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Positive expiratory pressure

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https://www.readbyqxmd.com/read/29137587/a-lung-model-to-demonstrate-dynamic-gas-trapping-and-intrinsic-positive-end-expiratory-pressure-at-realistic-ventilation-settings
#1
S H Freebairn, R Imlay, E Barrett, Maj Park, R C Freebairn
Intrinsic positive end-expiratory pressure (PEEP) and gas trapping are recognised hazards during ventilation of patients with airflow obstruction. Demonstration of these phenomena on conventional lung models using realistic ventilation settings is difficult. We describe an Intrinsic PEEP Model that is able to demonstrate dynamic gas trapping and intrinsic PEEP at realistic ventilation settings, and demonstrate its ability to develop intrinsic PEEP in a timeframe useful for teaching. The model uses a Heimlich valve to permit a lower resistance on inspiration than expiration...
November 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29134246/does-high-peep-prevent-alveolar-cycling
#2
REVIEW
M Cressoni, C Chiurazzi, D Chiumello, L Gattinoni
Acute respiratory distress syndrome (ARDS) patients need mechanical ventilation to sustain gas exchange. Animal experiments showed that mechanical ventilation with high volume/plateau pressure and no positive end-expiratory pressure (PEEP) damages healthy lungs, while low tidal volumes and the application of higher PEEP levels are protective. PEEP makes the lung homogeneous, reducing the pressure multiplication at the interface between lung units with different inflation statuses and keeps the lung open through the whole respiratory cycle, avoiding intratidal opening and closing...
November 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29134245/esophageal-pressure-research-or-clinical-tool
#3
REVIEW
E Baedorf Kassis, S H Loring, D Talmor
Esophageal manometry has traditionally been utilized for respiratory physiology research, but clinicians have recently found numerous applications within the intensive care unit. Esophageal pressure (PEs) is a surrogate for pleural pressures (PPl), and the difference between airway pressure (PAO) and PEs provides a good estimate for the pressure across the lung also known as the transpulmonary pressure (PL). Differentiating the effects of mechanical ventilation and spontaneous breathing on the respiratory system, chest wall, and across the lung allows for improved personalization in clinical decision making...
November 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29131002/low-tidal-volume-positive-end-expiratory-pressure-versus-high-tidal-volume-zero-positive-end-expiratory-pressure-and-postoperative-pulmonary-functions-in-robot-assisted-laparoscopic-radical-prostatectomy
#4
Murat Haliloglu, Beliz Bilgili, Mehtap Ozdemir, Tumay Umuroglu, Nurten Bakan
OBJECTIVE: The aim was to compare the effects of low tidal volume (VT) and moderate positive end-expiratory pressure(PEEP) with high tidal volume (VT) and zero end-expiratory pressure(ZEEP), on postoperative pulmonary functions and oxygenation in patients undergoing robot-assisted laparoscopic radical prostatectomy. SUBJECTS AND METHODS: Forty-four (44) patients were randomized into low VT-PEEP and high VT-ZEEP groups. The patients were ventilated with VT of 6 ml/kg and 8 cmH2O PEEP in low VT-PEEP group and VT of 10 ml/kg and 0 cmH2O PEEP in high VT-ZEEP group...
October 31, 2017: Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre
https://www.readbyqxmd.com/read/29119875/effects-of-positive-end-expiratory-pressure-on-intraoperative-core-temperature-in-patients-undergoing-posterior-spine-surgery-prospective-randomised-trial
#5
Hyungseok Seo, Je Do Son, Hyung-Chul Lee, Hyung-Min Oh, Chul-Woo Jung, Hee-Pyoung Park
Objective Positive end-expiratory pressure (PEEP) causes carotid baroreceptor unloading, which leads to thermoregulatory peripheral vasoconstriction. However, the effects of PEEP on intraoperative thermoregulation in the prone position remain unknown. Methods Thirty-seven patients undergoing spine surgery in the prone position were assigned at random to receive either 10 cmH2O PEEP (Group P) or no PEEP (Group Z). The primary endpoint was core temperature 180 minutes after intubation. Secondary endpoints were delta core temperature (difference in core temperature between 180 minutes and immediately after tracheal intubation), incidence of intraoperative hypothermia (core temperature of <36°C), and peripheral vasoconstriction-related data...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/29117951/long-term-benefit-of-enzyme-replacement-therapy-in-pompe-disease-a-5-year-prospective-study
#6
Esther Kuperus, Michelle E Kruijshaar, Stephan C A Wens, Juna M de Vries, Marein M Favejee, Jan C van der Meijden, Dimitris Rizopoulos, Esther Brusse, Pieter A van Doorn, Ans T van der Ploeg, Nadine A M E van der Beek
OBJECTIVE: To determine the effect of enzyme replacement therapy (ERT) after 5 years and to identify predictors for a favorable response because few data are available on the long-term efficacy of ERT in Pompe disease. METHODS: We included 102 adult patients with Pompe disease in a nationwide, prospective cohort study. We assessed muscle strength (manual muscle testing with Medical Research Council [MRC] grading, handheld dynamometry [HHD]), muscle function (6-minute walk test, Quick Motor Function Test), daily life activities (Rasch-Built Pompe-Specific Activity [R-PAct] Scale), and pulmonary function (forced vital capacity [FVC] in upright and supine positions, maximum inspiratory and expiratory pressures) at 3- to 6-month intervals before and after the start of ERT...
November 8, 2017: Neurology
https://www.readbyqxmd.com/read/29115949/neurally-adjusted-ventilatory-assist-nava-or-pressure-support-ventilation-psv-during-spontaneous-breathing-trials-in-critically-ill-patients-a-crossover-trial
#7
Juliana C Ferreira, Fabia Diniz-Silva, Henrique T Moriya, Adriano M Alencar, Marcelo B P Amato, Carlos R R Carvalho
BACKGROUND: Neurally Adjusted Ventilatory Assist (NAVA) is a proportional ventilatory mode that uses the electrical activity of the diaphragm (EAdi) to offer ventilatory assistance in proportion to patient effort. NAVA has been increasingly used for critically ill patients, but it has not been evaluated during spontaneous breathing trials (SBT). We designed a pilot trial to assess the feasibility of using NAVA during SBTs, and to compare the breathing pattern and patient-ventilator asynchrony of NAVA with Pressure Support (PSV) during SBTs...
November 7, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/29114887/cough-strength-and-expiratory-force-in-aspirating-and-nonaspirating-postradiation-head-and-neck-cancer-survivors
#8
Katherine A Hutcheson, Martha P Barrow, Carla L Warneke, Yiqun Wang, George Eapen, Stephen Y Lai, Denise A Barringer, Emily K Plowman, Jan S Lewin
OBJECTIVE: Expiratory functions that clear aspiration from the airway are compromised in patients with neurogenic dysphagia for whom cough and expiratory force may be impaired by the primary disease process. The relationship between expiratory function, cough, and aspiration is less clear in head and neck cancer (HNC) survivors for whom the disease process does not directly impact the lower respiratory system. Our objective was to compare mechanisms of airway clearance (expiratory force and cough) with aspiration status in postradiated HNC survivors...
November 8, 2017: Laryngoscope
https://www.readbyqxmd.com/read/29114011/albuterol-delivery-efficiency-in-a-pediatric-model-of-noninvasive-ventilation-with-double-limb-circuit
#9
Jeanne Velasco, Ariel Berlinski
BACKGROUND: Noninvasive ventilation (NIV) is used to treat respiratory failure in patients with concomitant need for aerosol delivery. Limited pediatric data are available on aerosol delivery efficiency, and none at all regarding aerosol delivery efficiency with a double-limb circuit. We compared the effect of position in the double-limb ventilator circuit, types of nebulizer, and ventilator settings on aerosol delivery efficiency in a pediatric model of NIV. We hypothesized that placing a vibrating mesh nebulizer at the ventilator and using the highest inspiratory pressures would increase aerosol delivery efficiency...
November 7, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29112971/effects-of-positive-end-expiratory-pressure-and-recruitment-maneuvers-in-a-ventilator-induced-injury-mouse-model
#10
Laura A Cagle, Lisa M Franzi, Angela L Linderholm, Jerold A Last, Jason Y Adams, Richart W Harper, Nicholas J Kenyon
BACKGROUND: Positive-pressure mechanical ventilation is an essential therapeutic intervention, yet it causes the clinical syndrome known as ventilator-induced lung injury. Various lung protective mechanical ventilation strategies have attempted to reduce or prevent ventilator-induced lung injury but few modalities have proven effective. A model that isolates the contribution of mechanical ventilation on the development of acute lung injury is needed to better understand biologic mechanisms that lead to ventilator-induced lung injury...
2017: PloS One
https://www.readbyqxmd.com/read/29109556/management-of-mechanical-ventilation-in-patients-with-hospital-acquired-pneumonia-a-retrospective-observational-study
#11
Radovan Uvizl, Tomas Herkel, Katerina Langova, Petr Jakubec
BACKGROUND: Hospital-acquired pneumonia (HAP) in intensive care patients is a frequent reason for mechanical ventilation (MV). The management of MV and ventilator weaning vary, depending on the type of lung inflammation. This retrospective, observational study screened the data from all patients admitted to the intensive care unit (ICU) of the Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc between 2011 and 2016...
November 2, 2017: Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
https://www.readbyqxmd.com/read/29107740/autonomic-function-testing-compliance-and-consequences
#12
Thorsten Kamlarczyk Rasmussen, John Hansen, Phillip A Low, Paola Sandroni, Wolfgang Singer, Troels Staehelin Jensen, Astrid Juhl Terkelsen
BACKGROUND: The deep breathing test (DB) and Valsalva maneuver (VM) are used to detect autonomic dysfunction. The VM induces sympathetically mediated changes in blood pressure (phase II late, phase IV, and recovery time) and both tests induce vagally mediated heart rate changes. There is limited information on effects of key variables, compliance with testing and the effects of non-compliance This study has twin goals of evaluating compliance with standard instructions and the effects of changes in key variables...
October 18, 2017: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/29105056/specific-anesthesia-induced-lung-volume-changes-from-induction-to-emergence-a-pilot-study
#13
P Kostic, A LoMauro, A Larsson, G Hedenstierna, P Frykholm, A Aliverti
BACKGROUND: Studies aimed at maintaining intraoperative lung volume to reduce post-operative pulmonary complications have been inconclusive because they mixed up the effect of general anesthesia and the surgical procedure. Our aims were to study: (1) lung volume during the entire course of anesthesia without the confounding effects of surgical procedures; (2) the combination of three interventions to maintain lung volume; and (3) the emergence phase with focus on the restored activation of the respiratory muscles...
November 3, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29089755/cost-effectiveness-of-the-aerobika-oscillating-positive-expiratory-pressure-device-in-the-management-of-copd-exacerbations
#14
Shoghag Khoudigian-Sinani, Stacey Kowal, Jason A Suggett, Dominic P Coppolo
INTRODUCTION: COPD places a huge clinical and economic burden on the US health care system, with acute exacerbations representing a key driver of direct medical costs. Current treatments, although effective in reducing symptoms and limiting exacerbations, do not adequately target the underlying disease processes that drive exacerbation development. The Aerobika* oscillating positive expiratory pressure (OPEP) device has been shown in a real-world effectiveness study to lower the frequency of moderate-to-severe exacerbations during a 30-day post-exacerbation period...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/29071429/risk-stratification-using-spo2-fio2-and-peep-at-initial-ards-diagnosis-and-after-24%C3%A2-h-in-patients-with-moderate-or-severe-ards
#15
Luigi Pisani, Jan-Paul Roozeman, Fabienne D Simonis, Antonio Giangregorio, Sophia M van der Hoeven, Laura R Schouten, Janneke Horn, Ary Serpa Neto, Emir Festic, Arjen M Dondorp, Salvatore Grasso, Lieuwe D Bos, Marcus J Schultz
BACKGROUND: We assessed the potential of risk stratification of ARDS patients using SpO2/FiO2 and positive end-expiratory pressure (PEEP) at ARDS onset and after 24 h. METHODS: We used data from a prospective observational study in patients admitted to a mixed medical-surgical intensive care unit of a university hospital in the Netherlands. Risk stratification was by cutoffs for SpO2/FiO2 and PEEP. The primary outcome was in-hospital mortality. Patients with moderate or severe ARDS with a length of stay of > 24 h were included in this study...
October 25, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/29071082/adjuncts-for-sputum-clearance-in-copd-clinical-consensus-versus-actual-use
#16
Ruth Barker, Anthony A Laverty, Nicholas S Hopkinson
INTRODUCTION: Oscillatory positive pressure devices (OPEP) can be used as adjuncts to improve sputum clearance in chronic obstructive pulmonary disease (COPD), though the evidence base is incomplete. The attitudes of physiotherapists towards these devices in the care of patients with COPD is unknown. In addition, actual use compared with the prescription of medications has not been studied. METHODS: We analysed English prescribing data, obtained from OpenPrescribing...
2017: BMJ Open Respiratory Research
https://www.readbyqxmd.com/read/29071075/evaluation-by-various-methods-of-the-physiological-mechanism-of-a-high-flow-nasal-cannula-hfnc-in-healthy-volunteers
#17
Miyuki Okuda, Nobuya Tanaka, Kazuyuki Naito, Takao Kumada, Koji Fukuda, Yuto Kato, Yuto Kido, Yutaro Okuda, Ryuji Nohara
INTRODUCTION: Several reports have described the usefulness of a high-flow nasal cannula (HFNC). However, the physiological mechanisms of this system are unclear. In the current study, various methods were used to investigate the physiological mechanisms of an HFNC in healthy volunteers. METHODS: The physiological mechanisms of the constant-flow and constant-pressure models of HFNC were studied in 10 healthy volunteers by the oesophageal balloon method, the electrical impedance method and the forced oscillation technique (FOT)...
2017: BMJ Open Respiratory Research
https://www.readbyqxmd.com/read/29066585/use-of-cardiac-cycle-locating-to-minimize-the-influence-of-cardiac-artifacts-on-esophageal-pressure-measurement-during-dynamic-occlusion-test
#18
Xuan He, Xiu-Mei Sun, Guang-Qiang Chen, Yan-Lin Yang, Zhong-Hua Shi, Ming Xu, Jian-Xin Zhou
BACKGROUND: The dynamic occlusion test is used to guide balloon catheter placement during esophageal pressure (Pes) monitoring. We introduced a cardiac cycle locating method to attenuate the influence of cardiac artifacts on Pes measurement. The aim was to provide a reliable analytic algorithm for the occlusion test. METHODS: Esophageal balloon catheters were placed in subjects receiving pressure support ventilation. During balloon position adjustment, end-expiratory occlusion was performed to induce 3 consecutive inspiratory efforts...
October 24, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29065956/distinct-patterns-of-hyperpnea-during-cheyne-stokes-respiration-implication-for-cardiac-function-in-patients-with-heart-failure
#19
Elisa Perger, Toru Inami, Owen D Lyons, Hisham Alshaer, Stephanie Smith, John S Floras, Alexander G Logan, Michael Arzt, Joaquin Duran Cantolla, Diego Delgado, Michael Fitzpatrick, John Fleetham, Takatoshi Kasai, R John Kimoff, Richard S T Leung, Geraldo Lorenzi Filho, Pierre Mayer, Lisa Mielniczuk, Debra L Morrison, Gianfranco Parati, Sairam Parthasarathy, Stefania Redolfi, Clodagh M Ryan, Frederic Series, George A Tomlinson, Anna Woo, T Douglas Bradley
STUDY OBJECTIVES: In heart failure (HF), we observed two patterns of hyperpnea during Cheyne-Stokes respiration with central sleep apnea (CSR-CSA): a positive pattern where end-expiratory lung volume remains at or above functional residual capacity, and a negative pattern where it falls below functional residual capacity. We hypothesized the negative pattern is associated with worse HF. METHODS: Patients with HF underwent polysomnography. During CSR-CSA, hyperpnea, apnea-hyperpnea cycle, and lung to finger circulation times (LFCT) were measured...
October 18, 2017: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
https://www.readbyqxmd.com/read/29062231/positive-end-expiratory-pressure-attenuates-hemodynamic-effects-induced-by-an-overload-of-inspiratory-muscles-in-patients-with-copd
#20
Flavia Schaper-Magalhães, José Felippe Pinho, Carolina Andrade Bragança Capuruço, Maria Glória Rodrigues-Machado
BACKGROUND: Inspiratory muscle training (IMT) using a Threshold(®) device is commonly used to improve the strength and endurance of inspiratory muscles. However, the effect of IMT, alone or with positive end-expiratory pressure (PEEP), on hemodynamic parameters in patients with chronic obstructive pulmonary disease (COPD) remains unknown. OBJECTIVE: To assess the effects of an overload of inspiratory muscles using IMT fixed at 30% of the maximal inspiratory pressure (MIP), and IMT associated with 5 cmH2O of PEEP (IMT + PEEP), on the echocardiographic parameters in healthy subjects and patients with COPD...
2017: International Journal of Chronic Obstructive Pulmonary Disease
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