were ventilated for eight hours using biphasic positive airway pressure (BIPAP) with similar ventilator parameters: inspiration pressure (PI) resulting in a tidal volume (VT) of 10 to 15 ml/kg, inspiratory-to-expiratory ratio of 1:1, positive end-expiration pressure (PEEP) of 2 cmH2O, and FiO2 of 0.5. Inflammatory markers in blood serum, lung homogenates and bronchoalveolar lavage fluid (BALF), total protein levels in BALF, mRNA expressions of selected cytokines in lung tissue, and lung injury histopathology scores were determined. Results Animals remained hemodynamically stable throughout the entire experiment. After eight hours of MV, compared to the CV Group, the SB Group had lower PaCO2 values and ratios of dead space to tidal volume, and higher lung compliance. The levels of cytokines in blood serum and BALF in both groups were similar, but spontaneous breathing led to significantly lower cytokine mRNA expressions in lung tissues and lower lung injury histological scores. Conclusions Preserving spontaneous breathing can not only improve ventilatory function, but can also attenuate selected markers of VILI in the mechanically-ventilated healthy lung.

2011-01-01

185

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

PubMed

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

Heck, Kara

2012-03-02

186

Noninvasive mechanical ventilation in acute hypoxaemic respiratory failure  

Microsoft Academic Search

ABSTRACT: In acute hypoxaemic respiratory failure (HRF), oxygenation, reduction in the work,of breathing and in dyspnoea,may,be achieved by delivering noninvasive mechanical,ventilation (NIMV). Several uncontrolled and 13 randomized,controlled studies (RCS) were,reviewed. Uncontrolled studies confirmed,the feasibility and the possibility to improve,arterial blood oxygenation,with NIMV. The 13 RCS compared,NIMV versus a conventional approach,in a total of 720 patients with HRF. Endotracheal intubation was

M. Wysocki; M. Antonelli

2001-01-01

187

Home mechanical ventilation: A Canadian Thoracic Society clinical practice guideline  

PubMed Central

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

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

2011-01-01

188

Ventilator Associated Pneumonia in Critically-Ill Neonates Admitted To Neonatal Intensive Care Unit, Zagazig University Hospitals  

PubMed Central

Objective ventilator associated pneumonia (VAP) is defined as nosocomial pneumonia in mechanically ventilated patients. It is considered to be most important cause of infection-related death in intensive care unit. We studied the characteristics and risk factors of VAP in critically-ill neonates. Methods Fifty six consecutive neonates with different diagnosis admitted from January to October 2010 to neonatal intensive care unit (NICU), Zagazig University Hospitals who needed mechanical ventilation were included in the study. There were 32 neonates, 18 males and 14 females with proven diagnosis of VAP, and 24 neonates, 11 males and 13 females without VAP served as control group. All studied neonates were subjected to history taking, clinical examination, routine investigations (Complete blood count, C-reactive protein, arterial blood gases, blood culture and liver and kidney function tests), and chest X-ray daily as well as non-bronchoscopic alveolar lavage culture for VAP group only. Findings Of 56 neonates who needed mechanical ventilation, 57.1% developed VAP. Prematurity, low birth weight and prolonged duration of mechanical ventilation were risk factors for developing VAP. Increased total leucocytic count, CRP and hypoalbuminemia were significantly presented in VAP-group. There were significant differences between VAP and non-VAP groups regarding hypothermia, mucopurulent endotracheal tube secretion, PaCO2 and PaO2. Microorganisms associated with blood stream infection in VAP diagnosed group were Klebsiella (15.6%), S. aureus (12.5%), Pseudomonas (9.4%), E. coli (6.2%), Candida (3.1%); 53.1% of obtained blood cultures were sterile. Of non-bronchoscopic alveolar lavage cultures obtained from VAP patients, 68.6% showed gram negative infection, 21.8% showed gram positive organisms and 9.3% revealed Candida infection. Conclusion The most important risk factors of VAP are prematurity, low birth weight, prolonged duration of mechanical ventilation, enteral nutrition and umbilical catheterization.

Badr, Mohamed A; Ali, Yasser F; Albanna, Ehab A M; Beshir, Mohamed R; Amr, Gahda E

2011-01-01

189

Gastric intramural pH in mechanically ventilated patients.  

PubMed Central

BACKGROUND: The hypothesis that gastric intramural pH (pHi) is predictive of outcome in haemodynamically stable, mechanically ventilated patients was tested in 25 patients on assisted mechanical ventilation for respiratory failure. METHODS: Simultaneous samples of arterial blood and gastric juice were obtained from patients on assist control, synchronised intermittent and pressure control ventilation during the first 48 hours of mechanical ventilation. Gastric pHi was calculated from the equation: pHi= 6.1 + log HCO3/(gastric PCO2 X 0.03). The outcome was survival or death due to respiratory or circulatory failure within 45 days of admission. RESULTS: Gastric pHi proved to be a better predictor of outcome than all presently utilised parameters. Although all patients included in this study were haemodynamically stable and were similar for all laboratory indices, the only variable capable of accurately predicting outcome was gastric pHi. Patients with a normal arterial pH but a gastric intramural pH of less than 7.25 had an observed mortality of 66%. Standard severity of illness scores grossly underestimated mortality rates. The sensitivity and specificity of a gastric pHi value of less than 7.25 in predicting death were 86% and 83%, respectively. A receiver operator curve for all variables exaggerates the superiority of gastric pHi as a predictor of outcome. CONCLUSION: Low gastric pHi, a marker of gastrointestinal ischaemia, may occur in the presence of normal haemodynamics and may be used to predict severity of illness and mortality accurately.

Mohsenifar, Z; Collier, J; Koerner, S K

1996-01-01

190

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

PubMed

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

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

2009-11-10

191

Pre-transplant mechanical ventilation and outcome in patients with cystic fibrosis  

Microsoft Academic Search

Background:Mechanical ventilation for ventilatory failure has been considered a relative contraindication to subsequent lung transplantation. The purpose of this study was to test the hypothesis that patients with cystic fibrosis (CF) who are intubated and mechanically ventilated before transplantation have poorer post-transplant outcomes than do patients who are not ventilated.

Raquel R Bartz; Robert B Love; Glen E Leverson; Lorna R Will; Debbie L Welter; Keith C Meyer

2003-01-01

192

Spatial distribution of sequential ventilation during mechanical ventilation of the uninjured lung: an argument for cyclical airway collapse and expansion  

PubMed Central

Background Ventilator-induced lung injury (VILI) is a recognized complication of mechanical ventilation. Although the specific mechanism by which mechanical ventilation causes lung injury remains an active area of study, the application of positive end expiratory pressure (PEEP) reduces its severity. We have previously reported that VILI is spatially heterogeneous with the most severe injury in the dorsal-caudal lung. This regional injury heterogeneity was abolished by the application of PEEP = 8 cm H2O. We hypothesized that the spatial distribution of lung injury correlates with areas in which cyclical airway collapse and recruitment occurs. Methods To test this hypothesis, rabbits were mechanically ventilated in the supine posture, and regional ventilation distribution was measured under four conditions: tidal volumes (VT) of 6 and 12 ml/kg with PEEP levels of 0 and 8 cm H2O. Results We found that relative ventilation was sequentially redistributed towards dorsal-caudal lung with increasing tidal volume. This sequential ventilation redistribution was abolished with the addition of PEEP. Conclusions These results suggest that cyclical airway collapse and recruitment is regionally heterogeneous and spatially correlated with areas most susceptible to VILI.

2010-01-01

193

Using ABGs to optimize mechanical ventilation: three case studies illustrate how arterial blood gas analyses can guide appropriate ventilator strategy.  

PubMed

This article focuses on translating arterial blood gas information into clinical benefits, with 3 case scenarios that focus on using arterial blood gases to manage mechanical ventilation. PMID:23759918

Lian, Jin Xiong

194

The impacts of balanced and exhaust mechanical ventilation on indoor radon  

SciTech Connect

Models for estimating radon entry rates, indoor radon concentrations, and ventilation rates in houses with a basement or a vented crawl-space and ventilated by natural infiltration, mechanical exhaust ventilation, or balanced mechanical ventilation are described. Simulations are performed for a range of soil and housing characteristics using hourly weather data for the heating season in Spokane, WA. For a house with a basement, we show that any ventilation technique should be acceptable when the soil permeability is less than approximately 10/sup -12/m/sup 2/. However, exhaust ventilation leads to substantially higher indoor radon concentrations than infiltration or balanced ventilation with the same average air exchange rate when the soil permeability is 10/sup -10/m/sup 2/ or greater. For houses with a crawl-space, indoor radon concentrations are lowest with balanced ventilation, intermediate with exhaust ventilation, and highest with infiltration.

Fisk, W.J.; Mowris, R.J.

1987-02-01

195

Chronic Obstructive Pulmonary Disease and Weaning of Difficult-to-Wean Patients from Mechanical Ventilation: Randomized Prospective Study  

PubMed Central

Aim To compare T-tube and pressure support ventilation (PSV) as two methods of mechanical ventilation weaning of patients with chronic obstructive pulmonary disease (COPD) after failed extubation. Methods A prospective randomized trial carried out at the multidisciplinary intensive care unit (ICU) over 2 years included 136 patients with COPD who required mechanical ventilation longer than 24 hours. The patients who could be weaned from mechanical ventilation were randomized to either a T-tube or PSV 2-hour spontaneous breathing trial. The patients in whom 2-hour trial was successful were extubated and excluded from further research. Patients in whom 2-hour trial failed had mechanical ventilation reinstated and underwent the same weaning procedure after 24 hours in case they fulfilled the weaning criteria. The weaning outcome was assessed according to the following parameters: extubation success, mechanical ventilation duration, time spent in ICU, reintubation rate, and mortality rate. Results Two-hour trial failed in 31 patients in T-tube and 32 patients in PSV group, of whom 17 and 23, respectively, were successfully extubated (P<0.001, ?2test). Mechanical ventilation lasted significantly longer in T-tube than in PSV group (187 hours vs 163 hours, respectively, P<0.001, Mann-Whitney test). Also, patients in T-tube group spent significantly more time in ICU than patients in PVS group (241 hours [interquartile range 211-268] vs 210 hours [211-268], respectively, P<0.001, Mann-Whitney test). Reintubation was required in 8 and 6 patients in T-tube and PVS group, respectively, and death occurred in 4 and 2 patients, respectively, during ICU stay. Conclusion Patients with COPD who failed the 2-hour spontaneous breathing trial had more favorable outcome when PVS rather than T-tube method was used for weaning from mechanical ventilation. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT00355732

Matic, Ivo; ?anic, Davorin; Majeric-Kogler, Visnja; Jurjevic, Matija; Mirkovic, Ivan; Mrzljak Vucinic, Natalija

2007-01-01

196

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

PubMed Central

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

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

2011-01-01

197

Heliumoxygen mixture does not improve gas exchange in mechanically ventilated children with bronchiolitis  

Microsoft Academic Search

STATEMENT OF FINDINGS: Varying concentrations of helium-oxygen (heliox) mixtures were evaluated in mechanically ventilated children with bronchiolitis. We hypothesized that, with an increase in the helium:oxygen ratio, and therefore a decrease in gas density, ventilation and oxygenation would improve in children with bronchiolitis. Ten patients, aged 1-9 months, were mechanically ventilated in synchronized intermittent mandatory ventilation (SIMV) mode with the

Matthew F Gross; Robert M Spear; Bradley M Peterson

2000-01-01

198

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

PubMed Central

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

2010-01-01

199

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

Microsoft Academic Search

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

Christine Foster; Leanne Monterosso

2012-01-01

200

Noninvasive ventilation in pediatric emergency care: a literature review and description of our experience.  

PubMed

Noninvasive ventilation (NIV) refers to a kind of mechanical respiratory support used in order to avoid the progression of respiratory failure to endotracheal intubation. Even though if this method is widely known in patients affected by chronic diseases and in children admitted in pediatric and neonatal intensive care units, few data are actually available on its use in intermediate care units. The present review focuses on the efficiency of NIV performed in children with acute respiratory failure due to different conditions. Moreover, the authors have described their experience with NIV in pediatric patients admitted to their acute and emergency room where NIV was started, well tolerated and led to an improvement of gas exchanges, decreasing the muscular respiratory work and endotracheal intubation avoidance in most of the patients. PMID:24138696

Vitaliti, Giovanna; Wenzel, Anette; Bellia, Francesco; Pavone, Piero; Falsaperla, Raffaele

2013-10-01

201

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

PubMed

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

Yamamoto, Makoto

2006-12-01

202

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

PubMed Central

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.

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

2013-01-01

203

The use of noninvasive ventilation outside the intensive care unit: a clinical case report.  

PubMed

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

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

2013-01-04

204

Multifocal atrial tachycardia as a prognostic indicator in patients with severe chronic obstructive pulmonary disease requiring mechanical ventilation.  

PubMed

The records of 121 patients admitted to the Medical Intensive Care Unit (MICU) of Chang Gung Memorial Hospital with severe chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation were reviewed retrospectively. Eighty-seven percent (20/23) of the patients with multifocal atrial tachycardia (MAT) expired during their ICU admission in contrast to 23.5% (23/98) of those without MAT. The only differences between these two groups were incidence of cor pulmonale, and right axis deviation, right bundle branch block, pulmonale P in electrocardiogram. MAT might be considered as a grave prognostic sign in patients with COPD severe enough to require mechanical ventilation. PMID:1933624

Tsai, Y H; Lee, C J; Lan, R S; Lee, C H

1991-09-01

205

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

PubMed

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

Kallet, Richard H

2013-06-01

206

Gentamicin Pharmacokinetics in Term Newborn Infants Receiving High-Frequency Oscillatory Ventilation or Conventional Mechanical Ventilation: a Case-controlled Study  

Microsoft Academic Search

OBJECTIVE: To compare the pharmacokinetics of gentamicin in infants receiving high-frequency oscillatory ventilation (HFOV) with infants receiving conventional mechanical ventilation.DESIGN: A case-controlled study design was used to compare the pharmacokinetics of gentamicin in critically ill infants receiving HFOV and conventional mechanical ventilation. Medical records of all full-term newborn infants (?37 weeks gestational age) who received either high-frequency mechanical ventilation or

Varsha Bhatt-Mehta; Steven M Donn

2003-01-01

207

Dexmedetomidine Versus Standard Therapy with Fentanyl for Sedation in Mechanically Ventilated Premature Neonates  

PubMed Central

OBJECTIVE To compare the efficacy and safety of dexmedetomidine and fentanyl for sedation in mechanically ventilated premature neonates. METHODS This was a retrospective, observational case-control study in a level III neonatal intensive care unit. Forty-eight premature neonates requiring mechanical ventilation were included. Patients received fentanyl (n=24) or dexmedetomidine (n=24) for pain or sedation. Each group also received fentanyl and lorazepam boluses as needed for agitation. The primary outcomes were efficacy and frequency of acute adverse events associated with each drug. Days on mechanical ventilation, stooling patterns, feeding tolerance, and neurologic outcomes were also evaluated. RESULTS There were no significant differences in baseline demographics between the dexmedetomidine and fentanyl patients. Patients in the dexmedetomidine group required less adjunctive sedation and had more days free of additional sedation in comparison to fentanyl (54.1% vs. 16.5%, p<0.0001). There were no differences in hemodynamic parameters between the 2 groups. Duration of mechanical ventilation was shorter in the dexmedetomidine group (14.4 vs. 28.4 days, p<0.001). Meconium passage (7.5 vs. 22.4 days, p<0.0002) and time from initiation to achievement of full enteral feeds (26.8 vs. 50.8 days, p<0.0001) were shorter in the dexmedetomidine group. Incidence of culture-positive sepsis was lower in the dexmedetomidine group (48% vs. 88%). The incidence of either severe intraventricular hemorrhage or periventricular leukomalacia was not statistically significantly reduced (2% vs. 7%). CONCLUSIONS Dexmedetomidine was safe and effective for sedation in the premature neonates included in this study. Prospective randomized-controlled trials are needed before routine use of dexmedetomidine can be recommended.

O'Mara, Keliana; Gal, Peter; Wimmer, John; Ransom, J. Laurence; Carlos, Rita Q.; Dimaguila, Mary Ann V.T.; Davanzo, Christie C.; Smith, McCrae

2012-01-01

208

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

PubMed

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

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

2011-04-02

209

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

PubMed

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

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

2013-05-18

210

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

NASA Astrophysics Data System (ADS)

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

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

2010-04-01

211

Are daily routine chest radiographs useful in critically ill, mechanically ventilated patients? A randomized study  

Microsoft Academic Search

Objective  Whether chest radiographs (CXRs) in mechanically ventilated patients should be routinely obtained or only when an abnormality\\u000a is anticipated remains debated. We aimed to compare the diagnostic, therapeutic and outcome efficacy of a restrictive prescription\\u000a of CXRs with that of a routine prescription, focusing on delayed diagnoses and treatments potentially related to the restrictive\\u000a prescription.\\u000a \\u000a \\u000a \\u000a Design  Randomized controlled trial.\\u000a \\u000a \\u000a \\u000a Setting  Intensive care unit of

Christophe Clec’h; Paul Simon; Aïcha Hamdi; Lilia Hamza; Philippe Karoubi; Jean-Philippe Fosse; Frédéric Gonzalez; François Vincent; Yves Cohen

2008-01-01

212

Noninvasive positive pressure ventilation in the acute care setting: where are we?  

Microsoft Academic Search

Noninvasive positive pressure ventilation (NPPV) is a technique used to deliver mechanical ventilation that is increasingly utilised in acute and chronic conditions. The present review examines the evidence supporting the use of NPPV in acute respiratory failure (ARF) due to different conditions. Strong evidence supports the use of NPPV for ARF to prevent endotracheal intubation (ETI), as well as to

N. Ambrosino; G. Vagheggini

2008-01-01

213

Open the lung with high-frequency oscillation ventilation or conventional mechanical ventilation? It may not matter!  

PubMed Central

The 'open lung' approach has been proposed as a reasonable ventilation strategy to mitigate ventilator-induced lung injury (VILI) and possibly reduce acute respiratory distress syndrome (ARDS)-related mortality. However, several randomized clinical trials have failed to show any significant clinical benefit of a ventilation strategy applying higher positive end-expiratory pressure (PEEP) and low tidal volume. Dispute regarding the optimal levels of PEEP in ARDS patients represents the substrate for a translational research effort from the bedside to the bench, driving animal studies aimed at elucidating which ventilation strategies reduce biotrauma, considered one of the most important driving forces of VILI and ARDS-related multi-organ failure and mortality. Inappropriate values for end-inspiratory or end-expiratory pressure have clear potential to damage a lung predisposed to VILI. In the heterogeneous environment of the ARDS 'baby lung', lung recruitment and the avoidance of tidal overstretch with high-frequency oscillation ventilation or conventional mechanical ventilation, guided by respiratory mechanics, appears to reduce VILI.

2010-01-01

214

Open the lung with high-frequency oscillation ventilation or conventional mechanical ventilation? It may not matter!  

PubMed

The 'open lung' approach has been proposed as a reasonable ventilation strategy to mitigate ventilator-induced lung injury (VILI) and possibly reduce acute respiratory distress syndrome (ARDS)-related mortality. However, several randomized clinical trials have failed to show any significant clinical benefit of a ventilation strategy applying higher positive end-expiratory pressure (PEEP) and low tidal volume.Dispute regarding the optimal levels of PEEP in ARDS patients represents the substrate for a translational research effort from the bedside to the bench, driving animal studies aimed at elucidating which ventilation strategies reduce biotrauma, considered one of the most important driving forces of VILI and ARDS-related multi-organ failure and mortality. Inappropriate values for end-inspiratory or end-expiratory pressure have clear potential to damage a lung predisposed to VILI. In the heterogeneous environment of the ARDS 'baby lung', lung recruitment and the avoidance of tidal overstretch with high-frequency oscillation ventilation or conventional mechanical ventilation, guided by respiratory mechanics, appears to reduce VILI. PMID:21156085

Fanelli, Vito; Mehta, Sangeeta

2010-12-09

215

Mechanical ventilation during acute lung injury: current recommendations and new concepts.  

PubMed

Despite a very large body of investigations, no effective pharmacological therapies have been found to cure acute lung injury. Hence, supportive care with mechanical ventilation remains the cornerstone of treatment. However, several experimental and clinical studies showed that mechanical ventilation, especially at high tidal volumes and pressures, can cause or aggravate ALI. Therefore, current clinical recommendations are developed with the aim of avoiding ventilator-induced lung injury (VILI) by limiting tidal volume and distending ventilatory pressure according to the results of the ARDS Network trial, which has been to date the only intervention that has showed success in decreasing mortality in patients with ALI/ARDS. In the past decade, a very large body of investigations has determined significant achievements on the pathophysiological knowledge of VILI. Therefore, new perspectives, which will be reviewed in this article, have been defined in terms of the efficiency and efficacy of recognizing, monitoring and treating VILI, which will eventually lead to further significant improvement of outcome in patients with ARDS. PMID:22104487

Del Sorbo, Lorenzo; Goffi, Alberto; Ranieri, V Marco

2011-11-21

216

Exhaled breath condensate pH in mechanically ventilated patients.  

PubMed

OBJECTIVES: In this prospective clinical trial we aimed to answer if spontaneous exhaled breath condensate (EBC) in the trap of the expiratory arm of the ventilator could replace EBC collected by coolant chamber standardized with Argon as an inert gas. Second, if EBC pH could predict ventilator associated pneumonia (VAP) and mortality. PATIENTS: We included 34 critically ill patients (males=26), aged=54.85±19.86 (mean±SD) yrs, that required mechanical ventilation due to non-pulmonary direct cause (APACHE II score=23.58±14.7; PaO(2)/FiO(2)=240.00±98.29). SETTING: ICU with 9 beds from a regional teaching hospital. INTERVENTION AND RESULTS: The patients were followed up until development of VAP, successful weaning or death. There were significant differences between mean EBC pH from the 4 procedures with the exception of spontaneous EBC de-aerated with Argon (n=79; 6.74±0.28) and coolant chamber deaerated with Argon (n=79; 6.70±0.36; p=NS by Tukey's Multiple Comparison Test). However, none of the procedures were extrapolated between each other according to Bland & Altman method. The mean EBC pH from the trap without Argon was 6.50±0.28. From the total of 34 patients, 22 survived and were discharged and 12 patients died in the ICU. CONCLUSION: Spontaneous EBC pH could not be extrapolated to EBC pH from coolant chamber and it did not change in subjects who dead, neither subject with VAP in comparison with baseline data. The lack of other biomarker in EBC and the lack of a control group determinate the need for further studies in this setting. PMID:23158868

Nannini, L J; Quintana, R; Bagilet, D H; Druetta, M; Ramírez, M; Nieto, R; Guelman Greta, G

2012-11-14

217

Acute exacerbations in patients with COPD: predictors of need for mechanical ventilation  

Microsoft Academic Search

ABSTRACT: Predictive factors in mechanically-ventilated patients with acute exac- erbations of chronic obstructive pulmonary disease (COPD) have been extensively studied but not in spontaneously breathing patients. The aim of this retrospective study was to evaluate the contribution of parameters of respiratory mechanics, clin- ical and nutritional status in predicting the need for mechanical ventilation (MV) inCOPD patients treated with medical

M. Vitacca; E. Clini; R. Porta; K. Foglio; N. Ambrosino

1996-01-01

218

Hospital Readmissions for Newly Discharged Pediatric Home Mechanical Ventilation Patients  

PubMed Central

Summary Background Ventilator-dependent children have complex chronic conditions that put them at risk for acute illness and repeated hospitalizations. Objectives To determine the 12-month incidence of and risk factors for non-elective readmission in children with chronic respiratory failure (CRF) after initiation on home mechanical ventilation (HMV) via tracheostomy. Methods A retrospective cohort study of 109 HMV patients initiated and followed at an university-affiliated children’s hospital between 2003 and 2009. Patient characteristics are presented using descriptive statistics; generalized estimated equations are used to estimate adjusted odds ratios of select predictor variables for readmission. Results The 12-month incidence of non-elective readmission was 40%. Close to half of these readmissions occurred within the first 3 months post-index discharge. Pneumonia and tracheitis were the most common reasons for readmission; 64% were pulmonary- or tracheostomy-related. Most demographic and clinical patient characteristics were not statistically associated with non-elective readmissions. Although, a change in the child’s management within 7 days before discharge was associated readmissions shortly after index discharge. Conclusion Non-elective readmissions of newly initiated pediatric HMV patients were common and likely multifactorial. Many of these readmissions were airway-related, and some may have been potentially preventable.

Kun, Sheila S.; Edwards, Jeffrey D.; Davidson Ward, Sally L.; Keens, Thomas G.

2013-01-01

219

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

Microsoft Academic Search

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

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

2000-01-01

220

SIVA: A Hybrid Knowledge-and-Model-Based Advisory System for Intensive Care Ventilators  

Microsoft Academic Search

The Sheffield Intelligent Ventilator Advisor is a hybrid knowledge-and-model-based advisory system designed for intensive care ventilator management. It consists of a top-level fuzzy rule-based module to give the qualitative component of the advice, and a lower-level model-based module to give the quantitative component of the advice. It is structured to offer adaptive patient-specific decision support. It can be operated in

Hoi-Fei Kwok; Derek A. Linkens; Mahdi Mahfouf; Gary H. Mills

2004-01-01

221

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

PubMed Central

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

2011-01-01

222

[Microbiological monitoring of ventilator-associated pneumonia in an intensive care unit].  

PubMed

Ventilator-associated pneumonia is the most frequent nosocomial infection in intensive care units (ICU) and causes high mortality. Approximately 50% of all antibiotics in ICUs are administered for the treatment of respiratory tract infections. Prompt and appropriate antibiotic treatment is paramount for a favourable clinical outcome as any delay in diagnosis and treatment will result in increased mortality. Therefore it is common practice in many ICUs to perform routine surveillance cultures of lower respiratory tract samples so that when pneumonia occurs, the empiric antibiotic regime can be based on the pathogens previously identified in surveillance cultures. This article highlights the advantages and disadvantages of routine surveillance cultures and provides a critical review of the recent literature. The majority of published studies favour surveillance cultures, because these can often predict the pathogens responsible for pneumonia and lead to timely administration of adequate antimicrobial therapy. Although the rationale behind this approach appears evident, the impact of surveillance cultures on clinical outcome as well as their cost effectiveness remains to be determined. Therefore, at this point, national and international guidelines do not recommend the routine use of surveillance cultures in mechanically ventilated patients but stress the need for larger, well designed clinical studies. PMID:20104440

Joost, I; Lange, C; Seifert, H

2010-01-26

223

Use of mechanical ventilation and renal replacement therapy in critically ill hematopoietic stem cell transplant recipients.  

PubMed

Hematopoietic stem cell transplantation (HSCT) is a treatment option for both malignant and nonmalignant disorders. HSCT patients remain at high risk for multiorgan failure, with previous studies noting mortality rates exceeding 90% when mechanical ventilation (MV) is required. We propose that advancements in critical care management and HSCT practices have improved these dismal outcomes. We performed a retrospective review of admissions to our bone marrow transplant unit between 2006 and 2010. All HSCT recipients requiring admission to the bone marrow transplant unit who received MV or renal replacement therapy (RRT) were evaluated. A total of 68 patients required MV. Twenty patients required RRT, all of whom required MV. Fifty-nine of the 68 ventilated patients died, for an overall mortality rate of 86.8%. The presence of renal failure and concomitant respiratory or liver dysfunction at the time of intubation was associated with a mortality rate of 100%. High mortality persists in our HSCT population requiring artificial support despite overall advances in critical care and HSCT practices. Critical care triage and management decisions in this high-risk population remain challenging. PMID:23025989

Gilbert, Christopher; Vasu, Tajender S; Baram, Michael

2012-09-28

224

Oxygen cost of breathing. Changes dependent upon mode of mechanical ventilation.  

PubMed

We describe a patient with respiratory failure who demonstrated marked increases in O2 consumption (VO2) when breathing with synchronized intermittent mandatory mechanical ventilation (SIMV). When the mode of ventilation was changed to facilitate inspiratory gas flow (pressure-support) during spontaneous breathing, O2 consumption decreased 27 percent. Several important factors contributing to the increased O2 cost of breathing in patients requiring mechanical ventilation are reviewed, including the high internal resistance of demand-flow SIMV systems. PMID:3880691

Kanak, R; Fahey, P J; Vanderwarf, C

1985-01-01

225

Bench-to-bedside review: Adjuncts to mechanical ventilation in patients with acute lung injury  

Microsoft Academic Search

Mechanical ventilation is indispensable for the survival of patients with acute lung injury and acute respiratory distress syndrome. However, excessive tidal volumes and inadequate lung recruitment may contribute to mortality by causing ventilator-induced lung injury. This bench-to-bedside review presents the scientific rationale for using adjuncts to mechanical ventilation aimed at optimizing lung recruitment and preventing the deleterious consequences of reduced

Jean-Jacques Rouby; Qin Lu

2005-01-01

226

Stress ulcer prophylaxis in mechanically ventilated patients: integrating evidence and judgment using a decision analysis  

Microsoft Academic Search

Objective  Stress ulcer prophylaxis with a histamine-2 receptor antagonist can reduce the risk of gastrointestinal bleeding in mechanically ventilated patients but may also increase the risk of ventilator-associated pneumonia. We sought to clarify the tradeoffs involved in selecting a prophylactic strategy.Design  Decision analysis.Patients and participants  A decision tree was constructed for a hypothetical cohort of patients receiving mechanical ventilation for an expected duration of longer than 48?h,

Jeremy M. Kahn; Jason N; Gordon D. Rubenfeld

2006-01-01

227

Improvement in Aerosol Delivery with HeliumOxygen Mixtures during Mechanical Ventilation  

Microsoft Academic Search

In mechanically ventilated patients with airway obstruction, he- lium-oxygen (He-O 2 ) mixtures reduce airway resistance and im- prove ventilation, but their influence on aerosol delivery is un- known. Accordingly, we determined the effect of various He-O 2 mixtures on albuterol delivery from metered-dose inhalers (MDIs) and jet nebulizers in an in vitro model of mechanical ventilation. Albuterol delivery from

MARK L. GOODE; JAMES B. FINK; RAJIV DHAND; MARTIN J. TOBIN

228

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

PubMed

The complete equation of motion for a single compartment model (SCM) includes an inertance term to describe pressure changes in phase with acceleration, as well as terms for resistance and elastance. Inertance has traditionally been excluded from the model when measuring respiratory mechanics at conventional ventilatory frequencies in mature respiratory systems. However, this omission has been questioned recently for measurements of respiratory mechanics in intubated infants where higher ventilation frequencies and smaller tracheal tubes are the norm. We investigated 1) the significance of inertance in an immature respiratory system during mechanical ventilation, and 2) the effect of omitting it from the model on estimates of respiratory mechanics. Six anesthetised, paralysed and mechanically ventilated puppies (2.6-3.9 kg) were studied. A SCM, including an inertance term was fitted to measurements of flow and airway opening (P(AO)) or transpulmonary (P(TP)) pressure using multiple linear regression to estimate respiratory system and lung resistance (R(RS), R(L)), elastance (E(RS), E(L)) and inertance (I(RS), I(L)) respectively, at various ventilation frequencies (0.2-2 Hz). Data obtained at each ventilation frequency were also fitted with a similar model without the inertance term. Inertance contributed significantly to the model at frequencies greater than approximately 0.3-0.5 Hz (20-30 breaths per minute), with I(RS) dominated by the lung. The importance of including the inertance term in the model increased as ventilation frequency increased. Exclusion of inertance from the model led to underestimation of E(RS) and E(L), but no errors in estimates of R(RS) or R(L). The errors increased with ventilation frequency to approximately 10-20% for E(RS) and approximately 10-40% for E(L) at 2 Hz. While inertance contributed significantly to the SCM at ventilation frequencies typically required to maintain normal gas exchange in puppies, the errors from excluding this term were small: <3% for E(RS) and <9% for E(L). PMID:10423313

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

1999-08-01

229

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

NASA Astrophysics Data System (ADS)

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.

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

2012-02-01

230

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

PubMed Central

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

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

2013-01-01

231

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

PubMed Central

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

2012-01-01

232

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

SciTech Connect

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

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

2011-11-08

233

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

PubMed Central

Background Noninvasive mechanical ventilation (NIV) is a front-line therapy for the management of acute respiratory failure (ARF) in the intensive care units. However, the data on factors and outcomes associated with the use of NIV in ARF patients is lacking. Therefore, we aimed to determine the utilization of NIV for ARF in a population-based study. Methods We conducted a populated-based retrospective cohort study, where in all consecutively admitted adults (?18?years) with ARF from Olmsted County, Rochester, MN, at the Mayo Clinic medical and surgical ICUs, during 2006 were included. Patients without research authorization or on chronic NIV use for sleep apnea were excluded. Results Out of 1461 Olmsted County adult residents admitted to the ICUs in 2006, 364 patients developed ARF, of which 146 patients were initiated on NIV. The median age in years was 75 (interquartile range, 60–84), 48% females and 88.7% Caucasians. Eighteen patients (12%) were on Continuous Positive Airway Pressure (CPAP) mode and 128 (88%) were on noninvasive intermittent positive-pressure ventilation (NIPPV) mode. Forty-six (10%) ARF patients were put on NIV for palliative strategy to alleviate dyspnea. Seventy-six ARF patients without treatment limitation were given a trial of NIV and 49 patients succeeded, while 27 had to be intubated. Mortality was similar between the patients initially supported with NIV versus invasive mechanical ventilation (33% vs 22%, P=0.289). In the multivariate analysis, the development of acute respiratory distress syndrome (ARDS) and higher APACHE III scores were associated with the failure of initial NIV treatment. Conclusions Our results have important implications for a future planning of NIV in a suburban US community with high access to critical care services. The higher APACHE III scores and the development of ARDS are associated with the failure of initial NIV treatment.

2013-01-01

234

Validation of a Behavioral Pain Scale in Critically Ill, Sedated, and Mechanically Ventilated Patients  

Microsoft Academic Search

Assessing pain in critically ill patients, particularly in nonverbal patients, is a great challenge. In this study, we validated a behavioral pain scale (BPS) in critically ill, sedated, and mechanically ventilated patients. The BPS score was the sum of 3 subscales that have a range score of 1-4: facial expression, upper limb movements, and compliance with mechanical ventilation. Two as-

Amine Ali Zeggwagh; Khalid Abidi; Redouane Abouqal

2005-01-01

235

Inadequate humidification of respiratory gases during mechanical ventilation of the newborn.  

PubMed

Proximal airway humidity was measured during mechanical ventilation in 14 infants using an electronic hygrometer. Values below recommended minimum humidity of adult inspired gas were recorded on 251 of 396 occasions. Inadequate humidification, largely due to inadequate proximal airway temperature, is commoner than recognised in infants receiving mechanical ventilation. PMID:3740912

Tarnow-Mordi, W O; Sutton, P; Wilkinson, A R

1986-07-01

236

New perspectives on the evolution of lung ventilation mechanisms in vertebrates  

Microsoft Academic Search

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

E. L. Brainerd

1999-01-01

237

Outcome prediction in mechanically ventilated neurologic patients by junior neurointensivists(CME)  

PubMed Central

Objective: Physician prediction of outcome in critically ill neurologic patients impacts treatment decisions and goals of care. In this observational study, we prospectively compared predictions by neurointensivists to patient outcomes at 6 months. Methods: Consecutive neurologic patients requiring mechanical ventilation for 72 hours or more were enrolled. The attending neurointensivist was asked to predict 6-month 1) functional outcome (modified Rankin scale [mRS]), 2) quality of life (QOL), and 3) whether supportive care should be withdrawn. Six-month functional outcome was determined by telephone interviews and dichotomized to good (mRS 0–3) and poor outcome (mRS 4–6). Results: Of 187 eligible patients, 144 were enrolled. Neurointensivists correctly predicted 6-month functional outcome in 80% (95% confidence interval [CI], 72%–86%) of patients. Accuracy for a predicted good outcome was 63% (95% CI, 50%–74%) and for poor outcome 94% (95% CI, 85%–98%). Excluding patients who had life support withdrawn, accuracy for good outcome was 73% (95% CI, 60%–84%) and for poor outcome 87% (95% CI, 74%–94%). Accuracy for exact agreement between neurointensivists' mRS predictions and actual 6-month mRS was only 43% (95% CI, 35%–52%). Predicted accuracy for QOL was 58% (95% CI, 39%–74%) for good/excellent and 67% (95% CI, 46%–83%) for poor/fair. Of 27 patients for whom withdrawal of care was recommended, 1 patient survived in a vegetative state. Conclusions: Prediction of long-term functional outcomes in critically ill neurologic patients is challenging. Our neurointensivists were more accurate in predicting poor outcome than good outcome in patients requiring mechanical ventilation ?72 hours. GLOSSARY BI = Barthel index; CI = confidence interval; E-GOS = extended Glasgow outcome scale score; ICU = intensive care unit; IQR = interquartile range; mRS = modified Rankin scale; QOL = quality of life.

Finley Caulfield, A.; Gabler, L.; Lansberg, M.G.; Eyngorn, I.; Mlynash, M.; Buckwalter, M.S.; Venkatasubramanian, C.; Wijman, C.A.C.

2010-01-01

238

Outcome of Pediatric Hematopoietic Stem Cell Transplant Recipients Requiring Mechanical Ventilation.  

PubMed

Purpose: To assess the risk factors for intensive care unit admission among children receiving hematopoietic stem cell transplantation (HSCT) and to test the hypothesis that multiple organ failure (MOF) increases the odds of death among HSCT patients who receive mechanical ventilation (MV). Methods: The chart of all consecutive HSCTs at Seattle Children's Hospital and pediatric HSCT patients admitted to the pediatric critical care unit of a tertiary care pediatric hospital from January 2000 to September 2006 were reviewed retrospectively. Results: Charts of 266 HSCT patients were reviewed. Nonmalignant disease compared to hematologic malignancy, acute graft versus host disease grades III and IV, and second transplant increased the odds of pediatric intensive care unit admission. Among patients receiving MV for >24 hours, 9 (25%) survived for 6 months, while 8 patients (22%) were long-term survivors with a median follow-up time of 3.6 years, a significant improvement compared to a long-term survival of 7% (odds ratio 0.25, 95% confidence intervals: 0.09-0.72, P = .01) reported in a previously published cohort of pediatric HSCT patients at the same institution from 1983 to 1996. Cardiovascular failure, duration of MV for greater than 1 week, and prolonged receipt of continuous renal replacement therapy (CRRT) increased the risk of mortality. Conclusions: Six-month survival of pediatric HSCT patients was 25% and the odds of death were increased by cardiovascular failure but not by MOF. Receipt of mechanical support (ventilation, CRRT) or cardiovascular support (inotropic agents) decreased the likelihood of long-term survival. PMID:22904208

Aspesberro, Francois; Guthrie, Katherine A; Woolfrey, Ann E; Brogan, Thomas V; Roberts, Joan S

2012-08-17

239

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

PubMed

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

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

2010-08-01

240

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

PubMed Central

Introduction Mechanical ventilation (MV) with high tidal volumes may induce or aggravate lung injury in critical ill patients. We compared the effects of a protective versus a conventional ventilatory strategy, on systemic and lung production of tumor necrosis factor-? (TNF-?) and interleukin-8 (IL-8) in patients without lung disease. Methods Patients without lung disease and submitted to mechanical ventilation admitted to one trauma and one general adult intensive care unit of two different university hospitals were enrolled in a prospective randomized-control study. Patients were randomized to receive MV either with tidal volume (VT) of 10 to 12 ml/kg predicted body weight (high VT group) (n = 10) or with VT of 5 to 7 ml/kg predicted body weight (low VT group) (n = 10) with an oxygen inspiratory fraction (FIO2) enough to keep arterial oxygen saturation >90% with positive end-expiratory pressure (PEEP) of 5 cmH2O during 12 hours after admission to the study. TNF-? and IL-8 concentrations were measured in the serum and in the bronchoalveolar lavage fluid (BALF) at admission and after 12 hours of study observation time. Results Twenty patients were enrolled and analyzed. At admission or after 12 hours there were no differences in serum TNF-? and IL-8 between the two groups. While initial analysis did not reveal significant differences, standardization against urea of logarithmic transformed data revealed that TNF-? and IL-8 levels in bronchoalveolar lavage (BAL) fluid were stable in the low VT group but increased in the high VT group (P = 0.04 and P = 0.03). After 12 hours, BALF TNF-? (P = 0.03) and BALF IL-8 concentrations (P = 0.03) were higher in the high VT group than in the low VT group. Conclusions The use of lower tidal volumes may limit pulmonary inflammation in mechanically ventilated patients even without lung injury. Trial Registration Clinical Trial registration: NCT00935896

2010-01-01

241

Oxygen Consumption with Mechanical Ventilation in a Field Anesthesia Machine  

Microsoft Academic Search

Field anesthesia machines (FAM) with gas-powered ventilators have been developed for remote locations that may not have a central supply of oxygen. These ventilators may rapidly deplete oxygen cylinders, espe- cially in patients with decreased pulmonary compli- ance. Our goal in this study was to determine oxygen consumption rates with a contemporary FAM in mod- els of high (HC) and

Dale F. Szpisjak; Charles L. Lamb; Kenneth D. Klions

2005-01-01

242

Brief mechanical ventilation impacts airway cartilage properties in neonatal lambs.  

PubMed

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

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

2011-12-13

243

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

Microsoft Academic Search

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

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

1992-01-01

244

Analysis of Risk Factors for Ventilator-Associated Pneumonia in a Multidisciplinary Intensive Care Unit  

Microsoft Academic Search

A prospective study was conducted to determine the incidence, risk factors and pathogens of ventilator-associated pneumonia\\u000a (VAP) in 198 patients requiring mechanical ventilation for more than 48 hours. VAP occurred in 67 (33.8%) patients. Risk factors\\u000a associated with VAP were admission APACHE II score >20 (odds ratio [OR] 4.77, 95% confidence interval [CI] 2.04–11.27, P10 days (OR 44.4, 95% CI

D. C. Sofianou; T. C. Constandinidis; M. Yannacou; H. Anastasiou; E. Sofianos

2000-01-01

245

Noninvasive positive pressure ventilation in critical and palliative care settings: Understanding the goals of therapy  

Microsoft Academic Search

Objective: Although noninvasive positive pressure ventilation (NPPV) is a widely accepted treatment for some patients with acute respiratory failure, the use of NPPV in patients who have decided to forego endotracheal intubation is controversial. There- fore, the Society of Critical Care Medicine charged this Task Force with developing an approach for considering use of NPPV for patients who choose to

J. Randall Curtis; Deborah J. Cook; Tasnim Sinuff; Douglas B. White; Nicholas Hill; Sean P. Keenan; Joshua O. Benditt; Robert Kacmarek; Karin T. Kirchhoff; Mitchell M. Levy

2007-01-01

246

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

Microsoft Academic Search

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

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

2009-01-01

247

Recombinant Human Deoxyribonuclease Improves Atelectasis in Mechanically Ventilated Children with Cardiac Disease  

PubMed Central

Objective To investigate if a mucolytic agent, recombinant human deoxyribonuclease (rhDNase), improves atelectasis in children with cardiac illness requiring mechanical ventilation. Design A retrospective cohort study on consecutive patients receiving short-term (? 14 days) rhDNase therapy for atelectasis in the cardiac intensive care unit from January 2005 through February 2007 was carried out. Data relating to patient characteristics, gas exchange, ventilatory parameters and chest radiographs was collected and analyzed. The effectiveness of rhDNase therapy in the presence of neutrophils and/ or bacteria in the pre-rhDNase therapy tracheal aspirates was also investigated. Results rhDNase was effective in significantly improving established atelectasis without any major changes in gas exchange and ventilatory parameters. Therapeutic effect of rhDNase is most effective in ameliorating atelectasis in the lungs within 10 doses. rhDNase was more effective in improving chest radiographic atelectasis score in patients who had > moderate amounts PMN (p value= 0.0008), or bacteria (p value=0.007) or both (p value =0.004) present in their pre-rhDNase therapy trachea aspirate. No adverse effects were seen with rhDNase administration in the study cohort. Conclusions rhDNase can be safely and effectively used to improve atelectasis in mechanically ventilated children with cardiac disease especially in the presence of bacteria and/ or moderate amounts of PMN in the pre-rhDNase therapy tracheal aspirate.

Prodhan, P; Greenberg, B; Bhutta, AT; Hyde, C; Vankatesan, A; Imamura, M; Jaquiss, RDB; Dyamenahalli, U

2010-01-01

248

Ventilator-Associated Pneumonia: A Review  

Microsoft Academic Search

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

Kimberly A. Davis

2006-01-01

249

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

NASA Astrophysics Data System (ADS)

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

Vanrhein, Timothy; Banerjee, Arindam

2010-11-01

250

Tissue strains induced in airways due to mechanical ventilation.  

PubMed

Better understanding of the stress/strain environment in airway tissues is very important in order to avoid lung injuries for patients undergoing mechanical ventilation for treatment of respiratory problems. Airway tissue strains responsible for stressing the lung's fiber network and rupturing the lung due to compliant airways are very difficult to measure experimentally. A computational model that incorporates the heterogeneity of the airways was developed to study the effects of airway tissue material properties on strain distributions within each layer of the airway wall. The geometry and boundary conditions of the tissue strain analysis were obtained from the organ-level analysis model. Two sets of airway tissue properties (heterogeneous and homogeneous) were considered in order to estimate the strain levels induced within the tissue. The simulation results showed that the homogeneous model overestimated the maximum strain in the mucosa layer and underestimated the maximum strain in the smooth muscle and cartilage layers. The results of strain levels obtained from the tissue analysis are very important because these strains at the cellular-level can create inflammatory responses, thus damaging the airway tissues. PMID:21608415

Pidaparti, Ramana M; Koombua, Kittisak

2011-06-01

251

Stress ulcer prophylaxis in mechanically ventilated patients: integrating evidence and judgment using a decision analysis  

Microsoft Academic Search

Objective: Stress ulcer pro- phylaxis with a histamine-2 receptor antagonist can reduce the risk of gas- trointestinal bleeding in mechanically ventilated patients but may also in- crease the risk of ventilator-associated pneumonia. We sought to clarify the tradeoffs involved in selecting a pro- phylactic strategy. Design: Decision analysis. Patients and participants: A decision tree was constructed for a hypothetical cohort

J. M. Kahn; G. D. Rubenfeld

2006-01-01

252

Noninvasive mechanical ventilation in a patient with respiratory failure after hematopoietic progenitor transplantation  

Microsoft Academic Search

Respiratory failure requiring orotracheal intubation (OTI) and mechanical ventilation (MV) is almost always a fatal complication in patients who undergo hematopoietic progenitor transplantation (HPT). We present the case of a woman who suffered respiratory failure with bilateral infiltrates on a chest X-ray taken on day +14 following autologous bone marrow transplantation. We managed the patient satisfactorily with noninvasive ventilation, avoiding

D Marín; E González-Barca; E Domingo; J Berlanga; A Grañena

1998-01-01

253

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

Microsoft Academic Search

Background: Effective noninvasive mechanical ventilation (NIV) requires a patient to be comfortable and in synch with the ventilator, for which sedation is usually needed. Choice of the proper drug for sedation can lead to improved clinical outcomes.Objective: The aim of this study was to compare the effectiveness of dexmedetomidine and midazolam on sedation and their effects on hemodynamics and gas

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

2010-01-01

254

Simulation on energy use for mechanical ventilation and air-conditioning (MVAC) systems in train compartments  

Microsoft Academic Search

Unlike the conventional automotive, modem railway trains are designed with non-openable windows; and a mechanical ventilation and air-conditioning (MVAC) system is installed in each train compartment for better indoor air quality as well as to provide a thermally comfortable environment. The ventilation rate is no doubt a critical element in the design of a MVAC system, especially in Hong Kong

W. K. Chow; Philip C. H. Yu

2000-01-01

255

Pulmonary Transit of Sonicated Albumin Microbubbles During Controlled Mechanical Ventilation: A Transthoracic Echocardiographic Study  

Microsoft Academic Search

Air-filled human serum albumin microspheres are ul- trasonic contrast tracers that pass through the right ven- tricle, traverse the lungs, and effectively opacify the left heart chambers in spontaneously breathing patients. In this clinical study, we assessed whether they also do so in anesthetized patients during and after mechanical ventilation. In 20 anesthetized patients undergoing in- termittent positive pressure ventilation

KENNETH J. TUMAN; Federico Bilotta; Laura Fiorani; Eugenio Lendaro; Sergio Picardo; Italia La Rosa; Giovanni Rosa; Francesco Fedele

256

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

Microsoft Academic Search

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

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

2002-01-01

257

Respiratory Muscle Dysfunction: A Multicausal Entity in the Critically Ill Patient Undergoing Mechanical Ventilation.  

PubMed

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

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

2013-05-10

258

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

PubMed Central

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.

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

259

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

Microsoft Academic Search

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

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

2011-01-01

260

A microprocessor based feedback controller for mechanical ventilation  

Microsoft Academic Search

A microcomputer feedback system has been developed which adjusts the inspired minute volume of a ventilator based on the patient's\\u000a end-tidal CO2 concentration. The feedback controlled ventilator was evaluated in 6 dogs (18–20 kg). Arterial PCO2 was monitored continuously while end-tidal CO2 concentration was controlled by the microcomputer system and the following perturbations introduced: [1] NaHCO3 was infused IV, [2

Kevin B. Ohlson; Dwayne R. Westenskow; William S. Jordan

1982-01-01

261

Interagency Home Care Model for Ventilator Assisted Individuals in Louisiana.  

National Technical Information Service (NTIS)

The project developed a model for care and services and a services resource network and coordinated education and training resources. The project worked with over 40 families, published a book, Homeward Bound: Resources for Living at Home with a Chronical...

A. J. Gates

1988-01-01

262

Champ 5. Procédures de sécurisation au cours de la ventilation mécanique invasive  

Microsoft Academic Search

Invasive or endotracheal mechanical ventilation can lead to numerous complications likely to burden morbidity and mortality of patients in the intensive care unit. Various safety practices for mechanical ventilation may involve intubation, the mechanical ventilation period, weaning and extubation, the use of tracheostomy as well as non-invasive ventilation. The main objective of safety practices described in this chapter is to

C. Girault; I. Auriant; S. Jaber

2008-01-01

263

Applied respiratory physiology: use of ventilator waveforms and mechanics in the management of critically ill patients.  

PubMed

Graphical waveforms have become ubiquitous in clinical care. Using and understanding pictures and symbols is a daily activity. Humans are neurologically equipped to understand symbolic information and have done so for millennia. Cave drawings are examples of using images to convey information. The same approach used in understanding "art" is needed to use ventilator waveforms effectively. Didactic study, frequent viewing, and understanding of the background of the artist (artistic context) are needed to fully appreciate art. Using waveforms to care for patients requires understanding of the clinical context under which they are obtained, factors that affect their creation, and artifacts that interfere with interpretation. This article summarizes the presentation and discussions at this Journal Conference on ventilator waveforms in relation to lung and chest wall compliance, resistance, carbon dioxide kinetics, hemodynamics, specific modes of ventilation, specific lung diseases, and ventilator-weaning. PMID:15691397

Durbin, Charles G

2005-02-01

264

Comparison between tube compensation and pressure support ventilation techniques on respiratory mechanics.  

PubMed

In the intubated patient, the presence of an endotracheal tube increases the work of breathing during spontaneous breathing. The tube compensation technique was developed as a new ventilator mode that can compensate for that additional the work of breathing. We investigated the respiratory parameters during the pressure support ventilation 0, 5, 10 cmH2O and tube compensation 100% modes of the Puritan Bennett 840 ventilator in ten postoperative patients who had undergone radical surgery for oesophageal cancer. Measurements were performed just before extubation. The tidal volume, respiratory rate and other respiratory parameters were measured with a Ventrak respiratory monitor, and the duty ratio, mean inspiratory flow, and rapid shallow breathing index were calculated. In particular, we performed a comparison between pressure support ventilation 5 cmH2O and tube compensation 100%, because pressure support ventilation 5 cmH2O is the usual ventilating mode before the extubation in our intensive care unit. The tidal volume of pressure support ventilation 10 cmH2O was significantly larger and the respiratory rate was significantly lower than the other three modes. There was no significant difference in the minute volume, tidal volume, and respiratory rate between pressure support ventilation 5 cmH2O and tube compensation 100%. The duty ratio of pressure support ventilation 10 cmH2O was significantly smaller than the other three modes. There was no significant difference in the duty ratio and rapid shallow breathing index between pressure support ventilation 5 cmH2O and tube compensation 100%. It was concluded that the assist levels of pressure support ventilation 5 cmH2O and tube compensation 100% were almost equal for clinical purposes. PMID:12973959

Sasaki, C; Hoshi, K; Wagatsuma, T; Ejima, Y; Hasegawa, R; Matsukawa, S

2003-08-01

265

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

Microsoft Academic Search

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

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

1996-01-01

266

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

PubMed

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

Tracy, Mary Fran; Chlan, Linda

2011-06-01

267

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

PubMed Central

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

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

2013-01-01

268

Model-based PEEP optimisation in mechanical ventilation  

PubMed Central

Background Acute Respiratory Distress Syndrome (ARDS) patients require mechanical ventilation (MV) for breathing support. Patient-specific PEEP is encouraged for treating different patients but there is no well established method in optimal PEEP selection. Methods A study of 10 patients diagnosed with ALI/ARDS whom underwent recruitment manoeuvre is carried out. Airway pressure and flow data are used to identify patient-specific constant lung elastance (Elung) and time-variant dynamic lung elastance (Edrs) at each PEEP level (increments of 5cmH2O), for a single compartment linear lung model using integral-based methods. Optimal PEEP is estimated using Elung versus PEEP, Edrs-Pressure curve and Edrs Area at minimum elastance (maximum compliance) and the inflection of the curves (diminishing return). Results are compared to clinically selected PEEP values. The trials and use of the data were approved by the New Zealand South Island Regional Ethics Committee. Results Median absolute percentage fitting error to the data when estimating time-variant Edrs is 0.9% (IQR = 0.5-2.4) and 5.6% [IQR: 1.8-11.3] when estimating constant Elung. Both Elung and Edrs decrease with PEEP to a minimum, before rising, and indicating potential over-inflation. Median Edrs over all patients across all PEEP values was 32.2 cmH2O/l [IQR: 26.1-46.6], reflecting the heterogeneity of ALI/ARDS patients, and their response to PEEP, that complicates standard approaches to PEEP selection. All Edrs-Pressure curves have a clear inflection point before minimum Edrs, making PEEP selection straightforward. Model-based selected PEEP using the proposed metrics were higher than clinically selected values in 7/10 cases. Conclusion Continuous monitoring of the patient-specific Elung and Edrs and minimally invasive PEEP titration provide a unique, patient-specific and physiologically relevant metric to optimize PEEP selection with minimal disruption of MV therapy.

2011-01-01

269

A microprocessor based feedback controller for mechanical ventilation.  

PubMed

A microcomputer feedback system has been developed which adjusts the inspired minute volume of a ventilator based on the patient's end-tidal CO2 concentration. The feedback controlled ventilator was evaluated in 6 dogs (18-20 kg). Arterial PCO2 was monitored continuously while end-tidal CO2 concentration was controlled by the micro-computer system and the following perturbations introduced: [1] NaHCO3 was infused IV, [2] a pulmonary artery was occluded, [3] one lumen of a double lumen endobronchial tube was occluded, and [4] an air embolism was given. The end-tidal PCO2 controller kept PaCO2 within 1.2 mm Hg of the desired value when CO2 production increased by as much as 44%. Changing the ventilation/perfusion ratios caused differences as large as 22 mm Hg between the arterial and end-tidal PCO2 and the controller was not effective in keeping PaCO2 at the desired level. Closed loop control of ventilation based on end-tidal PCO2 measurements successfully compensated for increases in CO2 production keeping PaCO2 constant. The controller did not, however, keep PaCO2 at the desired level when significant changes occurred in the distribution of blood flow to ventilation. PMID:6819792

Ohlson, K B; Westenskow, D R; Jordan, W S

1982-01-01

270

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. ...

271

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 ...

272

Automatic control of arterial carbon dioxide tension in mechanically ventilated patients  

Microsoft Academic Search

This paper presents a method of controlling the arte- rial carbon dioxide tension of patients receiving mechanical venti- lation. Controlling of the CO tension is achieved by regulating the ventilator initiated breath frequency and also volume per breath.

Tyrone Fernando; John Cade; John Packer

2002-01-01

273

Compariso of two different modes for noninvasive mechanical ventilation in chronic respiratory failure: volume versus pressure controlled device  

Microsoft Academic Search

Comparison of two different modes for noninvasive mechanical ventilation in chronic respiratory failure: volume versus pressure controlled device. B. Schönhofer, M. Sonneborn, P. Haidl, H. Böhrer, D. Köhler. ©ERS Journals Ltd 1997. ABSTRACT: The most commonly used mode of noninvasive mechanical ventila- tion (NMV) is volume-controlled intermittent positive pressure ventilation (IPPV). Pressure support ventilation has recently become increasingly popular, but

B. Schönhofer; M. Sonneborn; P. Haidl; H. Böhrer; D. Köhler

1997-01-01

274

Air Distribution Effectiveness for Different MechanicalVentilation Systems  

SciTech Connect

The purpose of ventilation is to dilute 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 conditions between zones. Different types of ventilation systems will provide different amounts of dilution depending on the effectiveness of their air distribution systems and the location of sources and occupants. This paper will report on work being done to both model the impact of different systems and measurements using a new 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 ultimate objective of this project is to determine the effectiveness of different systems so that appropriate adjustments can be made in residential ventilation standards such as ASHRAE Standard 62.2.

Sherman, Max H.; Walker, Iain S.

2007-08-01

275

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

SciTech Connect

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

Hurford, W.E.; Lynch, K.E.; Strauss, H.W.; Lowenstein, E.; Zapol, W.M. (Department of Anesthesia, Harvard Medical School, Massachusetts General Hospital, Boston (USA))

1991-06-01

276

Mechanical ventilation effect on surfactant content, function, and lung compliance in the newborn rat.  

PubMed

Studies of ventilator-associated lung injury in adult experimental animal models have documented that high tidal volume (TV) results in lung injury characterized by impaired compliance and dysfunctional surfactant. Yet, there is evidence that, in neonates, ventilation with a higher than physiologic TV leads to improved lung compliance. The purpose of our study was to evaluate how lung compliance and surfactant was altered by high TV ventilation in the neonate. We utilized a new model (mechanically air-ventilated newborn rats, 4-8 d old), and used 40 or 10 mL/kg TV strategies. Age-matched nonventilated animals served as controls. In all animals, dynamic compliance progressively increased after initiation of mechanical ventilation and was significantly greater than basal values after 60 min (p < 0.01). Lung lavage total surfactant with both TV strategies (p < 0.05) and the large aggregate fraction (only in TV = 40 mL/kg; p < 0.01) were significantly increased by 60 min of mechanical ventilation, compared with control animals. Ventilation with 40 mL/kg TV for 60 min adversely affected the lung surfactant surface-tension lowering properties (p < 0.01). After 180 min of ventilation with 40 mL/kg TV, the lung total surfactant content and dynamic compliance values were no longer distinct from the nonventilated animals' values. We conclude that, in the newborn rat, mechanical ventilation with a higher than physiologic TV increases alveolar surfactant content and, over time, alters its biophysical properties, thus promoting an initial but transient improvement in lung compliance. PMID:15128929

Martinez, Francisco; Lewis, James; Copland, Ian; Engelberts, Doreen; Kavanagh, Brian P; Post, Martin; Schurch, Samuel; Belik, Jaques

2004-05-05

277

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

Microsoft Academic Search

Objective To investigate the effects of weaning protocols on the total duration of mechanical ventilation, mortality, adverse events, quality of life, weaning duration, and length of stay in the intensive care unit and hospital.Design Systematic review.Data sources Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, LILACS, ISI Web of Science, ISI Conference Proceedings, Cambridge Scientific Abstracts, and reference lists

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

2011-01-01

278

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

PubMed Central

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.

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

2013-01-01

279

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

SciTech Connect

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

Sherman, Max; Logue, Jennifer; Singer, Brett

2010-06-01

280

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

PubMed

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

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

2005-01-01

281

Long term mechanical ventilation equipment for neuromuscular patients: meeting the expectations of patients and prescribers.  

PubMed

BACKGROUND: To maximise the likelihood of successful long term mechanical ventilation (MV) in patients with neuromuscular diseases, ventilators characteristics and settings must be chosen carefully taking into account both medical requisites and the patient's preference and comfort. The general objectives of the survey were 1) to evaluate patients comfort with, and knowledge about, their long term MV; 2) to compare patients and prescribers opinions and expectations regarding long term MV; 3) to compare the equipment used by the patients with prescribers present opinion. METHODS: Neuromuscular patients receiving long term MV and home MV prescribers in Belgium and France and MV prescribers were asked to respond to a questionnaire survey specifically developed for the study. RESULTS: Completed questionnaires were collected from 209 patients, mean age 35.4±15.9 years (range 3 to 86 years), ventilated since 11 ± 17 year, and 45 MV prescribers. Hundred sixty three (78%) patients correctly designed their MV mode as a volume or a pressure targeted mode and 86% considered their MV as "efficient". When an inspiratory trigger was available, 92% of the patients were able to use it but only 72% were satisfied. Prescribers were more prone than patients to use new technologies, such as an emergency system to release a noninvasive interface (visual analogue scale (VAS/10): 9.2±1.5 vs 6.8±3.3, P=0.0001), a humidification system (VAS: 8.6±1.4 vs 7.8±2.6, P=0.02), a contactor for providing larger inspiratory volumes (VAS: 8.4±1.7 vs 6.0±3.0, P=0.009), an in-built cough assistance mode (VAS: 9.2±1.4 vs 5.5±3.3 P=0.00001), new options to improve speech, or new MV modes such as a volume targeted-pressure controlled mode. CONCLUSIONS: Patient's and prescriber's opinion differ about the ideal home ventilator. Patients are less prone to use new technologies, mainly because of a lack of information, underlining the need of regular MV update in patients receiving long term MV. PMID:23764860

Lofaso, Frédéric; Prigent, Hélène; Tiffreau, Vincent; Menoury, Nathalie; Toussaint, Michel; Finet Monnier, Armelle; Stremler, Natalie; Devaux, Christian; Leroux, Karl; Orlikowski, David; Mauri, Cécile; Pin, Isabelle; Sacconi, Sabrina; Pereira, Cécile; Pépin, Jean-Louis; Fauroux, Brigitte

2013-06-13

282

Use of oral clonidine for sedation in ventilated paediatric intensive care patients  

Microsoft Academic Search

Objectives We aimed to document our experience with oral clonidine when used as a sedative in combination with intravenous morphine and lorazepam in a group of mechanically ventilated children with single-organ, respiratory failure. In particular, our objectives were to establish the relationship between oral dose, plasma concentration, and sedative effect, and second, to document the side-effect profile. Design Prospective, cohort

Sara Arenas-López; Shelley Riphagen; Shane M. Tibby; Andrew Durward; Steve Tomlin; Graham Davies; Ian A. Murdoch

2004-01-01

283

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

PubMed

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

Gödecke, Christiane; Kohlen, Helen

2013-04-01

284

Retinal, choroidal and total ocular blood flow response to hypercarbia during spontaneous breathing and mechanical ventilation.  

PubMed

The effect of hypercarbia on ocular blood flow was studied in the newborn piglet with the isotope-labeled microsphere method. Blood flow measurements were made during spontaneous breathing and during paralyzation (pancuronium) and mechanical ventilation. Retinal blood flow increased from 0.40 +/- 0.07 (mean +/- SEM) ml/min/g at baseline levels to 0.91 +/- 0.17 ml/min/g at a PaCO2 level of 11.0 kPa during spontaneous ventilation. A similar response was observed during paralyzation and mechanical ventilation (0.89 +/- 0.15 ml/min/g at a PaCO2 of 11.1 kPa). For choroidal blood flow, however, the increase caused by hypercarbia during spontaneous ventilation (16.14 +/- 3.69 to 29.15 +/- 3.22 ml/min/g) was significantly reduced when the animals were paralyzed and mechanically ventilated (15.99 +/- 2.99 to 23.51 +/- 3.41 ml/min/g). Since choroidal blood flow accounts for 60-80% of oxygen delivery to the retina, paralyzation and mechanical ventilation may significantly reduce oxygen delivery to the retina during hypercarbia. PMID:2036472

Stiris, T; Hall, C; Bratlid, D

1991-01-01

285

Characteristics and clinical outcome of 458 patients with acute myocardial infarction requiring mechanical ventilation. Results of the BEAT registry of the ALKK-study group  

Microsoft Academic Search

Background  Information about the clinical course of patients with acute myocardial infarction requiring mechanical ventilation is scarce.\\u000a We sought to evaluate the clinical outcome of a large cohort of such patients in clinical practice.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The German BEAT registry prospectively enrolled consecutive patients requiring mechanical ventilation who were admitted to\\u000a an internal intensive care unit (ICU) of 45 participating German hospitals between

Kleopatra Kouraki; Steffen Schneider; Rainer Uebis; Ulrich Tebbe; Hermann H. Klein; Uwe Janssens; Ralf Zahn; Jochen Senges; Uwe Zeymer

2011-01-01

286

Measurement of lung volume and an index of ventilation inhomogeneity during mechanical ventilation  

Microsoft Academic Search

In the intensive Care Unit there is a striking difference between the state\\u000aof the art of haemodynamic monitoring and that of pulmonary function\\u000amonitoring. The haemodynamic status of Intensive Care patients\\u000ais continuously monitored by devices producing signals of beat-to-beat\\u000aelectro-cardiograms and blood pressures, using sophisticated, fully developed\\u000adevices, that can be delivered from stock and handled with ease

P. E. M. Huygen

1994-01-01

287

Prediction of death and prolonged mechanical ventilation in acute lung injury  

Microsoft Academic Search

INTRODUCTION: Prediction of death and prolonged mechanical ventilation is important in terms of projecting resource utilization and in establishing protocols for clinical studies of acute lung injury (ALI). We aimed to identify risk factors for a combined end-point of death and\\/or prolonged ventilator dependence and developed an ALI-specific prediction model. METHODS: In this retrospective analysis of three multicenter clinical studies,

Ognjen Gajic; Bekele Afessa; B Taylor Thompson; Fernando Frutos-Vivar; Michael Malinchoc; Gordon D Rubenfeld; André Esteban; Antonio Anzueto; Rolf D Hubmayr

2007-01-01

288

A comparison of invasive versus noninvasive full-time mechanical ventilation in Duchenne muscular dystrophy  

Microsoft Academic Search

The aim of this study was to compare morbidity and causes of death in a series of 42 Duchenne patients receiving full-time mechanical ventilation either by tracheostomy (TR, n = 16 or by noninvasive methods (noninvasive ventilation [NIV], n = 26). At inclusion for a 5-year observation period (2002–2006), TR and NIV patients were 32.7 and 27 years old, respectively.

P Soudon; M Steens; M Toussaint

2008-01-01

289

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

Microsoft Academic Search

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

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

2007-01-01

290

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

Microsoft Academic Search

\\u000a Pneumonia is a common complication in patients requiring mechanical ventilation, with prevalence estimates varying between\\u000a 6 and 52 cases per 100 patients, depending on the population studied (1). Far from a benign event, ventilator-associated pneumonia (VAP) is associated with a significant increase in mortality (2–4), with an attributable mortality exceeding 25% in one matched cohort study (5).

Richard G. Wunderink; Grant W. Waterer

291

Review of ventilatory techniques to optimize mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease  

PubMed Central

Chronic obstructive pulmonary disease (COPD) is a major global healthcare problem. Studies vary widely in the reported frequency of mechanical ventilation in acute exacerbations of COPD. Invasive intubation and mechanical ventilation may be associated with significant morbidity and mortality. A good understanding of the airway pathophysiology and lung mechanics in COPD is necessary to appropriately manage acute exacerbations and respiratory failure. The basic pathophysiology in COPD exacerbation is the critical expiratory airflow limitation with consequent dynamic hyperinflation. These changes lead to further derangement in ventilatory mechanics, muscle function and gas exchange which may result in respiratory failure. This review discusses the altered respiratory mechanics in COPD, ways to detect these changes in a ventilated patient and formulating ventilatory techniques to optimize management of respiratory failure due to exacerbation of COPD.

Reddy, Raghu M; Guntupalli, Kalpalatha K

2007-01-01

292

Improvement in accuracy of transcutaneous measurement of oxygen with resumption of spontaneous ventilation in mechanically ventilated patients after off pump coronary artery bypass procedure: a prospective study  

Microsoft Academic Search

Introduction  Transcutaneous measurement of gases depends on the degree of skin perfusion. Mechanical ventilation causes alteration in the\\u000a peripheral perfusion. The aim of this prospective observational study was to assess change in the accuracy of interchangeability\\u000a of arterial blood gases with those obtained transcutaneously at various phases of mechanical ventilation such as controlled\\u000a mandatory, synchronized intermittent mandatory, continuous positive airway pressure

Murali Chakravarthy; Sandeep Narayan; Raghav Govindarajan; Vivek Jawali

2009-01-01

293

Mechanisms of decreased left ventricular preload during continuous positive pressure ventilation in ARDS  

Microsoft Academic Search

Continuous positive pressure ventilation is associated with a reduction in left ventricular preload and cardiac output, but the mechanisms responsible are controversial. The decrease in left ventricular preload may result exclusively from a decreased systemic venous return due to increased pleural pressure, or from an additional effect such as decreased left ventricular compliance. To determine the mechanisms responsible, we studied

J. F. Dhainaut; J. Y. Devaux; J. F. Monsallier; F. Brunet; D. Villemant; M. F. Huyghebaert

1986-01-01

294

RV filling modulates LV function by direct ventricular interaction during mechanical ventilation.  

PubMed

During mechanical ventilation, phasic changes in systemic venous return modulate right ventricular output but may also affect left ventricular function by direct ventricular interaction. In 13 anesthetized, closed-chest, normal dogs, we measured inferior vena cava flow and left and right ventricular dimensions and output during mechanical ventilation, during an inspiratory hold, and (during apnea) vena caval constriction and abdominal compression. During a single ventilation cycle preceded by apnea, positive pressure inspiration decreased caval flow and right ventricular dimension; the transseptal pressure gradient increased, the septum shifted rightward, reflecting an increased left ventricular volume (the anteroposterior diameter did not change); and stroke volume increased. The opposite occurred during expiration. Similarly, the maneuvers that decreased venous return shifted the septum rightward, and left ventricular volume and stroke volume increased. Increased venous return had opposite effects. Changes in left ventricular function caused by changes in venous return alone were similar to those during mechanical ventilation except for minor quantitative differences. We conclude that phasic changes in systemic venous return during mechanical ventilation modulate left ventricular function by direct ventricular interaction. PMID:15792988

Mitchell, Jamie R; Whitelaw, William A; Sas, Rozsa; Smith, Eldon R; Tyberg, John V; Belenkie, Israel

2005-03-25

295

Locally measured shear moduli of pulmonary tissue and global lung mechanics in mechanically ventilated rats.  

PubMed

This study was aimed at measuring shear moduli in vivo in mechanically ventilated rats and comparing them to global lung mechanics. Wistar rats (n = 28) were anesthetized, tracheally intubated, and mechanically ventilated in supine position. The animals were randomly assigned to the healthy control or the lung injury group where lung injury was induced by bronchoalveolar lavage. The respiratory system elastance E(rs) was analyzed based on the single compartment resistance/elastance lung model using multiple linear regression analysis. The shear modulus (G) of alveolar parenchyma was studied using a newly developed endoscopic system with adjustable pressure at the tip that was designed to induce local mechanostimulation. The data analysis was then carried out with an inverse finite element method. G was determined at continuous positive airway pressure (CPAP) levels of 15, 17, 20, and 30 mbar. The resulting shear moduli of lungs in healthy animals increased from 3.3 ± 1.4 kPa at 15 mbar CPAP to 5.8 ± 2.4 kPa at 30 mbar CPAP (P = 0.012), whereas G was ~2.5 kPa at all CPAP levels for the lung-injured animals. Regression analysis showed a negative correlation between G and relative E(rs) in the control group (r = -0.73, P = 0.008 at CPAP = 20 mbar) and no significant correlation in the lung injury group. These results suggest that the locally measured G were inversely associated with the elastance of the respiratory system. Rejecting the study hypothesis the researchers concluded that low global respiratory system elastance is related to high local resistance against tissue deformation. PMID:22628379

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

2012-05-24

296

The preoperative and intraoperative risk factors for early postoperative mechanical ventilation after scoliosis surgery: A retrospective study  

PubMed Central

Background: Patients undergoing corrective surgery for scoliosis of spine are commonly ventilated in our institute after the operation. Postoperative mechanical ventilation (PMV) and subsequent prolongation of intensive care unit stay are associated with increase in medical expenditure and complications such as ventilator-associated pneumonia. Identification of factors which may contribute to PMV and their modification may help in allocation of resources effectively. The present study was performed to identify preoperative and intraoperative factors associated with early PMV after scoliosis surgery. Methods: One hundred and two consecutive patients who underwent operation for scoliosis correction between January 2006 to July 2011 were reviewed retrospectively. Patients requiring PMV included patients who were not extubated in the operating room and were continued on mechanical ventilation. Preoperative and intraoperative factors which were analysed included age, gender, weight, cardiorespiratory function, presence of kyphosis, number and level of vertebrae involved, surgical approach, whether thoracoplasty was done, duration of surgery, blood loss, fluids and blood transfused, hypothermia and use of antifibrinolytics. Results: The average age of the patients was 14.31±3.78 years with female preponderance (57.8%). Univariate analysis found that longer fusions of vertebrae (more than 8), blood loss, amount of crystalloids infused, blood transfused and hypothermia were significantly associated with PMV (P<0.05). Independent risk factors for PMV were longer fusion (Odds Ratio (OR), 1.290; 95% confidence interval (CI), 1.038-1.604) and hypothermia (OR, 0.096; 95% CI, 0.036-0.254; P<0.05). Conclusion: The authors identified that longer fusions and hypothermia were independent risk factors for early PMV. Implementation of measures to prevent hypothermia may result in decrease in PMV.

Gurajala, Indira; Ramachandran, Gopinath; Iyengar, Raju; Durga, Padmaja

2013-01-01

297

Gorham syndrome with postoperative respiratory failure and requiring prolonged mechanical ventilation.  

PubMed

Gorham syndrome is a rare disease that presents as progressive osteolysis, and may affect any part of the skeleton. The pathologic process involves the replacement of normal bone by aggressively expanding but non-neoplastic vascular tissue, resulting in massive osteolysis of the adjacent bone. If the spine and ribs are affected, the subsequent kyphosis and chest wall deformity may cause severe restrictive ventilatory impairment. We report a 34-year-old male with Gorham syndrome presenting as progressive kyphosis, severe back pain, unstable gait, and exertional dyspnea. Pulmonary function testing revealed severe restrictive ventilatory impairment. He underwent spinal surgery but could not be extubated after surgery. Postoperative left lower lung pneumonia and respiratory failure required prolonged mechanical ventilation. After a weaning program of pressure support ventilation and T-piece spontaneous breathing trials, he was successfully weaned from mechanical ventilation. PMID:23550170

Huang, Shiang-Yu; Lee, Ying-Min; Tzeng, Shiau-Tzu; Su, Chiu-Ping; Huang, Shiu-Feng; Wu, Yao-Kuang; Lan, Chou-Chin

2013-04-02

298

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

Microsoft Academic Search

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

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

2005-01-01

299

Achieving and sustaining ventilator-associated pneumonia-free time among intensive care units (ICUs): evidence from the Keystone ICU Quality Improvement Collaborative.  

PubMed

Our retrospective analysis of the Michigan Keystone intensive care unit (ICU) collaborative demonstrated that adult ICUs could achieve and sustain a zero rate of ventilator-associated pneumonia (VAP) for a considerable number of ventilator and calendar months. Moreover, the results highlight the importance of adjustment for ventilator-days before comparing VAP-free time among ICUs. PMID:23739079

Matar, Dany S; Pham, Julius C; Louis, Thomas A; Berenholtz, Sean M

2013-05-22

300

The Effect of Non-Invasive Positive Pressure Ventilation (NPPV) via a Face Mask vs. Conventional Mechanical Ventilation (CMV) via Endotracheal Intubation (ETI) in Adult Patients with Acute Respiratory Failure (ARF): A Systematic Review of the Literature  

Microsoft Academic Search

Background: Traditionally, conventional mechanical ventilation (CMV) and intubation was the preferred route commonly employed by physicians to support patients with acute respiratory failure. However, mechanical ventilation via endotracheal intubation (ETI) may lead to injury of the trachea and may also result in ventilator-associated nosocomial pneumonia. As a consequence, there has been growing interest in NPPV support because of its promising

My T. Ly

2009-01-01

301

Ventilator discontinuation protocols.  

PubMed

Mechanical ventilation is a life-saving supportive therapy, but it can also cause lung injury, diaphragmatic dysfunction, and lung infection. Ventilator liberation should be attempted as soon as clinically indicated, to minimize morbidity and mortality. The most effective method of liberation follows a systematic approach that includes a daily assessment of weaning readiness, in conjunction with interruption of sedation infusions and spontaneous breathing trials. Protocols and checklists are decision support tools that help ensure consistent application of key elements of evidence-based practice. A majority of studies of weaning protocols applied by non-physician healthcare providers suggest faster weaning and shorter duration of ventilation and ICU stay, and some suggest reduced failed extubation and ventilator-associated pneumonia rates. Checklists can be used to reinforce application of the protocol, or possibly in lieu of one, particularly in environments where the caregiver-to-patient ratio is high and clinicians are well versed in and dedicated to applying evidence-based care. There is support for integrating best-evidence rules for weaning into the mechanical ventilator so that a substantial portion of the weaning process can be automated, which may be most effective in environments with low caregiver-to-patient ratios or those in which it is challenging to consistently apply evidence-based care. This paper reviews evidence for ventilator liberation protocols and discusses issues of implementation and ongoing monitoring. PMID:23013902

Haas, Carl F; Loik, Paul S

2012-10-01

302

Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery  

Microsoft Academic Search

Objective: We hypothesized that measuring stroke volume variation (SVV) during mechanical ventilation by continuous arterial pulse contour analysis allows the accurate prediction and monitoring of changes in cardiac index (CI) in response to volume administration. Design and setting: Prospective study in an university hospital. Patients: Twenty mechanically ventilated patients following cardiac surgery. Interventions: Volume loading with oxypolygelatin (3.5%) 20 ml

Daniel A. Reuter; Thomas W. Felbinger; Christian Schmidt; Erich Kilger; Oliver Goedje; Peter Lamm; Alwin E. Goetz

2002-01-01

303

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

PubMed

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

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

2012-11-01

304

Mechanical Ventilation in Patients with End-Stage Idiopathic Pulmonary Fibrosis  

Microsoft Academic Search

Background: Acute respiratory failure (ARF) occurring during idiopathic pulmonary fibrosis (IPF) is associated with a poor prognosis. In this subset of individuals, mechanical ventilation (MV) may be required. Objectives: We analysed the characteristics of a group of IPF patients undergoing MV for ARF in order to give some indications on the supposed prognosis. Methods: Hospital records of 34 consecutive patients

Corrado Mollica; Gregorino Paone; Vittoria Conti; Daniela Ceccarelli; Giovanni Schmid; Paolo Mattia; Nicola Perrone; Angelo Petroianni; Alfredo Sebastiani; Luca Cecchini; Remo Orsetti; Claudio Terzano

2010-01-01

305

Aspiration in chest compression alone without mechanical ventilation in the head down position in dogs  

Microsoft Academic Search

Background: Previous work by the authors has shown that chest compressions alone without mechanical ventilation during cardiopulmonary resuscitation in the natural supine position was associated with pulmonary aspiration in dogs. The purpose of this investigation was to test the hypothesis that a head down position may prevent aspiration during chest compressions alone and whether oxygenation can be improved by simply

Bruno Jawan; Zu-Kong Chong; Hak-Kim Cheung; Yan-Yuen Poon; Yu-Feng Cheng; Han-Shiang Chen; Kwok-Wai Cheng; Chih-Shien Wang; Ju-Hao Lee

2000-01-01

306

Effects of fentanyl on isoflurane minimum alveolar concentration and cardiovascular function in mechanically ventilated goats  

Microsoft Academic Search

The effects of fentanyl on the minimum alveolar concentration (MAC) of isoflurane and cardiovascular function in mechanically ventilated goats were evaluated using six healthy goats (three does and three wethers). Following induction of general anaesthesia with isoflurane delivered via a mask, endotracheal intubation was performed and anaesthesia was maintained with isoflurane. The baseline MAC of isoflurane (that is, the lowest

T. B. Dzikiti; G. F. Stegmann; L. N. Dzikiti; L. J. Hellebrekers

2011-01-01

307

A critical examination of ducted mechanical ventilation in new residential housing in the Pacific Northwest  

SciTech Connect

Researchers from the Pacific Northwest Laboratory (PNL) critically examined AAHX installations in several dwelling types. This paper describes problems noted with various AAHX installations. The author documents a field experiment conducted in energy-efficient manufactured homes that resulted in guidelines for improved design and installation of mechanical ventilation equipment.

Parker, G.B. (Pacific Northwest Lab., Richland, WA (USA))

1988-01-01

308

Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation  

Microsoft Academic Search

According to the Frank-Starling relationship, a patient is a 'responder' to volume expansion only if both ventricles are preload dependent. Mechanical ventilation induces cyclic changes in left ventricular (LV) stroke volume, which are mainly related to the expiratory decrease in LV preload due to the inspiratory decrease in right ventricular (RV) filling and ejection. In the present review, we detail

Frédéric Michard; Jean-Louis Teboul

2000-01-01

309

USING OUTSIDE TEMPERATURE TO PREDICT ODOUR EMISSION FROM MECHANICAL VENTILATED LIVESTOCK BUILDINGS  

Microsoft Academic Search

Odour emission of livestock buildings is of interest for the residents in the vicinity of animal husbandry due to its annoying potential. To apply a Gauss dispersion model to odour emissions, the emission parameters have to be known. The emission parameters of a mechanically ventilated livestock building, the odour flow and the volume flow of the outlet air, are calculated

G. Schauberger; M. Piringer; E. Petz

2000-01-01

310

Assessment of resting energy expenditure in mechanically ventilated patients1-3  

Microsoft Academic Search

Background: Usual equations for predicting resting energy expenditure (REE) are not appropriate for critically ill patients, and indirect calorimetry criteria render its routine use difficult. Objective: Variables that might influence the REE of mechani- cally ventilated patients were evaluated to establish a predictive relation between these variables and REE. Design: The REE of 70 metabolically stable, mechanically venti- lated patients

Christophe Faisy; Emmanuel Guerot; Jean-Luc Diehl; Jacques Labrousse; Jean-Yves Fagon

311

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 ...

312

Sinusitis in mechanically ventilated patients and its role in the pathogenesis of nosocomial pneumonia  

Microsoft Academic Search

Nosocomial sinusitis is a complication of endotracheal intubation and mechanical ventilation in critically ill patients. Its incidence is often underestimated because of a lack of clinical signs. It is suspected in patients with nasal discharge or unexplained fever. Its diagnosis is based on radiological examination, by radiograph or computed tomography scan, and microbiological cultures of maxillary sinus aspirate. Maxillary sinusitis

F. Bert; N. Lambert-Zechovsky

1996-01-01

313

Heliumoxygen reduces the production of carbon dioxide during weaning from mechanical ventilation  

Microsoft Academic Search

BACKGROUND: Prolonged weaning from mechanical ventilation has a major impact on ICU bed occupancy and patient outcome, and has significant cost implications. There is evidence in patients around the period of extubation that helium-oxygen leads to a reduction in the work of breathing. Therefore breathing helium-oxygen during weaning may be a useful adjunct to facilitate weaning. We hypothesised that breathing

Gordon Flynn; Gerlinde Mandersloot; Marie Healy; Mark Saville; Daniel F McAuley

2010-01-01

314

Thermal behaviour of interactive mechanically ventilated double glazed façade: Non-dimensional analysis  

Microsoft Academic Search

Non-dimensional analysis is proposed as a method to analyse mechanically ventilated double glazed façade energy performance. The 12 non-dimensional numbers defined, can be used to describe thermal and energy performance of interactive façade designs. A comparison between Nusselt number solved by experimental data and Nusselt calculated by the validated multivariable correlation function is reported in the present paper. Due to

Carla Balocco; Massimo Colombari

2006-01-01

315

Does taking endurance into account improve the prediction of weaning outcome in mechanically ventilated children?  

PubMed Central

Introduction We conducted the present study to determine whether a combination of the mechanical ventilation weaning predictors proposed by the collective Task Force of the American College of Chest Physicians (TF) and weaning endurance indices enhance prediction of weaning success. Method Conducted in a tertiary paediatric intensive care unit at a university hospital, this prospective study included 54 children receiving mechanical ventilation (?6 hours) who underwent 57 episodes of weaning. We calculated the indices proposed by the TF (spontaneous respiratory rate, paediatric rapid shallow breathing, rapid shallow breathing occlusion pressure [ROP] and maximal inspiratory pressure during an occlusion test [Pimax]) and weaning endurance indices (pressure-time index, tension-time index obtained from P0.1 [TTI1] and from airway pressure [TTI2]) during spontaneous breathing. Performances of each TF index and combinations of them were calculated, and the best single index and combination were identified. Weaning endurance parameters (TTI1 and TTI2) were calculated and the best index was determined using a logistic regression model. Regression coefficients were estimated using the maximum likelihood ratio (LR) method. Hosmer–Lemeshow test was used to estimate goodness-of-fit of the model. An equation was constructed to predict weaning success. Finally, we calculated the performances of combinations of best TF indices and best endurance index. Results The best single TF index was ROP, the best TF combination was represented by the expression (0.66 × ROP) + (0.34 × Pimax), and the best endurance index was the TTI2, although their performance was poor. The best model resulting from the combination of these indices was defined by the following expression: (0.6 × ROP) – (0.1 × Pimax) + (0.5 × TTI2). This integrated index was a good weaning predictor (P < 0.01), with a LR+ of 6.4 and LR+/LR- ratio of 12.5. However, at a threshold value <1.3 it was only predictive of weaning success (LR- = 0.5). Conclusion The proposed combined index, incorporating endurance, was of modest value in predicting weaning outcome. This is the first report of the value of endurance parameters in predicting weaning success in children. Currently, clinical judgement associated with spontaneous breathing trials apparently remain superior.

Noizet, Odile; Leclerc, Francis; Sadik, Ahmed; Grandbastien, Bruno; Riou, Yvon; Dorkenoo, Aimee; Fourier, Catherine; Cremer, Robin; Leteurtre, Stephane

2005-01-01

316

Ventilator-Induced Mechanical Stress and Lung Vascular Dysfunction  

Microsoft Academic Search

\\u000a By virtue of their design as a gas-exchange organ, lungs are constantly exposed to mechanical stimulation associated with\\u000a inflation–deflation cycles. Pulmonary vasculature experiences mechanical forces resulting from blood circulation and respiratory\\u000a cycles. These forces are transduced onto pulmonary vessels in the form of shear stress, intravascular hydrostatic pressure,\\u000a and tensile stress. Normally, mechanical loads on pulmonary vasculature are well tolerated

Konstantin G. Birukov

317

[Acute decompensation in chronic obstructive respiratory insufficiency. Pathogenesis of edema and role of noninvasive mechanical ventilation].  

PubMed

Chronic obstructive pulmonary disease (COPD) is rather common. It is nearly always associated with excessive smoking. In advanced stages of COPD, patients have severe obstruction of airways and develop often acute episodes of respiratory failure, commonly due to broncho-pulmonary infections. This review addresses nonpharmacological treatment of these episodes of acute decompensation. The value of mechanical ventilation is discussed in view of two recent advances: noninvasive ventilation by face or nose mask as alternative to tracheal intubation and improved notions about the pathogenesis of fluids and salt retention as causes of occasionally occurring edema. PMID:8643892

Chevrolet, J C

1996-03-12

318

Automatic Control of Mechanical Ventilation. Part 2: The Existing Techniques and Future Trends  

Microsoft Academic Search

Objective  The major automatic techniques that are available in commercial ventilators are described and a discussion of the recently\\u000a developed systems along with the future trends in the field is provided.\\u000a \\u000a \\u000a \\u000a Methods  The major available automatic control techniques for mechanical ventilation are analyzed and the future trends are discussed\\u000a in view of today’s ICU requirements and the recently developed technologies.\\u000a \\u000a \\u000a \\u000a Results  Several major

Fleur T. Tehrani

2008-01-01

319

Mechanical ventilation of a patient with decreased lung compliance and tracheal dilatation.  

PubMed

Tracheal injury resulting from tracheal intubation is common. Injuries vary in type and severity, from mucosal sloughing to tracheal stenosis and fistula formation. We report a patient with poor lung compliance and massive tracheal dilatation as a result of prolonged mechanical ventilation with high inflation pressure despite the use of a high-volume, low-pressure cuff. To reduce the tracheal dilatation but maintain adequate ventilation and continuous positive airway pressure, we substituted a longer double-cuff tracheotomy appliance and used an automatic intermittent cuff inflator. The problems related to the design of modern tracheal tube cuffs are discussed. PMID:1562339

Jaeger, J M; Wells, N C; Kirby, R R; Blanch, P B

320

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

PubMed

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

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

2012-11-15

321

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

Microsoft Academic Search

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

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

1992-01-01

322

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

PubMed Central

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

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

2012-01-01

323

[Ventilator associated acute lung injury].  

PubMed

Mechanical ventilation plays a central role in the critical care setting; but its use is closely related with some life threatening complications as nosocomial pneumonia and low cardiac performance. One of the most severe complications is called ventilator-associated lung injury (VALI) and it includes: Barotrauma, volutrauma, atelectrauma, biotrauma and oxygen-mediated toxic effects and it is related with an inflammatory response secondary to the stretching and recruitment process of alveoli within mechanical ventilation. The use of some protective ventilatory strategies has lowered the mortality rate 10% approximately. PMID:16187708

Namendys-Silva, Silvio Antonio; Posadas-Calleja, Juan Gabriel

324

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

PubMed Central

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.

Lipes, Jed; Bojmehrani, Azadeh; Lellouche, Francois

2012-01-01

325

Ventilator associated pneumonia  

PubMed Central

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

Hunter, J D

2006-01-01

326

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

PubMed

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

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

2009-12-01

327

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

PubMed Central

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

2012-01-01

328

Bench-to-bedside review: Adjuncts to mechanical ventilation in patients with acute lung injury  

PubMed Central

Mechanical ventilation is indispensable for the survival of patients with acute lung injury and acute respiratory distress syndrome. However, excessive tidal volumes and inadequate lung recruitment may contribute to mortality by causing ventilator-induced lung injury. This bench-to-bedside review presents the scientific rationale for using adjuncts to mechanical ventilation aimed at optimizing lung recruitment and preventing the deleterious consequences of reduced tidal volume. To enhance CO2 elimination when tidal volume is reduced, the following are possible: first, ventilator respiratory frequency can be increased without necessarily generating intrinsic positive end-expiratory pressure; second, instrumental dead space can be reduced by replacing the heat and moisture exchanger with a conventional humidifier; and third, expiratory washout can be used for replacing the CO2-laden gas present at end expiration in the instrumental dead space by a fresh gas (this method is still experimental). For optimizing lung recruitment and preventing lung derecruitment there are the following possibilities: first, recruitment manoeuvres may be performed in the most hypoxaemic patients before implementing the preset positive end-expiratory pressure or after episodes of accidental lung derecruitment; second, the patient can be turned to the prone position; third, closed-circuit endotracheal suctioning is to be preferred to open endotracheal suctioning.

Rouby, Jean-Jacques; Lu, Qin

2005-01-01

329

A Pumpless Lung Assist Device Reduces Mechanical Ventilation-Induced Lung Injury in Juvenile Piglets  

PubMed Central

Respiratory failure is a major contributor to mortality and morbidity in newborn infants. The lung assist device (LAD) is a novel gas exchange device that supplements mechanical ventilation. To test the effect of the LAD on pulmonary histopathology in juvenile piglets with acute lung injury caused by saline lung lavage (SLL) followed by intermittent mandatory ventilation (IMV). 3–4 week old piglets were randomized to either no intervention (control group), SLL alone (SLL group), SLL + IMV (IMV group), or SLL+IMV+LAD (LAD group) (n=6/group). The carotid artery and jugular vein were cannulated and an arteriovenous circuit completed, and the LAD was inserted into this circuit. Gas exchange via the LAD was initiated by passage of 100% oxygen over the blood-carrying hollow fibers of the LAD. Hemodynamic variables were recorded. Mechanical ventilation was systematically weaned. Lung histology was scored by two observers masked to treatment group. There were no differences in hemodynamic variables between the study groups. There was a significant increase in the total lung injury score in the IMV group compared to the LAD group. The novel pumpless low-resistance LAD has shown feasibility and potential to decrease ventilator-induced lung injury in a juvenile animal model.

El-Ferzli, George T.; Philips, Joseph B.; Bulger, Arlene; Ambalavanan, Namasivayam

2009-01-01

330

SIVA: a hybrid knowledge-and-model-based advisory system for intensive care ventilators.  

PubMed

The Sheffield Intelligent Ventilator Advisor is a hybrid knowledge-and-model-based advisory system designed for intensive care ventilator management. It consists of a top-level fuzzy rule-based module to give the qualitative component of the advice, and a lower-level model-based module to give the quantitative component of the advice. It is structured to offer adaptive patient-specific decision support. It can be operated in either invasive or noninvasive modes depending on the availability of data from invasive clinical measurements. The user can choose between the full-advisory mode and the clinician-directed mode. The advice given by the top-level module has been validated against retrospective real patient data and compared with intensivists expertise and performance under simulation conditions. Closed-loop simulations were performed assuming various clinical scenarios including sudden changes in the patient parameters such as the shunt or deadspace with noise and disturbances. They have shown that the advice given was appropriate and the blood gases resulting from the closed-loop decision support were acceptable. The system was also shown to be tolerant to noise and disturbances. It is implemented in MATLAB/SIMULINK and LabVIEW. PMID:15217261

Kwok, Hoi-Fei; Linkens, Derek A; Mahfouf, Mahdi; Mills, Gary H

2004-06-01

331

Ventilation Strategies for Different Climates.  

National Technical Information Service (NTIS)

Until recently, residential ventilation in the United States has been provided by infiltration. In this report we compare natural ventilation (ventilation by infiltration) with several mechanical ventilation strategies and examine the overall energy consu...

H. E. Feustel M. P. Modera A. H. Rosenfeld

1987-01-01

332

Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants Ventilated With Continuous Positive Airway Pressure vs. Mechanical Ventilation  

PubMed Central

OBJECTIVE To compare continuous positive airway pressure (CPAP) vs. traditional mechanical ventilation (MV) at 24 h of age as predictors of neurodevelopmental (ND) outcomes in extremely low birth weight (ELBW) infants at 18-22 mo corrected gestational age (CGA). METHODS Infants ? 1000g birth weight born from January 2000 through December 2006 at two hospitals at the Cincinnati site of the National Institute of Child Health and Human Development Neonatal Research Network were evaluated comparing CPAP (N = 198) vs. MV (N = 109). Primary outcomes included the Bayley Score of Infant Development Version II (BSID-II), presence of deafness, blindness, cerebral palsy, bronchopulmonary dysplasia and death. RESULTS Ventilatory groups were similar in gender, rates of preterm prolonged rupture of membranes, antepartum hemorrhage, use of antenatal antibiotics, steroids, and tocolytics. Infants receiving CPAP weighed more, were older, were more likely to be non-Caucasian and from a singleton pregnancy. Infants receiving CPAP had better BSID-II scores, and lower rates of BPD and death. CONCLUSIONS After adjusting for acuity differences, ventilatory strategy at 24 h of age independently predicts long-term neurodevelopmental outcome in ELBW infants.

Thomas, Cameron W.; Meinzen-Derr, Jareen; Hoath, Steven B.; Narendran, Vivek

2012-01-01

333

Management of mechanical ventilation in acute severe asthma: practical aspects  

Microsoft Academic Search

Background  Acute severe asthma induces marked alterations in respiratory mechanics, characterized by a critical limitation of expiratory\\u000a flow and a heterogeneous and reversible increase in airway resistance, resulting in premature airway closure, lung, and chest\\u000a wall dynamic hyperinflation and high intrinsic PEEP.\\u000a \\u000a \\u000a \\u000a Discussion  These abnormalities increase the work of breathing and can lead to respiratory muscle fatigue and life-threatening respiratory\\u000a failure, in which case

Mauro Oddo; François Feihl; Marie-Denise Schaller; Claude Perret

2006-01-01

334

Plasma levels of surfactant protein D and KL-6 for evaluation of lung injury in critically ill mechanically ventilated patients  

PubMed Central

Background Preventing ventilator-associated lung injury (VALI) has become pivotal in mechanical ventilation of patients with acute lung injury (ALI) or its more severe form, acute respiratory distress syndrome (ARDS). In the present study we investigated whether plasma levels of lung-specific biological markers can be used to evaluate lung injury in patients with ALI/ARDS and patients without lung injury at onset of mechanical ventilation. Methods Plasma levels of surfactant protein D (SP-D), Clara Cell protein (CC16), KL-6 and soluble receptor for advanced glycation end-products (sRAGE) were measured in plasma samples obtained from 36 patients - 16 patients who were intubated and mechanically ventilated because of ALI/ARDS and 20 patients without lung injury at the onset of mechanical ventilation and during conduct of the study. Patients were ventilated with either a lung-protective strategy using lower tidal volumes or a potentially injurious strategy using conventional tidal volumes. Levels of biological markers were measured retrospectively at baseline and after 2 days of mechanical ventilation. Results Plasma levels of CC16 and KL-6 were higher in ALI/ARDS patients at baseline as compared to patients without lung injury. SP-D and sRAGE levels were not significantly different between these patients. In ALI/ARDS patients, SP-D and KL-6 levels increased over time, which was attenuated by lung-protective mechanical ventilation using lower tidal volumes (P = 0.02 for both biological markers). In these patients, with either ventilation strategy no changes over time were observed for plasma levels of CC16 and sRAGE. In patients without lung injury, no changes of plasma levels of any of the measured biological markers were observed. Conclusion Plasma levels of SP-D and KL-6 rise with potentially injurious ventilator settings, and thus may serve as biological markers of VALI in patients with ALI/ARDS.

2010-01-01

335

[Should mechanical ventilation be used in ICU patients in developing countries?].  

PubMed

The purpose of this monocentric prospective cohort study was to assess mortality in intensive care unit (ICU) patients requiring more than 6 hours of mechanical ventilation (MV) in a developing country. The study setting was a 10-bed polyvalent ICU at the Centre Hospitalier Régiona1 in El Maarouf, Comoros Islands. The study population included a total of 106 patients requiring MV out of 633 consecutive patients admitted to the ICU over a 10-month period. Study parameters included demographic data, simplified acute physiology score version 2 (SAPS II), reason for admission, urgency of MV, duration of MV, complications of MV need for sedation and mortality in hospital and at one year. In-hospital mortality was 59%. Mortality was significantly higher in patients presenting elevated SAPS II and requiring myorelaxant drugs. Age, gender, reason of admission, emergency, sedation, complications of MV, duration of MV were not correlated with mortality. The best prognosis was associated with the following indications: severe malaria, meningitis, eclampsia and poisoning. All patients who left the ICU (41) were alive at one year. Mortality associated with use of MV for resuscitation in a developing country was similar to that observed in developed countries. The young age of patients, acute nature of manifestations and reversibility of diseases encountered may explain the favorable outcome observed in this study. The initial diagnosis and associated risk factors (using a severity score if necessary) must be taken into account in deciding the indication for starting and stopping MV. The results of this study show that MV is feasible and effective in a developing country, but requires experience, inventiveness and realism. PMID:16555512

Durasnel, P; Gallet de Santerre, P; Merzouki, D; Ridhoine, M; Charif, M; Dada, A; Lahaye, F M

2005-11-01

336

Mechanical ventilation during experimental sepsis increases deposition of advanced glycation end products and myocardial inflammation  

PubMed Central

Introduction Increasing evidence links advanced glycation end products (AGE) including N?-(carboxymethyl)lysine (CML) to the development of heart failure. Accumulation of AGE leads to myocardial inflammation, which is considered as one of the possible mechanisms underlying sepsis-induced cardiac dysfunction. We hypothesized that mechanical ventilation (MV) augmented sepsis-induced myocardial CML deposition and inflammation. Methods Sepsis was induced using a modified cecal ligation and perforation (CLP) technique in 36 male adult Sprague Dawley rats. Rats were randomized to four hours of MV with low tidal volume (LTV: 6 ml/kg, PEEP 5 cmH2O, n = 10) or high tidal volume (HTV: 15 ml/kg, PEEP 3 cmH2O, n = 10) 24 hours after the induction of sepsis. Eight rats served as septic, non-ventilated controls and eight as non-septic, non-ventilated controls. After 28 hours all rats were killed. The number of extravascular polymorphonuclear (PMN) leucocytes, macrophages, and lymphocytes was measured as the number of positive cells/mm2. The number of CML positive endothelial cells were semi-quantified based upon an intensity score. The CML intensity score was correlated with the number of inflammatory cells to study the association between CML depositions and inflammation. Results Gas exchange was comparable between the ventilated groups. Sepsis induced a significant increase in CML deposition in both ventricles that was significantly augmented by MV compared with non-ventilated septic controls (left ventricle 1.1 ± 1.0 vs 0.7 ± 0.1, P = 0.030; right ventricle 2.5 ± 0.5 vs 0.6 ± 0.1, P = 0.037), irrespective of ventilatory strategy. In the right ventricle there was a non-significant tendency towards increased CML deposition in the HTV group compared with septic, non-ventilated controls (1.0 ± 0.1 vs 0.7 ± 0.09, P = 0.07). Sepsis induced a significant increase in the number of macrophages and PMNs compared with non-ventilated septic controls that was augmented by MV, irrespective of ventilatory strategy. CML deposition was significantly correlated with the number of macrophages and PMNs in the heart. Conclusions Sepsis induces CML deposition in the heart with a predominant right ventricular inflammation that is significantly augmented by MV, irrespective of the ventilatory strategy.

Kneyber, Martin CJ; Gazendam, Roel P; Niessen, Hans WM; Kuiper, Jan-Willem; Dos Santos, Claudia C; Slutsky, Arthur S; Plotz, Frans B

2009-01-01

337

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

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.

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

2013-01-01

338

Electroporation- and Mechanical Ventilation-Mediated Gene Transfer to the Lung  

PubMed Central

Our lab has previously demonstrated that cytoplasmic trafficking and subsequent nuclear entry of non-viral plasmid DNA can be significantly enhanced through the application of cyclic stretch following transfection in vitro 1,2. Here, we demonstrate that cyclic stretching of the murine lung using ventilation immediately following the endotracheal administration and transthoracic electroporation of plasmid DNA increases exogenous gene expression up to 4-fold over Our mice that were not ventilated after plasmid administration and transfection via electroporation in vivo. This increase is time and sequence specific (i.e. the ventilation must occur immediately after the transfection event). The ventilation-enhanced gene transfer is also amplitude-dependent, confirming similar studies completed in vitro, and is mediated, at least in part, through the cytoplasmic tubulin deacetylase, HDAC6. Using immunohistochemistry, we demonstrate that this increase in expression is due to an increase in the number of cells expressing the exogenous protein rather than an increase in the amount of protein produced per cell. These studies demonstrate the potential mechanical stimulation has in vivo in significantly increasing non-viral DNA gene expression, and may ultimately pave the way for more successful clinical trials using this type of therapy in the future.

Kaufman, Christopher D.; Geiger, R. Christopher; Dean, David A.

2012-01-01

339

Influence of drive and timing mechanisms on breathing pattern and ventilation during mental task performance.  

PubMed

Assessment of multiple respiratory measures may provide insight into how behavioral demands affect the breathing pattern. This is illustrated by data from a study among 44 subjects, in which tidal volume, respiration rate, minute ventilation and indices of central drive and timing mechanisms were assessed via inductive plethysmography, in addition to end-tidal PCO2. After a baseline, three conditions of a memory comparison task were presented. The first two conditions differed only with regard to the presence or absence of feedback of performance (NFB and FB). In the third 'all-or-nothing' (AON) condition, subjects only received a monetary bonus, if their performance exceeded that of the previous two conditions. Minute ventilation increased from baseline to all task conditions, and from NFB and FB to AON. Respiration rate increased in all task conditions, but there were no differences between task conditions. Tidal volume decreased during NFB, but was equal to baseline during FB and AON. Of the respiratory control indices, inspiratory flow rate covaried much more closely with minute ventilation than duty cycle. The task performance induced a minor degree of hyperventilation. The discussion focusses on how behavioral demands affect respiratory control processes to produce alterations in breathing pattern and ventilation. PMID:9792484

Wientjes, C J; Grossman, P; Gaillard, A W

1998-09-01

340

Bronchoscopy during non-invasive mechanical ventilation: a review of techniques and procedures.  

PubMed

Non-invasive mechanical ventilation (NIMV) is used to treat acute respiratory failure by improving gas exchange abnormalities and reducing the signs of respiratory effort, dyspnea and the activity of accessory respiratory muscles. Bronchoscopy is a key technique in the study of respiratory diseases that is necessary to perform in acute and critical patients, often times only after orotracheal intubation (OTI) due to possible complications of the technique. In this review, we evaluate the evidence of NIMV use during bronchoscopy, concluding that its use should be considered in severe patients as an alternative that is capable of preventing the complications related with OTI and mechanical ventilation, especially in patients with chronic obstructive pulmonary disease and with a tendency towards developing hypercapnia. PMID:22819004

Esquinas, Antonio; Zuil, Marcos; Scala, Raffaele; Chiner, Eusebi

2012-07-20

341

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

PubMed Central

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

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

2011-01-01

342

Nutritional depletion in patients on long-term oxygen therapy and\\/or home mechanical ventilation  

Microsoft Academic Search

The purpose of this study was to estimate the prevalence of malnutrition in outpatients on long-term oxygen therapy or home mechanical ventilation, to determine the relationships between malnutrition and impairment\\/disability and smoking and also to identify relevant tools for routine nutritional assessment. In 744 patients (M:F 1.68, aged 65¡15 yrs) with chronic obstructive pulmonary disease (COPD, 40%), restrictive disorders (27%),

N. J. M. Cano; H. Roth; I. Court-Fortune; L. Cynoberz; M. Gerard-Boncompain; J. P. Laaban; J. C. Melchior; C. Pichard; J. C. Raphael; C. M. Pison

2002-01-01

343

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

Microsoft Academic Search

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

Jill P. Karpel; Thomas K. Aldrich

1986-01-01

344

An image-based computational model of ovine lung mechanics and ventilation distribution  

Microsoft Academic Search

A computational model of soft tissue mechanics and air flow has been developed with the aim of linking computed tomography measures of ventilation distribution to subject-specific predictions in image-based geometric (finite element) models of the lung and airway tree. Computational techniques that can deal with anatomical detail and spatially-distributed non-linear material properties have been used to couple solution of parenchymal

Merryn H. Tawhai; Martyn P. Nash; Juerg Tschirren; Eric A. Hoffman; Peter J. Hunter

2005-01-01

345

Effects of PEEP on oxygenation and respiratory mechanics during one-lung ventilation  

Microsoft Academic Search

Background. One-lung ventilation-related hypoxaemia (OLV-RH) can occur in patients with healthy lungs. In this case, PEEP frequently improves oxygenation. The aim of this study was to determine, in a healthy lung model of OLV, whether the increase in PEEP improved oxygenation and whether the mechanisms involved include both inspiratory lung recruitment and an end-expiratory lung volume increase. Since inhaled nitric

P. Michelet; A. Roch; D. Brousse; X.-B. D'Journo; F. Bregeon; D. Lambert; G. Perrin; L. Papazian; P. Thomas; J.-P. Carpentier; J.-P. Auffray

2005-01-01

346

Non-Invasive Ventilation  

Microsoft Academic Search

Mechanical ventilation represents the most widely used supportive technique in the intensive care unit (ICU). Without mechanical\\u000a support for respiration, many patients would die within a few hours due to acute hypoxaemic and hypercapnic respiratory failure.\\u000a Several forms of external support for respiration have been described in the literature to assist the failing ventilatory\\u000a system. Chief among these is endotracheal

A. Peratoner; V. Antonaglia; U. Lucangelo

347

Effect of mechanical ventilation on regional variation of pleural liquid thickness in rabbits.  

PubMed

We studied the effect of ventilation on the regional distribution of pleural liquid thickness in anesthetized rabbits. Three transparent pleural windows were made between the second and eight intercostal space along the midaxillary line of the right chest. Fluorescein isothiocyanate-labeled dextran (1 ml) was injected into the pleural space through a rib capsule and allowed to mix with the pleural liquid. The light emitted from the pleural space beneath the windows was measured by fluorescence videomicroscopy at a constant tidal volume (20 ml) and two ventilation frequencies (20 and 40 breaths/min). Pleural liquid thickness was determined from the light measurements after in vitro calibration of pleural liquid collected postmortem. At 20 breaths/min, pleural liquid thickness increased with a cranial-caudal distance from 5 microns at the second to third intercostal space to 30 microns at the sixth through eighth intercostal space. At 40 breaths/min, pleural space thickness was unchanged at the second to third intercostal space but increased to 46 microns at the sixth through eighth intercostal space. To determine this effect on pleural liquid shear stress, we measured relative lung velocity from videomicroscopic images of the lung surface through the windows. Lung velocity amplitude increased with cranial-caudal distance and with ventilation frequency. Calculated shear stress amplitude was constant with cranial-caudal distance but increased with ventilation frequency. Thus, pleural liquid thickness is matched to the relative lung motion so as to maintain a spatially uniform shear stress amplitude in pleural liquid during mechanical ventilation. PMID:9087944

Wang, P M; Lai-Fook, S J

1997-01-01

348

Mechanical Ventilation Enhances HMGB1 Expression in an LPS-Induced Lung Injury Model  

PubMed Central

Background Mechanical ventilation (MV) can augment inflammatory response in lipopolysaccharide (LPS) challenged lungs. High mobility group box 1 protein (HMGB1) is a pro-inflammatory mediator in ventilator-induced lung injury, but its mechanisms are not well defined. This study investigated the role of HMGB1 in lung inflammation in response to the combination of MV and LPS treatment. Methods Forty-eight male Sprague-Dawley rats were randomized to one of four groups: sham control; LPS treatment; mechanical ventilation; mechanical ventilation with LPS treatment. Mechanically ventilated animals received 10 ml/kg tidal volumes at a rate of 40 breaths/min for 4 h. In the HMGB1-blockade study, sixteen rats were randomly assigned to HMGB1 antibody group or control antibody group and animals were subjected to MV+LPS as described above. A549 cells were pre-incubated with different signal inhibitors before subjected to 4 h of cyclic stretch. Lung wet/dry weight (W/D) ratio, total protein and IgG concentration, number of neutrophils in bronchoalveolar lavage fluid (BALF), and lung histological changes were examined. The levels of interleukin-1? (IL-1?), IL-6, tumor necrosis factor-? (TNF-?), macrophage inflammatory protein-2 (MIP-2) and HMGB1 in BALF were measured using ELISA. Real-time quantitative PCR and Western blot were used to analyze mRNA and protein expression of HMGB1. Western blot were employed to analyze the activation of I?B-?, NF-?B, JNK, ERK, and p38. Results MV significantly augmented LPS-induced lung injury and HMGB1 expression, which was correlated with the increase in IL-1?, IL-6 and MIP-2 levels in BALF. In vivo, intratracheally administration of HMGB1 antibody significantly attenuated pulmonary inflammatory injury. In vitro experiments showed cyclic stretch induced HMGB1 expression through signaling pathways including p38 and NF-?B. Conclusions The findings indicated that moderate tidal volume MV augmented LPS induced lung injury by up-regulating HMGB1. The mechanism of HMGB1-mediated lung injury is likely to be signaling through p38 and NF-?B pathways.

Ding, Ning; Wang, Fang; Xiao, Hui; Xu, Lixin; She, Shouzhang

2013-01-01

349

High-frequency percussive ventilation using the VDR-4 ventilator: an effective strategy for patients with refractory hypoxemia.  

PubMed

High-frequency percussive ventilation (HFPV) has been used for patients with severe respiratory compromise refractory to conventional mechanical ventilation. It frequently results in equivalent or improved oxygenation and ventilation at lower peak pressures than conventional ventilation, thus minimizing secondary ventilator-associated lung injury. The only ventilator currently available that delivers HFPV is the volume diffusive respirator (VDR-4; Percussionaire Corp, Sandpoint, Idaho). High-frequency percussive ventilation is delivered via a pneumatically powered, pressure-limited, time-cycled, high-frequency flow interrupter and provides small tidal volumes with 300 to 700 oscillations per minute. Following transition to HFPV, respiratory status often stabilizes or improves within a few hours. The unique gas flow mobilizes significant volumes of pulmonary secretions, further facilitating gas exchange. This article reviews the operating principles of HFPV, the functional components of the VDR-4, and the special nursing care considerations to include sedation, hemodynamic assessment, skin and oral care, nutrition, and weaning from ventilation. PMID:23095962

Kunugiyama, Sujen K; Schulman, Christine S

350

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 ...

351

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

PubMed

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

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

2008-04-01

352

Mechanisms of decreased left ventricular preload during continuous positive pressure ventilation in ARDS  

SciTech Connect

Continuous positive pressure ventilation is associated with a reduction in left ventricular preload and cardiac output, but the mechanisms responsible are controversial. The decrease in left ventricular preload may result exclusively from a decreased systemic venous return due to increased pleural pressure, or from an additional effect such as decreased left ventricular compliance. To determine the mechanisms responsible, we studied the changes in cardiac output induced by continuous positive pressure ventilation in eight patients with the adult respiratory distress syndrome. We measured cardiac output by thermodilution, and biventricular ejection fraction by equilibrium gated blood pool scintigraphy. Biventricular end-diastolic volumes were then calculated by dividing stroke volume by ejection fraction. As positive end-expiratory pressure increased from 0 to 20 cm H/sub 2/O, stroke volume and biventricular end-diastolic volumes fell about 25 percent, and biventricular ejection fraction remained unchanged. At 20 cm H/sub 2/O positive end-expiratory pressure, volume expansion for normalizing cardiac output restored biventricular end-diastolic volumes without markedly changing biventricular end-diastolic transmural pressures. The primary cause of the reduction in left ventricular preload with continuous positive pressure ventilation appears to be a fall in venous return and hence in right ventricular stroke volume, without evidence of change in left ventricular diastolic compliance.

Dhainaut, J.F.; Devaux, J.Y.; Monsallier, J.F.; Brunet, F.; Villemant, D.; Huyghebaert, M.F.

1986-07-01

353

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

PubMed

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

Pelosi, Paolo; Vargas, Maria

2012-12-18

354

"Expiratory holding" approach in measuring end-expiratory pulmonary artery wedge pressure for mechanically ventilated patients  

PubMed Central

Objective To accurately measure the end-expiratory pulmonary artery wedge pressure (PAWP) with the “expiration holding” function on the ventilator and the “pulmonary artery wedge pressure review” software on the monitor. Materials and methods Fifty prospective measurements were made on 12 patients undergoing pulmonary artery catheter and mechanical ventilation. All measurements were divided into <8 mmHg or ?8 mmHg subgroups according to respiratory variability, and they were then subdivided into either an airway pressure display measurement group (AM group) or an expiration holding (EH) group for comparison. Results In all measurements, the two groups showed similar levels of accuracy; however, for the time spent for measurement, the EH group was much faster than the airway pressure display measurement group (P<0.001). Additionally, the EH group was associated with lower medical costs. Conclusion The expiration holding approach measured the PAWP more accurately, more quickly, and with reduced costs in comparison to the airway pressure display approach.

Yang, Wanjie; Zhao, Xuefeng; Feng, Qingguo; An, Youzhong; Wei, Kai; Wang, Wei; Li, Chang; Cheng, Xiuling

2013-01-01

355

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

PubMed

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

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

2013-03-01

356

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

NASA Astrophysics Data System (ADS)

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

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

2007-03-01

357

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

NASA Astrophysics Data System (ADS)

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.

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

2013-03-01

358

Measurement of pressure-volume curves in patients on mechanical ventilation: methods and significance  

Microsoft Academic Search

Physiological background concerning mechanics of the respiratory\\u0009\\u0009\\u0009 system, techniques of measurement and clinical implications of pressure-volume\\u0009\\u0009\\u0009 curve measurement in mechanically ventilated patients are discussed in the\\u0009\\u0009\\u0009 present review. The significance of lower and upper inflection points, the\\u0009\\u0009\\u0009 assessment of positive end-expiratory pressure (PEEP)-induced alveolar\\u0009\\u0009\\u0009 recruitment and overdistension and rationale for optimizing ventilatory\\u0009\\u0009\\u0009 settings in patients with acute lung injury are

Qin Lu; Jean-Jacques Rouby

2000-01-01

359

Comparison of High Frequency Positive Pressure Mechanical Ventilation (HFPPV) With Conventional Method in the Treatment of Neonatal Respiratory Failure  

PubMed Central

Background Respiratory failure is a major problem in neonatal medicine in all over the world and has different causes. Using mechanical ventilation is one of its major treatments. Objectives Different strategies have been expressed in this context, including high frequency mechanical ventilation. Patients and Methods This study is a prospective randomized clinical trial conducted on all newborns with respiratory failure hospitalized in the NICU of Tehran vali-asr Hospital during 2009.These patients were divided in to two groups through block Randomization method; conventional mechanical ventilation group and high frequency ventilation group. Results Intraventricular hemorrhage (IVH) and air leak (e.g. pneumothorax) were less in HFPPV group than conventional group (P = 0.012 and P = 0.038). The mean time needed for mechanical ventilation was lower in HFPPV group, but this difference was not statistically significant (P = 0.922). Needing to O2 in 28 days of age was almost equal in both groups (P = 0. 99). Mortality, and refractory hypoxia and PVL were lower in HFPPV group, but the difference was not statistically significant (P = 0.301, P = 0. 508, P = 0. 113). Conclusions Treatment of neonatal respiratory failure with high rate mechanical ventilation may reduce some complications.

Amini, Elahe; Nayeri, Fatemeh Sadat; Hemati, Arezu; Esmaeilinia, Tahere; Nili, Firuzeh; Dalili, Hossein; Aminnejad, Majid

2013-01-01

360

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

PubMed Central

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

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

2007-01-01

361

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

SciTech Connect

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

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

1993-09-01

362

Skin breakdown in children and high-frequency oscillatory ventilation  

Microsoft Academic Search

Objective: To investigate the relationship of high-frequency oscillatory ventilation (HFOV) to skin breakdown on the scalp and ears in mechanically ventilated children.Study Design: Retrospective cohort study of 32 patients supported with HFOV paired with 32 patients supported with conventional mechanical ventilation (CV) in a pediatric intensive care unit (PICU).Results: By univariate analysis, more HFOV patients had skin breakdown than did

Jeffrey E. Schmidt; Richard J. Berens; Mary B. Zollo; Margaret Weisner; Carl G. M. Weigle

1998-01-01

363

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

PubMed Central

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.

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

364

Positive End-Expiratory Pressure may alter breathing cardiovascular variability and baroreflex gain in mechanically ventilated patients  

PubMed Central

Background Baroreflex allows to reduce sudden rises or falls of arterial pressure through parallel RR interval fluctuations induced by autonomic nervous system. During spontaneous breathing, the application of positive end-expiratory pressure (PEEP) may affect the autonomic nervous system, as suggested by changes in baroreflex efficiency and RR variability. During mechanical ventilation, some patients have stable cardiorespiratory phase difference and high-frequency amplitude of RR variability (HF-RR amplitude) over time and others do not. Our first hypothesis was that a steady pattern could be associated with reduced baroreflex sensitivity and HF-RR amplitude, reflecting a blunted autonomic nervous function. Our second hypothesis was that PEEP, widely used in critical care patients, could affect their autonomic function, promoting both steady pattern and reduced baroreflex sensitivity. Methods We tested the effect of increasing PEEP from 5 to 10 cm H2O on the breathing variability of arterial pressure and RR intervals, and on the baroreflex. Invasive arterial pressure, ECG and ventilatory flow were recorded in 23 mechanically ventilated patients during 15 minutes for both PEEP levels. HF amplitude of RR and systolic blood pressure (SBP) time series and HF phase differences between RR, SBP and ventilatory signals were continuously computed by complex demodulation. Cross-spectral analysis was used to assess the coherence and gain functions between RR and SBP, yielding baroreflex-sensitivity indices. Results At PEEP 10, the 12 patients with a stable pattern had lower baroreflex gain and HF-RR amplitude of variability than the 11 other patients. Increasing PEEP was generally associated with a decreased baroreflex gain and a greater stability of HF-RR amplitude and cardiorespiratory phase difference. Four patients who exhibited a variable pattern at PEEP 5 became stable at PEEP 10. At PEEP 10, a stable pattern was associated with higher organ failure score and catecholamine dosage. Conclusions During mechanical ventilation, stable HF-RR amplitude and cardiorespiratory phase difference over time reflect a blunted autonomic nervous function which might worsen as PEEP increases.

2010-01-01

365

Effect of residual leaning force on intrathoracic pressure during mechanical ventilation in children?  

PubMed Central

Aim Determine the effect of residual leaning force on intrathoracic pressure (ITP) in healthy children receiving mechanical ventilation. We hypothesized that application of significant residual leaning force (2.5 kg or 20% of subject body weight) would be associated with a clinically important change in ITP. Methods IRB-approved pilot study of healthy, anesthetized, paralyzed mechanically ventilated children (6 months to 7 years). Peak endotracheal pressure (ETP), a surrogate of ITP, was continuously measured before and during serial incremental increases in sternal force from 10% to 25% of the subject’s body weight. A delta ETP of ?2.0 cmH2O was considered clinically significant. Results 13 healthy, anesthetized, paralyzed mechanically ventilated children (age: 26 ± 24 m, range: 6.5–87 m; weight: 13 ± 5 kg, range: 7.4–24.8 kg) were enrolled. Peak ETP increased from baseline for all force applications (10% body weight: mean difference of 0.8 cmH2O, p < 0.01; 15% body weight: mean difference of 1.1 cmH2O, p < 0.01; 20% body weight: mean difference of 1.5 cmH2O, p < 0.01; 25% body weight: mean difference of 1.89 cmH2O, p < 0.01). Residual leaning force of ?2.5 kg was associated with a 2.0 cmH2O change in peak ETP (odds ratio 7.5; CI95 1.5–37.7; p = 0.014) while sternal force ?20% body weight was not (odds ratio 2.4; CI95 0.6–9.2; p = 0.2). Conclusion In healthy anesthetized children, changes in ETP were detectable at residual leaning forces as low as 10% of subject body weight. Residual leaning force of 2.5 kg was associated with increases in ETP ?2.0 cmH2O.

Sutton, Robert Michael; Niles, Dana; Nysaether, Jon; Stavland, Mette; Thomas, Melissa; Ferry, Susan; Bishnoi, Ram; Litman, Ronald; Allen, Julian; Srinivasan, Vijay; Berg, Robert A.; Nadkarni, Vinay M.

2013-01-01

366

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

Microsoft Academic Search

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

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

2011-01-01

367

Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency  

Microsoft Academic Search

Study design:Prospective clinical study of two treatments.Objective:To compare mechanical ventilation (MV) with phrenic nerve stimulation (PNS) for treatment of respiratory device-dependent (RDD) spinal cord-injured (SCI) patients.Setting:Department for spinal cord-injured patients of an insurance-company-run trauma hospital in Hamburg, Germany.Methods:Prospective data collection of treatment-related data over 20 years.Results:In total, 64 SCI-RDD patients were treated during the study period. Of these, 32 of

S Hirschfeld; G Exner; T Luukkaala; G A Baer

2008-01-01

368

Dynamic and Quasi-Static Lung Mechanics System for Gas-Assisted and Liquid-Assisted Ventilation  

Microsoft Academic Search

Our aim was to develop a computerized system for real-time monitoring of lung mechanics measurements during both gas and liquid ventilation. System accuracy was demonstrated by calculating regression and percent error of the following parameters compared to standard device: airway pressure difference (DeltaPaw), respiratory frequency (fR ), tidal volume (VT), minute ventilation (V'E), inspiratory and expiratory maximum flows (V'ins,max, V'exp,max),

Francisco J. Alvarez; Elena Gastiasoro; M. Carmen Rey-Santano; Miguel A. Gomez-Solaetxe; Nelson G. Publicover; Juan L. Larrabe

2009-01-01

369

Nasal ventilation.  

PubMed Central

Nasal intermittent positive pressure ventilation is likely to have an increasing role in the management of acute ventilatory failure, weaning, and chronic ventilatory problems. Further improvements in ventilator and mask design will be seen. Appropriate application is likely to reduce both mortality and admissions to intensive care, while domiciliary use can improve life expectancy and/or quality of life in chronic ventilatory disorders. As with any new technique, enthusiasm should not outweigh clear outcome information, and possible new indications should always be subject to careful assessment. Images Figure 2

Simonds, A. K.

1998-01-01

370

Outcomes of prolonged mechanic ventilation: a discrimination model based on longitudinal health insurance and death certificate data  

PubMed Central

Background This study investigated prognosis among patients under prolonged mechanical ventilation (PMV) through exploring the following issues: (1) post-PMV survival rates, (2) factors associated with survival after PMV, and (3) the number of days alive free of hospital stays requiring mechanical ventilation (MV) care after PMV. Methods This is a retrospective cohort study based on secondary analysis of prospectively collected data in the national health insurance system and governmental data on death registry in Taiwan. It used data for a nationally representative sample of 25,482 patients becoming under PMV (> = 21 days) during 1998-2003. We calculated survival rates for the 4 years after PMV, and adopted logistic regression to construct prediction models for 3-month, 6-month, 1-year, and 2-year survival, with data of 1998-2002 for model estimation and the 2003 data for examination of model performance. We estimated the number of days alive free of hospital stays requiring MV care in the immediate 4-year period after PMV, and contrasted patients who had low survival probability with all PMV patients. Results Among these patients, the 3-month survival rate was 51.4%, and the 1-year survival rate was 31.9%. Common health conditions with significant associations with poor survival included neoplasm, acute and unspecific renal failure, chronic renal failure, non-alcoholic liver disease, shock and septicaemia (odd ratio < 0.7, p < 0.05). During a 4-year follow-up period for patients of year 2003, the mean number of days free of hospital stays requiring MV was 66.0 in those with a predicted 6-month survival rate < 10%, and 111.3 in those with a predicted 2-year survival rate < 10%. In contrast, the mean number of days was 256.9 in the whole sample of patients in 2003. Conclusions Neoplasm, acute and unspecific renal failure, shock, chronic renal failure, septicemia, and non-alcoholic liver disease are significantly associated with lower survival among PMV patients. Patients with anticipated death in a near future tend to spend most of the rest of their life staying in hospital using MV services. This calls for further research into assessing PMV care need among patients at different prognosis stages of diseases listed above.

2012-01-01

371

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

PubMed Central

Rationale: Mechanical ventilation induces heterogeneous lung injury by mitogen-activated protein kinase (MAPK) and nuclear factor-?B. Mechanisms regulating regional injury and protective effects of prone positioning are unclear. Objectives: To determine the key regulators of the lung regional protective effects of prone positioning in rodent lungs exposed to injurious ventilation. Methods: Adult rats were ventilated with high (18 ml/kg, positive end-expiratory pressure [PEEP] 0) or low Vt (6 ml/kg; PEEP 3 cm H2O; 3 h) in supine or prone position. Dorsal–caudal lung mRNA was analyzed by microarray and MAPK phosphatases (MKP)-1 quantitative polymerase chain reaction. MKP-1?/? or wild-type mice were ventilated with very high (24 ml/kg; PEEP 0) or low Vt (6–7 ml/kg; PEEP 3 cm H2O). The MKP-1 regulator PG490-88 (MRx-108; 0.75 mg/kg) or phosphate-buffered saline was administered preventilation. Injury was assessed by lung mechanics, bronchioalveolar lavage cell counts, protein content, and lung injury scoring. Immunoblotting for MKP-1, and I?B? and cytokine ELISAs were performed on lung lysates. Measurements and Main Results: Prone positioning was protective against injurious ventilation in rats. Expression profiling demonstrated MKP-1 20-fold higher in rats ventilated prone rather than supine and regional reduction in p38 and c-jun N-terminal kinase activation. MKP-1?/? mice experienced amplified injury. PG490-88 improved static lung compliance and injury scores, reduced bronchioalveolar lavage cell counts and cytokine levels, and induced MKP-1 and I?B?. Conclusions: Injurious ventilation induces MAPK in an MKP-1–dependent fashion. Prone positioning is protective and induces MKP-1. PG490-88 induced MKP-1 and was protective against high Vt in a nuclear factor-?B–dependent manner. MKP-1 is a potential target for modulating regional effects of injurious ventilation.

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

2012-01-01

372

Reduction of ventilator-associated pneumonia in the Neuroscience Intensive Care Unit: a Multimodality Prevention And Testing Protocol.  

PubMed

Aim: Ventilator-associated pneumonia (VAP) is a serious concern for patients in the Neuroscience Intensive Care Unit (NSICU). The risks to patients are significant and the monetary costs are astronomical. We review a multimodality approach that substantially reduced VAP rate in our ICU Methods: Data from all patients admitted to the NSICU between January 2005 and April 2010 were reviewed. All ventilated patients were treated according to a multimodality VAP assessment and prevention protocol, implementation of which began in August of 2008 and was completed by March 2009. Rates of VAP before, during, and after implementation of the protocol are compared. VAP rates are also compared to national rates as obtained from the National Healthcare Safety Network (NHSN). Results: In the pre-implementation period, the VAP rate was 11.6 per 1000 ventilator days. This rate was twice the national average. In the post implementation period, the VAP rate was 5.5/1000 ventilator days. VAP rate dropped precipitously after full compliance with the protocol was achieved. Conclusion: Although intubated patients in the NSICU are at high risk for VAP, a significant reduction in VAP-related morbidity and monetary costs can be obtained with multimodality prevention and testing protocols. PMID:24091431

Johnson, M; Rocque, B; Kamps, T; Medow, J

2013-12-01

373

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

PubMed Central

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.

Yamaguchi, Miku; Suzuki, Machiko

2013-01-01

374

A critical examination of ducted mechanical ventilation in new residential housing in the Pacific Northwest  

SciTech Connect

Several programs have been undertaken in the Pacific Northwest Region to demonstrate new energy-efficient housing construction practices. These programs, sponsored by the Bonneville Power Administration (BPA), have spawned the construction of hundreds of tight, energy-efficient single-family, multifamily, and manufactured homes that are equipped with mechanical ventilation equipment, primarily a whole-house air-to-air heat exchanger (AAHX). The design and installation of an AAHX is a new and developing technology in the Northwest. Although builders received instruction and guidance in installing an AAHX, field data indicates that many of the early installations did not perform as designed. Specifically, in many dwellings, the location of fresh air intake and exhaust ducts was less than optimum, resulting in exhaust air being pulled into the dwelling through the fresh air intake. This paper critically examines AAHX installations in several dwelling types. Field data taken in two energy-efficient manufactured homes showed a significant improvement in fresh air exchange rate after relocating the exhaust air duct of the AAHX in each home. The whole-house air exchange rates, measured by tracer gas, increased by greater than 50/percent/ in each home after the exhaust ducts were moved away from the intake ducts. The duct relocation significantly reduced the probability of contaminated air entering the fresh air intake duct. This experiment has led to developing improved proposed guidelines for design and installation of mechanical ventilation equipment in energy-efficient manufactured homes. 23 refs.

Parker, G. B.

1988-03-01

375

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

Microsoft Academic Search

Introduction  Hospitals are increasingly forced to consider the economics of technology use. We estimated the incremental cost-consequences\\u000a of remifentanil-based analgo-sedation (RS) vs. conventional analgesia and sedation (CS) in patients requiring mechanical ventilation\\u000a (MV) in the intensive care unit (ICU), using a modelling approach.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A Markov model was developed to describe patient flow in the ICU. The hourly probabilities to move from

Maiwenn J Al; Leona Hakkaart; Siok Swan Tan; Jan Bakker

2010-01-01

376

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

PubMed Central

Background Liberation from the ventilator is a difficult task, whereas early echocardiographic indices of weaning readiness are still lacking. The aim of this study was to test whether tricuspid annular plane systolic excursion (TAPSE) and right ventricular (RV) systolic (Sm) and diastolic (Em & Am) tissue Doppler imaging (TDI) velocities are related with duration of weaning in mechanically ventilated patients with acute respiratory failure due to acute pulmonary edema (APE). Methods Detailed quantification of left and right ventricular systolic and diastolic function was performed at admission to the Intensive Care Unit by Doppler echocardiography, in a cohort of 32 mechanically ventilated patients with APE. TAPSE and RV TDI velocities were compared between patients with and without prolonged weaning (? or < 7 days from the first weaning trial respectively), whereas their association with duration of ventilation and left ventricular (LV) echo-derived indices was tested with multivariate linear and logistic regression analysis. Results Patients with prolonged weaning (n = 12) had decreased TAPSE (14.59 ± 1.56 vs 19.13 ± 2.59 mm), Sm (8.68 ± 0.94 vs 11.62 ± 1.77 cm/sec) and Em/Am ratio (0.98 ± 0.80 vs 2.62 ± 0.67, p <0.001 for all comparisons) and increased ?/e' (11.31 ± 1.02 vs 8.98 ± 1.70, p <0.001) compared with subjects without prolonged weaning (n = 20). Logistic regression analysis revealed that TAPSE (R2 = 0.53, beta slope = 0.76, p < 0.001), Sm (R2 = 0.52, beta = 0.75, p < 0.001) and Em/Am (R2 = 0.57, beta = 0.32, p < 0.001) can predict length of weaning ? 7 days. The above measures were also proven to correlate significantly with ?/e' (r = -0.83 for TAPSE, r = -0.87 for Sm and r = -0.79 for Em/Am, p < 0.001 for all comparisons). Conclusions We suggest that in mechanically ventilated patients with APE, low TAPSE and RV TDI velocities upon admission are associated with delayed liberation from mechanical ventilation, probably due to more severe LV heart failure.

2010-01-01

377

Pathogenic analysis of sputum from ventilator-associated pneumonia in a pediatric intensive care unit.  

PubMed

Ventilator-associated pneumonia (VAP) is a common and sometimes fatal complication in pediatric intensive care units (PICU). The aim of our study was to characterize the distribution and drug susceptibility of the pathogens isolated from the sputum of patients with VAP in the PICU of our hospital and to provide support to the administration of antibiotics early and reasonably in the clinic. Our study was conducted between January 2007 and December 2011 at the PICU of the Children's Hospital of Zhejiang University School of Medicine. The endotracheal aspirates were collected and transported to a microbiology laboratory within 15 min. The pathogens were routinely analyzed and identified with Vitek 60 and Kirby-Bauer disk diffusion methods. Among the 121 VAP patients, 127 pathogenic strains were isolated from sputum specimens. Gram-negative and gram-positive bacteria and fungi accounted for 64.57% (82/127), 29.92% (38/127) and 5.51% (7/127), respectively. Acinetobacter baumannii (25.61%), Escherichia coli (20.27%), Stenotrophomonas maltophilia (20.27%), Klebsiella pneumoniae (16.22%) and Pseudomonas aeruginosa (9.46%) were frequently identified isolates among gram-negative bacteria. Staphylococci were susceptible to vancomycin and linezolid. All fungi were sensitive to the antimicrobial agents. The gram-negative bacteria were more prevalent than gram-positive bacteria and fungi in VAP and demonstrated a higher drug resistance. It is important to administer antimicrobial agents early and reasonably for children with VAP. Knowledge of antibiotic resistance and the characteristics of drug resistance is important for VAP prophylaxis and treatment. PMID:23251300

Ning, Bo-Tao; Zhang, Chen-Mei; Liu, Tao; Ye, Sheng; Yang, Zi-Hao; Chen, Zhen-Jie

2012-10-22

378

Pathogenic analysis of sputum from ventilator-associated pneumonia in a pediatric intensive care unit  

PubMed Central

Ventilator-associated pneumonia (VAP) is a common and sometimes fatal complication in pediatric intensive care units (PICU). The aim of our study was to characterize the distribution and drug susceptibility of the pathogens isolated from the sputum of patients with VAP in the PICU of our hospital and to provide support to the administration of antibiotics early and reasonably in the clinic. Our study was conducted between January 2007 and December 2011 at the PICU of the Children’s Hospital of Zhejiang University School of Medicine. The endotracheal aspirates were collected and transported to a microbiology laboratory within 15 min. The pathogens were routinely analyzed and identified with Vitek 60 and Kirby-Bauer disk diffusion methods. Among the 121 VAP patients, 127 pathogenic strains were isolated from sputum specimens. Gram-negative and gram-positive bacteria and fungi accounted for 64.57% (82/127), 29.92% (38/127) and 5.51% (7/127), respectively. Acinetobacter baumannii (25.61%), Escherichia coli (20.27%), Stenotrophomonas maltophilia (20.27%), Klebsiella pneumoniae (16.22%) and Pseudomonas aeruginosa (9.46%) were frequently identified isolates among gram-negative bacteria. Staphylococci were susceptible to vancomycin and linezolid. All fungi were sensitive to the antimicrobial agents. The gram-negative bacteria were more prevalent than gram-positive bacteria and fungi in VAP and demonstrated a higher drug resistance. It is important to administer antimicrobial agents early and reasonably for children with VAP. Knowledge of antibiotic resistance and the characteristics of drug resistance is important for VAP prophylaxis and treatment.

NING, BO-TAO; ZHANG, CHEN-MEI; LIU, TAO; YE, SHENG; YANG, ZI-HAO; CHEN, ZHEN-JIE

2013-01-01

379

Vigorous cleaning and adequate ventilation are necessary to control an outbreak in a neonatal intensive care unit.  

PubMed

An outbreak of Bacillus cereus (B. cereus) bacteremia occurred in our neonatal intensive care unit (NICU) in July 2005. Many strains of B. cereus were cultured from patient specimens, as well as from environmental samples such as the surfaces of instruments and air in the NICU. Some of these strains were analyzed by pulsed field gel electrophoresis, and several were confirmed to be identical. We speculated that the bacterial load in the environment had initially increased and then possibly spread throughout the NICU facility via the airflow of the ventilation system. For this reason, besides maintaining standard precautions, we performed a vigorous clean of the NICU, and covered the vents to prevent dust falling from them. These protective measures ended the outbreak. In the hospital environment, adequate ventilation is important, especially in single-occupancy isolation rooms and operating theaters. However, the criteria for the adequate ventilation of multioccupancy rooms for acute care environments such as the NICU have not yet been defined. We need to pay more attention to these environmental factors in order to avoid cross contamination and infectious outbreaks. PMID:22038125

Shimono, Nobuyuki; Hayashi, Jun; Matsumoto, Hiroko; Miyake, Noriko; Uchida, Yujiro; Shimoda, Shinji; Furusyo, Norihiro; Akashi, Koichi

2011-10-26

380

Mechanical ventilation reduces rat diaphragm blood flow and impairs O2 delivery and uptake  

PubMed Central

Objectives Although mechanical ventilation (MV) is a life-saving intervention in patients suffering from respiratory failure, prolonged MV is often associated with numerous complications including problematic weaning. In contracting skeletal muscle, inadequate O2 supply can limit oxidative phosphorylation resulting in muscular fatigue. However, whether prolonged MV results in decreased diaphragmatic blood and induces an O2 supply-demand imbalance in the diaphragm remains unknown. Design We tested the hypothesis that prolonged controlled MV results in a time-dependent reduction in rat diaphragmatic blood flow and microvascular PO2 and that prolonged MV would diminish the diaphragm’s ability to increase blood flow in response to muscular contractions. Measurements and Main Results Compared to 30 min of MV, 6 hrs of MV resulted in a 75% reduction in diaphragm blood flow (via radiolabeled microspheres), which did not occur in the intercostal muscle or high-oxidative hindlimb muscle (e.g., soleus). There was also a time-dependent decline in diaphragm microvascular PO2 (via phosphorescence quenching). Further, when contrasted to 30 min of MV, 6 hrs of MV significantly compromised the diaphragm’s ability to increase blood flow during electrically-induced contractions which resulted in a ~80% reduction in diaphragm O2 uptake. In contrast, 6 hrs of spontaneous breathing in anesthetized animals did not alter diaphragm blood flow or the ability to augment flow during electrically-induced contractions. Conclusions These new and important findings reveal that prolonged MV results in a time-dependent decrease in the ability of the diaphragm to augment blood flow to match O2 demand in response to contractile activity and could be a key contributing factor to difficult weaning. Although additional experiments are required to confirm, it is tempting to speculate that this ventilator-induced decline in diaphragmatic oxygenation could promote a hypoxia-induced generation of reactive oxygen species in diaphragm muscle fibers and contribute to ventilator-induced diaphragmatic atrophy and contractile dysfunction.

Davis, Robert T.; Bruells, Christian S.; Stabley, John N.; McCullough, Danielle J.; Powers, Scott K.; Behnke, Bradley J.

2012-01-01

381

[Use of noninvasive assisted lung ventilation in children in intensive care units].  

PubMed

Thirty-six patients aged 2 months to 14 years were observed. Noninvasive assisted ventilation of the lungs (NAVL) was performed through Respironix Inc. masks (USA) with Puritan-Bennet 7200, Bear 1000, and Bear 750 respirators in the SIMV + PS, CPAP + PS modes with manual regulation of the supporting pressure level. Respiratory rate, heart rate, respiratory volume, pO2, pCO2, SpO2, stroke volume, and minute volume of the heart were evaluated. During development of central respiratory failure in the early postoperative period or in case of forced deep medicamentous neuroplegia NAVL normalized the external respiration function and promoted adequate ventilation of the lungs; in the majority of cases with development of restrictive respiratory failure (RF) it improved ventilation of the lungs and therefore no intubation of the trachea and transfer to forced ventilation was needed. NAVL is indicated as a component of multiple-modality treatment for obstructive RF. PMID:10769465

Ostre?kov, I F; Shtatnov, M K; Nikitin, V V; Tarasov, S V; Liapunov, A V

382

Respiratory mechanics during high-frequency oscillatory ventilation: a physical model and preterm infant study.  

PubMed

Accurate mechanics measurements during high-frequency oscillatory ventilation (HFOV) facilitate optimizing ventilator support settings. Yet, these are influenced substantially by endotracheal tube (ETT) contributions, which may dominate when leaks around uncuffed ETT are present. We hypothesized that 1) the effective removal of ETT leaks may be confirmed via direct comparison of measured vs. model-predicted mean intratracheal pressure [mPtr (meas) vs. mPtr (pred)], and 2) reproducible respiratory system resistance (Rrs) and compliance (Crs) may be derived from no-leak oscillatory Ptr and proximal flow. With the use of ETT test-lung models, proximal airway opening (Pao) and distal (Ptr) pressures and flows were measured during slow-cuff inflations until leaks are removed. These were repeated for combinations of HFOV settings [frequency, mean airway pressure (Paw), oscillation amplitudes (?P), and inspiratory time (%t(I))] and varying test-lung Crs. Results showed that leaks around the ETT will 1) systematically reduce the effective distending pressures and lung-delivered oscillatory volumes, and 2) derived mechanical properties are increasingly nonphysiologic as leaks worsen. Mean pressures were systematically reduced along the ventilator circuit and ETT (Paw > Pao > Ptr), even for no-leak conditions. ETT size-specific regression models were then derived for predicting mPtr based on mean Pao (mPao), ?P, %t(I), and frequency. Next, in 10 of 11 studied preterm infants (0.77 ± 0.24 kg), no-to-minimal leak was confirmed based on excellent agreement between mPtr (meas) and mPtr (pred), and consequently, their oscillatory respiratory mechanics were evaluated. Infant resistance at the proximal ETT (R(ETT); resistance airway opening = R(ETT) + Rrs; P < 0.001) and ETT inertance (P = 0.014) increased significantly with increasing ?P (50%, 100%, and 150% baseline), whereas Rrs showed a modest, nonsignificant increase (P = 0.14), and Crs was essentially unchanged (P = 0.39). We conclude that verifying no-leak conditions is feasible by comparison of model-derived vs. distending mPtr (meas). This facilitated the reliable and accurate assessment of physiologic respiratory mechanical properties that can objectively guide ventilatory management of HFOV-treated preterm infants. PMID:22207721

Singh, Rachana; Courtney, Sherry E; Weisner, Michael D; Habib, Robert H

2011-12-29

383

Predictive equation for assessing energy expenditure in mechanically ventilated critically ill patients.  

PubMed

Traditional formulas, such as the Harris and Benedict equation (HBE), do not accurately predict energy expenditure (EE) in mechanically ventilated, critically ill patients (MVCIP). The purpose of this study was to develop a predictive EE equation to assess EE requirements in MVCIP. A portable metabolic cart was used to measure indirectly EE in 112 MVCIP. Patients were studied at rest and for 30 min on the first or second day of ICU admission. No nutrition was received during the study period. Variables investigated were: age, BSA, Acute Physiology and Chronic Health Evaluation (APACHE II) score, sepsis score, Injury Severity Score (ISS), respiratory rate (f), tidal volume (VT), minute ventilation, mean arterial pressure, heart rate, body temperature (Temp), and outcome. Patient age, APACHE II score, sepsis score, ISS, and BSA were 50 +/- 20 yr, 16 +/- 7, 11 +/- 6, 32 +/- 14, and 1.80 +/- 0.27 m2, respectively. Correlation and multiple regression analyses were used with EE as the dependent variable. A predictive equation (EE [kcal/day] = 945 BSA -6.4 age + 108 Temp + 24.2 f + 817 VT -4349) was determined from variables that contributed greater than 3% to the variance of EE: BSA (52%), age (10%), f (5%), VT (5%), and Temp (3%). The HBE underestimated measured EE by 34 +/- 19% and in 79 patients deviated greater than 15%. Using the new equation, only 15 patients' EE deviated greater than 15% from measured EE. The new predictive EE equation can accurately assess EE in MVCIP. PMID:2344758

Swinamer, D L; Grace, M G; Hamilton, S M; Jones, R L; Roberts, P; King, E G

1990-06-01

384

Intelligent model-based advisory system for the management of ventilated intensive care patients: Hybrid blood gas patient model.  

PubMed

Arterial blood gas (ABG) analyses are essential for assessing the acid-base status and guiding the adjustment of mechanical ventilation in critically ill patients. Conventional ABG sampling requires repeated arterial punctures or the insertion of an arterial catheter causing pain, haemorrhage and thrombosis to the patients. Less invasive and non-invasive blood gas analysers, with a technology still in transition, have offered some promise in the recent years. SOPAVent (Simulation of Patients under Artificial Ventilation) is a five compartment blood gas model which captures the basic features of respiratory physiology and gas exchange in the human lungs. It uses ventilator settings and routinely monitored physiological parameters as inputs to produce steady-state estimates of the patient's ABG. This paper overviews the original SOPAVent model and presents an improved data-driven hybrid model that is patient-specific and gives continuous and totally non-invasive ABG predictions. The model has been comprehensively tested in simulations and validated using recorded measurements of ABG and ventilator parameters from ICU patients. PMID:19864039

Wang, A; Mahfouf, M; Mills, G H; Panoutsos, G; Linkens, D A; Goode, K; Kwok, H F; Denaï, M

2009-10-27

385

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

PubMed Central

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

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

2012-01-01

386

Effects of Different Peep Levels on Mesenteric Leukocyte-Endothelial Interactions in Rats During Mechanical Ventilation  

PubMed Central

INTRODUCTION: Mechanical ventilation with positive end expiratory pressure (PEEP) improves oxygenation and treats acute pulmonary failure. However, increased intrathoracic pressure may cause regional blood flow alterations that may contribute to mesenteric ischemia and gastrointestinal failure. We investigated the effects of different PEEP levels on mesenteric leukocyte-endothelial interactions. METHODS: Forty-four male Wistar rats were initially anesthetized (Pentobarbital I.P. 50mg/kg) and randomly assigned to one of the following groups: 1) NAIVE (only anesthesia; n=9), 2) PEEP 0 (PEEP of 0 cmH2O, n=13), 3) PEEP 5 (PEEP of 5 cmH2O, n=12), and 4) PEEP 10 (PEEP of 10 cmH2O, n=13). Positive end expiratory pressure groups were tracheostomized and mechanically ventilated with a tidal volume of 10 mL/kg, respiratory rate of 70 rpm, and inspired oxygen fraction of 1. Animals were maintained under isoflurane anesthesia. After two hours, laparotomy was performed, and leukocyte-endothelial interactions were evaluated by intravital microscopy. RESULTS: No significant changes were observed in mean arterial blood pressure among groups during the study. Tracheal peak pressure was smaller in PEEP 5 compared with PEEP 0 and PEEP 10 groups (11, 15, and 16 cmH2O, respectively; p<0.05). After two hours of MV, there were no differences among NAIVE, PEEP 0 and PEEP 5 groups in the number of rollers (118±9,127±14 and 147±26 cells/10minutes, respectively), adherent leukocytes (3±1,3±1 and 4±2 cells/100?m venule length, respectively), and migrated leukocytes (2±1,2±1 and 2±1 cells/5,000?m2, respectively) at the mesentery. However, the PEEP 10 group exhibited an increase in the number of rolling, adherent and migrated leukocytes (188±15 cells / 10 min, 8±1 cells / 100 ?m and 12±1 cells / 5,000 ?m2, respectively; p<0.05). CONCLUSIONS: High intrathoracic pressure was harmful to mesenteric microcirculation in the experimental model of rats with normal lungs and stable systemic blood pressure, a finding that may have relevance for complications related to mechanical ventilation.

Aikawa, Priscila; Farsky, Sandra Helena Poliselli; de Oliveira, Maria Aparecida; Pazetti, Rogerio; Mauad, Thais; Sannomiya, Paulina; Nakagawa, Naomi Kondo

2009-01-01

387

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

Code of Federal Regulations, 2012 CFR

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

2012-10-01

388

Liquid Ventilation  

PubMed Central

Mammals have lungs to breathe air and they have no gills to breath liquids. 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 theoretical 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. The potential for multiple clinical applications for liquid-assisted ventilation will be clarified and optimized in future.

Tawfic, Qutaiba A.; Kausalya, Rajini

2011-01-01

389

Transporting newborn infants with suspected duct dependent congenital heart disease on low-dose prostaglandin E1 without routine mechanical ventilation  

PubMed Central

Aim To evaluate the safety of transporting newborn infants with suspected duct dependent congenital heart disease (CHD) treated with prostaglandin E1 (PGE1) without routine mechanical ventilation. Methods A retrospective population?based audit of newborn infants with suspected CHD transported on PGE1 by the New South Wales newborn and paediatric Transport Service from 1995 through 2005. Results Mechanical ventilation was not used prior to treatment with PGE1 in 94 (31%) of the 300 infants. The indications for mechanical ventilation in the remaining 206 infants (69%) included elective mechanical ventilation because of the intention to use PGE1 (n ?=? 125) and severe hypoxaemia, acidosis or cardiorespiratory failure prior to commencing PGE1 (n ?=? 81). 16 (17%) of the 94 infants who were not ventilated initially required mechanical ventilation before transport because of apnoea, which developed within one hour of commencing PGE1. 2 (2.6%) of the 78 infants transported without mechanical ventilation developed apnoea in transit and both were receiving ?15?ng/kg/min of PGE1. Apnoea was more likely to occur in non?ventilated infants when the PGE1 infusion rate was ?15?ng/kg/min compared with <15?ng/kg/min (14/33 vs 4/61, ?2 ?=? 15.55, p<.001). Conclusions Newborn infants with suspected duct dependent CHD treated with low dose PGE1 (<15?ng/kg/min) may not require mechanical ventilation for safe transport.

Carmo, Kathryn A Browning; Barr, Peter; West, Maureen; Hopper, Neil W; White, Jennifer P; Badawi, Nadia

2007-01-01

390

Effects of helium-oxygen on respiratory mechanics, gas exchange, and ventilation-perfusion relationships in a porcine model of stable methacholine-induced bronchospasm  

Microsoft Academic Search

Objective: To explore the consequences of helium\\/oxygen (He\\/O2) inhalation on respiratory mechanics, gas exchange, and venti- lation-perfusion (VA\\/Q) relation- ships in an animal model of severe induced bronchospasm during me- chanical ventilation. Design: Pro- spective, interventional study. Setting: Experimental animal labora- tory, university hospital. Interven- tions: Seven piglets were anesthe- tized, paralyzed, and mechanically ventilated, with all ventilator settings remaining

Christine Watremez; Giuseppe Liistro; Marc deKock; Jean Roeseler; Thierry Clerbaux; Bruno Detry; Marc Reynaert; Pierre Gianello; Philippe Jolliet

2003-01-01

391

A computerized decision support system to predict the variations in the cerebral blood flow of mechanically ventilated infants.  

PubMed

A computerized decision support system is described to predict the changes in the cerebral blood flow (CBF) of mechanically ventilated infants in response to different ventilatory settings. A CBF controller was developed and combined with a mathematical model of the infant's respiratory system to simulate the effects of ventilatory settings on the infant's CBF. The performance of the system was examined under various ventilatory treatments and the results were compared with available experimental data. The comparisons showed good agreement between the simulation results and experimental data for preterm infants. These included the results obtained under conditions of hypoventilation, hyperventilation, hypoxia, and hyperoxia. The presented decision support system has the potential to be used as an aide to the intensivist in choosing appropriate ventilation treatments for infants to prevent the untoward consequences of hazardous changes in CBF in mechanically ventilated infants such as hypoxic-ischemic brain injuries. PMID:24034731

Tehrani, Fleur T

2013-07-03

392

A novel fuzzy logic inference system for decision support in weaning from mechanical ventilation.  

PubMed

Weaning from mechanical ventilation represents one of the most challenging issues in management of critically ill patients. Currently used weaning predictors ignore many important dimensions of weaning outcome and have not been uniformly successful. A fuzzy logic inference system that uses nine variables, and five rule blocks within two layers, has been designed and implemented over mathematical simulations and random clinical scenarios, to compare its behavior and performance in predicting expert opinion with those for rapid shallow breathing index (RSBI), pressure time index and Jabour' weaning index. RSBI has failed to predict expert opinion in 52% of scenarios. Fuzzy logic inference system has shown the best discriminative power (ROC: 0.9288), and RSBI the worst (ROC: 0.6556) in predicting expert opinion. Fuzzy logic provides an approach which can handle multi-attribute decision making, and is a very powerful tool to overcome the weaknesses of currently used weaning predictors. PMID:20703599

Kilic, Yusuf Alper; Kilic, Ilke

2009-06-11

393

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

PubMed

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

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

2013-09-01

394

A simple automated method for measuring pressure-volume curves during mechanical ventilation.  

PubMed

Measurement of respiratory compliance is advocated for assessing the severity of acute respiratory failure (ARF). Recently, the administration of an automated constant flow of 15 L/min was proposed as a method easier to implement at the bedside than supersyringe or inspiratory occlusions methods. However, pressure-volume (P-V) curves were shifted to the right because of the resistive properties of the respiratory system. The aim of this study was to compare the P-V curves obtained using two constant flows-3 and 9 L/min-during volume-controlled mechanical ventilation with those obtained with the supersyringe and the inspiratory occlusions methods. Fourteen paralyzed patients with ARF were studied. The supersyringe and the inspiratory occlusions methods were performed according to usual recommendations. The new automated method was performed during volume-controlled mechanical ventilation by setting the inspiratory:expiratory ratio at 80%, the respiratory frequency at 5 breaths/min, and the tidal volume at 500 or 1,500 ml. These peculiar ventilatory settings were equivalent to administering a constant flow of 3 or 9 L/min during a 9.6-s inspiration. Esophageal and airway pressures were recorded. P-V curves obtained by the 3-L/min constant-flow method were identical to those obtained by the reference methods, whereas the P-V curve obtained by the 9-L/min constant flow was slightly shifted to the right. The slopes of the P-V curves and the lower inflection points were not different between all methods, indicating that the resistive component induced by administering a constant flow equal to or less than 9 L/min is not of clinical relevance. Because the 3-L/min constant-flow method is not artifacted by the resistive properties of the respiratory system and does not require any other equipment than a ventilator, it is an easy-to-implement, inexpensive, safe, and reliable method for measuring the thoracopulmonary P-V curve at the bedside. PMID:9872850

Lu, Q; Vieira, S R; Richecoeur, J; Puybasset, L; Kalfon, P; Coriat, P; Rouby, J J

1999-01-01

395

Pressure modes of mechanical ventilation: the good, the bad, and the ugly.  

PubMed

Numerous pressure modes are currently available on ventilators. The application of microprocessor technology has resulted in sophisticated mode options that are very responsive to patient-initiated efforts, yet little is known about how to use the modes or their effect on patient outcomes. This article describes a wide variety of pressure modes including traditional modes such as pressure support and pressure-controlled ventilation in addition to less traditional new modes such as airway pressure release ventilation, biphasic positive airway pressure, Pressure Augmentation (Bear 1000, Viasys Healthcare, Yorba Linda, California), Volume Support (Maquet, Bridgewater, New Jersey), Pressure Regulated Volume Control (Maquet, Bridgewater, New Jersey), Volume Ventilation Plus (Puritan Bennett, Boulder, Colorado), Adaptive Support Ventilation (Hamilton Medical, Switzerland), and Proportional Assist Ventilation (Dräger Medical, Richmond Hill, Ontario, Canada). The "good, the bad, and the ugly" issues surrounding the application, evaluation, and outcomes of the modes are discussed. PMID:18981742

Burns, Suzanne M

396

77 FR 42185 - Rural Health Care Support Mechanism  

Federal Register 2010, 2011, 2012, 2013

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

2012-07-18

397

Review Article: Mechanical ventilation in Duchenne patients with chronic respiratory insufficiency: clinical implications of 20 years published experience  

Microsoft Academic Search

Chronic respiratory insufficiency is inevitable in the course of disease progression in patients with Duchenne muscular dystrophy (DMD). Without mechanical ventilation (MV), morbidity and mortality are highly likely towards the end of the second decade of life. The present review reports evidence and clinical implications regarding DMD patients treated with MV. There is no doubt that nocturnal hypercapnia precedes daytime

M. Toussaint; M. Chatwin; P. Soudon

2007-01-01

398

The virtual absence of stress-ulceration related bleeding in ICU patients receiving prolonged mechanical ventilation without any prophylaxis  

Microsoft Academic Search

Objective: To study the incidence of stress-ulcer related bleeding in ICU patients receiving prolonged (> 2 days) mechanical ventilation without any stress ulcer- ation prophylaxis. Design: A prospective cohort study in 183 patients. Interventions: All patients received clinical treatment in- cluding maintenance of adequate tissue perfusion (with low dose inotropes and vasodilators), infection preven- tion (by selective decontamination of the

D. F. Zandstra; Ch. P. Stoutenbeek

1994-01-01

399

Expiratory Washout versus Optimization of Mechanical Ventilation during Permissive Hypercapnia in Patients with Severe Acute Respiratory Distress Syndrome  

Microsoft Academic Search

The aim of this study was to compare three ventilatory techniques for reducing Pa CO 2 in patients with severe acute respiratory distress syndrome treated with permissive hypercapnia: ( 1 ) expiratory wash- out alone at a flow of 15 L\\/min, ( 2 ) optimized mechanical ventilation defined as an increase in the respiratory frequency to the maximal rate possible

JACK RICHECOEUR; QIN LU; SILVIA R. R. VIEIRA; LOUIS PUYBASSET; PIERRE CORIAT; JEAN-JACQUES ROUBY

400

Efficiency and Safety of Mechanical Ventilation with a Heat and Moisture Exchanger Changed Only Once a Week  

Microsoft Academic Search

The cost of mechanical ventilation (MV) is high. Efforts to reduce this cost, as long as they are not detrimental for the patients, are needed. MV with heat and moisture exchangers (HME) changed ev- ery 48 h is safe, efficient, and cost-effective. Preliminary reports suggest that the life span of these fil- ters may be prolonged. We determined prospectively whether

JEAN-DAMIEN RICARD; ERIC LE MIÈRE; PHILIPPE MARKOWICZ; SERGE LASRY; GEORGES SAUMON; KAMEL DJEDAÏNI; FRANÇOIS COSTE; DIDIER DREYFUSS

401

Early Use of Noninvasive Mechanical Ventilation in Patients with Acute Hypercapnic Respiratory Failure in a Respiratory Ward: A Prospective Study  

Microsoft Academic Search

BackgroundIn recent years, the optimal location for noninvasive mechanical ventilation (NIMV) has been a matter of debate. Our aim was to detect the effectiveness of NIMV in acute hypercapnic respiratory failure (AHRF) in respiratory ward and factors associated with failure.

Aydin Ciledag; Akin Kaya; Buket Basa Akdogan; Pinar Akin Kabalak; Zeynep P. Onen; Elif Seny Banu Gulbay

2010-01-01

402

Tidal variation of pulmonary blood flow and blood volume in piglets during mechanical ventilation during hyper-, normo- and hypovolaemia  

Microsoft Academic Search

Effects of changes in blood volume on changes in pulmonary blood flow and pulmonary blood volume during the ventilatory cycle during mechanical ventilation with a positive end-expiratory pressure of 2 cm H2O were determined in six pentobarbital anaesthetized, curarized pigs weighing about 10 kg. Haemodynamic variables were analysed for each cardiac cycle in eight ventilatory cycles in four consecutive series

Adrian Versprille; Jos R. C. Jansen

1993-01-01

403

Non-invasive positive pressure ventilation in acute respiratory failure: providing competent care  

Microsoft Academic Search

Non-invasive positive pressure ventilation (NPPV) has been used as an alternative strategy to provide ventilatory support for patients with acute respiratory failure. Most studies demonstrate that the use of NPPV in acute respiratory failure results in a reduction in the need for endotracheal intubation and an overall survival advantage. However, current evidence, in the form of randomized controlled trials, suggests

Rosa PY Ho; Martin Boyle

2000-01-01

404

Replacement of fentanyl infusion by enteral methadone decreases the weaning time from mechanical ventilation: a randomized controlled trial  

PubMed Central

Introduction Patients undergoing mechanical ventilation (MV) are frequently administered prolonged and/or high doses of opioids which when removed can cause a withdrawal syndrome and difficulty in weaning from MV. We tested the hypothesis that the introduction of enteral methadone during weaning from sedation and analgesia in critically ill adult patients on MV would decrease the weaning time from MV. Methods A double-blind randomized controlled trial was conducted in the adult intensive care units (ICUs) of four general hospitals in Brazil. The 75 patients, who met the criteria for weaning from MV and had been using fentanyl for more than five consecutive days, were randomized to the methadone (MG) or control group (CG). Within the first 24 hours after study enrollment, both groups received 80% of the original dose of fentanyl, the MG received enteral methadone and the CG received an enteral placebo. After the first 24 hours, the MG received an intravenous (IV) saline solution (placebo), while the CG received IV fentanyl. For both groups, the IV solution was reduced by 20% every 24 hours. The groups were compared by evaluating the MV weaning time and the duration of MV, as well as the ICU stay and the hospital stay. Results Of the 75 patients randomized, seven were excluded and 68 were analyzed: 37 from the MG and 31 from the CG. There was a higher probability of early extubation in the MG, but the difference was not significant (hazard ratio: 1.52 (95% confidence interval (CI) 0.87 to 2.64; P = 0.11). The probability of successful weaning by the fifth day was significantly higher in the MG (hazard ratio: 2.64 (95% CI: 1.22 to 5.69; P < 0.02). Among the 54 patients who were successfully weaned (29 from the MG and 25 from the CG), the MV weaning time was significantly lower in the MG (hazard ratio: 2.06; 95% CI 1.17 to 3.63; P < 0.004). Conclusions The introduction of enteral methadone during weaning from sedation and analgesia in mechanically ventilated patients resulted in a decrease in the weaning time from MV.

2012-01-01

405

Efficacy of noninvasive mechanical ventilation in obese patients with chronic respiratory failure.  

PubMed

Chronic respiratory failure (CRF) develops in a minority of obese patients. Noninvasive mechanical ventilation (NIMV) is a new optional treatment for such patients. The aim of this study was to evaluate the effectiveness of NIMV in obese patients with CRF. The material of the study consisted of 34 obese patients (body mass index 47.3 ± 7.9 kg/m(2)) with CRF (PaO2 = 6.40 ± 0.93 kPa and PaCO2 = 8.67 ± 2.13 kPa) who were hypoxemic despite an optimal therapy. Thirteen patients had an overlap syndrome (OS) - chronic obstructive pulmonary disease (COPD) coexisting with obstructive sleep apnea syndrome (OSAS) and 21 patients had obesity-hypoventilation syndrome (OHS). Ventilation parameters were determined during polysomnography. The efficacy of NIMV was evaluated on the fifth day and after 1 year's home treatment. We observed a significant increase in the mean blood oxygen saturation during sleep in all patients; the increase was greater in patients with OHS (92.6 ± 1.4 %) than in patients with OS (90.4 ± 1.8 %). There was a significant improvement of diurnal PaO2 and PaCO2 on the fifth day of NIMV (mean PaO2 increase 2.1 kPa and PaCO2 decrease 0.9 kPa) and also after 1 year of home NIMV (mean PaO2 increase 1.9 kPa and PaCO2 decrease 2.4 kPa). Only one patient stopped treatment because of lack of tolerance during the observation period (1-3 years). In conclusion, NIMV is an effective and well tolerated treatment option in obese patients with CRF resulting in a rapid relief of respiratory disorders during sleep and a gradual, long-term improvement of gas exchange during the day, particularly in patients with OHS. PMID:23835975

Piesiak, P; Brzecka, A; Kosacka, M; Jankowska, R

2013-01-01

406

Changes in pulse pressure variability during cardiac resynchronization therapy in mechanically ventilated patients  

PubMed Central

Introduction The respiratory variation in pulse pressure (PP) has been established as a dynamic variable of cardiac preload which indicates fluid responsiveness in mechanically ventilated patients. The impact of acute changes in cardiac performance on respiratory fluctuations in PP has not been evaluated until now. We used cardiac resynchronization therapy as a model to assess the acute effects of changes in left ventricular performance on respiratory PP variability without the need of pharmacological intervention. Methods In 19 patients undergoing the implantation of a biventricular pacing/defibrillator device under general anesthesia, dynamic blood pressure regulation was assessed during right ventricular and biventricular pacing in the frequency domain (power spectral analysis) and in the time domain (PP variation: difference between the maximal and minimal PP values, normalized by the mean value). Results PP increased slightly during biventricular pacing but without statistical significance (right ventricular pacing, 33 ± 10 mm Hg; biventricular pacing, 35 ± 11 mm Hg). Respiratory PP fluctuations increased significantly (logarithmically transformed PP variability -1.27 ± 1.74 ln mm Hg2 versus -0.66 ± 1.48 ln mm Hg2; p < 0.01); the geometric mean of respiratory PP variability increased 1.8-fold during cardiac resynchronization. PP variation, assessed in the time domain and expressed as a percentage, showed comparable changes, increasing from 5.3% (3.1%; 12.3%) during right ventricular pacing to 6.9% (4.7%; 16.4%) during biventricular pacing (median [25th percentile; 75th percentile]; p < 0.01). Conclusion Changes in cardiac performance have a significant impact on respiratory hemodynamic fluctuations in ventilated patients. This influence should be taken into consideration when interpreting PP variation.

Keyl, Cornelius; Stockinger, Jochem; Laule, Sven; Staier, Klaus; Schiebeling-Romer, Jochen; Wiesenack, Christoph

2007-01-01

407

Population pharmacodynamic model of bicarbonate response to acetazolamide in mechanically ventilated chronic obstructive pulmonary disease patients  

PubMed Central

Introduction Acetazolamide is commonly given to chronic obstructive pulmonary disease (COPD) patients with metabolic alkalosis. Little is known of the pharmacodynamics of acetazolamide in the critically ill. We undertook the pharmacod