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Positive end expiratory pressure

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https://www.readbyqxmd.com/read/28227081/noninvasive-estimation-of-alveolar-pressure
#1
Francesco Vicario, Roberto Buizza, William A Truschel, Nicolas W Chbat, Francesco Vicario, Roberto Buizza, William A Truschel, Nicolas W Chbat, Francesco Vicario, Roberto Buizza, Nicolas W Chbat, William A Truschel
This paper presents an algorithm for noninvasive estimation of alveolar pressure in mechanically ventilated patients who are spontaneously breathing. Continual monitoring of alveolar pressure is desirable to prevent ventilator-induced lung injury and to assess the intrinsic positive end-expiratory pressure (PEEPi), which is a parameter of clinical relevance in respiratory care and difficult to measure noninvasively. The algorithm is based on a physiological model of the respiratory system and, as such, it also provides insight into the respiratory mechanics of the patient under mechanical ventilation...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28225887/it-is-impossible-to-know-the-way-if-we-do-not-know-where-to-start-tidal-volume-driving-pressure-and-positive-end-expiratory-pressure
#2
Marcelo Cunio Machado Fonseca, Werther Brunow de Carvalho
No abstract text is available yet for this article.
January 1, 2017: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/28187051/kinetics-of-plasma-biomarkers-of-inflammation-and-lung-injury-in-surgical-patients-with-or-without-postoperative-pulmonary-complications
#3
Ary Serpa Neto, Pedro P Z A Campos, Sabrine N T Hemmes, Lieuwe D Bos, Thomas Bluth, Marion Ferner, Andreas Güldner, Markus W Hollmann, Inmaculada India, Thomas Kiss, Rita Laufenberg-Feldmann, Juraj Sprung, Demet Sulemanji, Carmen Unzueta, Marcos F Vidal Melo, Toby N Weingarten, Anita M Tuip-de Boer, Paolo Pelosi, Marcelo Gama de Abreu, Marcus J Schultz
BACKGROUND: Postoperative pulmonary complications (PPCs) are common after major abdominal surgery. The kinetics of plasma biomarkers could improve identification of patients developing PPCs, but the kinetics may depend on intraoperative ventilator settings. OBJECTIVE: To test whether the kinetics of plasma biomarkers are capable of identifying patients who will develop PPCs, and whether the kinetics depend on the intraoperative level of positive end-expiratory pressure (PEEP)...
February 9, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28178996/hemodynamic-effects-of-lung-recruitment-maneuvers-in-acute-respiratory-distress-syndrome
#4
Anup Das, Mainul Haque, Marc Chikhani, Oana Cole, Wenfei Wang, Jonathan G Hardman, Declan G Bates
BACKGROUND: Clinical trials have, so far, failed to establish clear beneficial outcomes of recruitment maneuvers (RMs) on patient mortality in acute respiratory distress syndrome (ARDS), and the effects of RMs on the cardiovascular system remain poorly understood. METHODS: A computational model with highly integrated pulmonary and cardiovascular systems was configured to replicate static and dynamic cardio-pulmonary data from clinical trials. Recruitment maneuvers (RMs) were executed in 23 individual in-silico patients with varying levels of ARDS severity and initial cardiac output...
February 8, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28159013/the-effects-of-low-tidal-ventilation-on-lung-strain-correlate-with-respiratory-system-compliance
#5
Jianfeng Xie, Fang Jin, Chun Pan, Songqiao Liu, Ling Liu, Jingyuan Xu, Yi Yang, Haibo Qiu
BACKGROUND: The effect of alterations in tidal volume on mortality of acute respiratory distress syndrome (ARDS) is determined by respiratory system compliance. We aimed to investigate the effects of different tidal volumes on lung strain in ARDS patients who had various levels of respiratory system compliance. METHODS: Nineteen patients were divided into high (Chigh group) and low (Clow group) respiratory system compliance groups based on their respiratory system compliance values...
February 3, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28157140/a-quasi-experimental-before-after-trial-examining-the-impact-of-an-emergency-department-mechanical-ventilator-protocol-on-clinical-outcomes-and-lung-protective-ventilation-in-acute-respiratory-distress-syndrome
#6
Brian M Fuller, Ian T Ferguson, Nicholas M Mohr, Anne M Drewry, Christopher Palmer, Brian T Wessman, Enyo Ablordeppey, Jacob Keeperman, Robert J Stephens, Cristopher C Briscoe, Angelina A Kolomiets, Richard S Hotchkiss, Marin H Kollef
OBJECTIVES: To evaluate the impact of an emergency department mechanical ventilation protocol on clinical outcomes and adherence to lung-protective ventilation in patients with acute respiratory distress syndrome. DESIGN: Quasi-experimental, before-after trial. SETTING: Emergency department and ICUs of an academic center. PATIENTS: Mechanically ventilated emergency department patients experiencing acute respiratory distress syndrome while in the emergency department or after admission to the ICU...
February 2, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28150228/personalizing-mechanical-ventilation-according-to-physiologic-parameters-to-stabilize-alveoli-and-minimize-ventilator-induced-lung-injury-vili
#7
REVIEW
Gary F Nieman, Joshua Satalin, Penny Andrews, Hani Aiash, Nader M Habashi, Louis A Gatto
It has been shown that mechanical ventilation in patients with, or at high-risk for, the development of acute respiratory distress syndrome (ARDS) can be a double-edged sword. If the mechanical breath is improperly set, it can amplify the lung injury associated with ARDS, causing a secondary ventilator-induced lung injury (VILI). Conversely, the mechanical breath can be adjusted to minimize VILI, which can reduce ARDS mortality. The current standard of care ventilation strategy to minimize VILI attempts to reduce alveolar over-distension and recruitment-derecruitment (R/D) by lowering tidal volume (Vt) to 6 cc/kg combined with adjusting positive-end expiratory pressure (PEEP) based on a sliding scale directed by changes in oxygenation...
December 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28149559/a-bench-evaluation-of-fraction-of-oxygen-in-air-delivery-and-tidal-volume-accuracy-in-home-care-ventilators-available-for-hospital-use
#8
Loredana Baboi, Fabien Subtil, Claude Guérin
BACKGROUND: Turbine-powered ventilators are not only designed for long-term ventilation at home but also for hospital use. It is important to verify their capabilities in delivering fraction of oxygen in air (FIO2) and tidal volume (VT). METHODS: We assessed the FIO2 accuracy and the VT delivery in four home care ventilators (HCV) on the bench. The four HCV were Astral 150, Elisée 150, Monnal T50 and Trilogy 200 HCV, which were connected to a lung model (ASL 5000)...
December 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28146639/fifty-years-of-research-in-ards-setting-positive-end-expiratory-pressure-in-the-acute-respiratory-distress-syndrome
#9
Sarina K Sahetya, Ewan C Goligher, Roy G Brower
Positive end-expiratory pressure (PEEP) has been utilized during mechanical ventilation since the first description of the acute respiratory distress syndrome (ARDS). In the subsequent decades, many different strategies for optimally titrating PEEP have been proposed. Higher PEEP can improve arterial oxygenation, reduce tidal lung stress and strain, and promote more homogenous ventilation by preventing alveolar collapse at end expiration. However, PEEP may also cause circulatory depression and contribute to ventilator-induced lung injury through alveolar overdistention...
February 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28145966/comparison-of-the-effects-of-different-positive-end-expiratory-pressure-levels-on-cerebral-oxygen-saturation-with-near-infrared-spectroscopy-during-laparoscopic-cholecystectomy
#10
Mehmet Sargin, Mehmet Selçuk Uluer, Sadik Özmen
PURPOSE: Although positive end-expiratory pressure (PEEP) is commonly used to improve respiratory mechanics and oxygenation during pneumoperitoneum (PP), the effect of PEEP on cerebral homeostasis during carbon dioxide PP remains uncertain. This study investigated the changes in regional cerebral oxygen saturation (rSO2) associated with 0, 5, and 10 cm H2O PEEP during PP while undergoing laparoscopic cholecystectomy under sevoflurane anesthesia. MATERIALS AND METHODS: In total, 105 patients between the ages of 18 to 60 years, scheduled to undergo laparoscopic cholecystectomy under general anesthesia, were studied...
February 2017: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
https://www.readbyqxmd.com/read/28143962/pressures-and-oscillation-frequencies-generated-by-bubble-positive-expiratory-pressure-devices
#11
Mary D Santos, Maree A Milross, John P Eisenhuth, Jennifer A Alison
BACKGROUND: Positive expiratory pressure (PEP) devices are used to assist with airway clearance. Little is known about the therapist-made or commercially available bubble-PEP devices. The aim of this study was to determine the end-expiratory pressures (cm H2O) and oscillation frequencies (Hz) generated when a range of flows were applied to the therapist-made bubble-PEP devices (Bubble-PEP-3cm and Bubble-PEP-0cm) and commercial bubble-PEP devices (AguaPEP, Hydrapep, and Therabubble). METHODS: This was a bench-top experimental study using a compressed air source, flow rotameter (flows of 5, 10, 15, 20, and 25 L/min), and pressure transducer...
January 31, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28137269/a-diaphragmatic-electrical-activity-based-optimization-strategy-during-pressure-support-ventilation-improves-synchronization-but-does-not-impact-work-of-breathing
#12
Francois Beloncle, Lise Piquilloud, Nuttapol Rittayamai, Christer Sinderby, Hadrien Rozé, Laurent Brochard
BACKGROUND: Poor patient-ventilator synchronization is often observed during pressure support ventilation (PSV) and has been associated with prolonged duration of mechanical ventilation and poor outcome. Diaphragmatic electrical activity (Eadi) recorded using specialized nasogastric tubes is a surrogate of respiratory brain stem output. This study aimed at testing whether adapting ventilator settings during PSV using a protocolized Eadi-based optimization strategy, or Eadi-triggered and -cycled assisted pressure ventilation (or PSVN) could (1) improve patient-ventilator interaction and (2) reduce or normalize patient respiratory effort as estimated by the work of breathing (WOB) and the pressure time product (PTP)...
January 31, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28127231/mechanical-ventilation-during-extracorporeal-membrane-oxygenation-in-patients-with-acute-severe-respiratory-failure
#13
REVIEW
Zhongheng Zhang, Wan-Jie Gu, Kun Chen, Hongying Ni
Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV) to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO) provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed...
2017: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
https://www.readbyqxmd.com/read/28125527/an-open-lung-strategy-in-the-management-of-acute-respiratory-distress-syndrome-a-systematic-review-and-meta-analysis
#14
Jun Lu, Xing Wang, Mingqi Chen, Lu Cheng, Qiuhua Chen, Hua Jiang, Zhiguang Sun
PURPOSE: An Open lung strategy (OLS) that includes positive end expiratory pressure (PEEP) and recruitment maneuvers (RMs) during mechanical ventilation is probably an important treatment method in patients with acute respiratory distress syndrome (ARDS). However, the effect of OLS is unknown. We therefore hypothesized that patients with ARDS may benefit from OLS treatment. METHODS: We identified relevant randomized controlled trials by searching through Pubmed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials updated to May 22, 2016...
January 25, 2017: Shock
https://www.readbyqxmd.com/read/28124234/dynamic-driving-pressure-associated-mortality-in-acute-respiratory-distress-syndrome-with-extracorporeal-membrane-oxygenation
#15
Li-Chung Chiu, Han-Chung Hu, Chen-Yiu Hung, Chih-Hao Chang, Feng-Chun Tsai, Cheng-Ta Yang, Chung-Chi Huang, Huang-Pin Wu, Kuo-Chin Kao
BACKGROUND: The survival predictors and optimal mechanical ventilator settings in patients with severe acute respiratory distress syndrome (ARDS) undergoing extracorporeal membrane oxygenation (ECMO) are uncertain. This study was designed to investigate the influences of clinical variables and mechanical ventilation settings on the outcomes for severe ARDS patients receiving ECMO. METHODS: We reviewed severe ARDS patients who received ECMO due to refractory hypoxemia from May 2006 to October 2015...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28108768/severe-hypercapnia-and-outcome-of-mechanically-ventilated-patients-with-moderate-or-severe-acute-respiratory-distress-syndrome
#16
Nicolas Nin, Alfonso Muriel, Oscar Peñuelas, Laurent Brochard, José Angel Lorente, Niall D Ferguson, Konstantinos Raymondos, Fernando Ríos, Damian A Violi, Arnaud W Thille, Marco González, Asisclo J Villagomez, Javier Hurtado, Andrew R Davies, Bin Du, Salvatore M Maggiore, Luis Soto, Gabriel D'Empaire, Dimitrios Matamis, Fekri Abroug, Rui P Moreno, Marco Antonio Soares, Yaseen Arabi, Freddy Sandi, Manuel Jibaja, Pravin Amin, Younsuck Koh, Michael A Kuiper, Hans-Henrik Bülow, Amine Ali Zeggwagh, Antonio Anzueto, Jacob I Sznajder, Andres Esteban
PURPOSE: To analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS). PATIENTS AND METHODS: We performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010...
February 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28108076/safety-and-effectiveness-of-alveolar-recruitment-maneuvers-and-positive-end-expiratory-pressure-during-general-anesthesia-for-cesarean-section-a-prospective-randomized-trial
#17
D Aretha, F Fligou, P Kiekkas, C Messini, E Panteli, E Zintzaras, M Karanikolas
INTRODUCTION: During cesarean section, the supine position reduces functional residual capacity and worsens lung compliance. We tested the hypothesis that alveolar recruitment maneuvers and positive end-expiratory pressure improve lung compliance in women undergoing general anesthesia for cesarean section. METHODS: Ninety women undergoing cesarean section were randomly assigned to one of two groups in a prospective, double-blind trial. In the alveolar recruitment maneuver group, pressure-control ventilation was used and inspiratory time was increased to 50% after delivery; positive end-expiratory pressure was increased to 20cmH2O and peak airway inspiratory pressure gradually increased to 45-50cmH2O...
December 23, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28107408/effect-of-positive-end-expiratory-pressure-on-the-sonographic-optic-nerve-sheath-diameter-as-a-surrogate-for-intracranial-pressure-during-robot-assisted-laparoscopic-prostatectomy-a-randomized-controlled-trial
#18
Ji-Hyun Chin, Wook-Jong Kim, Joonho Lee, Yun A Han, Jinwook Lim, Jai-Hyun Hwang, Seong-Sik Cho, Young-Kug Kim
BACKGROUND: Positive end-expiratory pressure (PEEP) can increase intracranial pressure. Pneumoperitoneum and the Trendelenburg position are associated with an increased intracranial pressure. We investigated whether PEEP ventilation could additionally influence the sonographic optic nerve sheath diameter as a surrogate for intracranial pressure during pneumoperitoneum combined with the Trendelenburg position in patients undergoing robot-assisted laparoscopic prostatectomy. METHODS: After anesthetic induction, 38 patients were randomly allocated to a low tidal volume ventilation (8 ml/kg) without PEEP group (zero end-expiratory pressure [ZEEP] group, n = 19) or low tidal volume ventilation with 8 cmH2O PEEP group (PEEP group, n = 19)...
2017: PloS One
https://www.readbyqxmd.com/read/28107207/dynamic-mechanical-interactions-between-neighboring-airspaces-determine-cyclic-opening-and-closure-in-injured-lung
#19
Ludovic Broche, Gaetano Perchiazzi, Liisa Porra, Angela Tannoia, Mariangela Pellegrini, Savino Derosa, Alessandra Sindaco, João Batista Borges, Loïc Degrugilliers, Anders Larsson, Göran Hedenstierna, Anthony S Wexler, Alberto Bravin, Sylvia Verbanck, Bradford J Smith, Jason H T Bates, Sam Bayat
OBJECTIVES: Positive pressure ventilation exposes the lung to mechanical stresses that can exacerbate injury. The exact mechanism of this pathologic process remains elusive. The goal of this study was to describe recruitment/derecruitment at acinar length scales over short-time frames and test the hypothesis that mechanical interdependence between neighboring lung units determines the spatial and temporal distributions of recruitment/derecruitment, using a computational model. DESIGN: Experimental animal study...
January 19, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28103448/bedside-contribution-of-electrical-impedance-tomography-to-set-positive-end-expiratory-pressure-for-ecmo-treated-severe-ards-patients
#20
Guillaume Franchineau, Nicolas Bréchot, Guillaume Lebreton, Guillaume Hekimian, Ania Nieszkowska, Jean-Louis Trouillet, Pascal Leprince, Jean Chastre, Charles-Edouard Luyt, Alain Combes, Matthieu Schmidt
RATIONALE: Optimal positive end-expiratory pressure (PEEP) is unknown in severe acute respiratory distress syndrome (ARDS) patients on extracorporeal membrane oxygenation (ECMO) receiving mechanical ventilation with very low tidal volume. OBJECTIVES: To evaluate electrical impedance tomography's (EIT) ability to monitor a PEEP trial and to derive from EIT the best compromise PEEP in this setting. METHODS: A decremental PEEP trial (20-0 cmH2O) in 5 cmH2O steps was monitored by EIT, with lung images divided into four ventral-to-dorsal horizontal regions of interest...
January 19, 2017: American Journal of Respiratory and Critical Care Medicine
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