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Positive end expiratory pressure

Fabienne D Simonis, Carmen S V Barbas, Antonio Artigas-Raventós, Jaume Canet, Rogier M Determann, James Anstey, Goran Hedenstierna, Sabrine N T Hemmes, Greet Hermans, Michael Hiesmayr, Markus W Hollmann, Samir Jaber, Ignacio Martin-Loeches, Gary H Mills, Rupert M Pearse, Christian Putensen, Werner Schmid, Paolo Severgnini, Roger Smith, Tanja A Treschan, Edda M Tschernko, Marcos F Vidal Melo, Hermann Wrigge, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J Schultz, Ary Serpa Neto
BACKGROUND: The majority of critically ill patients do not suffer from acute respiratory distress syndrome (ARDS). To improve the treatment of these patients, we aimed to identify potentially modifiable factors associated with outcome of these patients. METHODS: The PRoVENT was an international, multicenter, prospective cohort study of consecutive patients under invasive mechanical ventilatory support. A predefined secondary analysis was to examine factors associated with mortality...
March 21, 2018: Annals of Intensive Care
Toru Kotani, Masanori Hanaoka, Shinya Hirahara, Hisashi Yamanaka, Eckhard Teschner, Atsuko Shono
Background: Prone positioning may provide a uniform distribution of transpulmonary pressure and contribute to prevent ventilator-induced lung injury. However, despite moderate positive end-expiratory pressure and low tidal volumes, there is still a risk of regional overdistension. Case presentation: A man with refractory hypoxemia was mechanically ventilated with prone positioning. Although prone positioning with a plateau pressure of 18 cmH2 O and a positive end-expiratory pressure of 8 cmH2 O promptly improved oxygenation, regional ventilation monitoring using electrical impedance tomography initially detected decreased distribution in the dorsal region but increased in the ventral, suggesting overdistension...
2018: Journal of Intensive Care
Emmanuel Marret, Raphael Cinotti, Laurence Berard, Vincent Piriou, Jacques Jobard, Benoit Barrucand, Dragos Radu, Samir Jaber, Francis Bonnet
BACKGROUND: Thoracic surgery for lung resection is associated with a high incidence of postoperative pulmonary complications. Controlled ventilation with a large tidal volume has been documented to be a risk factor for postoperative respiratory complications after major abdominal surgery, whereas the use of low tidal volumes and positive end-expiratory pressure (PEEP) has a protective effect. OBJECTIVE: To evaluate the effects of ventilation with low tidal volume and PEEP on major complications after thoracic surgery...
March 19, 2018: European Journal of Anaesthesiology
Usman Maqsood, Nehal Patel
We describe a case of near-fatal asthma, treated successfully by initiation of extracorporeal membrane oxygenation (ECMO). A 29-year-old woman, known asthmatic on steroid inhalers, inhaled/nebulised bronchodilators, long-term oral prednisolone, theophylline and montelukast, presented with acute shortness of breath. She deteriorated following initial treatment with nebulised bronchodilators and magnesium sulfate requiring intubation and mechanical ventilation. Severe bronchospasm ensued following mechanical ventilation and peak airway pressures remained at 55 cm H2 O with intrinsic positive end expiratory pressure(PEEP) of 14 cm H2 O...
March 20, 2018: BMJ Case Reports
Satoshi Suzuki, Yuko Mihara, Yukiko Hikasa, Shuji Okahara, Takuma Ishihara, Ayumi Shintani, Hiroshi Morimatsu, Akiko Sato, Sachio Kusume, Hidekuni Hidaka, Hidehiko Yatsuzuka, Masahiro Okawa, Makoto Takatori, Shinsei Saeki, Takeshi Samuta, Hiroaki Tokioka, Toshiaki Kurasako, Masato Maeda, Mamoru Takeuchi, Akihito Hirasaki, Michio Kitaura, Hideki Kajiki, Osamu Kobayashi, Hiroshi Katayama, Hideki Nakatsuka, Satoshi Mizobuchi, Seiji Sugimoto, Masataka Yokoyama, Kazuhito Kusudo, Kensuke Shiraishi, Toshio Iwaki, Tatsuhiko Komatsu, Yasuo Hirai, Tetsufumi Sato, Masakazu Kimura, Takeshi Yasukawa, Motonobu Kimura, Masahiro Taniguchi, Yutaka Shimoda, Yoji Kobayashi, Mitsunori Tsukioki, Nobuki Manabe, Eiji Ando, Makoto Kosaka, Takashi Tsukiji, Chika Tokura, Yasuhiro Asao, Masatoshi Sugiyama, Kozo Seto
BACKGROUND: Intraoperative oxygen management is poorly understood. It was hypothesized that potentially preventable hyperoxemia and substantial oxygen exposure would be common during general anesthesia. METHODS: A multicenter, cross-sectional study was conducted to describe current ventilator management, particularly oxygen management, during general anesthesia in Japan. All adult patients (16 yr old or older) who received general anesthesia over 5 consecutive days in 2015 at 43 participating hospitals were identified...
March 19, 2018: Anesthesiology
Yu Onodera, Ryo Akimoto, Hiroto Suzuki, Masayuki Okada, Masaki Nakane, Kaneyuki Kawamae
BACKGROUND: Although clinical studies of the high-flow nasal cannula (HFNC) and its effect on positive end-expiratory pressure (PEEP) have been done, the washout effect has not been well evaluated. Therefore, we made an experimental respiratory model to evaluate the respiratory physiological effect of HFNC. METHODS: An airway model was made by a 3D printer using the craniocervical 3D-CT data of a healthy 32-year-old male. CO2 was infused into four respiratory lung models (normal-lung, open- and closed-mouth models; restrictive- and obstructive-lung, open-mouth models) to maintain the partial pressure of end-tidal CO2 (PET CO2 ) at 40 mmHg...
March 15, 2018: Intensive Care Medicine Experimental
Yuwen Shen, Chuanzhen Liu, Changcun Fang, Jie Xi, Shuming Wu, Xinyan Pang, Guangmin Song
OBJECTIVE: To study the risk factors of oxygenation impairment in patients with type-A acute aortic dissection who underwent total arch replacement with a stented elephant trunk. METHODS: In this study, 169 consecutive patients were enrolled who were diagnosed with type-A acute aortic dissection and underwent a total arch replacement procedure at the Qilu Hospital of Shandong University between January 2015 and February 2017. Postoperative oxygenation impairment was defined as arterial oxygen partial pressure/inspired oxygen fraction ≤ 200 with positive end expiratory pressure ≥ 5 cm H2 O that occurred within 72 hours of surgery...
February 14, 2018: Journal of Thoracic and Cardiovascular Surgery
Jaime Retamal, Daniel Hurtado, Nicolás Villarroel, Alejandro Bruhn, Guillermo Bugedo, Marcelo Britto Passos Amato, Eduardo Leite Vieira Costa, Göran Hedenstierna, Anders Larsson, João Batista Borges
OBJECTIVE: It is known that ventilator-induced lung injury causes increased pulmonary inflammation. It has been suggested that one of the underlying mechanisms may be strain. The aim of this study was to investigate whether lung regional strain correlates with regional inflammation in a porcine model of acute respiratory distress syndrome. DESIGN: Retrospective analysis of CT images and positron emission tomography images using [F]fluoro-2-deoxy-D-glucose. SETTING: University animal research laboratory...
March 9, 2018: Critical Care Medicine
Ron Dueck, Eric G Wong, G Kim Prisk, Randolph H Hastings
Patients with end-expiratory flow limitation (eEFL) demonstrate a terminal rise in capnography slope. The high slope could represent phase 5, a phenomenon described for single breath N2 tests but previously unreported during capnography. This study evaluated 6 healthy subjects exhaling from total lung capacity to residual volume at several set constant rates. We measured the volumes of flow limitation (VFL ) and phase 5 (VP5 ) for CO2 and N2 . A distinct phase 5 occurred shortly after eEFL for both gases. Increased expiratory flow rate resulted in parallel increases in VFL and VP5 ...
March 8, 2018: Respiratory Physiology & Neurobiology
Keamogetswe Molokoane-Mokgoro, Lara Nicole Goldstein, Mike Wells
INTRODUCTION: Ultrasound assessment of the inferior vena cava (IVC) has gained favour in aiding fluid management decisions for controlled, mechanically ventilated patients as well as in non-mechanically ventilated, spontaneously breathing patients. Its utility in spontaneously breathing patients during positive pressure non-invasive ventilation has not yet been determined. The use of the axillary vein, as an alternative option to the IVC due to its ease of accessibility and independence from intra-abdominal pressure, has also not been evaluated...
March 9, 2018: Emergency Medicine Journal: EMJ
Abirami Kumaresan, Robert Gerber, Ariel Mueller, Stephen H Loring, Daniel Talmor
BACKGROUND: The effects of prone positioning on esophageal pressures have not been investigated in mechanically ventilated patients. Our objective was to characterize effects of prone positioning on esophageal pressures, transpulmonary pressure, and lung volume, thereby assessing the potential utility of esophageal pressure measurements in setting positive end-expiratory pressure (PEEP) in prone patients. METHODS: We studied 16 patients undergoing spine surgery during general anesthesia and neuromuscular blockade...
March 9, 2018: Anesthesiology
Wissam Shalish, Samantha Latremouille, Jesse Papenburg, Guilherme Mendes Sant'Anna
CONTEXT: A variety of extubation readiness tests have already been incorporated into clinical practice in preterm infants. OBJECTIVE: To identify predictor tests of successful extubation and determine their accuracy compared with clinical judgement alone. METHODS: MEDLINE, Embase, PubMed, Cochrane Library and Web of Science were searched between 1984 and June 2016. Studies evaluating predictors of extubation success during a period free of mechanical inflations in infants less than 37 weeks' gestation were included...
March 8, 2018: Archives of Disease in Childhood. Fetal and Neonatal Edition
Xiumei Sun, Jianxin Zhou
Esophageal pressure monitoring provides a minimally invasive method to assess the pleural pressure, which can be used to differentiate the lung and chest wall mechanics. The information of transpulmonary pressure, work of breathing, intrinsic positive end-expiratory pressure and respiratory muscle performance can facilitate the proper setting of mechanical ventilation. Esophageal pressure monitoring is still not routinely used in the clinical setting because of difficulty in esophageal balloon catheter placement and data interpretation due to esophageal pressure monitoring has certain technical requirements, and the measurement results are influenced by many factors such as airbag volume, location, esophageal wall elasticity and mediastinal organ weight...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Lingchen Kong, Jianzhong Li, Peng Wu, Jianhua Xu, Honglei Li, Haifei Long, Pan Liu, Fangfang Wei, Wenhong Peng
OBJECTIVE: To investigate the curative effect of lateral position ventilation combined with vibration sputum drainage on the patients with acute respiratory distress syndrome (ARDS). METHODS: A prospective randomized controlled trial was conducted. The patients with ARDS undergoing mechanical ventilation (MV) admitted to intensive care unit (ICU) of Linyi Central Hospital from January 2013 to June 2017 were enrolled, and they were divided into simple ventilation group and combined treatment group according to random number table...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Andrew C McKown, Matthew W Semler, Todd W Rice
No abstract text is available yet for this article.
March 6, 2018: JAMA: the Journal of the American Medical Association
Idunn S Morris, Andrew S Lane, Ian Seppelt
No abstract text is available yet for this article.
March 6, 2018: JAMA: the Journal of the American Medical Association
Carmen Silvia Valente Barbas, Sérgio Nogueira Nemer
No abstract text is available yet for this article.
March 6, 2018: JAMA: the Journal of the American Medical Association
Karen E A Burns, Stavroula Raptis, Rosane Nisenbaum, Leena Rizvi, Andrew Jones, Jyoti Bakshi, Wylie Tan, Aleksander Meret, Deborah J Cook, Francois Lellouche, Scott K Epstein, David Gattas, Farhad N Kapadia, Jesús Villar, Laurent Brochard, Martin R Lessard, Maureen O Meade
RATIONALE: Randomized trials and meta-analyses have informed several aspects of weaning. Results are rarely replicated in practice as evidence is applied in intensive care units (ICUs) that differ from the settings in which it was generated. OBJECTIVES: We aimed to (i) describe weaning practice variation (identifying weaning candidates, conducting spontaneous breathing trials (SBTs), using ventilator modes, other aspects of care during weaning); (ii) characterize regional differences in weaning practices; and (iii) identify predictors of common practices...
March 6, 2018: Annals of the American Thoracic Society
Marta Thio, Jennifer A Dawson, Kelly J Crossley, Timothy J Moss, Charles C Roehr, Graeme R Polglase, Peter G Davis, Stuart B Hooper
BACKGROUND: In neonatal resuscitation, a ventilation device providing positive end-expiratory pressure (PEEP) is recommended. There is limited information about PEEP delivery in vivo, using different models of self-inflating bag (SIB) at different inflation rates and PEEP settings. METHODS: We compared PEEP delivery to intubated preterm lambs using four commonly available models of paired SIBs and PEEP valves, with a T-piece, with gas flow of 8 L/min. Peak inspiratory pressure inflations of 30 cmH2 O, combined with set PEEP of 5, 7 and 10 cmH2 O, were delivered at rates of 20, 40 and 60/min...
March 2, 2018: Archives of Disease in Childhood. Fetal and Neonatal Edition
Min Hur, Seokha Yoo, Jung-Yoon Choi, Sun-Kyung Park, Dhong Eun Jung, Won Ho Kim, Jin-Tae Kim, Jae-Hyon Bahk
BACKGROUND: Dynamic change in central venous pressure (CVP) was associated with fluid responsiveness. External jugular venous pressure (EJVP) may reliably estimate CVP and have the advantages of being less invasive. We investigated whether increase in EJVP induced by positive end-expiratory pressure (PEEP) could be a reliable predictor of fluid responsiveness in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). METHODS: Fifty patients who underwent RALP with steep Trendelenburg position were enrolled...
February 27, 2018: Journal of Anesthesia
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