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Sample records for pressure support ventilation

  1. Oscillations and noise: inherent instability of pressure support ventilation?

    PubMed

    Hotchkiss, John R; Adams, Alexander B; Stone, Mary K; Dries, David J; Marini, John J; Crooke, Philip S

    2002-01-01

    Pressure support ventilation (PSV) is almost universally employed in the management of actively breathing ventilated patients with acute respiratory failure. In this partial support mode of ventilation, a fixed pressure is applied to the airway opening, and flow delivery is monitored by the ventilator. Inspiration is terminated when measured inspiratory flow falls below a set fraction of the peak flow rate (flow cutoff); the ventilator then cycles to a lower pressure and expiration commences. We used linear and nonlinear mathematical models to investigate the dynamic behavior of pressure support ventilation and confirmed the predicted behavior using a test lung. Our mathematical and laboratory analyses indicate that pressure support ventilation in the setting of airflow obstruction can be accompanied by marked variations in tidal volume and end-expiratory alveolar pressure, even when subject effort is unvarying. Unstable behavior was observed in the simplest plausible linear mathematical model and is an inherent consequence of the underlying dynamics of this mode of ventilation. The mechanism underlying the observed instability is "feed forward" behavior mediated by oscillatory elevation in end-expiratory pressure. In both mathematical and mechanical models, unstable behavior occurred at impedance values and ventilator settings that are clinically realistic.

  2. Inspiratory work and response times of a modified pediatric volume ventilator during synchronized intermittent mandatory ventilation and pressure support ventilation.

    PubMed

    Martin, L D; Rafferty, J F; Wetzel, R C; Gioia, F R

    1989-12-01

    Volume ventilation by demand flow ventilators significantly increases work of breathing during inspiration. Although various ventilator modifications and different modes of ventilation have been developed, there have been few studies regarding imposed work of breathing in infants and children. This study was designed to evaluate several modifications of a commercially available demand flow ventilator designed to shorten response time (tr) and decrease the imposed work (Wi) involved in opening the demand valve. Minimum withdrawal volume (Vmin), maximum negative pressure (P mneg), and tr were measured. Wi was defined as the product of Vmin and P mneg. Seven Siemens Servo 900C ventilators were tested under 16 different trial conditions with four variables: 1) mode of ventilation (synchronized intermittent mandatory ventilation [SIMV] vs. pressure support ventilation [PSV]); 2) caliber of circuit tubing (adult vs. pediatric); 3) location of airway pressure monitor (distal vs. proximal); and 4) ventilator trigger sensitivity (0 cm H2O--high vs. -2 cm H2O--low). Vmin, Pmneg, and Wi were all decreased (P less than .05) while tr was unaffected by changing ventilator trigger sensitivity from low to high. Wi was decreased by pediatric tubing and proximal airway pressure monitoring only when low trigger sensitivity was used. PSV and proximal airway monitoring shortened tr. The authors conclude that the use of pediatric circuit tubing and proximal airway pressure monitoring with a Siemens Servo 900C ventilator significantly improved ventilator performance.

  3. Pressure-supported ventilation for posterior fossa operation.

    PubMed

    Mori, N; Takahashi, H; Yanase, T; Suzuki, M

    1990-03-01

    To maintain enough gas exchange while using spontaneous respiration as a monitor of the normal brainstem function, we tried pressure-supported ventilation (PSV) with a Servo 900C ventilator (Siemens Elema AB, Sweden) on 12 otherwise healthy patients during posterior fossa operation. Ventilation mode was switched from controlled to PSV after the dura was open uneventfully in all cases but one. With a trigger level of -1 to -2 cm H2O, spontaneous respiration was triggered to start the inspiration. With supporting inspiratory pressure of 4-20 cm H2O, PaCO2 was kept at 31.7-45.9 mm Hg. The ventilatory level could be monitored breath by breath by ventilatory frequency, tidal volume, minute volume, and end-tidal CO2 concentration shown on the ventilator system. Apnea was observed in two cases during surgical manipulation around the brainstem. It was indicated immediately by the ventilator's alarm for decreased expiratory minute volume, and no sign of brainstem dysfunction was observed postoperatively. PSV was useful in maintaining adequate ventilation whereas spontaneous respiration was used as an indicator of normal brainstem function. The alarm system of the ventilator was sensitive enough to detect the surgical invasion of the brainstem at a very early stage.

  4. Pressure support ventilation decreases inspiratory work of breathing during general anesthesia and spontaneous ventilation.

    PubMed

    Christie, J M; Smith, R A

    1992-08-01

    Spontaneous ventilation may offer advantages over controlled mechanical ventilation (CMV), but increase in work of breathing may diminish its usefulness. During general anesthesia, respiratory depression and increased work of breathing often preclude spontaneous ventilation, and patients then receive CMV. We compared the inspiratory work of breathing of anesthetized patients who breathed with pressure support ventilation (PSV) with that associated with a demand gas flow and a standard anesthesia circle system. We studied nine consenting patients who underwent general inhaled anesthesia with or without regional supplementation. An anesthesia/ventilator system (Siemens 900D, Solna, Sweden) provided PSV (5 cm H2O) or demand gas flow during spontaneous inspiration. Gas flow during demand breathing and PSV was initiated when inspiration produced a 2-cm H2O reduction in airway pressure. An anesthesia machine (Dräger Narkomed 3, Telford, Pa.) provided a gas flow rate of 6 L/min through a standard semiclosed circle system. Airway pressure, airway gas flow rate, and esophageal pressure were continuously transduced, and data or signals were conveyed to a computer. Tidal volume and respiratory rate were computed from the flow curve. The inspiratory work of breathing was calculated as the integral of the area subserved by a plot of esophageal pressure and tidal volume during inspiration. Heart rate and mean arterial blood pressure were recorded, and arterial blood was sampled for gas tension and pH analysis. No differences were found in pHa, Paco2, Pao2, tidal volume, respiratory rate, heart rate, or mean arterial blood pressure among the three modes of ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)

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

    PubMed Central

    Lourenço, Isabela Scali; Franco, Aline Marques; Bassetto, Solange; Rodrigues, Alfredo José

    2013-01-01

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

  6. Online estimation of respiratory mechanics in non-invasive pressure support ventilation: a bench model study.

    PubMed

    Mulqueeny, Qestra; Tassaux, Didier; Vignaux, Laurence; Jolliet, Philippe; Schindhelm, Klaus; Redmond, Stephen; Lovell, Nigel H

    2010-01-01

    An online algorithm for determining respiratory mechanics in patients using non-invasive ventilation (NIV) in pressure support mode was developed and embedded in a ventilator system. Based on multiple linear regression (MLR) of respiratory data, the algorithm was tested on a patient bench model under conditions with and without leak and simulating a variety of mechanics. Bland-Altman analysis indicates reliable measures of compliance across the clinical range of interest (± 11-18% limits of agreement). Resistance measures showed large quantitative errors (30-50%), however, it was still possible to qualitatively distinguish between normal and obstructive resistances. This outcome provides clinically significant information for ventilator titration and patient management.

  7. Contrasting pressure-support ventilation and helium-oxygen during exercise in severe COPD.

    PubMed

    Hussain, Omar; Collins, Eileen G; Adiguzel, Nalan; Langbein, W Edwin; Tobin, Martin J; Laghi, Franco

    2011-03-01

    Helium-oxygen mixtures and pressure-support ventilation have been used to unload the respiratory muscles and increase exercise tolerance in COPD. Considering the different characteristics of these techniques, we hypothesized that helium-oxygen would be more effective in reducing exercise-induced dynamic hyperinflation than pressure-support. We also hypothesized that patients would experience greater increases in respiratory rate and minute ventilation with helium-oxygen than with pressure-support. The hypotheses were tested in ten patients with severe COPD (FEV(1) = 28 ± 3% predicted [mean ± SE]) during constant-load cycling (80% maximal workrate) while breathing 30% oxygen-alone, helium-oxygen, and pressure-support in randomized order. As hypothesized, helium-oxygen had greater impact on dynamic hyperinflation than did pressure-support (end-exercise; p = 0.03). For the most part of exercise, respiratory rate and minute ventilation were greater with helium-oxygen than with pressure-support (p ≤ 0.008). During the initial phases of exercise, helium-oxygen caused less rib-cage muscle recruitment than did pressure-support (p < 0.03), and after the start of exercise it caused greater reduction in inspiratory reserve volume (p ≤ 0.02). Despite these different responses, helium-oxygen and pressure-support caused similar increases in exercise duration (oxygen-alone: 6.9 ± 0.8 min; helium-oxygen: 10.7 ± 1.4 min; pressure-support: 11.2 ± 1.6 min; p = 0.003) and similar decreases in inspiratory effort (esophageal pressure-time product), respiratory drive, pulmonary resistance, dyspnea and leg effort (p < 0.03). In conclusion, helium-oxygen reduced exercise-induced dynamic hyperinflation by improving the relationship between hyperinflation and minute ventilation. In contrast, pressure-support reduced hyperinflation solely as a result of lowering ventilation. Helium-oxygen was more effective in reducing exercise-induced dynamic hyperinflation in severe COPD, and was

  8. Comparison of patient-ventilator asynchrony during pressure support ventilation and proportional assist ventilation modes in surgical Intensive Care Unit: A randomized crossover study

    PubMed Central

    Gautam, Parshotam Lal; Kaur, Gaganjot; Katyal, Sunil; Gupta, Ruchi; Sandhu, Preetveen; Gautam, Nikhil

    2016-01-01

    Background: The patient-ventilator asynchrony is almost observed in all modes of ventilation, and this asynchrony affects lung mechanics adversely resulting in deleterious outcome. Innovations and advances in ventilator technology have been trying to overcome this problem by designing newer modes of ventilation. Pressure support ventilation (PSV) is a commonly used flow-cycled mode where a constant pressure is delivered by ventilator. Proportional assist ventilation (PAV) is a new dynamic inspiratory pressure assistance and is supposed to be better than PSV for synchrony and tolerance, but reports are still controversial. Moreover, most of these studies are conducted in chronic obstructive pulmonary disease patients with respiratory failure; the results of these studies may not be applicable to surgical patients. Thus, we proposed to do compare these two modes in surgical Intensive Care Unit (ICU) patients as a randomized crossover study. Aims: Comparison of patient-ventilator asynchrony between PSV and PAV plus (PAV+) in surgical patients while weaning. Subjects and Methods: After approval by the Hospital Ethics Committee, we enrolled twenty patients from surgical ICU of tertiary care institute. The patients were ventilated with pressure support mode (PSV) and PAV+ for 12 h as a crossover from one mode to another after 6 h while weaning. Results: Average age and weight of patients were 41.80 ± 15.20 years (mean ± standard deviation [SD]) and 66.50 ± 12.47 (mean ± SD) kg, respectively. Comparing the asynchronies between the two modes, the mean number of total asynchronous recorded breaths in PSV was 7.05 ± 0.83 and 4.35 ± 5.62, respectively, during sleep and awake state, while the same were 6.75 ± 112.24 and 10.85 ± 11.33 in PAV+. Conclusion: Both PSV and PAV+ modes of ventilation performed similarly for patient-ventilator synchrony in surgical patients. In surgical patients with acute respiratory failure, dynamic inspiratory pressure assistance modalities

  9. Effectiveness of Inspiratory Termination Synchrony with Automatic Cycling During Noninvasive Pressure Support Ventilation.

    PubMed

    Chen, Yuqing; Cheng, Kewen; Zhou, Xin

    2016-05-20

    BACKGROUND Pressure support ventilation (PSV) is a standard method for non-invasive home ventilation. A bench study was designed to compare the effectiveness of patient-ventilator inspiratory termination synchronization with automated and conventional triggering in various respiratory mechanics models. MATERIAL AND METHODS Two ventilators, the Respironics V60 and Curative Flexo ST 30, connected to a Hans Rudolph Series 1101 lung simulator, were evaluated using settings that simulate lung mechanics in patients with chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS), or normal lungs. Ventilators were operated with automated (Auto-Trak) or conventional high-, moderate-, and low-sensitivity flow-cycling software algorithms, 5 cmH2O or 15 cmH2O pressure support, 5 cmH2O positive end-expiratory pressure (PEEP), and an air leak of 25-28 L/min. RESULTS Both ventilators adapted to the system leak without requiring adjustment of triggering settings. In all simulated lung conditions, automated cycling resulted in shorter triggering delay times (<100 ms) and lower triggering pressure-time product (PTPt) values. Tidal volumes (VT) increased with lower conventional cycling sensitivity level. In the COPD model, automated cycling had higher leak volumes and shorter cycling delay times than in conventional cycling. Asynchronous events were rare. Inspiratory time (Tinsp), peak expiratory flow (PEF), and cycling off delay time (Cdelay) increased as a result of reduction in conventional cycling sensitivity level. In the ARDS and normal adult lung models, premature cycling was frequent at the high-sensitive cycling level. CONCLUSIONS Overall, the Auto-Trak protocol showed better patient-machine cycling synchronization than conventional triggering. This was evident by shorter triggering time delays and lower PTPt.

  10. Prediction of extubation outcome: a randomised, controlled trial with automatic tube compensation vs. pressure support ventilation

    PubMed Central

    Cohen, Jonathan; Shapiro, Maury; Grozovski, Elad; Fox, Ben; Lev, Shaul; Singer, Pierre

    2009-01-01

    Introduction Tolerance of a spontaneous breathing trial is an evidence-based strategy to predict successful weaning from mechanical ventilation. Some patients may not tolerate the trial because of the respiratory load imposed by the endotracheal tube, so varying levels of respiratory support are widely used during the trial. Automatic tube compensation (ATC), specifically developed to overcome the imposed work of breathing because of artificial airways, appears ideally suited for the weaning process. We further evaluated the use of ATC in this setting. Methods In a prospective study, patients who had received mechanical ventilation for more than 24 hours and met defined criteria for a weaning trial, underwent a one-hour spontaneous breathing trial with either ATC (n = 87) or pressure support ventilation (PSV; n = 93). Those tolerating the trial were immediately extubated. The primary outcome measure was the ability to maintain spontaneous, unassisted breathing for more than 48 hours after extubation. In addition, we measured the frequency/tidal volume ratio (f/VT) both with (ATC-assisted) and without ATC (unassisted-f/VT) at the start of the breathing trial as a pretrial predictor of extubation outcome. Results There were no significant differences in any of the baseline characteristics between the two groups apart from a significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II score in the ATC group (p = 0.009). In the PSV group, 13 of 93 (14%) patients failed the breathing trial compared with only 6 of 87 (6%) in the ATC group; this observed 8% difference, however, did not reach statistical significance (p = 0.12). The rate of reintubation was not different between the groups (total group = 17.3%; ATC = 18.4% vs. PSV = 12.9%, p = 0.43). The percentage of patients who remained extubated for more than 48 hours was similar in both groups (ATC = 74.7% vs. PSV = 73.1%; p = 0.81). This represented a positive predictive value for PSV of 0.85 and

  11. Chest compression with a higher level of pressure support ventilation: effects on secretion removal, hemodynamics, and respiratory mechanics in patients on mechanical ventilation*

    PubMed Central

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

    2014-01-01

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

  12. Non-invasive ventilation with intelligent volume-assured pressure support versus pressure-controlled ventilation: effects on the respiratory event rate and sleep quality in COPD with chronic hypercapnia

    PubMed Central

    Nilius, Georg; Katamadze, Nato; Domanski, Ulrike; Schroeder, Maik; Franke, Karl-Josef

    2017-01-01

    Background COPD patients who develop chronic hypercapnic respiratory failure have a poor prognosis. Treatment of choice, especially the best form of ventilation, is not well known. Objectives This study compared the effects of pressure-controlled (spontaneous timed [ST]) non-invasive ventilation (NIV) and NIV with intelligent volume-assured pressure support (IVAPS) in chronic hypercapnic COPD patients regarding the effects on alveolar ventilation, adverse patient/ventilator interactions and sleep quality. Methods This prospective, single-center, crossover study randomized patients to one night of NIV using ST then one night with the IVAPS function activated, or vice versa. Patients were monitored using polysomnography (PSG) and transcutaneous carbon dioxide pressure (PtcCO2) measurement. Patients rated their subjective experience (total score, 0–45; lower scores indicate better acceptability). Results Fourteen patients were included (4 females, age 59.4±8.9 years). The total number of respiratory events was low, and similar under pressure-controlled (5.4±6.7) and IVAPS (8.3±10.2) conditions (P=0.064). There were also no clinically relevant differences in PtcCO2 between pressure-controlled and IVAPS NIV (52.9±6.2 versus 49.1±6.4 mmHg). Respiratory rate was lower under IVAPS overall; between-group differences reached statistical significance during wakefulness and non-rapid eye movement sleep. Ventilation pressures were 2.6 cmH2O higher under IVAPS versus pressure-controlled ventilation, resulting in a 20.1 mL increase in breathing volume. Sleep efficiency was slightly higher under pressure-controlled ventilation versus IVAPS. Respiratory arousals were uncommon (24.4/h [pressure-controlled] versus 25.4/h [IVAPS]). Overall patient assessment scores were similar, although there was a trend toward less discomfort during IVAPS. Conclusion Our results show that IVAPS NIV allows application of higher nocturnal ventilation pressures versus ST without affecting sleep

  13. Brief report: pressure support ventilation during an ascent and on the summit of Mt. Everest? A theoretical approach.

    PubMed

    Kleinsasser, Axel; Loeckinger, Alex

    2002-01-01

    At extreme altitude, air has an almost identical composition compared to air at sea level, while its pressure is altitude-dependently lower. When supplementary oxygen is used to achieve an acceptable inspiratory pressure of oxygen (PI(O2)) during climbing, the barometric pressure difference to lower altitudes is not compensated for. In this report, we tried theoretically to apply pressure support ventilation (PSV) to partially compensate for low barometric pressures. PSV is widely used for respiratory home care and is applicable via a nasal mask. Since there are light-weight units with long battery lives on the market, we speculated that these units may to some extent replace bottled oxygen. PSV was in theory applied at barometric pressures of 400 torr (Everest Base Camp), 284 torr (South Col), and 253 torr (summit of Mt. Everest). We found that during PSV at a mean airway pressure of 16.5 torr on the summit of Mt. Everest, a fraction of inspired oxygen (FI(O2)) of 0.34 sufficed to achieve an alveolar partial pressure (PA(O2)) of 67 torr. PSV increases PI(O2) by 3.5 torr, which in theory elevates the maximum oxygen consumption (V(O2max)) by 218 mL.min(-1) in an acclimatized climber in this setting. An additional benefit of PSV at extreme altitude may come from the unloading of the respiratory muscles.

  14. Source of human ventilatory chaos: lessons from switching controlled mechanical ventilation to inspiratory pressure support in critically ill patients.

    PubMed

    Mangin, Laurence; Fiamma, Marie-Noëlle; Straus, Christian; Derenne, Jean-Philippe; Zelter, Marc; Clerici, Christine; Similowski, Thomas

    2008-04-30

    Ventilatory flow measured at the airway opening in humans exhibits a complex dynamics that has the features of chaos. Currently available data point to a neural origin of this feature, but the role of respiratory mechanics has not been specifically assessed. In this aim, we studied 17 critically ill mechanically ventilated patients during a switch form an entirely machine-controlled assistance mode (assist-controlled ventilation ACV) to a patient-driven mode (inspiratory pressure support IPS). Breath-by-breath respiratory variability was assessed with the coefficient of variation of tidal volume, total cycle time, inspiratory time, expiratory time, mean inspiratory flow, duty cycle. The detection of chaos was performed with the noise titration technique. When present, chaos was characterized with numerical indexes (correlation dimension, irregularity; largest Lyapunov exponent, sensitivity to initial conditions). Expectedly, the coefficients of variations of the respiratory variables were higher during IPS than during ACV. During ACV, noise titration failed to detect nonlinearities in 12 patients who did not exhibit signs of spontaneous respiratory activity. This indicates that the mechanical properties of the respiratory system were not sufficient to produce ventilatory chaos in the presence of a nonlinear command (ventilator clock). A positive noise limit was found in the remaining 5 cases, but these patients exhibited signs of active expiratory control (highly variable expiratory time, respiratory frequency higher than the set frequency). A positive noise limit was also observed in 16/17 patients during IPS (p<0.001). These observations suggest that ventilatory chaos predominantly has a neural origin (intrinsic to the respiratory central pattern generators, resulting from their perturbation by respiratory afferents, or both), with little contribution of respiratory mechanics, if any.

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

    PubMed Central

    2013-01-01

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

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

    PubMed Central

    2013-01-01

    Background Non-invasive mechanical ventilation (NIV) in patients with acute respiratory failure has been traditionally determined based on clinical assessment and changes in blood gases, with NIV support pressures manually adjusted by an operator. Bilevel positive airway pressure-spontaneous/timed (BiPAP S/T) with average volume assured pressure support (AVAPS) uses a fixed tidal volume that automatically adjusts to a patient’s needs. Our study assessed the use of BiPAP S/T with AVAPS in patients with chronic obstructive pulmonary disease (COPD) and hypercapnic encephalopathy as compared to BiPAP S/T alone, upon immediate arrival in the Emergency-ICU. Methods We carried out a prospective interventional match-controlled study in Guayaquil, Ecuador. A total of 22 patients were analyzed. Eleven with COPD exacerbations and hypercapnic encephalopathy with a Glasgow Coma Scale (GCS) <10 and a pH of 7.25-7.35 were assigned to receive NIV via BiPAP S/T with AVAPS. Eleven patients were selected as paired controls for the initial group by physicians who were unfamiliar with our study, and these patients were administered BiPAP S/T. Arterial blood gases, GCS, vital signs, and ventilatory parameters were then measured and compared between the two groups. Results We observed statistically significant differences in favor of the BiPAP S/T + AVAPS group in GCS (P = .00001), pCO2 (P = .03) and maximum inspiratory positive airway pressure (IPAP) (P = .005), among others. However, no significant differences in terms of length of stay or days on NIV were observed. Conclusions BiPAP S/T with AVAPS facilitates rapid recovery of consciousness when compared to traditional BiPAP S/T in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy. Trial registration Current Controlled Trials application ref is ISRCTN05135218 PMID:23497021

  17. Dynamic behavior during noninvasive ventilation: chaotic support?

    PubMed

    Hotchkiss, J R; Adams, A B; Dries, D J; Marini, J J; Crooke, P S

    2001-02-01

    Acute noninvasive ventilation is generally applied via face mask, with modified pressure support used as the initial mode to assist ventilation. Although an adequate seal can usually be obtained, leaks frequently develop between the mask and the patient's face. This leakage presents a theoretical problem, since the inspiratory phase of pressure support terminates when flow falls to a predetermined fraction of peak inspiratory flow. To explore the issue of mask leakage and machine performance, we used a mathematical model to investigate the dynamic behavior of pressure-supported noninvasive ventilation, and confirmed the predicted behavior through use of a test lung. Our mathematical and laboratory analyses indicate that even when subject effort is unvarying, pressure-support ventilation applied in the presence of an inspiratory leak proximal to the airway opening can be accompanied by marked variations in duration of the inspiratory phase and in autoPEEP. The unstable behavior was observed in the simplest plausible mathematical models, and occurred at impedance values and ventilator settings that are clinically realistic.

  18. Acidemia in severe acute cardiogenic pulmonary edema treated with noninvasive pressure support ventilation: a single-center experience.

    PubMed

    Lazzeri, Chiara; Gensini, Gian F; Picariello, Claudio; Attanà, Paola; Mattesini, Alessio; Chiostri, Marco; Valente, Serafina

    2015-09-01

    In clinical practice, acidotic patients with acute cardiogenic pulmonary edema (ACPE) are commonly considered more severe in comparison with nonacidotic patients, and data on the outcome of these patients treated with noninvasive pressure support ventilation (NIV) are lacking.The present investigation was aimed at assessing whether acidosis on admission (pH < 7.35) was associated with adverse outcome in 65 consecutive patients with ACPE treated with NIV and admitted to our Intensive Cardiac Care Unit (ICCU).In our population, 28 patients were acidotic (28 of 65, 43.1%), whereas 41 patients were not (37 of 65, 56.9%). According to the Repeated Measures General Linear Model, pCO2 values significantly changed throughout the 2-h NIV treatment (P = 0.019) in both groups (P = 0001). In acidotic patients, pCO2 significantly decreased (51.9 ± 15.3 → 47.0 ± 12.8 → 44.8 ± 12.7), whereas they increased in the nonacidotic subgroup (36.8 ± 6.5 → 36.9 ± 7.2 → 37.6 ± 6.4). No difference was observed in intubation rate between acidotic (eight patients, 28.6%) and nonacidotic patients (12 patients, 32.4%) (P = 0.738). In-ICCU mortality rate did not differ between (13 patients, 35.1%) and nonacidotic patients (nine patients, 32.1%) (P = 0.801).Our data strongly suggest that in patients with severe ACPE treated with NIV, the presence of acidosis is not associated with adverse outcomes (early mortality and intubation rates) in these patients.

  19. Physiological Effects of Positive Pressure Ventilation.

    DTIC Science & Technology

    1992-05-01

    spontaneous breath (Banner, et al., 1990). This "stacking" of mechanical on spontaneous breaths could increase the peak inflation, airway , and intrapleural...J., & Gottfried, S. B. (1990). Continuous positive airway pressure reduces work of breathing and dyspnea during weaning from mechanical ventilation in...insufficiency is caused by numerous physiological aberrations, some of which can be reversed or improved by mechanical respiratory support, thus

  20. Ventilatory failure, ventilator support, and ventilator weaning.

    PubMed

    Tobin, Martin J; Laghi, Franco; Jubran, Amal

    2012-10-01

    The development of acute ventilatory failure represents an inability of the respiratory control system to maintain a level of respiratory motor output to cope with the metabolic demands of the body. The level of respiratory motor output is also the main determinant of the degree of respiratory distress experienced by such patients. As ventilatory failure progresses and patient distress increases, mechanical ventilation is instituted to help the respiratory muscles cope with the heightened workload. While a patient is connected to a ventilator, a physician's ability to align the rhythm of the machine with the rhythm of the patient's respiratory centers becomes the primary determinant of the level of rest accorded to the respiratory muscles. Problems of alignment are manifested as failure to trigger, double triggering, an inflationary gas-flow that fails to match inspiratory demands, and an inflation phase that persists after a patient's respiratory centers have switched to expiration. With recovery from disorders that precipitated the initial bout of acute ventilatory failure, attempts are made to discontinue the ventilator (weaning). About 20% of weaning attempts fail, ultimately, because the respiratory controller is unable to sustain ventilation and this failure is signaled by development of rapid shallow breathing. Substantial advances in the medical management of acute ventilatory failure that requires ventilator assistance are most likely to result from research yielding novel insights into the operation of the respiratory control system.

  1. Validation of indirect calorimetry for measurement of energy expenditure in healthy volunteers undergoing pressure controlled non-invasive ventilation support.

    PubMed

    Siirala, Waltteri; Noponen, Tommi; Olkkola, Klaus T; Vuori, Arno; Koivisto, Mari; Hurme, Saija; Aantaa, Riku

    2012-02-01

    The aim of this validation study was to assess the reliability of gas exchange measurement with indirect calorimetry among subjects who undergo non-invasive ventilation (NIV). Oxygen consumption (VO2) and carbon dioxide production (VCO2) were measured in twelve healthy volunteers. Respiratory quotient (RQ) and resting energy expenditure (REE) were then calculated from the measured VO2 and VCO2 values. During the measurement period the subjects were breathing spontaneously and ventilated using NIV. Two different sampling air flow values 40 and 80 l/min were used. The gas leakage from the measurement setup was assessed with a separate capnograph. The mean weight of the subjects was 93 kg. Their mean body mass index was 29 (range 22-40) kg/m2. There was no statistically significant difference in the measured values for VO2, VCO2, RQ and REE during NIV-supported breathing and spontaneous breathing. The change of sampling air flow had no statistically significant effect on any of the above parameters. We found that REE can be accurately measured with an indirect calorimeter also during NIV-supported breathing and the change of sampling air flow does not distort the gas exchange measurement. A higher sampling air flow in indirect calorimetry decreases the possibility for air leakages in the measurement system and increases the reliability of REE measurement.

  2. [Evaluation of patient-ventilator synchrony of three new types of ventilators with pressure sunnort ventilation mode].

    PubMed

    Zhou, Juan; Wu, Hao; Cao, Desen

    2014-08-01

    Pressure-support ventilation (PSV) is a form of important ventilation mode. Patient-ventilator synchrony of pressure support ventilation can be divided into inspiration-triggered and expiration-triggered ones. Whether the ventilator can track the patient's inspiration and expiration very well or not is an important evaluating item of the performance of the ventilator. The ventilator should response to the patient's inspiration effort on time and deliver the air flow to the patient under various conditions, such as different patient's lung types and inspiration effort, etc. Similarly, the ventilator should be able to response to the patient's expiration action, and to decrease the patient lung's internal pressure rapidly. Using the Active Servo Lung (ASL5000) respiratory simulation system, we evaluated the spontaneous breathing of PSV mode on E5, Servo i and Evital XL. The following parameters, the delay time before flow to the patient starts once the trigger variable signaling the start of inspiration, the lowest inspiratory airway pressure generated prior to the initiation of PSV, etc. were measured.

  3. Elective nasal continuous positive airway pressure to support respiration after prolonged ventilation in infants after congenital cardiac surgery

    PubMed Central

    Gandhi, Hemang; Mishra, Amit; Thosani, Rajesh; Acharya, Himanshu; Shah, Ritesh; Surti, Jigar; Sarvaia, Alpesh

    2017-01-01

    Background: We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2 mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery. Methods: In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2 mask immediately after extubation. From pre-extubation to 24 h after treatment, arterial blood gas and hemodynamic data were measured. Results: After 24 h of NCPAP institution, the patients showed a significant improvement in oxygenation compared to O2 mask group. Respiratory rate (per minute) decreased from 31.67 ± 4.55 to 24.31 ± 3.69 (P < 0.0001), PO2 (mmHg) increased from 112.12 ± 22.83 to 185.74 ± 14.81 (P < 0.0001), and PCO2 (mmHg) decreased from 42.88 ± 5.01 to 37.00 ± 7.22 (P < 0.0076) in patients on NCPAP. In this group, mean pediatric cardiac surgical Intensive Care Unit (PCSICU) stay was 4.72 ± 1.60 days, with only 2 (11.11%) patients requiring re-intubation. Conclusion: NCPAP can be used safely and effectively in infants undergoing congenital cardiac surgery to improve oxygenation/ventilation. It also reduces the work of breathing, PCSICU stay, and may reduce the likelihood of re-intubation. PMID:28163425

  4. Model-based setting of inspiratory pressure and respiratory rate in pressure-controlled ventilation.

    PubMed

    Schranz, C; Becher, T; Schädler, D; Weiler, N; Möller, K

    2014-03-01

    Mechanical ventilation carries the risk of ventilator-induced-lung-injury (VILI). To minimize the risk of VILI, ventilator settings should be adapted to the individual patient properties. Mathematical models of respiratory mechanics are able to capture the individual physiological condition and can be used to derive personalized ventilator settings. This paper presents model-based calculations of inspiration pressure (pI), inspiration and expiration time (tI, tE) in pressure-controlled ventilation (PCV) and a retrospective evaluation of its results in a group of mechanically ventilated patients. Incorporating the identified first order model of respiratory mechanics in the basic equation of alveolar ventilation yielded a nonlinear relation between ventilation parameters during PCV. Given this patient-specific relation, optimized settings in terms of minimal pI and adequate tE can be obtained. We then retrospectively analyzed data from 16 ICU patients with mixed pathologies, whose ventilation had been previously optimized by ICU physicians with the goal of minimization of inspiration pressure, and compared the algorithm's 'optimized' settings to the settings that had been chosen by the physicians. The presented algorithm visualizes the patient-specific relations between inspiration pressure and inspiration time. The algorithm's calculated results highly correlate to the physician's ventilation settings with r = 0.975 for the inspiration pressure, and r = 0.902 for the inspiration time. The nonlinear patient-specific relations of ventilation parameters become transparent and support the determination of individualized ventilator settings according to therapeutic goals. Thus, the algorithm is feasible for a variety of ventilated ICU patients and has the potential of improving lung-protective ventilation by minimizing inspiratory pressures and by helping to avoid the build-up of clinically significant intrinsic positive end-expiratory pressure.

  5. Pressure dynamic characteristics of pressure controlled ventilation system of a lung simulator.

    PubMed

    Shi, Yan; Ren, Shuai; Cai, Maolin; Xu, Weiqing; Deng, Qiyou

    2014-01-01

    Mechanical ventilation is an important life support treatment of critically ill patients, and air pressure dynamics of human lung affect ventilation treatment effects. In this paper, in order to obtain the influences of seven key parameters of mechanical ventilation system on the pressure dynamics of human lung, firstly, mechanical ventilation system was considered as a pure pneumatic system, and then its mathematical model was set up. Furthermore, to verify the mathematical model, a prototype mechanical ventilation system of a lung simulator was proposed for experimental study. Last, simulation and experimental studies on the air flow dynamic of the mechanical ventilation system were done, and then the pressure dynamic characteristics of the mechanical system were obtained. The study can be referred to in the pulmonary diagnostics, treatment, and design of various medical devices or diagnostic systems.

  6. 21 CFR 868.5935 - External negative pressure ventilator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false External negative pressure ventilator. 868.5935... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5935 External negative pressure ventilator. (a) Identification. An external negative pressure ventilator (e.g., iron lung, cuirass) is...

  7. 21 CFR 868.5935 - External negative pressure ventilator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External negative pressure ventilator. 868.5935... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5935 External negative pressure ventilator. (a) Identification. An external negative pressure ventilator (e.g., iron lung, cuirass) is...

  8. 21 CFR 868.5935 - External negative pressure ventilator.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false External negative pressure ventilator. 868.5935... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5935 External negative pressure ventilator. (a) Identification. An external negative pressure ventilator (e.g., iron lung, cuirass) is...

  9. 21 CFR 868.5935 - External negative pressure ventilator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false External negative pressure ventilator. 868.5935... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5935 External negative pressure ventilator. (a) Identification. An external negative pressure ventilator (e.g., iron lung, cuirass) is...

  10. Transpulmonary pressure monitoring during mechanical ventilation: a bench-to-bedside review.

    PubMed

    Mietto, Cristina; Malbrain, Manu L N G; Chiumello, Davide

    2015-01-01

    Different ventilation strategies have been suggested in the past in patients with acute respiratory distress syndrome (ARDS). Airway pressure monitoring alone is inadequate to assure optimal ventilatory support in ARDS patients. The assessment of transpulmonary pressure (PTP) can help clinicians to tailor mechanical ventilation to the individual patient needs. Transpulmonary pressure monitoring, defined as airway pressure (Paw) minus intrathoracic pressure (ITP), provides essential information about chest wall mechanics and its effects on the respiratory system and lung mechanics. The positioning of an esophageal catheter is required to measure the esophageal pressure (Peso), which is clinically used as a surrogate for ITP or pleural pressure (Ppl), and calculates the transpulmonary pressure. The benefits of such a ventilation approach are avoiding excessive lung stress and individualizing the positive end-expiratory pressure (PEEP) setting. The aim is to prevent over-distention of alveoli and the cyclic recruitment/derecruitment or shear stress of lung parenchyma, mechanisms associated with ventilator-induced lung injury (VILI). Knowledge of the real lung distending pressure, i.e. the transpulmonary pressure, has shown to be useful in both controlled and assisted mechanical ventilation. In the latter ventilator modes, Peso measurement allows one to assess a patient's respiratory effort, patient-ventilator asynchrony, intrinsic PEEP and the calculation of work of breathing. Conditions that have an impact on Peso, such as abdominal hypertension, will also be discussed briefly.

  11. [Comparison of volume preset and pressure preset ventilators during daytime nasal ventilation in chronic respiratory failure].

    PubMed

    Perrin, C; Wolter, P; Berthier, F; Tamisier, R; Jullien, V; Lemoigne, F; Blaive, B

    2001-02-01

    Both volume preset and pressure preset ventilators are available for domiciliary nasal ventilation. Owing to their technical characteristics, it has been suggested that impaired ventilatory mechanics might cause a drop in the tidal volume (Vt) delivered by pressure preset devices, thereby placing mechanical ventilation at risk of inefficacy. We have assessed two ventilator systems (one pressure preset and one volume preset) with regard to the tidal volume and end-tidal carbon dioxide tension (PetCO(2)) changes that may be achieved in a group of awake patients with stable chronic respiratory failure (CRF). Eleven patients with stable CRF were ventilated in the assist/control mode for two consecutive one-hour periods. One ventilator was tested each hour, in random order. The VIGIL'AIR(R) system was used to record Vt, Respiratory Rate (RR), and Inspiratory/Expiratory ratio (I/E). The deviation E (E=preset value - measured value) was calculated for each measurement. Changes in PetCO(2) and arterial oxygen saturation were determined respectively by a capnometer and a pulse oximeter. Comparison of the mean deviation of Vt calculated for the two ventilators revealed a difference in patients with chronic obstructive pulmonary disease (COPD). The deviation was greatest with the pressure preset ventilator (PPV), which gave mean measured values higher than the mean preset values. The same comparison failed to reveal any difference in restrictive CRF. Comparison of the volume preset and pressure preset ventilators for RR, I/E and PetCO(2) did not reveal any difference. Compared to the volume preset ventilator, the efficacy of PPV to ventilate is not affected by the restrictive or obstructive nature of CRF. Our results show that pressure-preset ventilator is an adequate alternative to the volume-preset device for daytime non invasive ventilation in chronic respiratory insufficiency.

  12. Assisted Ventilation.

    PubMed

    Dries, David J

    2016-01-01

    Controlled Mechanical Ventilation may be essential in the setting of severe respiratory failure but consequences to the patient including increased use of sedation and neuromuscular blockade may contribute to delirium, atelectasis, and diaphragm dysfunction. Assisted ventilation allows spontaneous breathing activity to restore physiological displacement of the diaphragm and recruit better perfused lung regions. Pressure Support Ventilation is the most frequently used mode of assisted mechanical ventilation. However, this mode continues to provide a monotonous pattern of support for respiration which is normally a dynamic process. Noisy Pressure Support Ventilation where tidal volume is varied randomly by the ventilator may improve ventilation and perfusion matching but the degree of support is still determined by the ventilator. Two more recent modes of ventilation, Proportional Assist Ventilation and Neurally Adjusted Ventilatory Assist (NAVA), allow patient determination of the pattern and depth of ventilation. Proposed advantages of Proportional Assist Ventilation and NAVA include decrease in patient ventilator asynchrony and improved adaptation of ventilator support to changing patient demand. Work of breathing can be normalized with these modes as well. To date, however, a clear pattern of clinical benefit has not been demonstrated. Existing challenges for both of the newer assist modes include monitoring patients with dynamic hyperinflation (auto-positive end expiratory pressure), obstructive lung disease, and air leaks in the ventilator system. NAVA is dependent on consistent transduction of diaphragm activity by an electrode system placed in the esophagus. Longevity of effective support with this technique is unclear.

  13. Pressure versus volume controlled modes in invasive mechanical ventilation.

    PubMed

    Garnero, A J; Abbona, H; Gordo-Vidal, F; Hermosa-Gelbard, C

    2013-05-01

    The first generation of mechanical ventilators were controlled and cycled by pressure. Unfortunately, they did not allow control of the delivered tidal volume under changes in the dynamics of the respiratory system. This led to a second generation of ventilators that allowed volume control, hence favoring the ventilatory strategy based on normalization of the arterial gases. Studies conducted in the 1980s which related lung injury to the high ventilator pressures utilized while treating acute respiratory distress syndrome patients renewed interest in pressure-controlled mechanical ventilation. In addition, new evidence became available, leading to the development of pulmonary protective strategies aiming at preventing the progression of ventilator-induced lung injury. This review provides a detailed description of the control of pressure or volume using certain ventilatory modes, and offers a general view of their advantages and disadvantages, based on the latest available evidence.

  14. Nutritional support of the mechanically ventilated patient.

    PubMed

    Shikora, S A; Benotti, P N

    1997-03-01

    As with all critically ill patients, those requiring mechanical ventilation are susceptible to the wasting of illness and cannot survive without prompt nutritional support. It may be fair to say that the proper provision of nutrients, and in particular the avoidance of overfeeding, are even more crucial for this subset of critically ill patients. To maximize the overall benefits of feeding, it is crucial to provide the nutritional support early and enterally whenever possible. Therefore, the best strategy for early removal of the mechanical ventilatory support must include the timely and careful administration of nutrients, micronutrients, minerals, vitamins, and fluid, in conjunction with standard intensive care therapeutics and the appropriate respiratory muscle-strengthening program.

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

    PubMed Central

    Putensen, Christian; Wrigge, Hermann

    2004-01-01

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

  16. Anaesthesia ventilators

    PubMed Central

    Jain, Rajnish K; Swaminathan, Srinivasan

    2013-01-01

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

  17. Modeling systolic pressure variation due to positive pressure ventilation.

    PubMed

    Messerges, Joanne

    2006-01-01

    Although many clinical techniques have been proposed to assess blood volume none have been established as an undisputed standard practice, Volume studies suggest systolic pressure variation (SPV) as a promising volume indicator but underlying influences on SPV are not well understood. Successful modeling of SPV will reveal the major SPV influencers, guide algorithm development to accommodate these influencers, and potentially lead to a more clinically relevant interpretation of SPV values, thus improving upon current clinical methods for assessing blood volume. This study takes a first step towards identifying SPV influencers by investigating three variations of an existing pressure-flow cardiovascular model. Each successive version introduces an additional modification in attempt to model SPV under normovolemic and hypovolemic conditions, where the last model accounts for positive pressure ventilation, venous compression, and a rightward septum shift. Under normovolemic conditions, each model yields SPV values of 5.8, 6.4, and 6.7 mmHg, respectively. Under hypovolemic conditions the results do not agree with clinical findings, suggesting these three mechanisms alone do not dictate the clinical SPV response to a decrease in volume. Model results are used to suggest improvements for future work.

  18. MEASUREMENT OF FRICTIONAL PRESSURE DIFFERENTIALS DURING A VENTILATION SURVEY

    SciTech Connect

    B.S. Prosser, PE; I.M. Loomis, PE, PhD

    2003-11-03

    During the course of a ventilation survey, both airflow quantity and frictional pressure losses are measured and quantified. The measurement of airflow has been extensively studied as the vast majority of ventilation standards/regulations are tied to airflow quantity or velocity. However, during the conduct of a ventilation survey, measurement of airflow only represents half of the necessary parameters required to directly calculate the airway resistance. The measurement of frictional pressure loss is an often misunderstood and misapplied part of the ventilation survey. This paper compares the two basic methods of frictional pressure drop measurements; the barometer and the gauge and tube. Personal experiences with each method will be detailed along with the authors' opinions regarding the applicability and conditions favoring each method.

  19. Are there benefits or harm from pressure targeting during lung-protective ventilation?

    PubMed

    MacIntyre, Neil R; Sessler, Curtis N

    2010-02-01

    Mechanically, breath design is usually either flow/volume-targeted or pressure-targeted. Both approaches can effectively provide lung-protective ventilation, but they prioritize different ventilation parameters, so their responses to changing respiratory-system mechanics and patient effort are different. These different response behaviors have advantages and disadvantages that can be important in specific circumstances. Flow/volume targeting guarantees a set minute ventilation but sometimes may be difficult to synchronize with patient effort, and it will not limit inspiratory pressure. In contrast, pressure targeting, with its variable flow, may be easier to synchronize and will limit inspiratory pressure, but it provides no control over delivered volume. Skilled clinicians can maximize benefits and minimize problems with either flow/volume targeting or pressure targeting. Indeed, as is often the case in managing complex life-support devices, it is operator expertise rather than the device design features that most impacts patient outcomes.

  20. Ventilation of Nonparalyzed Patients Under Anesthesia with Laryngeal Mask Airway, Comparison of Three Modes of Ventilation: Volume Controlled Ventilation, Pressure Controlled Ventilation, and Pressure Controlled Ventilation-volume Guarantee

    PubMed Central

    Ghabach, Maroun Badwi; El Hajj, Elie M.; El Dib, Rouba D.; Rkaiby, Jeanette M.; Matta, May S.; Helou, May R.

    2017-01-01

    Background: Pressure controlled ventilation (PCV) is the preferable mode of ventilation of nonparalyzed patients undergoing anesthesia with laryngeal mask airway (LMA) as compared to volume controlled ventilation (VCV) and spontaneously breathing patient. In this study, we compared the PC–volume guarantee (PC-VG) mode of ventilation with VCV and PCV modes. Materials and Methods: A total of 30 patients, American Society of Anesthesiologists (ASA) physical status Classes I and II, scheduled for elective surgery under general anesthesia with a classic LMA were ventilated, subsequently, with the three modes of ventilation: VCV, PCV, and PC-VG for 10 min each mode. Tidal volume set for all patients was 8 ml/kg of ideal body weight. Parameters measured with modes of ventilation include peak inspiratory pressure (PIP), compliance, measured tidal volume, O2 saturation, end-tidal CO2, and presence of an oropharyngeal leak. Results: The PIP was significantly higher with the application of VCV mode of ventilation than PCV and PC-VG modes. The compliance was significantly lower when using the mode of ventilation VCV than PCV and PC-VG. The PIP and the compliance were not statistically different between the PCV and PC-VG modes of ventilation. Conclusions: Ventilation of nonparalyzed patients with LMA under anesthesia with PC-VG is advantageous over VCV in reducing PIP and increasing lung compliance. No difference was noted between PCV and PC-VG in ASA Classes I or II under the adequate depth of anesthesia in patients with normal pulmonary function. PMID:28298784

  1. Intermittent negative pressure ventilation in patients with restrictive respiratory failure.

    PubMed

    Schiavina, M; Fabiani, A

    1993-01-01

    Thirty one patients in stable respiratory failure (arterial oxygen tension (PaO2) 67 +/- 20 mmHg (8.9 +/- 2.7 kPa) and arterial carbon dioxide tension (PaCO2) 59 +/- 10 mmHg 7.9 +/- 1.3 kPa)), secondary to non-obstructive ventilatory impairment, were treated by intermittent negative pressure ventilation (INPV), using a pneumowrap or poncho during the night. Daytime arterial blood gas measurements, taken before and after the ventilation, revealed a substantial improvement in PaO2, PaCO2 and maximal inspiratory pressure (Pimax). This improvement persisted during the six month follow-up of home nocturnal ventilation. The polysomnographic, recording during mechanical ventilation by poncho, in five patients, showed a general improvement in the quality and structure of sleep. All patients returned to normal arterial oxygen saturation (SaO2) values (> 90%), except for one. In three patients, the appearance of obstructive events was noted but the desaturation that they caused was, remarkably, lower than that caused by central events in baseline recording. We conclude that non-invasive treatment by INPV, in patients with neuromuscular and chest wall disease, is the method of choice as an alternative to intermittent positive pressure ventilation and to tracheostomy.

  2. Pressurizer tank upper support

    DOEpatents

    Baker, Tod H.; Ott, Howard L.

    1994-01-01

    A pressurizer tank in a pressurized water nuclear reactor is mounted between structural walls of the reactor on a substructure of the reactor, the tank extending upwardly from the substructure. For bearing lateral loads such as seismic shocks, a girder substantially encircles the pressurizer tank at a space above the substructure and is coupled to the structural walls via opposed sway struts. Each sway strut is attached at one end to the girder and at an opposite end to one of the structural walls, and the sway struts are oriented substantially horizontally in pairs aligned substantially along tangents to the wall of the circular tank. Preferably, eight sway struts attach to the girder at 90.degree. intervals. A compartment encloses the pressurizer tank and forms the structural wall. The sway struts attach to corners of the compartment for maximum stiffness and load bearing capacity. A valve support frame carrying the relief/discharge piping and valves of an automatic depressurization arrangement is fixed to the girder, whereby lateral loads on the relief/discharge piping are coupled directly to the compartment rather than through any portion of the pressurizer tank. Thermal insulation for the valve support frame prevents thermal loading of the piping and valves. The girder is shimmed to define a gap for reducing thermal transfer, and the girder is free to move vertically relative to the compartment walls, for accommodating dimensional variation of the pressurizer tank with changes in temperature and pressure.

  3. Pressurizer tank upper support

    DOEpatents

    Baker, T.H.; Ott, H.L.

    1994-01-11

    A pressurizer tank in a pressurized water nuclear reactor is mounted between structural walls of the reactor on a substructure of the reactor, the tank extending upwardly from the substructure. For bearing lateral loads such as seismic shocks, a girder substantially encircles the pressurizer tank at a space above the substructure and is coupled to the structural walls via opposed sway struts. Each sway strut is attached at one end to the girder and at an opposite end to one of the structural walls, and the sway struts are oriented substantially horizontally in pairs aligned substantially along tangents to the wall of the circular tank. Preferably, eight sway struts attach to the girder at 90[degree] intervals. A compartment encloses the pressurizer tank and forms the structural wall. The sway struts attach to corners of the compartment for maximum stiffness and load bearing capacity. A valve support frame carrying the relief/discharge piping and valves of an automatic depressurization arrangement is fixed to the girder, whereby lateral loads on the relief/discharge piping are coupled directly to the compartment rather than through any portion of the pressurizer tank. Thermal insulation for the valve support frame prevents thermal loading of the piping and valves. The girder is shimmed to define a gap for reducing thermal transfer, and the girder is free to move vertically relative to the compartment walls, for accommodating dimensional variation of the pressurizer tank with changes in temperature and pressure. 10 figures.

  4. [Domiciliary noninvasive positive pressure ventilation in chronic alveolar hypoventilation].

    PubMed

    Casas, J P; Robles, A M; Pereyra, M A; Abbona, H L; López, A M

    2000-01-01

    Effectiveness of treatment with domiciliary nocturnal noninvasive positive pressure ventilation is analyzed in a group of patients with chronic alveolar hypoventilation of different etiologies. It was applied with two levels of pressure (BiPAP) via nasal mask. Criteria for evaluation were symptomatology and improvement in gas exchange. Data were analyzed by Student t tests. A total of 13 patients were included, mean age 55.7 range 20 to 76 years (5 male 8 female). Main diagnosis was tuberculosis in 6, four of them having had surgical procedure (thoracoplasty 2, frenicectomy 1 and neumonectomy 1), myopathy 3 (myasthenia gravis 1, muscular dystrophy 1 and diaphragmatic paralysis 1), obesity-hypoventilation syndrome 1, escoliosis 1, bronchiectasis 1 and cystic fibrosis 1. These last two patients were on waiting list for lung transplantation. At the moment of consultation, the symptoms were: dysnea 13/13 (100%), astenia 13/13 (100%), hypersomnolency 10/13 (77%), cephalea 9/13 (69%), leg edema 6/13 (46%), loss of memory 6/13 (46%). Regarding gas exchange, they showed hypoxemia and hypercapnia. Mean follow up was of 2.2 years (range 6 months to 4 years). Within the year, all 13 patients became less dyspneic. Astenia, hypersomnolency, cephalea, leg edema and memory loss disappeared. Improvement in gas exchange was: PaO2/FiO2 from 269 +/- 65.4 (basal) to 336.7 +/- 75.3 post-treatment (p = 0.0018). PaCO2 from 70.77 +/- 25.48 mmHg (basal) to 46.77 +/- 8.14 mmHg (p = 0.0013). Ventilatory support was discontinued en 5 patients: three because of pneumonia requiring intubation and conventional mechanical ventilation, two of them died and one is still with tracheostomy; One patient with bronchiectasis and one with cystic fibrosis were transplanted. The remaining eight patients are stable. In conclusion, chronic alveolar hypoventilation can be effectively treated with domiciliary nocturnal noninvasive ventilation. Long term improvement in symptomatology and arterial blood gases

  5. Ventilation.

    PubMed

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

    1995-01-01

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

  6. Pressure Losses across Multiple Fittings in Ventilation Ducts

    PubMed Central

    Ai, Z. T.; Mak, C. M.

    2013-01-01

    The accurate prediction of pressure losses across in-duct fittings is of significance in relation to the accurate sizing and good energy efficiency of air-delivery systems. Current design guides provide design methods and data for the prediction of pressure losses only for a single and isolated fitting. This study presents an investigation of pressure losses across multiple interactive in-duct fittings in a ventilation duct. A laboratory measurement of pressure losses across one fitting and multiple fittings in a ventilation duct is carried out. The pressure loss across multiple interactive fittings is lower than that across multiple similar individual fittings, while the percentage decrease is dependent on the configuration and combination of the fittings. This implies that the pressure loss across multiple closely mounted fittings calculated by summing the pressure losses across individual fittings, as provided in the ASHRAE handbook and the CIBSE guide, is overpredicted. The numerical prediction of the pressure losses across multiple fittings using the large-eddy simulation (LES) model shows good agreement with the measured data, suggesting that this model is a useful tool in ductwork design and can help to save experimental resources and improve experimental accuracy and reliability. PMID:24385871

  7. Pressure losses across multiple fittings in ventilation ducts.

    PubMed

    Ai, Z T; Mak, C M

    2013-01-01

    The accurate prediction of pressure losses across in-duct fittings is of significance in relation to the accurate sizing and good energy efficiency of air-delivery systems. Current design guides provide design methods and data for the prediction of pressure losses only for a single and isolated fitting. This study presents an investigation of pressure losses across multiple interactive in-duct fittings in a ventilation duct. A laboratory measurement of pressure losses across one fitting and multiple fittings in a ventilation duct is carried out. The pressure loss across multiple interactive fittings is lower than that across multiple similar individual fittings, while the percentage decrease is dependent on the configuration and combination of the fittings. This implies that the pressure loss across multiple closely mounted fittings calculated by summing the pressure losses across individual fittings, as provided in the ASHRAE handbook and the CIBSE guide, is overpredicted. The numerical prediction of the pressure losses across multiple fittings using the large-eddy simulation (LES) model shows good agreement with the measured data, suggesting that this model is a useful tool in ductwork design and can help to save experimental resources and improve experimental accuracy and reliability.

  8. Dynamic Characteristics of Mechanical Ventilation System of Double Lungs with Bi-Level Positive Airway Pressure Model

    PubMed Central

    Shen, Dongkai; Zhang, Qian

    2016-01-01

    In recent studies on the dynamic characteristics of ventilation system, it was considered that human had only one lung, and the coupling effect of double lungs on the air flow can not be illustrated, which has been in regard to be vital to life support of patients. In this article, to illustrate coupling effect of double lungs on flow dynamics of mechanical ventilation system, a mathematical model of a mechanical ventilation system, which consists of double lungs and a bi-level positive airway pressure (BIPAP) controlled ventilator, was proposed. To verify the mathematical model, a prototype of BIPAP system with a double-lung simulators and a BIPAP ventilator was set up for experimental study. Lastly, the study on the influences of key parameters of BIPAP system on dynamic characteristics was carried out. The study can be referred to in the development of research on BIPAP ventilation treatment and real respiratory diagnostics. PMID:27660646

  9. [Management of patients receiving home respiratory care with tracheostomy and positive-pressure ventilation].

    PubMed

    Aoki, Masashi

    2013-01-01

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

  10. Utility of Transcutaneous Capnography for Optimization of Non-Invasive Ventilation Pressures

    PubMed Central

    Gehrer, Simone; Pandey, Kamlesh V; Vaidya, Preyas J; Leuppi, Joerg D.; Tamm, Michael; Strobel, Werner

    2016-01-01

    Introduction Nocturnal Non-invasive Positive Pressure Ventilation (NPPV) is the treatment of choice in patients with chronic hypercapnic respiratory failure due to hypoventilation. Continuous oxygen saturation measured with a pulse oximeter provides a surrogate measure of arterial oxygen saturation but does not completely reflect ventilation. Currently, Partial Pressure of Arterial (PaCO2) measured by arterial blood analysis is used for estimating the adequacy of ventilatory support and serves as the gold standard Aim To examine the safety, feasibility and utility of cutaneous capnography to re-titrate the non-invasive positive pressure ventilation settings in patients with chronic hypercapnic respiratory failure due to hypoventilation. Materials and Methods Twelve patients with chronic hypercapnic respiratory failure prospectively underwent complete polysomnography and cutaneous capnography measurement on the ear lobe. Non-invasive ventilation pressures were adjusted with the aim of normalizing cutaneous carbon dioxide or at least reducing it by 10 to 15 mmHg. Sensor drift for cutaneous carbon dioxide of 0.7 mmHg per hour was integrated in the analysis. Results Mean baseline cutaneous carbon dioxide was 45.4 ± 6.5 mmHg and drift corrected awake value was 45.1 ± 8.3 mmHg. The correlation of baseline cutaneous carbon dioxide and the corrected awake cutaneous carbon dioxide with arterial blood gas values were 0.91 and 0.85 respectively. Inspiratory positive airway pressures were changed in nine patients (75%) and expiratory positive airway pressures in eight patients (66%). Epworth sleepiness score before and after the study showed no change in five patients, improvement in six patients and deterioration in one patient. Conclusion Cutaneous capnography is feasible and permits the optimization of non-invasive ventilation pressure settings in patients with chronic hypercapnic respiratory failure due to hypoventilation. Continuous cutaneous capnography might serve as

  11. The role of an ambient pressure oxygen source during one-lung ventilation for thoracoscopic surgery.

    PubMed

    Pfitzner, J

    2016-01-01

    Video-assisted thoracoscopic surgery is facilitated by prompt collapse of the non-ventilated ('operated') lung, and interrupted and impeded if there is a need for oxygen (O2) delivery by continuous positive airways pressure in order to manage hypoxaemia. It has been proposed that connecting an ambient pressure O2 source to the airway of the non-ventilated lung at the time one-lung ventilation is initiated and before the chest is opened will, by avoiding entrainment of ambient nitrogen, serve to facilitate lung collapse. It has also been proposed that leaving the O2 source connected will enable, not only ongoing apnoeic oxygenation before the chest is opened, but also the thoracoscopic procedure to commence with the operated lung fully pre-oxygenated (with an inspired oxygen fraction of 1), and apnoeic oxygenation to continue throughout the operative procedure in those patients who exhibit a degree of small airways patency at ambient pressure. In reality, several factors can influence the speed of collapse of the operated lung, and very many factors can influence the incidence of hypoxaemia during one-lung ventilation. It therefore appears unlikely that the necessary evidence to support these proposals will be forthcoming from randomised clinical studies on large numbers of patients. Rather, the necessary evidence may only be provided by specifically designed within-patient clinical measurement studies. Nevertheless, it is argued that, in the meantime, there is already sufficient rationale for an ambient pressure O2 source to be connected to the airway of the non-ventilated lung, and for it to remain connected for the duration of one-lung ventilation.

  12. 30 CFR 18.28 - Devices for pressure relief, ventilation, or drainage.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Construction and Design Requirements § 18.28 Devices for pressure relief, ventilation, or drainage. (a) Devices... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Devices for pressure relief, ventilation, or... metal will prevent discharge of flame in explosion tests. (b) Devices for pressure relief,...

  13. 30 CFR 18.28 - Devices for pressure relief, ventilation, or drainage.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Construction and Design Requirements § 18.28 Devices for pressure relief, ventilation, or drainage. (a) Devices... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Devices for pressure relief, ventilation, or... metal will prevent discharge of flame in explosion tests. (b) Devices for pressure relief,...

  14. 30 CFR 18.28 - Devices for pressure relief, ventilation, or drainage.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Construction and Design Requirements § 18.28 Devices for pressure relief, ventilation, or drainage. (a) Devices... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Devices for pressure relief, ventilation, or... metal will prevent discharge of flame in explosion tests. (b) Devices for pressure relief,...

  15. 30 CFR 18.28 - Devices for pressure relief, ventilation, or drainage.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Construction and Design Requirements § 18.28 Devices for pressure relief, ventilation, or drainage. (a) Devices... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Devices for pressure relief, ventilation, or... metal will prevent discharge of flame in explosion tests. (b) Devices for pressure relief,...

  16. Different characteristics of ventilator application between tracheostomy- and noninvasive positive pressure ventilation patients with amyotrophic lateral sclerosis

    PubMed Central

    Park, Donghwi; Lee, Goo Joo; Kim, Ha Young; Ryu, Ju Seok

    2017-01-01

    Abstract The aim of the study was to investigate the appropriate home ventilator settings for patients with amyotrophic lateral sclerosis (ALS). In total, 71 patients with ALS, who had received either a noninvasive positive pressure ventilation (NIPPV) or tracheostomy positive pressure ventilation (TPPV), were included. Accordingly, patients were divided into 2 groups (the TPPV and NIPPV groups). We retrospectively evaluated the values used in home ventilators for patients with ALS, who had maintained a stable level of CO2 on both the arterial blood gas analysis (ABGA) and transcutaneous blood gas monitoring. To measure the main outcome, we also investigated the actual body weight (ABW) and predicted body weight (PBW) of patients, and the following setting values of ventilators were also recorded: the inspired tidal volume (VTi), minute ventilation (MV), peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP), and inspiratory time (Tins). VTi and MV showed a significantly positive correlation with both PBW and ABW of patients in the TPPV group. However, both VTi and MV had greater significant correlation with PBW than ABW in the TPPV group. In addition, VTi and MV did not show a significantly positive correlation with either PBW or ABW in the NIPPV group. In patients with ALS, PBW was more useful for predicting VTi and MV than ABW. Moreover, it will be helpful to know the differences of setting values between TPPV and NIPPV, especially because ALS patients are usually treated with TPPV due to the initial difficulties associated with NIPPV. PMID:28272226

  17. Airway Pressure Release Ventilation and High-Frequency Oscillatory Ventilation: Potential Strategies to Treat Severe Hypoxemia and Prevent Ventilator-Induced Lung Injury.

    PubMed

    Facchin, Francesca; Fan, Eddy

    2015-10-01

    Although lifesaving, mechanical ventilation can itself be responsible for damage to lung parenchyma. This ventilator-induced lung injury is especially observed in already injured lungs of patients with ARDS. New ventilatory approaches are needed to safely treat patients with ARDS, and recent studies have suggested the potential utility of open-lung strategies. Airway pressure release ventilation (APRV) and high-frequency oscillatory ventilation (HFOV) are 2 different open-lung strategies that have been proposed to treat refractory hypoxemic respiratory failure while preventing ventilator-induced lung injury. APRV provides increased airway pressure as a potential recruitment mechanism and allows spontaneous breathing, with the potential benefits of decreased sedation, shorter duration of mechanical ventilation, and improvement in cardiac performance. HFOV delivers very small tidal volumes, to prevent volutrauma, at a constant (relatively high) mean airway pressure, thus avoiding atelectrauma. Despite their theoretical benefits, the utility of APRV and HFOV remains unproven and controversial for the routine treatment of ARDS in adult patients. This review is focused on the theoretical and practical aspects of APRV and HFOV, provides an overview of the current evidence, and addresses their possible use in the treatment of ARDS.

  18. Respiratory muscle activity and patient–ventilator asynchrony during different settings of noninvasive ventilation in stable hypercapnic COPD: does high inspiratory pressure lead to respiratory muscle unloading?

    PubMed Central

    Duiverman, Marieke L; Huberts, Anouk S; van Eykern, Leo A; Bladder, Gerrie; Wijkstra, Peter J

    2017-01-01

    Introduction High-intensity noninvasive ventilation (NIV) has been shown to improve outcomes in stable chronic obstructive pulmonary disease patients. However, there is insufficient knowledge about whether with this more controlled ventilatory mode optimal respiratory muscle unloading is provided without an increase in patient–ventilator asynchrony (PVA). Patients and methods Ten chronic obstructive pulmonary disease patients on home mechanical ventilation were included. Four different ventilatory settings were investigated in each patient in random order, each for 15 min, varying the inspiratory positive airway pressure and backup breathing frequency. With surface electromyography (EMG), activities of the intercostal muscles, diaphragm, and scalene muscles were determined. Furthermore, pressure tracings were derived simultaneously in order to assess PVA. Results Compared to spontaneous breathing, the most pronounced decrease in EMG activity was achieved with the high-pressure settings. Adding a high breathing frequency did reduce EMG activity per breath, while the decrease in EMG activity over 1 min was comparable with the high-pressure, low-frequency setting. With high backup breathing frequencies less breaths were pressure supported (25% vs 97%). PVAs occurred more frequently with the low-frequency settings (P=0.017). Conclusion High-intensity NIV might provide optimal unloading of respiratory muscles, without undue increases in PVA. PMID:28138234

  19. Comparison of respiratory and hemodynamic stability in patients with traumatic brain injury ventilated by two ventilator modes: Pressure regulated volume control versus synchronized intermittent mechanical ventilation

    PubMed Central

    Aghadavoudi, Omid; Alikiaii, Babak; Sadeghi, Fariba

    2016-01-01

    Background: This study aimed to compare pressure regulated volume control (PRVC) and synchronized intermittent mechanical ventilation (SIMV) modes of ventilation according to respiratory and hemodynamic stability in patients with traumatic brain injury (TBI) admitted to Intensive Care Unit (ICU). Materials and Methods: In a randomized, single-blinded, clinical trial study, 100 patients who hospitalized in ICU due to TBI were selected and randomly divided into two groups. The first and second groups were ventilated by PRVC and SIMV modes, respectively. During mechanical ventilation, arterial blood gas and respiratory and hemodynamic parameters were also recorded and compared between the two groups. Results: According to the t-test, the mean rapid shallow breathing index (RSBI) after the first 8 h of mechanical ventilation was significantly higher in SIMV group compared with PRVC group (107.6 ± 2.75 vs. 102.2 ± 5.2, respectively, P < 0.0001). Further, according to ANOVA with repeated measures, the trend of RSBI changes had a significant difference between the two groups (P < 0.001). The trend of ratio of partial pressure arterial oxygen and fraction of inspired oxygen was different between the two groups according to Mann–Whitney–Wilcoxon test (P < 0.001). Conclusions: Using PRVC mode might be more desirable than using SIMV mode in patients with TBI due to better stability of ventilation and oxygenating. To ensure for more advantages of PRVC mode, further studies with longer follow-up and more detailed measurements are recommended. PMID:28028515

  20. A model-based decision support system for critiquing mechanical ventilation treatments.

    PubMed

    Tehrani, Fleur T; Abbasi, Soraya

    2012-06-01

    A computerized system for critiquing mechanical ventilation treatments is presented that can be used as an aide to the intensivist. The presented system is based on the physiological model of the subject's respiratory system. It uses modified versions of previously developed models of adult and neonatal respiratory systems to simulate the effects of different ventilator treatments on the patient's blood gases. The physiological models that have been used for research and teaching purposes by many researchers in the field include lungs, body tissue, and the brain tissue. The lung volume is continuously time-varying and the effects of shunt in the lung, changes in cardiac output and cerebral blood flow, and the arterial transport delays are included in the system. Evaluation tests were done on adult and neonate patients with different diagnoses. In both groups combined, the differences between the arterial partial pressures of CO(2) predicted by the system and the experimental values were 1.86 ± 1.6 mmHg (mean ± SD), and the differences between the predicted arterial hemoglobin oxygen saturation values, S(aO2), and the experimental values measured by using pulse oximetry, S(pO2), were 0.032 ± 0.02 (mean ± SD). The proposed system has the potential to be used alone or in combination with other decision support systems to set ventilation parameters and optimize treatment for patients on mechanical ventilation.

  1. High intensity positive pressure ventilation and long term pulmonary function responses in severe stable COPD. A delicate and difficult balance.

    PubMed

    Esquinas, Antonio M; Petroianni, Angelo

    2014-06-01

    Method to improve minute ventilation (MV) during spontaneous breathing (SB) in stable severe chronic obstructive pulmonary disease (COPD) have a great clinical relevant in long term outcome. In this scenario, recommendations of early use of high-Intensity non-invasive Positive pressure Ventilation (HI-NPPV) or intelligent Volume Assured Pressure (iVAP) Support in Hypercapnic COPD have been proposed by safe therapeutics options. We analyze in this letter, Ekkernkamp et al. study that described the effect of HI-NPPV compared with SB on MV in patients receiving long-term treatment. We consider that interpretation of relationships between ABG, functional parameters, and respiratory mechanics reported need clarifications. Further prospective large clinical trials identifying the best mode of ventilation according to the characteristics in severe stable COPD are necessary to balance an effective approach and response on clinical symptoms and long-term effects.

  2. High frequency jet ventilation and intermittent positive pressure ventilation. Effect of cerebral blood flow in patients after open heart surgery

    SciTech Connect

    Pittet, J.F.; Forster, A.; Suter, P.M. )

    1990-02-01

    Attenuation of ventilator-synchronous pressure fluctuations of intracranial pressure has been demonstrated during high frequency ventilation in animal and human studies, but the consequences of this effect on cerebral blood flow have not been investigated in man. We compared the effects of high frequency jet ventilation and intermittent positive pressure ventilation on CBF in 24 patients investigated three hours after completion of open-heart surgery. The patients were investigated during three consecutive periods with standard sedation (morphine, pancuronium): a. IPPV; b. HFJV; c. IPPV. Partial pressure of arterial CO{sub 2} (PaCO{sub 2}: 4.5-5.5 kPa) and rectal temperature (35.5 to 37.5{degree}C) were maintained constant during the study. The CBF was measured by intravenous {sup 133}Xe washout technique. The following variables were derived from the cerebral clearance of {sup 133}Xe: the rapid compartment flow, the initial slope index, ie, a combination of the rapid and the slow compartment flows, and the ratio of fast compartment flow over total CBF (FF). Compared to IPPV, HFJV applied to result in the same mean airway pressure did not produce any change in pulmonary gas exchange, mean systemic arterial pressure, and cardiac index. Similarly, CBF was not significantly altered by HFJV. However, important variations of CBF values were observed in three patients, although the classic main determinants of CBF (PaCO{sub 2}, cerebral perfusion pressure, Paw, temperature) remained unchanged. Our results suggest that in patients with normal systemic hemodynamics, the effects of HFJV and IPPV on CBF are comparable at identical levels of mean airway pressure.

  3. Noninvasive Positive Pressure Ventilation in Chronic Heart Failure

    PubMed Central

    Han, Yi

    2016-01-01

    Instruction and Objectives. Noninvasive positive pressure ventilation (NPPV) alleviates sleep-disordered breathing (SDB) and it may improve cardiac function in SDB patients. Because large randomized controlled trials directly evaluating the impact of NPPV on cardiac function are lacking, we conducted a meta-analysis of published data on effectiveness of NPPV in improving cardiac function in patients with chronic heart failure regardless of SDB presence. Methods. Controlled trials were identified in PubMed, OVID, and EMBASE databases. Both fixed and randomized models were used in meta-analysis with primary outcomes of left ventricular ejection fraction (LVEF). Results. Nineteen studies were included with a total of 843 patients. Compared to standard medical treatment (SMT) plus sham-NPPV or SMT only, NPPV plus SMT was associated with improvement in LVEF (weighted mean difference 5.34, 95% CI, [3.85,6.82]; P < 0.00001) and plasma brain natriuretic peptide (BNP) level (weighted mean difference −117.37, 95% CI, [−227.22, −7.52]; P = 0.04) and no influence on overall mortality (RR 1.00, 95% CI, [0.96,1.04]; P = 0.95). Conclusions. In the present meta-analysis, use of NPPV plus SMT improved LVEF and reduced plasma BNP level but did not improve overall mortality in patients with chronic heart failure. PMID:27891061

  4. The Effect of Pressure-Controlled Ventilation and Volume-Controlled Ventilation in Prone Position on Pulmonary Mechanics and Inflammatory Markers.

    PubMed

    Şenay, Hasan; Sıvacı, Remziye; Kokulu, Serdar; Koca, Buğra; Bakı, Elif Doğan; Ela, Yüksel

    2016-08-01

    The aim of this present study is to compare the effect of pressure-controlled ventilation and volume-controlled ventilation on pulmonary mechanics and inflammatory markers in prone position. The study included 41 patients undergoing to vertebrae surgery. The patients were randomized into two groups: Group 1 received volume-controlled ventilation, while group 2 received pressure-controlled ventilation. The demographic data, pulmonary mechanics, the inflammatory marker levels just after the induction of anesthetics, at the 6th and 12th hours, and gas analysis from arterial blood samples taken at the beginning and the 30th minute were recorded. The inflammatory marker levels increased in both groups, without any significant difference among groups. Peak inspiratory pressure level was higher in the volume-controlled ventilation group. This study revealed that there is no difference regarding inflammatory marker levels between volume- and pressure-controlled ventilation.

  5. Effects of assisted ventilation on the work of breathing: volume-controlled versus pressure-controlled ventilation.

    PubMed

    Cinnella, G; Conti, G; Lofaso, F; Lorino, H; Harf, A; Lemaire, F; Brochard, L

    1996-03-01

    During assisted ventilation, the same tidal volume can be delivered in different ways, with the possibility for the physician to vary the ventilatory target (pressure or volume) and the peak flow setting. We compared the effects on the respiratory work rate of assisted ventilation, delivered either with a square wave flow pattern (assist control ventilation [ACV]) or with a decelerating flow pattern and a constant pressure (assisted pressure-control ventilation [APCV]). In the first part of the study where seven patients were studied, inspiratory time and tidal volume were similar in the two modes of ventilation. High and moderate levels of tidal volume (VT) were studied (12 ml/kg and 8 ml/kg, respectively). To obtain moderate VT, inspiratory time was kept constant and, therefore, mean inspiratory flow was reduced. At high VT, no difference between ACV and APCV was noted for breathing pattern, respiratory drive indexes, respiratory muscle work, or arterial blood gases. All patients exhibited respiratory alkalosis. At moderate VT, normal pH was achieved. In this situation significantly lower levels were observed during APCV than during ACV for the power of breathing (10 +/- 2 versus 19 +/- 5 J/min, p<0.05), transdiaphragmatic pressure swing (7 +/- 1 versus 11 +/- 2 cm H2O, p<0.05), and pressure-time index (252 +/- 43 versus 484 +/- 114 cm H2O.s, p<0.05), even though breathing pattern and gas exchange were similar. In the second part of the study where six additional patients were studied, tidal volume was kept constant at a moderate level (8 ml/kg), and we studied the effect of shortening inspiratory time and increasing mean inspiratory flow. At moderate VT and high inspiratory flow, no significant differences could be found between ACV and APCV, and although pressure-time index tended to be lower during APCV, absolute levels of effort were of small magnitude (56 +/- 55 versus 76 +/- 55 cm H2O.s). We conclude that at moderate VT and low flow rates only, inspiratory

  6. Effect of high-frequency positive-pressure ventilation on halothane ablation of hypoxic pulmonary vasoconstriction.

    PubMed

    Hall, S M; Chapleau, M; Cairo, J; Levitzky, M G

    1985-08-01

    High-frequency positive-pressure ventilation (HFPPV) was compared to intermittent positive-pressure ventilation (IPPV) during unilateral atelectasis with and without halothane anesthesia. Dogs with electromagnetic flow probes chronically implanted on their main (Qt) and left (Ql) pulmonary arteries were ventilated via Carlen's dual-lumen endotracheal tubes. In eight closed-chest dogs, about 43% of the cardiac output perfused the left lung during bilateral ventilation by either a Harvard animal respirator (IPPV) or a Health-dyne model 300 high-frequency ventilator (HFPPV). Unilateral atelectasis decreased blood flow (Ql/Qt) to that lung. Ql/Qt was 19 +/- 1% with HFPPV during left-lung atelectasis and right-lung ventilation, compared to 32 +/- 1% with unilateral IPPV. This suggests that HFPPV permits stronger hypoxic pulmonary vasoconstriction. Addition of 1% halothane increased blood flow to the atelectatic left lung during unilateral ventilation with IPPV but not with HFPPV. This suggests that halothane decreases the effects of hypoxic pulmonary vasoconstriction during conventional ventilation but not during HFPPV.

  7. Deviation of tracheal pressure from airway opening pressure during high-frequency oscillatory ventilation in a porcine lung model.

    PubMed

    Johannes, Amélie; Zollhoefer, Bernd; Eujen, Ulrike; Kredel, Markus; Rauch, Stefan; Roewer, Norbert; Muellenbach, Ralf M

    2013-04-01

    Oxygenation during high-frequency oscillatory ventilation is secured by a high level of mean airway pressure. Our objective was to identify a pressure difference between the airway opening of the respiratory circuit and the trachea during application of different oscillatory frequencies. Six female Pietrain pigs (57.1 ± 3.6 kg) were first ventilated in a conventional mechanical ventilation mode. Subsequently, the animals were switched to high-frequency oscillatory ventilation by setting mean airway opening pressure 5 cmH(2)O above the one measured during controlled mechanical ventilation. Measurements at the airway opening and at tracheal levels were performed in healthy lungs and after induction of acute lung injury by surfactant depletion. During high-frequency oscillatory ventilation, the airway opening pressure was set at a constant level. The pressure amplitude was fixed at 90 cmH(2)O. Starting from an oscillatory frequency of 3 Hz, the frequency was increased in steps of 3 Hz to 15 Hz and then decreased accordingly. At each frequency, measurements were performed in the trachea through a side-lumen of the endotracheal tube and the airway opening pressure was recorded. The pressure difference was calculated. At every oscillatory frequency, a pressure loss towards the trachea could be shown. This pressure difference increased with higher oscillatory frequencies (3 Hz 2.2 ± 2.1 cmH(2)O vs. 15 Hz 7.5 ± 1.8 cmH(2)O). The results for healthy and injured lungs were similar. Tracheal pressures decreased with higher oscillatory frequencies. This may lead to pulmonary derecruitment. This has to be taken into consideration when increasing oscillatory frequencies and differentiated pressure settings are mandatory.

  8. Inhibitory Effect of Nasal Intermittent Positive Pressure Ventilation on Gastroesophageal Reflux

    PubMed Central

    Cantin, Danny; Djeddi, Djamal; Carrière, Vincent; Samson, Nathalie; Nault, Stéphanie; Jia, Wan Lu; Beck, Jennifer; Praud, Jean-Paul

    2016-01-01

    Non-invasive intermittent positive pressure ventilation can lead to esophageal insufflations and in turn to gastric distension. The fact that the latter induces transient relaxation of the lower esophageal sphincter implies that it may increase gastroesophageal refluxes. We previously reported that nasal Pressure Support Ventilation (nPSV), contrary to nasal Neurally-Adjusted Ventilatory Assist (nNAVA), triggers active inspiratory laryngeal closure. This suggests that esophageal insufflations are more frequent in nPSV than in nNAVA. The objectives of the present study were to test the hypotheses that: i) gastroesophageal refluxes are increased during nPSV compared to both control condition and nNAVA; ii) esophageal insufflations occur more frequently during nPSV than nNAVA. Polysomnographic recordings and esophageal multichannel intraluminal impedance pHmetry were performed in nine chronically instrumented newborn lambs to study gastroesophageal refluxes, esophageal insufflations, states of alertness, laryngeal closure and respiration. Recordings were repeated without sedation in control condition, nPSV (15/4 cmH2O) and nNAVA (~ 15/4 cmH2O). The number of gastroesophageal refluxes recorded over six hours, expressed as median (interquartile range), decreased during both nPSV (1 (0, 3)) and nNAVA [1 (0, 3)] compared to control condition (5 (3, 10)), (p < 0.05). Meanwhile, the esophageal insufflation index did not differ between nPSV (40 (11, 61) h-1) and nNAVA (10 (9, 56) h-1) (p = 0.8). In conclusion, nPSV and nNAVA similarly inhibit gastroesophageal refluxes in healthy newborn lambs at pressures that do not lead to gastric distension. In addition, the occurrence of esophageal insufflations is not significantly different between nPSV and nNAVA. The strong inhibitory effect of nIPPV on gastroesophageal refluxes appears identical to that reported with nasal continuous positive airway pressure. PMID:26785264

  9. Optimization of ventilator setting by flow and pressure waveforms analysis during noninvasive ventilation for acute exacerbations of COPD: a multicentric randomized controlled trial

    PubMed Central

    2011-01-01

    Introduction The analysis of flow and pressure waveforms generated by ventilators can be useful in the optimization of patient-ventilator interactions, notably in chronic obstructive pulmonary disease (COPD) patients. To date, however, a real clinical benefit of this approach has not been proven. Methods The aim of the present randomized, multi-centric, controlled study was to compare optimized ventilation, driven by the analysis of flow and pressure waveforms, to standard ventilation (same physician, same initial ventilator setting, same time spent at the bedside while the ventilator screen was obscured with numerical data always available). The primary aim was the rate of pH normalization at two hours, while secondary aims were changes in PaCO2, respiratory rate and the patient's tolerance to ventilation (all parameters evaluated at baseline, 30, 120, 360 minutes and 24 hours after the beginning of ventilation). Seventy patients (35 for each group) with acute exacerbation of COPD were enrolled. Results Optimized ventilation led to a more rapid normalization of pH at two hours (51 vs. 26% of patients), to a significant improvement of the patient's tolerance to ventilation at two hours, and to a higher decrease of PaCO2 at two and six hours. Optimized ventilation induced physicians to use higher levels of external positive end-expiratory pressure, more sensitive inspiratory triggers and a faster speed of pressurization. Conclusions The analysis of the waveforms generated by ventilators has a significant positive effect on physiological and patient-centered outcomes during acute exacerbation of COPD. The acquisition of specific skills in this field should be encouraged. Trial registration ClinicalTrials.gov NCT01291303. PMID:22115190

  10. [Long-term effects of home mechanical ventilation with positive pressure using a nasal mask].

    PubMed

    Escarrabill, J; Estopà, R; Robert, D; Casolivé, V; Manresa, F

    1991-10-05

    Home mechanical ventilation (HMV) is an efficient alternative in the treatment of patients with chronic respiratory failure secondary to restrictive mechanical disorders (neuromuscular disease, such as Duchenne's disease, thorax deformities due to kyphoscoliosis or tuberculosis sequelae). The case of a patient with severe kyphoscoliosis in the phase of chronic respiratory failure (PaO2 34 mmHg and PaCO2 61 mmHg, breathing ambient air) is presented in which, following the failure of negative pressure mechanical ventilation ("poncho"), positive pressure ventilation was tested with a silicon made-to-measure nasal mask as the access via. Adaptation to HMV was good with the patient using the ventilation nightly. Following 12 months of treatment the patient is able to carry out everyday activities and arterial gasometry breathing ambient air is PaO2 77 mmHg and PaCO2 43 mmHg.

  11. Helium:oxygen versus air:oxygen noninvasive positive-pressure ventilation in patients exposed to sulfur mustard.

    PubMed

    Ghanei, Mostafa; Rajaeinejad, Mohsen; Motiei-Langroudi, Rouzbeh; Alaeddini, Farshid; Aslani, Jafar

    2011-01-01

    Exposure to sulfur mustard (SM) causes a variety of respiratory symptoms, such as chronic bronchitis and constrictive bronchiolitis. This study assessed the effectiveness of noninvasive positive-pressure ventilation, adjunct with 79:21 helium:oxygen instead of 79:21 air:oxygen, in 24 patients with a previous exposure to SM presenting with acute respiratory failure. Both air:oxygen and helium:oxygen significantly decreased systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse rate, respiratory rate, dyspnea, and increased oxygen saturation (P values: .007, .029, .002, <.001, <.001, <.001, and .002 for air:oxygen, respectively, and <.001, .020, .001, <.001, <.001, <.001, and .002, for helium:oxygen, respectively). Moreover, helium:oxygen more potently improved systolic pressure, mean arterial pressure, pulse rate, respiratory rate, and dyspnea (P values: .012, .048, <.001, <.001, and .012, respectively). The results of our study support the benefit of using helium:oxygen adjunct with noninvasive positive-pressure ventilation in patients exposed to SM with acute respiratory decompensation.

  12. Management of Ventilatory Insufficiency in Neuromuscular Patients Using Mechanical Ventilator Supported by the Korean Government.

    PubMed

    Kang, Seong-Woong; Choi, Won Ah; Cho, Han Eol; Lee, Jang Woo; Park, Jung Hyun

    2016-06-01

    Since 2001, financial support has been provided for all patients with neuromuscular disease (NMD) who require ventilatory support due to the paralysis of respiratory muscles in Korea. The purpose of this study was to identify ventilator usage status and appropriateness in these patients. We included 992 subjects with rare and incurable NMD registered for ventilator rental fee support. From 21 February 2011 to 17 January 2013, ventilator usage information, regular follow-up observation, and symptoms of chronic hypoventilation were surveyed by phone. Home visits were conducted for patients judged by an expert medical team to require medical examination. Abnormal ventilatory status was assessed by respiratory evaluation. Chronic respiratory insufficiency symptoms were reported by 169 of 992 subjects (17%), while 565 subjects (57%) did not receive regular respiratory evaluation. Ventilatory status was abnormal in 102 of 343 home-visit subjects (29.7%). Although 556 subjects (56%) reported 24-hour ventilator use, only 458 (46%) had an oxygen saturation monitoring device, and 305 (31%) performed an airstacking exercise. A management system that integrates ventilator usage monitoring, counselling and advice, and home visits for patients who receive ventilator support could improve the efficiency of the ventilator support project.

  13. Management of Ventilatory Insufficiency in Neuromuscular Patients Using Mechanical Ventilator Supported by the Korean Government

    PubMed Central

    2016-01-01

    Since 2001, financial support has been provided for all patients with neuromuscular disease (NMD) who require ventilatory support due to the paralysis of respiratory muscles in Korea. The purpose of this study was to identify ventilator usage status and appropriateness in these patients. We included 992 subjects with rare and incurable NMD registered for ventilator rental fee support. From 21 February 2011 to 17 January 2013, ventilator usage information, regular follow-up observation, and symptoms of chronic hypoventilation were surveyed by phone. Home visits were conducted for patients judged by an expert medical team to require medical examination. Abnormal ventilatory status was assessed by respiratory evaluation. Chronic respiratory insufficiency symptoms were reported by 169 of 992 subjects (17%), while 565 subjects (57%) did not receive regular respiratory evaluation. Ventilatory status was abnormal in 102 of 343 home-visit subjects (29.7%). Although 556 subjects (56%) reported 24-hour ventilator use, only 458 (46%) had an oxygen saturation monitoring device, and 305 (31%) performed an airstacking exercise. A management system that integrates ventilator usage monitoring, counselling and advice, and home visits for patients who receive ventilator support could improve the efficiency of the ventilator support project. PMID:27247509

  14. Development of a lightweight portable ventilator for far-forward battlefield combat casualty support

    NASA Astrophysics Data System (ADS)

    Cutchis, Protagoras N.; Smith, Dexter G.; Ko, Harvey W.; Wiesmann, William P.; Pranger, L. Alex

    1999-07-01

    Immediate medical provision substantially reduces the number of fatalities sustained during military operations. However, the shift from large-scale regional conflicts to smaller peacekeeping and humanitarian missions has reduced the military medical support infrastructure. Civilian emergency medical services have long emphasized the 'golden hour' during which a patient must receive definitive medical attention. Without on-scene medical support, injured soldiers must be transported significant distances before receiving advanced medical care, and rapid transport to a medical facility is not always a viable option. Technological solutions enable military medics to deliver advanced medical care on the battlefield. We report here on the development of a small lightweight portable respirator for the treatment of far- forward battlefield casualties. The Far Forward Life Support System (FFLSS) utilizes a combination of COTS (commercial off the shelf) components and custom designed systems to provide ventilatory support to injured combatants. It also incorporates a small IV fluid pump and IV fluids for resuscitation. A microcompressor control system monitors both system performance and patient parameters for system control. Telemetry to a pager-like device worn by the front line medic alerts of any anomalies in ventilator or patient parameters, which will add greatly to triage decisions and resource management. Novel elements of the FLSS design include oxygen generation, low-pressure air generation, available patient suction, and the absence of any high pressure air cylinders. A prototype developed for animal testing will be described in detail as well as further design requirements for the human rated prototype.

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

    PubMed

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

    2002-09-01

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

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

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

    2011-01-01

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

  18. Monitoring of total positive end-expiratory pressure during mechanical ventilation by artificial neural networks.

    PubMed

    Perchiazzi, Gaetano; Rylander, Christian; Pellegrini, Mariangela; Larsson, Anders; Hedenstierna, Göran

    2016-04-11

    Ventilation treatment of acute lung injury (ALI) requires the application of positive airway pressure at the end of expiration (PEEPapp) to avoid lung collapse. However, the total pressure exerted on the alveolar walls (PEEPtot) is the sum of PEEPapp and intrinsic PEEP (PEEPi), a hidden component. To measure PEEPtot, ventilation must be discontinued with an end-expiratory hold maneuver (EEHM). We hypothesized that artificial neural networks (ANN) could estimate the PEEPtot from flow and pressure tracings during ongoing mechanical ventilation. Ten pigs were mechanically ventilated, and the time constant of their respiratory system (τRS) was measured. We shortened their expiratory time (TE) according to multiples of τRS, obtaining different respiratory patterns (Rpat). Pressure (PAW) and flow (V'AW) at the airway opening during ongoing mechanical ventilation were simultaneously recorded, with and without the addition of external resistance. The last breath of each Rpat included an EEHM, which was used to compute the reference PEEPtot. The entire protocol was repeated after the induction of ALI with i.v. injection of oleic acid, and 382 tracings were obtained. The ANN had to extract the PEEPtot, from the tracings without an EEHM. ANN agreement with reference PEEPtot was assessed with the Bland-Altman method. Bland Altman analysis of estimation error by ANN showed -0.40 ± 2.84 (expressed as bias ± precision) and ±5.58 as limits of agreement (data expressed as cmH2O). The ANNs estimated the PEEPtot well at different levels of PEEPapp under dynamic conditions, opening up new possibilities in monitoring PEEPi in critically ill patients who require ventilator treatment.

  19. Positive-Pressure Ventilator Systems at High Altitude: A Preliminary Study.

    DTIC Science & Technology

    1986-06-01

    Respiratory Distress Syndrome ( ARDS ), which is...of using mechanical ventilator systems with ARDA patients in high-altitude environments. DTIC A1 - a ADULT RESPIRATORY DISTRESS SYNDROME ARDS has been...capillary pressure) pulmonary edema and acute respiratory failure. The clinical physiology of severe ARDS is characterized by three phenomena: 1)

  20. 30 CFR 18.28 - Devices for pressure relief, ventilation, or drainage.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... TESTING, EVALUATION, AND APPROVAL OF MINING PRODUCTS ELECTRIC MOTOR-DRIVEN MINE EQUIPMENT AND ACCESSORIES Construction and Design Requirements § 18.28 Devices for pressure relief, ventilation, or drainage. (a) Devices... designed that they can be cleaned readily. Provision shall be made for secure attachment of such...

  1. The Newmarket pump: a new suction pump for external negative pressure ventilation.

    PubMed

    Kinnear, W J; Shneerson, J M

    1985-09-01

    A new electronically controlled pump has been developed for use with a cuirass in providing external negative pressure ventilation. It is smaller, lighter, and more versatile than currently available pumps and operates on a servo principle. A rotary valve between the pump and the cuirass varies the rate of extraction of air from the cuirass. The pressure within the cuirass is sensed by a pressure transducer, and the output of this is used to control the position of the rotary valve by means of a motor so that the pressure within the cuirass follows a predetermined half sine wave pattern. The respiratory rate varies from 10 to 30 per minute and the inspiratory to expiratory time (I/E) ratio from 3:2 to 2:3. Inspiratory pressure varies from 0 to -50 cm H2O and an expiratory pressure of 0 to +50 cm H2O can be imposed. The performance of the new pump was assessed in 21 patients with nocturnal hypoxaemia who were accustomed to external negative pressure ventilation. The mean tidal volume achieved increased with increase in cuirass suction pressure, and changing the I/E ratio from 1:1 to 3:2 produced a small increase at a cuirass negative pressure at 20 cm water. Comparison of the Newmarket pump with the Cape pump in 14 patients showed that similar tidal volumes were achieved. Overnight monitoring of cuirass pressure in one patient showed more even control of peak negative pressure with the Newmarket pump than with the Cape pump. Ten pumps are in use in patients' homes; five have been in service for more than six months and no important problems have been encountered. The new pump seems to offer advantages that make external negative pressure ventilation more acceptable.

  2. The Newmarket pump: a new suction pump for external negative pressure ventilation.

    PubMed Central

    Kinnear, W J; Shneerson, J M

    1985-01-01

    A new electronically controlled pump has been developed for use with a cuirass in providing external negative pressure ventilation. It is smaller, lighter, and more versatile than currently available pumps and operates on a servo principle. A rotary valve between the pump and the cuirass varies the rate of extraction of air from the cuirass. The pressure within the cuirass is sensed by a pressure transducer, and the output of this is used to control the position of the rotary valve by means of a motor so that the pressure within the cuirass follows a predetermined half sine wave pattern. The respiratory rate varies from 10 to 30 per minute and the inspiratory to expiratory time (I/E) ratio from 3:2 to 2:3. Inspiratory pressure varies from 0 to -50 cm H2O and an expiratory pressure of 0 to +50 cm H2O can be imposed. The performance of the new pump was assessed in 21 patients with nocturnal hypoxaemia who were accustomed to external negative pressure ventilation. The mean tidal volume achieved increased with increase in cuirass suction pressure, and changing the I/E ratio from 1:1 to 3:2 produced a small increase at a cuirass negative pressure at 20 cm water. Comparison of the Newmarket pump with the Cape pump in 14 patients showed that similar tidal volumes were achieved. Overnight monitoring of cuirass pressure in one patient showed more even control of peak negative pressure with the Newmarket pump than with the Cape pump. Ten pumps are in use in patients' homes; five have been in service for more than six months and no important problems have been encountered. The new pump seems to offer advantages that make external negative pressure ventilation more acceptable. Images PMID:3864285

  3. Effect of Positive End-Expiratory Pressure on Central Venous Pressure in Patients under Mechanical Ventilation

    PubMed Central

    Shojaee, Majid; Sabzghabaei, Anita; Alimohammadi, Hossein; Derakhshanfar, Hojjat; Amini, Afshin; Esmailzadeh, Bahareh

    2017-01-01

    Introduction: Finding the probable governing pattern of PEEP and CVP changes is an area of interest for in-charge physicians and researchers. Therefore, the present study was designed with the aim of evaluating the relationship between the mentioned pressures. Methods: In this quasi-experimental study, patients under mechanical ventilation were evaluated with the aim of assessing the effect of PEEP change on CVP. Non-trauma patients, over 18 years of age, who were under mechanical ventilation and had stable hemodynamics, with inserted CV line were entered. After gathering demographic data, patients underwent 0, 5, and 10 cmH2O PEEPs and the respective CVPs of the mentioned points were recorded. The relationship of CVP and PEEP in different cut points were measured using SPSS 21.0 statistical software. Results: 60 patients with the mean age of 73.95 ± 11.58 years were evaluated (68.3% male). The most frequent cause of ICU admission was sepsis with 45.0%. 5 cmH2O increase in PEEP led to 2.47 ± 1.53 mean difference in CVP level. If the PEEP baseline is 0 at the time of 5 cmH2O increase, it leads to a higher raise in CVP compared to when the baseline is 5 cmH2O (2.47 ± 1.53 vs. 1.57 ± 1.07; p = 0.039). The relationship between CVP and 5 cmH2O (p = 0.279), and 10 cmH2O (p = 0.292) PEEP changes were not dependent on the baseline level of CVP. Conclusion: The findings of this study revealed the direct relationship between PEEP and CVP. Approximately, a 5 cmH2O increase in PEEP will be associated with about 2.5 cmH2O raise in CVP. When applying a 5 cmH2O PEEP increase, if the baseline PEEP is 0, it leads to a significantly higher raise in CVP compared to when it is 5 cmH2O (2.5 vs. 1.6). It seems that sex, history of cardiac failure, baseline CVP level, and hypertension do not have a significant effect in this regard. PMID:28286808

  4. High Frequency Nasal Ventilation for 21 Days Maintains Gas Exchange with Lower Respiratory Pressures and Promotes Alveolarization in Preterm Lambs

    PubMed Central

    Null, Donald M.; Alvord, Jeremy; Leavitt, Wendy; Wint, Albert; Dahl, Mar Janna; Presson, Angela P.; Lane, Robert H.; DiGeronimo, Robert J.; Yoder, Bradley A.; Albertine, Kurt H.

    2014-01-01

    Background Short-term high-frequency nasal ventilation (HFNV) of preterm neonates provides acceptable gas exchange compared to endotracheal intubation and intermittent mandatory ventilation (IMV). Whether long-term HFNV will provide acceptable gas exchange is unknown. We hypothesized that HFNV for up to 21d would lead to acceptable gas exchange at lower inspired oxygen (O2) levels and airway pressures compared to intubation and IMV. Methods Preterm lambs were exposed to antenatal steroids, and treated with perinatal surfactant and postnatal caffeine. Lambs were intubated and resuscitated by IMV. At ~3h of age, half of the lambs were switched to non-invasive HFNV. Support was for 3d or 21d. By design, PaO2 and PaCO2 were not different between groups. Results At 3d (n=5) and 21d (n=4) of HFNV, fractional inspired O2 (FiO2), peak inspiratory pressure, mean airway, intra-tracheal, and positive end-expiratory pressures, oxygenation index, and Alveolar-arterial gradient were significantly lower than matched periods of intubation and IMV. PaO2/FiO2 ratio was significantly higher at 3d and 21d of HFNV compared to matched intubation and IMV. HFNV led to better alveolarization at 3d and 21d. Conclusion Long-term HFNV provides acceptable gas exchange at lower inspired O2 levels and respiratory pressures compared to intubation and IMV. PMID:24378898

  5. [Central alveolar hypoventilation with cor pulmonale: successful treatment by non-invasive intermittent positive pressure ventilation].

    PubMed

    Montiel, G C; Roncoroni, A J; Quadrelli, S A; De Vito, E L

    1994-01-01

    A 62 year-old woman with a bilateral carotid body paraganglioma presented, 2 years after the removal of the right one, with signs of right-heart failure. Hypoxemia, hypercapnia, polycythemia and pulmonary hypertension with normal ventilatory capacity were found. Central alveolar hypoventilation was diagnosed on the basis of absence of ventilatory response and sensation of provoked hypercapnia, prolonged breath-holding time and correction of hypercapnia by voluntary ventilation. Progesterone (200 mg/d during 3 weeks) or naloxone did not improve either arterial blood gases (ABG) or the P 0.1/PCO2 curve. Hypoxemia and hypercapnia were not corrected during metabolic acidosis provoked by acetazolamide (250 mg/d). Nasal CPAP did not control hypoventilation periods. Mechanical ventilation was initiated with negative pressure (NPV) through a poncho. The patient presented severe discomfort with NPV and obstructive apneas were verified during it. She refused to continue NPV. Mechanical ventilation was initiated with positive intermittent pressure (IPPV) through a nasal mask. The patient had excellent tolerance to the procedure. SpO2 during IPPV was always higher than 95%. During sleep induction (under IPPV), respiration in phase with the ventilator 1: 1 was observed; instead, during consolidated sleep there was a complete dependence of the ventilator with apnea for over 2 min when IPPV was interrupted (Fig. 1). After 2 months of treatment, a relief of right ventricular failure occurred and hematocrit fell to 39%. There was an improvement of day-time ABG (Table I). The P. 0.1/PaCO2 curve 3 months after IPPV was the same as the previous one (Fig. 2). The patient has been for 18 months on home ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Measurement of airflow and pressure characteristics of a fan built in a car ventilation system

    NASA Astrophysics Data System (ADS)

    Pokorný, Jan; Poláček, Filip; Fojtlín, Miloš; Fišer, Jan; Jícha, Miroslav

    2016-03-01

    The aim of this study was to identify a set of operating points of a fan built in ventilation system of our test car. These operating points are given by the fan pressure characteristics and are defined by a pressure drop of the HVAC system (air ducts and vents) and volumetric flow rate of ventilation air. To cover a wide range of pressure drops situations, four cases of vent flaps setup were examined: (1) all vents opened, (2) only central vents closed (3) only central vents opened and (4) all vents closed. To cover a different volumetric flows, the each case was measured at least for four different speeds of fan defined by the fan voltage. It was observed that the pressure difference of the fan is proportional to the fan voltage and strongly depends on the throttling of the air distribution system by the settings of the vents flaps. In case of our test car we identified correlations between volumetric flow rate of ventilation air, fan pressure difference and fan voltage. These correlations will facilitate and reduce time costs of the following experiments with this test car.

  7. Optimizing lung aeration at birth using a sustained inflation and positive pressure ventilation in preterm rabbits

    PubMed Central

    te Pas, Arjan B.; Kitchen, Marcus J.; Lee, Katie; Wallace, Megan J.; Fouras, Andreas; Lewis, Robert A.; Yagi, Naoto; Uesugi, Kentaro; Hooper, Stuart B.

    2016-01-01

    Background: A sustained inflation (SI) facilitates lung aeration, but the most effective pressure and duration are unknown. We investigated the effect of gestational age (GA) and airway liquid volume on the required inflation pressure and SI duration. Methods: Rabbit kittens were delivered at 27, 29, and 30 d gestation, intubated and airway liquid was aspirated. Either no liquid (control) or 30 ml/kg of liquid was returned to the airways. Lung gas volumes were measured by plethysmography and phase-contrast X-ray-imaging. Starting at 22 cmH2O, airway pressure was increased until airflow commenced and pressure was then held constant. The SI was truncated when 20 ml/kg air had entered the lung and ventilation continued with intermittent positive pressure ventilation (iPPV). Results: Higher SI pressures and longer durations were required in 27-d kittens compared to 30-d kittens. During iPPV, 27-d kittens needed higher pressures and had lower functional residual capacity (FRC) compared to 30-d kittens. Adding lung liquid increased SI duration, reduced FRC, and increased resistance and pressures during iPPV in 29- and 30-d kittens. Conclusion: Immature kittens required higher starting pressures and longer SI durations to achieve a set inflation volume. Larger airway liquid volumes adversely affected lung function during iPPV in older but not young kittens. PMID:26991259

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

    PubMed

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

    2014-02-01

    Patients assisted with left ventricular assist device (LVAD) may require prolonged mechanical ventilatory assistance secondary to postoperative respiratory failure. The goal of this work is the study of the interdependent effects LVAD like pulsatile catheter (PUCA) pump and mechanical ventilatory support or thoracic artificial lung (TAL), by the hemodynamic point of view, using a numerical simulator of the human cardiovascular system. In the simulator, different circulatory sections are described using lumped parameter models. Lumped parameter models have been designed to describe the hydrodynamic behavior of both PUCA pump and thoracic artificial lung. Ventricular behavior atrial and septum functions were reproduced using variable elastance model. Starting from simulated pathological conditions we studied the effects produced on some hemodynamic variables by simultaneous PUCA pump, thoracic artificial lung or mechanical ventilation assistance. Thoracic artificial lung was applied in parallel or in hybrid mode. The effects of mechanical ventilation have been simulated by changing mean intrathoracic pressure value from -4 mmHg to +5 mmHg. The hemodynamic variables observed during the simulations, in different assisted conditions, were: left and right ventricular end systolic (diastolic) volume, systolic/diastolic aortic pressure, mean pulmonary arterial pressure, left and right mean atrial pressure, mean systemic venous pressure and the total blood flow. Results show that the application of PUCA (without mechanical ventilatory assistance) increases the total blood flow, reduces the left ventricular end systolic volume and increases the diastolic aortic pressure. Parallel TAL assistance increases the right ventricular end diastolic (systolic) volume reduction both when PUCA is switched "ON" and both when PUCA is switched "OFF". By switching "OFF" the PUCA pump, it seems that parallel thoracic artificial lung assistance produces a greater cardiac output (respect to

  9. Non-invasive determination of respiratory effort in spontaneous breathing and support ventilation: a validation study with healthy volunteers.

    PubMed

    Lopez-Navas, Kristel; Brandt, Sebastian; Strutz, Merle; Gehring, Hartmut; Wenkebach, Ullrich

    2014-08-01

    The proper setting of support ventilation aims to follow the patients' demands, ensuring adequate assistance to their respiratory effort. Effort assessment is thus necessary. But invasive procedures like measuring transdiaphragmatic pressure (Pdi) are impractical in long-term ventilation. Our purpose was therefore the development of the Occlusion+Delta (O+D) method for non-invasive continuous assessment of effort, quantified by the inspiratory pressure-time-product (PTPinsp), during ventilatory support. Flow and airway pressure were measured from 25 healthy volunteers at three effort levels. For the non-invasive method, short expiratory occlusions were executed each three to seven cycles to estimate resistance and compliance with a fitting algorithm fed with the differences between occluded and undisturbed cycles. Signals and estimates were then used to calculate the effort. For the validation of O+D, its estimations were compared to the results from invasive measurement of Pdi using balloon catheters. The agreement between PTPinsp from the invasive measurement and the proposed alternative was confirmed by regression analysis (PTP(O+D)=1.13PTP(Pdi)- 0.85, R²=0.84) and calculation of their differences (mean±SD=1.78±7.18 cm H2O s). Repeated execution of the non-invasive O+D method facilitates a safe automatic assessment of respiratory mechanics and breathing effort, promoting the rapid recognition of changes in patient's demands and the adaptation of support.

  10. Effectiveness of an inspiratory pressure-limited approach to mechanical ventilation in septic patients.

    PubMed

    Martin-Loeches, Ignacio; de Haro, Candelaria; Dellinger, R Phillip; Ferrer, Ricard; Phillips, Gary S; Levy, Mitchell M; Artigas, Antonio

    2013-01-01

    Severe sepsis is one of the most common causes of acute lung injury (ALI) and is associated with high mortality. The aim of the study was to see whether a protective strategy based approach with a plateau pressure <30 cmH(2)O was associated with lower mortality in septic patients with ALI in the Surviving Sepsis Campaign international database. A retrospective analysis of an international multicentric database of 15,022 septic patients from 165 intensive care units was used. Septic patients with ALI and mechanical ventilation (n=1,738) had more accompanying organ dysfunction and a higher mortality rate (48.3% versus 33.0%, p<0.001) than septic patients without ALI (n=13,284). In patients with ALI and mechanical ventilation, the use of inspiratory plateau pressures maintained at <30 cmH(2)O was associated with lower mortality by Chi-squared test (46.4% versus 55.1%, p<0.001) and by Kaplan-Meier and log-rank test (p<0.001). In a multivariable random-effects Cox regression, plateau pressure <30 cmH(2)O was significantly associated with lower mortality (hazard ratio 0.84, 95% CI 0.72-0.99; p=0.038). ALI in sepsis was associated with higher mortality, especially when an inspiratory pressure-limited mechanical ventilation approach was not implemented.

  11. Estimation of spontaneous baroreflex sensitivity using transfer function analysis: effects of positive pressure ventilation.

    PubMed

    Glos, Martin; Romberg, Dietrich; Endres, Susanne; Fietze, Ingo

    2007-02-01

    To determine the short-term effects of non-invasive positive pressure ventilation (PPV) on spontaneous baroreflex sensitivity, we acquired time series of RR interval and beat-to-beat blood pressure in 55 healthy volunteers (mean age 46.5+/-10.5 years), who performed breathing tests on four occasions at frequencies of 12 and 15/min, with application of PPV of 5 mbar, and without positive pressure (control). Using spectral and transfer function analysis, we estimated RR interval variability (HRV) and systolic blood pressure variability (SBPV), as well as the gain (alpha-index) and phase shift (Phi) of the baroreceptor reflex for low- (LF) and high-frequency (HF) bands. Compared to control breathing, PPV at 12 and 15/min led to an increase in mean RR (p<0.001) and blood pressure (p<0.05). The alpha-index in the HF band increased significantly due to PPV for both respiratory frequencies (p<0.05). Phase shifts did not show significant changes in response to pressure ventilation. These results indicate that short-term administration of PPV in normal subjects elicits significant enhancement in the HF index of baroreflex gain. These findings may contribute to understanding the mechanisms, indications, and effectiveness of positive pressure breathing strategies in treating cardiorespiratory and other disease conditions.

  12. Parametric instabilities of rotor-support systems with application to industrial ventilators

    NASA Technical Reports Server (NTRS)

    Parszewski, Z.; Krodkiemski, T.; Marynowski, K.

    1980-01-01

    Rotor support systems interaction with parametric excitation is considered for both unequal principal shaft stiffness (generators) and offset disc rotors (ventilators). Instability regions and types of instability are computed in the first case, and parametric resonances in the second case. Computed and experimental results are compared for laboratory machine models. A field case study of parametric vibrations in industrial ventilators is reported. Computed parametric resonances are confirmed in field measurements, and some industrial failures are explained. Also the dynamic influence and gyroscopic effect of supporting structures are shown and computed.

  13. Comparison of volume controlled ventilation and pressure controlled ventilation in patients undergoing robot-assisted pelvic surgeries: An open-label trial

    PubMed Central

    Jaju, Rishabh; Jaju, Pooja Bihani; Dubey, Mamta; Mohammad, Sadik; Bhargava, AK

    2017-01-01

    Background and Aims: Although volume controlled ventilation (VCV) has been the traditional mode of ventilation in robotic surgery, recently pressure controlled ventilation (PCV) has been used more frequently. However, evidence on whether PCV is superior to VCV is still lacking. We intended to compare the effects of VCV and PCV on respiratory mechanics and haemodynamic in patients undergoing robotic surgeries in steep Trendelenburg position. Methods: This prospective, randomized trial was conducted on sixty patients between 20 and 70 years belonging to the American Society of Anesthesiologist Physical Status I–II. Patients were randomly assigned to VCV group (n = 30), where VCV mode was maintained through anaesthesia, or the PCV group (n = 30), where ventilation mode was changed to PCV after the establishment of 40° Trendelenburg position and pneumoperitoneum. Respiratory (peak and mean airway pressure [APpeak, APmean], dynamic lung compliance [Cdyn] and arterial blood gas analysis) and haemodynamics variables (heart rate, mean blood pressure [MBP] central venous pressure) were measured at baseline (T1), post-Trendelenburg position at 60 min (T2), 120 min (T3) and after resuming supine position (T4). Results: Demographic profile, haemodynamic variables, oxygen saturation and minute ventilation (MV) were comparable between two groups. Despite similar values of APmean, APpeak was significantly higher in VCV group at T2 and T3 as compared to PCV group (P < 0.001). Cdyn and PaCO2 were also better in PCV group than in VCV group (P < 0.001 and 0.045, respectively). Conclusion: PCV should be preferred in robotic pelvic surgeries as it offers lower airway pressures, greater Cdyn and a better-preserved ventilation-perfusion matching for the same levels of MV. PMID:28216699

  14. A comparison of synchronized intermittent mandatory ventilation and pressure-regulated volume control ventilation in elderly patients with acute exacerbations of COPD and respiratory failure

    PubMed Central

    Chang, Suchi; Shi, Jindong; Fu, Cuiping; Wu, Xu; Li, Shanqun

    2016-01-01

    Background COPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Intensive care unit patients with acute exacerbations of COPD requiring mechanical ventilation have higher mortality rates than other hospitalized patients. Although mechanical ventilation is the most effective intervention for these conditions, invasive ventilation techniques have yielded variable effects. Objective We evaluated pressure-regulated volume control (PRVC) ventilation treatment efficacy and preventive effects on pulmonary barotrauma in elderly COPD patients with respiratory failure. Patients and methods Thirty-nine intubated patients were divided into experimental and control groups and treated with the PRVC and synchronized intermittent mandatory ventilation – volume control methods, respectively. Vital signs, respiratory mechanics, and arterial blood gas analyses were monitored for 2–4 hours and 48 hours. Results Both groups showed rapidly improved pH, partial pressure of oxygen (PaO2), and PaO2 per fraction of inspired O2 levels and lower partial pressure of carbon dioxide (PaCO2) levels. The pH and PaCO2 levels at 2–4 hours were lower and higher, respectively, in the test group than those in the control group (P<0.05 for both); after 48 hours, blood gas analyses showed no statistical difference in any marker (P>0.05). Vital signs during 2–4 hours and 48 hours of treatment showed no statistical difference in either group (P>0.05). The level of peak inspiratory pressure in the experimental group after mechanical ventilation for 2–4 hours and 48 hours was significantly lower than that in the control group (P<0.05), while other variables were not significantly different between groups (P>0.05). Conclusion Among elderly COPD patients with respiratory failure, application of PRVC resulted in rapid improvement in arterial blood gas analyses while maintaining

  15. Influence of Barometric Pressure Changes on Ventilation Conditions in Deep Mines

    NASA Astrophysics Data System (ADS)

    Wasilewski, Stanisław

    2014-10-01

    Barometric air pressure and its changes have a critical impact on ventilation conditions in the underground workings of deep mines. Changes in pressure are particularly important because they are responsible for the transient states of ventilation conditions, therefore, assessing the scale of pressure change is essential. Unfortunately, previously for many years in the Polish mining industry barometric pressure was recorded only on tapes of mechanical barographs by the ventilation department on the surface and therefore such dependencies of methane concentration due to barometric pressure changes have not been properly documented. Today, after the implementation in mines of instruments enabling the monitoring of absolute pressure in the workings of mines (Wasilewski, 2009) the conditions have been created to study the influence of pressure changes on changes of air parameters in the mine workings. Barometric pressure changes were observed and recorded over a course of approximately two years using monitoring system that utilized high accuracy pressure sensors on the surface and in selected workings of an underground mine. This paper presents a statistical analysis of the data that we generated from assessing pressure changes on the surface and at selected underground points in the mine. In the article, which presents the results of the first part of the study, some examples of when significant changes in pressure prior to the tragic events, which were not accompanied by changes in the methane concentration in mine workings, will also be shown. Interestingly, we found that the relationship between methane ignitions and explosions in longwall gob mined via the cave-in method is associated with changes in the barometric pressure. Several instances of methane ignitions and explosions in the gob of cave-in longwalls in recent years were compared with background barometric pressure changes. Research carried out in within the strategic project "Improving work safety in

  16. Facial pressure zones of an oronasal interface for noninvasive ventilation: a computer model analysis* **

    PubMed Central

    Barros, Luana Souto; Talaia, Pedro; Drummond, Marta; Natal-Jorge, Renato

    2014-01-01

    OBJECTIVE: To study the effects of an oronasal interface (OI) for noninvasive ventilation, using a three-dimensional (3D) computational model with the ability to simulate and evaluate the main pressure zones (PZs) of the OI on the human face. METHODS: We used a 3D digital model of the human face, based on a pre-established geometric model. The model simulated soft tissues, skull, and nasal cartilage. The geometric model was obtained by 3D laser scanning and post-processed for use in the model created, with the objective of separating the cushion from the frame. A computer simulation was performed to determine the pressure required in order to create the facial PZs. We obtained descriptive graphical images of the PZs and their intensity. RESULTS: For the graphical analyses of each face-OI model pair and their respective evaluations, we ran 21 simulations. The computer model identified several high-impact PZs in the nasal bridge and paranasal regions. The variation in soft tissue depth had a direct impact on the amount of pressure applied (438-724 cmH2O). CONCLUSIONS: The computer simulation results indicate that, in patients submitted to noninvasive ventilation with an OI, the probability of skin lesion is higher in the nasal bridge and paranasal regions. This methodology could increase the applicability of biomechanical research on noninvasive ventilation interfaces, providing the information needed in order to choose the interface that best minimizes the risk of skin lesion. PMID:25610506

  17. Improved Oxygenation 24 Hours After Transition to Airway Pressure Release Ventilation or High-Frequency Oscillatory Ventilation Accurately Discriminates Survival in Immunocompromised Pediatric Patients With Acute Respiratory Distress Syndrome*

    PubMed Central

    Yehya, Nadir; Topjian, Alexis A.; Thomas, Neal J.; Friess, Stuart H.

    2014-01-01

    Objectives Children with an immunocompromised condition and requiring invasive mechanical ventilation have high risk of death. Such patients are commonly transitioned to rescue modes of non-conventional ventilation, including airway pressure release ventilation and high-frequency oscillatory ventilation, for acute respiratory distress syndrome refractory to conventional ventilation. Our aim was to describe our experience with airway pressure release ventilation and high-frequency oscillatory ventilation in children with an immunocompromised condition and acute respiratory distress syndrome refractory to conventional ventilation and to identify factors associated with survival. Design Retrospective cohort study. Setting Tertiary care, university-affiliated PICU. Patients Sixty pediatric patients with an immunocompromised condition and acute respiratory distress syndrome refractory to conventional ventilation transitioned to either airway pressure release ventilation or high-frequency oscillatory ventilation. Interventions None. Measurements and Main Results Demographic data, ventilator settings, arterial blood gases, oxygenation index, and Pao2/Fio2 were recorded before transition to either mode of nonconventional ventilation and at predetermined intervals after transition for up to 5 days. Mortality in the entire cohort was 63% and did not differ between patients transitioned to airway pressure release ventilation and high-frequency oscillatory ventilation. For both airway pressure release ventilation and high-frequency oscillatory ventilation, improvements in oxygenation index and Pao2/Fio2 at 24 hours expressed as a fraction of pretransition values (oxygenation index24/oxygenation indexpre and Pao2/Fio224/Pao2/FIO2pre) reliably discriminated nonsurvivors from survivors, with receiver operating characteristic areas under the curves between 0.89 and 0.95 (p for all curves < 0.001). Sensitivity-specificity analysis suggested that less than 15% reduction in

  18. Ventilation Transport Trade Study for Future Space Suit Life Support Systems

    NASA Technical Reports Server (NTRS)

    Kempf, Robert; Vogel, Matthew; Paul, Heather L.

    2008-01-01

    A new and advanced portable life support system (PLSS) for space suit surface exploration will require a durable, compact, and energy efficient system to transport the ventilation stream through the space suit. Current space suits used by NASA circulate the ventilation stream via a ball-bearing supported centrifugal fan. As NASA enters the design phase for the next generation PLSS, it is necessary to evaluate available technologies to determine what improvements can be made in mass, volume, power, and reliability for a ventilation transport system. Several air movement devices already designed for commercial, military, and space applications are optimized in these areas and could be adapted for EVA use. This paper summarizes the efforts to identify and compare the latest fan and bearing technologies to determine candidates for the next generation PLSS.

  19. The use of intermittent positive pressure ventilation to differentiate pneumonia from atelectasis during anesthesia in a red panda (Ailurus fulgens).

    PubMed

    Phair, Kristen; West, Gary; Biller, David

    2010-12-01

    Radiography is a valuable tool for assessment of pulmonary disease. Specifically, radiographs utilizing positive pressure ventilation can distinguish between anesthesia-induced atelectasis and pulmonary disease when survey radiographs are ambiguous. Positive pressure ventilation can be used to radiographically prove or disprove pulmonary disease. This is of particular clinical importance when working with exotic, zoo, or wildlife species because the majority of these patients require general anesthesia to perform physical examinations and diagnostics such as radiography safely and efficiently. This report is a case example of pulmonary disease in a red panda (Ailurus fulgens) and demonstrates how positive pressure ventilation verified both the presence of pulmonary disease and the eventual resolution of the disease. Anesthetized patients on gas anesthesia will rapidly become atelectic. Through the use of positive pressure ventilation, anesthesia-induced atelectasis and true pulmonary disease can readily be distinguished. This is a technique that should not be overlooked when performing thoracic radiography in zoo species.

  20. Choosing a negative pressure ventilation pump: are there any important differences?

    PubMed

    Smith, I E; King, M A; Shneerson, J M

    1995-10-01

    Five negative pressure ventilator pumps were assessed to determine whether there were any differences in performance which were likely to be of clinical importance. The pumps tested were the NEV-100 (Lifecare Inc.), the Negavent Respirator DA-1 (Dima Italia), the Thompson Maxivent (Puritan Bennett), the CCP-001 and Newmarket pumps (Si-Plan Electronics Research Ltd). A patient model was employed to investigate the relationship between the pressure waveform of each pump and the tidal volume generated, the stability of performance on a continuous 8 h test, and the response to a change in leak. On the continuous tests, the stability was better than +/- 1% for the inspiratory/expiratory (I:E) ratio and rate, and better than +/- 10% for the peak negative pressure for all of the pumps. The Negavent and NEV-100 pumps generated a square wave of pressure and for the same peak negative pressure produced a tidal volume up to 30% greater than the CCP-001 and the Newmarket pumps, which produced a half sine wave. The Maxivent produced an intermediate waveform, with a plateau at peak negative pressure but a curved decay back to atmospheric pressure. It is argued that if the pressure of the pumps producing a half sine wave is made more negative to compensate and produce an equivalent tidal volume, they are more likely to induce upper airway obstruction. The leak compensation of the NEV-100 and Negavent pumps was nearly complete but took several breaths to develop, the CCP-001 and Newmarket pumps had a very rapid compensation but this was less complete, whilst the Maxivent has no mechanism for leak compensation. From these results, it seems that in patients liable to upper airway obstruction the NEV-100 and Negavent pumps would be advantageous, whilst when rapidly changing leaks impair the efficiency of negative pressure ventilation the CCP-001 and Newmarket pumps would be preferable. The Maxivent pump seems to offer no advantages.

  1. Use of the Draeger Apollo to Deliver Bilevel Positive Pressure Ventilation During Awake Frontal Craniotomy for a Patient with Severe Chronic Obstructive Pulmonary Disease.

    PubMed

    Lee, Susie So-Hyun; Berman, Mitchell F

    2015-12-01

    In this case report, we describe the use of the Draeger Apollo anesthesia machine to deliver bilevel positive airway pressure (BiPAP) to a patient with severe chronic obstructive pulmonary disease and a history of lung resection undergoing frontal craniotomy for the removal of a brain tumor under moderate to deep sedation. BiPAP in the perioperative period has been described for purposes of preoxygenation and postextubation recruitment. Although its utility as a mode of ventilation during moderate to deep sedation has been demonstrated, it has not come into widespread use. We describe the intraoperative use of pressure support mode on the anesthesia machine to deliver noninvasive positive pressure ventilation through a standard anesthesia mask. Given its ease of access and effectiveness, it is our belief that intraoperative BiPAP may reduce hypoxemia and/or hypercarbia in patients with chronic obstructive pulmonary disease and obstructive sleep apnea undergoing moderate to deep sedation.

  2. Difficult weaning from mechanical ventilation.

    PubMed

    Oh, T E

    1994-07-01

    Weaning from mechanical ventilation may be influenced by factors relating to equipment, techniques and procedures. Criteria to initiate weaning and predictors of weaning outcome are generally unreliable, but mechanical work of breathing, the tidal volume: frequency ratio and the inspiratory pressure: maximal inspiratory pressure ratio may anticipate those likely to fail weaning. The optimal weaning ventilatory mode is not known, but intermittent mandatory ventilation, pressure support ventilation, and continuous positive pressure ventilation are the most commonly used. The resistances of individual components of breathing circuits are extremely important. Blow-by heated humidifiers and ventilators which compensate for the impedances of their inspiratory demand valves impose clinically acceptable spontaneous breathing loads. Close monitoring, adequate respiratory muscle rest, attention to mineral deficiencies, nutrition and pulmonary hygiene are also important parts of the weaning process.

  3. Fatal brain gas embolism during non-invasive positive pressure ventilation

    PubMed Central

    Rivara, Claire B; Chevrolet, Jean-Claude; Gasche, Yvan; Charbonney, Emmanuel

    2008-01-01

    Gas embolism is a dreaded complication following invasive medical procedures, traumatic lung injury and decompression accidents. We report a case of fatal gas embolism following the use of non-invasive ventilation (NIV) with bilevel positive airway pressure (BiPAP). The patient initially underwent left bronchial artery embolisation for massive haemoptysis in the context of severe tuberculotic sequels. Under NIV and after heavy coughing he became hemiparetic and his level of consciousness suddenly dropped. Computed tomography of the brain showed multiple air embolism and ischaemic lesions were confirmed by magnetic resonance imaging. Echocardiographic investigations showed no intracardiac defect. Vasculo-pulmonary abnormalities in the context of heavy coughing and non-invasive ventilation may have played a major role in the occurrence of this event. New neurological events in a patient with tuberculotic sequels or any known vascular pulmonary abnormalities and NIV should raise the suspicion of brain gas embolism. PMID:21716825

  4. Partial Support Ventilation and Mitochondrial-Targeted Antioxidants Protect against Ventilator-Induced Decreases in Diaphragm Muscle Protein Synthesis.

    PubMed

    Hudson, Matthew B; Smuder, Ashley J; Nelson, W Bradley; Wiggs, Michael P; Shimkus, Kevin L; Fluckey, James D; Szeto, Hazel H; Powers, Scott K

    2015-01-01

    Mechanical ventilation (MV) is a life-saving intervention in patients in respiratory failure. Unfortunately, prolonged MV results in the rapid development of diaphragm atrophy and weakness. MV-induced diaphragmatic weakness is significant because inspiratory muscle dysfunction is a risk factor for problematic weaning from MV. Therefore, developing a clinical intervention to prevent MV-induced diaphragm atrophy is important. In this regard, MV-induced diaphragmatic atrophy occurs due to both increased proteolysis and decreased protein synthesis. While efforts to impede MV-induced increased proteolysis in the diaphragm are well-documented, only one study has investigated methods of preserving diaphragmatic protein synthesis during prolonged MV. Therefore, we evaluated the efficacy of two therapeutic interventions that, conceptually, have the potential to sustain protein synthesis in the rat diaphragm during prolonged MV. Specifically, these experiments were designed to: 1) determine if partial-support MV will protect against the decrease in diaphragmatic protein synthesis that occurs during prolonged full-support MV; and 2) establish if treatment with a mitochondrial-targeted antioxidant will maintain diaphragm protein synthesis during full-support MV. Compared to spontaneously breathing animals, full support MV resulted in a significant decline in diaphragmatic protein synthesis during 12 hours of MV. In contrast, diaphragm protein synthesis rates were maintained during partial support MV at levels comparable to spontaneous breathing animals. Further, treatment of animals with a mitochondrial-targeted antioxidant prevented oxidative stress during full support MV and maintained diaphragm protein synthesis at the level of spontaneous breathing animals. We conclude that treatment with mitochondrial-targeted antioxidants or the use of partial-support MV are potential strategies to preserve diaphragm protein synthesis during prolonged MV.

  5. Effect of negative pressure ventilation on arterial blood gas pressures and inspiratory muscle strength during an exacerbation of chronic obstructive lung disease.

    PubMed Central

    Montserrat, J. M.; Martos, J. A.; Alarcon, A.; Celis, R.; Plaza, V.; Picado, C.

    1991-01-01

    The effects of intermittent negative pressure ventilation have been studied in 20 patients with chronic obstructive pulmonary disease during an exacerbation of their disease. Measurements of arterial blood gas tensions and maximal inspiratory pressure (MIP) were performed before and after six hours of negative pressure ventilation or standard treatment (control day) given in random order on two consecutive days. After negative pressure ventilation the mean (SD) value of MIP increased from 68.1 (21.5) to 74.8 (20) cm H2O;* arterial oxygen tension (PaCO2) fell from 60.6 (12.2) to 50.9 (8.9) mm Hg* but PaO2 changed little (from 48.4 (7.4) to 47.6 (8.2) mm Hg). There were no significant changes on the control day in arterial blood gas tensions (PaO2 47.8 (8.1) and 48.9 (9.4) and Paco2 59.8 (10.9) and 57.5 (8.06) mm Hg) or in MIP (69.4 (22.4) and 70.9 (22.9) cm H2O). Six patients tolerated negative pressure ventilation poorly and these patients showed less improvement after negative pressure ventilation. Our results suggest that intermittent negative pressure ventilation can increase alveolar ventilation in patients with an exacerbation of chronic obstructive lung disease, particularly in those who tolerate the procedure well. Most subjects showed a fall in PaCO2 and an increase in MIP. The fact that PaO2 was unchanged despite the fall in PaCO2 suggests that gas exchange may deteriorate with negative pressure ventilation in these patients. PMID:1908138

  6. Determinants of ventilation and pulmonary artery pressure during early acclimatization to hypoxia in humans.

    PubMed

    Fatemian, Marzieh; Herigstad, Mari; Croft, Quentin P P; Formenti, Federico; Cardenas, Rosa; Wheeler, Carly; Smith, Thomas G; Friedmannova, Maria; Dorrington, Keith L; Robbins, Peter A

    2016-03-01

    Pulmonary ventilation and pulmonary arterial pressure both rise progressively during the first few hours of human acclimatization to hypoxia. These responses are highly variable between individuals, but the origin of this variability is unknown. Here, we sought to determine whether the variabilities between different measures of response to sustained hypoxia were related, which would suggest a common source of variability. Eighty volunteers individually underwent an 8-h isocapnic exposure to hypoxia (end-tidal P(O2)=55 Torr) in a purpose-built chamber. Measurements of ventilation and pulmonary artery systolic pressure (PASP) assessed by Doppler echocardiography were made during the exposure. Before and after the exposure, measurements were made of the ventilatory sensitivities to acute isocapnic hypoxia (G(pO2)) and hyperoxic hypercapnia, the latter divided into peripheral (G(pCO2)) and central (G(cCO2)) components. Substantial acclimatization was observed in both ventilation and PASP, the latter being 40% greater in women than men. No correlation was found between the magnitudes of pulmonary ventilatory and pulmonary vascular responses. For G(pO2), G(pCO2) and G(cC O2), but not the sensitivity of PASP to acute hypoxia, the magnitude of the increase during acclimatization was proportional to the pre-acclimatization value. Additionally, the change in G(pO2) during acclimatization to hypoxia correlated well with most other measures of ventilatory acclimatization. Of the initial measurements prior to sustained hypoxia, only G(pCO2) predicted the subsequent rise in ventilation and change in G(pO2) during acclimatization. We conclude that the magnitudes of the ventilatory and pulmonary vascular responses to sustained hypoxia are predominantly determined by different factors and that the initial G(pCO2) is a modest predictor of ventilatory acclimatization.

  7. Airway pressure release ventilation in morbidly obese surgical patients with acute lung injury and acute respiratory distress syndrome.

    PubMed

    Testerman, George M; Breitman, Igal; Hensley, Sarah

    2013-03-01

    Morbidly obese patients with body mass index greater than 40 kg/m(2) and respiratory failure requiring critical care services are increasingly seen in trauma and acute care surgical centers. Baseline respiratory pathophysiology including decreased pulmonary compliance with dependent atelectasis and abnormal ventilation-perfusion relationships predisposes these patients to acute lung injury (ALI) and adult respiratory distress syndrome (ARDS) as well as prolonged stays in the intensive care unit. Airway pressure release ventilation (APRV) is an increasingly used alternative mode for salvage therapy in patients with hypoxemic respiratory failure that also provides lung protection from ventilator-induced lung injury. APRV provides the conceptual advantage of an "open lung" approach to ventilation that may be extended to the morbidly obese patient population with ALI and ARDS. We discuss the theoretical benefits and a recent clinical experience of APRV ventilation in the morbidly obese patient with respiratory failure at a Level I trauma, surgical critical care, and acute care surgery center.

  8. Combination of constant-flow and continuous positive-pressure ventilation in canine pulmonary edema.

    PubMed

    Sznajder, J I; Becker, C J; Crawford, G P; Wood, L D

    1989-08-01

    Constant-flow ventilation (CFV) maintains alveolar ventilation without tidal excursion in dogs with normal lungs, but this ventilatory mode requires high CFV and bronchoscopic guidance for effective subcarinal placement of two inflow catheters. We designed a circuit that combines CFV with continuous positive-pressure ventilation (CPPV; CFV-CPPV), which negates the need for bronchoscopic positioning of CFV cannula, and tested this system in seven dogs having oleic acid-induced pulmonary edema. Addition of positive end-expiratory pressure (PEEP, 10 cmH2O) reduced venous admixture from 44 +/- 17 to 10.4 +/- 5.4% and kept arterial CO2 tension (PaCO2) normal. With the innovative CFV-CPPV circuit at the same PEEP and respiratory rate (RR), we were able to reduce tidal volume (VT) from 437 +/- 28 to 184 +/- 18 ml (P less than 0.001) and elastic end-inspiratory pressures (PEI) from 25.6 +/- 4.6 to 17.7 +/- 2.8 cmH2O (P less than 0.001) without adverse effects on cardiac output or pulmonary exchange of O2 or CO2; indeed, PaCO2 remained at 35 +/- 4 Torr even though CFV was delivered above the carina and at lower (1.6 l.kg-1.min-1) flows than usually required to maintain eucapnia during CFV alone. At the same PEEP and RR, reduction of VT in the CPPV mode without CFV resulted in CO2 retention (PaCO2 59 +/- 8 Torr). We conclude that CFV-CPPV allows CFV to effectively mix alveolar and dead spaces by a small bulk flow bypassing the zone of increased resistance to gas mixing, thereby allowing reduction of the CFV rate, VT, and PEI for adequate gas exchange.

  9. Negative- versus positive-pressure ventilation in intubated patients with acute respiratory distress syndrome

    PubMed Central

    2012-01-01

    Introduction Recent experimental data suggest that continuous external negative-pressure ventilation (CENPV) results in better oxygenation and less lung injury than continuous positive-pressure ventilation (CPPV). The effects of CENPV on patients with acute respiratory distress syndrome (ARDS) remain unknown. Methods We compared 2 h CENPV in a tankrespirator ("iron lung") with 2 h CPPV. The six intubated patients developed ARDS after pulmonary thrombectomy (n = 1), aspiration (n = 3), sepsis (n = 1) or both (n = 1). We used a tidal volume of 6 ml/kg predicted body weight and matched lung volumes at end expiration. Haemodynamics were assessed using the pulse contour cardiac output (PiCCO) system, and pressure measurements were referenced to atmospheric pressure. Results CENPV resulted in better oxygenation compared to CPPV (median ratio of arterial oxygen pressure to fraction of inspired oxygen of 345 mmHg (minimum-maximum 183 to 438 mmHg) vs 256 mmHg (minimum-maximum 123 to 419 mmHg) (P < 0.05). Tank pressures were -32.5 cmH2O (minimum-maximum -30 to -43) at end inspiration and -15 cmH2O (minimum-maximum -15 to -19 cmH2O) at end expiration. NO Inspiratory transpulmonary pressures decreased (P = 0.04) and airway pressures were considerably lower at inspiration (-1.5 cmH2O (minimum-maximum -3 to 0 cmH2O) vs 34.5 cmH2O (minimum-maximum 30 to 47 cmH2O), P = 0.03) and expiration (4.5 cmH2O (minimum-maximum 2 to 5) vs 16 cmH2O (minimum-maximum 16 to 23), P =0.03). During CENPV, intraabdominal pressures decreased from 20.5 mmHg (12 to 30 mmHg) to 1 mmHg (minimum-maximum -7 to 5 mmHg) (P = 0.03). Arterial pressures decreased by approximately 10 mmHg and central venous pressures by 18 mmHg. Intrathoracic blood volume indices and cardiac indices increased at the initiation of CENPV by 15% and 20% (P < 0.05), respectively. Heart rate and extravascular lung water indices remained unchanged. Conclusions CENPV with a tank respirator improved gas exchange in patients with ARDS at

  10. Acute effects of external negative pressure ventilation in chronic obstructive pulmonary disease compared with normal subjects.

    PubMed

    Cooper, C B; Harris, N D; Howard, P

    1991-01-01

    This study compares the acute physiological effects of external negative pressure ventilation (ENPV) in normal subjects and patients with chronic obstructive pulmonary disease (COPD). The equipment consisted of an airtight jacket (Pneumosuit) and vacuum pump. Minute ventilation (Ve) was recorded using a light-emitting turbine transducer. Oxygen uptake (VO2) and carbon dioxide output (VCO2) were calculated every 30 s. Measurements were made at rest and during ENPV with pressures of -20 cmH2O and -40 cmH2O. The ventilator rate was fixed at 16.min-1. In 10 normal subjects, Ve increased from 8.6 to 22.9 l.min-1 (p less than 0.01) accompanied by an increase in VCO2 from 0.25 to 0.39 l.min-1 (p less than 0.01). In 10 normocapnic COPD patients (arterial carbon dioxide tension (PaCO2) less than 6.0 kPa) Ve increased from 11.5 to 17.1 l.min-1 (p less than 0.01) whilst in 10 hypercapnic patients (PaCO2 greater than 6.0 kPa) Ve increased from 9.7 to 12.4 l.min-1 (p less than 0.01). A change in VCO2 was not detected in the COPD patients, and VO2 did not change in any group. Arterial blood samples were obtained in eight hypercapnic patients. Baseline mean physiological deadspace ventilation (VD) was calculated to be 4.9 l.min-1 (56% of Ve) whilst Ve was 8.8 l.min-1 in this subgroup. During ENPV, arterial oxygen tension (PaO2) increased from 6.8 to 8.2 kPa (p less than 0.01) whilst PaCO2 decreased from 6.8 to 5.8 kPa (p less than 0.01) suggesting that despite the large physiological deadspace, a significant increase in alveolar ventilation had occurred. In advanced COPD, thoracic compliance falls and limits the ventilatory response to ENPV.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Positive End-Expiratory Pressure and Variable Ventilation in Lung-Healthy Rats under General Anesthesia

    PubMed Central

    Camilo, Luciana M.; Ávila, Mariana B.; Cruz, Luis Felipe S.; Ribeiro, Gabriel C. M.; Spieth, Peter M.; Reske, Andreas A.; Amato, Marcelo; Giannella-Neto, Antonio; Zin, Walter A.; Carvalho, Alysson R.

    2014-01-01

    Objectives Variable ventilation (VV) seems to improve respiratory function in acute lung injury and may be combined with positive end-expiratory pressure (PEEP) in order to protect the lungs even in healthy subjects. We hypothesized that VV in combination with moderate levels of PEEP reduce the deterioration of pulmonary function related to general anesthesia. Hence, we aimed at evaluating the alveolar stability and lung protection of the combination of VV at different PEEP levels. Design Randomized experimental study. Setting Animal research facility. Subjects Forty-nine male Wistar rats (200–270 g). Interventions Animals were ventilated during 2 hours with protective low tidal volume (VT) in volume control ventilation (VCV) or VV and PEEP adjusted at the level of minimum respiratory system elastance (Ers), obtained during a decremental PEEP trial subsequent to a recruitment maneuver, and 2 cmH2O above or below of this level. Measurements and Main Results Ers, gas exchange and hemodynamic variables were measured. Cytokines were determined in lung homogenate and plasma samples and left lung was used for histologic analysis and diffuse alveolar damage scoring. A progressive time-dependent increase in Ers was observed independent on ventilatory mode or PEEP level. Despite of that, the rate of increase of Ers and lung tissue IL-1 beta concentration were significantly lower in VV than in VCV at the level of the PEEP of minimum Ers. A significant increase in lung tissue cytokines (IL-6, IL-1 beta, CINC-1 and TNF-alpha) as well as a ventral to dorsal and cranial to caudal reduction in aeration was observed in all ventilated rats with no significant differences among groups. Conclusions VV combined with PEEP adjusted at the level of the PEEP of minimal Ers seemed to better prevent anesthesia-induced atelectasis and might improve lung protection throughout general anesthesia. PMID:25383882

  12. Evaluation of intermittent long-term negative-pressure ventilation in patients with severe chronic obstructive pulmonary disease.

    PubMed

    Zibrak, J D; Hill, N S; Federman, E C; Kwa, S L; O'Donnell, C

    1988-12-01

    We tested the hypothesis that intermittent ventilatory assistance in patients with severe chronic obstructive pulmonary disease (COPD) improves pulmonary function and exercise capacity. Twenty stable patients with severe COPD were recruited from outpatient pulmonary clinics and were randomized to use a poncho wrap, negative-pressure ventilator or to receive standard care. After 6 months, the patients receiving standard care were switched over to the ventilator and vice versa, and follow-up was continued for an additional 6 months. After 3 to 6 months of ventilator use, we observed no clinically significant improvements in FEV1, FVC, blood gas determinations, maximal inspiratory and expiratory pressures, and exercise duration. However, 11 of our patients dropped out of the study because of an inability to tolerate the ventilator, and all but one of the nine who completed the study expressed dissatisfaction with it, using it for less time (4.1 h/day) than we recommended. Musculoskeletal pain and inconvenience were the most frequently voiced complaints. Because we did not document that ventilator use actually rested the respiratory muscles in our patients and because duration of ventilator use may have been too brief, we cannot conclude that intermittent rest of respiratory muscles in patients with severe COPD fails to bring about improvement. On the other hand, our results demonstrate that the poncho wrap ventilator is poorly tolerated by patients with severe COPD in a typical outpatient setting. We suggest that future trials seek to utilize better tolerated ventilatory assist devices.

  13. Use of volume-targeted non-invasive bilevel positive airway pressure ventilation in a patient with amyotrophic lateral sclerosis*,**

    PubMed Central

    Diaz-Abad, Montserrat; Brown, John Edward

    2014-01-01

    Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease in which most patients die of respiratory failure. Although volume-targeted non-invasive bilevel positive airway pressure (BPAP) ventilation has been studied in patients with chronic respiratory failure of various etiologies, its use in ALS has not been reported. We present the case of a 66-year-old woman with ALS and respiratory failure treated with volume-targeted BPAP ventilation for 15 weeks. Weekly data downloads showed that disease progression was associated with increased respiratory muscle weakness, decreased spontaneous breathing, and increased use of non-invasive positive pressure ventilation, whereas tidal volume and minute ventilation remained relatively constant. PMID:25210968

  14. Speed of collapse of the non-ventilated lung during single-lung ventilation for thoracoscopic surgery: the effect of transient increases in pleural pressure on the venting of gas from the non-ventilated lung.

    PubMed

    Pfitzner, J; Peacock, M J; Harris, R J

    2001-10-01

    A study of 10 anaesthetised patients placed in the lateral position for thoracoscopic surgery assessed whether transient increases in pleural pressure on the side of the non-ventilated lung might increase the speed at which gas vents from that lung. The transient increases in pleural pressure were generated by the mediastinal displacement that occurs with each inspiratory phase of positive pressure ventilation of the dependent lung. When combined with a unidirectional valve allowing gas to flow out of the non-ventilated lung, and a second valve allowing ambient airflow into, but not out of, the thoracic cavity via an initial thoracoscopy access site, this mediastinal displacement could conceivably serve to 'pump' gas out of the non-ventilated lung. Using the four different combinations of valve inclusion or omission, the volume of gas that vented from the non-ventilated lung into a measuring spirometer was recorded during a 120-s measurement sequence. It was found that the speed of venting was not increased by the transient increases in pleural pressure, and that in all but one of a total of 34 measurement sequences, venting had ceased by the end of the sequence. Gas venting was a mean (SD) of 85.5 (11.9)% complete in 25 s (five breaths), and 96.6 (6.1)% complete in 60 s. This prompt partial lung collapse very likely reflected the passive elastic recoil of the lung, while the failure of transient increases in pleural pressure to result in ongoing venting of gas was probably a consequence of airways closure as the lung collapsed. It is concluded that techniques that aim to speed lung collapse by increasing pleural pressure are unlikely to be effective.

  15. Pulmonary rehabilitation coupled with negative pressure ventilation decreases decline in lung function, hospitalizations, and medical cost in COPD

    PubMed Central

    Huang, Hung-Yu; Chou, Pai-Chien; Joa, Wen-Ching; Chen, Li-Fei; Sheng, Te-Fang; Lin, Horng-Chyuan; Yang, Lan-Yan; Pan, Yu-Bin; Chung, Fu-Tsai; Wang, Chun-Hua; Kuo, Han-Pin

    2016-01-01

    Abstract Pulmonary rehabilitation (PR) brings benefits to patients with chronic obstructive pulmonary disease (COPD). Negative pressure ventilation (NPV) increases ventilation and decreases hyperinflation as well as breathing work in COPD. We evaluated the long-term effects of a hospital-based PR program coupled with NPV support in patients with COPD on clinical outcomes. One hundred twenty-nine patients with COPD were followed up for more than 5 years, with the NPV group (n = 63) receiving the support of NPV (20–30 cm H2O delivery pressure for 60 min) and unsupervised home exercise program of 20 to 30 min daily walk, while the control group (n = 6) only received unsupervised home exercise program. Pulmonary function tests and 6 min walk tests (6MWT) were performed every 3 to 6 months. Emergency room (ER) visits and hospitalization with medical costs were recorded. A significant time-by-group interaction in the yearly decline of forced expiratory volume in 1 s in the control group analyzed by mixed-model repeated-measure analysis was found (P = 0.048). The 6MWT distance of the NPV group was significantly increased during the first 4 years, with the interaction of time and group (P = 0.003), the time alone (P = 0.014), and the quadratic time (P < 0.001) being significant between the 2 groups. ER exacerbations and hospitalizations decreased by 66% (P < 0.0001) and 54% (P < 0.0001) in the NPV group, respectively. Patients on PR program coupled with NPV had a significant reduction of annual medical costs (P = 0.022). Our hospital-based multidisciplinary PR coupled with NPV reduced yearly decline of lung function, exacerbations, and hospitalization rates, and improved walking distance and medical costs in patients with COPD during a 5-year observation PMID:27741132

  16. Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during laparoscopic cholecystectomy.

    PubMed

    Sen, Oznur; Umutoglu, Tarik; Aydın, Nurdan; Toptas, Mehmet; Tutuncu, Ayse Cigdem; Bakan, Mefkur

    2016-01-01

    Pressure-controlled ventilation (PCV) is less frequently employed in general anesthesia. With its high and decelerating inspiratory flow, PCV has faster tidal volume delivery and different gas distribution. The same tidal volume setting, delivered by PCV versus volume-controlled ventilation (VCV), will result in a lower peak airway pressure and reduced risk of barotrauma. We hypothesized that PCV instead of VCV during laparoscopic surgery could achieve lower airway pressures and reduce the systemic stress response. Forty ASA I-II patients were randomly selected to receive either the PCV (Group PC, n = 20) or VCV (Group VC, n = 20) during laparoscopic cholecystectomy. Blood sampling was made for baseline arterial blood gases (ABG), cortisol, insulin, and glucose levels. General anesthesia with sevoflurane and fentanyl was employed to all patients. After anesthesia induction and endotracheal intubation, patients in Group PC were given pressure support to form 8 mL/kg tidal volume and patients in Group VC was maintained at 8 mL/kg tidal volume calculated using predicted body weight. All patients were maintained with 5 cmH2O positive-end expiratory pressure (PEEP). Respiratory parameters were recorded before and 30 min after pneumoperitonium. Assessment of ABG and sampling for cortisol, insulin and glucose levels were repeated 30 min after pneumoperitonium and 60 min after extubation. The P-peak levels observed before (18.9 ± 3.8 versus 15 ± 2.2 cmH2O) and during (23.3 ± 3.8 versus 20.1 ± 2.9 cmH2O) pneumoperitoneum in Group VC were significantly higher. Postoperative partial arterial oxygen pressure (PaO2) values are higher (98 ± 12 versus 86 ± 11 mmHg) in Group PC. Arterial carbon dioxide pressure (PaCO2) values (41.8 ± 5.4 versus 36.7 ± 3.5 mmHg) during pneumoperitonium and post-operative mean cortisol and insulin levels were higher in Group VC. When compared to VCV mode, PCV mode may improve compliance during pneumoperitoneum

  17. A ventilation capacity test for the Eustachian tube using a soundproof pressure chamber.

    PubMed

    Kodama, A; Kitahara, M; Ozawa, H; Izukura, H

    1994-01-01

    Using a soundproof pressure chamber, we performed Békésy air conduction audiometry at 1000 Hz under the following pressure conditions: 1) from atmospheric pressure (AP) to 200 mmH2O below AP, 2) AP to 200 mmH2O above AP, 3) AP to 700 mmH2O below AP, and 4) AP to 700 mmH2O above AP. In conditions 1) and 2), the patient was instructed not to swallow until the pressure change was complete, then to swallow once every 15 seconds. The number of swallows required for hearing to return to the baseline level was counted. In conditions 3) and 4), the patient was told to swallow as many times as possible both before and after completion of the pressure change; maximum hearing level and the time needed for return to the baseline level were measured. Although all except one of the seven patients with suspected tubal dysfunction showed normal results with catheter insufflation and tympanometry, six of the seven showed abnormality and one reported the disappearance of ear stuffiness after the ventilation capacity test. We concluded that this test is useful not only for the diagnosis of tubal dysfunction but also as a possible therapy for aiding adaptation to changing environmental pressure.

  18. Ventilation loss and pressurization in the NASA launch/entry suit: Potential for heat stress

    NASA Technical Reports Server (NTRS)

    Kaufman, Jonathan W.; Dejneka, Katherine Y.; Askew, Gregory K.

    1989-01-01

    The potential of the NASA Launch/Entry Suit (LES) for producing heat stress in a simulated Space Shuttle cabin environment was studied. The testing was designed to identify potential heat stress hazards if the LES were pressurized or if ventilation were lost. Conditions were designed to simulate an extreme pre-launch situation with chamber temperatures maintained at dry bulb temperature = 27.2 +/- 0.1 C, globe temperature = 27.3 +/- 0.1 C, and wet bulb temperature = 21.1 +/- 0.3 C. Two females and two males, 23 to 34 years of age, were employed in this study, with two subjects having exposures in all 3 conditions. Test durations in the ventilated (V) and unventilated (UV) conditions were designed for 480 minutes, which all subjects achieved. Pressurized runs (Pr) were designed for 45 minutes, which all subjects also achieved. While some significant differences related to experimental conditions were noted in rectal and mean skin temperatures, evaporation rates, sweat rates, and heart rate, these differences were not thought to be physiologically significant. The results indicate that the LES garment, in either the Pr or UV state, poses no danger of inducing unacceptable heat stress under the conditions expected within the Space Shuttle cabin during launch or reentry.

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

    SciTech Connect

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

    2011-11-08

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

  20. Experience of step-wise protocol using noninvasive positive pressure ventilation for treating cardiogenic pulmonary edema.

    PubMed

    Momii, Hidetoshi; Tashima, Yuki; Kadokami, Toshiaki; Narita, Sumito; Yoshida, Masayoshi; Ando, Shin-ichi

    2012-08-01

    Initiating and weaning procedure of noninvasive positive pressure ventilation (NIPPV) on acute cardiogenic pulmonary edema (ACPE) has been determined empirically, and the total time of its use has been sometimes prolonged unnecessarily. A simple protocol for its use may facilitate initiation and avoids prolongation of the NIPPV treatment. We designed a step-wise protocol for NIPPV use and retrospectively examined the clinical outcome of our protocol for initiation and weaning of NIPPV in 45 patients with ACPE. Almost all patients recovered from respiratory distress successfully. There was no intubation nor complication related to NIPPV. In most of the cases, maximal-end expiratory pressure was less than 7-cm H2O. The mean duration of NIPPV was 19.5±28.0 h and the median duration was 8.0 h (interquartile range=14.0 h). This simple step-wise NIPPV protocol for ACPE can facilitate quick and safe initiation and termination of the treatment.

  1. Non-invasive Positive Pressure Ventilation during Sleep at 3800m: relationship to Acute Mountain Sickness and sleeping oxyhemoglobin saturation

    PubMed Central

    Johnson, PL; Popa, DA; Prisk, GK; Sullivan, CE; Edwards, N

    2014-01-01

    Background and objectives Ascent to high altitude results in hypobaric hypoxia and some individuals will develop Acute Mountain Sickness, which has been shown to be associated with low oxyhemoglobin saturation during sleep. Previous research has shown that positive end-expiratory pressure by use of expiratory valves in a face mask while awake, results in a reduction in AMS symptoms and higher oxyhemoglobin saturation. We aimed to test whether pressure ventilation during sleep would prevent AMS by keeping oxyhaemoglobin higher during sleep. Methods We compared sleeping oxyhemoglobin saturation and the incidence and severity of Acute Mountain Sickness in seven subjects sleeping for two consecutive nights at 3800m above sea level using either non-invasive positive pressure ventilation that delivered positive inspiratory and expiratory airway pressure via a face mask, or sleeping without assisted ventilation. The presence and severity of Acute Mountain Sickness was assessed by administration of the Lake Louise questionnaire. Results We found significant increases in the mean and minimum sleeping oxyhemoglobin saturation and decreases in AMS symptoms in subjects who used positive pressure ventilation during sleep. Mean and minimum sleeping SaO2 was lower in subjects who developed AMS after the night spent without positive pressure ventilation. Conclusion The use of positive pressure ventilation during sleep at 3800m significantly increased the sleeping oxygen saturation; we suggest that the marked reduction in symptoms of AMS is due to this higher sleeping SaO2. We agree with the findings from previous studies that the development of AMS is associated with a lower sleeping oxygen saturation. PMID:20051046

  2. Effect of a downstream ventilated gas cavity on turbulent boundary layer wall pressure fluctuation spectra

    NASA Astrophysics Data System (ADS)

    Young, Steven D.; Brungart, Timothy A.; Lauchle, Gerald C.; Howe, Michael S.

    2005-12-01

    An analytical and experimental investigation is made of the effect of a 2-D ventilated gas cavity on the spectrum of turbulent boundary layer wall pressure fluctuations upstream of a gas cavity on a plane rigid surface. The analytical model predicts the ratio of the wall pressure spectrum in the presence of the cavity to the blocked wall pressure spectrum that would exist if the cavity were absent. The ratio is found to oscillate in amplitude with upstream distance (-x) from the edge of the cavity. It approaches unity as -ωx/Uc-->∞, where ω is the radian frequency and Uc is the upstream turbulence convection velocity. To validate these predictions an experiment was performed in a water tunnel over a range of mean flow velocities. Dynamic wall pressure sensors were flush mounted to a flat plate at various distances upstream from a backward facing step. The cavity was formed downstream of the step by injecting carbon dioxide gas. The water tunnel measurements confirm the predicted oscillatory behavior of the spectral ratio, as well as its relaxation to unity as -ωx/Uc-->∞. For -ωx/Uc>7 the cavity has a negligible influence on the upstream wall pressure fluctuations.

  3. [High-frequency ventilation. I. Distribution of alveolar pressure amplitudes during high frequency oscillation in the lung model].

    PubMed

    Theissen, J; Lunkenheimer, P P; Niederer, P; Bush, E; Frieling, G; Lawin, P

    1987-09-01

    The pattern of intrapulmonary pressure distribution was studied during high-frequency ventilation in order to explain the inconsistent results reported in the literature. Methods. Pressure and flow velocity (hot-wire anemometry) were measured in different lung compartments: 1. In transalveolar chambers sealed to the perforated pleural surfaces of dried pig lungs; 2. In emphysema-simulating airbags sealed to the isolated bronchial trees of dried pig lungs; and 3. In transalveolar chambers sealed to the perforated pleural surfaces of freshly excised pig lungs. Results. 1. The pressure amplitudes change from one area to another and depending on the exciting frequency. 2. High-frequency oscillation is associated with an increase in pressure amplitude when the exciting frequency rises, whereas with conventional high-frequency jet ventilation the pressure amplitude is more likely to decrease with frequency. 3. During high-frequency jet ventilation the local pressure amplitude changes with the position of the tube in the trachea rather than with the exciting frequency. 4. When the volume of the measuring chamber is doubled the resulting pressure amplitude falls to half the control value. 5. The pressure amplitude and mean pressure measured in the transalveolar chamber vary more or less independently from the peak flow velocity. High-frequency ventilation is thus seen to be a frequency-dependant, inhomogeneous mode of ventilation that can essentially be homogenized by systematically changing the exciting frequency. The frequency-dependant response to different lung areas to excitation is likely to result from an intrabronchially-localized aerodynamic effect rather than the mechanical properties of the lung parenchyma.

  4. Intraoperative mechanical ventilation for the pediatric patient.

    PubMed

    Kneyber, Martin C J

    2015-09-01

    Invasive mechanical ventilation is required when children undergo general anesthesia for any procedure. It is remarkable that one of the most practiced interventions such as pediatric mechanical ventilation is hardly supported by any scientific evidence but rather based on personal experience and data from adults, especially as ventilation itself is increasingly recognized as a harmful intervention that causes ventilator-induced lung injury. The use of low tidal volume and higher levels of positive end-expiratory pressure became an integral part of lung-protective ventilation following the outcomes of clinical trials in critically ill adults. This approach has been readily adopted in pediatric ventilation. However, a clear association between tidal volume and mortality has not been ascertained in pediatrics. In fact, experimental studies have suggested that young children might be less susceptible to ventilator-induced lung injury. As such, no recommendations on optimal lung-protective ventilation strategy in children with or without lung injury can be made.

  5. Application of the open-lung concept during positive-pressure ventilation reduces pulmonary inflammation in newborn piglets.

    PubMed

    van Kaam, Anton H; Dik, Willem A; Haitsma, Jack J; De Jaegere, Anne; Naber, Birgitta A; van Aalderen, Wim M; Kok, Joke H; Lachmann, Burkhard

    2003-01-01

    It has been shown that application of the open-lung concept (OLC) during high-frequency oscillatory ventilation (HFOV) attenuates pulmonary inflammation. We hypothesized that this attenuation could also be achieved by applying the OLC during positive-pressure ventilation (PPV). After repeated whole-lung lavage, newborn piglets were assigned to one of three ventilation groups: (1) PPV(OLC); (2) HFOV(OLC), or (3) conventional PPV (PPV(CON)). After a ventilation period of 5 h, analysis of bronchoalveolar lavage fluid showed a reduced influx of polymorphonuclear neutrophils, interleukin 8, and thrombin activity in both OLC groups as compared with the PPV(CON) group. There were no differences in tumor necrosis factor alpha levels. We conclude that application of the OLC during PPV reduces pulmonary inflammation as compared with conventional PPV and that the magnitude of this reduction is comparable to that of HFOV.

  6. The effect of positive end expiratory pressure on the respiratory profile during one-lung ventilation for thoracotomy.

    PubMed

    Leong, L M C; Chatterjee, S; Gao, F

    2007-01-01

    Summary In this randomised controlled trial we examined the effects of four different levels of positive end expiratory pressure (PEEP at 0, 5, 8 or 10 cmH(2)O), added to the dependent lung, on respiratory profile and oxygenation during one lung ventilation. Forty-six patients were recruited to receive one of the randomised PEEP levels during one lung ventilation. We did not find significant differences in lung compliance, intra-operative or postoperative oxygenation amongst the four different groups. However, the physiological deadspace to tidal volume ventilation ratio was significantly lower in the 8 cmH(2)O PEEP group compared with the other levels of PEEP (p < 0.0001). We concluded that the use of PEEP (< or =10 cmH(2)O) during one lung ventilation does not clinically improve lung compliance, intra-operative or postoperative oxygenation despite a statistically significant reduction in the physiological deadspace to tidal volume ratio.

  7. IMPACT OF VENTILATION FREQUENCY AND PARENCHYMAL STIFFNESS ON FLOW AND PRESSURE DISTRIBUTION IN A CANINE LUNG MODEL

    PubMed Central

    Amini, Reza; Kaczka, David W.

    2013-01-01

    To determine the impact of ventilation frequency, lung volume, and parenchymal stiffness on ventilation distribution, we developed an anatomically-based computational model of the canine lung. Each lobe of the model consists of an asymmetric branching airway network subtended by terminal, viscoelastic acinar units. The model allows for empiric dependencies of airway segment dimensions and parenchymal stiffness on transpulmonary pressure. We simulated the effects of lung volume and parenchymal recoil on global lung impedance and ventilation distribution from 0.1 to 100 Hz, with mean transpulmonary pressures from 5 to 25 cmH2O. With increasing lung volume, the distribution of acinar flows narrowed and became more synchronous for frequencies below resonance. At higher frequencies, large variations in acinar flow were observed. Maximum acinar flow occurred at first antiresonance frequency, where lung impedance achieved a local maximum. The distribution of acinar pressures became very heterogeneous and amplified relative to tracheal pressure at the resonant frequency. These data demonstrate the important interaction between frequency and lung tissue stiffness on the distribution of acinar flows and pressures. These simulations provide useful information for the optimization of frequency, lung volume, and mean airway pressure during conventional ventilation or high frequency oscillation (HFOV). Moreover our model indicates that an optimal HFOV bandwidth exists between the resonant and antiresonant frequencies, for which interregional gas mixing is maximized. PMID:23872936

  8. Determinants of ventilation and pulmonary artery pressure during early acclimatization to hypoxia in humans

    PubMed Central

    Fatemian, Marzieh; Herigstad, Mari; Croft, Quentin P. P.; Formenti, Federico; Cardenas, Rosa; Wheeler, Carly; Smith, Thomas G.; Friedmannova, Maria; Dorrington, Keith L.

    2015-01-01

    Key points Lung ventilation and pulmonary artery pressure rise progressively in response to 8 h of hypoxia, changes described as ‘acclimatization to hypoxia’. Acclimatization responses differ markedly between humans for unknown reasons.We explored whether the magnitudes of the ventilatory and vascular responses were related, and whether the degree of acclimatization could be predicted by acute measurements of ventilatory and vascular sensitivities.In 80 healthy human volunteers measurements of acclimatization were made before, during, and after a sustained exposure to 8 h of isocapnic hypoxia.No correlation was found between measures of ventilatory and pulmonary vascular acclimatization.The ventilatory chemoreflex sensitivities to acute hypoxia and hypercapnia all increased in proportion to their pre‐acclimatization values following 8 h of hypoxia. The peripheral (rapid) chemoreflex sensitivity to CO2, measured before sustained hypoxia against a background of hyperoxia, was a modest predictor of ventilatory acclimatization to hypoxia. This finding has relevance to predicting human acclimatization to the hypoxia of altitude. Abstract Pulmonary ventilation and pulmonary arterial pressure both rise progressively during the first few hours of human acclimatization to hypoxia. These responses are highly variable between individuals, but the origin of this variability is unknown. Here, we sought to determine whether the variabilities between different measures of response to sustained hypoxia were related, which would suggest a common source of variability. Eighty volunteers individually underwent an 8‐h isocapnic exposure to hypoxia (end‐tidal P O2=55 Torr) in a purpose‐built chamber. Measurements of ventilation and pulmonary artery systolic pressure (PASP) assessed by Doppler echocardiography were made during the exposure. Before and after the exposure, measurements were made of the ventilatory sensitivities to acute isocapnic hypoxia (GpO2) and

  9. Effects of short term high frequency negative pressure ventilation on gas exchange using the Hayek oscillator in normal subjects.

    PubMed Central

    Hardinge, F. M.; Davies, R. J.; Stradling, J. R.

    1995-01-01

    BACKGROUND--The Hayek oscillator is a negative pressure cuirass that can operate at a range of frequencies to provide ventilation, and is a technique which could potentially be used on a general ward. This study examined the effect of different frequencies and different ranges of inspiratory and expiratory pressures on gas exchange, respiratory rate, and blood pressure in normal subjects. METHODS--Eight normal subjects received five minute periods of ventilation using the Hayek oscillator at five different frequencies, and a combination of two spans of inspiratory and expiratory pressures and two mean chamber pressures. A "sham" or control period was also performed at each frequency. Measurements were made of changes in gas exchange, spontaneous respiratory rate, and blood pressure before and after ventilation. RESULTS--There was significant intersubject variation in all results, independent of their height and weight. "Sham" settings acted as true controls in terms of gas exchange, but produced a fall in respiratory rate at 30 oscillations/min. The lower oscillatory frequencies of 30 and 60 oscillations/min produced the greatest increase in oxygenation, decrease in end tidal carbon dioxide pressure, and decrease in spontaneous respiratory rate. These effects were most significant at higher spans of pressure and were different from "sham" settings. No adverse effects were observed on blood pressure. CONCLUSIONS--The Hayek oscillator can provide assisted ventilation for short periods in normal conscious subjects with no adverse side effects on blood pressure. Maximal changes in gas exchange and a significant reduction in the spontaneous respiratory rate are seen when a combination of lower frequencies (30 and 60 oscillations/min) and higher spans of pressure are used. PMID:7886648

  10. High pressure versus high intensity noninvasive ventilation in stable hypercapnic chronic obstructive pulmonary disease: a randomized crossover trial

    PubMed Central

    Murphy, Patrick B; Brignall, Kate; Moxham, John; Polkey, Michael I; Davidson, A Craig; Hart, Nicholas

    2012-01-01

    Background High-intensity (high-pressure and high backup rate) noninvasive ventilation has recently been advocated for the management of stable hypercapnic chronic obstructive pulmonary disease (COPD). However, the relative contributions of high inspiratory pressure and high backup rate to ventilator adherence and physiological outcome have not been investigated. Methods Patients with stable hypercapnic COPD (daytime PaCO2 > 6 kPa) and nocturnal hypoventilation were enrolled. Patients were randomly allocated to high-pressure and high backup rate (high-intensity) and high-pressure and low backup rate (high-pressure) for a 6-week period. At the end of the first treatment period, patients were switched to the alternative treatment. The primary outcome measure was mean nightly ventilator usage. Results Twelve patients were recruited, with seven completing the 12-week trial protocol. The mean patient age was 71 ± 8 years, with a forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) of 50% ± 13% and FEV1 of 32% ± 12%. The baseline PaCO2 and PaO2 were 8.6 ± 1.7 kPa and 7.3 ± 1.4 kPa, respectively. There was no significant difference demonstrated in mean nightly ventilator usage between the high-intensity and high-pressure groups (difference of 4 minutes; 95% confidence interval −45 to 53; P = 0.9). Furthermore, there were no differences in any of the secondary endpoints, with the exception of the respiratory domain of the Severe Respiratory Insufficiency questionnaire, which was lower in the high-intensity arm than in the high-pressure arm (57 ± 11 versus 69 ± 16; P < 0.05). Conclusion There was no additional benefit, in terms of night-time ventilator adherence or any of the other measured parameters, demonstrated by addition of a high backup rate to high-pressure noninvasive ventilation. These data suggest that it is the high-pressure component of the high-intensity noninvasive ventilation approach that plays the important therapeutic role in

  11. Literature review supporting assessment of potential radionuclides in the 291-Z exhaust ventilation

    SciTech Connect

    Mahoney, L.A.; Ballinger, M.Y.; Jette, S.J.; Thomas, L.M. Glissmeyer, J.A.; Davis, W.E.

    1994-08-01

    This literature review was prepared to support a study conducted by Pacific Northwest Laboratory to assess the potential deposition and resuspension of radionuclides in the 291-Z ventilation exhaust building located in the 200 West Area of the US Department of Energy`s Hanford Project near Richland, Washington. The filtered ventilation air from three of the facilities at the Plutonium Finishing Plant (PFP) complex are combined together in the 291-Z building before discharge through a common stack. These three facilities contributing filtered exhaust air to the discharge stream are (1) the PFP, also known as the Z-Plant or 234-5Z, (2) the Plutonium Reclamation Facility (PRF or 236-Z), and (3), the Waste Incinerator Building (WIB or 232-Z). The 291-Z building houses the exhaust fans that pull air from the 291-Z central collection plenum and exhausts the air to the stack. Section 2.0 of this report is a description of the physical characteristic of the ventilation system from the High Efficiency Particulate Air (HEPA) filters to the exhaust stack. A description of the processes performed in the facilities that are vented through 291-Z is given in Section 3.0. The description focuses on the chemical and physical forms of potential aerosols given off from the unit operations. A timeline of the operations and events that may have affected the deposition of material in the ventilation system is shown. Aerosol and radiation measurements taken in previous studies are also discussed. Section 4.0 discusses the factors that influence particle deposition and adhesion. Mechanisms of attachment and resuspension are covered with specific attention to the PFP ducts. Conclusions and recommendations are given in Section 5.0.

  12. Radiation effects on reactor pressure vessel supports

    SciTech Connect

    Johnson, R.E.; Lipinski, R.E.

    1996-05-01

    The purpose of this report is to present the findings from the work done in accordance with the Task Action Plan developed to resolve the Nuclear Regulatory Commission (NRC) Generic Safety Issue No. 15, (GSI-15). GSI-15 was established to evaluate the potential for low-temperature, low-flux-level neutron irradiation to embrittle reactor pressure vessel (RPV) supports to the point of compromising plant safety. An evaluation of surveillance samples from the High Flux Isotope Reactor (HFIR) at the Oak Ridge National Laboratory (ORNL) had suggested that some materials used for RPV supports in pressurized-water reactors could exhibit higher than expected embrittlement rates. However, further tests designed to evaluate the applicability of the HFIR data to reactor RPV supports under operating conditions led to the conclusion that RPV supports could be evaluated using traditional method. It was found that the unique HFIR radiation environment allowed the gamma radiation to contribute significantly to the embrittlement. The shielding provided by the thick steel RPV shell ensures that degradation of RPV supports from gamma irradiation is improbable or minimal. The findings reported herein were used, in part, as the basis for technical resolution of the issue.

  13. Assisted mechanical ventilation: the future is now!

    PubMed

    Kacmarek, Robert M; Pirrone, Massimiliano; Berra, Lorenzo

    2015-07-29

    Assisted ventilation is a highly complex process that requires an intimate interaction between the ventilator and the patient. The complexity of this form of ventilation is frequently underappreciated by the bedside clinician. In assisted mechanical ventilation, regardless of the specific mode, the ventilator's gas delivery pattern and the patient's breathing pattern must match near perfectly or asynchrony between the patient and the ventilator occurs. Asynchrony can be categorized into four general types: flow asynchrony; trigger asynchrony; cycle asynchrony; and mode asynchrony. In an article recently published in BMC Anesthesiology, Hodane et al. have demonstrated reduced asynchrony during assisted ventilation with Neurally Adjusted Ventilatory Assist (NAVA) as compared to pressure support ventilation (PSV). These findings add to the growing volume of data indicating that modes of ventilation that provide proportional assistance to ventilation - e.g., NAVA and Proportional Assist Ventilation (PAV) - markedly reduce asynchrony. As it becomes more accepted that the respiratory center of the patient in most circumstances is the most appropriate determinant of ventilatory pattern and as the negative outcome effects of patient-ventilator asynchrony become ever more recognized, we can expect NAVA and PAV to become the preferred modes of assisted ventilation!

  14. 14 CFR 25.831 - Ventilation.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Design and Construction Ventilation and Heating § 25.831 Ventilation... probable failures or malfunctioning of the ventilating, heating, pressurization, or other systems...

  15. 14 CFR 25.831 - Ventilation.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Design and Construction Ventilation and Heating § 25.831 Ventilation... probable failures or malfunctioning of the ventilating, heating, pressurization, or other systems...

  16. 14 CFR 25.831 - Ventilation.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Design and Construction Ventilation and Heating § 25.831 Ventilation... probable failures or malfunctioning of the ventilating, heating, pressurization, or other systems...

  17. 14 CFR 25.831 - Ventilation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Design and Construction Ventilation and Heating § 25.831 Ventilation... probable failures or malfunctioning of the ventilating, heating, pressurization, or other systems...

  18. 14 CFR 25.831 - Ventilation.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Design and Construction Ventilation and Heating § 25.831 Ventilation... probable failures or malfunctioning of the ventilating, heating, pressurization, or other systems...

  19. The use of equine surfactant and positive pressure ventilation to treat a premature alpaca cria with severe hypoventilation and hypercapnia.

    PubMed

    Tinkler, Stacy H; Mathews, Lindsey A; Firshman, Anna M; Quandt, Jane E

    2015-04-01

    A 5-hour-old, premature alpaca cria was presented with failure to nurse, weakness, hypoglycemia, hypercapnia, and respiratory distress. The cria was treated with 3 doses of fresh, crude equine surfactant, positive pressure ventilation, and supplemental intranasal oxygen. Recovery to discharge was uneventful, and the cria regained apparently normal respiratory function. Three years after hospital discharge, the alpaca was a healthy adult.

  20. Best Clinical Practices for the Sleep Center Adjustment of Noninvasive Positive Pressure Ventilation (NPPV) in Stable Chronic Alveolar Hypoventilation Syndromes

    PubMed Central

    2010-01-01

    Summary: Noninvasive positive pressure ventilation (NPPV) devices are used during sleep to treat patients with diurnal chronic alveolar hypoventilation (CAH). Bilevel positive airway pressure (BPAP) using a mask interface is the most commonly used method to provide ventilatory support in these patients. BPAP devices deliver separately adjustable inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP). The IPAP and EPAP levels are adjusted to maintain upper airway patency, and the pressure support (PS = IPAP-EPAP) augments ventilation. NPPV devices can be used in the spontaneous mode (the patient cycles the device from EPAP to IPAP), the spontaneous timed (ST) mode (a backup rate is available to deliver IPAP for the set inspiratory time if the patient does not trigger an IPAP/EPAP cycle within a set time window), and the timed (T) mode (inspiratory time and respiratory rate are fixed). During NPPV titration with polysomnography (PSG), the pressure settings, backup rate, and inspiratory time (if applicable) are adjusted to maintain upper airway patency and support ventilation. However, there are no widely available guidelines for the titration of NPPV in the sleep center. A NPPV Titration Task Force of the American Academy of Sleep Medicine reviewed the available literature and developed recommendations based on consensus and published evidence when available. The major recommendations derived by this consensus process are as follows: General Recommendations:The indications, goals of treatment, and side effects of NPPV treatment should be discussed in detail with the patient prior to the NPPV titration study.Careful mask fitting and a period of acclimatization to low pressure prior to the titration should be included as part of the NPPV protocol.NPPV titration with PSG is the recommended method to determine an effective level of nocturnal ventilatory support in patients with CAH. In circumstances in which NPPV treatment is initiated

  1. Nuclear reactor pressure vessel support system

    DOEpatents

    Sepelak, George R.

    1978-01-01

    A support system for nuclear reactor pressure vessels which can withstand all possible combinations of stresses caused by a postulated core disrupting accident during reactor operation. The nuclear reactor pressure vessel is provided with a flange around the upper periphery thereof, and the flange includes an annular vertical extension formed integral therewith. A support ring is positioned atop of the support ledge and the flange vertical extension, and is bolted to both members. The plug riser is secured to the flange vertical extension and to the top of a radially outwardly extension of the rotatable plug. This system eliminates one joint through which fluids contained in the vessel could escape by making the fluid flow path through the joint between the flange and the support ring follow the same path through which fluid could escape through the plug risers. In this manner, the sealing means to prohibit the escape of contained fluids through the plug risers can also prohibit the escape of contained fluid through the securing joint.

  2. [Home mechanical ventilation: Invasive and noninvasive ventilation therapy for chronic respiratory failure].

    PubMed

    Huttmann, S E; Storre, J H; Windisch, W

    2015-06-01

    Home mechanical ventilation represents a valuable therapeutic option to improve alveolar ventilation in patients with chronic respiratory failure. For this purpose both invasive ventilation via tracheostomy and noninvasive ventilation via facemasks are available. The primary goal of home mechanical ventilation is a reduction of symptoms, improvement of quality of life and in many cases reduction of mortality. Elective establishment of home mechanical ventilation is typically provided for noninvasive ventilation in respect to clinical symptoms and partial pressure of carbon dioxide depending on the underlying disease. However, invasive mechanical ventilation is increasingly being used to continue ventilatory support in polymorbid patients following unsuccessful weaning. Recommendations and guidelines have been published by the German Respiratory Society (DGP).

  3. EVALUATION OF BEST AVAILABLE CONTROL TECHNOLOGY FOR TOXICS (TBACT) DOUBLE SHELL TANK FARMS PRIMARY VENTILATION SYSTEM SUPPORTING WASTE TRANSFER OPERATIONS

    SciTech Connect

    KELLY SE; HAASS CC; KOVACH JL; TURNER DA

    2010-06-03

    This report is an evaluation of Best Available Control Technology for Toxics (tBACT) for installation and operation of the Hanford double shell (DST) tank primary ventilation systems. The DST primary ventilation systems are being modified to support Hanford's waste retrieval, mixing, and delivery of single shell tank (SST) and DST waste throught the DST storage system to the Waste Treatment and Immobilization Plant (WTP).

  4. EVALUATION OF BEST AVAILABLE CONTROL TECHNOLOGY FOR TOXICS -TBACT- DOUBLE SHELL TANK FARMS PRIMARY VENTILATION SYSTEMS SUPPORTING WASTE TRANSFER OPERATIONS

    SciTech Connect

    HAAS CC; KOVACH JL; KELLY SE; TURNER DA

    2010-06-24

    This report is an evaluation of Best Available Control Technology for Toxics (tBACT) for installation and operation of the Hanford double shell (DST) tank primary ventilation systems. The DST primary ventilation systems are being modified to support Hanford's waste retrieval, mixing, and delivery of single shell tank (SST) and DST waste through the DST storage system to the Waste Treatment and Immobilizaiton Plant (WTP).

  5. Conventional mechanical ventilation

    PubMed Central

    Tobias, Joseph D.

    2010-01-01

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

  6. Heart rate variability and stroke volume variability to detect central hypovolemia during spontaneous breathing and supported ventilation in young, healthy volunteers.

    PubMed

    Elstad, Maja; Walløe, Lars

    2015-04-01

    Cardiovascular oscillations exist in many different variables and may give important diagnostic and prognostic information in patients. Variability in cardiac stroke volume (SVV) is used in clinical practice for diagnosis of hypovolemia, but currently is limited to patients on mechanical ventilation. We investigated if SVV and heart rate variability (HRV) could detect central hypovolemia in spontaneously breathing humans: We also compared cardiovascular variability during spontaneous breathing with supported mechanical ventilation.Ten subjects underwent simulated central hypovolemia by lower body negative pressure (LBNP) with >10% reduction of cardiac stroke volume. The subjects breathed spontaneously and with supported mechanical ventilation. Heart rate, respiratory frequency and mean arterial blood pressure were measured. Stroke volume (SV) was estimated by ModelFlow (Finometer). Respiratory SVV was calculated by: 1) SVV% = (SVmax - SVmin)/SVmean during one respiratory cycle, 2) SVIntegral from the power spectra (Fourier transform) at 0.15-0.4 Hz and 3) SVV_norm = (√SVIntegral)/SVmean. HRV was calculated by the same methods.During spontaneous breathing two measures of SVV and all three measures of HRV were reduced during hypovolemia compared to baseline. During spontaneous breathing SVIntegral and HRV% were best to detect hypovolemia (area under receiver operating curve 0.81). HRV% ≤ 11% and SVIntegral ≤ 12 ml(2) differentiated between hypovolemia and baseline during spontaneous breathing.During supported mechanical ventilation, none of the three measures of SVV changed and two of the HRV measures were reduced during hypovolemia. Neither measures of SVV nor HRV were classified as a good detector of hypovolemia.We conclude that HRV% and SVIntegral detect hypovolemia during spontaneous breathing and both are candidates for further clinical testing.

  7. Ventilators for noninvasive ventilation to treat acute respiratory failure.

    PubMed

    Scala, Raffaele; Naldi, Mario

    2008-08-01

    The application of noninvasive ventilation (NIV) to treat acute respiratory failure has increased tremendously both inside and outside the intensive care unit. The choice of ventilator is crucial for success of NIV in the acute setting, because poor tolerance and excessive air leaks are significantly correlated with NIV failure. Patient-ventilator asynchrony and discomfort can occur if the physician or respiratory therapist fails to adequately set NIV to respond to the patient's ventilatory demand, so clinicians need to fully understood the ventilator's technical peculiarities (eg, efficiency of trigger and cycle systems, speed of pressurization, air-leak compensation, CO(2) rebreathing, reliability of fraction of inspired oxygen reading, monitoring accuracy). A wide range of ventilators of different complexity have been introduced into clinical practice to noninvasively support patients in acute respiratory failure, but the numerous commercially available ventilators (bi-level, intermediate, and intensive care unit ventilators) have substantial differences that can influence patient comfort, patient-ventilator interaction, and, thus, the chance of NIV clinical success. This report examines the most relevant aspects of the historical evolution, the equipment, and the acute-respiratory-failure clinical application of NIV ventilators.

  8. Flexible bronchoscopy during non-invasive positive pressure mechanical ventilation: are two better than one?

    PubMed

    Scala, Raffaele

    2016-09-01

    Flexible bronchoscopy (FBO) and non-invasive positive pressure ventilation (NIPPV) are largely applied in respiratory and general intensive care units. FBO plays a crucial role for the diagnosis of lung infiltrates of unknown origin and for the treatment of airways obstruction due to bronchial mucous plugging and hemoptysis in critical patients. NIPPV is the first-choice ventilatory strategy for acute respiratory failure (ARF) of different causes as it could be used as prevention or as alternative to the conventional mechanical ventilation (CMV) via endotracheal intubation (ETI). Some clinical scenarios represent contraindications for these techniques such as severe ARF in spontaneous breathing patients for FBO and accumulated tracheo-bronchial secretions in patients with depressed cough for NIPPV. In these contexts, the decision of performing ETI should carefully consider the risk of CMV-correlated complications. An increasing amount of published data suggested the use of FBO during NIPPV in ARF in order to avoid/reduce the need of ETI. Despite a strong rationale for the combined use of the two techniques, there is not still enough evidence for a large-scale application of this strategy in all different clinical scenarios. The majority of the available data are in favor of the "help" given by NIPPV to diagnostic FBO in high-risk spontaneously breathing patients with severe hypoxemia. Preliminary findings report the successful "help" given by early FBO to NIPPV in patients with hypoxemic-hypercapnic ARF who are likely to fail because of hypersecretion. Synergy of FBO and NIPPV application is emerging also to perform ETI in challenging situations, such as predicted difficult laringoscopy and NPPV failure in severely hypoxemic patients. This combined approach should be performed only in centers showing a wide experience with both NIPPV and FBO, where close monitoring and ETI facilities are promptly available.

  9. Effect of assist negative pressure ventilation by microprocessor based iron lung on breathing effort

    PubMed Central

    Gorini, M; Villella, G; Ginanni, R; Augustynen, A; Tozzi, D; Corrado, A

    2002-01-01

    Background: The lack of patient triggering capability during negative pressure ventilation (NPV) may contribute to poor patient synchrony and induction of upper airway collapse. This study was undertaken to evaluate the performance of a microprocessor based iron lung capable of thermistor triggering. Methods: The effects of NPV with thermistor triggering were studied in four normal subjects and six patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) by measuring: (1) the time delay (TDtr) between the onset of inspiratory airflow and the start of assisted breathing; (2) the pressure-time product of the diaphragm (PTPdi); and (3) non-triggering inspiratory efforts (NonTrEf). In patients the effects of negative extrathoracic end expiratory pressure (NEEP) added to NPV were also evaluated. Results: With increasing trigger sensitivity the mean (SE) TDtr ranged from 0.29 (0.02) s to 0.21 (0.01) s (mean difference 0.08 s, 95% CI 0.05 to 0.12) in normal subjects and from 0.30 (0.02) s to 0.21 (0.01) s (mean difference 0.09 s, 95% CI 0.06 to 0.12) in patients with COPD; NonTrEf ranged from 8.2 (1.8)% to 1.2 (0.1)% of the total breaths in normal subjects and from 11.8 (2.2)% to 2.5 (0.4)% in patients with COPD. Compared with spontaneous breathing, PTPdi decreased significantly with NPV both in normal subjects and in patients with COPD. NEEP added to NPV resulted in a significant decrease in dynamic intrinsic PEEP, diaphragm effort exerted in the pre-trigger phase, and NonTrEf. Conclusions: Microprocessor based iron lung capable of thermistor triggering was able to perform assist NPV with acceptable TDtr, significant unloading of the diaphragm, and a low rate of NonTrEf. NEEP added to NPV improved the synchrony between the patient and the ventilator. PMID:11867832

  10. The effects of positive expiratory pressure on isovolume flow and dynamic hyperinflation in patients receiving mechanical ventilation.

    PubMed

    Gay, P C; Rodarte, J R; Hubmayr, R D

    1989-03-01

    The use of continuous positive airway pressure (CPAP) or positive end-expiratory pressure (PEEP) has been advocated by some to assist in the weaning process of patients receiving mechanical ventilation for respiratory failure. The efficacy of this technique and its effect on respiratory system mechanics are not well understood. The theoretical advantage of CPAP or PEEP during the weaning process can be obliterated if excessive dynamic hyperinflation is induced. A key determinant of the individual response to this proposed weaning technique is the recognition of the presence or absence of expiratory flow limitation. We studied the effect of progressively increased levels of applied PEEP on isovolume expiratory flow and end-expiratory lung volume in seven patients during controlled mechanical ventilation. In the absence of expiratory flow limitation, passive expiratory flow decreased and end-expiratory lung volume increased when any level of PEEP was applied. In contrast, flow-limited patients did not demonstrate a change in isovolume expiratory flow or end-expiratory lung volume until the applied PEEP reduced the driving pressure for expiratory flow below a critical value. All patients demonstrated dynamic hyperinflation during controlled ventilation as evident by the existence of intrinsic PEEP. The nominal value of applied PEEP that caused a reduction in isovolume expiratory flow was unrelated to the initial level of intrinsic PEEP. The clinical implications of these findings with respect to CPAP therapy during weaning from mechanical ventilation are discussed.

  11. Blood pressure management in mechanical circulatory support

    PubMed Central

    Adatya, Sirtaz

    2015-01-01

    Durable mechanical support has become widely available for end stage heart failure as destination therapy and as bridge to transplantation. The accurate measurement of blood pressure (BP) as well as the recognition and management of hypertension in patients with continuous flow left ventricular assist devices (CF-VADs) is an essential component of optimal clinical care. Strategies for the control of BP in CF-VAD patients are increasingly important as there is an evolving understanding of the connection between hypertension, pump output, and adverse outcomes. As clinical experience grows, optimal BP targets, as well as methods to measure BP in CF-VAD patients have been further defined. PMID:26793332

  12. Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation.

    PubMed

    Neder, J A; Andreoni, S; Lerario, M C; Nery, L E

    1999-06-01

    The strength of the respiratory muscles can be evaluated from static measurements (maximal inspiratory and expiratory pressures, MIP and MEP) or inferred from dynamic maneuvers (maximal voluntary ventilation, MVV). Although these data could be suitable for a number of clinical and research applications, no previous studies have provided reference values for such tests using a healthy, randomly selected sample of the adult Brazilian population. With this main purpose, we prospectively evaluated 100 non-smoking subjects (50 males and 50 females), 20 to 80 years old, selected from more than 8,000 individuals. Gender-specific linear prediction equations for MIP, MEP and MVV were developed by multiple regression analysis: age and, secondarily, anthropometric measurements explained up to 56% of the variability of the dependent variables. The most cited previous studies using either Caucasian or non-Caucasian samples systematically underestimated the observed values of MIP (P < 0.05). Interestingly, the self-reported level of regular physical activity and maximum aerobic power correlates strongly with both respiratory and peripheral muscular strength (knee extensor peak torque) (P < 0.01). Our results, therefore, provide a new frame of reference to evaluate the normalcy of some useful indexes of respiratory muscle strength in Brazilian males and females aged 20 to 80.

  13. Asynchrony Between Ventilator Flow and Pressure Waveforms and the Capnograph on Dräger Anesthesia Workstations: A Case Report.

    PubMed

    Tripathi, Mukesh; Tripathi, Nilay; Pandey, Mamta

    2017-03-01

    Modern anesthesia workstations display capnography, flow-time, and pressure-time waveforms in real time. We observed that at certain ventilator settings (10 breaths/min) on Dräger workstations, the expiratory phase of the capnograph overlaps both the inspiratory and the expiratory phases of ventilation. This discrepancy disappears at respiratory rates of 16 breaths/min. This synchronous respiratory monitoring display at respiratory rates 16 breaths/min is not physiologically correct, because it implies a synchronization of waveforms that is not actually present. This again becomes asynchronous once the respiratory rate is increased to >18 breaths/min. Such an artifact may not affect the patient's safety in most cases but may mislead clinicians when synchrony between flow/pressure and capnography is needed for diagnostic purposes. We wish to share this discrepancy with clinicians and notify the manufacturer so that potential solutions may be found.

  14. International project to repair Chernobyl Units 3 and 4 ventilation stack supports

    SciTech Connect

    Schmidt, J.P.; Neal, J.K.; Gore, B.F.; Osterloh, J.V.; Winkel, B.V.

    1998-09-01

    The US Department of State and the US Department of Energy (DOE) are sponsoring bilateral efforts at Chernobyl. These efforts are an integral part of a broader international effort being undertaken by the G-7 nations, which resulted in development of the shelter implementation plan (SIP) to place the shelter in a manageable and environmentally safe condition. One of these projects involves financing repairs to the units 3 and 4 ventilation stack external bracing and foundation supports. Canada has also elected to contribute to this project. This paper describes the trilateral cooperation involving a Western approach to work planning that resulted in G-7 concurrence for repairs to the stack and elimination of the safety threat imposed by this unstable structure.

  15. The use of equine surfactant and positive pressure ventilation to treat a premature alpaca cria with severe hypoventilation and hypercapnia

    PubMed Central

    Tinkler, Stacy H.; Mathews, Lindsey A.; Firshman, Anna M.; Quandt, Jane E.

    2015-01-01

    A 5-hour-old, premature alpaca cria was presented with failure to nurse, weakness, hypoglycemia, hypercapnia, and respiratory distress. The cria was treated with 3 doses of fresh, crude equine surfactant, positive pressure ventilation, and supplemental intranasal oxygen. Recovery to discharge was uneventful, and the cria regained apparently normal respiratory function. Three years after hospital discharge, the alpaca was a healthy adult. PMID:25829556

  16. Albuterol delivery in a neonatal ventilated lung model: Nebulization versus chlorofluorocarbon- and hydrofluoroalkane-pressurized metered dose inhalers.

    PubMed

    Lugo, R A; Kenney, J K; Keenan, J; Salyer, J W; Ballard, J; Ward, R M

    2001-03-01

    The aim of this study was to compare albuterol delivery in a neonatal ventilated lung model, using three delivery methods: 1) jet nebulizer; 2) chlorofluorocarbon-pressurized metered dose inhaler (CFC-MDI) actuated into an ACE(R) spacer; and 3) hydrofluoroalkane-pressurized MDI (HFA-MDI) actuated into an ACE(R) spacer. The bench model consisted of a mechanically ventilated infant test lung with ventilator settings to simulate a very low birth weight neonate with moderate lung disease. Albuterol solution (0.5%) was nebulized at the humidifier and temperature port, 125 cm and 30 cm from the Y-piece, respectively. Albuterol metered dose inhalers (MDIs) were actuated into an ACE(R) spacer that was tested in two positions: 1) inline between the endotracheal (ET) tube and the Y-piece; and 2) attached to the ET tube and administered by manual ventilation. Albuterol was collected on a filter at the distal end of the ET tube and was quantitatively analyzed by high performance liquid chromatography. Albuterol delivery by CFC-MDI (position 1, 4.8 +/- 1.0%, vs. position 2, 3.8 +/- 1.6%, P > 0.05) and HFA-MDI (position 1, 5.7 +/- 1.6%, vs. position 2, 5.5 +/- 2.4%, P > 0.05) were significantly greater than delivery by nebulization at 30 cm (0.16 +/- 0.07%) and 125 cm (0.15 +/- 0.03%) from the Y-piece (P < 0.001). A single actuation of albuterol MDI delivered the equivalent of nebulizing 2.5-3.7 mg of albuterol solution. We conclude that albuterol administered by MDI and ACE(R) spacer resulted in more efficient delivery than by nebulization in this mechanically ventilated neonatal lung model. There was no significant difference in drug delivery between CFC-MDI and HFA-MDI; nor did the placement of the spacer significantly affect drug delivery.

  17. Sex differences in alpha-adrenergic support of blood pressure.

    PubMed

    Schmitt, Judith A M; Joyner, Michael J; Charkoudian, Nisha; Wallin, B Gunnar; Hart, Emma C

    2010-08-01

    We tested whether the inter-individual variability in alpha-adrenergic support of blood pressure plays a critical role in the sex differences in tonic support of blood pressure by the autonomic nervous system. Blockade of the alpha-adrenergic receptors was achieved via phentolamine and showed a smaller (P < 0.05) decrease in blood pressure in women compared to men, implying that alpha-adrenergic support of blood pressure is less in women than in men.

  18. Positive pressure ventilation during anesthesia in dogs: Assessment of surface area derived tidal volume.

    PubMed

    Dyson, Doris H

    2012-01-01

    The purpose of this study was to assess the use of surface area derived tidal volume in anesthetized ventilated dogs (n = 71, random assignment) compared to settings by experienced personnel. There was no significant difference (P = 0.1030) between methods (p(a)CO(2) of 43.1 ± 7 mmHg and 39.8 ± 7 mmHg, respectively). Surface area derived tidal volume can achieve satisfactory ventilation.

  19. “Expiratory holding” approach in measuring end-expiratory pulmonary artery wedge pressure for mechanically ventilated patients

    PubMed Central

    Yang, Wanjie; Zhao, Xuefeng; Feng, Qingguo; An, Youzhong; Wei, Kai; Wang, Wei; Li, Chang; Cheng, Xiuling

    2013-01-01

    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. PMID:24133370

  20. Automatic versus manual pressure support reduction in the weaning of post-operative patients: a randomised controlled trial

    PubMed Central

    Taniguchi, Corinne; Eid, Raquel C; Saghabi, Cilene; Souza, Rogério; Silva, Eliezer; Knobel, Elias; Paes, Ângela T; Barbas, Carmen S

    2009-01-01

    Introduction Reduction of automatic pressure support based on a target respiratory frequency or mandatory rate ventilation (MRV) is available in the Taema-Horus ventilator for the weaning process in the intensive care unit (ICU) setting. We hypothesised that MRV is as effective as manual weaning in post-operative ICU patients. Methods There were 106 patients selected in the post-operative period in a prospective, randomised, controlled protocol. When the patients arrived at the ICU after surgery, they were randomly assigned to either: traditional weaning, consisting of the manual reduction of pressure support every 30 minutes, keeping the respiratory rate/tidal volume (RR/TV) below 80 L until 5 to 7 cmH2O of pressure support ventilation (PSV); or automatic weaning, referring to MRV set with a respiratory frequency target of 15 breaths per minute (the ventilator automatically decreased the PSV level by 1 cmH2O every four respiratory cycles, if the patient's RR was less than 15 per minute). The primary endpoint of the study was the duration of the weaning process. Secondary endpoints were levels of pressure support, RR, TV (mL), RR/TV, positive end expiratory pressure levels, FiO2 and SpO2 required during the weaning process, the need for reintubation and the need for non-invasive ventilation in the 48 hours after extubation. Results In the intention to treat analysis there were no statistically significant differences between the 53 patients selected for each group regarding gender (p = 0.541), age (p = 0.585) and type of surgery (p = 0.172). Nineteen patients presented complications during the trial (4 in the PSV manual group and 15 in the MRV automatic group, p < 0.05). Nine patients in the automatic group did not adapt to the MRV mode. The mean ± sd (standard deviation) duration of the weaning process was 221 ± 192 for the manual group, and 271 ± 369 minutes for the automatic group (p = 0.375). PSV levels were significantly higher in MRV compared with that of

  1. [Classification and terminology of artificial lung ventilation].

    PubMed

    Gal'perin, Iu S

    2005-01-01

    The author considers the main features of a prepared edition of the international standard ISO 4135:2001 "Equipment for anesthesia and artificial ventilation. Glossary" as the state standard of Russia. He shows methods for classification of the modes of ventilation support. A classification scheme of its procedures is proposed, by giving necessary notes. The abbreviations of these procedures are given in the Russian and English languages. The shorthand notations of airways gas pressure in the characteristic points of a respiratory cycle are clarified in detail and on this basis the procedures for limiting inspiration pressure during controlled artificial ventilation.

  2. The growing role of noninvasive ventilation in patients requiring prolonged mechanical ventilation.

    PubMed

    Hess, Dean R

    2012-06-01

    For many patients with chronic respiratory failure requiring ventilator support, noninvasive ventilation (NIV) is preferable to invasive support by tracheostomy. Currently available evidence does not support the use of nocturnal NIV in unselected patients with stable COPD. Several European studies have reported benefit for high intensity NIV, in which setting of inspiratory pressure and respiratory rate are selected to achieve normocapnia. There have also been studies reporting benefit for the use of NIV as an adjunct to exercise training. NIV may be useful as an adjunct to airway clearance techniques in patients with cystic fibrosis. Accumulating evidence supports the use of NIV in patients with obesity hypoventilation syndrome. There is considerable observational evidence supporting the use of NIV in patients with chronic respiratory failure related to neuromuscular disease, and one randomized controlled trial reported that the use of NIV was life-prolonging in patients with amyotrophic lateral sclerosis. A variety of interfaces can be used to provide NIV in patients with stable chronic respiratory failure. The mouthpiece is an interface that is unique in this patient population, and has been used with success in patients with neuromuscular disease. Bi-level pressure ventilators are commonly used for NIV, although there are now a new generation of intermediate ventilators that are portable, have a long battery life, and can be used for NIV and invasive applications. Pressure support ventilation, pressure controlled ventilation, and volume controlled ventilation have been used successfully for chronic applications of NIV. New modes have recently become available, but their benefits await evidence to support their widespread use. The success of NIV in a given patient population depends on selection of an appropriate patient, selection of an appropriate interface, selection of an appropriate ventilator and ventilator settings, the skills of the clinician, the

  3. Oxygen saturation/FiO2 ratio is a simple predictor of noninvasive positive pressure ventilation failure in critically ill patients

    PubMed Central

    Spada, Carol; Gandhi, Rikesh; Patel, Sanjay R.; Nuccio, Paul; Weinhouse, Gerald L.; Lee, Po-Shun

    2010-01-01

    Purpose Noninvasive positive pressure ventilation (NPPV) can improve outcomes of critically ill patients. Early and simple predictors of NPPV outcome could improve clinical management of patients with respiratory failure. Materials and Methods A prospective observational study was conducted in a medical intensive care unit (ICU) of a tertiary medical center. Patients requiring NPPV were included and followed. Clinical data including respiratory mechanics at the time of NPPV initiation, and clinical outcomes were recorded. Data were analyzed to identify variables that distinguished NPPV success or failure. Results A total of 133 patients were included in the study. NPPV success rate was 41%. Patients diagnosed with malignancy had only 29% NPPV success rate. Among patients without malignancy, higher oxygen saturation, oxygen saturation/FiO2 (SF) ratios, and SF/minute ventilation (MV) ratios were associated with NPPV success. Receiver operating curve analyses identify SF < 98.5 to be a specific (89% specificity, P=0.013) predictor of NPPV failure. Furthermore, for patients requiring at least 24hr of NPPV support, tidal volume (TV)/predicted body weight (PBW) ratio inversely correlated with respiratory improvement. Conclusions For patients without malignancy, SF ratios at the time of NPPV initiation discriminated NPPV success and failure, and could be used to help guide the management of critically ill patients who require ventilatory support. PMID:21036535

  4. The Effect of Equal Ratio Ventilation on Oxygenation, Respiratory Mechanics, and Cerebral Perfusion Pressure During Laparoscopy in the Trendelenburg Position.

    PubMed

    Jo, Youn Yi; Kim, Ji Young; Chang, Young Jin; Lee, Sehwan; Kwak, Hyun Jeong

    2016-06-01

    The aim of this study was to investigate the effects of equal ratio ventilation (ERV) on oxygenation, respiratory mechanics, and the cerebral perfusion pressure during pneumoperitoneum in the Trendelenburg position. Thirty patients undergoing laparoscopic low anterior resection (25 to 65 y) were enrolled. Mechanical ventilator was set to volume-controlled mode at an inspiratory to expiratory (I:E) ratio of 1:2 with a tidal volume of 8 mL/kg of ideal body weight with a 5 cm H2O positive end-expiratory pressure. Twenty minutes after pneumoperitoneum in the Trendelenburg position, the I:E ratio was changed to 1:1 for 20 minutes and then restored to 1:2. No significant changes in arterial oxygen tension and respiratory compliance after adopting ERV. Mean arterial pressure and cerebral perfusion pressure decreased significantly over time after adopting the Trendelenburg position during pneumoperitoneum (P=0.014 and 0.005, respectively). In conclusion, there was no improvement in oxygenation or respiratory mechanics with ERV.

  5. Technology for noninvasive mechanical ventilation: looking into the black box

    PubMed Central

    Navajas, Daniel; Montserrat, Josep M.

    2016-01-01

    Current devices for providing noninvasive respiratory support contain sensors and built-in intelligence for automatically modifying ventilation according to the patient's needs. These devices, including automatic continuous positive airway pressure devices and noninvasive ventilators, are technologically complex and offer a considerable number of different modes of ventilation and setting options, the details of which are sometimes difficult to capture by the user. Therefore, better predicting and interpreting the actual performance of these ventilation devices in clinical application requires understanding their functioning principles and assessing their performance under well controlled bench test conditions with simulated patients. This concise review presents an updated perspective of the theoretical basis of intelligent continuous positive airway pressure and noninvasive ventilation devices, and of the tools available for assessing how these devices respond under specific ventilation phenotypes in patients requiring breathing support. PMID:27730162

  6. VENTILATION NEEDS DURING CONSTRUCTION

    SciTech Connect

    C.R. Gorrell

    1998-07-23

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

  7. [Mechanical ventilator].

    PubMed

    Kimura, Akio; Hashimoto, S

    2009-07-01

    The development of the computer technology brought reform in the field of medical equipment. Originally the mechanical ventilator was an instrument only as for running by pressure and the tool that let you breathe. However, it has a function to assist a measurement (tidal volume, peek pressure, etc.) and to wean from a ventilator. There is a case to use a mechanical ventilator for after a chest surgical operation. After the operation without the complication, it seems that there is not the special administration. However, special respiratory management is necessary in case of chronic respiratory failure and acute lung injury, acute respiratory distress syndrome. Therefore I introduce a method to use a respirator after an operation in our institution.

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

    PubMed

    Frutos-Vivar, F; Esteban, A

    2013-12-01

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

  9. Social Support, Assimilation and Biological Effective Blood Pressure Levels.

    ERIC Educational Resources Information Center

    Walsh, Anthony; Walsh, Patricia Ann

    1987-01-01

    The twin processes of migration and assimilation are highly stressful. This stress can be manifested in elevated blood pressure. According to this study, immigrants receiving high levels of social support had significantly lower blood pressure levels than those receiving less social support. (VM)

  10. Pulmonary rehabilitation coupled with negative pressure ventilation decreases decline in lung function, hospitalizations, and medical cost in COPD: A 5-year study.

    PubMed

    Huang, Hung-Yu; Chou, Pai-Chien; Joa, Wen-Ching; Chen, Li-Fei; Sheng, Te-Fang; Lin, Horng-Chyuan; Yang, Lan-Yan; Pan, Yu-Bin; Chung, Fu-Tsai; Wang, Chun-Hua; Kuo, Han-Pin

    2016-10-01

    Pulmonary rehabilitation (PR) brings benefits to patients with chronic obstructive pulmonary disease (COPD). Negative pressure ventilation (NPV) increases ventilation and decreases hyperinflation as well as breathing work in COPD. We evaluated the long-term effects of a hospital-based PR program coupled with NPV support in patients with COPD on clinical outcomes.One hundred twenty-nine patients with COPD were followed up for more than 5 years, with the NPV group (n = 63) receiving the support of NPV (20-30 cm H2O delivery pressure for 60 min) and unsupervised home exercise program of 20 to 30 min daily walk, while the control group (n = 6) only received unsupervised home exercise program. Pulmonary function tests and 6 min walk tests (6MWT) were performed every 3 to 6 months. Emergency room (ER) visits and hospitalization with medical costs were recorded.A significant time-by-group interaction in the yearly decline of forced expiratory volume in 1 s in the control group analyzed by mixed-model repeated-measure analysis was found (P = 0.048). The 6MWT distance of the NPV group was significantly increased during the first 4 years, with the interaction of time and group (P = 0.003), the time alone (P = 0.014), and the quadratic time (P < 0.001) being significant between the 2 groups. ER exacerbations and hospitalizations decreased by 66% (P < 0.0001) and 54% (P < 0.0001) in the NPV group, respectively. Patients on PR program coupled with NPV had a significant reduction of annual medical costs (P = 0.022).Our hospital-based multidisciplinary PR coupled with NPV reduced yearly decline of lung function, exacerbations, and hospitalization rates, and improved walking distance and medical costs in patients with COPD during a 5-year observation.

  11. Ventilation Model

    SciTech Connect

    V. Chipman

    2002-10-05

    The purpose of the Ventilation Model is to simulate the heat transfer processes in and around waste emplacement drifts during periods of forced ventilation. The model evaluates the effects of emplacement drift ventilation on the thermal conditions in the emplacement drifts and surrounding rock mass, and calculates the heat removal by ventilation as a measure of the viability of ventilation to delay the onset of peak repository temperature and reduce its magnitude. The heat removal by ventilation is temporally and spatially dependent, and is expressed as the fraction of heat carried away by the ventilation air compared to the fraction of heat produced by radionuclide decay. One minus the heat removal is called the wall heat fraction, or the remaining amount of heat that is transferred via conduction to the surrounding rock mass. Downstream models, such as the ''Multiscale Thermohydrologic Model'' (BSC 2001), use the wall heat fractions as outputted from the Ventilation Model to initialize their post-closure analyses. The Ventilation Model report was initially developed to analyze the effects of preclosure continuous ventilation in the Engineered Barrier System (EBS) emplacement drifts, and to provide heat removal data to support EBS design. Revision 00 of the Ventilation Model included documentation of the modeling results from the ANSYS-based heat transfer model. The purposes of Revision 01 of the Ventilation Model are: (1) To validate the conceptual model for preclosure ventilation of emplacement drifts and verify its numerical application in accordance with new procedural requirements as outlined in AP-SIII-10Q, Models (Section 7.0). (2) To satisfy technical issues posed in KTI agreement RDTME 3.14 (Reamer and Williams 2001a). Specifically to demonstrate, with respect to the ANSYS ventilation model, the adequacy of the discretization (Section 6.2.3.1), and the downstream applicability of the model results (i.e. wall heat fractions) to initialize post

  12. Combined effects of ventilation mode and positive end-expiratory pressure on mechanics, gas exchange and the epithelium in mice with acute lung injury.

    PubMed

    Thammanomai, Apiradee; Hamakawa, Hiroshi; Bartolák-Suki, Erzsébet; Suki, Béla

    2013-01-01

    The accepted protocol to ventilate patients with acute lung injury is to use low tidal volume (V(T)) in combination with recruitment maneuvers or positive end-expiratory pressure (PEEP). However, an important aspect of mechanical ventilation has not been considered: the combined effects of PEEP and ventilation modes on the integrity of the epithelium. Additionally, it is implicitly assumed that the best PEEP-V(T) combination also protects the epithelium. We aimed to investigate the effects of ventilation mode and PEEP on respiratory mechanics, peak airway pressures and gas exchange as well as on lung surfactant and epithelial cell integrity in mice with acute lung injury. HCl-injured mice were ventilated at PEEPs of 3 and 6 cmH(2)O with conventional ventilation (CV), CV with intermittent large breaths (CV(LB)) to promote recruitment, and a new mode, variable ventilation, optimized for mice (VV(N)). Mechanics and gas exchange were measured during ventilation and surfactant protein (SP)-B, proSP-B and E-cadherin levels were determined from lavage and lung homogenate. PEEP had a significant effect on mechanics, gas exchange and the epithelium. The higher PEEP reduced lung collapse and improved mechanics and gas exchange but it also down regulated surfactant release and production and increased epithelial cell injury. While CV(LB) was better than CV, VV(N) outperformed CV(LB) in recruitment, reduced epithelial injury and, via a dynamic mechanotransduction, it also triggered increased release and production of surfactant. For long-term outcome, selection of optimal PEEP and ventilation mode may be based on balancing lung physiology with epithelial injury.

  13. End-inspiratory airway occlusion: a method to assess the pressure developed by inspiratory muscles in patients with acute lung injury undergoing pressure support.

    PubMed

    Foti, G; Cereda, M; Banfi, G; Pelosi, P; Fumagalli, R; Pesenti, A

    1997-10-01

    We evaluated the end-inspiratory occlusion maneuver as a means to estimate the inspiratory effort during pressure support ventilation (PS). In nine nonobstructed acute lung injury (ALI) patients, we applied four levels of PS (0, 5, 10, 15 cm H2O) to modify the inspiratory effort. End inspiratory occlusions (2 to 3 s) were performed at the end of each experimental period by pushing the inspiratory hold button of the ventilator (Servo 900 C; Siemens, Berlin, Germany). We took the difference between the end-inspiratory occlusion plateau pressure and the airway pressure before the occlusion (PEEP + PS) as an estimate of the inspiratory effort and called it PMI (Pmusc,index). From the esophageal pressure tracing we obtained a reference measurement of the pressure developed by the inspiratory muscles at end inspiration (Pmusc,ei) and of the pressure-time product per breath (PTP/b) and per minute (PTP/min). In each patient, PMI was correlated with Pmusc,ei (p < 0.01) and PTP/b (p < 0.01). A PMI threshold of 6 cm H2O detected PTP/min < 125 cm H2O s/min with a sensitivity of 0.89 and a specificity of 0.89. We conclude that PMI is a good estimate of the pressure developed by the inspiratory muscles in ALI patients and may be used to titrate PS level. The major advantage of PMI is that it can be obtained from the ventilator display without any additional equipment.

  14. Heliox and noninvasive positive-pressure ventilation: a role for heliox in exacerbations of chronic obstructive pulmonary disease?

    PubMed

    Hess, Dean R

    2006-06-01

    Evidence-based respiratory therapy for exacerbations of chronic obstructive pulmonary disease (COPD) includes oxygen, inhaled bronchodilators, and noninvasive positive-pressure ventilation. Examining the physics of gas flow, a case can be made either for or against the use of helium-oxygen mixture (heliox) in the care of patients with COPD. The evidence for the use of heliox in patients with COPD exacerbation is not strong at present. Most of the peer-reviewed literature consists of case reports, case series, and physiologic studies in small samples of carefully selected patients. Some patients with COPD exacerbation have a favorable physiologic response to heliox therapy, but predicting who will be a responder is difficult. Moreover, the use of heliox is hampered by the lack of widespread availability of an approved heliox delivery system. Appropriately designed randomized controlled trials with patient-important outcomes, such as avoidance of intubation, decreased intensive-care-unit and hospital days, and decreased cost of therapy, are sorely needed to establish the role of heliox in patients with COPD exacerbation, including those receiving noninvasive positive-pressure ventilation. Lacking such evidence, the use of heliox in patients with COPD exacerbation cannot be considered standard therapy.

  15. Pressure vessel sliding support unit and system using the sliding support unit

    DOEpatents

    Breach, Michael R.; Keck, David J.; Deaver, Gerald A.

    2013-01-15

    Provided is a sliding support and a system using the sliding support unit. The sliding support unit may include a fulcrum capture configured to attach to a support flange, a fulcrum support configured to attach to the fulcrum capture, and a baseplate block configured to support the fulcrum support. The system using the sliding support unit may include a pressure vessel, a pedestal bracket, and a plurality of sliding support units.

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

    PubMed Central

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

    2009-01-01

    Objective To compare 13 commercially available, new-generation, intensive-care-unit (ICU) ventilators regarding trigger function, pressurization capacity during pressure-support ventilation (PSV), accuracy of pressure measurements and expiratory resistance. Design and Setting Bench study at a research laboratory in a university hospital. Material Four turbine-based ventilators and nine conventional servo-valve compressed-gas ventilators were tested using a two-compartment lung model. Results Three levels of effort were simulated. Each ventilator was evaluated at four PSV levels (5, 10, 15, and 20 cm H2O), with and without positive end-expiratory pressure (5 cm H2O, Trigger function was assessed as the time from effort onset to detectable pressurization. Pressurization capacity was evaluated using the airway pressure-time product computed as the net area under the pressure-time curve over the first 0.3 s after inspiratory effort onset. Expiratory resistance was evaluated by measuring trapped volume in controlled ventilation. Significant differences were found across the ventilators, with a range of triggering-delay from 42 ms to 88 ms for all conditions averaged (P<.001). Under difficult conditions, the triggering delay was longer than 100 ms and the pressurization was poor with five ventilators at PSV5 and three at PSV10, suggesting an inability to unload patient’s effort. On average, turbine-based ventilators performed better than conventional ventilators, which showed no improvement compared to a 2000 bench comparison. Conclusion Technical performances of trigger function, pressurization capacity and expiratory resistance vary considerably across new-generation ICU ventilators. ICU ventilators seem to have reached a technical ceiling in recent years, and some ventilators still perform inadequately. PMID:19352622

  17. The effect of a bellows leak in an Ohmeda 7810 ventilator on room contamination, inspired oxygen, airway pressure, and tidal volume.

    PubMed

    Lampotang, Samsun; Sanchez, Justin C; Chen, Baixi; Gravenstein, Nikolaus

    2005-07-01

    We investigated the effect of a small bellows leak (bellows full at end-expiration) on inspired oxygen fraction (Fio(2)), exhaled tidal volume (Vt), airway pressure, and room contamination in an oxygen-driven anesthesia ventilator (Ohmeda 7810, Madison, WI). CO(2) concentration at the ventilator exhalation valve, Fio(2), Vt, and airway pressure were measured (n = 3) while ventilating a CO(2)-producing test lung at 8 breaths/min and an inspiratory/expiratory ratio of 1:2, with and without a bellows leak (4-mm-long tear). Set Vt was 400, 600, 800, and 1000 mL. Fresh gas flow (FGF) was 0.3 L/min O(2) and (a) 5.0 L/min air, (b) 2.0 L/min air, and (c) 0.2 L/min nitrogen. There was no clinical difference in Fio(2), Vt, PIP (peak inspiratory pressure) and PEEP (positive end-expiratory pressure), with and without a 4-mm bellows tear, at all FGFs and Vt settings. CO(2) at the ventilator exhalation valve was always nonzero with a bellows leak, indicating that CO(2)-laden circuit gas was contaminating the drive gas via the bellows leak. A 4-mm bellows tear in an Ohmeda 7810 ventilator allows anesthetic gases to contaminate ambient air but does not cause clinically significant changes in Fio(2), exhaled Vt, PIP, or PEEP.

  18. Liquid ventilation

    PubMed Central

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

    2014-01-01

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

  19. Ventilation and ventilators.

    PubMed

    Hayes, B

    1982-01-01

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

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

    PubMed

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

    2014-12-01

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

  1. Reliability of the special support system for sitting pressure redistribution

    PubMed Central

    Lee, Sang-Heon

    2016-01-01

    [Purpose] This study investigated the reliability of the Special Support System. [Subjects and Methods] Eighteen female and 14 male volunteers participated in this study. Participants were asked to sit on the Special Support System with their chins tucked in, spines straight, pelvis neutrally positioned, and their hands placed on their thighs. They were also asked to flex their hips, knees, and ankles to approximately 90 degrees and to put their feet flat on the floor. The total contact area, mean total pressure, as well as mean and peak pressures of each quadrant were each measured 15 times. Test-retest reliability was analyzed for inflated air pressure, and pressure redistribution values by using intraclass correlation coefficients. [Results] The intraclass correlation coefficient was greater than 0.89 for inflated air pressure and greater than 0.92 for total contact area, mean total pressure, and each quadrant’s mean and peak pressure. [Conclusion] The findings suggest that the Special Support System is reliable and can be used as an alternative method for redistributing sitting pressure. PMID:28174458

  2. Bench performance of ventilators during simulated paediatric ventilation.

    PubMed

    Park, M A J; Freebairn, R C; Gomersall, C D

    2013-05-01

    This study compares the accuracy and capabilities of various ventilators using a paediatric acute respiratory distress syndrome lung model. Various compliance settings and respiratory rate settings were used. The study was done in three parts: tidal volume and FiO2 accuracy; pressure control accuracy and positive end-expiratory pressure (PEEP) accuracy. The parameters set on the ventilator were compared with either or both of the measured parameters by the test lung and the ventilator. The results revealed that none of the ventilators could consistently deliver tidal volumes within 1 ml/kg of the set tidal volume, and the discrepancy between the delivered volume and the volume measured by the ventilator varied greatly. The target tidal volume was 8 ml/kg, but delivered tidal volumes ranged from 3.6-11.4 ml/kg and the volumes measured by the ventilator ranged from 4.1-20.6 ml/kg. All the ventilators maintained pressure within 20% of the set pressure, except one ventilator which delivered pressures of up to 27% higher than the set pressure. Two ventilators maintained PEEP within 10% of the prescribed PEEP. The majority of the readings were also within 10%. However, three ventilators delivered, at times, PEEPs over 20% higher. In conclusion, as lung compliance decreases, especially in paediatric patients, some ventilators perform better than others. This study highlights situations where ventilators may not be able to deliver, nor adequately measure, set tidal volumes, pressure, PEEP or FiO2.

  3. New modes of assisted mechanical ventilation.

    PubMed

    Suarez-Sipmann, F

    2014-05-01

    Recent major advances in mechanical ventilation have resulted in new exciting modes of assisted ventilation. Compared to traditional ventilation modes such as assisted-controlled ventilation or pressure support ventilation, these new modes offer a number of physiological advantages derived from the improved patient control over the ventilator. By implementing advanced closed-loop control systems and using information on lung mechanics, respiratory muscle function and respiratory drive, these modes are specifically designed to improve patient-ventilator synchrony and reduce the work of breathing. Depending on their specific operational characteristics, these modes can assist spontaneous breathing efforts synchronically in time and magnitude, adapt to changing patient demands, implement automated weaning protocols, and introduce a more physiological variability in the breathing pattern. Clinicians have now the possibility to individualize and optimize ventilatory assistance during the complex transition from fully controlled to spontaneous assisted ventilation. The growing evidence of the physiological and clinical benefits of these new modes is favoring their progressive introduction into clinical practice. Future clinical trials should improve our understanding of these modes and help determine whether the claimed benefits result in better outcomes.

  4. Modes of mechanical ventilation for the operating room.

    PubMed

    Ball, Lorenzo; Dameri, Maddalena; Pelosi, Paolo

    2015-09-01

    Most patients undergoing surgical procedures need to be mechanically ventilated, because of the impact of several drugs administered at induction and during maintenance of general anaesthesia on respiratory function. Optimization of intraoperative mechanical ventilation can reduce the incidence of post-operative pulmonary complications and improve the patient's outcome. Preoxygenation at induction of general anaesthesia prolongs the time window for safe intubation, reducing the risk of hypoxia and overweighs the potential risk of reabsorption atelectasis. Non-invasive positive pressure ventilation delivered through different interfaces should be considered at the induction of anaesthesia morbidly obese patients. Anaesthesia ventilators are becoming increasingly sophisticated, integrating many functions that were once exclusive to intensive care. Modern anaesthesia machines provide high performances in delivering the desired volumes and pressures accurately and precisely, including assisted ventilation modes. Therefore, the physicians should be familiar with the potential and pitfalls of the most commonly used intraoperative ventilation modes: volume-controlled, pressure-controlled, dual-controlled and assisted ventilation. Although there is no clear evidence to support the advantage of any one of these ventilation modes over the others, protective mechanical ventilation with low tidal volume and low levels of positive end-expiratory pressure (PEEP) should be considered in patients undergoing surgery. The target tidal volume should be calculated based on the predicted or ideal body weight rather than on the actual body weight. To optimize ventilation monitoring, anaesthesia machines should include end-inspiratory and end-expiratory pause as well as flow-volume loop curves. The routine administration of high PEEP levels should be avoided, as this may lead to haemodynamic impairment and fluid overload. Higher PEEP might be considered during surgery longer than 3 h

  5. Masses of radiation pressure supported stars in extreme relativistic realm

    NASA Astrophysics Data System (ADS)

    Mitra, Abhas

    2007-04-01

    It is known that there could be stars supported by radiation pressure alone. In Newtonian gravity, it turns out that such stars must be excessively massive and are called ``Supermassive Stars''. We show that this requirement for excessive mass arises because of weak gravity associated with Newtonian stars . The weakness of gravity here is expressed by the fact that for Newtonian stars, z << 1, where z is the surface gravitational redshift of the star. However, it is also known that sufficiently massive stars undergo continued gravitational collapse to become Black Holes (BH) marked by z=Infinity. Hence as the massive stars would tend to form BHs, they would pass through stages z>> 1. Recently, it has been shown that, such z>>1 stages would be be completely dominated by radiation energy rather than rest mass energy (Mitra, MNRAS Lett., 367, L66, 2006, gr-qc/0601025). By using this result, we show here that, in the realm of extremely strong gravity, there could be radiation pressure supported stars at arbitrary mass scale. Therefore, as we break free from the Newtonian restriction of z <<1, (1) Radiation Pressure Supported Stars need not be supermassive , (2) Radiation Pressure supported stars may have arbitrary low mass (say a few solar mass) or (3) They could be as massive as billion solar masses. The latter would be examples of Relativistic Supermassive Stars. All radiation pressure supported stars are shining at their respective maximal Eddington values and they are never in strict hydrodynamical equilibrium. On the other hand, they are in dynamical quasistatic state and their luminosity could be simply due to secular gravitational contraction known as Helmholtz -Kelvin process. The observed BH candidates could be in this intermediate state of radiation pressure supported relativistic stars (z >>1) rather than in the limiting BH stage (z = Infinity). Ref: A. Mitra, ``Radiation Pressure Supported Stars in Einstein Gravity: Eternally Collapsing Objects'', MNRAS (in

  6. Prediction of Arterial Blood pH and Partial Pressure of Carbon dioxide from Venous Blood Samples in Patients Receiving Mechanical Ventilation.

    PubMed

    Tavakol, Kamran; Ghahramanpoori, Bahareh; Fararouei, Mohammad

    2013-07-01

    Substitution of arterial with venous blood samples to estimate blood gas status is highly preferable due to practical and safety concerns. Numerous studies support the substitution of arterial by venous blood samples, reporting strong correlations between arterial and venous values. This study further investigated the predictive ability of venous blood samples for arterial Acid-Base Balance (pH) and pressure of carbon dioxide (pCO2). Participants were 51 post-brain surgery patients receiving mechanical ventilation, who had blood samples taken simultaneously from radial artery of the wrist and elbow vein. Results showed significant associations between arterial and venous pH and pCO2. However, the variation of regression residuals was not homogenous, and the regression line did not fit properly to the data, indicating that simple linear regression is sub-optimal for prediction of arterial pH and pCO2 by venous blood sample. Although highly significant correlations were found between arterial and venous blood pH and pCO2, the results did not support the reliability of prediction of arterial blood pH and pCO2 by venous blood samples across a range of concentrations.

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

    PubMed Central

    Narchi, Hassib; Chedid, Fares

    2015-01-01

    Continuous improvements in perinatal care have resulted in increased survival of premature infants. Their immature lungs are prone to injury with mechanical ventilation and this may develop into chronic lung disease (CLD) or bronchopulmonary dysplasia. Strategies to minimize the risk of lung injury have been developed and include improved antenatal management (education, regionalization, steroids, and antibiotics), exogenous surfactant administration and reduction of barotrauma by using exclusive or early noninvasive ventilatory support. The most frequently used mode of assisted ventilation is pressure support ventilation that may lead to patient-ventilator asynchrony that is associated with poor outcome. Ventilator-induced diaphragmatic dysfunction or disuse atrophy of diaphragm fibers may also occur. This has led to the development of new ventilation modes including neurally adjusted ventilatory assist (NAVA). This ventilation mode is controlled by electrodes embedded within a nasogastric catheter which detect the electrical diaphragmatic activity (Edi) and transmit it to trigger the ventilator in synchrony with the patient’s own respiratory efforts. This permits the patient to control peak inspiratory pressure, mean airway pressure and tidal volume. Back up pressure control (PC) is provided when there is no Edi signal and no pneumatic trigger. Compared with standard conventional ventilation, NAVA improves blood gas regulation with lower peak inspiratory pressure and oxygen requirements in preterm infants. NAVA is safe mode of ventilation. The majority of studies have shown no significant adverse events in neonates ventilated with NAVA nor a difference in the rate of intraventricular hemorrhage, pneumothorax, or necrotizing enterocolitis when compared to conventional ventilation. Future large size randomized controlled trials should be established to compare NAVA with volume targeted and pressure controlled ventilation in newborns with mature respiratory drive

  8. Attenuation of pressure swings along the endotracheal tube is indicative of optimal distending pressure during high-frequency oscillatory ventilation in a model of acute lung injury.

    PubMed

    van Genderingen, Huibert R; van Vught, Adrianus J; Duval, Elisabeth L I M; Markhorst, Dick G; Jansen, Jos R C

    2002-06-01

    We tested the hypothesis that during high-frequency oscillatory ventilation, the oscillatory pressure ratio (OPR) is minimal at the optimal mean airway pressure (Paw). OPR is defined as the ratio of pressure swings at the distal end and the proximal opening of the endotracheal tube. Optimal Paw was assumed to be the lowest Paw at which the physiological shunt fraction was below 0.1. Acute lung injury was produced by saline lung lavage of pigs who were then subjected to a stepwise increase of Paw to impose underinflation, optimal inflation, and overdistention (inflation phase), followed by a stepwise decrease of Paw (deflation phase). OPR reached a minimum of 0.10 +/- 0.01 at Paw = 31 +/- 4 cm H(2)O during the inflation phase and a minimum of 0.04 +/- 0.01 at Paw = 18 +/- 1 cm H(2)O during the deflation phase. Optimal Paw was 31 +/- 4 cm H(2)O on the inflation limb and 14 +/- 2 cm H(2)O on the deflation limb. Paw at the minimal OPR was not significantly different from the optimal Paw during the inflation phase, and slightly but significantly higher (4.1 +/- 1.6 cm H(2)O) during the deflation phase. In conclusion, a consistent relationship was found between OPR and Paw, with a minimum in all animals. The minimal OPR coincides fairly well with the Paw where oxygenation is optimal.

  9. Protective garment ventilation system

    NASA Technical Reports Server (NTRS)

    Lang, R. (Inventor)

    1970-01-01

    A method and apparatus for ventilating a protective garment, space suit system, and/or pressure suits to maintain a comfortable and nontoxic atmosphere within is described. The direction of flow of a ventilating and purging gas in portions of the garment may be reversed in order to compensate for changes in environment and activity of the wearer. The entire flow of the ventilating gas can also be directed first to the helmet associated with the garment.

  10. [Neurally adjusted ventilatory assist: a revolution of mechanical ventilation?].

    PubMed

    Piquilloud, Lise; Jolliet, Philippe; Tassaux, Didier

    2010-12-15

    Neurally adjusted ventilatory assist or NAVA is a new assisted ventilatory mode which, in comparison with pressure support, leads to improved patient-ventilator synchrony and a more variable ventilatory pattern. It also improves arterial oxygenation. With NAVA, the electrical activity of the diaphragm is recorded through a nasogastric tube equipped with electrodes. This electrical activity is then used to pilot the ventilator. With NAVA, the patient's respiratory pattern controls the ventilator's timing of triggering and cycling as well as the magnitude of pressurization, which is proportional to inspiratory demand. The effect of NAVA on patient outcome remains to be determined through well-designed prospective studies.

  11. Heat Exchanger/Humidifier Trade Study and Conceptual Design for the Constellation Space Suit Portable Life Support System Ventilation Subsystem

    NASA Technical Reports Server (NTRS)

    Paul, Heather L.; Sompayrac, Robert; Conger, Bruce; Chamberlain, Mateo

    2009-01-01

    As development of the Constellation Space Suit Element progresses, designing the most effective and efficient life support systems is critical. The baseline schematic analysis for the Portable Life Support System (PLSS) indicates that the ventilation loop will need some method of heat exchange and humidification prior to entering the helmet. A trade study was initiated to identify the challenges associated with conditioning the spacesuit breathing gas stream for temperature and water vapor control, to survey technological literature and resources on heat exchanger and humidifiers to provide solutions to the problems of conditioning the spacesuit breathing gas stream, and to propose potential candidate technologies to perform the heat exchanger and humidifier functions. This paper summarizes the results of this trade study and also describes the conceptual designs that NASA developed to address these issues.

  12. Heat Exchanger/Humidifier Trade Study and Conceptual Design for the Constellation Space Suit Portable Life Support System Ventilation Subsystem

    NASA Technical Reports Server (NTRS)

    Paul, Heather L.; Conger, Bruce; Sompyrac, Robert; Chamberlain, Mateo

    2008-01-01

    As development of the Constellation Space Suit Element progresses, designing the most effective and efficient life support systems is critical. The baseline schematic analysis for the Portable Life Support System (PLSS) indicates that the ventilation loop will need some method of heat exchange and humidification prior to entering the helmet. A trade study was initiated to identify the challenges associated with conditioning the spacesuit breathing gas stream for temperature and water vapor control, to survey technological literature and resources on heat exchanger and humidifiers to provide solutions to the problems of conditioning the spacesuit breathing gas stream, and to propose potential candidate technologies to perform the heat exchanger and humidifier functions. This paper summarizes the results of this trade study and also describes the conceptual designs that NASA developed to address these issues.

  13. Regenerative Blower for EVA Suit Ventilation Fan

    NASA Technical Reports Server (NTRS)

    Izenson, Michael G.; Chen, Weibo; Paul, Heather L.

    2010-01-01

    Portable life support systems in future space suits will include a ventilation subsystem driven by a dedicated fan. This ventilation fan must meet challenging requirements for pressure rise, flow rate, efficiency, size, safety, and reliability. This paper describes research and development that showed the feasibility of a regenerative blower that is uniquely suited to meet these requirements. We proved feasibility through component tests, blower tests, and design analysis. Based on the requirements for the Constellation Space Suit Element (CSSE) Portable Life Support System (PLSS) ventilation fan, we designed the critical elements of the blower. We measured the effects of key design parameters on blower performance using separate effects tests, and used the results of these tests to design a regenerative blower that will meet the ventilation fan requirements. We assembled a proof-of-concept blower and measured its performance at sub-atmospheric pressures that simulate a PLSS ventilation loop environment. Head/flow performance and maximum efficiency point data were used to specify the design and operating conditions for the ventilation fan. We identified materials for the blower that will enhance safety for operation in a lunar environment, and produced a solid model that illustrates the final design. The proof-of-concept blower produced the flow rate and pressure rise needed for the CSSE ventilation subsystem while running at 5400 rpm, consuming only 9 W of electric power using a non-optimized, commercial motor and controller and inefficient bearings. Scaling the test results to a complete design shows that a lightweight, compact, reliable, and low power regenerative blower can meet the performance requirements for future space suit life support systems.

  14. [The choice of a pediatric anesthesia ventilator].

    PubMed

    Kern, D; Larcher, C; Cottron, N; Ait Aissa, D; Fesseau, R; Alacoque, X; Delort, F; Masquère, P; Agnès, E; Visnadi, G; Fourcade, O

    2013-12-01

    The technology of anesthesia ventilators has substantially progressed during last years. The choice of a pediatric anesthesia ventilator needs to be led by multiple parameters: requirement, technical (pneumatic performance, velocity of halogenated or oxygen delivery), cost (purchase, in operation, preventive and curative maintenance), reliability, ergonomy, upgradability, and compatibility. The demonstration of the interest of pressure support mode during maintenance of spontaneous ventilation anesthesia makes this mode essential in pediatrics. In contrast, the financial impact of target controlled inhalation of halogenated has not be studied in pediatrics. Paradoxically, complex and various available technologies had not been much prospectively studied. Anesthesia ventilators performances in pediatrics need to be clarified in further clinical and bench test studies.

  15. [Effect of artificial ventilation on pulmonary capillary pressure in acute respiratory insufficiency].

    PubMed

    Labrousse, J; Tenaillon, A; Massabie, P; Simonneau, G; Lissac, J

    1977-05-07

    To determine the influence of intermittent positive pressure breathing (IPPB), the level of pulmonary capillary wedge pressure (PCWP) was compared during IPPB and after a short period off the respirator in 68 occasions on 42 patients with an acute respiratory failure (ARF) of various etiologies. During IPPB, the average PCWP was in the normal range in patients with toxic or neurologic comas and in cases of increased pulmonary capillary permeability edema (IPCPE), PCWP slightly increased within chronic obstructive pulmonary disease (COPD) complicated with ARF and in hemodynamic acute pulmonary edema (HAPE). During the weaning stage, PCWP decreased in the groups of coma, COPD, and IPCPE, but increased in HAPE. The weaning test demonstrates that IPPB influenced PCWP in all patients. Therefore, PCWP cannot be assumed to represent the left ventricle filling pressure. The weaning test allows differentiation of IPCPE from HAPE. In the event of over-infusion or hypovolemia, PCWP measured under IPPB can lead to misinterpretation if not followed up by a second measurement off the respirator.

  16. Performance of ICU ventilators during noninvasive ventilation with large leaks in a total face mask: a bench study* **

    PubMed Central

    Nakamura, Maria Aparecida Miyuki; Costa, Eduardo Leite Vieira; Carvalho, Carlos Roberto Ribeiro; Tucci, Mauro Roberto

    2014-01-01

    Objective: Discomfort and noncompliance with noninvasive ventilation (NIV) interfaces are obstacles to NIV success. Total face masks (TFMs) are considered to be a very comfortable NIV interface. However, due to their large internal volume and consequent increased CO2 rebreathing, their orifices allow proximal leaks to enhance CO2 elimination. The ventilators used in the ICU might not adequately compensate for such leakage. In this study, we attempted to determine whether ICU ventilators in NIV mode are suitable for use with a leaky TFM. Methods: This was a bench study carried out in a university research laboratory. Eight ICU ventilators equipped with NIV mode and one NIV ventilator were connected to a TFM with major leaks. All were tested at two positive end-expiratory pressure (PEEP) levels and three pressure support levels. The variables analyzed were ventilation trigger, cycling off, total leak, and pressurization. Results: Of the eight ICU ventilators tested, four did not work (autotriggering or inappropriate turning off due to misdetection of disconnection); three worked with some problems (low PEEP or high cycling delay); and one worked properly. Conclusions: The majority of the ICU ventilators tested were not suitable for NIV with a leaky TFM. PMID:25029653

  17. Pinching, electrocution, ravens' beaks, and positive pressure ventilation: a brief history of neonatal resuscitation

    PubMed Central

    O'Donnell, C P F; Gibson, A T; Davis, P G

    2006-01-01

    Since ancient times many different methods have been used to revive newborns. Although subject to the vagaries of fashion for 2000 years, artificial respiration has been accepted as the mainstay of neonatal resuscitation for about the last 40. Formal teaching programmes have evolved over the last 20 years. The last 10 years have seen international collaboration, which has resulted in careful evaluation of the available evidence and publication of recommendations for clinical practice. There is, however, little evidence to support current recommendations, which are largely based on expert opinion. The challenge for neonatologists today is to gather robust evidence to support or refute these recommendations, thereby refining this common and important intervention. PMID:16923936

  18. Protective lung ventilation in operating room: a systematic review.

    PubMed

    Futier, E; Constantin, J M; Jaber, S

    2014-06-01

    Postoperative pulmonary and extrapulmonary complications adversely affect clinical outcomes and healthcare utilization, so that prevention has become a measure of the quality of perioperative care. Mechanical ventilation is an essential support therapy to maintain adequate gas exchange during general anesthesia for surgery. Mechanical ventilation using high tidal volume (VT) (between 10 and 15 mL/kg) has been historically encouraged to prevent hypoxemia and atelectasis formation in anesthetized patients undergoing abdominal and thoracic surgery. However, there is accumulating evidence from both experimental and clinical studies that mechanical ventilation, especially the use of high VT and plateau pressure, may potentially aggravate or even initiate lung injury. Ventilator-associated lung injury can result from cyclic alveolar overdistension of non-dependent lung tissue, and repetitive opening and closing of dependent lung tissue resulting in ultrastructural damage at the junction of closed and open alveoli. Lung-protective ventilation, which refers to the use of lower VT and limited plateau pressure to minimize overdistension, and positive end-expiratory pressure to prevent alveolar collapse at end-expiration, was shown to improve outcome in critically ill patients with acute respiratory distress syndrome (ARDS). It has been recently suggested that this approach might also be beneficial in a broader population, especially in critically ill patients without ARDS at the onset of mechanical ventilation. There is, however, little evidence regarding a potential beneficial effect of lung protective ventilation during surgery, especially in patients with healthy lungs. Although surgical patients are frequently exposed to much shorter periods of mechanical ventilation, this is an important gap in knowledge given the number of patients receiving mechanical ventilation in the operating room. This review developed the benefits of lung protective ventilation during surgery

  19. Effects of intermittent positive pressure ventilation on cardiopulmonary function in horses anesthetized with total intravenous anesthesia using combination of medetomidine, lidocaine, butorphanol and propofol (MLBP-TIVA).

    PubMed

    Ishizuka, Tomohito; Tamura, Jun; Nagaro, Tsukasa; Sudo, Kanako; Itami, Takaharu; Umar, Mohammed Ahamed; Miyoshi, Kenjirou; Sano, Tadashi; Yamashita, Kazuto

    2014-12-01

    Effects of intermittent positive pressure ventilation (IPPV) on cardiopulmonary function were evaluated in horses anesthetized with total intravenous anesthesia using constant rate infusions of medetomidine (3.5 µg/kg/hr), lidocaine (3 mg/kg/hr), butorphanol (24 µg/kg/hr) and propofol (0.1 mg/kg/min) (MLBP-TIVA). Five horses were anesthetized twice using MLBP-TIVA with or without IPPV at 4-week interval (crossover study). In each occasion, the horses breathed 100% oxygen with spontaneous ventilation (SB-group, n=5) or with IPPV (CV-group, n=5), and changes in cardiopulmonary parameters were observed for 120 min. In the SB-group, cardiovascular parameters were maintained within acceptable ranges (heart rate: 33-35 beats/min, cardiac output: 27-30 l/min, mean arterial blood pressure [MABP]: 114-123 mmHg, mean pulmonary arterial pressure [MPAP]: 28-29 mmHg and mean right atrial pressure [MRAP]: 19-21 mmHg), but severe hypercapnea and insufficient oxygenation were observed (arterial CO(2) pressure [PaCO(2)]: 84-103 mmHg and arterial O(2) pressure [PaO(2)]: 155-172 mmHg). In the CV-group, normocapnea (PaCO(2): 42-50 mmHg) and good oxygenation (PaO(2): 395-419 mmHg) were achieved by the IPPV without apparent cardiovascular depression (heart rate: 29-31 beats/min, cardiac output: 17-21 l /min, MABP: 111-123 mmHg, MPAP: 27-30 mmHg and MRAP: 15-16 mmHg). MLBP-TIVA preserved cardiovascular function even in horses artificially ventilated.

  20. Effects of Intermittent Positive Pressure Ventilation on Cardiopulmonary Function in Horses Anesthetized with Total Intravenous Anesthesia Using Combination of Medetomidine, Lidocaine, Butorphanol and Propofol (MLBP-TIVA)

    PubMed Central

    ISHIZUKA, Tomohito; TAMURA, Jun; NAGARO, Tsukasa; SUDO, Kanako; ITAMI, Takaharu; UMAR, Mohammed Ahamed; MIYOSHI, Kenjirou; SANO, Tadashi; YAMASHITA, Kazuto

    2014-01-01

    Effects of intermittent positive pressure ventilation (IPPV) on cardiopulmonary function were evaluated in horses anesthetized with total intravenous anesthesia using constant rate infusions of medetomidine (3.5 µg/kg/hr), lidocaine (3 mg/kg/hr), butorphanol (24 µg/kg/hr) and propofol (0.1 mg/kg/min) (MLBP-TIVA). Five horses were anesthetized twice using MLBP-TIVA with or without IPPV at 4-week interval (crossover study). In each occasion, the horses breathed 100% oxygen with spontaneous ventilation (SB-group, n=5) or with IPPV (CV-group, n=5), and changes in cardiopulmonary parameters were observed for 120 min. In the SB-group, cardiovascular parameters were maintained within acceptable ranges (heart rate: 33–35 beats/min, cardiac output: 27–30 l/min, mean arterial blood pressure [MABP]: 114–123 mmHg, mean pulmonary arterial pressure [MPAP]: 28–29 mmHg and mean right atrial pressure [MRAP]: 19–21 mmHg), but severe hypercapnea and insufficient oxygenation were observed (arterial CO2 pressure [PaCO2]: 84–103 mmHg and arterial O2 pressure [PaO2]: 155–172 mmHg). In the CV-group, normocapnea (PaCO2: 42–50 mmHg) and good oxygenation (PaO2: 395–419 mmHg) were achieved by the IPPV without apparent cardiovascular depression (heart rate: 29–31 beats/min, cardiac output: 17–21 l /min, MABP: 111–123 mmHg, MPAP: 27–30 mmHg and MRAP: 15–16 mmHg). MLBP-TIVA preserved cardiovascular function even in horses artificially ventilated. PMID:25649938

  1. Developing a neonatal unit ventilation protocol for the preterm baby.

    PubMed

    Sant'Anna, G M; Keszler, M

    2012-12-01

    Mechanical ventilation is a resource-intensive complex medical intervention associated with high morbidity. Considerable practice style variation exists in most hospitals and is not only confusing for parents, but the lack of consistently high standard of optimal ventilation deprives some infants of the benefits of state-of-the-art care. Developing a unit protocol for mechanical ventilation requires exhaustive research, inclusion of all stake-holders, thoughtful protocol development and careful implementation after a thorough educational process, followed by monitoring. A protocol for respiratory support should be comprehensive, addressing respiratory support in the delivery room, the use of non-invasive support, intubation criteria, surfactant administration, specific ventilation modes and settings, criteria for escalating therapy, weaning protocols, extubation criteria, and post-extubation management. Evidence favors the use of non-invasive support as first line treatment, progressing to assist/control or pressure support ventilation combined with volume guarantee, if needed, and high-frequency ventilation only for specific indications. The open lung strategy is crucial to lung-protective ventilation.

  2. Experimental Investigation of Ventilation of a Surface Piercing Hydrofoil

    NASA Astrophysics Data System (ADS)

    Harwood, Casey; Miguel Montero, Francisco; Young, Yin Lu; Ceccio, Steven

    2013-11-01

    Bodies that pierce a liquid free-surface are prone to entrainment of atmospheric and/or vaporous gases. This process, called ventilation, can occur suddenly and violently, drastically altering hydrodynamic response. Experiments have been conducted at the free-surface towing-tank in the University of Michigan Marine Hydrodynamics Laboratory to investigate fully attached, partially ventilated, and fully ventilated flows around a canonical surface-piercing hydrofoil. The objectives of the work are: (i) to gain a broad and improved understanding of the physics of ventilation, (ii) to classify the physical mechanisms by which ventilation inception and washout may occur and quantify the conditions required for each mechanism and (iii) to quantify the effects of ventilation on global hydrodynamic responses, including the six force and moment components. Experimental data and high-speed video will be used to illustrate the impact of ventilation on hydrodynamic loads, pressures, and flow structures. The completion of this study is expected to contribute significantly toward a comprehensive understanding of ventilation physics, and toward an improved ability to design safe and controllable ventilated lifting surfaces for use in propulsion, energy harvesting, and turbomachinery. Supported by: The Office of Naval Research (ONR) (Grant No. N00014-09-1-1204); the National Research Foundation of Korea (NRF) (GCRC-SOP Grant No. 2012-0004783); the National Science Foundation Graduate Student Research Fellowship (Grant No. DGE 1256260).

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

    PubMed Central

    2013-01-01

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

  4. Open circuit mouthpiece ventilation: Concise clinical review.

    PubMed

    Garuti, G; Nicolini, A; Grecchi, B; Lusuardi, M; Winck, J C; Bach, J R

    2014-01-01

    In 2013 new "mouthpiece ventilation" modes are being introduced to commercially available portable ventilators. Despite this, there is little knowledge of how to use noninvasive intermittent positive pressure ventilation (NIV) as opposed to bi-level positive airway pressure (PAP) and both have almost exclusively been reported to have been used via nasal or oro-nasal interfaces rather than via a simple mouthpiece. Non-invasive ventilation is often reported as failing because of airway secretion encumbrance, because of hypercapnia due to inadequate bi-level PAP settings, or poor interface tolerance. The latter can be caused by factors such as excessive pressure on the face from poor fit, excessive oral air leak, anxiety, claustrophobia, and patient-ventilator dys-synchrony. Thus, the interface plays a crucial role in tolerance and effectiveness. Interfaces that cover the nose and/or nose and mouth (oro-nasal) are the most commonly used but are more likely to cause skin breakdown and claustrophobia. Most associated drawbacks can be avoided by using mouthpiece NIV. Open-circuit mouthpiece NIV is being used by large populations in some centers for daytime ventilatory support and complements nocturnal NIV via "mask" interfaces for nocturnal ventilatory support. Mouthpiece NIV is also being used for sleep with the mouthpiece fixed in place by a lip-covering flange. Small 15 and 22mm angled mouthpieces and straw-type mouthpieces are the most commonly used. NIV via mouthpiece is being used as an effective alternative to ventilatory support via tracheostomy tube (TMV) and is associated with a reduced risk of pneumonias and other respiratory complications. Its use facilitates "air-stacking" to improve cough, speech, and pulmonary compliance, all of which better maintain quality of life for patients with neuromuscular diseases (NMDs) than the invasive alternatives. Considering these benefits and the new availability of mouthpiece ventilator modes, wider knowledge of this

  5. Effect of Switching between Pressure-controlled and Volume-controlled Ventilation on Respiratory Mechanics and Hemodynamics in Obese Patients during Abdominoplasty

    PubMed Central

    Messeha, Medhat Mikhail

    2017-01-01

    Background: The ideal intraoperative ventilation strategy in obese patients remains obscure. This prospective, randomized study was designed to evaluate the effect of pressure-controlled ventilation (PCV) before or after volume-controlled ventilation (VCV) on lung mechanics and hemodynamics variables in obese patients subjected to abdominoplasty operation. Patients and Methods: The study included forty patients with body mass index 30–45 kg/m2 subjected to abdominoplasty. All patients were randomly allocated in two groups after the induction of general anesthesia (twenty patients each), according to intraoperative ventilatory strategy. Group I (P-V): started with PCV until the plication of rectus muscle changes into VCV till the end of surgery. Group II (V-P): started with VCV until the plication of rectus muscle changes into PCV till the end of surgery. Lung mechanics, hemodynamics variables (heart rate and mean blood pressure), and arterial blood gases (ABGs) were recorded. Results: No significant difference in the hemodynamics and ABGs were recorded between the studied groups. The use of PCV after VCV induced the improvement of lung mechanics. Conclusion: Switching from VCV to PCV is preferred to improve intraoperative oxygenation and lung compliance without adverse hemodynamic effects in obese patients. PMID:28298763

  6. Effect of Pressure Controlled Waveforms on Flow Transport and Gas mixing in a Patient Specific Lung Model during Invasive High Frequency Oscillatory Ventilation

    NASA Astrophysics Data System (ADS)

    Alzahrany, Mohammed; Banerjee, Arindam

    2012-11-01

    A computational fluid dynamic study is carried out to investigate gas transport in patient specific human lung models (based on CT scans) during high frequency oscillatory ventilation (HFOV). Different pressure-controlled waveforms and various ventilator frequencies are studied to understand the effect of flow transport and gas mixing during these processes. Three different pressure waveforms are created by solving the equation of motion subjected to constant lung wall compliance and flow resistance. Sinusoidal, exponential and constant waveforms shapes are considered with three different frequencies 6, 10 and 15 Hz and constant tidal volume 50 ml. The velocities are calculated from the obtained flow rate and imposed as inlet flow conditions to represent the mechanical ventilation waveforms. An endotracheal tube ETT is joined to the model to account for the effect of the invasive management device with the peak Reynolds number (Re) for all the cases ranging from 6960 to 24694. All simulations are performed using high order LES turbulent model. The gas transport near the flow reversal will be discussed at different cycle phases for all the cases and a comparison of the secondary flow structures between different cases will be presented.

  7. Special cases: mechanical ventilation of neurosurgical patients.

    PubMed

    Johnson, Victoria E; Huang, Jason H; Pilcher, Webster H

    2007-04-01

    Mechanical ventilation has evolved greatly over the last half century, guided primarily by improved comprehension of the relevant pathology/physiology. Neurosurgical patients are a unique subgroup of patients who heavily use this technology for both support, and less commonly, as a therapy. Such patients demand special consideration with regard to mode of ventilation, use of positive end-expiratory pressure, and monitoring. In addition, meeting the ventilatory needs of neurosurgical patients while minimizing ventilatory-induced lung damage can be a challenging aspect of care.

  8. Ventilation Model Report

    SciTech Connect

    V. Chipman; J. Case

    2002-12-20

    The purpose of the Ventilation Model is to simulate the heat transfer processes in and around waste emplacement drifts during periods of forced ventilation. The model evaluates the effects of emplacement drift ventilation on the thermal conditions in the emplacement drifts and surrounding rock mass, and calculates the heat removal by ventilation as a measure of the viability of ventilation to delay the onset of peak repository temperature and reduce its magnitude. The heat removal by ventilation is temporally and spatially dependent, and is expressed as the fraction of heat carried away by the ventilation air compared to the fraction of heat produced by radionuclide decay. One minus the heat removal is called the wall heat fraction, or the remaining amount of heat that is transferred via conduction to the surrounding rock mass. Downstream models, such as the ''Multiscale Thermohydrologic Model'' (BSC 2001), use the wall heat fractions as outputted from the Ventilation Model to initialize their post-closure analyses. The Ventilation Model report was initially developed to analyze the effects of preclosure continuous ventilation in the Engineered Barrier System (EBS) emplacement drifts, and to provide heat removal data to support EBS design. Revision 00 of the Ventilation Model included documentation of the modeling results from the ANSYS-based heat transfer model. Revision 01 ICN 01 included the results of the unqualified software code MULTIFLUX to assess the influence of moisture on the ventilation efficiency. The purposes of Revision 02 of the Ventilation Model are: (1) To validate the conceptual model for preclosure ventilation of emplacement drifts and verify its numerical application in accordance with new procedural requirements as outlined in AP-SIII-10Q, Models (Section 7.0). (2) To satisfy technical issues posed in KTI agreement RDTME 3.14 (Reamer and Williams 2001a). Specifically to demonstrate, with respect to the ANSYS ventilation model, the adequacy of

  9. Clinical review: Long-term noninvasive ventilation

    PubMed Central

    Robert, Dominique; Argaud, Laurent

    2007-01-01

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

  10. Noninvasive ventilation in trauma

    PubMed Central

    Karcz, Marcin K; Papadakos, Peter J

    2015-01-01

    Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange, any associated injuries, and the individual feasibility of potentially using a noninvasive ventilation approach. Noninvasive ventilation may reduce the need to intubate patients with trauma-related hypoxemia. It is well-known that these patients are at increased risk to develop hypoxemic respiratory failure which may or may not be associated with hypercapnia. Hypoxemia in these patients is due to ventilation perfusion mismatching and right to left shunt because of lung contusion, atelectasis, an inability to clear secretions as well as pneumothorax and/or hemothorax, all of which are common in trauma patients. Noninvasive ventilation has been tried in these patients in order to avoid the complications related to endotracheal intubation, mainly ventilator-associated pneumonia. The potential usefulness of noninvasive ventilation in the ventilatory management of trauma patients, though reported in various studies, has not been sufficiently investigated on a large scale. According to the British Thoracic Society guidelines, the indications and efficacy of noninvasive ventilation treatment in respiratory distress induced by trauma have thus far been inconsistent and merely received a low grade recommendation. In this review paper, we analyse and compare the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of this ventilator modality in trauma. PMID:25685722

  11. Diagnosis Accuracy of Mean Arterial Pressure Variation during a Lung Recruitment Maneuver to Predict Fluid Responsiveness in Thoracic Surgery with One-Lung Ventilation

    PubMed Central

    Kang, Woon-Seok; Oh, Chung-Sik; Park, Chulmin; Shin, Bo Mi; Yoon, Tae-Gyoon; Rhee, Ka-Young; Woo, Nam-Sik

    2016-01-01

    Background. Lung recruitment maneuver (LRM) during thoracic surgery can reduce systemic venous return and resulting drop in systemic blood pressure depends on the patient's fluid status. We hypothesized that changes in systemic blood pressure during the transition in LRM from one-lung ventilation (OLV) to two-lung ventilation (TLV) may provide an index to predict fluid responsiveness. Methods. Hemodynamic parameters were measured before LRM (T0); after LRM at the time of the lowest mean arterial blood pressure (MAP) (T1) and at 3 minutes (T2); before fluid administration (T3); and 5 minutes after ending it (T4). If the stroke volume index increased by >25% following 10 mL/kg colloid administration for 30 minutes, then the patients were assigned to responder group. Results. Changes in MAP, central venous pressure (CVP), and stroke volume variation (SVV) between T0 and T1 were significantly larger in responders. Areas under the curve for change in MAP, CVP, and SVV were 0.852, 0.759, and 0.820, respectively; the optimal threshold values for distinguishment of responders were 9.5 mmHg, 0.5 mmHg, and 3.5%, respectively. Conclusions. The change in the MAP associated with LRM at the OLV to TLV conversion appears to be a useful indicator of fluid responsiveness after thoracic surgery. Trial Registration. This trial is registered at Clinical Research Information Service with KCT0000774. PMID:27819002

  12. Writing for publication: pressures, barriers and support strategies.

    PubMed

    Keen, Adam

    2007-07-01

    This paper details the increasing pressure that exists on academic and clinical staff to publish in the context of personal and professional development. Numerous barriers to writing for publication are considered along with suggested strategies for encouraging staff to work towards publication. Although the paper identifies a wealth of literature describing how to go about writing for publication, it is argued that this is of limited use in the support of individual authors, and that most authors learn academic writing skills through a process of trial and error. The paper is intended to encourage those wanting to write for publication, whilst trying to persuade those with influence on developing academic writing to think more broadly in regards to the support provided and need for research.

  13. Adaptive lung ventilation.

    PubMed

    Linton, D M

    2001-09-01

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

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

    PubMed

    Guler, Hasan; Ata, Fikret

    2014-09-01

    The aim of this article is to develop a knowledge-based therapy for management of rats with respiratory distress. A mechanical ventilator was designed to achieve this aim. The designed ventilator is called an intelligent mechanical ventilator since fuzzy logic was used to control the pneumatic equipment according to the rat's status. LabVIEW software was used to control all equipments in the ventilator prototype and to monitor respiratory variables in the experiment. The designed ventilator can be controlled both manually and by fuzzy logic. Eight female Wistar-Albino rats were used to test the designed ventilator and to show the effectiveness of fuzzy control over manual control on pressure control ventilation mode. The anesthetized rats were first ventilated for 20 min manually. After that time, they were ventilated for 20 min by fuzzy logic. Student's t-test for p < 0.05 was applied to the measured minimum, maximum and mean peak inspiration pressures to analyze the obtained results. The results show that there is no statistical difference in the rat's lung parameters before and after the experiments. It can be said that the designed ventilator and developed knowledge-based therapy support artificial respiration of living things successfully.

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

    PubMed

    Pfenninger, J; Minder, C

    1988-01-01

    Eight premature infants with hyaline membrane disease needing artificial ventilation were studied at a mean age of 26.5 h. After a preparative phase they were randomly assigned either first to conventional mechanical ventilation (CMV; delivered by a Siemens Servo 900 C), followed by high-frequency ventilation (HFV; delivered by Percussionaire VDR 1 at 10 Hz) or vice versa, each period lasting 4 h. At the end of each period, arterial blood gases, lung volumes and alveolar pressures (Palv) during CMV or HFV and pressure-volume (P-V) curves of the total respiratory system were determined. Expiratory volumes were measured spirometrically, Palv by the clamping method, and the P-V curve was constructed by the syringe method. Single point static compliance at end-inspiration was higher during HFV (0.40 +/- 0.10 vs. 0.32 +/- 0.08 ml/cmH2O.kg-1; p = 0.02), whereas at end-expiration no difference was noted. Two points static compliances were also better during HFV than during CMV (0.32 +/- 0.08 vs. 0.24 +/- 0.06 ml/cmH2O.kg-1; p = 0.01). Static compliances derived from the steepest part of the inflation limb of the P-V curve were 0.55 +/- 0.12 after CMV and 0.50 +/- 0.12 ml/cmH2O.kg-1 after HFV (n.s.). Compared to CMV, HFV resulted in similar oxygenation and CO2-elimination at equal mean lung volumes, but at significantly lower mean Palv. It is concluded that recruitment of lung volume is achieved with less static recoil pressure by HFV. These findings are explained by differences in inspiration allowing more time for volume recruitment during HFV.

  16. Randomised controlled comparison of continuous positive airways pressure, bilevel non-invasive ventilation, and standard treatment in emergency department patients with acute cardiogenic pulmonary oedema

    PubMed Central

    Crane, S; Elliott, M; Gilligan, P; Richards, K; Gray, A

    2004-01-01

    Background: Continuous positive airways pressure (CPAP) and bilevel non-invasive ventilation may have beneficial effects in the treatment of patients with acute cardiogenic pulmonary oedema. The efficacy of both treatments was assessed in the UK emergency department setting, in a randomised comparison with standard oxygen therapy. Methods: Sixty patients presenting with acidotic (pH<7.35) acute, cardiogenic pulmonary oedema, were randomly assigned conventional oxygen therapy, CPAP (10 cm H2O), or bilevel ventilation (IPAP 15 cm H2O, EPAP 5 cm H2O) provided by a standard ventilator through a face mask. The main end points were treatment success at two hours and in-hospital mortality. Analyses were by intention to treat. Results: Treatment success (defined as all of respiratory rate<23 bpm, oxygen saturation of>90%, and arterial blood pH>7.35 (that is, reversal of acidosis), at the end of the two hour study period) occurred in three (15%) patients in the control group, seven (35%) in the CPAP group, and nine (45%) in the bilevel group (p = 0.116). Fourteen (70%) of the control group patients survived to hospital discharge, compared with 20 (100%) in the CPAP group and 15 (75%) in the bilevel group (p = 0.029; Fisher's test). Conclusions: In this study, patients presenting with acute cardiogenic pulmonary oedema and acidosis, were more likely to survive to hospital discharge if treated with CPAP, rather than with bilevel ventilation or with conventional oxygen therapy. There was no relation between in hospital survival and early physiological changes. Survival rates were similar to other studies despite a low rate of endotracheal intubation. PMID:14988338

  17. Predicting Ventilation Failure in Children with Inhalation Injury.

    DTIC Science & Technology

    1994-08-01

    oxygenation preselected peak inspiratory pressure , followed by index greater than 40 for three of five arterial blood passive exhalation (Fig 1). The high ...positive pressure ventilators for pa- blood and necrotic debris. The records of all patients were tients requiring mechanical ventilatory support... pressures , high -frequency rate, inspiratory:expiratory (I:E) ratio, Address reprint requests to John C. Fitzpatrick, MD, US Army and FIo 2 sufficient to

  18. Regenerative Blower for EVA Suit Ventilation Fan

    NASA Technical Reports Server (NTRS)

    Paul, Heather; Izenson, Mike; Chen, Weibo

    2008-01-01

    Portable life support systems in future space suits will include a ventilation subsystem driven by a dedicated fan. This ventilation fan must meet challenging requirements for pressure rise, flow rate, efficiency, size, safety, and reliability. This paper describes research and development that showed the feasibility of a regenerative blower that is uniquely suited to meet these requirements. We proved feasibility through component tests, blower tests, and design analysis. Based on the requirements for the Constellation Space Suit ventilation fan, we designed the critical elements of the blower. We measured the effects of key design parameters on blower performance using separate effects tests, and used the results of these tests to design a regenerative blower that will meet the ventilation fan requirements. We assembled a proof-of-concept blower and measured its performance at low pressures that simulate a PLSS environment. We obtained head/flow performance curves over a range of operating speeds, identified the maximum efficiency point for the blower, and used these results to specify the design and operating conditions for the ventilation fan. We designed a compact motor that can drive the blower under all anticipated operating requirements and operate with high efficiency during normal operation. We identified materials for the blower that will enhance safety for operation in a lunar environment. We produced a solid model that illustrates the final design. The proof-of-concept blower produced the flow rate and pressure rise needed for the CSSS ventilation subsystem while running at 5400 rpm and consuming only 9 W of electric power and using a non-optimized, commercial motor and controller and inefficient bearings. Scaling the test results to a complete design shows that a lightweight, compact, reliable, and low power blower can meet the performance requirements for future PLSSs.

  19. Mathematical modelling to support traceable dynamic calibration of pressure sensors

    NASA Astrophysics Data System (ADS)

    Matthews, C.; Pennecchi, F.; Eichstädt, S.; Malengo, A.; Esward, T.; Smith, I.; Elster, C.; Knott, A.; Arrhén, F.; Lakka, A.

    2014-06-01

    This paper focuses on the mathematical modelling required to support the development of new primary standard systems for traceable calibration of dynamic pressure sensors. We address two fundamentally different approaches to realizing primary standards, specifically the shock tube method and the drop-weight method. Focusing on the shock tube method, the paper presents first results of system identification and discusses future experimental work that is required to improve the mathematical and statistical models. We use simulations to identify differences between the shock tube and drop-weight methods, to investigate sources of uncertainty in the system identification process and to assist experimentalists in designing the required measuring systems. We demonstrate the identification method on experimental results and draw conclusions.

  20. Early use of noninvasive techniques for clearing respiratory secretions during noninvasive positive-pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease and hypercapnic encephalopathy

    PubMed Central

    Wang, Jinrong; Cui, Zhaobo; Liu, Shuhong; Gao, Xiuling; Gao, Pan; Shi, Yi; Guo, Shufen; Li, Peipei

    2017-01-01

    Abstract Noninvasive positive-pressure ventilation (NPPV) might be superior to conventional mechanical ventilation (CMV) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). Inefficient clearance of respiratory secretions provokes NPPV failure in patients with hypercapnic encephalopathy (HE). This study compared CMV and NPPV combined with a noninvasive strategy for clearing secretions in HE and AECOPD patients. The present study is a prospective cohort study of AECOPD and HE patients enrolled between October 2013 and August 2015 in a critical care unit of a major university teaching hospital in China. A total of 74 patients received NPPV and 90 patients received CMV. Inclusion criteria included the following: physician-diagnosed AECOPD, spontaneous airway clearance of excessive secretions, arterial blood gas analysis requiring intensive care, moderate-to-severe dyspnea, and a Kelly–Matthay scale score of 3 to 5. Exclusion criteria included the following: preexisting psychiatric/neurological disorders unrelated to HE, upper gastrointestinal bleeding, upper airway obstruction, acute coronary syndromes, preadmission tracheostomy or endotracheal intubation, and urgent endotracheal intubation for cardiovascular, psychomotor agitation, or severe hemodynamic conditions. Intensive care unit participants were managed by NPPV. Participants received standard treatment consisting of controlled oxygen therapy during NPPV-free periods; antibiotics, intravenous doxofylline, corticosteroids (e.g., salbutamol and ambroxol), and subcutaneous low-molecular-weight heparin; and therapy for comorbidities if necessary. Nasogastric tubes were inserted only in participants who developed gastric distension. No pharmacological sedation was administered. The primary and secondary outcome measures included comparative complication rates, durations of ventilation and hospitalization, number of invasive devices/patient, and in-hospital and 1-year mortality

  1. Background sound pressure fluctuations (5 DB) from overhead ventilation systems increase subjective fatigue of university students during three-hour lectures.

    PubMed

    Persinger, M A; Tiller, S G; Koren, S A

    1999-04-01

    During each of four successive sessions (once per week), 21 university students attended 3-hr. lectures. During alternative weeks the fans of the room's ventilation system were either on or off. When operating, they generated an average sound pressure that varied continuously between 60 and 65 dB. The dominant frequency of this 5-dB amplitude modulation of sound pressure was within the electroencephalographic range (5 Hz to 25 Hz). At the end of each hour of the lecture for each session each student estimated on 7-point summated rating scales fatigue (none to maximum) and concentration (poor to excellent). As a group, the students reported more fatigue during lectures when the fans were operating relative to lectures when the fans were not operating. This environmental effect explained about 30% of the variance in fatigue ratings and may be sufficient to affect adversely the attention of students within these settings.

  2. State of the evidence: mechanical ventilation with PEEP in patients with cardiogenic shock.

    PubMed

    Wiesen, Jonathan; Ornstein, Moshe; Tonelli, Adriano R; Menon, Venu; Ashton, Rendell W

    2013-12-01

    The need to provide invasive mechanical ventilatory support to patients with myocardial infarction and acute left heart failure is common. Despite the large number of patients requiring mechanical ventilation in this setting, there are remarkably few data addressing the ideal mode of respiratory support in such patients. Although there is near universal acceptance regarding the use of non-invasive positive pressure ventilation in patients with acute pulmonary oedema, there is more concern with invasive positive pressure ventilation owing to its more significant haemodynamic impact. Positive end-expiratory pressure (PEEP) is almost universally applied in mechanically ventilated patients due to benefits in gas exchange, recruitment of alveolar units, counterbalance of hydrostatic forces leading to pulmonary oedema and maintenance of airway patency. The limited available clinical data suggest that a moderate level of PEEP is safe to use in severe left ventricular (LV) dysfunction and cardiogenic shock, and may provide haemodynamic benefits as well in LV failure which exhibits afterload-sensitive physiology.

  3. End tidal CO2 monitoring in condition of constant ventilation: a useful guide during advanced cardiac life support.

    PubMed

    Pokorná, M; Andrlík, M; Necas, E

    2006-01-01

    Success of advanced cardiac life support (ACLS) depends on several factors: character and severity of the primary insult, time interval between cardiac arrest and effective basic life support (BLS) and the ensuing ACLS, patient's general condition before the insult, environmental circumstances and efficacy of BLS and ACLS. From these factors, only the efficacy of ACLS is under control of emergency personnel. The end tidal partial pressure of CO2 (P(ET)CO2) has been shown to be an indicator of the efficiency of ACLS and a general prognostic marker. In this study P(ET)CO2 was monitored during out-of hospital ACLS in three cases of cardiac arrest of different aetiology. The aetiology included lung oedema, tension pneumothorax and high voltage electric injury. P(ET)CO2 served for adjustments of ACLS. In these three cases the predictive value of P(ET)CO2 monitoring corresponded to previously reported recommendations.

  4. Efficiency and outcome of non-invasive versus invasive positive pressure ventilation therapy in respiratory failure due to chronic obstructive pulmonary disease.

    PubMed Central

    Amri Maleh, Valiollah; Monadi, Mahmood; Heidari, Behzad; Maleh, Parviz Amri; Bijani, Ali

    2016-01-01

    Background: Application noninvasive ventilation in the patients with exacerbation of chronic obstructive pulmonary disease (COPD) reduced mortality. This case-control study was designed to compare efficiency and outcome of non-invasive (NIV) versus invasive positive pressure ventilation (IPPV) in respiratory failure due to COPD. Methods: The patients were assigned to NIV or IPPV intermittantly.The clinical parameters, including RR (respiratory rate), BP (blood pressure), HR (heart rate) and PH, PaCO2, PaO2 before and 1, 4 and 24 h after treatment were measured. Demographic information such as age, sex, severity of disease based on APACHE score, length of stay and outcome were recorded. Results: Fifty patients were enrolled in the NIV group and 50 patients in IPPV. The mean age was 70.5 in NIV and 63.9 in invasive ventilation group (p>0.05). In IPPV group, the average values of PH: PCO2: and PO2, were 7.22±0.11, 69.64 + 24.25: and 68.86±24.41 .In NIV, the respective values were 7.30±0.07, 83.94±18.95, and 60.60±19.88. In NIV group, after 1, 4 and 24 h treatment, the clinical and ventilation parameters were stable. The mean APACHE score in was IPPV, 26.46±5.45 and in NIV was 12.26±5.54 (p<0.05). The average length of hospital stay in IPPV was 15.90±10 and in NIV 8.12±6.49 days (p<0.05). The total mortality in the NIV was 4 (8%) and in IPPV, 27 patients (54%) (p<0.05). Conclusion: This study indicates that using NIPPV is a useful therapeutic mode of treatment for respiratory failure with acceptable success rate and lower mortality. The application of NIPPV reduces hospital stay, intubation and its consequent complications. PMID:27386061

  5. Demand Controlled Ventilation and Classroom Ventilation

    SciTech Connect

    Fisk, William J.; Mendell, Mark J.; Davies, Molly; Eliseeva, Ekaterina; Faulkner, David; Hong, Tienzen; Sullivan, Douglas P.

    2012-05-01

    This document summarizes a research effort on demand controlled ventilation and classroom ventilation. The research on demand controlled ventilation included field studies and building energy modeling.

  6. Use of Biphasic Continuous Positive Airway Pressure in Premature Infant with Cleft Lip–Cleft Palate

    PubMed Central

    George, Lovya; Jain, Sunil K.

    2015-01-01

    Preterm infants (PIs) often require respiratory support due to surfactant deficiency. Early weaning from mechanical ventilation to noninvasive respiratory support decreases ventilation-associated irreversible lung damage. This wean is particularly challenging in PIs with cleft lip and cleft palate due to anatomical difficulties encountered in maintaining an adequate seal for positive pressure ventilation. PI with a cleft lip and palate often fail noninvasive respiratory support and require continued intubation and mechanical ventilation. We are presenting the first case report of a PI with cleft lip and palate who was managed by biphasic nasal continuous positive airway pressure. PMID:26495158

  7. Mechanical ventilation for status asthmaticus in children.

    PubMed

    Dworkin, G; Kattan, M

    1989-04-01

    We retrospectively reviewed the time course of recovery of pediatric patients in status asthmaticus who were undergoing mechanical ventilation for life-threatening respiratory failure to evaluate the results with current medications and technology. Ten patients between 2 and 18 years of age underwent intubation on 20 occasions. Mechanical ventilation was maintained for a mean of 2 days. Positive end-expiratory pressure was introduced in the recovery phase to prevent hypoxemia. Twelve episodes (Group 1) involved intubation less than 48 hours; in eight episodes (group 2) the patients required ventilatory support greater than 48 hours. The two groups did not differ in regard to age, pharmacologic therapy, preintubation arterial blood gas data, or initial ventilator settings, but the rise in pH and fall in Paco2 differed significantly over the first 12 hours of therapy. In the group 2 patients, peak pressures were not increased greater than 60 cm H2O despite elevated Paco2 values, and aggressive sodium bicarbonate therapy for pH correction was not pursued. Complications were few and all patients survived. We conclude that asthma patients have variable resolution of airway obstruction during mechanical ventilation and that controlled hypoventilation can be a safe therapy for the patients with more severe obstruction.

  8. Limitations of split-night polysomnography for the diagnosis of nocturnal hypoventilation and titration of non-invasive positive pressure ventilation in amyotrophic lateral sclerosis.

    PubMed

    Loewen, Andrea H S; Korngut, Lawrence; Rimmer, Karen; Damji, Omar; Turin, Tanvir C; Hanly, Patrick J

    2014-12-01

    Split-night polysomnography is performed at our centre in all patients with ALS who require assessment for nocturnal hypoventilation and their response to non-invasive ventilation. The purpose of this study was to determine how successful this practice has been, reflected by whether a complete assessment was achieved by a single split-night polysomnogram. We undertook a systematic, retrospective review of all consecutive split-night polysomnograms in ALS patients between 2005 and 2012. A total of 47 cases were reviewed. Forty-three percent of patients had an incomplete test, resulting in a recommendation to repeat the polysomnogram. Poor sleep efficiency and absence of REM sleep in the diagnostic portion of the study were strongly associated with incomplete studies. Clinical variables that reflect severity of ALS (FVC, PaCO2, ALSFRS-R) and use of REM-suppressing antidepressants or sedative-hypnotics were not associated with incomplete split-night polysomnogram. In conclusion, a single, split-night polysomnogram is frequently inconclusive for the assessment of nocturnal hypoventilation and complete titration of non-invasive positive pressure ventilation in patients with ALS. Poor sleep efficiency and absence of REM sleep are the main limitations of split-night polysomnography in this patient population.

  9. Inter-Module Ventilation Changes to the International Space Station Vehicle to Support Integration of the International Docking Adapter and Commercial Crew Vehicles

    NASA Technical Reports Server (NTRS)

    Link, Dwight E., Jr.; Balistreri, Steven F., Jr.

    2015-01-01

    The International Space Station (ISS) Environmental Control and Life Support System (ECLSS) is continuing to evolve in the post-Space Shuttle era. The ISS vehicle configuration that is in operation was designed for docking of a Space Shuttle vehicle, and designs currently under development for commercial crew vehicles require different interfaces. The ECLSS Temperature and Humidity Control Subsystem (THC) Inter-Module Ventilation (IMV) must be modified in order to support two docking interfaces at the forward end of ISS, to provide the required air exchange. Development of a new higher-speed IMV fan and extensive ducting modifications are underway to support the new Commercial Crew Vehicle interfaces. This paper will review the new ECLSS IMV development requirements, component design and hardware status, subsystem analysis and testing performed to date, and implementation plan to support Commercial Crew Vehicle docking.

  10. Non-invasive ventilation.

    PubMed Central

    Spence, D.

    1996-01-01

    Nasal intermittent positive pressure ventilation is an effective treatment for nocturnal hypoventilation secondary to chest wall deformity or respiratory muscle weakness. Physicians should be aware that, in these groups of patients, disabling breathlessness can be alleviated and established cor pulmonale reversed by the technique. Images Figure 1 Figure 2 Figure 3 PMID:8949588

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

    PubMed Central

    2012-01-01

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

  12. In vitro validation and clinical testing of an indirect calorimetry system for ventilated preterm infants that is unaffected by endotracheal tube leaks and can be used during nasal continuous positive airway pressure.

    PubMed

    Bauer, K; Ketteler, J; Laurenz, M; Versmold, H

    2001-03-01

    Energy expenditure measurements in ventilated preterm infants are difficult because indirect calorimetry underestimates energy expenditure during gas leaks around uncuffed endotracheal tubes routinely used in preterm infants or during nasal continuous positive airway pressure (CPAP). We, therefore, developed a breath collector that simultaneously sampled expired air expelled at the ventilator outlet and escaping via the tube leak from the infant's mouth and nose. Our breath collector was combined with a proprietary calorimeter (Deltatrac II). In vitro validation was done by methanol burning (VO(2), 13.8 mL/min; VCO(2), 9.2 mL/min) during intermittent positive pressure ventilation (IPPV) with two commonly used ventilators (Sechrist IV-100B and Infant Star). Measurement error was determined at different ventilator flows, peak inspiratory pressures of 12-24 cm H(2)O, and during a complete tube leak. The mean measurement error with both ventilators was low (VO(2) +/- 3 %, VCO(2) +/- 2 %) even during a complete tube leak and did not increase with peak inspiratory pressure. The system response time was 2 min. In vivo measurements at the bedside were performed in 25 preterm infants (body weight, 537-1402 g). Energy expenditure during IPPV was 40 +/- 9 kcal/kg per day and 46 +/- 15 kcal/kg per day during nasal CPAP. The tube leak in the preterm infants studied during IPPV was 0 to 47 %, and during nasal CPAP 84 to 97 %. In conclusion, indirect calorimetry performed with our breath collector was accurate during IPPV and nasal CPAP and was unaffected by tube leaks.

  13. Maintaining end-expiratory transpulmonary pressure prevents worsening of ventilator-induced lung injury caused by chest wall constriction in surfactant-depleted rats

    PubMed Central

    Loring, Stephen H.; Pecchiari, Matteo; Valle, Patrizia Della; Monaco, Ario; Gentile, Guendalina; D'Angelo, Edgardo

    2014-01-01

    Objective To see whether in acute lung injury (ALI) 1) compression of the lungs caused by thoracoabdominal constriction degrades lung function and worsens ventilator-induced lung injury (VILI), and 2) maintaining end-expiratory transpulmonary pressure (Pl) by increasing positive end-expiratory pressure (PEEP) reduces the deleterious effects of chest wall constriction. Design Experimental study in rats. Setting Physiology laboratory. Interventions ALI was induced in 3 groups of 9 rats by saline lavage. Nine animals immediately sacrificed served as control group. Group L had lavage only, group LC had the chest wall constricted with an elastic binder, and group LCP had the same chest constriction but with PEEP raised to maintain end-expiratory Pl. After lavage, all groups were ventilated with the same pattern for 1½ hr. Measurements and Main Results Pl, measured with an esophageal balloon-catheter, lung volume changes, arterial blood gasses and pH were assessed during mechanical ventilation (MV). Lung wet-to-dry ratio (W/D), albumin, TNF-α, IL-1β, IL-6, IL-10, and MIP-2 in serum and bronchoalveolar lavage fluid (BALF), and serum E-selectin and von Willebrand Factor (vWF) were measured at the end of MV. Lavage caused hypoxemia and acidemia, increased lung resistance and elastance, and decreased end-expiratory lung volume. With prolonged MV, lung mechanics, hypoxemia, and W/D were significantly worse in group LC. Pro-inflammatory cytokines except E-selectin were elevated in serum and BALF in all groups, with significantly greater levels of TNF-α, IL-1β, and IL-6 in group LC, which also exhibited significantly worse bronchiolar injury and greater heterogeneity of airspace expansion at a fixed Pl than other groups. Conclusions Chest wall constriction in ALI reduces lung volume, worsens hypoxemia, and increases pulmonary edema, mechanical abnormalities, pro-inflammatory mediator release, and histological signs of VILI. Maintaining end-expiratory Pl at preconstriction

  14. Pressure ulcers. Physical, supportive, and local aspects of management.

    PubMed

    Alvarez, O M; Childs, E J

    1991-10-01

    Pressure ulcers are a common and serious problem predominately among elderly persons who are confined to bed or chair. Additional factors associated with pressure ulcer development include cerebrovascular accident, impaired nutritional intake, urinary or fecal incontinence, hypoalbuminemia, and previous fracture. Implementation of preventive measures, such as an in-depth assessment for mobility, a pressure-relieving device combined with adequate repositioning, and thorough evaluation for nutritional status and urinary incontinence, significantly reduce pressure ulcer incidence. If the pressure ulcer is a partial thickness (stage II) wound, the causative factors are probably friction or moisture. If the ulcer is full thickness (stage III and IV), it is secondary to pressure or shearing forces. The development of wound infection is the most common complication in the management approach. Osteomyelitis is not an uncommon occurrence and must be initially ruled out in all full thickness pressure ulcers. Surgical debridement of necrotic tissue is necessary prior to further treatment and assessments. Antibiotic therapy is indicated only upon evidence of infection (cellulitis, osteomyelitis, leukocytosis, bandemia, or fever). Topical pharmacologic agents may be used to prevent or treat infection but must be carefully controlled to avoid such adverse effects as toxicity to the wound, allergic reaction, and development of resistant pathogens. Proper use of occlusive dressings increase patient comfort, enhance healing, decrease the possibility of infection, save time, and reduce costs. A patient presenting an ulcer that fails to improve or, because of its size, will take a great deal of time to heal should be evaluated for surgical closure.

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

    PubMed Central

    2011-01-01

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

  16. Comparison of a phospholipid-based protein-free surfactant and a natural bovine surfactant (SURVANTA) during pressure and volume-controlled ventilation in an improved rabbit fetus model.

    PubMed

    Häfner, D; Kilian, U; Bühler, R; Beume, R; Habel, R

    1993-03-01

    During pressure- or volume-controlled ventilation different surfactant preparations were compared in an improved rabbit fetus model. Based on a self-designed software program, this model enables on-line registration of lung mechanics and heart rate in up to ten fetuses. Using a commercially available bovine lung surfactant (SURVANTA) as standard, we compared animals treated with a protein-free surfactant preparation containing only phospholipids, PL (dipalmitoylphosphatidylcholine:palmitoyloleoylphosphatidylglycerol++ +, DPPC:POPG 70:30) plus palmitic acid (PA) with an untreated ventilated control group. During pressure-controlled ventilation the insufflation pressure (IP) was decreased and increased stepwise with and without positive end-expiratory pressure (PEEP). SURVANTA was significantly more potent than PL plus PA and both differed significantly from the untreated controls. With additional PEEP the differences between SURVANTA and PL+PA disappeared but the differences to the controls were still present. We found that, with additional PEEP, active natural surfactants lead to ECG-irregularities, which indicates that PEEP influences pulmonary and cardiovascular function and compromises the benefits of surfactant therapy. Also during volume-controlled ventilation SURVANTA was superior to PL+PA and the untreated controls. In order to raise the level of activity of pure PL mixtures to that of natural bovine surfactants, we suggest that a surface active protein (probably SP-C) must be added to such mixtures.

  17. Effects of Methadone on the Minimum Anesthetic Concentration of Isoflurane, and Its Effects on Heart Rate, Blood Pressure and Ventilation during Isoflurane Anesthesia in Hens (Gallus gallus domesticus)

    PubMed Central

    Pypendop, Bruno Henri; Zangirolami Filho, Darcio; Sousa, Samuel Santos; Valadão, Carlos Augusto Araújo

    2016-01-01

    The aim of this study was to measure the temporal effects of intramuscular methadone administration on the minimum anesthetic concentration (MAC) of isoflurane in hens, and to evaluate the effects of the isoflurane-methadone combination on heart rate and rhythm, blood pressure and ventilation. Thirteen healthy adult hens weighing 1.7 ± 0.2 kg were used. The MAC of isoflurane was determined in each individual using the bracketing method. Subsequently, the reduction in isoflurane MAC produced by methadone (3 or 6 mg kg-1, IM) was determined by the up-and-down method. Stimulation was applied at 15 and 30 minutes, and at 45 minutes if the bird had not moved at 30 minutes. Isoflurane MAC reduction was calculated at each time point using logistic regression. After a washout period, birds were anesthetized with isoflurane and methadone, 6 mg kg-1 IM was administered. Heart rate and rhythm, respiratory rate, blood gas values and invasive blood pressure were measured at 1.0 and 0.7 isoflurane MAC, and during 45 minutes after administration of methadone once birds were anesthetized with 0.7 isoflurane MAC. Fifteen minutes after administration of 3 mg kg-1 of methadone, isoflurane MAC was reduced by 2 (-9 to 13)% [logistic regression estimate (95% Wald confidence interval)]. Administration of 6 mg kg-1 of methadone decreased isoflurane MAC by 29 (11 to 46)%, 27 (-3 to 56)% and 10 (-8 to 28)% after 15, 30 and 45 minutes, respectively. Methadone (6 mg kg-1) induced atrioventricular block in three animals and ventricular premature contractions in two. Methadone caused an increase in arterial blood pressure and arterial partial pressure of carbon dioxide, while heart rate and pH decreased. Methadone, 6 mg kg-1 IM significantly reduced isoflurane MAC by 30% in hens 15 minutes after administration. At this dose, methadone caused mild respiratory acidosis and increase in systemic blood pressure. PMID:27018890

  18. Effects of Methadone on the Minimum Anesthetic Concentration of Isoflurane, and Its Effects on Heart Rate, Blood Pressure and Ventilation during Isoflurane Anesthesia in Hens (Gallus gallus domesticus).

    PubMed

    Escobar, André; da Rocha, Rozana Wendler; Pypendop, Bruno Henri; Zangirolami Filho, Darcio; Sousa, Samuel Santos; Valadão, Carlos Augusto Araújo

    2016-01-01

    The aim of this study was to measure the temporal effects of intramuscular methadone administration on the minimum anesthetic concentration (MAC) of isoflurane in hens, and to evaluate the effects of the isoflurane-methadone combination on heart rate and rhythm, blood pressure and ventilation. Thirteen healthy adult hens weighing 1.7 ± 0.2 kg were used. The MAC of isoflurane was determined in each individual using the bracketing method. Subsequently, the reduction in isoflurane MAC produced by methadone (3 or 6 mg kg(-1), i.m.) was determined by the up-and-down method. Stimulation was applied at 15 and 30 minutes, and at 45 minutes if the bird had not moved at 30 minutes. Isoflurane MAC reduction was calculated at each time point using logistic regression. After a washout period, birds were anesthetized with isoflurane and methadone, 6 mg kg(-1) i.m. was administered. Heart rate and rhythm, respiratory rate, blood gas values and invasive blood pressure were measured at 1.0 and 0.7 isoflurane MAC, and during 45 minutes after administration of methadone once birds were anesthetized with 0.7 isoflurane MAC. Fifteen minutes after administration of 3 mg kg(-1) of methadone, isoflurane MAC was reduced by 2 (-9 to 13)% [logistic regression estimate (95% Wald confidence interval)]. Administration of 6 mg kg(-1) of methadone decreased isoflurane MAC by 29 (11 to 46)%, 27 (-3 to 56)% and 10 (-8 to 28)% after 15, 30 and 45 minutes, respectively. Methadone (6 mg kg(-1)) induced atrioventricular block in three animals and ventricular premature contractions in two. Methadone caused an increase in arterial blood pressure and arterial partial pressure of carbon dioxide, while heart rate and pH decreased. Methadone, 6 mg kg(-1) i.m. significantly reduced isoflurane MAC by 30% in hens 15 minutes after administration. At this dose, methadone caused mild respiratory acidosis and increase in systemic blood pressure.

  19. Design and Development of a Regenerative Blower for Space Suit Ventilation

    NASA Technical Reports Server (NTRS)

    Izenson, Mike; Chen, Weibo; Paul, Heather

    2010-01-01

    The ventilation subsystem in future space suits will require a dedicated ventilation fan. The unique requirements for the ventilation fan, including stringent safety requirements and the ability to increase output to operate in buddy mode, combine to make a regenerative blower an attractive technology choice. This paper describes progress in the design, development, and testing of a regenerative blower designed to meet requirements for a ventilation subsystem for future space suit life support. Analysis methods were developed for the blower s complex internal flows and impeller geometries were identified that enable significant improvements in blower efficiency. Performance predictions were verified by test, measuring aerodynamic efficiencies of 45% at operating conditions that correspond to the ventilation fan s design point. A compact motor/controller was developed to drive the blower efficiently at low rotating speed (4500 rpm). Finally, a low-pressure oxygen test loop was assembled to demonstrate the blower s reliability under prototypical conditions.

  20. Vibration response imaging: a novel noninvasive tool for evaluating the initial therapeutic effect of noninvasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

    PubMed Central

    2012-01-01

    Background The popular methods for evaluating the initial therapeutic effect (ITE) of noninvasive positive pressure ventilation (NPPV) can only roughly reflect the therapeutic outcome of a patient’s ventilation because they are subjective, invasive and time-delayed. In contrast, vibration response imaging (VRI) can monitor the function of a patient’s ventilation over the NPPV therapy in a non-invasive manner. This study aimed to investigate the value of VRI in evaluating the ITE of NPPV for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Thirty-six AECOPD patients received VRI at three time points: before NPPV treatment (T1), at 15 min of NPPV treatment (T2), and at 15 min after the end of NPPV treatment (T4). Blood gas analysis was also performed at T1 and at 2 hours of NPPV treatment (T3). Thirty-nine healthy volunteers also received VRI at T1 and T2. VRI examination at the time point T2 in either the patients or volunteers did not require any interruption of the on-going NPPV. The clinical indices at each time point were compared between the two groups. Moreover, correlations between the PaCO2 changes (T3 vs T1) and abnormal VRI scores (AVRIS) changes (T2 vs T1) were analyzed. Results No significant AVRIS differences were found between T1 and T2 in the healthy controls (8.51 ± 3.36 vs. 8.53 ± 3.57, P > 0.05). The AVRIS, dynamic score, MEF score and EVP score showed a significant decrease in AECOPD patients at T2 compared with T1 (P < 0.05), but a significant increase at T4 compared with T2 (P < 0.05). We also found a positive correlation (R2 = 0.6399) between the PaCO2 changes (T3 vs T1) and AVRIS changes (T2 vs T1). Conclusions VRI is a promising noninvasive tool for evaluating the initial therapeutic effects of NPPV in AECOPD patients and predicting the success of NPPV in the early stage. PMID:22856613

  1. [Quantitative comparison of ventilator-induced work during simulated CPAP in eight demand-flow valve ventilators].

    PubMed

    Nishimura, M; Imanaka, H; Taenaka, N; Yoshiya, I; Takezawa, J

    1989-08-01

    The ventilator-induced work during continuous positive airway pressure (CPAP) mode in demand-valve ventilators was evaluated by using a piston pump as a simulator for active breathing. A piston pump delivered and withdrew a stroke volume of 500 ml at rates of 10, 20 and 40 cycle.min-1 with a sinusoidal waveform. A hot-wire flowmeter and a differential pressure transducer were interposed between the pump and ventilators and their signals were fed to a microcomputer to display a pressure-volume loop. The area of the loop was divided into the four parts. Inspiratory work associated with the opening of the demand valve was represented by the area of baseline airway pressure (BPa) during inspiration. The remaining area during inspiration reflected the work done by the ventilators. Expiratory work for overcoming the flow resistance of the expiratory apparatus was represented by the area above BPa during exhalation. The fourth was the area below the baseline during exhalation. The Puritan-Bennett 7200a, the Bear 5, the Siemens Servo 900C, the Hamilton Veolar, the Bird 6400ST, the Engström Erica, the Dräger EV-A, and the CPU-1 were examined at varying CPAP and pressure support levels. Because of demand valve oscillation throughout inspiration, the inspiratory workload of the Bear 5, the Siemens Servo 900C, the Hamilton Veolar, the Bird 6400ST, and the Dräger EV-A could not be calculated. Expiratory flow-resistive work was higher in the Siemens Servo 900C and the Bird 6400ST than the others. The present system can assess the entire performance of ventilators, and may serve to compare ventilators' performance.

  2. Social support and ambulatory blood pressure: an examination of both receiving and giving.

    PubMed

    Piferi, Rachel L; Lawler, Kathleen A

    2006-11-01

    The relationship between the social network and physical health has been studied extensively and it has consistently been shown that individuals live longer, have fewer physical symptoms of illness, and have lower blood pressure when they are a member of a social network than when they are isolated. Much of the research has focused on the benefits of receiving social support from the network and the effects of giving to others within the network have been neglected. The goal of the present research was to systematically investigate the relationship between giving and ambulatory blood pressure. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate were recorded every 30 min during the day and every 60 min at night during a 24-h period. Linear mixed models analyses revealed that lower systolic and diastolic blood pressure and mean arterial pressure were related to giving social support. Furthermore, correlational analyses revealed that participants with a higher tendency to give social support reported greater received social support, greater self-efficacy, greater self-esteem, less depression, and less stress than participants with a lower tendency to give social support to others. Structural equation modeling was also used to test a proposed model that giving and receiving social support represent separate pathways predicting blood pressure and health. From this study, it appears that giving social support may represent a unique construct from receiving social support and may exert a unique effect on health.

  3. Portable power supply for continuous mechanical ventilation during intrahospital transport of critically ill patients with ARDS.

    PubMed

    Barton, A C; Tuttle-Newhall, J E; Szalados, J E

    1997-08-01

    Patients with respiratory failure and poor pulmonary compliance requiring high levels of positive pressure ventilation are at high risk during intrahospital transportation. Most ICU ventilators currently do not have a built-in power supply. Manual bag-valve ventilation frequently is used but often without optimum mean airway pressures or minute ventilation guarantees. Transport ventilators also are limited in their ability to provide high positive end-expiratory pressure, variable inspiratory-expiratory ratios, or pressure-controlled ventilation. The 3M SARNS HELP (Hospital Emergency Limited Power) 115, a portable battery, provides continuous power to ICU ventilators and eliminates ventilator circuit interruption for the critical period of patient transportation.

  4. Comparison of Comfort and Effectiveness of Total Face Mask and Oronasal Mask in Noninvasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure: A Clinical Trial.

    PubMed

    Sadeghi, Somayeh; Fakharian, Atefeh; Nasri, Peiman; Kiani, Arda

    2017-01-01

    Background. There is a growing controversy about the use of oronasal masks (ONM) or total facemask (TFM) in noninvasive positive pressure ventilation (NPPV), so we designed a trial to compare the uses of these two masks in terms of effectiveness and comfort. Methods. Between February and November 2014, a total of 48 patients with respiratory failure were studied. Patients were randomized to receive NPPV via ONM or TFM. Data were recorded at 60 minutes and six and 24 hours after intervention. Patient comfort was assessed using a questionnaire. Data were analyzed using t-test and chi-square test. Repeated measures ANOVA and Mann-Whitney U test were used to compare clinical and laboratory data. Results. There were no differences in venous blood gas (VBG) values between the two groups (P > 0.05). However, at six hours, TFM was much more effective in reducing the partial pressure of carbon dioxide (PCO2) (P = 0.04). Patient comfort and acceptance were statistically similar in both groups (P > 0.05). Total time of NPPV was also similar in the two groups (P > 0.05). Conclusions. TFM was superior to ONM in acute phase of respiratory failure but not once the patients were out of acute phase.

  5. Comparison of Comfort and Effectiveness of Total Face Mask and Oronasal Mask in Noninvasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure: A Clinical Trial

    PubMed Central

    Sadeghi, Somayeh; Nasri, Peiman

    2017-01-01

    Background. There is a growing controversy about the use of oronasal masks (ONM) or total facemask (TFM) in noninvasive positive pressure ventilation (NPPV), so we designed a trial to compare the uses of these two masks in terms of effectiveness and comfort. Methods. Between February and November 2014, a total of 48 patients with respiratory failure were studied. Patients were randomized to receive NPPV via ONM or TFM. Data were recorded at 60 minutes and six and 24 hours after intervention. Patient comfort was assessed using a questionnaire. Data were analyzed using t-test and chi-square test. Repeated measures ANOVA and Mann–Whitney U test were used to compare clinical and laboratory data. Results. There were no differences in venous blood gas (VBG) values between the two groups (P > 0.05). However, at six hours, TFM was much more effective in reducing the partial pressure of carbon dioxide (PCO2) (P = 0.04). Patient comfort and acceptance were statistically similar in both groups (P > 0.05). Total time of NPPV was also similar in the two groups (P > 0.05). Conclusions. TFM was superior to ONM in acute phase of respiratory failure but not once the patients were out of acute phase. PMID:28270737

  6. Evaluation of self-perception of mechanical ventilation knowledge among Brazilian final-year medical students, residents and emergency physicians

    PubMed Central

    Tallo, Fernando Sabia; de Campos Vieira Abib, Simone; de Andrade Negri, Alexandre Jorgi; Filho, Paulo Cesar; Lopes, Renato Delascio; Lopes, Antônio Carlos

    2017-01-01

    OBJECTIVE: To present self-assessments of knowledge about mechanical ventilation made by final-year medical students, residents, and physicians taking qualifying courses at the Brazilian Society of Internal Medicine who work in urgent and emergency settings. METHODS: A 34-item questionnaire comprising different areas of knowledge and training in mechanical ventilation was given to 806 medical students, residents, and participants in qualifying courses at 11 medical schools in Brazil. The questionnaire’s self-assessment items for knowledge were transformed into scores. RESULTS: The average score among all participants was 21% (0-100%). Of the total, 85% respondents felt they did not receive sufficient information about mechanical ventilation during medical training. Additionally, 77% of the group reported that they would not know when to start noninvasive ventilation in a patient, and 81%, 81%, and 89% would not know how to start volume control, pressure control and pressure support ventilation modes, respectively. Furthermore, 86.4% and 94% of the participants believed they would not identify the basic principles of mechanical ventilation in patients with obstructive pulmonary disease and acute respiratory distress syndrome, respectively, and would feel insecure beginning ventilation. Finally, 77% said they would fear for the safety of a patient requiring invasive mechanical ventilation under their care. CONCLUSION: Self-assessment of knowledge and self-perception of safety for managing mechanical ventilation were deficient among residents, students and emergency physicians from a sample in Brazil. PMID:28273238

  7. Basic concepts in mechanical ventilation.

    PubMed

    Carbery, Catherine

    2008-03-01

    Mechanical ventilatory support is a major component of the clinical management of critically ill patients admitted into intensive care. Closely linked with the developments within critical care medicine, the use of ventilatory support has been increasing since the polio epidemics in the 1950s (Lassen 1953). Initially used to provide controlled mandatory ventilation, today with advances in technology, most mechanical ventilators are triggered by the patient, increasing the awareness of the complexity of patient/ventilator interaction (Tobin 1994). Though ventilator appearance and design may have changed quite significantly and the variety of options for support extensive, the basic concepts of mechanical ventilatory support of the critically ill patient remains unchanged. This paper aims to outline these concepts so as to gain a better understanding of mechanical ventilatory support.

  8. Stem Photosynthesis not Pressurized Ventilation is Responsible for Light-enhanced Oxygen Supply to Submerged Roots of Alder (Alnus glutinosa)

    PubMed Central

    ARMSTRONG, WILLIAM; ARMSTRONG, JEAN

    2005-01-01

    • Background and Aims Claims that submerged roots of alder and other wetland trees are aerated by pressurized gas flow generated in the stem by a light-induced thermo-osmosis have seemed inconsistent with root anatomy. Our aim was to seek a verification using physical root–stem models, stem segments with or without artificial roots, and rooted saplings. • Methods Radial O2 loss (ROL) from roots was monitored polarographically as the gas space system of the models, and stems were pressurized artificially. ROL and internal pressurization were also measured when stems were irradiated and the xylem stream was either CO2 enriched or not. Stem photosynthesis and respiration were measured polarographically. Stem and root anatomy were examined by light and fluorescence microscopy. • Key Results Pressurizing the models and stems to ≤10 kPa, values much higher than those reportedly generated by thermo-osmosis, created only a negligible density-induced increase in ROL, but ROL increased rapidly when ambient O2 concentrations were raised. Internal pressures rose by several kPa when shoots were exposed to high light flux and ROL increased substantially, but both were due to O2 accumulation from stem photosynthesis using internally sourced CO2. Increased stem pressures had little effect on O2 transport, which remained largely diffusive. Oxygen flux from stems in high light periods indicated a net C gain by stem photosynthesis. Chloroplasts were abundant in the secondary cortex and secondary phloem, and occurred throughout the secondary xylem rays and medulla of 3-year-old stems. Diurnal patterns of ROL, most marked when light reached submerged portions of the stem, were modified by minor variations in light flux and water level. Low root temperatures also helped improve root aeration. • Conclusions Pressurized gas flow to submerged roots does not occur to any significant degree in alder, but stem photosynthesis, using internally sourced CO2 from respiration and the

  9. Ventilation flow: Submerged

    NASA Technical Reports Server (NTRS)

    Hutchinson, D.

    1985-01-01

    The ventilation system on a submarine is discussed. When the submarine is submerged. The ventilation system provides a conditioned atmosphere in the ship with complete isolation from the outside. A conditioned atmosphere includes not only filtration and temperature and humidity control, but also air purification (removal of potentially harmful quantities of impurities and comtaminants) and revitalization (addition of vital life support oxygen). Carbon dioxide removal, the oxygen system, air conditioning, carbon monoxide removal, hydrogen removal, and atmosphere monitoring systems are among the topics discussed.

  10. [Principles and function of mechanical ventilation: classification and modes of ventilators].

    PubMed

    Kelbel, C; Huntemann, M; Lorenz, J

    2006-04-01

    A spectrum of diseases is associated with the necessity for partial or total support of pulmonary ventilation. The insight into the function of ventilators and their modes reduces the spectrum of ventilatory support to a few basic principles. The knowledge enables the pulmonary intensivist to adapt mechanical ventilation to the individual patient's needs. This overview describes the technical aspects of mechanical ventilation and summarizes the variety of specific modes implied.

  11. Convexity, Jensen's inequality and benefits of noisy mechanical ventilation.

    PubMed

    Brewster, John F; Graham, M Ruth; Mutch, W Alan C

    2005-09-22

    Mechanical ventilators breathe for you when you cannot or when your lungs are too sick to do their job. Most ventilators monotonously deliver the same-sized breaths, like clockwork; however, healthy people do not breathe this way. This has led to the development of a biologically variable ventilator--one that incorporates noise. There are indications that such a noisy ventilator may be beneficial for patients with very sick lungs. In this paper we use a probabilistic argument, based on Jensen's inequality, to identify the circumstances in which the addition of noise may be beneficial and, equally important, the circumstances in which it may not be beneficial. Using the local convexity of the relationship between airway pressure and tidal volume in the lung, we show that the addition of noise at low volume or low pressure results in higher mean volume (at the same mean pressure) or lower mean pressure (at the same mean volume). The consequence is enhanced gas exchange or less stress on the lungs, both clinically desirable. The argument has implications for other life support devices, such as cardiopulmonary bypass pumps. This paper illustrates the benefits of research that takes place at the interface between mathematics and medicine.

  12. Mechanical ventilation in abdominal surgery.

    PubMed

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

    2014-01-01

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

  13. Noninvasive ventilation in acute respiratory failure

    PubMed Central

    Mas, Arantxa; Masip, Josep

    2014-01-01

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

  14. Corporate Support of Higher Education. Pressure for a Realistic Appraisal.

    ERIC Educational Resources Information Center

    Smith, Hayden W.; And Others

    The texts of three speeches on corporate giving to higher education are presented. In "The Potentials for Corporate Support of Higher Education--Realism Revisited," Hayden W. Smith outlines current corporate giving to education and trends in giving since 1950, a period during which changes in the law have encouraged the practice. These…

  15. Science supporting negative pressure wound therapy with instillation.

    PubMed

    Rycerz, Anthony M; Allen, Diwi; Lessing, M Christian

    2013-12-01

    A new method (V.A.C.ULTA Therapy System, KCI USA, Inc., San Antonio, TX) combines the benefits of negative pressure wound therapy (NPWT; V.A.C. Therapy, KCI USA, Inc.) with regulated, periodic instillation of user-selected topical wound solutions (V.A.C. VeraFlo Therapy, KCI USA, Inc.). In simulated wound model studies comparing solution distribution using NPWT with and without a soak phase, the instillation soak phase allowed for uniform solution distribution across the wound bed, whereas continuous (no soak) irrigation resulted in uneven coverage. Additional in vitro work illustrated that bacterial particle aerosolisation during wound cleansing was significantly decreased using NPWT with instillation (NPWTi) versus commercially available low-pressure wound cleansers (P < 0·05). In porcine studies, NPWT with saline instillation induced 43% more granulation tissue versus NPWT (P < 0·05) and was as effective at wound cleansing as pulsed lavage. These studies have demonstrated that NPWTi may be an effective wound management therapy that provides both wound cleansing and NPWT benefits.

  16. Lunar Surface Scenarios: Habitation and Life Support Systems for a Pressurized Rover

    NASA Technical Reports Server (NTRS)

    Anderson, Molly; Hanford, Anthony; Howard, Robert; Toups, Larry

    2006-01-01

    Pressurized rovers will be a critical component of successful lunar exploration to enable safe investigation of sites distant from the outpost location. A pressurized rover is a complex system with the same functions as any other crewed vehicle. Designs for a pressurized rover need to take into account significant constraints, a multitude of tasks to be performed inside and out, and the complexity of life support systems to support the crew. In future studies, pressurized rovers should be given the same level of consideration as any other vehicle occupied by the crew.

  17. Self-reported racism and social support predict blood pressure reactivity in Blacks.

    PubMed

    Clark, Rodney

    2003-01-01

    This study explored the effects of perceived racism and social support (quantity and quality) on blood pressure reactivity. In a college sample of 64 Blacks (M age = 22.69 years, SD =6.60), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were assessed before and during a standardized serial subtraction task. Perceptions of racism and the quantity and quality of social support were measured by self-report. Separate multiple regression analyses revealed that perceived racism and social support (neither quantity nor quality) were not independent predictors of SBP or DBP changes (ps >.05). These analyses did indicate that perceived racism interacted with the quantity of social support (p <.002, partial R2 =.175) and with the quality of social support (p <.0007, partial R2 =.195) to predict DBP changes. Perceived racism also interacted with the quantity of social support to predict changes in SBP (p <.02, partial R2 =.11). In general, whereas high social support was related to less marked blood pressure changes under conditions of low perceived racism, high social support was associated with exaggerated blood pressure changes under conditions of high perceived racism. These significant interaction effects persisted after statistically controlling for potential confounders. The findings highlight the importance of examining the joint contribution of real-world experiences and coping resources to blood pressure reactivity in Blacks.

  18. Preventing Ventilation On Sailboard Skegs

    NASA Technical Reports Server (NTRS)

    Caldwell, Richard A.

    1990-01-01

    Design effort undertaken to solve spinout problem plaguing high-performance sailboards. Proposed skeg section designed by use of computer model of pressure field and boundary layer. Prevents ventilation by maintaining attached boundary-layer flow throughout operating environment. Cavitation also avoided by preventing valleys in pressure distribution while skeg operated throughout its range.

  19. Inhalation therapy in mechanical ventilation

    PubMed Central

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

    2015-01-01

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

  20. Clinical review: Acute respiratory distress syndrome - clinical ventilator management and adjunct therapy.

    PubMed

    Silversides, Jonathan A; Ferguson, Niall D

    2013-04-29

    Acute respiratory distress syndrome (ARDS) is a potentially devastating form of acute inflammatory lung injury with a high short-term mortality rate and significant long-term consequences among survivors. Supportive care, principally with mechanical ventilation, remains the cornerstone of therapy - although the goals of this support have changed in recent years - from maintaining normal physiological parameters to avoiding ventilator-induced lung injury while providing adequate gas exchange. In this article we discuss the current evidence base for ventilatory support and adjunctive therapies in patients with ARDS. Key components of such a strategy include avoiding lung overdistension by limiting tidal volumes and airway pressures, and the use of positive end-expiratory pressure with or without lung recruitment manoeuvres in patients with severe ARDS. Adjunctive therapies discussed include pharmacologic techniques (for example, vasodilators, diuretics, neuromuscular blockade) and nonpharmacologic techniques (for example, prone position, alternative modes of ventilation).

  1. Jet ventilation for surgical interventions in the upper airway.

    PubMed

    Biro, Peter

    2010-09-01

    The clinical applications of jet ventilation (JV) in ear, nose, and throat surgery can be best understood by the characteristics that distinguish this form of ventilation from conventional positive pressure ventilation. By definition, JV is based on the application of gas portions under high pressure through an unblocked catheter into the airway, which is open to the ambient air. Beneficial opportunities arise in JV, which otherwise are not available in regular ventilation.

  2. Economics of mechanical ventilation and respiratory failure.

    PubMed

    Cooke, Colin R

    2012-01-01

    For patients with acute respiratory failure, mechanical ventilation provides the most definitive life-sustaining therapy. Because of the intense resources required to care for these patients, its use accounts for considerable costs. There is great societal need to ensure that use of mechanical ventilation maximizes societal benefits while minimizing costs, and that mechanical ventilation, and ventilator support in general, is delivered in the most efficient and cost-effective manner. This review summarizes the economic aspects of mechanical ventilation and summarizes the existing literature that examines its economic impact cost effectiveness.

  3. High-Frequency Percussive Ventilation and Low Tidal Volume Ventilation in Burns: A Randomized Controlled Trial

    DTIC Science & Technology

    2010-01-01

    incidence of ventilator - associated pneumonia (VAP) in patients with inha- lation injury when supported with HFPV compared with conventional modes of...no. (%) 0 (0) 4 (13) .04 HFPV, high-frequency percussive ventilation ; LTV, low-tidal volume ventilation ; VAP, ventila- tor- associated pneumonia ...LTV, low-tidal volume ventilation ; VAP, ventila- tor- associated pneumonia ; NS, nonsignificant. aMean SD. 1973Crit Care Med 2010 Vol. 38, No. 10

  4. Prevention of ventilator-associated pneumonia.

    PubMed

    Lau, Arthur C W; So, H M; Tang, S L; Yeung, Alwin; Lam, S M; Yan, W W

    2015-02-01

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

  5. Can non-invasive positive pressure ventilation prevent endotracheal intubation in acute lung injury/acute respiratory distress syndrome? A meta-analysis.

    PubMed

    Luo, Jian; Wang, Mao-yun; Zhu, Hui; Liang, Bin-miao; Liu, Dan; Peng, Xia-ying; Wang, Rong-chun; Li, Chun-tao; He, Chen-yun; Liang, Zong-an

    2014-11-01

    The role of non-invasive positive pressure ventilation (NIPPV) in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is controversial. The aim of this study was to investigate whether NIPPV could prevent endotracheal intubation and decrease mortality rate in patients with ALI/ARDS. Randomized controlled trials (RCT) which reported endotracheal intubation and mortality rate in patients with ALI/ARDS treated by NIPPV were identified in Pubmed, Medline, Embase, Central Cochrane Controlled Trials Register, Chinese National Knowledge Infrastructure, reference lists and by manual searches. Fixed- and random-effects models were used to calculate pooled relative risks. This meta-analysis included six RCT involving 227 patients. The results showed that endotracheal intubation rate was lower in NIPPV (95% confidence interval (CI): 0.44-0.80, z = 3.44, P = 0.0006), but no significant difference was found either in intensive care unit (ICU) mortality (95% CI: 0.45-1.07, z = 1.65, P = 0.10) or in hospital mortality (95% CI: 0.17-1.58, z = 1.16, P = 0.25). Only two studies discussed the aetiology of ALI/ARDS as pulmonary or extra-pulmonary, and neither showed statistical heterogeneity (I(2)  = 0%, χ(2)  = 0.31, P = 0.58), nor a significant difference in endotracheal intubation rate (95% CI: 0.35-9.08, z = 0.69, P = 0.49). In conclusion, the early use of NIPPV can decrease the endotracheal intubation rate in patients with ALI/ARDS, but does not change the mortality of these patients.

  6. Short- and long-term effects of a maternal low-protein diet on ventilation, O₂/CO₂ chemoreception and arterial blood pressure in male rat offspring.

    PubMed

    de Brito Alves, José Luiz; Nogueira, Viviane Oliveira; de Oliveira, Gerliny Bezerra; da Silva, Glauber Santos Ferreira; Wanderley, Almir Gonçalves; Leandro, Carol Góis; Costa-Silva, João Henrique

    2014-02-01

    Maternal undernutrition increases the risk of adult arterial hypertension. The present study investigated the short- and long-term effects of a maternal low-protein diet on respiratory rhythm, O₂/CO₂ chemosensitivity and arterial blood pressure (ABP) of the offspring. Male Wistar rats were divided into two groups according to their mothers' diets during gestation and lactation: control (NP, 17% of casein) and low-protein (LP, 8% of casein) groups. Direct measurements of ABP, respiratory frequency (RF), tidal volume (V T) and ventilation (VE), as well as hypercapnia (7% CO₂) and hypoxia (7% O₂) evoked respiratory responses were recorded from the awake male offspring at the 30th and 90th days of life. Blood samples were collected for the analyses of protein, creatinine and urea concentrations. The LP offspring had impaired body weight and length throughout the experiment. At 30 d of age, the LP rats showed a reduction in the concentrations of total serum protein (approximately 24%). ABP in the LP rats was similar to that in the NP rats at 30 d of age, but it was 20% higher at 90 d of age. With respect to ventilatory parameters, the LP rats showed enhanced RF (approximately 34%) and VE (approximately 34%) at 30 d of age, which was associated with increased ventilatory responses to hypercapnia (approximately 21% in VE) and hypoxia (approximately 82% in VE). At 90 d of age, the VE values and CO₂/O₂ chemosensitivity of the LP rats were restored to the control range, but the RF values remained elevated. The present data show that a perinatal LP diet alters respiratory rhythm and O₂/CO₂ chemosensitivity at early ages, which may be a predisposing factor for increased ABP at adulthood.

  7. Aircraft engine with inter-turbine engine frame supported counter rotating low pressure turbine rotors

    NASA Technical Reports Server (NTRS)

    Seda, Jorge F. (Inventor); Dunbar, Lawrence W. (Inventor); Gliebe, Philip R. (Inventor); Szucs, Peter N. (Inventor); Brauer, John C. (Inventor); Johnson, James E. (Inventor); Moniz, Thomas (Inventor); Steinmetz, Gregory T. (Inventor)

    2003-01-01

    An aircraft gas turbine engine assembly includes an inter-turbine frame axially located between high and low pressure turbines. Low pressure turbine has counter rotating low pressure inner and outer rotors with low pressure inner and outer shafts which are at least in part rotatably disposed co-axially within a high pressure rotor. Inter-turbine frame includes radially spaced apart radially outer first and inner second structural rings disposed co-axially about a centerline and connected by a plurality of circumferentially spaced apart struts. Forward and aft sump members having forward and aft central bores are fixedly joined to axially spaced apart forward and aft portions of the inter-turbine frame. Low pressure inner and outer rotors are rotatably supported by a second turbine frame bearing mounted in aft central bore of aft sump member. A mount for connecting the engine to an aircraft is located on first structural ring.

  8. Social support is associated with blood pressure responses in parents caring for children with developmental disabilities.

    PubMed

    Gallagher, Stephen; Whiteley, Jenny

    2012-01-01

    The present study tested whether parents caring for children with developmental disabilities would have higher blood pressure compared to parents of typically developing children (controls). It also examined the psychosocial factors underlying this observation. Thirty-five parents of children with developmental disability and thirty controls completed standard measures of perceived stress, child challenging behaviours and social support and wore an ambulatory blood pressure (BP) monitor throughout the day, for one day. Relative to controls, parents caring for children with developmental disabilities reported poorer psychosocial functioning and had a higher mean systolic BP. Of the psychosocial predictors, only social support was found to be predictive. Moreover, variations in social support accounted for some of the between group differences with the β for parental group attenuated from .42 to .34 in regression analyses. It appears that social support may influence blood pressure responses in parental caregivers. Finally, our findings underscore the importance of providing psychosocial interventions to improve the health of family caregivers.

  9. Treatment of sleep central apnea with non-invasive mechanical ventilation with 2 levels of positive pressure (bilevel) in a patient with myotonic dystrophy type 1

    PubMed Central

    Akamine, Ricardo Tera; Grossklauss, Luís Fernando; Moreira, Gustavo Antonio; Pradella-Hallinan, Marcia; Chiéia, Marco Antônio; Mesquita, Denis; Bulle Oliveira, Acary Souza; Tufik, Sergio

    2014-01-01

    We are reporting a case of a 29 year-old female with diagnosis of myotonic dystrophy type 1 (Steinert’s disease) with excessive daytime sleepiness, muscle fatigue, snoring, frequent arousals, non-restorative sleep, and witnessed apneas. Pulmonary function tests revealed a mild decrease of forced vital capacity. Nocturnal polysomnography showed an increase of apnea/hypopnea index (85.9 events/h), mainly of central type (236), minimal oxygen saturation of 72%, and end-tidal carbon dioxide values that varied from 45 to 53 mmHg. Bi-level positive airway pressure titration was initiated at an inspiratory pressure (IPAP) of 8 and an expiratory pressure (EPAP) of 4 cm H2O. IPAP was then gradually increased to eliminate respiratory events and improve oxygen saturation. An IPAP of 12cm H20 and an EPAP of 4cm H2O eliminated all respiratory events, and the oxygen saturation remained above 90%. Bi-level positive airway pressure treatment at spontaneous/timed mode showed an improvement in snoring, apneas, and Epworth sleepiness scale decreased from 20 to 10. This case illustrates the beneficial effects of Bi-level positive airway pressure support in central sleep apnea syndrome of a patient with myotonic dystrophy type 1. PMID:26483914

  10. Pressurized Testing of Solid Oxide Electrolysis Stacks with Advanced Electrode-Supported Cells

    SciTech Connect

    J. E. O'Brien; X. Zhang; G. K. Housley; K. DeWall; L. Moore-McAteer; G. Tao

    2012-06-01

    A new facility has been developed at the Idaho National Laboratory for pressurized testing of solid oxide electrolysis stacks. Pressurized operation is envisioned for large-scale hydrogen production plants, yielding higher overall efficiencies when the hydrogen product is to be delivered at elevated pressure for tank storage or pipelines. Pressurized operation also supports higher mass flow rates of the process gases with smaller components. The test stand can accommodate cell dimensions up to 8.5 cm x 8.5 cm and stacks of up to 25 cells. The pressure boundary for these tests is a water-cooled spool-piece pressure vessel designed for operation up to 5 MPa. The stack is internally manifolded and operates in cross-flow with an inverted-U flow pattern. Feed-throughs for gas inlets/outlets, power, and instrumentation are all located in the bottom flange. The entire spool piece, with the exception of the bottom flange, can be lifted to allow access to the internal furnace and test fixture. Lifting is accomplished with a motorized threaded drive mechanism attached to a rigid structural frame. Stack mechanical compression is accomplished using springs that are located inside of the pressure boundary, but outside of the hot zone. Initial stack heatup and performance characterization occurs at ambient pressure followed by lowering and sealing of the pressure vessel and subsequent pressurization. Pressure equalization between the anode and cathode sides of the cells and the stack surroundings is ensured by combining all of the process gases downstream of the stack. Steady pressure is maintained by means of a backpressure regulator and a digital pressure controller. A full description of the pressurized test apparatus is provided in this paper.

  11. A novel target-type low pressure drop bidirectional optoelectronic air flow sensor for infant artificial ventilation: Measurement principle and static calibration

    NASA Astrophysics Data System (ADS)

    Saccomandi, Paola; Schena, Emiliano; Silvestri, Sergio

    2011-02-01

    An optoelectronic target-type volumetric air flow-rate transducer for bidirectional measurements is presented. The sensor is composed of a T-shaped target and two nominally identical LED-photodiode couples which are operated in differential mode. The sensitive surfaces of the photodiodes are differentially shadowed by the deflection of the target, which in turn depends on the gas flow-rate. The principle of operation is described in mathematical terms and the design parameters have been optimized in order to obtain the highest sensitivity along with minimal pressure drop and reduced dimensions. The sensor is placed in a 20 mm diameter hose and was tested with air flow-rate in the typical temperature range of mechanical ventilation between 20 and 40 °C. The theoretical model was validated through experiments carried out in the volumetric flow range from -7.0 to +7.0 l min-1. The nonlinear behavior allows sensitivities equal to 0.6 V l-1 min for flow rates ranging from -2.0 to +2.0 l min-1, equal to 2.0 V l-1 min for flow rates ranging from -3.0 to -2.0 l min-1 and from +2.0 to +3.0 l min-1, up to 5.7 V l-1 min at higher flow rates ranging from -7.0 to -3.0 l min-1 and from +3.0 to +7.0 l min-1. The linear range extends from 3.0 to 7.0 l min-1 with constant sensitivity equal to 5.7 V l-1 min. The sensor is able to detect a flow-rate equal to 1.0 l min-1 with a sensitivity of about 400 mV l-1 min. The differential nature of the output minimizes the influence of the LEDs' power supply variations and allows to obtain a repeatability in the order of 3% of full scale output. The small pressure drop produced by the sensor placed in-line the fluid stream, of about 2.4 Pa at 7 l min-1, corresponds to a negligible fluid dynamic resistance lower than 0.34 Pa l-1 min.

  12. A novel target-type low pressure drop bidirectional optoelectronic air flow sensor for infant artificial ventilation: Measurement principle and static calibration

    SciTech Connect

    Saccomandi, Paola; Schena, Emiliano; Silvestri, Sergio

    2011-02-15

    An optoelectronic target-type volumetric air flow-rate transducer for bidirectional measurements is presented. The sensor is composed of a T-shaped target and two nominally identical LED-photodiode couples which are operated in differential mode. The sensitive surfaces of the photodiodes are differentially shadowed by the deflection of the target, which in turn depends on the gas flow-rate. The principle of operation is described in mathematical terms and the design parameters have been optimized in order to obtain the highest sensitivity along with minimal pressure drop and reduced dimensions. The sensor is placed in a 20 mm diameter hose and was tested with air flow-rate in the typical temperature range of mechanical ventilation between 20 and 40 deg. C. The theoretical model was validated through experiments carried out in the volumetric flow range from -7.0 to +7.0 l min{sup -1}. The nonlinear behavior allows sensitivities equal to 0.6 V l{sup -1} min for flow rates ranging from -2.0 to +2.0 l min{sup -1}, equal to 2.0 V l{sup -1} min for flow rates ranging from -3.0 to -2.0 l min{sup -1} and from +2.0 to +3.0 l min{sup -1}, up to 5.7 V l{sup -1} min at higher flow rates ranging from -7.0 to -3.0 l min{sup -1} and from +3.0 to +7.0 l min{sup -1}. The linear range extends from 3.0 to 7.0 l min{sup -1} with constant sensitivity equal to 5.7 V l{sup -1} min. The sensor is able to detect a flow-rate equal to 1.0 l min{sup -1} with a sensitivity of about 400 mV l{sup -1} min. The differential nature of the output minimizes the influence of the LEDs' power supply variations and allows to obtain a repeatability in the order of 3% of full scale output. The small pressure drop produced by the sensor placed in-line the fluid stream, of about 2.4 Pa at 7 l min{sup -1}, corresponds to a negligible fluid dynamic resistance lower than 0.34 Pa l{sup -1} min.

  13. A novel target-type low pressure drop bidirectional optoelectronic air flow sensor for infant artificial ventilation: measurement principle and static calibration.

    PubMed

    Saccomandi, Paola; Schena, Emiliano; Silvestri, Sergio

    2011-02-01

    An optoelectronic target-type volumetric air flow-rate transducer for bidirectional measurements is presented. The sensor is composed of a T-shaped target and two nominally identical LED-photodiode couples which are operated in differential mode. The sensitive surfaces of the photodiodes are differentially shadowed by the deflection of the target, which in turn depends on the gas flow-rate. The principle of operation is described in mathematical terms and the design parameters have been optimized in order to obtain the highest sensitivity along with minimal pressure drop and reduced dimensions. The sensor is placed in a 20 mm diameter hose and was tested with air flow-rate in the typical temperature range of mechanical ventilation between 20 and 40 °C. The theoretical model was validated through experiments carried out in the volumetric flow range from -7.0 to +7.0 l min(-1). The nonlinear behavior allows sensitivities equal to 0.6 V l(-1) min for flow rates ranging from -2.0 to +2.0 l min(-1), equal to 2.0 V l(-1) min for flow rates ranging from -3.0 to -2.0 l min(-1) and from +2.0 to +3.0 l min(-1), up to 5.7 V l(-1) min at higher flow rates ranging from -7.0 to -3.0 l min(-1) and from +3.0 to +7.0 l min(-1). The linear range extends from 3.0 to 7.0 l min(-1) with constant sensitivity equal to 5.7 V l(-1) min. The sensor is able to detect a flow-rate equal to 1.0 l min(-1) with a sensitivity of about 400 mV l(-1) min. The differential nature of the output minimizes the influence of the LEDs' power supply variations and allows to obtain a repeatability in the order of 3% of full scale output. The small pressure drop produced by the sensor placed in-line the fluid stream, of about 2.4 Pa at 7 l min(-1), corresponds to a negligible fluid dynamic resistance lower than 0.34 Pa l(-1) min.

  14. DEVELOPMENT AND DEMONSTRATION OF A PILOT SCALE FACILITY FOR FABRICATION AND MARKETING OF LIGHTWEIGHT-COAL COMBUSTION BYPRODUCTS-BASED SUPPORTS AND MINE VENTILATION BLOCKS FOR UNDERGROUND MINES

    SciTech Connect

    Yoginder P. Chugh

    2002-10-01

    The overall goal of this program was to develop a pilot scale facility, and design, fabricate, and market CCBs-based lightweight blocks for mine ventilation control devices, and engineered crib elements and posts for use as artificial supports in underground mines to replace similar wooden elements. This specific project was undertaken to (1) design a pilot scale facility to develop and demonstrate commercial production techniques, and (2) provide technical and marketing support to Fly Lite, Inc to operate the pilot scale facility. Fly Lite, Inc is a joint venture company of the three industrial cooperators who were involved in research into the development of CCBs-based structural materials. The Fly-Lite pilot scale facility is located in McLeansboro, Illinois. Lightweight blocks for use in ventilation stoppings in underground mines have been successfully produced and marketed by the pilot-scale facility. To date, over 16,000 lightweight blocks (30-40 pcf) have been sold to the mining industry. Additionally, a smaller width (6-inch) full-density block was developed in August-September 2002 at the request of a mining company. An application has been submitted to Mine Safety and Health Administration for the developed block approval for use in mines. Commercialization of cribs and posts has also been accomplished. Two generations of cribs have been developed and demonstrated in the field. MSHA designated them suitable for use in mines. To date, over 2,000 crib elements have been sold to mines in Illinois. Two generations of posts were also demonstrated in the field and designated as suitable for use in mines by MSHA. Negotiations are currently underway with a mine in Illinois to market about 1,000 posts per year based on a field demonstration in their mine. It is estimated that 4-5 million tons CCBs (F-fly ash or FBC fly ash) may be utilized if the developed products can be commercially implemented in U.S. coal and non-coal mines.

  15. Ventilator Associated Pneumonia in Children.

    PubMed

    Chang, Ivy; Schibler, Andreas

    2016-09-01

    Ventilator associated pneumonia (VAP) is a common complication in mechanically ventilated children and adults. There remains much controversy in the literature over the definition, treatment and prevention of VAP. The incidence of VAP is variable, depending on the definition used and can effect up to 12% of ventilated children. For the prevention and reduction of the incidence of VAP, ventilation care bundles are suggested, which include vigorous hand hygiene, head elevation and use of non-invasive ventilation strategies. Diagnosis is mainly based on the clinical presentation with a lung infection occurring after 48hours of mechanical ventilation requiring a change in ventilator settings (mainly increased oxygen requirement, a positive culture of a specimen taken preferentially using a sterile sampling technique either using a bronchoscope or a blind lavage of the airways). A new infiltrate on a chest X ray supports the diagnosis of VAP. For the treatment of VAP, initial broad-spectrum antibiotics should be used followed by a specific antibiotic therapy with a narrow target once the bacterium is confirmed.

  16. [Preliminary report and indications of assisted ventilation at home (author's transl)].

    PubMed

    Levi-Valensi, P; Duwoos, H; Weitzenblum, E; Pedinielli, J L; Aubry, P; Fourquet, B

    1979-01-01

    Two uses of intermittent positive pressure can be distinguished: one supports inhalotherapy and the other longterm assisted ventilation. The apparatus can be connected to the patient either through mouth-piece or by tracheostomy. The main factors involved in the indication of assisted ventilation are the number of acute failures, hypoxemia, hypercapnia, cor pulmonale. In our department, 53 patients were kept under prolonged supervision before a decision was made to use assisted ventilation or not. This attitude seems absolutely necessary. An oxygen test of several hours provides very useful information. Finally, the authors review the indication of various ventilation methods (tracheostomy, oral) in relation to different chronic respiratory insufficiency etiologies (ie., chronic obstructive broncho-pneumonia, restrictive syndrome).

  17. Extracorporeal CO2 removal--a way to achieve ultraprotective mechanical ventilation and lung support: the missing piece of multiple organ support therapy.

    PubMed

    Gramaticopolo, Silvia; Chronopoulos, Alexandra; Piccinni, Pasquale; Nalesso, Federico; Brendolan, Alessandra; Zanella, Monica; Cruz, Dinna N; Ronco, Claudio

    2010-01-01

    Extracorporeal therapies are able to sustain life through different mechanisms. This approach, called multiple organ support therapy, can in fact obtain blood purification by hemodialysis/hemofiltration to replace kidney function, temperature control, electrolyte and acid-base control to mimic homeostatic regulation of the kidney and circulation, fluid balance control to support the right hydration and cardiac performance, cardiac support removing cardiodepressant substances and equilibrating potassium levels, blood detoxification and liver support by coupled plasma filtration and adsorption or direct adsorption on blood (hemoperfusion), immunomodulation and endothelial support in the presence of sepsis by cutting the peaks of pro- and anti-inflammatory mediators, and immunoadsorption or adsorption of specific substances such as endotoxin. A missing piece of this group of therapies was the protective lung support. Today this is made possible by removal of CO(2) either by complete extracorporeal membrane oxygenation or by using decapneization in conjunction with hemofiltration in a system called DECAP/DECAPSMART. In conclusion, circulating blood outside the body and treating it with different filters or cartridges in a multiple organ support therapy may represent an important support for multiple organ dysfunction conditions induced by sepsis, acute respiratory distress syndrome and in recent times by complicated H1N1-related infections.

  18. Summary of human responses to ventilation

    SciTech Connect

    Seppanen, Olli A.; Fisk, William J.

    2004-06-01

    The effects of ventilation on indoor air quality and health is a complex issue. It is known that ventilation is necessary to remove indoor generated pollutants from indoor air or dilute their concentration to acceptable levels. But, as the limit values of all pollutants are not known, the exact determination of required ventilation rates based on pollutant concentrations and associated risks is seldom possible. The selection of ventilation rates has to be based also on epidemiological research (e.g. Seppanen et al., 1999), laboratory and field experiments (e.g. CEN 1996, Wargocki et al., 2002a) and experience (e.g. ECA 2003). Ventilation may also have harmful effects on indoor air quality and climate if not properly designed, installed, maintained and operated as summarized by Seppdnen (2003). Ventilation may bring indoors harmful substances that deteriorate the indoor environment. Ventilation also affects air and moisture flow through the building envelope and may lead to moisture problems that deteriorate the structures of the building. Ventilation changes the pressure differences over the structures of building and may cause or prevent the infiltration of pollutants from structures or adjacent spaces. Ventilation is also in many cases used to control the thermal environment or humidity in buildings. Ventilation can be implemented with various methods which may also affect health (e.g. Seppdnen and Fisk, 2002, Wargocki et al., 2002a). In non residential buildings and hot climates, ventilation is often integrated with air-conditioning which makes the operation of ventilation system more complex. As ventilation is used for many purposes its health effects are also various and complex. This paper summarizes the current knowledge on positive and negative effects of ventilation on health and other human responses. The focus of the paper is on office-type working environment and residential buildings. In the industrial premises the problems of air quality are usually

  19. Anesthesia and critical care ventilator modes: past, present, and future.

    PubMed

    Bristle, Timothy J; Collins, Shawn; Hewer, Ian; Hollifield, Kevin

    2014-10-01

    Mechanical ventilators have evolved from basic machines to complicated, electronic, microprocessing engines. Over the last 2 decades, ventilator capabilities and options for critical care and anesthesia ventilators have rapidly advanced. These advances in ventilator modalities--in conjunction with a better understanding of patient physiology and the effects of positive pressure ventilation on the body--have revolutionized the mechanical ventilation process. Clinicians today have a vast array of mechanical ventilator mode options designed to match the pulmonary needs of the critically ill and anesthetized patient. Modes of mechanical ventilation continue to be based on 1 of 2 variances: volume-based or pressure-based. The wording describing the standard ventilatory modes on select present-day ventilators has changed, yet the basic principles of operation have not changed compared with older ventilators. Anesthesia providers need to understand these ventilator modes to best care for patients. This literature review encompasses a brief history of mechanical ventilation and current modes available for anesthesia and critical care ventilators, including definitions of each mode, definitions of the various descriptive labels given each mode, and techniques for optimizing and meeting the ventilator needs of the patient while avoiding complications in the surgical and critical care patient.

  20. Physiology in Medicine: Understanding dynamic alveolar physiology to minimize ventilator induced lung injury (VILI).

    PubMed

    Nieman, Gary F; Satalin, Joshua; Kollisch-Singule, Michaela; Andrews, Penny L; Aiash, Hani; Habashi, Nader M; Gatto, Louis A

    2017-04-06

    The acute respiratory distress syndrome (ARDS) remains a serious clinical problem with the main treatment being supportive in the form of mechanical ventilation. However, mechanical ventilation can be a double edge sword, if set improperly can exacerbate the tissue damage caused by ARDS and is known as ventilator induced lung injury (VILI). In order to minimize VILI we must understand the pathophysiologic mechanisms of tissue damage at the alveolar level. In this Physiology in Medicine paper the dynamic physiology of alveolar inflation and deflation during mechanical ventilation will be reviewed. In addition, the pathophysiologic mechanisms of VILI will be reviewed and this knowledge used to suggest an optimal mechanical breath profile (MBP - all airway pressures, volumes, flows, rates and the duration that they are applied at both inspiration and expiration) necessary to minimize VILI. Our review suggests that the current protective ventilation strategy known as the 'Open Lung Strategy' would be the optimal lung protective approach. However, the viscoelastic behavior of dynamic alveolar inflation and deflation has not yet been incorporated into protective mechanical ventilation strategies. Using our knowledge of dynamic alveolar mechanics (i.e the dynamic change in alveolar and alveolar duct size and shape during tidal ventilation) to modify the MBP necessary to minimize VILI will reduce the morbidity and mortality associated with ARDS.

  1. Effect of body temperature on the pattern of spontaneous breathing in extremely low birth weight infants supported by proportional assist ventilation.

    PubMed

    Rieger-Fackeldey, Esther; Schaller-Bals, Susanne; Schulze, Andreas

    2003-09-01

    The optimum body temperature for infants <1000 g is unknown. We investigated body temperature effects on spontaneous breathing using proportional assist ventilation (PAV), because this mode supports spontaneous breathing such that all breathing pattern variables remain controlled by the infant. Minute volume (MV), respiratory rate (RR), tidal volume (Vt), incidence and duration of respiratory pauses, arterial oxygen desaturations <85%, and arterial Pco2 levels will remain unaffected by targeting core body temperature to 36.1-36.5 degrees C (low normal range) versus 37.7-37.9 degrees C (upper normal). Twenty infants (mean +/- SD: birth weight, 696 +/- 155 g; gestational age, 25 +/- 1 wk; age, 5 +/- 3 d) who were supported by PAV were exposed to each target temperature range on 2 consecutive days in four 2-h intervals for a total of 8 h with the sequence of the temperature ranges randomized. Core body temperature was 36.5 +/- 0.2 degrees C and 37.9 +/- 0.2 degrees C in the two conditions. MV was 291 and 314 mL. min-1. kg-1, respectively (7% difference; p < 0.001) as a result of a difference in RR (8%; p < 0.001). The infants maintained their blood CO2 levels and Vt (5.25 +/- 0.6 versus 5.19 +/- 0.6 mL/kg). Incidence and duration of respiratory pauses were not different between conditions. Extremely immature infants who are supported by PAV modify their spontaneous breathing in response to changes in thermal environment such that Pco2 levels are appropriately maintained early in postnatal life. This response pattern occurred consistently and is currently of uncertain clinical significance.

  2. Ultrasonic Nondestructive Evaluation of PRSEUS Pressure Cube Article in Support of Load Test to Failure

    NASA Technical Reports Server (NTRS)

    Johnston, Patrick H.

    2013-01-01

    The PRSEUS Pressure Cube Test was a joint development effort between the Boeing Company and NASA Langley Research Center, sponsored in part by the Environmentally Responsible Aviation Project and Boeing internal R&D. This Technical Memorandum presents the results of ultrasonic inspections in support of the PRSEUS Pressure Cube Test, and is a companion document with the NASA test report and a report on the acoustic emission measurements made during the test.

  3. Lung-protective ventilation in neonatology.

    PubMed

    van Kaam, Anton

    2011-01-01

    Ventilator-induced lung injury (VILI) is considered an important risk factor in the development of bronchopulmonary dysplasia (BPD) and is primarily caused by overdistension (volutrauma) and repetitive opening and collapse (atelectrauma) of terminal lung units. Lung-protective ventilation should therefore aim to reduce tidal volumes, and recruit and stabilize atelectatic lung units (open lung ventilation strategy). This review will summarize the available evidence on lung-protective ventilation in neonatology, discussing both high-frequency ventilation (HFV) and positive pressure ventilation (PPV). It shows that HFV does not appear to have a clear benefit over PPV, although most studies failed to apply a true open lung ventilation strategy during HFV. The evidence on the optimal tidal volume, positive end-expiratory pressure and the role for lung recruitment during lung-protective PPV is extremely limited. Volume-targeted ventilation seems to be a promising mode in terms of lung protection, but more studies are needed. Due to the lack of convincing evidence, lung-protective ventilation and modes seem to be implemented in daily clinical practice at a slow pace.

  4. The interplay of parental support, parental pressure and test anxiety--Gender differences in adolescents.

    PubMed

    Ringeisen, Tobias; Raufelder, Diana

    2015-12-01

    This study examined gender-specific relationships between adolescents' perceptions of school-related support/pressure from their parents and test anxiety. A sample of German students (N = 845; Mage = 15.32; SD = .49) completed questionnaires that measured their perceived parental support/pressure (for mother and father separately) as well as the four main components of test anxiety (worry, interference, lack of confidence, and emotionality). Gender-specific relations were identified using multigroup structural equation modeling: For girls, perceived maternal pressure was positively associated with emotionality and interference; for boys, perceived father pressure and father support were positively associated with interference and worry, respectively. For both genders, perceived mother pressure and support were related to lack of confidence. Our findings suggest that adolescents' perceptions of maternal attitudes are associated with students' self-confidence irrespective of the child's gender, whereas the remaining facets of test anxiety follow same-sex trajectories between perceived parental attitudes and adolescents' test anxiety.

  5. Effectiveness of Synchronized Noninvasive Ventilation to Prevent Intubation in Preterm Infants

    PubMed Central

    Ramos-Navarro, Cristina; Sanchez-Luna, Manuel; Sanz-López, Ester; Maderuelo-Rodriguez, Elena; Zamora-Flores, Elena

    2016-01-01

    Background Noninvasive ventilation is being increasingly used on preterm infants to reduce ventilator lung injury and bronchopulmonary dysplasia. The aim of this study was to evaluate the effectiveness of synchronized nasal intermittent positive pressure ventilation (SNIPPV) to prevent intubation in premature infants. Methods Prospective observational study of SNIPPV use on preterm infants of less than 32 weeks' gestation. All patients were managed using a prospective protocol intended to reduce invasive mechanical ventilation (iMV) use. Previous respiratory status, as well as respiratory outcomes and possible secondary side effects were analyzed. Results SNIPPV was used on 78 patients: electively to support extubation on 25 ventilator-dependent patients and as a rescue therapy after nasal continuous positive airway pressure failure on 53 patients. For 92% of patients in the elective group and 66% in the rescue group, iMV was avoided over the following 72 hours. No adverse effects were detected, and all patients were in a stable condition even if intubation was eventually needed. Conclusions The application of SNIPPV in place of or to remove mechanical ventilation avoids intubation in 74.4% of preterm infants with respiratory failure. No adverse effects were detected. PMID:27500013

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

    PubMed

    Slutsky, Arthur S

    2015-05-15

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

  7. A Survey of Mechanical Ventilator Practices Across Burn Centers in North America

    PubMed Central

    Rhie, Ryan Y.; Lundy, Jonathan B.; Cartotto, Robert; Henderson, Elizabeth; Pressman, Melissa A.; Joe, Victor C.; Aden, James K.; Driscoll, Ian R.; Faucher, Lee D.; McDermid, Robert C.; Mlcak, Ronald P.; Hickerson, William L.; Jeng, James C.

    2016-01-01

    Burn injury introduces unique clinical challenges that make it difficult to extrapolate mechanical ventilator (MV) practices designed for the management of general critical care patients to the burn population. We hypothesize that no consensus exists among North American burn centers with regard to optimal ventilator practices. The purpose of this study is to examine various MV practice patterns in the burn population and to identify potential opportunities for future research. A researcher designed, 24-item survey was sent electronically to 129 burn centers. The χ2, Fisher’s exact, and Cochran–Mantel–Haenszel tests were used to determine if there were significant differences in practice patterns. We analyzed 46 questionnaires for a 36% response rate. More than 95% of the burn centers reported greater than 100 annual admissions. Pressure support and volume assist control were the most common initial MV modes used with or without inhalation injury. In the setting of Berlin defined mild acute respiratory distress syndrome (ARDS), ARDSNet protocol and optimal positive end-expiratory pressure were the top ventilator choices, along with fluid restriction/diuresis as a nonventilator adjunct. For severe ARDS, airway pressure release ventilation and neuromuscular blockade were the most popular. The most frequently reported time frame for mechanical ventilation before tracheostomy was 2 weeks (25 of 45, 55%); however, all respondents reported in the affirmative that there are certain clinical situations where early tracheostomy is warranted. Wide variations in clinical practice exist among North American burn centers. No single ventilator mode or adjunct prevails in the management of burn patients regardless of pulmonary insult. Movement toward American Burn Association–supported, multicenter studies to determine best practices and guidelines for ventilator management in burn patients is prudent in light of these findings. PMID:26135527

  8. Waste tank ventilation system waste material accumulations

    SciTech Connect

    Van Vleet, R.J., Westinghouse Hanford

    1996-08-06

    This paper calculates the amount of material that accumulates in the ventilation systems of various Tank Waste Remediation System facilities and estimates the amount of material that could be released due to a rapid pressurization.

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

    PubMed

    Mustafin, R; Bakirov, A

    2015-09-01

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

  10. Hydrostatic Hyperbaric Chamber Ventilation System

    NASA Technical Reports Server (NTRS)

    Sargusingh, Miriam M.

    2011-01-01

    The hydrostatic hyperbaric chamber (HHC) represents the merger of several technologies in development for NASA aerospace applications, harnessed to directly benefit global health. NASA has significant experience developing composite hyperbaric chambers for a variety of applications, including the treatment of medical conditions. NASA also has researched the application of water-filled vessels to increase tolerance of acceleration forces. The combination of these two applications has resulted in the hydrostatic chamber, which has been conceived as a safe, affordable means of making hyperbaric oxygen therapy available in the developing world for the treatment of a variety of medical conditions. Specifically, hyperbaric oxygen therapy is highly-desired as a possibly curative treatment for Buruli Ulcer, an infectious condition that afflicts children in sub-Saharan Africa. Hyperbaric oxygen therapy is simply too expensive and too dangerous to implement in the developing world using standard equipment. The hydrostatic hyperbaric chamber technology changes the paradigm. The HHC differs from standard hyperbaric chambers in that the majority of its volume is filled with water which is pressurized by oxygen being supplied in the portion of the chamber containing the patient s head. This greatly reduces the amount of oxygen required to sustain a hyperbaric atmosphere, thereby making the system more safe and economical to operate. An effort was taken to develop an HHC system to apply HBOT to children that is simple and robust enough to support transport, assembly, maintenance and operation in developing countries. This paper details the concept for an HHC ventilation and pressurization system that will provide controlled pressurization of the system, and provide adequate washout of carbon dioxide while the subject is enclosed in the confined space during the administration of the medical treatment. The concept took into consideration operational complexity, safety to the

  11. Hydrostatic Hyperbaric Chamber Ventilation System

    NASA Technical Reports Server (NTRS)

    Sarguisingh, Miriam J.

    2012-01-01

    The hydrostatic hyperbaric chamber (HHC) represents the merger of several technologies in development for NASA aerospace applications, harnessed to directly benefit global health. NASA has significant experience developing composite hyperbaric chambers for a variety of applications. NASA also has researched the application of water-filled vessels to increase tolerance of acceleration forces. The combination of these two applications has resulted in the hydrostatic chamber, which has been conceived as a safe, affordable means of making hyperbaric oxygen therapy (HBOT) available in the developing world for the treatment of a variety of medical conditions. Specifically, HBOT is highly-desired as a possibly curative treatment for Buruli Ulcer, an infectious condition that afflicts children in sub-Saharan Africa. HBOT is simply too expensive and too dangerous to implement in the developing world using standard equipment. The HHC technology changes the paradigm. The HHC differs from standard hyperbaric chambers in that the majority of its volume is filled with water which is pressurized by oxygen being supplied in the portion of the chamber containing the patient s head. This greatly reduces the amount of oxygen required to sustain a hyperbaric atmosphere, thereby making the system more safe and economical to operate. An effort was taken to develop an HHC system to apply HBOT to children that is simple and robust enough to support transport, assembly, maintenance and operation in developing countries. This paper details the concept for an HHC ventilation and pressurization system to provide controlled pressurization and adequate washout of carbon dioxide while the subject is enclosed in the confined space during the administration of the medical treatment. The concept took into consideration operational complexity, safety to the patient and operating personnel, and physiological considerations. The simple schematic, comprised of easily acquired commercial hardware

  12. Focal cartilage defect compromises fluid-pressure dependent load support in the knee joint.

    PubMed

    Dabiri, Yaghoub; Li, LePing

    2015-06-01

    A focal cartilage defect involves tissue loss or rupture. Altered mechanics in the affected joint may play an essential role in the onset and progression of osteoarthritis. The objective of the present study was to determine the compromised load support in the human knee joint during defect progression from the cartilage surface to the cartilage-bone interface. Ten normal and defect cases were simulated with a previously tested 3D finite element model of the knee. The focal defects were considered in both condyles within high load-bearing regions. Fluid pressurization, anisotropic fibril-reinforcement, and depth-dependent mechanical properties were considered for the articular cartilages and menisci. The results showed that a small cartilage defect could cause 25% reduction in the load support of the knee joint due to a reduced capacity of fluid pressurization in the defect cartilage. A partial-thickness defect could cause a fluid pressure decrease or increase in the remaining underlying cartilage depending on the defect depth. A cartilage defect also increased the shear strain at the cartilage-bone interface, which was more significant with a full-thickness defect. The effect of cartilage defect on the fluid pressurization also depended on the defect sites and contact conditions. In conclusion, a focal cartilage defect causes a fluid-pressure dependent load reallocation and a compromised load support in the joint, which depend on the defect depth, site, and contact condition.

  13. Space Station Environment Control and Life Support System Pressure Control Pump Assembly Modeling and Analysis

    NASA Technical Reports Server (NTRS)

    Schunk, R. Gregory

    2002-01-01

    This paper presents the Modeling and Analysis of the Space Station Environment Control and Life Support System Pressure Control Pump Assembly (PCPA). The contents include: 1) Integrated PCPA/Manifold Analyses; 2) Manifold Performance Analysis; 3) PCPA Motor Heat Leak Study; and 4) Future Plans. This paper is presented in viewgraph form.

  14. Reduced Pressure Atmosphere Impacts on Life Support and Internal Thermal Systems

    NASA Technical Reports Server (NTRS)

    Anderson, Molly

    2006-01-01

    Selecting the appropriate atmosphere for a spacecraft and mission is a complicated problem. NASA has previously used atmospheres from Earth normal composition and pressure to pure oxygen at low pressures. Future exploration missions will likely strike a compromise somewhere between the two, trying to balance operation impacts on EVA, safety concerns for flammability and health risks, life science and physiology questions, and other issues. Life support systems and internal thermal control systems are areas that will have to respond to changes in the atmospheric composition and pressure away from the Earthlike conditions currently used on the International Space Station. This paper examines life support and internal thermal control technologies currently in use or in development to find what impacts in design, efficiency and performance, or feasibility might be expected. Understanding these changes should be helpful in producing better results during future trade studies or mission analyses.

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

    PubMed Central

    2013-01-01

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

  16. International Space Station Environmental Control and Life Support System Acceptance Testing for the Pressurized Mating Adapters

    NASA Technical Reports Server (NTRS)

    Williams, David E.

    2008-01-01

    The International Space Station (ISS) Pressurized Mating Adapters (PMAs) Environmental Control and Life Support (ECLS) System is comprised of three subsystems: Atmosphere Control and Supply (ACS), Temperature and Humidity Control (THC), and Water Recovery and Management (WRM). PMAs 1 and 2 flew to ISS on Flight 2A and Pressurized Mating Adapter (PMA) 3 flew to ISS on Flight 3A. This paper provides a summary of the PMAs ECLS design and a detailed discussion of the ISS ECLS Acceptance Testing methodologies utilized for the PMAs.

  17. PaCO2 in Surfactant, Positive Pressure, and Oxygenation Randomized Trial (SUPPORT)

    PubMed Central

    Ambalavanan, Namasivayam; Carlo, Waldemar A.; Wrage, Lisa A.; Das, Abhik; Laughon, Matthew; Cotten, C. Michael; Kennedy, Kathleen A.; Laptook, Abbot R.; Shankaran, Seetha; Walsh, Michele C.; Higgins, Rosemary D.

    2015-01-01

    Objective To determine the association of PaCO2 with severe intraventricular hemorrhage (sIVH), bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (NDI) at 18–22 months in premature infants. Design Secondary exploratory data analysis of SUPPORT. Setting Multiple referral NICUs. Patients 1316 infants 24 0/7 to 27 6/7 weeks gestation randomized to different oxygenation (SpO2 target 85–89% vs 91–95%) and ventilation strategies. Main Outcome Measures Blood gases from postnatal days 0–14 were analyzed. Five PaCO2 variables were defined: minimum [Min], maximum [Max], standard deviation, average (time-weighted), and a 4 level categorical variable (hypercapnic [highest quartile of Max PaCO2], hypocapnic [lowest quartile of Min PaCO2], fluctuators [both hypercapnia and hypocapnia], and normocapnic [middle two quartiles of Max and Min PaCO2]). PaCO2 variables were compared for infants with and without sIVH, BPD, and NDI (+/− death). Multivariable logistic regression models were developed for adjusted results. Results sIVH, BPD, and NDI (+/− death) were associated with hypercapnic infants and fluctuators. Association of Max PaCO2 and outcomes persisted after adjustment (Per 10 mmHg increase: sIVH/death: OR 1.27 [1.13–1.41]; BPD/death: OR 1.27 [1.12–1.44]; NDI/death: OR 1.23 [1.10–1.38], Death: OR 1.27 [1.12–1.44], all p <0.001). No interaction was found between PaCO2 category and SpO2 treatment group for sIVH/death, NDI/death, or death. Max PaCO2 was positively correlated with maximum FiO2 (rs0.55, p<0.0001) & ventilator days (rs0.61, p<0.0001). Conclusions Higher PaCO2 was an independent predictor of sIVH/death, BPD/death, and NDI/death. Further trials are needed to evaluate optimal PaCO2 targets for high risk infants. PMID:25425651

  18. Jet Ventilation during Rigid Bronchoscopy in Adults: A Focused Review.

    PubMed

    Putz, Laurie; Mayné, Alain; Dincq, Anne-Sophie

    2016-01-01

    The indications for rigid bronchoscopy for interventional pulmonology have increased and include stent placements and transbronchial cryobiopsy procedures. The shared airway between anesthesiologist and pulmonologist and the open airway system, requiring specific ventilation techniques such as jet ventilation, need a good understanding of the procedure to reduce potentially harmful complications. Appropriate adjustment of the ventilator settings including pause pressure and peak inspiratory pressure reduces the risk of barotrauma. High frequency jet ventilation allows adequate oxygenation and carbon dioxide removal even in cases of tracheal stenosis up to frequencies of around 150 min(-1); however, in an in vivo animal model, high frequency jet ventilation along with normal frequency jet ventilation (superimposed high frequency jet ventilation) has been shown to improve oxygenation by increasing lung volume and carbon dioxide removal by increasing tidal volume across a large spectrum of frequencies without increasing barotrauma. General anesthesia with a continuous, intravenous, short-acting agent is safe and effective during rigid bronchoscopy procedures.

  19. Effect of a suspension seat support chair on the trunk flexion angle and gluteal pressure during computer work

    PubMed Central

    Yoo, Won-gyu

    2015-01-01

    [Purpose] We assessed the effects of a suspension seat support chair on the trunk flexion angle and gluteal pressure during computer work. [Subjects] Ten males were recruited. [Methods] The suspension seat support was developed to prevent abnormal gluteal pressure and a slumped sitting posture during computer work. The gluteal pressure was measured with a TekScan system and the trunk flexion angle was measured with a video camera, to compare the differences between a general chair and the suspension seat support. [Results] The gluteal peak pressures were decreased significantly in the suspension seat support versus the general chair. The trunk flexion angle was also decreased significantly in the suspension seat support compared with the general chair. [Conclusions] This study suggests that the suspension seat support chair contributes to preventing abnormal gluteal pressure and a slumped sitting posture. PMID:26504341

  20. Effect of a suspension seat support chair on the trunk flexion angle and gluteal pressure during computer work.

    PubMed

    Yoo, Won-Gyu

    2015-09-01

    [Purpose] We assessed the effects of a suspension seat support chair on the trunk flexion angle and gluteal pressure during computer work. [Subjects] Ten males were recruited. [Methods] The suspension seat support was developed to prevent abnormal gluteal pressure and a slumped sitting posture during computer work. The gluteal pressure was measured with a TekScan system and the trunk flexion angle was measured with a video camera, to compare the differences between a general chair and the suspension seat support. [Results] The gluteal peak pressures were decreased significantly in the suspension seat support versus the general chair. The trunk flexion angle was also decreased significantly in the suspension seat support compared with the general chair. [Conclusions] This study suggests that the suspension seat support chair contributes to preventing abnormal gluteal pressure and a slumped sitting posture.

  1. Design of high pressure oxygen filter for extravehicular activity life support system, volume 1

    NASA Technical Reports Server (NTRS)

    Wilson, B. A.

    1977-01-01

    The experience of the National Aeronautics and Space Administration (NASA) with extravehicular activity life support emergency oxygen supply subsystems has shown a large number of problems associated with particulate contamination. These problems have resulted in failures of high pressure oxygen component sealing surfaces. A high pressure oxygen filter was designed which would (a) control the particulate contamination level in the oxygen system to a five-micron glass bead rating, ten-micron absolute condition (b) withstand the dynamic shock condition resulting from the sudden opening of 8000 psi oxygen system shutoff valve. Results of the following program tasks are reported: (1) contaminant source identification tests, (2) dynamic system tests, (3) high pressure oxygen filter concept evaluation, (4) design, (5) fabrication, (6) test, and (7) application demonstration.

  2. A new system for continuous and remote monitoring of patients receiving home mechanical ventilation

    NASA Astrophysics Data System (ADS)

    Battista, L.

    2016-09-01

    Home mechanical ventilation is the treatment of patients with respiratory failure or insufficiency by means of a mechanical ventilator at a patient's home. In order to allow remote patient monitoring, several tele-monitoring systems have been introduced in the last few years. However, most of them usually do not allow real-time services, as they have their own proprietary communication protocol implemented and some ventilation parameters are not always measured. Moreover, they monitor only some breaths during the whole day, despite the fact that a patient's respiratory state may change continuously during the day. In order to reduce the above drawbacks, this work reports the development of a novel remote monitoring system for long-term, home-based ventilation therapy; the proposed system allows for continuous monitoring of the main physical quantities involved during home-care ventilation (e.g., differential pressure, volume, and air flow rate) and is developed in order to allow observations of different remote therapy units located in different places of a city, region, or country. The developed remote patient monitoring system is able to detect various clinical events (e.g., events of tube disconnection and sleep apnea events) and has been successfully tested by means of experimental tests carried out with pulmonary ventilators typically used to support sick patients.

  3. International Space Station Environmental Control and Life Support System: Verification for the Pressurized Mating Adapters

    NASA Technical Reports Server (NTRS)

    Williams, David E.

    2007-01-01

    The International Space Station (ISS) Pressurized Mating Adapters (PMAs) Environmental Control and Life Support (ECLS) System is comprised of three subsystems: Atmosphere Control and Supply (ACS), Temperature and Humidity Control (THC), and Water Recovery and Management (WRM). PMA 1 and PMA 2 flew to ISS on Flight 2A and PMA 3 flew to ISS on Flight 3A. This paper provides a summary of the PMAs ECLS design and the detailed Element Verification methodologies utilized during the Qualification phase for the PMAs.

  4. ORION Environmental Control and Life Support Systems Suit Loop and Pressure Control Analysis

    NASA Technical Reports Server (NTRS)

    Eckhardt, Brad; Conger, Bruce; Stambaugh, Imelda C.

    2015-01-01

    Under NASA's ORION Multi-Purpose Crew Vehicle (MPCV) Environmental Control and Life Support System (ECLSS) Project at Johnson Space Center's (JSC), the Crew and Thermal Systems Division has developed performance models of the air system using Thermal Desktop/FloCAD. The Thermal Desktop model includes an Air Revitalization System (ARS Loop), a Suit Loop, a Cabin Loop, and Pressure Control System (PCS) for supplying make-up gas (N2 and O2) to the Cabin and Suit Loop. The ARS and PCS are designed to maintain air quality at acceptable O2, CO2 and humidity levels as well as internal pressures in the vehicle Cabin and during suited operations. This effort required development of a suite of Thermal Desktop Orion ECLSS models to address the need for various simulation capabilities regarding ECLSS performance. An initial highly detailed model of the ARS Loop was developed in order to simulate rapid pressure transients (water hammer effects) within the ARS Loop caused by events such as cycling of the Pressurized Swing Adsorption (PSA) Beds and required high temporal resolution (small time steps) in the model during simulation. A second ECLSS model was developed to simulate events which occur over longer periods of time (over 30 minutes) where O2, CO2 and humidity levels, as well as internal pressures needed to be monitored in the cabin and for suited operations. Stand-alone models of the PCS and the Negative Pressure relief Valve (NPRV) were developed to study thermal effects within the PCS during emergency scenarios (Cabin Leak) and cabin pressurization during vehicle re-entry into Earth's atmosphere. Results from the Orion ECLSS models were used during Orion Delta-PDR (July, 2014) to address Key Design Requirements (KDR's) for Suit Loop operations for multiple mission scenarios.

  5. The Role of Internalized Stereotyping, Parental Pressure, and Parental Support on Asian Americans' Choice of College Major

    ERIC Educational Resources Information Center

    Shen, Frances C.

    2015-01-01

    The author explored the relationship between internalized stereotyping, parental pressure, and parental support on major choices among 315 Asian American undergraduate and graduate students. Results indicated that parental support, but not parental pressure, toward certain majors was associated with more stereotypical major choices. In addition,…

  6. An air bearing fan for EVA suit ventilation

    NASA Technical Reports Server (NTRS)

    Murry, Roger P.

    1990-01-01

    The portable life-support system (PLSS) ventilation requirements are outlined, along with the application of a high-speed axial fan technology for extravehicular-activity (EVA) space-suit ventilation. Focus is placed on a mechanical design employing high-speed gas bearings, permanent magnet rotor, and current-fed chopper/inverter electronics. The operational characteristics of the fan unit and its applicability for use in a pure-oxygen environment are discussed. It delivers a nominal 0.17 cu m/min at 1.24 kPa pressure rise using 13.8 w of input power. It is shown that the overall selection of materials for all major component meets the NASA requirements.

  7. Use of Pressure-Redistributing Support Surfaces among Elderly Hip Fracture Patients across the Continuum of Care: Adherence to Pressure Ulcer Prevention Guidelines

    ERIC Educational Resources Information Center

    Baumgarten, Mona; Margolis, David; Orwig, Denise; Hawkes, William; Rich, Shayna; Langenberg, Patricia; Shardell, Michelle; Palmer, Mary H.; McArdle, Patrick; Sterling, Robert; Jones, Patricia S.; Magaziner, Jay

    2010-01-01

    Purpose: To estimate the frequency of use of pressure-redistributing support surfaces (PRSS) among hip fracture patients and to determine whether higher pressure ulcer risk is associated with greater PRSS use. Design and Methods: Patients (n = 658) aged [greater than or equal] 65 years who had surgery for hip fracture were examined by research…

  8. Influence of lower body pressure support on the walking patterns of healthy children and adults.

    PubMed

    Kurz, Max J; Deffeyes, Joan E; Arpin, David J; Karst, Gregory M; Stuberg, Wayne A

    2012-11-01

    The purpose of this investigation was to evaluate the effect of a lower body positive pressure support system on the joint kinematics and activity of the lower extremity antigravity musculature of adults and children during walking. Adults (age = 25 ± 4 years) and children (age = 13 ± 2 years) walked at a preferred speed and a speed that was based on the Froude number, while 0-80% of their body weight was supported. Electrogoniometers were used to monitor knee and ankle joint kinematics. Surface electromyography was used to quantify the magnitude of the vastus lateralis and gastrocnemius muscle activity. There were three key findings: (1) The lower extremity joint angles and activity of the lower extremity antigravity muscles of children did not differ from those of adults. (2) The magnitude of the changes in the lower extremity joint motion and antigravity muscle activity was dependent upon an interaction between body weight support and walking speed. (3) Lower body positive pressure support resulted in reduced activation of the antigravity musculature, and reduced range of motion of the knee and ankle joints.

  9. Prediction of pore-water pressure response to rainfall using support vector regression

    NASA Astrophysics Data System (ADS)

    Babangida, Nuraddeen Muhammad; Mustafa, Muhammad Raza Ul; Yusuf, Khamaruzaman Wan; Isa, Mohamed Hasnain

    2016-11-01

    Nonlinear complex behavior of pore-water pressure responses to rainfall was modelled using support vector regression (SVR). Pore-water pressure can rise to disturbing levels that may result in slope failure during or after rainfall. Traditionally, monitoring slope pore-water pressure responses to rainfall is tedious and expensive, in that the slope must be instrumented with necessary monitors. Data on rainfall and corresponding responses of pore-water pressure were collected from such a monitoring program at a slope site in Malaysia and used to develop SVR models to predict pore-water pressure fluctuations. Three models, based on their different input configurations, were developed. SVR optimum meta-parameters were obtained using k-fold cross validation and a grid search. Model type 3 was adjudged the best among the models and was used to predict three other points on the slope. For each point, lag intervals of 30 min, 1 h and 2 h were used to make the predictions. The SVR model predictions were compared with predictions made by an artificial neural network model; overall, the SVR model showed slightly better results. Uncertainty quantification analysis was also performed for further model assessment. The uncertainty components were found to be low and tolerable, with d-factor of 0.14 and 74 % of observed data falling within the 95 % confidence bound. The study demonstrated that the SVR model is effective in providing an accurate and quick means of obtaining pore-water pressure response, which may be vital in systems where response information is urgently needed.

  10. Solar ventilation and tempering

    NASA Astrophysics Data System (ADS)

    Adámek, Karel; Pavlů, Miloš; Bandouch, Milan

    2014-08-01

    The paper presents basic information about solar panels, designed, realized and used for solar ventilation of rooms. Used method of numerical flow simulation gives good overview about warming and flowing of the air in several kinds of realized panels (window, facade, chimney). Yearlong measurements give a good base for calculations of economic return of invested capital. The operation of the system in transient period (spring, autumn) prolongs the period without classical heating of the room or building, in winter the classical heating is supported. In the summer period the system, furnished with chimney, can exhaust inner warm air together with necessary cooling of the system by gravity circulation, only. System needs not any invoiced energy source; it is supplied entirely by solar energy. Large building systems are supported by classical electric fan respectively.

  11. Standardizing Support Surface Testing and Reporting: A National Pressure Ulcer Advisory Panel Executive Summary.

    PubMed

    Stone, Arthur; Brienza, David; Call, Evan; Fontaine, Rick; Goldberg, Margaret; Hong, K Z; Jordan, Rosalyn; Lachenbruch, Charlie; LaFleche, Patrick; Sylvia, Cindy

    2015-01-01

    In 2001, the National Pressure Ulcer Advisory Panel's Research Committee identified the need to create uniform terminology, test methods, and reporting technical standards for support surfaces. As a result, the S3I Committee was formed and initial meetings of interested stakeholders who included clinicians, researchers, academics, manufacturers, providers, and regulators were held. The group's initial goal was to (1) establish common language to facilitate understanding by developing standardized terminology for describing and discussing support surfaces, (2) establish a suite of standardized tests of performance capable of repeatedly, reliably, and accurately reporting upon characteristics common to all support surfaces that are believed to be related to the extrinsic risk factors associated with skin breakdown, as indicated by the literature to date, and (3) identify and standardize methods to evaluate the effective life of a support surface. The purpose of this article was to summarize the current status of the effort of the Support Surface Standards Initiative (S3I) Committee to identify and standardize methods to evaluate the many characteristic factors that determine the effective life of a support surface.

  12. Consequence evaluation of radiation embrittlement of Trojan reactor pressure vessel supports

    SciTech Connect

    Lu, S.C.; Sommer, S.C.; Johnson, G.L. ); Lambert, H.E. )

    1990-10-01

    This report describes a consequence evaluation to address safety concerns raised by the radiation embrittlement of the reactor pressure vessel (RPV) supports for the Trojan nuclear power plant. The study comprises a structural evaluation and an effects evaluation and assumes that all four reactor vessel supports have completely lost the load carrying capability. By demonstrating that the ASME code requirements governing Level D service limits are satisfied, the structural evaluation concludes that the Trojan reactor coolant loop (RCL) piping is capable of transferring loads to the steam generator (SG) supports and the reactor coolant pump (RCP) supports. A subsequent design margins to accommodate additional loads transferred to them through the RCL piping. The effects evaluation, employing a systems analysis approach, investigates initiating events and the reliability of the engineered safeguard systems as the RPV is subject to movements caused by the RPV support failure. The evaluation identifies a number of areas of additional safety concerns, but further investigation of the above safety concerns, however, concludes that a hypothetical failure of the Trojan RPV supports due to radiation embrittlement will not result in consequences of significant safety concerns.

  13. VENTILATION MODEL REPORT

    SciTech Connect

    V. Chipman

    2002-10-31

    The purpose of the Ventilation Model is to simulate the heat transfer processes in and around waste emplacement drifts during periods of forced ventilation. The model evaluates the effects of emplacement drift ventilation on the thermal conditions in the emplacement drifts and surrounding rock mass, and calculates the heat removal by ventilation as a measure of the viability of ventilation to delay the onset of peak repository temperature and reduce its magnitude. The heat removal by ventilation is temporally and spatially dependent, and is expressed as the fraction of heat carried away by the ventilation air compared to the fraction of heat produced by radionuclide decay. One minus the heat removal is called the wall heat fraction, or the remaining amount of heat that is transferred via conduction to the surrounding rock mass. Downstream models, such as the ''Multiscale Thermohydrologic Model'' (BSC 2001), use the wall heat fractions as outputted from the Ventilation Model to initialize their postclosure analyses.

  14. RADIATION PRESSURE-SUPPORTED ACCRETION DISKS: VERTICAL STRUCTURE, ENERGY ADVECTION, AND CONVECTIVE STABILITY

    SciTech Connect

    Gu Weimin

    2012-07-10

    By taking into account the local energy balance per unit volume between the viscous heating and the advective cooling plus the radiative cooling, we investigate the vertical structure of radiation pressure-supported accretion disks in spherical coordinates. Our solutions show that the photosphere of the disk is close to the polar axis and therefore the disk seems to be extremely thick. However, the density profile implies that most of the accreted matter exists in a moderate range around the equatorial plane. We show that the well-known polytropic relation between the pressure and the density is unsuitable for describing the vertical structure of radiation pressure-supported disks. More importantly, we find that the energy advection is significant even for slightly sub-Eddington accretion disks. We argue that the non-negligible advection may help us understand why the standard thin disk model is likely to be inaccurate above {approx}0.3 Eddington luminosity, which was found by some works on black hole spin measurement. Furthermore, the solutions satisfy the Solberg-Hoiland conditions, which indicate the disk to be convectively stable. In addition, we discuss the possible link between our disk model and ultraluminous X-ray sources.

  15. Reasons for changes in the value of unit pressure of compression products supporting external treatment

    NASA Astrophysics Data System (ADS)

    Kowalski, K.; Ilska, A.; Kłonowska, M.

    2016-07-01

    The paper presents the basics of modelling compression products with intended values of unit pressure for body circumferences with fixed and variable radius of curvature. The derived relationships referring to the dimensions of the fabric's circumferences in a relaxed state of the product were based on Laplace law, local values of the radius of curvature, and the characteristics of stretching and relaxing (deformation) of the knitted fabric, described by experimental relation for the stress and relaxation phase for the 6th hysteresis loop, taking into account confidence intervals. The article indicates the possibilities of using 3D scanning techniques of the human body to identify the radius of curvature of various circumference of the human silhouette, for which the intended value of the unit pressure is designed, and quantitative changes in the body deformation due to compression. Classic method of modelling and design of compression products, based on a cylindrical model of the human body does not provide in each case the intended value of unit pressure, according to specific normative requirements, because it neglects the effect of different values of the radius of curvature of the body circumference and the properties of the viscoelastic knitted fabrics. The model and experimental research allowed for a quantitative and qualitative assessment of the reasons for the changes in the value of unit pressure of compression products supporting the process of external treatment.

  16. Physiological Responses During the Lower Body Positive Pressure Supported Treadmill Test

    PubMed Central

    2016-01-01

    Objective To quantify changes in cardiopulmonary function using a lower body positive pressure supported (LBPPS) treadmill during the exercise tolerance test (ETT) in healthy subjects before applying the LBPPS treadmill in patients with gait problems. Methods We evaluated 30 healthy subjects who were able to walk independently. The ETT was performed using the Modified Bruce Protocol (stages 1–5) at four levels (0%, 40%, 60%, and 80%) of LBPPS. The time interval at each level of the LBPPS treadmill test was 20 minutes to recover to baseline status. We measured systolic blood pressure, diastolic blood pressure, peak heart rate (PHR), rating of perceived exertion (RPE), metabolic equivalents (METs), and oxygen consumption rate (VO2) during each LBPPS condition. Results Systolic blood pressure increased as the LBPPS level was increased (40% to 80%). PHR, RPE, METs, and VO2 were negatively associated with the LBPPS condition, although they were not always significant different among the LBPPS levels. The equation from a random effect linear regression model was as follows: VO2 (mL/kg/min)=(2.75×stage)+(–0.14×LBPPS level)+11.9 (r2=0.69). Conclusion Detection of the changes in physiological parameters during a submaximal ETT using the LBPPS system may be helpful for applying the LBPPS treadmill in patients who cannot perform the ETT due to gait problems, even at submaximal intensity. PMID:27847722

  17. Ventilation Inception and Washout, Scaling, and Effects on Hydrodynamic Performance of a Surface Piercing Strut

    NASA Astrophysics Data System (ADS)

    Harwood, Casey; Young, Yin Lu; Ceccio, Steven

    2014-11-01

    High-lift devices that operate at or near a fluid free surface (such as surface-piercing or shallowly-submerged propellers and hydrofoils) are prone to a multiphase flow phenomenon called ventilation, wherein non-condensable gas is entrained in the low-pressure flow, forming a cavity around the body and dramatically altering the global hydrodynamic forces. Experiments are being conducted at the University of Michigan's towing tank using a canonical surface-piercing strut to investigate atmospheric ventilation. The goals of the work are (i) to gain an understanding of the dominant physics in fully wetted, partially ventilated, and fully ventilated flow regimes, (ii) to quantify the effects of governing dimensionless parameters on the transition between flow regimes, and (iii) to develop scaling relations for the transition between flow regimes. Using theoretical arguments and flow visualization techniques, new criteria are developed for classifying flow regimes and transition mechanisms. Unsteady transition mechanisms are described and mapped as functions of the governing non-dimensional parameters. A theoretical scaling relationship is developed for ventilation washout, which is shown to adequately capture the experimentally-observed washout boundary. This material is based upon work supported by the National Science Foundation Graduate Student Research Fellowship under Grant No. DGE 1256260. Support also comes from the Naval Engineering Education Center (Award No. N65540-10-C-003).

  18. An Environmental Control and Life Support System Concept for a Pressurized Lunar Rover

    NASA Technical Reports Server (NTRS)

    Bagdigian, Robert M.; Stambaugh, Imelda

    2010-01-01

    Pressurized rovers can add many attractive capabilities to a human lunar exploration campaign, most notably by extending the reach of astronauts far beyond the immediate vicinities of lunar landers and fixed assets such as habitats. Effective campaigns will depend on an efficient allocation of environmental control and life support system (ECLSS) equipment amongst mobile rovers and fixed habitats such that widespread and sustainable exploration can be achieved. This paper will describe some of the key drivers that influence the design of an ECLSS for a pressurized lunar rover and a conceptual design that has been formulated to address those drivers. Opportunities to realize programmatic and operational efficiencies through commonality of rover ECLSS and extravehicular activity (EVA) equipment have also been explored and will be described. Plans for the inclusion of ECLSS functionality in prototype lunar rovers will be summarized

  19. VENTILATION TECHNOLOGY SYSTEMS ANALYSIS

    EPA Science Inventory

    The report gives results of a project to develop a systems analysis of ventilation technology and provide a state-of-the-art assessment of ventilation and indoor air quality (IAQ) research needs. (NOTE: Ventilation technology is defined as the hardware necessary to bring outdoor ...

  20. Internally supported flexible duct joint. [device for conducting fluids in high pressure systems

    NASA Technical Reports Server (NTRS)

    Kuhn, R. F., Jr. (Inventor)

    1975-01-01

    An internally supported, flexible duct joint for use in conducting fluids under relatively high pressures in systems where relatively large deflection angles must be accommodated is presented. The joint includes a flexible tubular bellows and an elongated base disposed within the bellows. The base is connected through radiating struts to the bellows near mid-portion and to each of the opposite end portions of the bellows through a pivotal connecting body. A motion-controlling linkage is provided for linking the connecting bodies, whereby angular displacement of the joint is controlled and uniformity in the instantaneous bend radius of the duct is achieved as deflection is imposed.

  1. Space Suit Portable Life Support System Rapid Cycle Amine Repackaging and Sub-Scale Test Results

    NASA Technical Reports Server (NTRS)

    Paul, Heather L.; Rivera, Fatonia L.

    2010-01-01

    NASA is developing technologies to meet requirements for an extravehicular activity (EVA) Portable Life Support System (PLSS) for exploration. The PLSS Ventilation Subsystem transports clean, conditioned oxygen to the pressure garment for space suit pressurization and human consumption, and recycles the ventilation gas, removing carbon dioxide, humidity, and trace contaminants. This paper provides an overview of the development efforts conducted at the NASA Johnson Space Center to redesign the Rapid Cycle Amine (RCA) canister and valve assembly into a radial flow, cylindrical package for carbon dioxide and humidity control of the PLSS ventilation loop. Future work is also discussed.

  2. Non-invasive detection of respiratory muscles activity during assisted ventilation.

    PubMed

    Heyer, Laurent; Baconnier, Pierre F; Eberhard, André; Biot, Loïc; Viale, Jean-Paul; Perdrix, Jean-Pierre; Carry, Pierre-Yves

    2002-04-01

    The instantaneous pressure applied by the respiratory muscles [Pmus(t)] of a patient under ventilatory support may be continuously assessed with the help of a model of the passive respiratory system updated cycle by cycle. Inspiratory activity (IA) is considered present when Pmus goes below a given threshold. In six patients, we compared IA with (i) inspiratory activity (IAref) obtained from esophageal pressure and diaphragmatic EMG and (ii) that (IAvent) detected by the ventilator. In any case, a ventilator support onset coincides with an IA onset but the opposite is not true. IA onset is always later than IAref beginning ((0.21 +/- 0.10 s) and IA end always precedes IAref end (0.46 +/- 0.16 s). These results clearly deteriorate when the model is not updated.

  3. The effect of changing ventilator settings on indices of ventilation inhomogeneity in small ventilated lungs

    PubMed Central

    Schmalisch, G; Proquitté, H; Roehr, CC; Wauer, RR

    2006-01-01

    Background In ventilated newborns the use of multiple breath washout (MBW) techniques for measuring both lung volume and ventilation inhomogeneity (VI) is hampered by the comparatively high dead space fraction. We studied how changes in ventilator settings affected VI indices in this particular population. Methods Using a computer simulation of a uniformly ventilated volume the interaction between VI indices (lung clearance index (LCI), moment ratios (M1/M0, M2/M0, AMDN1, AMDN2) of the washout curve) and tidal volume (VT), dead space (VD) and functional residual capacity (FRC) were calculated. The theoretical results were compared with measurements in 15 ventilated piglets (age <12 h, median weight 1135 g) by increasing the peak inspiratory pressure (PIP). FRC and VI indices were measured by MBW using 0.8% heptafluoropropane as tracer gas. Results The computer simulation showed that the sensitivity of most VI indices to changes in VD/VT and VT/FRC increase, in particular for VD/VT > 0.5. In piglets, the raised PIP caused a significant increase of VT from 15.4 ± 9.5 to 21.9 ± 14.7 (p = 0.003) and of the FRC from 31.6 ± 14.7 mL to 35.0 ± 15.9 mL (p = 0.006), whereas LCI (9.15 ± 0.75 to 8.55 ± 0.74, p = 0.019) and the moment ratios M1/M0, M2/M0 (p < 0.02) decreased significantly. No significant changes were seen in AMDN1 and AMDN2. The within-subject variability of the VI indices (coefficient of variation in brackets) was distinctly higher (LCI (9.8%), M1/M0 (6.6%), M2/M0 (14.6%), AMDN1 (9.1%), AMDN2 (16.3%)) compared to FRC measurements (5.6%). Computer simulations showed that significant changes in VI indices were exclusively caused by changes in VT and FRC and not by an improvement of the homogeneity of alveolar ventilation. Conclusion In small ventilated lungs with a high dead space fraction, indices of VI may be misinterpreted if the changes in ventilator settings are not considered. Computer simulations can help to prevent this misinterpretation. PMID

  4. DEMAND CONTROLLED VENTILATION AND CLASSROOM VENTILATION

    SciTech Connect

    Fisk, William J.; Mendell, Mark J.; Davies, Molly; Eliseeva, Ekaterina; Faulkner, David; Hong, Tienzen; Sullivan, Douglas P.

    2014-01-06

    This document summarizes a research effort on demand controlled ventilation and classroom ventilation. The research on demand controlled ventilation included field studies and building energy modeling. Major findings included: ? The single-location carbon dioxide sensors widely used for demand controlled ventilation frequently have large errors and will fail to effectively control ventilation rates (VRs).? Multi-location carbon dioxide measurement systems with more expensive sensors connected to multi-location sampling systems may measure carbon dioxide more accurately.? Currently-available optical people counting systems work well much of the time but have large counting errors in some situations. ? In meeting rooms, measurements of carbon dioxide at return-air grilles appear to be a better choice than wall-mounted sensors.? In California, demand controlled ventilation in general office spaces is projected to save significant energy and be cost effective only if typical VRs without demand controlled ventilation are very high relative to VRs in codes. Based on the research, several recommendations were developed for demand controlled ventilation specifications in the California Title 24 Building Energy Efficiency Standards.The research on classroom ventilation collected data over two years on California elementary school classrooms to investigate associations between VRs and student illness absence (IA). Major findings included: ? Median classroom VRs in all studied climate zones were below the California guideline, and 40percent lower in portable than permanent buildings.? Overall, one additional L/s per person of VR was associated with 1.6percent less IA. ? Increasing average VRs in California K-12 classrooms from the current average to the required level is estimated to decrease IA by 3.4percent, increasing State attendance-based funding to school districts by $33M, with $6.2 M in increased energy costs. Further VR increases would provide additional benefits

  5. Predicted Sizes of Pressure-supported HI Clouds in the Outskirts of the Virgo Cluster

    NASA Astrophysics Data System (ADS)

    Burkhart, Blakesley; Loeb, Abraham

    2016-06-01

    Using data from the ALFALFA AGES Arecibo HI survey of galaxies and the Virgo cluster X-ray pressure profiles from XMM-Newton, we investigate the possibility that starless dark HI clumps, also known as “dark galaxies,” are supported by external pressure in the surrounding intercluster medium. We find that the starless HI clump masses, velocity dispersions, and positions allow these clumps to be in pressure equilibrium with the X-ray gas near the virial radius of the Virgo cluster. We predict the sizes of these clumps to range from 1 to 10 kpc, in agreement with the range of sizes found for spatially resolved HI starless clumps outside of Virgo. Based on the predicted HI surface density of the Virgo sources, as well as a sample of other similar resolved ALFALFA HI dark clumps with follow-up optical/radio observations, we predict that most of the HI dark clumps are on the cusp of forming stars. These HI sources therefore mark the transition between starless HI clouds and dwarf galaxies with stars.

  6. Behavior of Supported Palladium Oxide Nanoparticles under Reaction Conditions, Studied with near Ambient Pressure XPS.

    PubMed

    Jürgensen, Astrid; Heutz, Niels; Raschke, Hannes; Merz, Klaus; Hergenröder, Roland

    2015-08-04

    Near ambient pressure X-ray photoelectron spectroscopy (NAP-XPS) is a promising method to close the "pressure gap", and thus, study the surface composition during heterogeneous reactions in situ. The specialized spectrometers necessary for this analytical technique have recently been adapted to operate with a conventional X-ray source, making it available for routine quantitative analysis in the laboratory. This is shown in the present in situ study of the partial oxidation of 2-propanol catalyzed with PdO nanoparticles supported on TiO2, which was investigated under reaction conditions as a function of gas composition (alcohol-to-oxygen ratio) and temperature. Exposure of the nanoparticles to 2-propanol at 30 °C leads to immediate partial reduction of the PdO, followed by a continuous reduction of the remaining PdO during heating. However, gaseous oxygen inhibits the reduction of PdO below 90 °C, and the oxidation of 2-propanol to carboxylates only occurs in the presence of oxygen above 90 °C. These results support the theory that metallic palladium is the active catalyst material, and they show that environmental conditions affect the nanoparticles and the reaction process significantly. The study also revealed challenges and limitations of this analytical method. Specifically, the intensity and fixed photon energy of a conventional X-ray source limit the spectral resolution and surface sensitivity of lab-based NAP-XPS, which affect precision and accuracy of the quantitative analysis.

  7. Infiltration as Ventilation: Weather-Induced Dilution

    SciTech Connect

    Sherman, Max H.; Turner, William J.N.; Walker, Iain S.

    2011-06-01

    The purpose of outdoor air ventilation is to dilute or remove indoor contaminants to which occupants are exposed. It can be provided by mechanical or natural means. In most homes, especially older homes, weather-driven infiltration provides the dominant fraction of the total ventilation. As we seek to provide good indoor air quality at minimum energy cost, it is important to neither over-ventilate nor under-ventilate. Thus, it becomes critically important to evaluate correctly the contribution infiltration makes to the total outdoor air ventilation rate. Because weather-driven infiltration is dependent on building air leakage and weather-induced pressure differences, a given amount of air leakage will provide different amounts of infiltration. Varying rates of infiltration will provide different levels of contaminant dilution and hence effective ventilation. This paper derives these interactions and then calculates the impact of weather-driven infiltration for different climates. A new “N-factor” is introduced to provide a convenient method for calculating the ventilation contribution of infiltration for over 1,000 locations across North America. The results of this work could be used in indoor air quality standards (specifically ASHRAE 62.2) to account for the contribution of weather-driven infiltration towards the dilution of indoor pollutants.

  8. Development of Designer Diamond Technology for High Pressure High Temperature Experiments in Support of Stockpile Stewardship Program

    SciTech Connect

    Vohra, Yogesh, K.

    2009-10-28

    The role of nitrogen in the fabrication of designer diamond was systematically investigated by adding controlled amount of nitrogen in hydrogen/methane/oxygen plasma. This has led to a successful recipe for reproducible fabrication of designer diamond anvils for high-pressure high-temperature research in support of stockpile stewardship program. In the three-year support period, several designer diamonds fabricated with this new growth chemistry were utilized in high-pressure experiments at UAB and Lawrence Livermore National Laboratory. The designer diamond anvils were utilized in high-pressure studies on heavy rare earth metals, high pressure melting studies on metals, and electrical resistance measurements on iron-based layered superconductors under high pressures. The growth chemistry developed under NNSA support can be adapted for commercial production of designer diamonds.

  9. Potential model for single-sided naturally ventilated buildings in China

    SciTech Connect

    Wei, Yin; Guo-qiang, Zhang; Jing, Liu; San-xian, Xia; Xiao, Wang

    2010-09-15

    The paper investigates a single-sided naturally ventilated buildings potential model considering number of factors in China. This model can be used to estimate potential of natural ventilation via local climate data and building parameters. The main goal of the model is to predict natural ventilation hours and hourly ventilation flow rate. In fluid model, formula of single-sided natural ventilation by coupling wind pressure and temperature difference was used to calculate air flow rate. Accordingly, the paper analyzed four typical cities in different climate region in China and calculated pressure difference Pascal hours (PDPH). The results show that single-sided ventilation has fewer adaptive comfort hours than two-sided ventilation and much less ventilation volume. This model provided quantitative information for early stage architectural natural ventilation design and building energy efficiency evaluation. (author)

  10. Convexity, Jensen's inequality, and benefits of noisy or biologically variable life support (Keynote Address)

    NASA Astrophysics Data System (ADS)

    Mutch, W. Alan C.

    2005-05-01

    Life support with a mechanical ventilator is used to manage patients with a variety of lung diseases including acute respiratory distress syndrome (ARDS). Recently, management of ARDS has concentrated on ventilating at lower airway pressure using lower tidal volume. A large international study demonstrated a 22% reduction in mortality with the low tidal volume approach. The potential advantages of adding physiologic noise with fractal characteristics to the respiratory rate and tidal volume as delivered by a mechanical ventilator are discussed. A so-called biologically variable ventilator (BVV), incorporating such noise, has been developed. Here we show that the benefits of noisy ventilation - at lower tidal volumes - can be deduced from a simple probabilistic result known as Jensen"s Inequality. Using the local convexity of the pressure-volume relationship in the lung we demonstrate that the addition of noise results in higher mean tidal volume or lower mean airway pressure. The consequence is enhanced gas exchange or less stress on the lungs, both clinically desirable. Jensen"s Inequality has important considerations in engineering, information theory and thermodynamics. Here is an example of the concept applied to medicine that may have important considerations for the clinical management of critically ill patients. Life support devices, such as mechanical ventilators, are of vital use in critical care units and operating rooms. These devices usually have monotonous output. Improving mechanical ventilators and other life support devices may be as simple as adding noise to their output signals.

  11. Mechanical ventilation and respiratory mechanics during equine anesthesia.

    PubMed

    Moens, Yves

    2013-04-01

    The mechanical ventilation of horses during anesthesia remains a crucial option for optimal anesthetic management, if the possible negative cardiovascular side effects are managed, because this species is prone to hypercapnia and hypoxemia. The combined use of capnography and pitot-based spirometry provide complementary information on ventilation and respiratory mechanics, respectively. This facilitates management of mechanical ventilation in conditions of changing respiratory system compliance (ie, laparoscopy) and when investigating new ventilatory strategies including alveolar recruitment maneuvers and optimization of positive expiratory pressure.

  12. Special Considerations in Neonatal Mechanical Ventilation.

    PubMed

    Dalgleish, Stacey; Kostecky, Linda; Charania, Irina

    2016-12-01

    Care of infants supported with mechanical ventilation is complex, time intensive, and requires constant vigilance by an expertly prepared health care team. Current evidence must guide nursing practice regarding ventilated neonates. This article highlights the importance of common language to establish a shared mental model and enhance clear communication among the interprofessional team. Knowledge regarding the underpinnings of an open lung strategy and the interplay between the pathophysiology and individual infant's response to a specific ventilator strategy is most likely to result in a positive clinical outcome.

  13. Ventilator-induced lung injury in preterm infants

    PubMed Central

    Carvalho, Clarissa Gutierrez; Silveira, Rita C; Procianoy, Renato Soibelmann

    2013-01-01

    In preterm infants, the need for intubation and mechanical ventilation is associated with ventilator-induced lung injuries and subsequent bronchopulmonary dysplasia. The aim of the present review was to improve the understanding of the mechanisms of injury that involve cytokine-mediated inflammation to contribute to the development of new preventive strategies. Relevant articles were retrieved from the PubMed database using the search terms "ventilator-induced lung injury preterm", "continuous positive airway pressure", "preterm", and "bronchopulmonary dysplasia". The resulting data and other relevant information were divided into several topics to ensure a thorough, critical view of ventilation-induced lung injury and its consequences in preterm infants. The role of pro-inflammatory cytokines (particularly interleukins 6 and 8 and tumor necrosis factor alpha) as mediators of lung injury was assessed. Evidence from studies conducted with animals and human newborns is described. This evidence shows that brief periods of mechanical ventilation is sufficient to induce the release of pro-inflammatory cytokines. Other forms of mechanical and non-invasive ventilation were also analyzed as protective alternatives to conventional mechanical ventilation. It was concluded that non-invasive ventilation, intubation followed by early surfactant administration and quick extubation for nasal continuous positive airway pressure, and strategies that regulate tidal volume and avoid volutrauma (such as volume guarantee ventilation) protect against ventilator-induced lung injury in preterm infants. PMID:24553514

  14. Effects of arginine vasopressin on oxygenation and haemodynamics during one-lung ventilation in an animal model.

    PubMed

    Hüter, L; Schwarzkopf, K; Preussler, N P; Gaser, E; Bauer, R; Schubert, H; Schreiber, T

    2008-03-01

    In a case of arterial hypotension during one-lung ventilation, haemodynamic support may be required to maintain adequate mean arterial pressure. Arginine vasopressin, a potent systemic vasoconstrictor with limited effects on the pulmonary artery pressure, has not been studied in this setting. Twelve female pigs were anaesthetised and ventilated and arterial, central venous and pulmonary artery catheters were inserted. A left-sided double lumen tube was placed via tracheostomy and one-lung ventilation was initiated. The animals were in the left lateral position, with the left lung ventilated and right lung collapsed. Respiratory and haemodynamic values were recorded before and during a continuous infusion of arginine vasopressin sufficient to double the mean arterial pressure. The arginine vasopressin caused a decrease in cardiac output (3.8+/-1.1 vs. 2.7+/-0.7 l/min, P <0.001) and mixed-venous oxygen tension (39.1+/-5.8 vs. 34.4+/-5 mmHg, P=0.003). Pulmonary artery pressure was unchanged (24+/-2 vs. 24+/-3 mmHg, P=0.682). There was no effect of the arginine vasopressin on arterial oxygen tension (226+/-106 vs. 231+/-118 mmHg, P=0.745). However, there was a significant decrease in shunt fraction (28.3+/-6.2 vs. 24.3+/-7.8%, P=0.043) and a significant proportional increase in perfusion of the ventilated lung (78.8+/-9.5 vs. 85.5+/-7.9%, P=0.036). In our animal model of one-lung ventilation, doubling mean arterial pressure by infusion of arginine vasopressin significantly affected global haemodynamics, but had no influence on systemic arterial oxygen tension.

  15. Nasal mask ventilation is better than face mask ventilation in edentulous patients

    PubMed Central

    Kapoor, Mukul Chandra; Rana, Sandeep; Singh, Arvind Kumar; Vishal, Vindhya; Sikdar, Indranil

    2016-01-01

    Background and Aims: Face mask ventilation of the edentulous patient is often difficult as ineffective seating of the standard mask to the face prevents attainment of an adequate air seal. The efficacy of nasal ventilation in edentulous patients has been cited in case reports but has never been investigated. Material and Methods: Consecutive edentulous adult patients scheduled for surgery under general anesthesia with endotracheal intubation, during a 17-month period, were prospectively evaluated. After induction of anesthesia and administration of neuromuscular blocker, lungs were ventilated with a standard anatomical face mask of appropriate size, using a volume controlled anesthesia ventilator with tidal volume set at 10 ml/kg. In case of inadequate ventilation, the mask position was adjusted to achieve best-fit. Inspired and expired tidal volumes were measured. Thereafter, the face mask was replaced by a nasal mask and after achieving best-fit, the inspired and expired tidal volumes were recorded. The difference in expired tidal volumes and airway pressures at best-fit with the use of the two masks and number of patients with inadequate ventilation with use of the masks were statistically analyzed. Results: A total of 79 edentulous patients were recruited for the study. The difference in expiratory tidal volumes with the use of the two masks at best-fit was statistically significant (P = 0.0017). Despite the best-fit mask placement, adequacy of ventilation could not be achieved in 24.1% patients during face mask ventilation, and 12.7% patients during nasal mask ventilation and the difference was statistically significant. Conclusion: Nasal mask ventilation is more efficient than standard face mask ventilation in edentulous patients. PMID:27625477

  16. Pressure and Humidity Measurements at the MSL Landing Site Supported by Modeling of the Atmospheric Conditions

    NASA Astrophysics Data System (ADS)

    Harri, A.; Savijarvi, H. I.; Schmidt, W.; Genzer, M.; Paton, M.; Kauhanen, J.; Atlaskin, E.; Polkko, J.; Kahanpaa, H.; Kemppinen, O.; Haukka, H.

    2012-12-01

    of 0 - 100%RH in temperature range of -70°C - +25°C. Its survival temperature is as low as -135°C. The pressure device has overall dimensions of 62 x 55 x 17 mm. It weighs 35 g, and consumes 15 mW of power. The sensor makes use of two transducers placed on a single multi-layer PCB and protected by box-like FR4 Faraday cages. The transducers of the pressure device can be used in turn, thus providing redundancy and improved reliability. The pressure device measurement range is 0 - 1025 hPa in temperature range of -45°C - +55°C, but its calibration is optimized for the Martian pressure range of 4 - 12 hPa. In support of the in situ measurements we have analyzed the atmospheric conditions at the MSL landing site at the Gale crater by utilizing mesoscale and limited area models. The compatibility of the results of these modeling tools with the actual environmental conditions will be discussed.

  17. [Cardiopulmonary resuscitation: risks and benefits of ventilation].

    PubMed

    Cordioli, Ricardo Luiz; Garelli, Valentina; Lyazidi, Aissam; Suppan, Laurent; Savary, Dominique; Brochard, Laurent; Richard, Jean-Christophe M

    2013-12-11

    Knowledge of the physiological mechanisms that govern cardiopulmonary interactions during cardiopulmonary resuscitation (CPR) allows to better assess risks and benefits of ventilation. Ventilation is required to maintain gas exchange, particularly when CPR is prolonged. Nevertheless, conventional ventilation (bag mask or mechanical ventilation) may be harmful when excessive or when chest compressions are interrupted. In fact large tidal volume and/or rapid respiratory rate may adversely compromise hemodynamic effects of chest compressions. In this regard, international recommendations that give the priority to chest compressions, are meaningful. Continuous flow insufflation with oxygen that generates a moderate positive airway pressure avoids any interruption of chest compressions and prevents the risk of lung injury associated with prolonged resuscitation.

  18. A requirement for reduced pressure and modified atmosphere composition in lunar and martian biological life support systems

    NASA Astrophysics Data System (ADS)

    Dixon, Mike; Stasiak, Michael; Wehkamp, Cara Ann; Lawson, Jamie

    The Controlled Environment Systems Research Facility at the PlaceTypeUniversity of Place- NameGuelph (country-regionplaceCanada) represents an extensive collection of variable pressure plant growth chambers devoted to the study of biological systems including plants and microbes, in life support roles for space exploration. To simplify engineering requirements for plant growth structures on the Moon or Mars, lower pressures are required in order to reduce mass and decrease atmospheric leakage. Few facilities exist that can provide low pressure plant growth capabilities coupled with complete control over temperature, vapour pressure deficit (humidity), gas composition, nutrient delivery, and pressure. The Controlled Environment Systems Research Facility maintains five canopy-scale hypobaric plant growth chambers with capabilities ideally suited for low pressure advanced life support research. System performance evaluations during low pressure experiments on radish (Raphanus sativa L. cv. Cherry Bomb II) have demonstrated temperature control of +/- 0.5 ° C, vapour pressure deficit control of +/- 0.5 mb, CO2 injection control of +/- 20 ` ımol mol-1 , and leakage rates of less than 1% per day. Keywords: hypobaric, plant growth chamber, advanced life support, controlled environment, low pressure, atmospheric control

  19. Performance of Portable Ventilators at Temperature Extremes

    DTIC Science & Technology

    2015-03-30

    support of patients requires ventilators deliver desired settings accurately. Consistent tidal volume ( VT ) is of critical importance, especially in...low VT (6 mL/kg of predicted body weight) improved mortality [1]. Other ventilator settings such as respiratory rate and positive end expiratory...Delivered and set VTs were compared using the American Society for Testing and Materials (ASTM) standard of ±10% of set VT [4]. Table 1. Pediatric

  20. Utilizing a Suited Manikin Test Apparatus and Space Suit Ventilation Loop to Evaluate Carbon Dioxide Washout

    NASA Technical Reports Server (NTRS)

    Chullen, Cinda; Conger, Bruce; Korona, Adam; Kanne, Bryan; McMillin, Summer; Paul, Thomas; Norcross, Jason; Alonso, Jesus Delgado; Swickrath, Mike

    2015-01-01

    NASA is pursuing technology development of an Advanced Extravehicular Mobility Unit (AEMU) which is an integrated assembly made up of primarily a pressure garment system and a portable life support subsystem (PLSS). The PLSS is further composed of an oxygen subsystem, a ventilation subsystem, and a thermal subsystem. One of the key functions of the ventilation system is to remove and control the carbon dioxide (CO2) delivered to the crewmember. Carbon dioxide washout is the mechanism by which CO2 levels are controlled within the space suit helmet to limit the concentration of CO2 inhaled by the crew member. CO2 washout performance is a critical parameter needed to ensure proper and robust designs that are insensitive to human variabilities in a space suit. A suited manikin test apparatus (SMTA) was developed to augment testing of the PLSS ventilation loop in order to provide a lower cost and more controlled alternative to human testing. The CO2 removal function is performed by the regenerative Rapid Cycle Amine (RCA) within the PLSS ventilation loop and its performance is evaluated within the integrated SMTA and Ventilation Loop test system. This paper will provide a detailed description of the schematics, test configurations, and hardware components of this integrated system. Results and analysis of testing performed with this integrated system will be presented within this paper.

  1. Utilizing a Suited Manikin Test Apparatus and Spacesuit Ventilation Loop to Evaluate Carbon Dioxide Washout

    NASA Technical Reports Server (NTRS)

    Chullen, Cinda; Conger, Bruce; Korona, Adam; Kanne, Bryan; McMillin, Summer; Norcross, Jason; Jeng, Frank; Swickrath, Mike

    2014-01-01

    NASA is pursuing technology development of an Advanced Extravehicular Mobility Unit (AEMU) which is an integrated assembly made up of primarily a pressure garment system and a Portable Life Support System (PLSS). The PLSS is further composed of an oxygen subsystem, a ventilation subsystem, and a thermal subsystem. One of the key functions of the ventilation system is to remove and control the carbon dioxide delivered to the crewmember. Carbon dioxide washout is the mechanism by which CO2 levels are controlled within the spacesuit helmet to limit the concentration of CO2 inhaled by the crew member. CO2 washout performance is a critical parameter needed to ensure proper and robust designs that are insensitive to human variabilities in a spacesuit. A Suited Manikin Test Apparatus (SMTA) is being developed to augment testing of the PLSS ventilation loop in order to provide a lower cost and more controlled alternative to human testing. The CO2 removal function is performed by the regenerative Rapid Cycle Amine (RCA) within the PLSS ventilation loop and its performance is evaluated within the integrated SMTA and Ventilation Loop test system. This paper will provide a detailed description of the schematics, test configurations, and hardware components of this integrated system. Results and analysis of testing performed with this integrated system will be presented within this paper.

  2. Outcome of Concurrent Occult Hemothorax and Pneumothorax in Trauma Patients Who Required Assisted Ventilation

    PubMed Central

    Mahmood, Ismail; Tawfeek, Zainab; El-Menyar, Ayman; Zarour, Ahmad; Afifi, Ibrahim; Kumar, Suresh; Latifi, Rifat; Al-Thani, Hassan

    2015-01-01

    Background. The management and outcomes of occult hemopneumothorax in blunt trauma patients who required mechanical ventilation are not well studied. We aimed to study patients with occult hemopneumothorax on mechanical ventilation who could be carefully managed without tube thoracostomy. Methods. Chest trauma patients with occult hemopneumothorax who were on mechanical ventilation were prospectively evaluated. The presence of hemopneumothorax was confirmed by CT scanning. Hospital length of stay, complications, and outcome were recorded. Results. A total of 56 chest trauma patients with occult hemopneumothorax who were on ventilatory support were included with a mean age of 36 ± 13 years. Hemopneumothorax was managed conservatively in 72% cases and 28% underwent tube thoracostomy as indicated. 29% of patients developed pneumonia, 16% had Acute Respiratory Distress Syndrome (ARDS), and 7% died. Thickness of hemothorax, duration of mechanical ventilation, and development of ARDS were significantly associated with tube thoracostomy in comparison to no-chest tube group. Conclusions. The majority of occult hemopneumothorax can be carefully managed without tube thoracostomy in patients who required positive pressure ventilation. Tube thoracotomy could be restricted to those who had evidence of increase in the size of the hemothorax or pneumothorax on follow-up chest radiographs or developed respiratory compromise. PMID:25785199

  3. Improved Blood Pressure Control Using an Interactive Mobile Phone Support System.

    PubMed

    Bengtsson, Ulrika; Kjellgren, Karin; Hallberg, Inger; Lindwall, Magnus; Taft, Charles

    2016-02-01

    This explorative, longitudinal study evaluated the effect of the daily use of a mobile phone-based self-management support system for hypertension in reducing blood pressure (BP) among 50 primary care patients with hypertension over 8 weeks. The self-management system comprises modules for (1) self-reports of BP, pulse, lifestyle, symptoms, and well-being; (2) delivery of reminders and encouragements; and (3) graphical feedback of self-reports. Daily use of the support system significantly reduced BP (systolic BP -7 mm Hg, diastolic BP -4.9 mm Hg) between baseline and week 8, with daily improvements leveling off as the study progressed. Three homogenous subsets of patients were identified who, despite different initial BP levels, showed similar decreases in BP during the study, indicating that patients benefited irrespective of baseline BP. In showing significant reductions in BP, our results suggest that the self-management support system may be a useful tool in clinical practice to help patients self-manage their hypertension.

  4. Improving blood pressure control in end stage renal disease through a supportive educative nursing intervention.

    PubMed

    Kauric-Klein, Zorica

    2012-01-01

    Hypertension in patients on hemodialysis (HD) contributes significantly to their morbidity and mortality. This study examined whether a supportive nursing intervention incorporating monitoring, goal setting, and reinforcement can improve blood pressure (BP) control in a chronic HD population. A randomized controlled design was used and 118 participants were recruited from six HD units in the Detroit metro area. The intervention consisted of (1) BP education sessions; (2) a 12-week intervention, including monitoring, goal setting, and reinforcement; and (3) a 30-day post-intervention follow-up period. Participants in the treatment were asked to monitor their BP, sodium, and fluid intake weekly for 12 weeks in weekly logs. BP, fluid and sodium logs were reviewed weekly with the researcher to determine if goals were met or not met. Reinforcement was given for goals met and problem solving offered when goals were not met. The control group received standard care. Both systolic and diastolic BPs were significantly decreased in the treatment group.

  5. Effects of back support on intra-abdominal pressure and lumbar kinetics during heavy lifting.

    PubMed

    Woodhouse, M L; McCoy, R W; Redondo, D R; Shall, L M

    1995-09-01

    Lumbosacral supports (LSSs) have been used to minimize the risk of lower back injuries. Theoretically, an LSS will raise intra-abdominal pressure (IAP) and reduce loads in the lower back region. This investigation compared three different LSSs with an unsupported condition. Nine males lifted a weighted box four times, once per condition, at 90% of their one-repetition maximum. Conditions were compared in terms of effects on IAP and its relieving force on L5-S1 kinetics. A multivariate analysis of covariance revealed no statistically significant differences among the three LSSs and the nonsupport conditions on the aforementioned dependent variables. This suggests that there is no difference among LSSs in terms of their biomechanical effects on the lower back region and that the use of any LSS does not necessarily afford more protection than a proper lift without one.

  6. 46 CFR 108.185 - Ventilation for enclosed classified locations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Section 108.185 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT Construction and Arrangement Ventilation § 108.185 Ventilation for... designed to maintain a pressure differential between the enclosed classified location and each...

  7. 46 CFR 108.185 - Ventilation for enclosed classified locations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Section 108.185 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT Construction and Arrangement Ventilation § 108.185 Ventilation for... designed to maintain a pressure differential between the enclosed classified location and each...

  8. Awake palliative thoracic surgery in a high-risk patient: one-lung, non-invasive ventilation combined with epidural blockade.

    PubMed

    Guarracino, F; Gemignani, R; Pratesi, G; Melfi, F; Ambrosino, N

    2008-07-01

    We report the case of a terminally ill cancer patient with recurrent pericardial and bilateral pleural effusions who was scheduled for video-assisted thoracoscopic surgery. The operation was performed with the patient awake under epidural anaesthesia. The patient's cough reflex in response to lung manipulation was successfully minimised by the inhalation of aerosolised lidocaine. Video-assisted thoracic surgery requires the exclusion of a lung from ventilation. In order to support one-lung spontaneous ventilation in this high-risk patient, we successfully used non-invasive bilevel positive airway pressure ventilation via a facemask. Based on this preliminary experience, we think that critically ill patients scheduled for palliative surgery can be successfully managed with the combination of minimally invasive surgical techniques and neuraxial block with non-invasive lung ventilation.

  9. [Ventilation in acute respiratory distress. Lung-protective strategies].

    PubMed

    Bruells, C S; Rossaint, R; Dembinski, R

    2012-11-01

    Ventilation of patients suffering from acute respiratory distress syndrome (ARDS) with protective ventilator settings is the standard in patient care. Besides the reduction of tidal volumes, the adjustment of a case-related positive end-expiratory pressure and preservation of spontaneous breathing activity at least 48 h after onset is part of this strategy. Bedside techniques have been developed to adapt ventilatory settings to the individual patient and the different stages of ARDS. This article reviews the pathophysiology of ARDS and ventilator-induced lung injury and presents current evidence-based strategies for ventilator settings in ARDS.

  10. Non-invasive ventilation in prone position for refractory hypoxemia after bilateral lung transplantation.

    PubMed

    Feltracco, Paolo; Serra, Eugenio; Barbieri, Stefania; Persona, Paolo; Rea, Federico; Loy, Monica; Ori, Carlo

    2009-01-01

    Temporary graft dysfunction with gas exchange abnormalities is a common finding during the postoperative course of a lung transplant and is often determined by the post-reimplantation syndrome. Supportive measures including oxygen by mask, inotropes, diuretics, and pulmonary vasodilators are usually effective in non-severe post-reimplantation syndromes. However, in less-responsive clinical pictures, tracheal intubation with positive pressure ventilation, or non-invasive positive pressure ventilation (NIV), is necessary. We report on the clinical course of two patients suffering from refractory hypoxemia due to post-reimplantation syndrome treated with NIV in the prone and Trendelenburg positions. NIV was well tolerated and led to resolution of atelectactic areas and dishomogeneous lung infiltrates. Repeated turning from supine to prone under non invasive ventilation determined a stable improvement of gas exchange and prevented a more invasive approach. Even though NIV in the prone position has not yet entered into clinical practice, it could be an interesting option to achieve a better match between ventilation and perfusion. This technique, which we successfully applied in lung transplantation, can be easily extended to other lung diseases with non-recruitable dorso-basal areas.

  11. A Porcine Model for Initial Surge Mechanical Ventilator Assessment and Evaluation of Two Limited Function Ventilators

    PubMed Central

    Dickson, Robert P; Hotchkin, David L; Lamm, Wayne JE; Hinkson, Carl; Pierson, David J; Glenny, Robb W; Rubinson, Lewis

    2013-01-01

    Objective To adapt an animal model of acute lung injury for use as a standard protocol for a screening, initial evaluation of limited function, or “surge,” ventilators for use in mass casualty scenarios. Design Prospective, experimental animal study. Setting University research laboratory. Subjects 12 adult pigs. Interventions 12 spontaneously breathing pigs (6 in each group) were subjected to acute lung injury/acute respiratory distress syndrome (ALI/ARDS) via pulmonary artery infusion of oleic acid. Following development of respiratory failure, animals were mechanically ventilated with a limited function ventilator (Simplified Automatic Ventilator [SAVe] I or II; Automedx) for one hour or until the ventilator could not support the animal. The limited function ventilator was then exchanged for a full function ventilator (Servo 900C; Siemens). Measurements and Main Results Reliable and reproducible levels of ALI/ARDS were induced. The SAVe I was unable to adequately oxygenate 5 animals, with PaO2 (52.0 ± 11.1 torr) compared to the Servo (106.0 ± 25.6 torr; p=0.002). The SAVe II was able to oxygenate and ventilate all 6 animals for one hour with no difference in PaO2 (141.8 ± 169.3 torr) compared to the Servo (158.3 ± 167.7 torr). Conclusions We describe a novel in vivo model of ALI/ARDS that can be used to initially screen limited function ventilators considered for mass respiratory failure stockpiles, and is intended to be combined with additional studies to defintively assess appropriateness for mass respiratory failure. Specifically, during this study we demonstrate that the SAVe I ventilator is unable to provide sufficient gas exchange, while the SAVe II, with several more functions, was able to support the same level of hypoxemic respiratory failure secondary to ALI/ARDS for one hour. PMID:21187747

  12. Indicators of fatigue and of prolonged weaning from mechanical ventilation in surgical patients.

    PubMed

    O'Keefe, G E; Hawkins, K; Boynton, J; Burns, D

    2001-01-01

    Indicators of weaning success have been tested primarily in patients who have been ventilated for short periods of time, and they may not be as accurate in cases where support has been required for longer than a few days. In patients requiring longer periods of support it is difficult to estimate the likelihood of successful liberation. Therefore we evaluated established weaning indices for their accuracy in surgical patients who required > or = 72 hours of mechanical ventilation. Surgical patients who required mechanical ventilation for > or = 72 hours were prospectively followed (over 6 months). We obtained standard indices of ventilatory function daily once patients were ready to wean. These indices included the respiratory rate/tidal volume ratio (RSBI), the maximal inspiratory pressure, and the minute ventilation. The duration of weaning and explicitly defined episodes of fatigue were the outcomes of interest. Statistical analyses evaluated the multiple factors that might influence the duration of weaning. Ninety-five patients (66% trauma; 34% surgery) survived to begin weaning, and 93% were liberated. The median duration of mechanical ventilation prior to weaning was 4 days (range 3-16 days), and the median duration of weaning was 3 days (range 0-56 days). Fatigue occurred in 36 patients and was not reliably predicted by any of the weaning measurements. However, a RSBI of > 105 on the first day of weaning was associated with prolonged weaning. By multivariate analysis, an RSBI of > 105 on the first day of weaning predicted prolonged weaning (hazard ratio 1.9; p = 0.03). After 72 hours of mechanical ventilation, clinical fatigue and successful liberation are not reliably predicted by standard indices of respiratory muscle strength and reserve. However, an RSBI of >105 observed once the patient is ready to wean is associated with prolonged weaning.

  13. Advanced support systems development and supporting technologies for Controlled Ecological Life Support Systems (CELSS)

    NASA Technical Reports Server (NTRS)

    Simon, William E.; Li, Ku-Yen; Yaws, Carl L.; Mei, Harry T.; Nguyen, Vinh D.; Chu, Hsing-Wei

    1994-01-01

    A methyl acetate reactor was developed to perform a subscale kinetic investigation in the design and optimization of a full-scale metabolic simulator for long term testing of life support systems. Other tasks in support of the closed ecological life support system test program included: (1) heating, ventilation and air conditioning analysis of a variable pressure growth chamber, (2) experimental design for statistical analysis of plant crops, (3) resource recovery for closed life support systems, and (4) development of data acquisition software for automating an environmental growth chamber.

  14. Guide to Home Ventilation

    SciTech Connect

    2010-10-01

    A fact sheet from the U.S. Department of Energy's Office of Energy Efficiency and Renewable Energy: Ventilation refers to the exchange of indoor and outdoor air. Without proper ventilation, an otherwise insulated and airtight house will seal in harmful pollutants, such as carbon monoxide, and moisture that can damage a house.

  15. Multifamily Ventilation Retrofit Strategies

    SciTech Connect

    Ueno, K.; Lstiburek, J.; Bergey, D.

    2012-12-01

    In multifamily buildings, central ventilation systems often have poor performance, overventilating some portions of the building (causing excess energy use), while simultaneously underventilating other portions (causing diminished indoor air quality). BSC and Innova Services Corporation performed a series of field tests at a mid-rise test building undergoing a major energy audit and retrofit, which included ventilation system upgrades.

  16. Recommended Ventilation Strategies for Energy-Efficient Production Homes

    SciTech Connect

    Roberson, J.; Brown, R.; Koomey, J.; Warner, J.; Greenberg, S.

    1998-12-01

    This report evaluates residential ventilation systems for the U.S. Environmental Protection Agency's (EPA's) ENERGY STAR{reg_sign} Homes program and recommends mechanical ventilation strategies for new, low-infiltration, energy-efficient, single-family, ENERGY STAR production (site-built tract) homes in four climates: cold, mixed (cold and hot), hot humid, and hot arid. Our group in the Energy Analysis Department at Lawrence Berkeley National Lab compared residential ventilation strategies in four climates according to three criteria: total annualized costs (the sum of annualized capital cost and annual operating cost), predominant indoor pressure induced by the ventilation system, and distribution of ventilation air within the home. The mechanical ventilation systems modeled deliver 0.35 air changes per hour continuously, regardless of actual infiltration or occupant window-opening behavior. Based on the assumptions and analysis described in this report, we recommend independently ducted multi-port supply ventilation in all climates except cold because this strategy provides the safety and health benefits of positive indoor pressure as well as the ability to dehumidify and filter ventilation air. In cold climates, we recommend that multi-port supply ventilation be balanced by a single-port exhaust ventilation fan, and that builders offer balanced heat-recovery ventilation to buyers as an optional upgrade. For builders who continue to install forced-air integrated supply ventilation, we recommend ensuring ducts are airtight or in conditioned space, installing a control that automatically operates the forced-air fan 15-20 minutes during each hour that the fan does not operate for heating or cooling, and offering ICM forced-air fans to home buyers as an upgrade.

  17. Respiratory mechanics in mechanically ventilated patients.

    PubMed

    Hess, Dean R

    2014-11-01

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

  18. Coolant pressure and airflow distribution in a strut-supported transpiration-cooled vane for a gas turbine engine

    NASA Technical Reports Server (NTRS)

    Kaufman, A.; Poferl, D. J.; Richards, H. T.

    1972-01-01

    An analysis to predict pressure and flow distribution in a strut-supported wire-cloth vane was developed. Results were compared with experimental data obtained from room-temperature airflow tests conducted over a range of vane inlet airflow rates from 10.7 to 40.4 g/sec (0.0235 to 0.0890 lb/sec). The analytical method yielded reasonably accurate predictions of vane coolant flow rate and pressure distribution.

  19. Does the specific time of day used to capture data on ventilator-days have an impact on the documented rates of ventilator-associated pneumonia?

    PubMed

    Talbot, Thomas R; Starmer, John M

    2010-05-01

    Definitions of ventilator-associated pneumonia do not note a preferred daily time for obtaining denominator data. We examined collecting data on the number of ventilator-days at different times of day in 7 intensive care units. Rates of ventilator-associated pneumonia did not significantly differ when denominator data were collected at midnight, 8 am, or 4 pm, supporting standard definitions.

  20. New ventilators for the ICU--usefulness of lung performance reporting.

    PubMed

    Macnaughton, P D

    2006-07-01

    Monitoring the functional and mechanical properties of the lungs during positive pressure ventilation may assist in confirming the underlying pulmonary diagnosis, allow therapeutic interventions to be accurately assessed and provide information that ensures the optimal setting of the ventilator parameters and encourages timely weaning. This article reviews the range of lung function measurements, both continuous and intermittent, that may be undertaken during mechanical ventilation. The monitoring capability of ICU ventilators is increasing in complexity.

  1. Energy efficient engine, high pressure turbine thermal barrier coating. Support technology report

    NASA Technical Reports Server (NTRS)

    Duderstadt, E. C.; Agarwal, P.

    1983-01-01

    This report describes the work performed on a thermal barrier coating support technology task of the Energy Efficient Engine Component Development Program. A thermal barrier coating (TBC) system consisting of a Ni-Cr-Al-Y bond cost layer and ZrO2-Y2O3 ceramic layer was selected from eight candidate coating systems on the basis of laboratory tests. The selection was based on coating microstructure, crystallographic phase composition, tensile bond and bend test results, erosion and impact test results, furnace exposure, thermal cycle, and high velocity dynamic oxidation test results. Procedures were developed for applying the selected TBC to CF6-50, high pressure turbine blades and vanes. Coated HPT components were tested in three kinds of tests. Stage 1 blades were tested in a cascade cyclic test rig, Stage 2 blades were component high cycle fatigue tested to qualify thermal barrier coated blades for engine testing, and Stage 2 blades and Stage 1 and 2 vanes were run in factory engine tests. After completion of the 1000 cycle engine test, the TBC on the blades was in excellent condition over all of the platform and airfoil except at the leading edge above midspan on the suction side of the airfoil. The coating damage appeared to be caused by particle impingement; adjacent blades without TBC also showed evidence of particle impingement.

  2. Nondestructive Methods and Special Test Instrumentation Supporting NASA Composite Overwrapped Pressure Vessel Assessments

    NASA Technical Reports Server (NTRS)

    Saulsberry, Regor; Greene, Nathanael; Cameron, Ken; Madaras, Eric; Grimes-Ledesma, Lorie; Thesken, John; Phoenix, Leigh; Murthy, Pappu; Revilock, Duane

    2007-01-01

    Many aging composite overwrapped pressure vessels (COPVs), being used by the National Aeronautics and Space Administration (NASA) are currently under evaluation to better quantify their reliability and clarify their likelihood of failure due to stress rupture and age-dependent issues. As a result, some test and analysis programs have been successfully accomplished and other related programs are still in progress at the NASA Johnson Space Center (JSC) White Sands Test Facility (WSTF) and other NASA centers, with assistance from the commercial sector. To support this effort, a group of Nondestructive Evaluation (NDE) experts was assembled to provide NDE competence for pretest evaluation of test articles and for application of NDE technology to real-time testing. Techniques were required to provide assurance that the test article had adequate structural integrity and manufacturing consistency to be considered acceptable for testing and these techniques were successfully applied. Destructive testing is also being accomplished to better understand the physical and chemical property changes associated with progression toward "stress rupture" (SR) failure, and it is being associated with NDE response, so it can potentially be used to help with life prediction. Destructive work also includes the evaluation of residual stresses during dissection of the overwrap, laboratory evaluation of specimens extracted from the overwrap to evaluate physical property changes, and quantitative microscopy to inform the theoretical micromechanics.

  3. Variability in Mechanical Ventilation: What's All the Noise About?

    PubMed

    Naik, Bhiken I; Lynch, Carl; Durbin, Charles G

    2015-08-01

    Controlled mechanical ventilation is characterized by a fixed breathing frequency and tidal volume. Physiological and mathematical models have demonstrated the beneficial effects of varying tidal volume and/or inspiratory pressure during positive-pressure ventilation. The addition of noise (random changes) to a monotonous nonlinear biological system, such as the lung, induces stochastic resonance that contributes to the recruitment of collapsed alveoli and atelectatic lung segments. In this article, we review the mechanism of physiological pulmonary variability, the principles of noise and stochastic resonance, and the emerging understanding that there are beneficial effects of variability during mechanical ventilation.

  4. Impact of aspen furniture and restricted feeding on activity, blood pressure, heart rate and faecal corticosterone and immunoglobulin A excretion in rats (Rattus norvegicus) housed in individually ventilated cages.

    PubMed

    Kemppinen, N; Hau, J; Meller, A; Mauranen, K; Kohila, T; Nevalainen, T

    2010-04-01

    This study aims to evaluate the impact of adding different items in individually ventilated rat cages on the animal's activity, cardiovascular parameters and faecal stress indicators. The following three cage items made of aspen were compared: a cross made of two intersecting boards, a similar cross where drilled holes were loaded with food pellets (restricted feeding) and a rectangular tube. Male rats of the strains BN and F344 (n = 12) were housed in groups of three; one rat in each group was implanted with a telemetric transponder to measure mean arterial pressure (MAP) and heart rate (HR). In a crossover design, each group spent 14 days with each type of cage furniture, thereafter faecal pellets were collected for faecal analyses. The means of activity and means and coefficient of variation for MAP and HR were calculated for days 2, 6, 10 and 14. As a way of determining which of the statistically significant MAP and HR mean changes were biologically meaningful, the night-day differences of the controls on day 14 were used. Both board types lowered MAP of F344 rats; hence dividing walls seem beneficial for F344 welfare. None of the MAP or HR differences in BN rats were biologically significant. No statistically significant differences in faecal corticosterone or IgA excretion were detected. In conclusion, provision of general recommendations with respect to cage furniture for rat cages is complicated because there is a clear genetic component involved in how animals respond to these structures.

  5. Pretest Predictions for Phase II Ventilation Tests

    SciTech Connect

    Yiming Sun

    2001-09-19

    The objective of this calculation is to predict the temperatures of the ventilating air, waste package surface, and concrete pipe walls that will be developed during the Phase II ventilation tests involving various test conditions. The results will be used as inputs to validating numerical approach for modeling continuous ventilation, and be used to support the repository subsurface design. The scope of the calculation is to identify the physical mechanisms and parameters related to thermal response in the Phase II ventilation tests, and describe numerical methods that are used to calculate the effects of continuous ventilation. The calculation is limited to thermal effect only. This engineering work activity is conducted in accordance with the ''Technical Work Plan for: Subsurface Performance Testing for License Application (LA) for Fiscal Year 2001'' (CRWMS M&O 2000d). This technical work plan (TWP) includes an AP-2.21Q, ''Quality Determinations and Planning for Scientific, Engineering, and Regulatory Compliance Activities'', activity evaluation (CRWMS M&O 2000d, Addendum A) that has determined this activity is subject to the YMP quality assurance (QA) program. The calculation is developed in accordance with the AP-3.12Q procedure, ''Calculations''. Additional background information regarding this activity is contained in the ''Development Plan for Ventilation Pretest Predictive Calculation'' (DP) (CRWMS M&O 2000a).

  6. [Ventilator-associated pneumonia and other infections].

    PubMed

    Bobik, Piotr; Siemiątkowski, Andrzej

    2014-01-01

    One of the fundamental elements of therapy in patients hospitalised in the Intensive Care Unit (ICU) is mechanical ventilation (MV). MV enables sufficient gas exchange in patients with severe respiratory insufficiency, thus preserving the proper functioning of organs and systems. However, clinical and experimental studies show that mechanical ventilation may cause severe complications, e.g. lung injury (VALI, VILI), systemic inflammatory response syndrome (SIRS), and, on rare occasions, multiple organ failure (MOF). Mechanical ventilation and especially endotracheal intubation are associated also with higher risk of infectious complications of the respiratory system: ventilator-associated respiratory infection (VARI) and ventilator-associated pneumonia (VAP). The complications of the MV listed above have a significant influence on the length of treatment and also on the increase of the costs of therapy and mortality of patients who stay in an ICU. These negative effects of supported breathing are the reasons for intensive research to find new biological markers of inflammation and lung injury, more sensitive and specific diagnostic instruments, more effective methods of therapy, and programs of prevention. The purpose of this article is the presentation of current knowledge concerning VAP-related infections, to allow pulmonologists and general practitioners to become more familiar with the problem. Basic and the most important data concerning the definition, epidemiology, pathophysiology, microbiology, diagnostics, treatment, and prevention of VAP have been included. Additionally, ventilator-associated tracheobronchitis (VAT) was discussed.

  7. Intermodule ventilation studies for the Space Station

    NASA Technical Reports Server (NTRS)

    Davis, Roy G.; Reuter, James L.

    1987-01-01

    This paper examines the ability of the Space Station intermodule ventilation system to maintain centralized control of CO2 removal and O2 supply. The resulting concentration gradients that will arise are calculated by assuming steady state, ideal gas, isothermal conditions, and perfect mixing of air within and between the pressurized elements. In order to estimate the degree of mixing actually obtained for a given ventilation scheme, a program has been developed based on a potential flow solution technique. Preliminary results from this study indicate that substantial short circuiting and recirculation air flow patterns could arise if a simple duct and diffuser air exchange method at the docking port interface were employed.

  8. Understanding neonatal ventilation: strategies for decision making in the NICU.

    PubMed

    Petty, Julia

    2013-01-01

    Neonatal ventilation is an integral component of care delivered in the neonatal unit. The aim of any ventilation strategy is to support the neonate's respiratory system during compromise while limiting any long-term damage to the lungs. Understanding the principles behind neonatal ventilation is essential so that health professionals caring for sick neonates and families have the necessary knowledge to understand best practice. Given the range of existing ventilation modes and parameters available, these require explanation and clarification in the context of current evidence. Many factors can influence clinical decision making on both an individual level and within the wider perspective of neonatal care.

  9. Ventilating Air-Conditioner

    NASA Technical Reports Server (NTRS)

    Dinh, Khanh

    1994-01-01

    Air-conditioner provides ventilation designed to be used alone or incorporated into cooling or heating system operates efficiently only by recirculating stale air within building. Energy needed to operate overall ventilating cooling or heating system slightly greater than operating nonventilating cooling or heating system. Helps to preserve energy efficiency while satisfying need for increased forced ventilation to prevent accumulation of undesired gases like radon and formaldehyde. Provides fresh treated air to variety of confined spaces: hospital surgeries, laboratories, clean rooms, and printing shops and other places where solvents used. In mobile homes and portable classrooms, eliminates irritant chemicals exuded by carpets, panels, and other materials, ensuring healthy indoor environment for occupants.

  10. Mechanical ventilation in patients subjected to extracorporeal membrane oxygenation (ECMO).

    PubMed

    López Sanchez, M

    2017-02-08

    Mechanical ventilation (MV) is a crucial element in the management of acute respiratory distress syndrome (ARDS), because there is high level evidence that a low tidal volume of 6ml/kg (protective ventilation) improves survival. In these patients with refractory respiratory insufficiency, venovenous extracorporeal membrane oxygenation (ECMO) can be used. This salvage technique improves oxygenation, promotes CO2 clearance, and facilitates protective and ultraprotective MV, potentially minimizing ventilation-induced lung injury. Although numerous trials have investigated different ventilation strategies in patients with ARDS, consensus is lacking on the optimal MV settings during venovenous ECMO. Although the concept of "lung rest" was introduced years ago, there are no evidence-based guidelines on its use in application to MV in patients supported by ECMO. How MV in ECMO patients can promote lung recovery and weaning from ventilation is not clear. The purpose of this review is to describe the ventilation strategies used during venovenous ECMO in clinical practice.

  11. Four-dimensional optical coherence tomography imaging of total liquid ventilated rats

    NASA Astrophysics Data System (ADS)

    Kirsten, Lars; Schnabel, Christian; Gaertner, Maria; Koch, Edmund

    2013-06-01

    Optical coherence tomography (OCT) can be utilized for the spatially and temporally resolved visualization of alveolar tissue and its dynamics in rodent models, which allows the investigation of lung dynamics on the microscopic scale of single alveoli. The findings could provide experimental input data for numerical simulations of lung tissue mechanics and could support the development of protective ventilation strategies. Real four-dimensional OCT imaging permits the acquisition of several OCT stacks within one single ventilation cycle. Thus, the entire four-dimensional information is directly obtained. Compared to conventional virtual four-dimensional OCT imaging, where the image acquisition is extended over many ventilation cycles and is triggered on pressure levels, real four-dimensional OCT is less vulnerable against motion artifacts and non-reproducible movement of the lung tissue over subsequent ventilation cycles, which widely reduces image artifacts. However, OCT imaging of alveolar tissue is affected by refraction and total internal reflection at air-tissue interfaces. Thus, only the first alveolar layer beneath the pleura is visible. To circumvent this effect, total liquid ventilation can be carried out to match the refractive indices of lung tissue and the breathing medium, which improves the visibility of the alveolar structure, the image quality and the penetration depth and provides the real structure of the alveolar tissue. In this study, a combination of four-dimensional OCT imaging with total liquid ventilation allowed the visualization of the alveolar structure in rat lung tissue benefiting from the improved depth range beneath the pleura and from the high spatial and temporal resolution.

  12. A noninvasive high frequency oscillation ventilator: Achieved by utilizing a blower and a valve

    NASA Astrophysics Data System (ADS)

    Yuan, YueYang; Sun, JianGuo; Wang, Baicun; Feng, Pei; Yang, ChongChang

    2016-02-01

    After the High Frequency Oscillatory Ventilation (HFOV) has been applied in the invasive ventilator, the new technique of noninvasive High Frequency Oscillatory Ventilation (nHFOV) which does not require opening the patient's airway has attracted much attention from the field. This paper proposes the design of an experimental positive pressure-controlled nHFOV ventilator which utilizes a blower and a special valve and has three ventilation modes: spontaneous controlled ventilation combining HFOV, time-cycled ventilation combining HFOV (T-HFOV), and continuous positive airway pressure ventilation combining HFOV. Experiments on respiratory model are conducted and demonstrated the feasibility of using nHFOV through the control of fan and valve. The experimental ventilator is able to produce an air flow with small tidal volume (VT) and a large minute ventilation volume (MV) using regular breath tubes and nasal mask (e.g., under T-HFOV mode, with a maximum tidal volume of 100 ml, the minute ventilation volume reached 14 400 ml). In the process of transmission, there is only a minor loss of oscillation pressure. (Under experimental condition and with an oscillation frequency of 2-10 Hz, peak pressure loss was around 0%-50% when it reaches the mask.)

  13. A noninvasive high frequency oscillation ventilator: Achieved by utilizing a blower and a valve.

    PubMed

    Yuan, YueYang; Sun, JianGuo; Wang, Baicun; Feng, Pei; Yang, ChongChang

    2016-02-01

    After the High Frequency Oscillatory Ventilation (HFOV) has been applied in the invasive ventilator, the new technique of noninvasive High Frequency Oscillatory Ventilation (nHFOV) which does not require opening the patient's airway has attracted much attention from the field. This paper proposes the design of an experimental positive pressure-controlled nHFOV ventilator which utilizes a blower and a special valve and has three ventilation modes: spontaneous controlled ventilation combining HFOV, time-cycled ventilation combining HFOV (T-HFOV), and continuous positive airway pressure ventilation combining HFOV. Experiments on respiratory model are conducted and demonstrated the feasibility of using nHFOV through the control of fan and valve. The experimental ventilator is able to produce an air flow with small tidal volume (VT) and a large minute ventilation volume (MV) using regular breath tubes and nasal mask (e.g., under T-HFOV mode, with a maximum tidal volume of 100 ml, the minute ventilation volume reached 14,400 ml). In the process of transmission, there is only a minor loss of oscillation pressure. (Under experimental condition and with an oscillation frequency of 2-10 Hz, peak pressure loss was around 0%-50% when it reaches the mask.).

  14. Flammable gas cloud build up in a ventilated enclosure.

    PubMed

    Ivings, M J; Gant, S E; Saunders, C J; Pocock, D J

    2010-12-15

    Ventilation is frequently used as a means for preventing the build up of flammable or toxic gases in enclosed spaces. The effectiveness of the ventilation often has to be considered as part of a safety case or risk assessment. In this paper methods for assessing ventilation effectiveness for hazardous area classification are examined. The analysis uses data produced from Computational Fluid Dynamics (CFD) simulations of low-pressure jet releases of flammable gas in a ventilated enclosure. The CFD model is validated against experimental measurements of gas releases in a ventilation-controlled test chamber. Good agreement is found between the model predictions and the experimental data. Analysis of the CFD results shows that the flammable gas cloud volume resulting from a leak is largely dependent on the mass release rate of flammable gas and the ventilation rate of the enclosure. The effectiveness of the ventilation for preventing the build up of flammable gas can therefore be assessed by considering the average gas concentration at the enclosure outlet(s). It is found that the ventilation rate of the enclosure provides a more useful measure of ventilation effectiveness than considering the enclosure air change rate.

  15. Effect of Occlusal Scheme on the Pressure Distribution of Complete Denture Supporting Tissues: An In Vitro Study

    PubMed Central

    Madalli, Poornima; Murali, C R; Subhas, Sambit; Garg, Surbhi; Shahi, Prinka; Parasher, Pragati

    2015-01-01

    Background: The complete denture teeth arrangement that gives maximum denture stability, comfort, esthetics, and function have been studied since several years. Many occlusal schemes have been advised in which the lingualized occlusion, balanced occlusion, and monoplane occlusion are advocated most popularly. The purpose of this study was to compare the pressure values on the supporting tissue using three diff erent posterior occlusal schemes: Balanced occlusion, lingualized occlusion, and monoplane occlusion in simulated dentures Materials and Methods: The simulators used in this study, composed of the maxillary, and mandibular clear heat cure acrylic resin edentulous models. Pressures on the supporting structure under the complete denture were measured using eight strain gauges placed on the model surface on the buccal and lingual slopes of the ridges on the molar and pre-molar region. Pressure on the supporting structure was measured and signals from the sensors were amplifi ed and recorded by the multi-channel electronic strain indicator. Results: The mean pressure which was obtained at each measurement point was compared by one-way ANOVA test. Conclusion: Overall monoplane occlusion had lesser pressure values compared to completely balanced and lingualized occlusal scheme. Lingualized occlusal scheme was found to transfer stresses from working side to non-working side to stabilize the mandibular denture. PMID:26668486

  16. Associations among environmental supports, physical activity, and blood pressure in African-American adults in the PATH trial.

    PubMed

    Coulon, Sandra M; Wilson, Dawn K; Egan, Brent M

    2013-06-01

    High blood pressure disproportionately affects African-American adults and is a leading cause of stroke and heart attack. Engaging in recommended levels of physical activity reduces blood pressure, and social and physical environmental supports for physical activity may increase engagement in physical activity. Based on social cognitive theory within a bioecological framework, the present study tested hypotheses that perceived peer social support for physical activity and neighborhood walkability would be positively associated with physical activity, and that physical activity would mediate their relation with blood pressure. Baseline data were collected with 434 African-American adults in underserved communities (low income, high crime) participating in the Positive Action for Today's Health (PATH) trial. Perceived peer social support for physical activity and neighborhood walkability were measured with validated surveys. Physical activity was assessed with 7-day accelerometry (moderate-to-vigorous physical activity, min/day) and with a 4-week recall of walking. Three blood pressure assessments were taken by trained staff using standard protocols, with values from the second and third assessments averaged. The sample was predominantly female (63%), overweight (mean body mass index = 30.9, SD = 8.4), and had slightly elevated blood pressures with a mean systolic blood pressure of 132.4 (SD = 17.9) and a mean diastolic blood pressure of 81.4 (SD = 11.0). Results demonstrated that peer social support for physical activity (B = 2.43, p = .02) and neighborhood walkability (B = 2.40, p = .046) were significantly related to average daily moderate-to-vigorous physical activity. Neighborhood walkability was also significantly associated with self-reported average daily walking (B = 8.86, p = .02). Physical activity did not mediate their relation with blood pressure and no significant direct effects of these variables on blood pressure were found. The positive influence of

  17. WASTE HANDLING BUILDING VENTILATION SYSTEM DESCRIPTION DOCUMENT

    SciTech Connect

    P.A. Kumar

    2000-06-21

    The Waste Handling Building Ventilation System provides heating, ventilation, and air conditioning (HVAC) for the contaminated, potentially contaminated, and uncontaminated areas of the Monitored Geologic Repository's (MGR) Waste Handling Building (WHB). In the uncontaminated areas, the non-confinement area ventilation system maintains the proper environmental conditions for equipment operation and personnel comfort. In the contaminated and potentially contaminated areas, in addition to maintaining the proper environmental conditions for equipment operation and personnel comfort, the contamination confinement area ventilation system directs potentially contaminated air away from personnel in the WHB and confines the contamination within high-efficiency particulate air (HEPA) filtration units. The contamination confinement areas ventilation system creates airflow paths and pressure zones to minimize the potential for spreading contamination within the building. The contamination confinement ventilation system also protects the environment and the public by limiting airborne releases of radioactive or other hazardous contaminants from the WHB. The Waste Handling Building Ventilation System is designed to perform its safety functions under accident conditions and other Design Basis Events (DBEs) (such as earthquakes, tornadoes, fires, and loss of the primary electric power). Additional system design features (such as compartmentalization with independent subsystems) limit the potential for cross-contamination within the WHB. The system provides status of important system parameters and equipment operation, and provides audible and/or visual indication of off-normal conditions and equipment failures. The Waste Handling Building Ventilation System confines the radioactive and hazardous material within the building such that the release rates comply with regulatory limits. The system design, operations, and maintenance activities incorporate ALARA (as low as is

  18. Domiciliary ventilatory support: an analysis of outcome.

    PubMed Central

    Sawicka, E H; Loh, L; Branthwaite, M A

    1988-01-01

    Prolonged ventilatory support has been used to treat 51 patients with respiratory failure secondary to skeletal (22) or neuromuscular (29) disease. Symptomatic relief was achieved in five patients with rapidly progressive neurological disease who died within 27 months. The remaining 46 patients, aged 11-69 years at presentation, have been followed for more than two and a half years. All but 10 were treated with negative pressure ventilation from the outset, intermittent positive pressure ventilation being used initially in the others and continued at home in three. Nocturnal negative pressure ventilation has been used at home by 39 patients. A permanent tracheostomy has been maintained in 14, to facilitate positive pressure ventilation in three and to circumvent upper airway obstruction during sleep in 11. Sustained improvement in symptoms and arterial blood gas tensions has been maintained, independence and the capacity for gainful employment have been regained in those of an appropriate age, and the incidence of subsequent hospital admissions has been low. Neither the mode of presentation nor the aetiology of the restrictive ventilatory defect influenced outcome in patients with stable or only slowly progressive primary disease. PMID:3127911

  19. Evaluation of Family Health Education to Build Social Support for Long-Term Control of High Blood Pressure.

    ERIC Educational Resources Information Center

    Morisky, Donald E.; And Others

    1985-01-01

    An educational program was implemented to improve family member support for medical compliance among hypertensive patients. Family members were interviewed, counseled, and provided with a booklet for the purpose of educating and involving them in the home management of high blood pressure. Results of this program are presented and analyzed.…

  20. Evaluative Pressure in Mothers: Effects of Situation, Maternal, and Child Characteristics on Autonomy Supportive versus Controlling Behavior

    ERIC Educational Resources Information Center

    Grolnick, Wendy S.; Price, Carrie E.; Beiswenger, Krista L.; Sauck, Christine C.

    2007-01-01

    This study examined the effects of situational pressure and maternal characteristics (social contingent self-worth, controlling parenting attitudes) on mothers' autonomy support versus control in the social domain. Sixty 4th-grade children and their mothers worked on a laboratory task in preparation for meeting new children, with mothers in either…

  1. Why We Ventilate

    SciTech Connect

    Logue, Jennifer M.; Sherman, Max H.; Price, Phil N.; Singer, Brett C.

    2011-09-01

    It is widely accepted that ventilation is critical for providing good indoor air quality (IAQ) in homes. However, the definition of"good" IAQ, and the most effective, energy efficient methods for delivering it are still matters of research and debate. This paper presents the results of work done at the Lawrence Berkeley National Lab to identify the air pollutants that drive the need for ventilation as part of a larger effort to develop a health-based ventilation standard. First, we present results of a hazard analysis that identified the pollutants that most commonly reach concentrations in homes that exceed health-based standards or guidelines for chronic or acute exposures. Second, we present results of an impact assessment that identified the air pollutants that cause the most harm to the U.S. population from chronic inhalation in residences. Lastly, we describe the implications of our findings for developing effective ventilation standards.

  2. Rescue Ventilation Through a Small-Bore Transtracheal Cannula in Severe Hypoxic Pigs Using Expiratory Ventilation Assistance

    PubMed Central

    Hamaekers, Ankie E.; van der Beek, Tim; Theunissen, Maurice

    2015-01-01

    BACKGROUND: Suction-generated expiratory ventilation assistance (EVA) has been proposed as a way to facilitate bidirectional ventilation through a small-bore transtracheal cannula (TC). In this study, we investigated the efficiency of ventilation with EVA for restoring oxygenation and ventilation in a pig model of acute hypoxia. METHODS: Six pigs (61–76 kg) were anesthetized and ventilated (intermittent positive pressure ventilation) via a cuffed endotracheal tube (ETT). Monitoring lines were placed, and a 75-mm long, 2-mm inner diameter TC was inserted. After the baseline recordings, the ventilator was disconnected. After 2 minutes of apnea, reoxygenation with EVA was initiated through the TC and continued for 15 minutes with the ETT occluded. In the second part of the study, the experiment was repeated with the ETT either partially obstructed or left open. Airway pressures and hemodynamic data were recorded, and arterial blood gases were measured. Descriptive statistical analysis was performed. RESULTS: With a completely or partially obstructed upper airway, ventilation with EVA restored oxygenation to baseline levels in all animals within 20 seconds. In a completely obstructed airway, Paco2 remained stable for 15 minutes. At lesser degrees of airway obstruction, the time to reoxygenation was delayed. Efficacy probably was limited when the airway was completely unobstructed, with 2 of 6 animals having a Pao2 <85 mm Hg even after 15 minutes of ventilation with EVA and a mean Paco2 increased up to 90 mm Hg. CONCLUSIONS: In severe hypoxic pigs, ventilation with EVA restored oxygenation quickly in case of a completely or partially obstructed upper airway. Reoxygenation and ventilation were less efficient when the upper airway was completely unobstructed. PMID:25565319

  3. Effects of pressurization and temperature on power generating characteristics and impedances of anode-supported and electrolyte-supported planar solid oxide fuel cells

    NASA Astrophysics Data System (ADS)

    Hsieh, Y. D.; Chan, Y. H.; Shy, S. S.

    2015-12-01

    Power generating characteristics of pressurized anode-supported cell (ASC) and electrolyte-supported cell (ESC) are measured using the same single-cell stack setup, a planar full cell sandwiched by a pair of rib-channel flow distributors. Both ASC and ESC apply the same flow rates (Qanode = 0.5 slpm H2 + 0.4 slpm N2 and Qcathode = 0.9 slpm air) measured at three operating temperatures (T = 750 °C, 800 °C, 850 °C), each T under five pressures (p = 1, 2, 3, 4, 5 atm), having a total of 30 data sets for comparison. It is found that under loaded conditions, ASC has much larger increments in power densities, about three folds higher, than ESC due to pressurization. As T increases from 750 °C to 850 °C at 0.7 V, power densities of ASC/ESC increase from 175/97 mW cm-2 to 309/193 mW cm-2 at p = 1 atm, while at p = 5 atm, the increases of power densities are 281/137 mW cm-2 to 476/250 mW cm-2, showing a stronger temperature dependence than pressurization. Corresponding electrochemical impedance spectra show that the better cell performance of ASC is attributed to both lower ohmic and polarization resistances found in ASC than that in ESC.

  4. Flexible and self-powered temperature-pressure dual-parameter sensors using microstructure-frame-supported organic thermoelectric materials

    NASA Astrophysics Data System (ADS)

    Zhang, Fengjiao; Zang, Yaping; Huang, Dazhen; di, Chong-An; Zhu, Daoben

    2015-09-01

    Skin-like temperature- and pressure-sensing capabilities are essential features for the next generation of artificial intelligent products. Previous studies of e-skin and smart elements have focused on flexible pressure sensors, whereas the simultaneous and sensitive detection of temperature and pressure with a single device remains a challenge. Here we report developing flexible dual-parameter temperature-pressure sensors based on microstructure-frame-supported organic thermoelectric (MFSOTE) materials. The effective transduction of temperature and pressure stimuli into two independent electrical signals permits the instantaneous sensing of temperature and pressure with an accurate temperature resolution of <0.1 K and a high-pressure-sensing sensitivity of up to 28.9 kPa-1. More importantly, these dual-parameter sensors can be self-powered with outstanding sensing performance. The excellent sensing properties of MFSOTE-based devices, together with their unique advantages of low cost and large-area fabrication, make MFSOTE materials possess promising applications in e-skin and health-monitoring elements.

  5. Flexible and self-powered temperature–pressure dual-parameter sensors using microstructure-frame-supported organic thermoelectric materials

    PubMed Central

    Zhang, Fengjiao; Zang, Yaping; Huang, Dazhen; Di, Chong-an; Zhu, Daoben

    2015-01-01

    Skin-like temperature- and pressure-sensing capabilities are essential features for the next generation of artificial intelligent products. Previous studies of e-skin and smart elements have focused on flexible pressure sensors, whereas the simultaneous and sensitive detection of temperature and pressure with a single device remains a challenge. Here we report developing flexible dual-parameter temperature–pressure sensors based on microstructure-frame-supported organic thermoelectric (MFSOTE) materials. The effective transduction of temperature and pressure stimuli into two independent electrical signals permits the instantaneous sensing of temperature and pressure with an accurate temperature resolution of <0.1 K and a high-pressure-sensing sensitivity of up to 28.9 kPa−1. More importantly, these dual-parameter sensors can be self-powered with outstanding sensing performance. The excellent sensing properties of MFSOTE-based devices, together with their unique advantages of low cost and large-area fabrication, make MFSOTE materials possess promising applications in e-skin and health-monitoring elements. PMID:26387591

  6. Effect of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics.

    PubMed

    Logan, Alexander G; Irvine, M Jane; McIsaac, Warren J; Tisler, Andras; Rossos, Peter G; Easty, Anthony; Feig, Denice S; Cafazzo, Joseph A

    2012-07-01

    Lowering blood pressure reduces cardiovascular risk, yet hypertension is poorly controlled in diabetic patients. In a pilot study we demonstrated that a home blood pressure telemonitoring system, which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading, improved blood pressure control. Messages were based on care paths defined by running averages of transmitted readings. The present study tests the system's effectiveness in a randomized, controlled trial in diabetic patients with uncontrolled systolic hypertension. Of 244 subjects screened for eligibility, 110 (45%) were randomly allocated to the intervention (n = 55) or control (n = 55) group, and 105 (95.5%) completed the 1-year outcome visit. In the intention-to-treat analysis, mean daytime ambulatory systolic blood pressure, the primary end point, decreased significantly only in the intervention group by 9.1 ± 15.6 mmHg (SD; P < 0.0001), and the mean between-group difference was 7.1 ± 2.3 mmHg (SE; P < 0.005). Furthermore, 51% of intervention subjects achieved the guideline recommended target of <130/80 mmHg compared with 31% of control subjects (P < 0.05). These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians. Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale (baseline, 4.1 ± 3.76; exit, 5.2 ± 4.30; P = 0.014). This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension and improved hypertension control. Home blood pressure monitoring alone had no effect on blood pressure. Promoting patient self-care may have negative psychological effects.

  7. Out-of-hospital noninvasive ventilation: epidemiology, technology and equipment

    PubMed Central

    Baird, John Scott; Ravindranath, Thyyar M.

    2012-01-01

    Noninvasive ventilation has been utilized successfully in the pre- and out-of-hospital settings for a variety of disorders, including respiratory distress syndrome in neonates, neurologic and pulmonary diseases in infants and children, and heart failure as well as chronic obstructive pulmonary disease in adults. A variety of interfaces as well as mechanical positive pressure devices have been used: simple continuous positive airway pressure devices are available which do not require sophisticated equipment, while a broad spectrum of ventilators have been used to provide bilevel positive airway pressure. Extensive training of transport teams may be important, particularly when utilizing bilevel positive airway pressure in infants and children. PMID:22802995

  8. Protocol: inspiratory muscle training for promoting recovery and outcomes in ventilated patients (IMPROVe): a randomised controlled trial

    PubMed Central

    Leditschke, I Anne; Paratz, Jennifer D; Boots, Robert J

    2012-01-01

    Introduction Inspiratory muscle weakness is a known consequence of mechanical ventilation and a potential contributor to difficulty in weaning from ventilatory support. Inspiratory muscle training (IMT) reduces the weaning period and increases the likelihood of successful weaning in some patients. However, it is not known how this training affects the residual inspiratory muscle fatigability following successful weaning nor patients' quality of life or functional outcomes. Methods and analysis This dual centre study includes two concurrent randomised controlled trials of IMT in adult patients who are either currently ventilator-dependent (>7 days) (n=70) or have been recently weaned from mechanical ventilation (>7 days) in the past week (n=70). Subjects will be stable, alert and able to actively participate and provide consent. There will be concealed allocation to either treatment (IMT) or usual physiotherapy (including deep breathing exercises without a resistance device). Primary outcomes are inspiratory muscle fatigue resistance and maximum inspiratory pressures. Secondary outcomes are quality of life (Short Form-36v2, EQ-5D), functional status (Acute Care Index of Function), rate of perceived exertion (Borg Scale), intensive care length of stay (days), post intensive care length of stay (days), rate of reintubation (%) and duration of ventilation (days). Ethics and dissemination Ethics approval has been obtained from relevant institutions, and results will be published with a view to influencing physiotherapy practice in the management of long-term ventilator-dependent patients to accelerate weaning and optimise rehabilitation outcomes. Trial registration number ACTRN12610001089022. PMID:22389363

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

    PubMed

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

    2015-01-15

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

  10. Incidence of Parental Support and Pressure on Their Children’s Motivational Processes towards Sport Practice Regarding Gender

    PubMed Central

    Amado, Diana

    2015-01-01

    Grounded in Self-Determination Theory, structural equation modeling (SEM) with the aim of examining how parental support/pressure could influence their children´s motivational processes in sport was conducted, as well as the models´ differences in operability regarding gender. The sample size was 321 children ranging in age from 10 to 16 years old who were athletes from Extremadura, and 321 parents (included only the father or mother more involved with the sport of his or her child). 175 participants were male and 146 were female from individual (n = 130), and team sports (n=191). A questionnaire was conducted to assess parental perception of support/pressure and another questionnaire was conducted to measure satisfaction of basic psychological needs, type of motivation and enjoyment/boredom showed by their children towards sport practice. Results revealed that parental pressure negatively predicted satisfaction of the basic psychological needs. It also emerged as a strong positive predictor of intrinsic motivation and negative predictor of amotivation. Moreover, intrinsic motivation emerged as positive predictor of enjoyment and a negative predictor of boredom, whereas amotivation positively predicted boredom and negatively predicted enjoyment. Furthermore, results showed there were mean differences by gender: male athletes perceived greater parental pressure. Hence, it is necessary to decrease parental pressure towards their children in sport, with the aim of making them more motivated and enjoy, promoting positive consequences. PMID:26039062

  11. Negative-Pressure Pulmonary Edema.

    PubMed

    Bhattacharya, Mallar; Kallet, Richard H; Ware, Lorraine B; Matthay, Michael A

    2016-10-01

    Negative-pressure pulmonary edema (NPPE) or postobstructive pulmonary edema is a well-described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. Patients with NPPE generate very negative airway pressures, which augment transvascular fluid filtration and precipitate interstitial and alveolar edema. Pulmonary edema fluid collected from most patients with NPPE has a low protein concentration, suggesting hydrostatic forces as the primary mechanism for the pathogenesis of NPPE. Supportive care should be directed at relieving the upper airway obstruction by endotracheal intubation or cricothyroidotomy, institution of lung-protective positive-pressure ventilation, and diuresis unless the patient is in shock. Resolution of the pulmonary edema is usually rapid, in part because alveolar fluid clearance mechanisms are intact. In this review, we discuss the clinical presentation, pathophysiology, and management of negative-pressure or postobstructive pulmonary edema.

  12. Preoperational test report, recirculation ventilation systems

    SciTech Connect

    Clifton, F.T.

    1997-11-11

    This represents a preoperational test report for Recirculation Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102 and supports the ability to exhaust air from each tank. Each system consists of a valved piping loop, a fan, condenser, and moisture separator; equipment is located inside each respective tank farm in its own hardened building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  13. Assessment of mechanical ventilation parameters on respiratory mechanics.

    PubMed

    Pidaparti, Ramana M; Koombua, Kittisak; Ward, Kevin R

    2012-01-01

    Better understanding of airway mechanics is very important in order to avoid lung injuries for patients undergoing mechanical ventilation for treatment of respiratory problems in intensive-care medicine, as well as pulmonary medicine. Mechanical ventilation depends on several parameters, all of which affect the patient outcome. As there are no systematic numerical investigations of the role of mechanical ventilation parameters on airway mechanics, the objective of this study was to investigate the role of mechanical ventilation parameters on airway mechanics using coupled fluid-solid computational analysis. For the airway geometry of 3 to 5 generations considered, the simulation results showed that airflow velocity increased with increasing airflow rate. Airway pressure increased with increasing airflow rate, tidal volume and positive end-expiratory pressure (PEEP). Airway displacement and airway strains increased with increasing airflow rate, tidal volume and PEEP form mechanical ventilation. Among various waveforms considered, sine waveform provided the highest airflow velocity and airway pressure while descending waveform provided the lowest airway pressure, airway displacement and airway strains. These results combined with optimization suggest that it is possible to obtain a set of mechanical ventilation strategies to avoid lung injuries in patients.

  14. Performance and Life Tests of a Regenerative Blower for EVA Suit Ventilation

    NASA Technical Reports Server (NTRS)

    Izenson, Mike; Chen, Weibo; Paul, Heather L.; Jennings, Mallory A.

    2011-01-01

    Ventilation fans for future space suits must meet demanding performance specifications, satisfy stringent safety requirements for operation in an oxygen atmosphere, and be able to increase output to operate in buddy mode. A regenerative blower is an attractive choice due to its ability to meet these requirements at low operating speed. This paper describes progress in the development and testing of a regenerative blower designed to meet requirements for ventilation subsystems in a future space suit Portable Life Support Systems (PLSS). The blower assembly includes a custom-designed motor that has significantly improved in efficiency during this development effort. The blower was tested at both nominal and buddy mode operating points and head/flow performance and power consumption were measured. The blower was operated for over 1000 hours to demonstrate safe operation in an oxygen test loop at prototypical pressures. In addition, the blower demonstrated operation with the introduction of simulated lunar dust.

  15. Non-invasive ventilation in chronic obstructive pulmonary disease: management of acute type 2 respiratory failure.

    PubMed

    Roberts, C M; Brown, J L; Reinhardt, A K; Kaul, S; Scales, K; Mikelsons, C; Reid, K; Winter, R; Young, K; Restrick, L; Plant, P K

    2008-10-01

    Non-invasive ventilation (NIV) in the management of acute type 2 respiratory failure in patients with chronic obstructive pulmonary disease (COPD) represents one of the major technical advances in respiratory care over the last decade. This document updates the 2002 British Thoracic Society guidance and provides a specific focus on the use of NIV in COPD patients with acute type 2 respiratory failure. While there are a variety of ventilator units available most centres now use bi-level positive airways pressure units and this guideline refers specifically to this form of ventilatory support although many of the principles encompassed are applicable to other forms of NIV. The guideline has been produced for the clinician caring for COPD patients in the emergency and ward areas of acute hospitals.

  16. Proportional assist ventilation decreases thoracoabdominal asynchrony and chest wall distortion in preterm infants.

    PubMed

    Musante, G; Schulze, A; Gerhardt, T; Everett, R; Claure, N; Schaller, P; Bancalari, E

    2001-02-01

    Thoracoabdominal asynchrony (TAA) and chest wall distortion (CWD) are commonly seen in preterm infants secondary to a highly compliant rib cage and poor compensation of distorting forces by inspiratory rib cage muscles. Continuous positive airway pressure (CPAP) reduces TAA and CWD by stenting the chest wall. We hypothesized that application of positive airway pressure only during inspiration and in proportion to an infant's inspiratory effort should have a similar but more pronounced effect than CPAP alone. A ventilator providing airway pressure changes in proportion to flow and volume generated by an infant (proportional assist ventilation) was used to unload the respiratory pump during inspiration. Ten preterm infants were studied [birth weight, 745 (635-1175) g; gestational age, 26.5 (24-31) wk; postnatal age 3 (1-7) d; medium (range)]. TAA and CWD were determined by respiratory inductive plethysmography. TAA was expressed as the phase angle between the rib cage and abdominal motion and CWD as the total compartmental displacement ratio. In addition, we measured tidal volume with a pneumotachograph and esophageal and airway pressure deflections with pressure transducers. Measurements were obtained during alternating periods of CPAP and two different degrees of support (Gain 1 = 1.09 +/- 0.68, Gain 2 = 1.84 +/- 0.84 cm H(2)O/mL) that were provided by a proportional assist ventilator. Phase angle and the total compartmental displacement ratio decreased with increasing gain compared with CPAP alone. Peak airway pressure increased from 0.6 to 3.8 to 7.6 cm H(2)O above positive end-expiratory pressure (PEEP) with CPAP, Gain 1, and Gain 2, respectively, as tidal volume increased from 2.8 to 4.1 to 4.7 mL/kg. Esophageal pressure changes decreased only little with increasing gain. Chest wall excursion increased and abdominal movement decreased, indicating a redistribution of tidal volume between chest and abdomen. We conclude that proportional assist ventilation reduces

  17. Dynamic Behaviour of Ventilated Hydrofoils.

    NASA Astrophysics Data System (ADS)

    Kjeldsen, Morten; Arndt, Roger; Wosnik, Martin

    2006-11-01

    In certain types of pumping applications oscillations are induced by operation with liquids containing a free gas load. In order to understand the physics of this process, a series of tests with a ventilated A 2D NACA 0015 hydrofoil were performed in the water tunnel at the St. Anthony Falls Laboratory of the University of Minnesota. The special bubble removal feature of the water tunnel allowed continuous ventilation without experiencing visible bubbles upstream the hydrofoil. These studies build on previous work on cavitation-induced oscillations. Gas injection studies were made over a range of gas flow rates and test section pressure. The results clearly show that lift oscillations increase in intensity when the gas load is increased. The point of maximum unsteadiness is also associated the rapid decline of the foil performance as measured as average lift. Further increase of the gas injection load gives a steady behaviour with almost no lift. These experiments are compared with traditional cavitation experiments. The similarities between gas injection- and cavitation induced unsteadiness on the hydrofoil are many, but the amplitude of lift oscillations found on the foil with gas injection corresponds to about 50% of that found for cavitating hydrofoils. The fact that the oscillations are periodic leads to the consideration of both passive and active control.

  18. The role of external pressure and support on teacher choices related to evolution curriculum in the secondary biology classroom

    NASA Astrophysics Data System (ADS)

    Oschman, Scot

    The scientific community strongly and virtually universally supports the teaching of biological evolution in our public schools. However, there are many in the general public who object to the teaching of biological evolution in our nation's science classrooms. Groups such as Answers in Genesis and the Discovery Institute, along with parents, students, school boards, and school administrators are alleged by many in the scientific and science education communities to be pressuring teachers in a variety of ways regarding the teaching of evolution. The purpose of this study was to examine the sources of, extent of, and ways in which science teachers deal with external influences that attempt to alter their science curriculum related to the teaching of the theory of biological evolution in order to support it, deemphasize it or remove it from their classrooms. It also attempted to determine the impact these outside influences have on evolution education in the classroom. Internal influences were examined in order to ascertain other possible reasons why teachers might or might not de-emphasize, omit, or teach evidence contrary to evolution. Two thousand cover letters were sent out to high school biology teachers selected at random from three states in the U.S. Registry of Teachers, directing them to a web site where they could complete the questionnaire online. One hundred seventy eight teachers responded to the survey. The statistical analyses used in this study to examine the results included analysis of variance (ANOVA), independent samples t tests for means comparisons, as well as a variety of descriptive statistics. This study found that 59% of the teachers who responded had experienced some form of pressure related to their evolution curriculum, and that the majority of this pressure came from students, groups or individuals not affiliated with their school district, and parents. The most common manifestations of pressure were to teach that evolution was "only" a

  19. Model supporting the use of pressure in the hot slumping of glass substrates for X-ray telescopes.

    PubMed

    Salmaso, Bianca; Brizzolari, Claudia; Spiga, Daniele

    2016-10-17

    Thin glass foils are nowadays considered good substrates for lightweight focusing optics, especially for X-ray telescopes. The desired shape can be imparted to the foils by hot slumping, a process that replicates the shape of a slumping mould. During thermal slumping, when the glass and the mould come into contact, ripples in the glass surface appear spontaneously if the thermal expansions are mismatched. In our hot slumping setup, pressure is applied to ease the mould shape replication and to enhance the ripple relaxation. Starting from an existing model developed to explain the ripple formation in hot-slumped glass foils without pressure, we have developed a model that includes the pressure to support our experimental results.

  20. Jet Ventilation during Rigid Bronchoscopy in Adults: A Focused Review

    PubMed Central

    Mayné, Alain

    2016-01-01

    The indications for rigid bronchoscopy for interventional pulmonology have increased and include stent placements and transbronchial cryobiopsy procedures. The shared airway between anesthesiologist and pulmonologist and the open airway system, requiring specific ventilation techniques such as jet ventilation, need a good understanding of the procedure to reduce potentially harmful complications. Appropriate adjustment of the ventilator settings including pause pressure and peak inspiratory pressure reduces the risk of barotrauma. High frequency jet ventilation allows adequate oxygenation and carbon dioxide removal even in cases of tracheal stenosis up to frequencies of around 150 min−1; however, in an in vivo animal model, high frequency jet ventilation along with normal frequency jet ventilation (superimposed high frequency jet ventilation) has been shown to improve oxygenation by increasing lung volume and carbon dioxide removal by increasing tidal volume across a large spectrum of frequencies without increasing barotrauma. General anesthesia with a continuous, intravenous, short-acting agent is safe and effective during rigid bronchoscopy procedures. PMID:27847813

  1. Ventilation technologies scoping study

    SciTech Connect

    Walker, Iain S.; Sherman, Max H.

    2003-09-30

    This document presents the findings of a scoping study commissioned by the Public Interest Energy Research (PIER) program of the California Energy Commission to determine what research is necessary to develop new residential ventilation requirements for California. This study is one of three companion efforts needed to complete the job of determining the needs of California, determining residential ventilation requirements, and determining appropriate ventilation technologies to meet these needs and requirements in an energy efficient manner. Rather than providing research results, this scoping study identifies important research questions along with the level of effort necessary to address these questions and the costs, risks, and benefits of pursuing alternative research questions. In approaching these questions and level of effort, feasibility and timing were important considerations. The Commission has specified Summer 2005 as the latest date for completing this research in time to update the 2008 version of California's Energy Code (Title 24).

  2. Leakage estimation using Kalman filtering in noninvasive mechanical ventilation.

    PubMed

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

    2013-05-01

    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.

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

    SciTech Connect

    Sherman, Max H.; Walker, Iain S.

    2011-04-01

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

  4. A Universal Velocity Dispersion Profile for Pressure Supported Systems: Evidence for MONDian Gravity across Seven Orders of Magnitude in Mass

    NASA Astrophysics Data System (ADS)

    Durazo, R.; Hernandez, X.; Cervantes Sodi, B.; Sánchez, S. F.

    2017-03-01

    For any MONDian extended theory of gravity where the rotation curves of spiral galaxies are explained through a change in physics rather than the hypothesis of dark matter, a generic dynamical behavior is expected for pressure supported systems: an outer flattening of the velocity dispersion profile occurring at a characteristic radius, where both the amplitude of this flat velocity dispersion and the radius at which it appears are predicted to show distinct scalings with the total mass of the system. By carefully analyzing the dynamics of globular clusters and elliptical galaxies, we are able to significantly extend the astronomical diversity of objects in which MONDian gravity has been tested, from spiral galaxies to the much larger mass range covered by pressure supported systems. We show that a universal projected velocity dispersion profile accurately describes various classes of pressure supported systems, and further, that the expectations of extended gravity are met across seven orders of magnitude in mass. These observed scalings are not expected under dark matter cosmology, and would require particular explanations tuned at the scales of each distinct astrophysical system.

  5. [Using non-invasive mask lung ventilation in cardiosurgical patients with acute respiratory distress syndrome].

    PubMed

    Eremenko, A A; Levikov, D I; Egorov, V M; Zorin, D E; Kolomiets, V Ia

    2004-01-01

    Twenty patients aged 33 to 71 (54 +/- 6) years (male - 13, female - 7) operated on the heart and main vessels were included in the case study. I.e. those patient were investigated, whose immediate postoperative results were complicated by the syndrome of multiple organ failure (SMOF) that developed due to different-etiology shock, huge blood loss and hemotransfusion or to the syndrome of acute postperfusion lung damage. NIMLV was made at the resolution stage of SMOF and ARDS after artificial pulmonary ventilation (APL) for as long as 5-7 days. The indications for extubation of patients were as follows: PaO2/FiO2 of 200 and more mm Hg, respiratory rate (RR) of less than 30 per min, respiratory volume of more than 6 ml/kg with pressure support at inspiration of less than 5 cm H2O and with the total pressure at the exhalation end of no more than 3 cm H2O. Mask ventilation sessions were started in a growing dyspnea of more than 26 per min, a decreased content of oxyhemoglobin in arterial blood (below 95% at oxygen inhalation of 10-15 l/min), involvement of auxiliary muscles in breathing and at subjective complaints of patients related with complicated breathing and with being short of air. The mask SIMV ventilation with a preset apparatus-aided rate of inhales of 2-6/min, with Bi-PAP and PSV inhale pressure of 15 cm/ H2O and with PEEP of 3-5 cm/ H2O was made by 40-120 min sessions; the number of IFMLV sessions ranged from 6 to 22/patient, mean - 11 +/- 1.1 h. The total IFMLV duration was 10.7 +/- 1.1 h. The need for respiratory support persisted for 4-6 days after extubation. In 18 (90%) of 20 patients, the mask pulmonary ventilation resolved the respiratory insufficiency. Two (10%) patients were reintubated because of progressing multiorgan failure and because of obturation of the left main bronchus. A questioning of patients on the comfort degree of mask ventilation denoted the Flow-by triggering to be by far better tolerated by patients versus the pressure

  6. Respiratory controversies in the critical care setting. Does high-frequency ventilation offer benefits over conventional ventilation in adult patients with acute respiratory distress syndrome?

    PubMed

    Fessler, Henry E; Hess, Dean R

    2007-05-01

    High-frequency ventilation is the application of mechanical ventilation with a respiratory rate > 100 breaths/min. High-frequency oscillatory ventilation (HFOV) is the form of high-frequency ventilation most widely used in adult critical care. The principles of lung-protective ventilation have matured in parallel with the technology for HFOV. The 2 basic principles of lung-protective ventilation are the use of small tidal volume and maintenance of adequate alveolar recruitment. Research in animal models and humans demonstrate that HFOV can support gas exchange with much smaller tidal volume than can be achieved with conventional ventilation. HFOV also provides more effective lung recruitment than conventional mechanical ventilation. However, at present, evidence is lacking that survival in adults with acute respiratory distress syndrome is improved by HFOV. Although HFOV may improve P(aO(2)) in some patients, this improvement is often transitory. Available evidence does not support that pulmonary inflammation is reduced with HFOV in adult acute respiratory distress syndrome. Heavy sedation and often paralysis are necessary. The promise of HFOV as a lung-protective ventilation strategy remains attractive, but additional clinical trials are needed to determine whether this approach is superior to lung-protective ventilation with conventional mechanical ventilation.

  7. Pulmonary ventilation/perfusion scan

    MedlinePlus

    ... JavaScript. A pulmonary ventilation/perfusion scan involves two nuclear scan tests to measure breathing (ventilation) and circulation ( ... In: Mettler FA, Guiberteau MJ, eds. Essentials of Nuclear Medicine Imaging . 6th ed. Philadelphia, PA: Elsevier Saunders; ...

  8. Central Fan Integrated Ventilation Systems

    SciTech Connect

    2009-05-12

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

  9. Social Support Is Associated with Blood Pressure Responses in Parents Caring for Children with Developmental Disabilities

    ERIC Educational Resources Information Center

    Gallagher, Stephen; Whiteley, Jenny

    2012-01-01

    The present study tested whether parents caring for children with developmental disabilities would have higher blood pressure compared to parents of typically developing children (controls). It also examined the psychosocial factors underlying this observation. Thirty-five parents of children with developmental disability and thirty controls…

  10. Heating, Ventilating, Air Conditioning and Dehumidifying Systems.

    DTIC Science & Technology

    1980-08-01

    not be connected to other ventilating systems. Duct runs shall be as short as possible to avoid leakage of moisture. I b. Special Considerations. (1...For rectangular duct design, see the SMACNA -Low Pressure Duct Construction Standards. Under jnormal applications, a minimum duct size of 6 by 6 inches...prevent leakage of the moisture-laden discharge air into the intake duct , and the intake and discharge outlets shall be located to prevent any

  11. Overall Ventilation System Flow Network Calculation for Site Recommendation

    SciTech Connect

    Jeff J. Steinhoff

    2001-08-02

    The scope of this calculation is to determine ventilation system resistances, pressure drops, airflows, and operating cost estimates for the Site Recommendation (SR) design as detailed in the ''Site Recommendation Subsurface Layout'' (BSC (Bechtel SAIC Company) 2001a). The statutory limit for emplacement of waste in Yucca Mountain is 70,000 metric tons of uranium (MTU) and is considered the base case for this report. The objective is to determine the overall repository system ventilation flow network for the monitoring phase during normal operations and to provide a basis for the system description document design descriptions. Any values derived from this calculation will not be used to support construction, fabrication, or procurement. The work scope is identified in the ''Technical Work Plan for Subsurface Design Section FY01 Work Activities'' (CRWMS M&O 2001, pp. 6 and 13). In accordance with the technical work plan this calculation was prepared in accordance with AP-3.12Q, ''Calculations'' and other procedures invoked by AP-3.12Q. It also incorporates the procedure AP-SI1.Q, ''Software Management''.

  12. Different ventilation modes combined with ambroxol in the treatment of respiratory distress syndrome in premature infants

    PubMed Central

    Zhou, Bin; Zhai, Jing-Fang; Wu, Jie-Bin; Jin, Bao; Zhang, Yan-Yan

    2017-01-01

    The aim of the present study was to compare the effectiveness of different modes of mechanical ventilation in combination with secretolytic therapy with ambroxol in premature infants with respiratory distress syndrome. Seventy-three premature infants with hyaline membrane disease (HMD) (stage III–IV), also known as respiratory distress syndrome, who were supported by mechanical ventilation in the neonatal intensive care unit (NICU) of Xuzhou Central Hospital, were involved in the present study, between January 2013 and February 2015. Forty cases were randomly selected and treated with high frequency oscillatory ventilation (HFOV), forming the HFOV group, whereas 33 cases were selected and treated with conventional mechanical ventilation (CMV), forming the CMV group. Patients in the two groups were administered ambroxol intravenously at a dosage rate of 30 mg/kg body weight at the beginning of the study. The present study involved monitoring the blood gas index as well as changes in the respiratory function index in the two groups. Additionally, the incidence of complications in the premature infants in the two groups was observed prior to and following the ventilation. Pulmonary arterial oxygen tension (PaO2), the PaO2/fraction of inspired oxygen (FiO2) ratio, the oxygenation index [OI = 100 × mean airway pressure (MAP) × FiO2/PaO2], as well as the arterial/alveolar oxygen partial pressure ratio (a/APO2) = PaO2/(713 × FiO2 partial pressure of carbon dioxide (PaCO2)/0.8) of the patients in the HFOV group after 1, 12 and 24 h of treatment were significantly improved as compared to the patients of the CMV group. However, there was no significant difference between patients in the two groups with regard to the number of mortalities, complications such as pneumothorax, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), and the time of ventilation. In conclusion, combining HFOV

  13. Non-invasive mechanical ventilation in the treatment of acute respiratory failure in chronic obstructive pulmonary disease.

    PubMed

    Ambrosino, N; Nava, S; Rubini, F

    1993-01-01

    Acute respiratory failure is usually managed by means of mechanical ventilation via an endotracheal tube or tracheostomy, when conservative treatment fails. Invasive mechanical ventilation is associated with several complications. The recent development of non-invasive methods of ventilation, has led to an attempt to avoid the complications of invasive mechanical ventilation during episodes of acute respiratory failure, ensuring at the same time a similar degree of efficacy. Both intermittent negative pressure ventilation and positive pressure ventilation by face or nasal mask have recently been used for this purpose. Negative pressure ventilation by means of iron lung, cuirass or poncho-wrap ventilators, has never been used in place of endotracheal intubation, and studies of this kind of ventilation are inconclusive: as a consequence, there is, at the moment, no indication for the generalized use of negative pressure ventilation in acute respiratory failure. Intermittent positive pressure ventilation by facial or nasal masks, has recently been used in the treatment of respiratory failure in place of endotracheal intubation. The results are promising, but remain controversial. It may be attempted in selected patients with obstructive respiratory disorders, but the procedure is very time-consuming for nurses.

  14. Ventilation Systems Operating Experience Review for Fusion Applications

    SciTech Connect

    L. C. Cadwallader

    1999-12-01

    This report is a collection and review of system operation and failure experiences for air ventilation systems in nuclear facilities. These experiences are applicable for magnetic and inertial fusion facilities since air ventilation systems are support systems that can be considered generic to nuclear facilities. The report contains descriptions of ventilation system components, operating experiences with these systems, component failure rates, and component repair times. Since ventilation systems have a role in mitigating accident releases in nuclear facilities, these data are useful in safety analysis and risk assessment of public safety. An effort has also been given to identifying any safety issues with personnel operating or maintaining ventilation systems. Finally, the recommended failure data were compared to an independent data set to determine the accuracy of individual values. This comparison is useful for the International Energy Agency task on fusion component failure rate data collection.

  15. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery

    PubMed Central

    2016-01-01

    The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery, can reduce postoperative pulmonary complications. Facilitating perioperative bundle care by combining prophylactic and postoperative positive-pressure ventilation with intraoperative lung-protective ventilation may be helpful to reduce postoperative pulmonary complications. PMID:26885294

  16. How to Plan Ventilation Systems.

    ERIC Educational Resources Information Center

    Clarke, John H.

    1963-01-01

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

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

    PubMed

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

    2015-01-01

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

  18. Measure Guideline: Ventilation Cooling

    SciTech Connect

    Springer, D.; Dakin, B.; German, A.

    2012-04-01

    The purpose of this measure guideline on ventilation cooling is to provide information on a cost-effective solution for reducing cooling system energy and demand in homes located in hot-dry and cold-dry climates. This guideline provides a prescriptive approach that outlines qualification criteria, selection considerations, and design and installation procedures.

  19. Laboratory Ventilation and Safety.

    ERIC Educational Resources Information Center

    Steere, Norman V.

    1965-01-01

    In order to meet the needs of both safety and economy, laboratory ventilation systems must effectively remove air-borne toxic and flammable materials and at the same time exhaust a minimum volume of air. Laboratory hoods are the most commonly used means of removing gases, dusts, mists, vapors, and fumed from laboratory operations. To be effective,…

  20. Energy recovery ventilator

    SciTech Connect

    Schneider, S. L.; Dravnieks, K.

    1985-04-30

    An energy recovery ventilator adapted to be mounted on a roof and adapted to be connected to the outlet of an exhaust air duct of a building ventilation system and the inlet of an air supply duct of a building ventilation system. The energy recovery ventilator includes a housing having an exhaust air chamber and a supply air chamber separated by a divider wall. A circular heat transfer wheel is position in the housing, a portion of the wheel being housed in the exhaust air chamber and a second portion of the wheel being housed in the supply air chamber, and the heat transfer wheel is caused to rotate about a central axis. An exhaust fan is housed in the exhaust air chamber and causes exhaust air to be pulled through the exhaust air duct and the heat transfer wheel and to be exhausted from the housing. A supply air fan is housed in the supply air housing above the heat transfer wheel, and causes outside air to be drawn into the supply air chamber and to be forced through the heat transfer wheel into the air supply duct.

  1. Understanding mechanical ventilators.

    PubMed

    Chatburn, Robert L

    2010-12-01

    The respiratory care academic community has not yet adopted a standardized system for classifying and describing modes of ventilation. As a result, there is enough confusion that patient care, clinician education and even ventilator sales are all put at risk. This article summarizes a ventilator mode taxonomy that has been extensively published over the last 15 years. Specifically, the classification system has three components: a description of the control variables within breath; a description of the sequence of mandatory and spontaneous breaths; and a specification for the targeting scheme. This three-level specification provides scalability of detail to make the mode description appropriate for the particular need. At the bedside, we need only refer to a mode briefly using the first or perhaps first and second components. To distinguish between similar modes and brand names, we would need to include all components. This taxonomy uses the equation of motion for the respiratory system as the underlying theoretical framework. All terms relevant to describing modes of mechanical ventilation are defined in an extensive appendix.

  2. Space station ventilation study

    NASA Technical Reports Server (NTRS)

    Colombo, G. V.; Allen, G. E.

    1972-01-01

    A ventilation system design and selection method which is applicable to any manned vehicle were developed. The method was used to generate design options for the NASA 33-foot diameter space station, all of which meet the ventilation system design requirements. System characteristics such as weight, volume, and power were normalized to dollar costs for each option. Total system costs for the various options ranged from a worst case $8 million to a group of four which were all approximately $2 million. A system design was then chosen from the $2 million group and is presented in detail. A ventilation system layout was designed for the MSFC space station mockup which provided comfortable, efficient ventilation of the mockup. A conditioned air distribution system design for the 14-foot diameter modular space station, using the same techniques, is also presented. The tradeoff study resulted in the selection of a system which costs $1.9 million, as compared to the alternate configuration which would have cost $2.6 million.

  3. Patient-ventilator dyssynchrony during assisted invasive mechanical ventilation.

    PubMed

    Murias, G; Villagra, A; Blanch, L

    2013-04-01

    Patient-ventilator dyssynchrony is common during mechanical ventilation. Dyssynchrony decreases comfort, prolongs mechanical ventilation and intensive care unit stays, and might lead to worse outcome. Dyssynchrony can occur during the triggering of the ventilator, the inspiration period after triggering, the transition from inspiration to expiration, and the expiratory phase. The most common dyssynchronies are delayed triggering, autotriggering, ineffective inspiratory efforts (which can occur at any point in the respiratory cycle), mismatch between the patient's and ventilator's inspiratory times, and double triggering. At present, the detection of dyssynchronies usually depends on healthcare staff observing ventilator waveforms; however, performance is suboptimal and many events go undetected. To date, technological complexity has made it impossible to evaluate patient-ventilator synchrony throughout the course of mechanical ventilation. Studies have shown that a high index of dyssynchrony may increase the duration of mechanical ventilation. Better training, better ventilatory modes, and/or computerized systems that permit better synchronization of patients' demands and ventilator outputs are necessary to improve patient-ventilator synchrony.

  4. Project Design Concept Primary Ventilation System

    SciTech Connect

    MCGREW, D.L.

    2000-10-02

    Tank Farm Restoration and Safe Operation (TFRSO), Project W-3 14 was established to provide upgrades that would improve the reliability and extend the system life of portions of the waste transfer, electrical, ventilation, instrumentation and control systems for the Hanford Site Tank Farms. An assessment of the tank farm system was conducted and the results are documented in system assessment reports. Based on the deficiencies identified in the tank farm system assessment reports, and additional requirements analysis performed in support of the River Protection Project (RPP), an approved scope for the TFRSO effort was developed and documented in the Upgrade Scope Summary Report (USSR), WHC-SD-W314-RPT-003, Rev. 4. The USSR establishes the need for the upgrades and identifies the specific equipment to be addressed by this project. This Project Design Concept (PDC) is in support of the Phase 2 upgrades and provides an overall description of the operations concept for the W-314 Primary Ventilation Systems. Actual specifications, test requirements, and procedures are not included in this PDC. The PDC is a ''living'' document, which will be updated throughout the design development process to provide a progressively more detailed description of the W-314 Primary Ventilation Systems design. The Phase 2 upgrades to the Primary Ventilation Systems shall ensure that the applicable current requirements are met for: Regulatory Compliance; Safety; Mission Requirements; Reliability; and Operational Requirements.

  5. Monitoring Patient/Ventilator Interactions: Manufacturer's Perspective.

    PubMed

    Evers, Gerard; Loey, Carl Van

    2009-03-12

    The introduction of reduced and more powerful electronics has allowed the transition of medical equipment such as respiratory support devices from the hospital to the patient's home environment. Even if this move could be beneficial for the patient, the clinician ends up in a delicate situation where little or no direct supervision is possible on the delivered treatment.Progress in technologies led to an improved handling of patient-device interaction: manufacturers are promoting new or improved ventilation modes or cycling techniques for better patient-ventilator coupling. Even though these ventilation modes have become more responsive to patient efforts, adversely they might lead to events such as false triggering, autotriggering, delayed triggering.In addition, manufacturers are developing tools to enhance the follow-up, remotely or offline, of the treatment by using embedded memory in the respiratory devices. This logging might be beneficial for the caregiver to review and document the treatment and tune the settings to the patient's need and comfort. Also, remote telemedicine has been raised as a potential solution for many years without yet overall acceptance due to legal, technical and ethical problems.Benefits of new technologies in respiratory support devices give the technical foundation for the transition from hospital to home and reducing patient/ventilator asynchronies. Healthcare infrastructure has to follow this trend in terms of cost savings versus hospital stays.

  6. Ventilation System Effectiveness and Tested Indoor Air Quality Impacts

    SciTech Connect

    Rudd, A.; Bergey, D.

    2014-02-01

    Ventilation system effectiveness testing was conducted at two unoccupied, single-family, detached lab homes at the University of Texas - Tyler. Five ventilation system tests were conducted with various whole-building ventilation systems. Multizone fan pressurization testing characterized building and zone enclosure leakage. PFT testing showed multizone air change rates and interzonal airflow. Cumulative particle counts for six particle sizes, and formaldehyde and other Top 20 VOC concentrations were measured in multiple zones. The testing showed that single-point exhaust ventilation was inferior as a whole-house ventilation strategy. It was inferior because the source of outside air was not direct from outside, the ventilation air was not distributed, and no provision existed for air filtration. Indoor air recirculation by a central air distribution system can help improve the exhaust ventilation system by way of air mixing and filtration. In contrast, the supply and balanced ventilation systems showed that there is a significant benefit to drawing outside air from a known outside location, and filtering and distributing that air. Compared to the Exhaust systems, the CFIS and ERV systems showed better ventilation air distribution and lower concentrations of particulates, formaldehyde and other VOCs. System improvement percentages were estimated based on four System Factor Categories: Balance, Distribution, Outside Air Source, and Recirculation Filtration. Recommended System Factors could be applied to reduce ventilation fan airflow rates relative to ASHRAE Standard 62.2 to save energy and reduce moisture control risk in humid climates. HVAC energy savings were predicted to be 8-10%, or $50-$75/year.

  7. Ventilation System Effectiveness and Tested Indoor Air Quality Impacts

    SciTech Connect

    Rudd, Armin; Bergey, Daniel

    2014-02-01

    In this project, Building America research team Building Science Corporation tested the effectiveness of ventilation systems at two unoccupied, single-family, detached lab homes at the University of Texas - Tyler. Five ventilation system tests were conducted with various whole-building ventilation systems. Multizone fan pressurization testing characterized building and zone enclosure leakage. PFT testing showed multizone air change rates and interzonal airflow. Cumulative particle counts for six particle sizes, and formaldehyde and other Top 20 VOC concentrations were measured in multiple zones. The testing showed that single-point exhaust ventilation was inferior as a whole-house ventilation strategy. This was because the source of outside air was not direct from outside, the ventilation air was not distributed, and no provision existed for air filtration. Indoor air recirculation by a central air distribution system can help improve the exhaust ventilation system by way of air mixing and filtration. In contrast, the supply and balanced ventilation systems showed that there is a significant benefit to drawing outside air from a known outside location, and filtering and distributing that air. Compared to the exhaust systems, the CFIS and ERV systems showed better ventilation air distribution and lower concentrations of particulates, formaldehyde and other VOCs. System improvement percentages were estimated based on four system factor categories: balance, distribution, outside air source, and recirculation filtration. Recommended system factors could be applied to reduce ventilation fan airflow rates relative to ASHRAE Standard 62.2 to save energy and reduce moisture control risk in humid climates. HVAC energy savings were predicted to be 8-10%, or $50-$75/year.

  8. A multicentre, randomised controlled, non-inferiority trial, comparing high flow therapy with nasal continuous positive airway pressure as primary support for preterm infants with respiratory distress (the HIPSTER trial): study protocol

    PubMed Central

    Roberts, Calum T; Owen, Louise S; Manley, Brett J; Donath, Susan M; Davis, Peter G

    2015-01-01

    Introduction High flow (HF) therapy is an increasingly popular mode of non-invasive respiratory support for preterm infants. While there is now evidence to support the use of HF to reduce extubation failure, there have been no appropriately designed and powered studies to assess the use of HF as primary respiratory support soon after birth. Our hypothesis is that HF is non-inferior to the standard treatment—nasal continuous positive airway pressure (NCPAP)— as primary respiratory support for preterm infants. Methods and analysis The HIPSTER trial is an unblinded, international, multicentre, randomised, non-inferiority trial. Eligible infants are preterm infants of 28–36+6 weeks’ gestational age (GA) who require primary non-invasive respiratory support for respiratory distress in the first 24 h of life. Infants are randomised to treatment with either HF or NCPAP. The primary outcome is treatment failure within 72 h after randomisation, as determined by objective oxygenation, blood gas, and apnoea criteria, or the need for urgent intubation and mechanical ventilation. Secondary outcomes include the incidence of intubation, pneumothorax, bronchopulmonary dysplasia, nasal trauma, costs associated with hospital care and parental stress. With a specified non-inferiority margin of 10%, using a two-sided 95% CI and 90% power, the study requires 375 infants per group (total 750 infants). Ethics and dissemination Ethical approval has been granted by the relevant human research ethics committees at The Royal Women's Hospital (13/12), The Royal Children's Hospital (33144A), The Mercy Hospital for Women (R13/34), and the South-Eastern Norway Regional Health Authority (2013/1657). The trial is currently recruiting at 9 centres in Australia and Norway. The trial results will be published in peer-reviewed international journals, and presented at national and international conferences. Trial registration number Australian New Zealand Clinical Trials Registry ID: ACTRN

  9. Adsorption and reaction of methanol on supported palladium catalysts: microscopic-level studies from ultrahigh vacuum to ambient pressure conditions.

    PubMed

    Bäumer, Marcus; Libuda, Jörg; Neyman, Konstantin M; Rösch, Notker; Rupprechter, Günther; Freund, Hans-Joachim

    2007-07-21

    We investigated the decomposition and (partial) oxidation of methanol on Pd based catalysts in an integrated attempt, simultaneously bridging both the pressure and the materials gap. Combined studies were performed on well-defined Pd model catalysts based on ordered Al(2)O(3) and Fe(3)O(4) thin films, on well-defined particles supported on powders and on Pd single crystals. The interaction of Pd nanoparticles and Pd(111) with CH(3)OH and CH(3)OH/O(2) mixtures was examined from ultrahigh vacuum conditions up to ambient pressures, utilizing a broad range of surface specific vibrational spectroscopies which included IRAS, TR-IRAS, PM-IRAS, SFG, and DRIFTS. Detailed kinetic studies in the low pressure region were performed by molecular beam methods, providing comprehensive insights into the microkinetics of the reaction system. The underlying microscopic processes were studied theoretically on the basis of specially designed 3-D nanocluster models containing approximately 10(2) metal atoms. The efficiency of this novel modelling approach was demonstrated by rationalizing and complementing pertinent experimental results. In order to connect these results to the behavior under ambient conditions, kinetic and spectroscopic investigations were performed in reaction cells and lab reactors. Specifically, we focused on (1) particle size and structure dependent effects in methanol oxidation and decomposition, (2) support effects and their relation to activity and selectivity, (3) the influence of poisons such as carbon, and (4) the role of oxide and surface oxide formation on Pd nanoparticles.

  10. Design Features of Modern Mechanical Ventilators.

    PubMed

    MacIntyre, Neil

    2016-12-01

    A positive-pressure breath ideally should provide a VT that is adequate for gas exchange and appropriate muscle unloading while minimizing any risk for injury or discomfort. The latest generation of ventilators uses sophisticated feedback systems to sculpt positive-pressure breaths according to patient effort and respiratory system mechanics. Currently, however, these new control strategies are not totally closed-loop systems. This is because the automatic input variables remain limited, some clinician settings are still required, and the specific features of the perfect breath design still are not entirely clear. Despite these limitations, there are some rationale for many of these newer feedback features.

  11. Measuring Wind Ventilation of Dense Surface Snow

    NASA Astrophysics Data System (ADS)

    Drake, S. A.; Huwald, H.; Selker, J. S.; Higgins, C. W.; Lehning, M.; Thomas, C. K.

    2014-12-01

    Wind ventilation enhances exposure of suspended, canopy-captured and corniced snow to subsaturated air and can significantly increase sublimation rate. Although sublimation rate may be high for highly ventilated snow this snow regime represents a small fraction snow that resides in a basin potentially minimizing its influence on snow mass balance. In contrast, the vast majority of a seasonal snowpack typically resides as poorly ventilated surface snow. The sublimation rate of surface snow is often locally so small as to defy direct measurement but regionally pervasive enough that the integrated mass loss of frozen water across a basin may be significant on a seasonal basis. In a warming climate, sublimation rate increases even in subfreezing conditions because the equilibrium water vapor pressure over ice increases exponentially with temperature. To better understand the process of wintertime surface snow sublimation we need to quantify the depth to which turbulent and topographically driven pressure perturbations effect air exchange within the snowpack. Hypothetically, this active layer depth increases the effective ventilated snow surface area, enhancing sublimation above that given by a plane, impermeable snow surface. We designed and performed a novel set of field experiments at two sites in the Oregon Cascades during the 2014 winter season to examine the spectral attenuation of pressure perturbations with depth for dense snow as a function of turbulence intensity and snow permeability. We mounted a Campbell Scientific Irgason Integrated CO2 and H2O Open Path Gas Analyzer and 3-D Sonic Anemometer one meter above the snow to capture mean and turbulent wind forcing and placed outlets of four high precision ParoScientific 216B-102 pressure transducers at different depths to measure the depth-dependent pressure response to wind forcing. A GPS antenna captured data acquisition time with sufficient precision to synchronize a Campbell Scientific CR-3000 acquiring

  12. Performance of Portable Ventilators at Altitude

    DTIC Science & Technology

    2015-03-30

    Deploying ventilators that can maintain a consistent tidal volume ( VT ) delivery at various altitudes is imperative for lung protection when...and adult VT (250-750 mL) at 0 and 20 cm H2O positive end expiratory pressure and at inspired oxygen of 0.21 and 1.0. Airway pressure, volume, and...calibrated pneumotachograph connected to a training test lung in an altitude chamber. Set VT and delivered VT and changes in VT at each altitude were

  13. Laboratory Pressure Broadening Coefficients To Support SOIR/VEx And SOIR-NOMAD

    NASA Astrophysics Data System (ADS)

    Drummond, Rachel; Földes, T.; Vander Auwera, J.; Mahieux, A.; Robert, S.; Vandaele, A.; Wilquet, V.

    2010-10-01

    Precise spectroscopic data to describe CO2 pressure-broadened lineshapes of trace gases in the Venus and Mars atmospheres are rather scarce. In an attempt to compensate for such a situation, we recorded in the laboratory CO2 broadened absorption spectra of the 1-0 band of HCl near 2886 cm-1 and the ν3 band of CH4 near 3019 cm-1 at several pressures between 150 and 700 Torr, using a high-resolution Fourier transform spectrometer. CO2 pressure broadening half-width coefficients are extracted by least-squares fitting of suitable molecular line profiles, including instrumental effects. Sensitivity studies have been performed using the characteristics of the SOIR instrument. This instrument is currently on board the Venus Express mission (ESA) and has been proposed as payload for the future ExoMars 2016 TGO mission (ESA/NASA). The SOIR instrument is designed to measure atmospheric transmission in the near-IR (2.2 - 4.3 µm) at high resolution (0.12 cm-1) through solar occultation observations. It therefore allows the derivation of unique remote sensing information about the vertical structure and composition of the Venus mesosphere, with very good spatial resolution. At Venus, SOIR is able to provide HCl vertical profiles ranging typically from 80 to 105 km, at both morning and evening terminators, where the dynamics of the planetary atmosphere are relatively unknown. At Mars, the high resolution of the instrument will make it possible to observe CH4, if any. We show here how these two approaches, laboratory and space missions, are complimentary, as broadening coefficients measured in the laboratory allow us to simulate perfectly HCl and CH4 lines as seen by SOIR.

  14. Health and Safety Benefits of Small Pressurized Suitport Rovers as EVA Surface Support Vehicles

    NASA Technical Reports Server (NTRS)

    Gernhardt, Michael L.; Abercromby, Andrew F. J.

    2008-01-01

    Pressurized safe-haven providing SPE protection and decompression sickness (DCS) treatment capabilities within 20 mins at all times. Up to 50% reduction in time spent in EVA suits (vs. Unpressurized Rovers) for equal or greater Boots-on-Surface EVA exploration time. Reduces suit-induced trauma and provides improved options for nutrition, hydration, and waste-management. Time spent inside SPR during long translations may be spent performing resistive and cardiovascular exercise. Multiple shorter EVAs versus single 8 hr EVAs increases DCS safety and decreases prebreathe requirements. SPRs also offer many potential operational, engineering and exploration benefits not addressed here.

  15. Impact of Teachers' Implicit Theories and Perceived Pressures on the Establishment of an Autonomy Supportive Climate

    ERIC Educational Resources Information Center

    Leroy, Nadia; Bressoux, Pascal; Sarrazin, Philippe; Trouilloud, David

    2007-01-01

    According to self-determination theory, when teachers establish an autonomy supportive climate in the classroom, students demonstrate high levels of self-determination and are intrinsically motivated. The aim of this study was to identify factors leading teachers (N=336) to report that they create such a climate. We conducted a path analysis in…

  16. Impact of radiation embrittlement on integrity of pressure vessel supports for two PWR plants

    SciTech Connect

    Cheverton, R.D.; Pennell, W.E.; Robinson, G.C.; Nanstad, R.K.

    1989-01-01

    Recent data from the HFIR vessel surveillance program indicate a substantial radiation embrittlement rate effect at low irradiation temperatures (/approximately/120/degree/F) for A212-B, A350-LF3, A105-II, and corresponding welds. PWR vessel supports are fabricated of similar materials and are subjected to the same low temperatures and fast neutron fluxes (10/sup 8/ to 10/sup 9/ neutrons/cm/sup 2//center dot/s, E > 1.0 MeV) as those in the HFIR vessel. Thus, the embrittlement rate of these structures may be greater than previously anticipated. A study sponsored by the NRC is under way at ORNL to determine the impact of the rate effect on PWR vessel-support life expectancy. The scope includes the interpretation and application of the HFIR data, a survey of all light-water-reactor vessel support designs, and a structural and fracture-mechanics analysis of the supports for two specific PWR plants of particular interest with regard to a potential for support failure as a result of propagation of flaws. Calculations performed thus far indicate best-estimate critical flaw sizes, corresponding to 32 EFPY, of /approximately/0.2 in. for one plant and /approximately/0.4 in. for the other. These flaw sizes are small enough to be of concern. However, it appears that low-cycle fatigue is not a viable mechanism for creation of flaws of this size, and thus, presumably, such flaws would have to exist at the time of fabrication. 59 refs., 128 figs., 49 tabs.

  17. An approach to ventilation in acute respiratory distress syndrome

    PubMed Central

    Houston, Patricia

    2000-01-01

    Appropriate management of patients with acute respiratory distress syndrome (ARDS) represents a challenge for physicians working in the critical care environment. Significant advances have been made in understanding the pathophysiology of ARDS. There is also an increasing appreciation of the role of ventilator-induced lung injury (VILI). VILI is most likely related to several different aspects of ventilator management: barotrauma due to high peak airway pressures, lung overdistension or volutrauma due to high transpulmonary pressures, alveolar membrane damage due to insufficient positive end-expiratory pressure levels and oxygen-related cell toxicity. Various lung protective strategies have been suggested to minimize the damage caused by conventional modes of ventilation. These include the use of pressure- and volume-limited ventilation, the use of the prone position in the management of ARDS, and extracorporeal methods of oxygen delivery and carbon dioxide removal. Although the death rate resulting from ARDS has been declining over the past 10 years, there is no evidence that any specific treatment or change in approach to ventilation is the cause of this improved survival. PMID:10948686

  18. ASHRAE and residential ventilation

    SciTech Connect

    Sherman, Max H.

    2003-10-01

    In the last quarter of a century, the western world has become increasingly aware of environmental threats to health and safety. During this period, people psychologically retreated away from outdoors hazards such as pesticides, smog, lead, oil spills, and dioxin to the seeming security of their homes. However, the indoor environment may not be healthier than the outdoor environment, as has become more apparent over the past few years with issues such as mold, formaldehyde, and sick-building syndrome. While the built human environment has changed substantially over the past 10,000 years, human biology has not; poor indoor air quality creates health risks and can be uncomfortable. The human race has found, over time, that it is essential to manage the indoor environments of their homes. ASHRAE has long been in the business of ventilation, but most of the focus of that effort has been in the area of commercial and institutional buildings. Residential ventilation was traditionally not a major concern because it was felt that, between operable windows and envelope leakage, people were getting enough outside air in their homes. In the quarter of a century since the first oil shock, houses have gotten much more energy efficient. At the same time, the kinds of materials and functions in houses changed in character in response to people's needs. People became more environmentally conscious and aware not only about the resources they were consuming but about the environment in which they lived. All of these factors contributed to an increasing level of public concern about residential indoor air quality and ventilation. Where once there was an easy feeling about the residential indoor environment, there is now a desire to define levels of acceptability and performance. Many institutions--both public and private--have interests in Indoor Air Quality (IAQ), but ASHRAE, as the professional society that has had ventilation as part of its mission for over 100 years, is the

  19. Reactivity of Au nanoparticles supported over SiO2 and TiO2 studiedby ambient pressure photoelectron spectroscopy

    SciTech Connect

    Herranz, Tirma; Deng, Xingyi; Cabot, Andreu; Alivisatos, Paul; Liu, Zhi; Soler-Illia, Galo; Salmeron, Miquel

    2009-04-15

    The influence of the metal cluster size and the identity of the support on the reactivity of gold based catalysts have been studied in the CO oxidation reaction. To overcome the structural complexity of the supported catalysts, gold nanoparticles synthesized from colloidal chemistry with precisely controlled size have been used. Those particles were supported over SiO{sub 2} and TiO{sub 2} and their catalytic activity was measured in a flow reactor. The reaction rate was dependent on the particle size and the support, suggesting two reaction pathways in the CO oxidation reaction. In parallel, ambient pressure photoelectron spectroscopy (APPS) has been performed under reaction conditions using bidimensional model catalysts prepared upon supporting the Au nanoparticles over planar polycrystalline SiO{sub 2} and TiO{sub 2} thin films by means of the Langmuir-Blodgett (LB) technique to mimic the characteristic of the powder samples. In this way, the catalytically active surface was characterized under true reaction conditions, revealing that during CO oxidation gold remains in the metallic state.

  20. Goal-directed critiquing by computer: ventilator management.

    PubMed

    Miller, P L

    1985-10-01

    VQ-ATTENDING is an expert system which critiques aspects of the ventilator management of a patient receiving mechanical respiratory support. To use VQ-ATTENDING, the physician first inputs medical information describing a patient, a current set of arterial blood gas results, the current ventilator settings, and a proposed set of new ventilator settings. VQ-ATTENDING then critiques the appropriateness of the proposed settings. In its current developmental implementation, VQ-ATTENDING explores a particular expert system designed feature: the ability to assess appropriate treatment goals, and to use those goals to guide the system's critiquing analysis.

  1. Tension pneumocephalus induced by high-flow nasal cannula ventilation in a neonate.

    PubMed

    Iglesias-Deus, Alicia; Pérez-Muñuzuri, Alejandro; López-Suárez, Olalla; Crespo, Pilar; Couce, Maria-Luz

    2017-03-01

    The use of high-flow nasal cannula (HFNC) therapy as respiratory support for preterm infants has increased rapidly worldwide. The evidence available for the use of HFNC is as an alternative to nasal continuous positive airway pressure (CPAP) and in particular to prevent postextubation failure. We report a case of tension pneumocephalus in a preterm infant as a complication during HFNC ventilation. Significant neurological impairment was detected and support was eventually withdrawn. Few cases of pneumocephalus as a complication of positive airway pressure have been reported in the neonatal period, and they all have been related to CPAP. This report reinforces the need to be aware of this rare but possible complication during HFNC therapy, as timely diagnosis and treatment can prevent neurological sequelae. We also stress the importance of paying close attention to flow rate, nasal cannula size and insertion, and mouth position, and of regularly checking insertion depth.

  2. Inert gas analysis of ventilation-perfusion matching during hemodialysis.

    PubMed Central

    Ralph, D D; Ott, S M; Sherrard, D J; Hlastala, M P

    1984-01-01

    The mechanism of hypoxemia during hemodialysis was investigated by the multiple inert gas elimination technique in anesthetized, paralyzed, mechanically ventilated dogs. Profound leukopenia occurred in the first hour of a 2-h hemodialysis with a cuprophan membrane and dialysate that contained acetate. Arterial partial pressure of O2 and CO2 and oxygen consumption remained unchanged during dialysis. Pulmonary carbon dioxide elimination and lung respiratory exchange ratio decreased with the initiation of dialysis, remained depressed throughout the duration of dialysis, and returned to predialysis levels after the cessation of dialysis. Cardiac output diminished during dialysis but did not return to base-line levels after dialysis. Multiple indices calculated from inert gas analysis revealed no ventilation-perfusion mismatching during dialysis. The shunt and perfusion to regions of low alveolar ventilation-to-perfusion ratio (VA/Q) were unchanged during dialysis. There was no change in the mean or standard deviation of the profile of the percentage of total perfusion to regions of the lung that had VA/Q near 1.0; nor was there any increase in the directly calculated arterial-alveolar partial pressure differences for the inert gases during dialysis. Dead space became mildly elevated during dialysis. These results show that during dialysis with controlled ventilation there is no ventilation-perfusion mismatching that leads to hypoxemia. During spontaneous ventilation any hypoxemia must occur due to hypoventilation secondary to the CO2 exchange by the dialyzer and subsequent reduction in pulmonary CO2 exchange. PMID:6715542

  3. Energy efficient engine high pressure turbine ceramic shroud support technology report

    NASA Technical Reports Server (NTRS)

    Nelson, W. A.; Carlson, R. G.

    1982-01-01

    This work represents the development and fabrication of ceramic HPT (high pressure turbine) shrouds for the Energy Efficient Engine (E3). Details are presented covering the work performed on the ceramic shroud development task of the NASA/GE Energy Efficient Engine (E3) component development program. The task consists of four phases which led to the selection of a ZrO2-BY2O3 ceramic shroud material system, the development of an automated plasma spray process to produce acceptable shroud structures, the fabrication of select shroud systems for evaluation in laboratory, component, and CF6-50 engine testing, and finally, the successful fabrication of ZrO2-8Y2O3/superpeg, engine quality shrouds for the E3 engine.

  4. Measurement system support at the JAERI-CRT Facility: pressure transducers. [Containment Research Testing

    SciTech Connect

    Shay, W.M. Jr.; McCauley, E.W.

    1981-11-01

    As part of a continuing liaison between the US NRC and foreigh full scale containment research programs, measurements assistance in the form of the loan of 30 flush diaphram pressure transducers has been provided to the JAERI-CRT MK II research program at Tokai-Mura, Japan. Procedures developed earlier at the Lawrence Livermore National Laboratory (LLNL) under similar research work sponsored by the US NRC were used by LLNL to successfully complete final installation and in-situ end-to-end calibration of the transducers in the CRT facility. The results from this calibration showed a very close agreement between sensitivities and linearities calculated at LLNL and the ones calculated at JAERI and indicate the transducers should give valid data during future testing.

  5. Excitatory amino acids in rostral ventrolateral medulla support blood pressure during water deprivation in rats.

    PubMed

    Brooks, Virginia L; Freeman, Korrina L; Clow, Kathy A

    2004-05-01

    Water deprivation is associated with regional increases in sympathetic tone, but whether this is mediated by changes in brain stem regulation of sympathetic activity is unknown. Therefore, this study tested the hypothesis that water deprivation increases excitatory amino acid (EAA) drive of the rostral ventrolateral medulla (RVLM), by determining whether bilateral microinjection of kynurenate (Kyn; 2.7 nmol) into the RVLM decreases arterial pressure more in water-deprived than water-replete rats. Plasma osmolality was increased in 48-h water-deprived rats (313 +/- 1 mosmol/kgH2O; P < 0.05) compared with 24-h water-deprived rats (306 +/- 2 mosmol/kgH2O) and water-replete animals (300 +/- 2 mosmol/kgH2O). Kyn decreased arterial pressure by 28.1 +/- 5.2 mmHg (P < 0.01) in 48-h water-deprived rats but had no effect in water-replete rats (-5.9 +/- 1.3 mmHg). Variable depressor effects were observed in 24-h water-deprived animals (-12.5 +/- 2.4 mmHg, not significant); however, in all rats the Kyn depressor response was strongly correlated to the osmolality level (P < 0.01; r2 = 0.47). The pressor responses to unilateral microinjection of increasing doses (0.1, 0.5, 1.0, and 5.0 nmol) of glutamate were enhanced (P < 0.05) during water deprivation, but the pressor responses to intravenous phenylephrine injection were smaller (P < 0.05). These data suggest that water deprivation increases EAA drive to the RVLM, in part by increasing responsiveness of the RVLM to EAA such as glutamate.

  6. AT(1) and glutamatergic receptors in paraventricular nucleus support blood pressure during water deprivation.

    PubMed

    Freeman, Korrina L; Brooks, Virginia L

    2007-04-01

    Water deprivation activates sympathoexcitatory neurons in the paraventricular nucleus (PVN); however, the neurotransmitters that mediate this activation are unknown. To test the hypothesis that ANG II and glutamate are involved, effects on blood pressure (BP) of bilateral PVN microinjections of ANG II type 1 receptor (AT1R) antagonists, candesartan and valsartan, or the ionotropic glutamate receptor antagonist, kynurenate, were determined in urethane-anesthetized water-deprived and water-replete male rats. Because PVN may activate sympathetic neurons via the rostral ventrolateral medulla (RVLM) and because PVN disinhibition increases sympathetic activity in part via increased drive of AT1R in the RVLM, candesartan was also bilaterally microinjected into the RVLM. Total blockade of the PVN with bilateral microinjections of muscimol, a GABA(A) agonist, decreased BP more (P < 0.05) in water-deprived (-29 +/- 8 mmHg) than in water-replete (-7 +/- 2 mmHg) rats, verifying that the PVN is required for BP maintenance during water deprivation. PVN candesartan slowly lowered BP by 7 +/- 1 mmHg (P < 0.05). In water-replete rats, however, candesartan did not alter BP (1 +/- 1 mmHg). Valsartan also produced a slowly developing decrease in arterial pressure (-6 +/- 1 mmHg; P < 0.05) in water-deprived but not in water-replete (-1 +/- 1 mmHg) rats. In water-deprived rats, PVN kynurenate rapidly decreased BP (-19 +/- 3 mmHg), and the response was greater (P < 0.05) than in water-replete rats (-4 +/- 1 mmHg). Finally, as in PVN, candesartan in RVLM slowly decreased BP in water-deprived (-8 +/- 1 mmHg; P < 0.05) but not in water-replete (-3 +/- 1 mmHg) rats. These data suggest that activation of AT(1) and glutamate receptors in PVN, as well as of AT1R in RVLM, contributes to BP maintenance during water deprivation.

  7. Ventilator-associated pneumonia.

    PubMed

    2009-11-01

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

  8. Home Mechanical Ventilation in Children.

    PubMed

    Preutthipan, Aroonwan

    2015-09-01

    The number of children dependent on home mechanical ventilation has been reported to be increasing in many countries around the world. Home mechanical ventilation has been well accepted as a standard treatment of children with chronic respiratory failure. Some children may need mechanical ventilation as a lifelong therapy. To send mechanically ventilated children back home may be more difficult than adults. However, relatively better outcomes have been demonstrated in children. Children could be safely ventilated at home if they are selected and managed properly. Conditions requiring home ventilation include increased respiratory load from airway or lung pathologies, ventilatory muscle weakness and failure of neurologic control of ventilation. Home mechanical ventilation should be considered when the patient develops progressive respiratory failure or intractable failure to wean mechanical ventilation. Polysomnography or overnight pulse oximetry plus capnometry are used to detect nocturnal hypoventilation in early stage of respiratory failure. Ventilator strategy including non-invasive and invasive approach should be individualized for each patient. The author strongly believes that parents and family members are able to take care of their child at home if they are trained and educated effectively. A good team work with dedicated members is the key factor of success.

  9. Response of ventilation dampers to large airflow pulses

    SciTech Connect

    Gregory, W.S.; Smith, P.R.

    1985-04-01

    The results of an experiment program to evaluate the response of ventilation system dampers to simulated tornado transients are reported. Relevant data, such as damper response time, flow rate and pressure drop, and flow/pressure vs blade angle, were obtained, and the response of one tornado protective damper to simulated tornado transients was evaluated. Empirical relationships that will allow the data to be integrated into flow dynamics codes were developed. These flow dynamics codes can be used by safety analysts to predict the response of nuclear facility ventilation systems to tornado depressurization. 3 refs., 21 figs., 6 tabs.

  10. Simulation and communication analysis of the monitoring system for hydraulic support pressure based on CAN bus

    NASA Astrophysics Data System (ADS)

    Jin, Huawei; Luo, Ming; Zhang, Xin; Wang, Wei

    2016-01-01

    In order to realize online real-time monitoring of the hydraulic bracket support, improve the existing communication system, and improve the reliability of data transmission, this paper set up the communication simulation system and platform to simulate the coal mine communication based CAN bus. Based on the design and analysis of system hardware and software, this paper completed the construction of the whole hardware and the debugging of communication system. The debug end can communicate simulate by the CAN protocol simulation device, and realized the work of the entire communication system. Experiments showed that the monitoring system can work reliably.

  11. Sulforhodamine B interacts with albumin to lower surface tension and protect against ventilation injury of flooded alveoli.

    PubMed

    Kharge, Angana Banerjee; Wu, You; Perlman, Carrie E

    2015-02-01

    In the acute respiratory distress syndrome, alveolar flooding by proteinaceous edema liquid impairs gas exchange. Mechanical ventilation is used as a supportive therapy. In regions of the edematous lung, alveolar flooding is heterogeneous, and stress is concentrated in aerated alveoli. Ventilation exacerbates stress concentrations and injuriously overexpands aerated alveoli. Injury degree is proportional to surface tension, T. Lowering T directly lessens injury. Furthermore, as heterogeneous flooding causes the stress concentrations, promoting equitable liquid distribution between alveoli should, indirectly, lessen injury. We present a new theoretical analysis suggesting that liquid is trapped in discrete alveoli by a pressure barrier that is proportional to T. Experimentally, we identify two rhodamine dyes, sulforhodamine B and rhodamine WT, as surface active in albumin solution and investigate whether the dyes lessen ventilation injury. In the isolated rat lung, we micropuncture a surface alveolus, instill albumin solution, and obtain an area with heterogeneous alveolar flooding. We demonstrate that rhodamine dye addition lowers T, reduces ventilation-induced injury, and facilitates liquid escape from flooded alveoli. In vitro we show that rhodamine dye is directly surface active in albumin solution. We identify sulforhodamine B as a potential new therapeutic agent for the treatment of the acute respiratory distress syndrome.

  12. Numerical simulation of volume-controlled mechanical ventilated respiratory system with 2 different lungs.

    PubMed

    Shi, Yan; Zhang, Bolun; Cai, Maolin; Zhang, Xiaohua Douglas

    2016-11-09

    Mechanical ventilation is a key therapy for patients who cannot breathe adequately by themselves, and dynamics of mechanical ventilation system is of great significance for life support of patients. Recently, models of mechanical ventilated respiratory system with 1 lung are used to simulate the respiratory system of patients. However, humans have 2 lungs. When the respiratory characteristics of 2 lungs are different, a single-lung model cannot reflect real respiratory system. In this paper, to illustrate dynamic characteristics of mechanical ventilated respiratory system with 2 different lungs, we propose a mathematical model of mechanical ventilated respiratory system with 2 different lungs and conduct experiments to verify the model. Furthermore, we study the dynamics of mechanical ventilated respiratory system with 2 different lungs. This research study can be used for improving the efficiency and safety of volume-controlled mechanical ventilation system.

  13. One-lung overventilation does not induce inflammation in the normally ventilated contralateral lung.

    PubMed

    Almendros, Isaac; Gutierrez, Patricia T; Closa, Daniel; Navajas, Daniel; Farre, Ramon

    2008-06-30

    The aim was to assess whether induction of ventilator-induced lung injury (VILI) in one lung triggers a concomitant inflammatory response in the normally ventilated contralateral lung. To this end, a differential ventilator was used in 6 rats. One lung was normally ventilated (3.5 ml/kg b.w.) and the contralateral lung was overstretched (15 ml/kg b.w.). Six control rats were normally ventilated (3.5 ml/kg b.w. each lung). After 3h, edema and gene expression of MIP-2 in the lung, and plasma and liver TNF-alpha were assessed. Overexpression of MIP-2 and edema were found in the overventilated lung but not in the normally ventilated contralateral lung. No detectable levels of circulating and liver TNF-alpha were detected. These data do not support the hypothesis of an early positive feedback in the lung inflammation during the mechanical ventilation.

  14. Noninvasive ventilation for acute respiratory failure.

    PubMed

    Hess, Dean R

    2013-06-01

    Noninvasive ventilation (NIV) for acute respiratory failure has gained much academic and clinical interest. Despite this, NIV is underutilized. The evidence strongly supports its use in patients presenting with an exacerbation of COPD and in patients with acute cardiogenic pulmonary edema. As reviewed in this paper, there is now evidence supporting or not supporting the use of NIV in various other presentations of acute respiratory failure. It is important not only to know when to initiate NIV, but also when this therapy is failing. Whether NIV in the setting of acute respiratory failure can be managed appropriately outside the ICU setting is controversial. Although a variety of interfaces are available, the oronasal mask is the best initial interface in terms of leak prevention and patient comfort. Some critical care ventilators have NIV modes that compensate well for leaks, but as a group the ventilators that are designed specifically for NIV have better leak compensation. NIV should be part of the armamentarium of all clinicians caring from patients with acute respiratory failure.

  15. 46 CFR 111.105-21 - Ventilation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 4 2012-10-01 2012-10-01 false Ventilation. 111.105-21 Section 111.105-21 Shipping... REQUIREMENTS Hazardous Locations § 111.105-21 Ventilation. A ventilation duct which ventilates a hazardous location has the classification of that location. Each fan for ventilation of a hazardous location must...

  16. 46 CFR 111.105-21 - Ventilation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 4 2014-10-01 2014-10-01 false Ventilation. 111.105-21 Section 111.105-21 Shipping... REQUIREMENTS Hazardous Locations § 111.105-21 Ventilation. A ventilation duct which ventilates a hazardous location has the classification of that location. Each fan for ventilation of a hazardous location must...

  17. 46 CFR 111.105-21 - Ventilation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 4 2013-10-01 2013-10-01 false Ventilation. 111.105-21 Section 111.105-21 Shipping... REQUIREMENTS Hazardous Locations § 111.105-21 Ventilation. A ventilation duct which ventilates a hazardous location has the classification of that location. Each fan for ventilation of a hazardous location must...

  18. Study on air backflow in the goaf of working face with downward ventilation

    NASA Astrophysics Data System (ADS)

    Gao, Jianliang; Yang, Ming; Guo, Feipeng

    2011-10-01

    A commercial software package FLUENT is used for numerical simulation of the distribution of the air flow and gas in goaf of the working face with downward ventilation. With the increase of coal seam inclination, the phenomenon of airflow stagnant appears first on the upper part of the goaf, then backflow starts and eddy forms a certain distance away from the working face. When the coal seam slope increases to a certain angle, the air leakage in working face entirely reverses and flows into the gob from the bottom part of the mining face, and returns to working face from the upper part, particularly the upper corner of the working face. As the coal seam angle increases, the natural ventilation pressure in goaf increases too. When the natural ventilation pressure is less than the ventilation pressure differential in working face, the bigger of coal seam angle, the smaller of leakage air volume, and the closer of high-concentration gas migrate from goaf to working face. When the natural ventilation pressure in goaf is greater than the ventilation pressure differential in working face, with the increase of coal seam angle, the natural ventilation pressure and the air leakage volume increases, the range of leakage air backflow increases, high-concentration methane in the goaf will move to deep and total amount of gas in goaf decreases.

  19. 46 CFR 154.707 - Cargo boil-off as fuel: Ventilation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 5 2012-10-01 2012-10-01 false Cargo boil-off as fuel: Ventilation. 154.707 Section 154... SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction and Equipment Cargo Pressure and Temperature Control § 154.707 Cargo boil-off as fuel: Ventilation. (a)...

  20. 46 CFR 154.707 - Cargo boil-off as fuel: Ventilation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 5 2013-10-01 2013-10-01 false Cargo boil-off as fuel: Ventilation. 154.707 Section 154... SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction and Equipment Cargo Pressure and Temperature Control § 154.707 Cargo boil-off as fuel: Ventilation. (a)...

  1. Prophylactic Use of High-Frequency Percussive Ventilation in Patients with Inhalation Injury,

    DTIC Science & Technology

    1991-06-01

    frequency ventilation has been a technique in search of docu- in the last several years that the intubated patients receiving antacids or mented...processand that the use oflow-pressure 112 blockers and antacids titrated to keep the gastric pH above 4.5. ventilation by the use ofthis device or

  2. 46 CFR 154.707 - Cargo boil-off as fuel: Ventilation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 5 2014-10-01 2014-10-01 false Cargo boil-off as fuel: Ventilation. 154.707 Section 154.707 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES... Equipment Cargo Pressure and Temperature Control § 154.707 Cargo boil-off as fuel: Ventilation. (a)...

  3. Pulmonary mechanics during mechanical ventilation.

    PubMed

    Henderson, William R; Sheel, A William

    2012-03-15

    The use of mechanical ventilation has become widespread in the management of hypoxic respiratory failure. Investigations of pulmonary mechanics in this clinical scenario have demonstrated that there are significant differences in compliance, resistance and gas flow when compared with normal subjects. This paper will review the mechanisms by which pulmonary mechanics are assessed in mechanically ventilated patients and will review how the data can be used for investigative research purposes as well as to inform rational ventilator management.

  4. Current concepts in acute respiratory support for neonates and children.

    PubMed

    Arca, Marjorie J; Uhing, Michael; Wakeham, Martin

    2015-02-01

    Current trends in mechanical respiratory support are evolving toward gentle approaches to avoid short- and long-term problems that are historically associated with mechanical ventilation. These ventilator-associated issues include the need for long-term sedation, muscle deconditioning, ventilator-associated lung injury (VALI), and ventilator-associated pneumonia (VAP). This article will describe recent trends of ventilatory support in neonates and children: (1) utilization of volume ventilation in infants, (2) synchrony and improving patient-ventilator interaction specifically using neurally adjusted ventilatory assist (NAVA), and (3) use of noninvasive ventilation techniques. When applicable, their uses in the surgical newborn and pediatric patients are described.

  5. Field measurement of ventilation rates.

    PubMed

    Persily, A K

    2016-02-01

    Ventilation rates have significant impacts on building energy use and indoor contaminant concentrations, making them key parameters in building performance. Ventilation rates have been measured in buildings for many decades, and there are mature measurement approaches available to researchers and others who need to know actual ventilation rates in buildings. Despite the fact that ventilation rates are critical in interpreting indoor concentration measurements, it is disconcerting how few Indoor Air Quality field studies measure ventilation rates or otherwise characterize the ventilation design of the study building(s). This paper summarizes parameters of interest in characterizing building ventilation, available methods for quantifying these parameters, and challenges in applying these methods to different types of buildings and ventilation systems. These parameters include whole-building air change rates, system outdoor air intake rates, and building infiltration rates. Tracer gas methods are reviewed as well as system airflow rate measurements using, for example, duct traverses. Several field studies of ventilation rates conducted over the past 75 years are described to highlight the approaches employed and the findings obtained.

  6. Humidified High Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure as an Initial Respiratory Support in Preterm Infants with Respiratory Distress: a Randomized, Controlled Non-Inferiority Trial.

    PubMed

    Shin, Jeonghee; Park, Kyuhee; Lee, Eun Hee; Choi, Byung Min

    2017-04-01

    Heated, humidified, high-flow nasal cannula (HHFNC) is frequently used as a noninvasive respiratory support for preterm infants with respiratory distress. But there are limited studies that compares HHFNC with nasal continuous positive airway pressure (nCPAP) only as the initial treatment of respiratory distress in preterm infants immediately after birth. The aim of this study is to assess the effectiveness and safety of HHFNC compared to nCPAP for the initial treatment of preterm infants with respiratory distress. Preterm infants at between 30 and 35 weeks of gestational age were randomized to HHFNC or nCPAP when they showed respiratory distress in less than 24 hours of age postnatally. Preterm infants who needed invasive respiratory supports were excluded. Primary outcome was the incidence of treatment failure (defined as need for the intubation or mechanical ventilation). Eighty-five infants were analyzed. Sixteen of 42 infants randomized to HHFNC showed treatment failure compared to 9 of 43 infants using nCPAP (Risk difference 17.17 [-1.90-36.23]; P = 0.099). In terms of the reason for treatment failure, the frequency of hypoxia was significantly higher in the HHFNC group than in the nCPAP group (P = 0.020). There was no difference between the 2 groups in terms of respiratory and clinical outcomes and complications. Although HHFNC is safe compared to nCPAP, it is not certain that HHFNC is effective compared to nCPAP non-inferiorly as an initial respiratory support in preterm infants with respiratory distress.

  7. Humidified High Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure as an Initial Respiratory Support in Preterm Infants with Respiratory Distress: a Randomized, Controlled Non-Inferiority Trial

    PubMed Central

    2017-01-01

    Heated, humidified, high-flow nasal cannula (HHFNC) is frequently used as a noninvasive respiratory support for preterm infants with respiratory distress. But there are limited studies that compares HHFNC with nasal continuous positive airway pressure (nCPAP) only as the initial treatment of respiratory distress in preterm infants immediately after birth. The aim of this study is to assess the effectiveness and safety of HHFNC compared to nCPAP for the initial treatment of preterm infants with respiratory distress. Preterm infants at between 30 and 35 weeks of gestational age were randomized to HHFNC or nCPAP when they showed respiratory distress in less than 24 hours of age postnatally. Preterm infants who needed invasive respiratory supports were excluded. Primary outcome was the incidence of treatment failure (defined as need for the intubation or mechanical ventilation). Eighty-five infants were analyzed. Sixteen of 42 infants randomized to HHFNC showed treatment failure compared to 9 of 43 infants using nCPAP (Risk difference 17.17 [−1.90–36.23]; P = 0.099). In terms of the reason for treatment failure, the frequency of hypoxia was significantly higher in the HHFNC group than in the nCPAP group (P = 0.020). There was no difference between the 2 groups in terms of respiratory and clinical outcomes and complications. Although HHFNC is safe compared to nCPAP, it is not certain that HHFNC is effective compared to nCPAP non-inferiorly as an initial respiratory support in preterm infants with respiratory distress. PMID:28244292

  8. Non-invasive ventilation in acute cardiogenic pulmonary oedema

    PubMed Central

    Agarwal, R; Aggarwal, A; Gupta, D; Jindal, S

    2005-01-01

    Non-invasive ventilation (NIV) is the delivery of assisted mechanical ventilation to the lungs, without the use of an invasive endotracheal airway. NIV has revolutionised the management of patients with various forms of respiratory failure. It has decreased the need for invasive mechanical ventilation and its attendant complications. Cardiogenic pulmonary oedema (CPO) is a common medical emergency, and NIV has been shown to improve both physiological and clinical outcomes. From the data presented herein, it is clear that there is sufficiently high level evidence to favour the use of continuous positive airway pressure (CPAP), and that the use of CPAP in patients with CPO decreases intubation rate and improves survival (number needed to treat seven and eight respectively). However, there is insufficient evidence to recommend the use of bilevel positive airway pressure (BiPAP), probably the exception being patients with hypercapnic CPO. More trials are required to conclusively define the role of BiPAP in CPO. PMID:16210459

  9. Status asthmaticus treated by high-frequency oscillatory ventilation.

    PubMed

    Duval, E L; van Vught, A J

    2000-10-01

    We present a 2.5-year-old girl in severe asthma crisis who clinically deteriorated on conventional mechanical ventilation, but was successfully ventilated with high-frequency oscillatory ventilation (HFOV). Although HFOV is accepted as a technique for managing pediatric respiratory failure, its use in obstructive airway disease is generally thought to be contraindicated because of the risk of dynamic air-trapping. However, we suggest that obstructive airway disease can safely be managed with HFOV, provided certain conditions are met. These include the application of sufficiently high mean airway pressures to open and stent the airways ("an open airway strategy"), lower frequencies to overcome the greater attenuation of the oscillatory waves in the narrowed airways, permissive hypercapnia to enable reducing pressure swings as much as possible, longer expiratory times, and muscle paralysis to avoid spontaneous breathing.

  10. Time-accurate unsteady flow simulations supporting the SRM T+68-second pressure spike anomaly investigation (STS-54B)

    NASA Astrophysics Data System (ADS)

    Dougherty, N. S.; Burnette, D. W.; Holt, J. B.; Matienzo, Jose

    1993-07-01

    Time-accurate unsteady flow simulations are being performed supporting the SRM T+68sec pressure 'spike' anomaly investigation. The anomaly occurred in the RH SRM during the STS-54 flight (STS-54B) but not in the LH SRM (STS-54A) causing a momentary thrust mismatch approaching the allowable limit at that time into the flight. Full-motor internal flow simulations using the USA-2D axisymmetric code are in progress for the nominal propellant burn-back geometry and flow conditions at T+68-sec--Pc = 630 psi, gamma = 1.1381, T(sub c) = 6200 R, perfect gas without aluminum particulate. In a cooperative effort with other investigation team members, CFD-derived pressure loading on the NBR and castable inhibitors was used iteratively to obtain nominal deformed geometry of each inhibitor, and the deformed (bent back) inhibitor geometry was entered into this model. Deformed geometry was computed using structural finite-element models. A solution for the unsteady flow has been obtained for the nominal flow conditions (existing prior to the occurrence of the anomaly) showing sustained standing pressure oscillations at nominally 14.5 Hz in the motor IL acoustic mode that flight and static test data confirm to be normally present at this time. Average mass flow discharged from the nozzle was confirmed to be the nominal expected (9550 lbm/sec). The local inlet boundary condition is being perturbed at the location of the presumed reconstructed anomaly as identified by interior ballistics performance specialist team members. A time variation in local mass flow is used to simulate sudden increase in burning area due to localized propellant grain cracks. The solution will proceed to develop a pressure rise (proportional to total mass flow rate change squared). The volume-filling time constant (equivalent to 0.5 Hz) comes into play in shaping the rise rate of the developing pressure 'spike' as it propagates at the speed of sound in both directions to the motor head end and nozzle. The

  11. Radioaerosol ventilation imaging in ventilator-dependent patients. Technical considerations

    SciTech Connect

    Vezina, W.; Chamberlain, M.; Vinitski, S.; King, M.; Nicholson, R.; Morgan, W.K.

    1985-11-01

    The differentiation of pulmonary embolism (PE) from regional ventilatory abnormalities accompanied by reduced perfusion requires contemporary perfusion and ventilation studies. Distinguishing these conditions in ventilator-dependent patients is aided by administering a Tc-99m aerosol to characterize regional ventilation, and by performing a conventional Tc-99m MAA perfusion study. The technique uses a simple in-house constructed apparatus. Simple photographic techniques suffice, but computer subtraction of perfusion from the combined perfusion-ventilation image renders interpretation easier if aerosol administration follows perfusion imaging. Multiple defects can be examined in a single study. Excluding normal or near-normal perfusion studies, PE was thought to be present in eight of 16 patients after perfusion imaging alone, but in only one of eight after added aerosol imaging. Angiography confirmed the diagnosis in that patient. Of the eight patients who had abnormal perfusion but were thought unlikely to have PE from the perfusion study alone, two had normal ventilation, and subsequently were shown to have PE by angiography. Because angiography was only performed on patients who were thought to have a high probability of PE on sequential perfusion-ventilation imaging, the true incidence of PE may have been higher. Aerosol ventilation imaging is a useful adjunct to perfusion imaging in patients on ventilators. It requires an efficient delivery system, particularly if aerosol administration follows perfusion imaging, as it does in this study.

  12. Laboratory and Industrial Ventilation

    NASA Technical Reports Server (NTRS)

    1972-01-01

    This handbook supplements the Facilities Engineering Handbook (NHB 7320.1) and provides additional policies and criteria for uniform application to ventilation systems. It expands basic requirements, provides additional design and construction guidance, and places emphasis on those design considerations which will provide for greater effectiveness in the use of these systems. The provisions of this handbook are applicable to all NASA field installations and the Jet Propulsion Laboratory. Since supply of this handbook is limited, abstracts of the portion or portions applicable to a given requirement will be made for the individual specific needs encountered rather than supplying copies of the handbook as has been past practice.

  13. Monitoring of regional lung ventilation using electrical impedance tomography after cardiac surgery in infants and children.

    PubMed

    Krause, Ulrich; Becker, Kristin; Hahn, Günter; Dittmar, Jörg; Ruschewski, Wolfgang; Paul, Thomas

    2014-08-01