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Positive end 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/29115949/neurally-adjusted-ventilatory-assist-nava-or-pressure-support-ventilation-psv-during-spontaneous-breathing-trials-in-critically-ill-patients-a-crossover-trial
#6
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/29112971/effects-of-positive-end-expiratory-pressure-and-recruitment-maneuvers-in-a-ventilator-induced-injury-mouse-model
#7
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
#8
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/29105056/specific-anesthesia-induced-lung-volume-changes-from-induction-to-emergence-a-pilot-study
#9
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/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
#10
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/29071075/evaluation-by-various-methods-of-the-physiological-mechanism-of-a-high-flow-nasal-cannula-hfnc-in-healthy-volunteers
#11
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
#12
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
#13
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
#14
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
https://www.readbyqxmd.com/read/29060706/development-of-respiratory-function-monitor-for-neonates
#15
Fumihiko Takatori, Shinichiro Inoue, Satoru Togo, Shinji Yamamori
Approximately, 10 million babies do not breathe immediately at birth and some of them require positive pressure ventilation. However, inappropriate and excessive tidal volume delivery could lead to lung injury in neonatal patients. We developed a respiratory function monitor which can monitor mask leak, expiratory tidal volume, respiratory rate, peak inspiratory pressure, and end-tidal CO2 on a real-time basis. A neonatal flow sensor was specially designed and was integrated with a small mainstream capnometer, cap-ONE...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29060676/gamma-variate-modeling-of-indicator-dilution-curves-in-electrical-impedance-tomography
#16
Benjamin Hentze, Thomas Muders, Henning Luepschen, Steffen Leonhardt, Christian Putensen, Marian Walter
Electrical impedance tomography (EIT) is a non-invasive imaging technique, that can be used to monitor regional lung ventilation (V̇) in intensive care units (ICU) at bedside. This work introduces a method to extract regional lung perfusion (Q̇) from EIT image streams in order to quantify regional gas exchange in the lungs. EIT data from a single porcine animal trial, recorded during injection of a contrast agent (NaCl 10%) into a central venous catheter (CVC), are used for evaluation. Using semi-negative matrix factorization (Semi-NMF) a set of source signals is extracted from the data...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29059882/imaging-of-regional-air-distributions-in-porcine-lungs-using-high-performance-electrical-impedance-tomography-system
#17
G Y Jang, Y B Kim, H Wi, T I Oh, C R Chung, G Y Suh, E J Woo
Electrical impedance tomography (EIT) allows functional imaging of regional lung ventilation for real-time bedside monitoring of mechanically ventilated patients. Images showing time-changes of regional air distributions in the lungs can provide valuable diagnostic information for lung protective mechanical ventilation. This paper reports in vivo porcine imaging experiments of regional lung ventilation using a 16-channel parallel EIT system. Real-time time-difference chest images of 10 animals were reconstructed during mechanical ventilations with a temporal resolution of 50 frame/s...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29058315/atelectasis-is-inversely-proportional-to-transpulmonary-pressure-during-weaning-from-ventilator-support-in-a-large-animal-model
#18
M Gudmundsson, G Perchiazzi, M Pellegrini, A Vena, G Hedenstierna, C Rylander
BACKGROUND: In mechanically ventilated, lung injured, patients without spontaneous breathing effort, atelectasis with shunt and desaturation may appear suddenly when ventilator pressures are decreased. It is not known how such a formation of atelectasis is related to transpulmonary pressure (PL ) during weaning from mechanical ventilation when the spontaneous breathing effort is increased. If the relation between PL and atelectasis were known, monitoring of PL might help to avoid formation of atelectasis and cyclic collapse during weaning...
October 23, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29054769/positive-end-expiratory-pressure-adjusted-for-intra-abdominal-pressure-a-pilot-study
#19
Adrian Regli, Bart Leon De Keulenaer, Annamaria Palermo, Peter Vernon van Heerden
PURPOSE: Intra-abdominal hypertension (IAH) is associated with impaired respiratory function. Animal data suggest that positive end-expiratory pressure (PEEP) levels adjusted to intra-abdominal pressure (IAP) levels may counteract IAH-induced respiratory dysfunction. In this pilot study, our aim was to assess whether PEEP adjusted for IAP can be applied safely in patients with IAH. MATERIALS AND METHODS: We included patients on mechanical ventilation and with IAH...
October 16, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29052522/predictors-of-diffuse-alveolar-damage-in-patients-with-acute-respiratory-distress-syndrome-a-retrospective-analysis-of-clinical-autopsies
#20
Arnaud W Thille, Oscar Peñuelas, José A Lorente, Pilar Fernández-Segoviano, José-Maria Rodriguez, José-Antonio Aramburu, Julian Panizo, Andres Esteban, Fernando Frutos-Vivar
BACKGROUND: Although diffuse alveolar damage (DAD) is considered the typical histological pattern of acute respiratory distress syndrome (ARDS), only half of patients exhibit this morphological hallmark. Patients with DAD may have higher mortality than those without DAD. Therefore, we aimed to identify the factors associated with DAD in patients with ARDS. METHODS: We analyzed autopsy samples of 356 patients who had ARDS at the time of death. DAD was assessed by two pathologists, and ARDS criteria were evaluated by two intensivists...
October 20, 2017: Critical Care: the Official Journal of the Critical Care Forum
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