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mechanical ventilation

Eniko Szakmar, Colin J Morley, Gusztav Belteki
OBJECTIVES: To investigate how compensating for endotracheal tube leaks by targeting the leak-compensated tidal volume affects measured physiologic and ventilator variables during neonatal mechanical ventilation. DESIGN: Retrospective observational study. SETTING: A level III Neonatal ICU. PATIENTS: We enrolled 30 neonates who were ventilated using synchronized intermittent positive pressure mode with volume guarantee and had at least 12 hours of continuous detailed recording of ventilation variables...
June 21, 2018: Pediatric Critical Care Medicine
Luciana Moisés Camilo, Gabriel Casulari Motta-Ribeiro, Mariana Barcellos de Ávila, Luis Felipe Santos Cruz Paula, Mariana Boechat de Abreu, Alysson Roncally Carvalho, Walter Araujo Zin
BACKGROUND: Recruitment maneuver and positive end-expiratory pressure (PEEP) can be used to counteract intraoperative anesthesia-induced atelectasis. Variable ventilation can stabilize lung mechanics by avoiding the monotonic tidal volume and protect lung parenchyma as tidal recruitment is encompassed within the tidal volume variability. METHODS: Forty-nine (7 per group) male Wistar rats were anesthetized, paralyzed, and mechanically ventilated. A recruitment maneuver followed by stepwise decremental PEEP titration was performed while continuously estimating respiratory system mechanics using recursive least squares...
June 20, 2018: Anesthesia and Analgesia
Anna Holm, Pia Dreyer
The use of light and no sedation is gaining currency in the intensive care unit, resulting in more conscious patients. Due to mechanical ventilation, patients are unable to communicate verbally, and may feel frustration. Communication tools may help; however, they are not used systematically in clinical practice. Based on "complex interventions" and a qualitative approach, a communication tool was modified, tested, and evaluated in this study. The tools consisted of a tablet with communication software and a laminated "communication book" with identical structure...
June 22, 2018: Computers, Informatics, Nursing: CIN
Annette Pisanski, Silvia Pagliardini
Breathing at rest is typically characterized by three phases: active inspiration, post-inspiration (or stage 1 expiration), and passive expiration (or stage 2 expiration). Breathing during periods of increased respiratory demand, on the other hand, engages active expiration through recruitment of abdominal muscles in order to increase ventilation. It is currently hypothesized that different phases of the respiratory rhythm are driven by three coupled oscillators: the preBötzinger Complex, driving inspiration, the parafacial respiratory group (pFRG), driving active expiration and the post-inspiratory Complex, driving post-inspiration...
June 19, 2018: Respiratory Physiology & Neurobiology
Ken D O'Halloran, David P Burns
Duchenne muscular dystrophy is a fatal neuromuscular disease associated with respiratory-related morbidity and mortality. Herein, we review recent work by our group exploring deficits and compensation in the respiratory control network governing respiratory homeostasis in a pre-clinical model of DMD, the mdx mouse. Deficits at multiple sites of the network provide considerable challenges to respiratory control. However, our work has also revealed evidence of compensatory neuroplasticity in the motor drive to breathe enhancing diaphragm muscle activity during increased chemical drive...
June 19, 2018: Respiratory Physiology & Neurobiology
Jessica Keim-Malpass, Kyle B Enfield, James Forrest Calland, Douglas E Lake, Matthew T Clark
Predictive analytics monitoring that informs clinicians of the risk for failed extubation would help minimize both the duration of mechanical ventilation and the risk of emergency re-intubation in ICU patients. We hypothesized that dynamic monitoring of cardiorespiratory data, vital signs, and lab test results would add information to standard clinical risk factors. To develop predictive analytic models for patients who failed extubation in critical care settings in an academic medical center using standard and novel risk factors...
June 22, 2018: Physiological Measurement
Aliae Ar Mohamed-Hussein, Hoda A Makhlouf, Zahraa I Selim, Waleed Gamaleldin Saleh
BACKGROUND: In COPD weight loss and muscle wasting contribute significantly to morbidity, disability and handicap. Dominant-handgrip strength for evaluation of muscle strength has not been tested as a parameter to predict outcome of weaning from mechanical ventilation (MV). OBJECTIVES: to evaluate the association between handgrip strength and the duration and success of weaning and extubation outcome. PATIENTS AND METHODS: This prospective study included 34 COPD patients requiring MV for at least 48 hours...
June 22, 2018: Clinical Respiratory Journal
Karl Walsh, Ioannis Goutos, Baljit Dheansa
Acute acalculous cholecystitis (AAC) is an acute inflammatory disorder of the gallbladder, which can complicate the recovery of burn patients. No formal literature review has been performed about this uncommon but potentially fatal complication in burn care. A Pubmed search from 1950 to 2015 was performed using MESH terms: "acalculous cholecystitis," "burns or thermal injuries or thermal damage," and "cholecystitis or gallbladder inflammation." The articles were analyzed and data collected individually on the incidence, presenting symptoms or signs, risk factors, investigations, and treatment modalities used...
February 9, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
Pierre Raeven, Johannes Zipperle, Susanne Drechsler
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. It remains a highly lethal condition in which current tools for early diagnosis and therapeutic decision-making are far from ideal. Extracellular vesicles (EVs), 30 nm to several micrometers in size, are released from cells upon activation and apoptosis and express membrane epitopes specific for their parental cells. Since their discovery two decades ago, their role as biomarkers and mediators in various diseases has been intensively studied...
2018: Theranostics
Ashish Nagpal, Melissa-Moore Clingenpeel, Rajan K Thakkar, Renata Fabia, Jeffrey Lutmer
OBJECTIVE: To determine the association between fluid resuscitation volume following pediatric burn injury and impact on outcomes. METHODS: A retrospective chart review of pediatric patients (0-18 years) sustaining ≥15% TBSA burn, admitted to an American Burn Association verified pediatric burn center from 2010 to 2015. RESULTS: Twenty-seven patients met inclusion criteria and had complete data available for analysis. Fifteen (56%) patients received greater than 6ml/kg/total body surface area burn in first 24h and twelve (44%) patients received less than 6ml/kg/percent total body surface area burn in first 24h...
August 2018: Burns: Journal of the International Society for Burn Injuries
Niloofar Dehghan
Unstable chest wall injuries can result from multiple rib fractures or a flail chest, and are associated with high rates of morbidity and mortality. Traditionally such injuries have been treated non-operatively, with mechanical ventilation when required, and pain management. Surgical treatment of these fractures is technically possible, and studies suggest improved outcomes, such as lower time on mechanical ventilation and length of time in the intensive care unit, compared to non-operative treatment. However, there are many challenges and controversies regarding indications for surgical fixation, patient selection, outcomes, and fixation strategy...
June 2018: Injury
Yuan-Yuan Wang, Shuang-Fei Hu, Hui-Min Ying, Long Chen, Hui-Li Li, Fang Tian, Zhen-Feng Zhou
BACKGROUND: The benefit results of postoperative tight glycemic control (TGC) were controversial and there was a lack of well-powered studies that support current guideline recommendations. METHODS: The EMBASE, MEDLINE, and the Cochrane Library databases were searched utilizing the key words "Blood Glucose", "insulin" and "Postoperative Period" to retrieve all randomized controlled trials evaluating the benefits of postoperative TGC as compared to conventional glycemic control (CGC) in patients undergoing surgery...
June 22, 2018: BMC Endocrine Disorders
Lu Wang, Nannan Zhang, Yi Zhang, Jingen Xia, Qingyuan Zhan, Chen Wang
BACKGROUND: Mechanical ventilation can cause ventilator-induced lung injury (VILI) and lung fibrosis; however, the underlying mechanisms are still not fully understood. RNA sequencing is a powerful means for detecting vitally important protein-coding transcripts and long non-coding RNAs (lncRNAs) on a genome-wide scale, which may be helpful for reducing this knowledge gap. METHODS: Ninety C57BL/6 mice were subjected to either high tidal volume ventilation or sham operation, and then mice with ventilation were randomly allocated to periods of recovery for 0, 1, 3, 5, 7, 14, 21, or 28 days...
June 22, 2018: Respiratory Research
Rhodri Saunders, Dimitris Geogopoulos
Background: Mechanical ventilation is an integral, but expensive, part of the intensive care unit (ICU). Optimal use of mechanical ventilation could save costs and improve patient outcomes. Here, the cost effectiveness of proportional assist ventilation (PAV™ ventilation by Medtronic) is estimated relative to pressure support ventilation (PSV). Methods: A cohort-level, clinical model was built using data from clinical trials. The model estimates patient-ventilator asynchrony >10%, tracheostomy, ventilator-associated pneumonia, other nosocomial infections, spontaneous breathing trial success, hypoxemia, and death...
2018: Frontiers in Public Health
Sandy MacMillan, A Mark Evans
The hypoxic ventilatory response (HVR) is markedly attenuated by AMPK-α1 deletion conditional on the expression of Cre-recombinase in tyrosine hydroxylase (TH) expressing cells, precipitating marked increases in apnea frequency and duration. It was concluded that ventilatory dysfunction caused by AMPK deficiency was driven by neurogenic mechanisms. However, TH is transiently expressed in other cell types during development, and it is evident that central respiratory depression can also be triggered by myogenic mechanisms that impact blood supply to the brain...
2018: Frontiers in Physiology
Gabrielė Linkaitė, Mantas Riauka, Ignė Bunevičiūtė, Saulius Vosylius
Introduction: Delirium not only compromises patient care, but is also associated with poorer outcomes: increased duration of mechanical ventilation, higher mortality, and greater long-term cognitive dysfunction. The PRE-DELIRIC model is a tool used to calculate the risk of the development of delirium. The classification of the patients into groups by risk allows efficient initiation of preventive measures. The goal of this study was to validate the PRE-DELIRIC model using the CAM-ICU (The Confusion Assessment Method for the Intensive Care Unit) method for the diagnosis of delirium...
2018: Acta Medica Lituanica
O L Schjørring, A P Toft-Petersen, K H Kusk, P Mouncey, E E Sørensen, P Berezowicz, M H Bestle, H-H Bülow, H Bundgaard, S Christensen, S A Iversen, I Kirkeby-Garstad, K B Krarup, M Kruse, J H Laake, L Liboriussen, R L Laebel, M Okkonen, L M Poulsen, L Russell, F Sjövall, K Sunde, E Søreide, T Waldau, A R Walli, A Perner, J Wetterslev, B S Rasmussen
BACKGROUND: Oxygen is liberally administered in intensive care units (ICUs). Nevertheless, ICU doctors' preferences for supplementing oxygen are inadequately described. The aim was to identify ICU doctors' preferences for arterial oxygenation levels in mechanically ventilated adult ICU patients. METHODS: In April to August 2016, an online multiple-choice 17-part-questionnaire was distributed to 1080 ICU doctors in seven Northern European countries. Repeated reminder e-mails were sent...
June 21, 2018: Acta Anaesthesiologica Scandinavica
K M Yim, H F Ko, M Lc Yang, T Y Li, S Ip, J Tsui
With Hong Kong's ageing population, advancement of medical technologies and hospital congestion, it is not uncommon for emergency physicians to encounter complicated critically ill patients in daily practice. It becomes a fundamental role of emergency physicians to initiate timely diagnostic and therapeutic interventions to save a patient's life and improve their prognosis. It is the reason a critical care service has been developed in emergency departments worldwide over the last decade. This article shares how emergency department intensivists can contribute to this novel model of care with some illustrative cases...
June 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Bing-Qian Xiang, Hui Gao, Mao-Lin Hao, Yong-Yue Dai, Wan-Tie Wang
OBJECTIVE: To investigate the effects of excessive endoplasmic reticulum stress on lung ischemia/reperfusion (I/R) induced myocardial injury in mice. METHODS: Forty healthy SPF male C57BL/6J mice were divided into 4 groups randomly ( n =10):sham operation group (Sham group), lung I/R group (I/R group), endoplasmic reticulum stress (ERS) pathway agonist Tunicamycin group (TM) and ERS inhibitor 4-phenyl butyric acid group (4-PBA). The model of lung I/R injury was established by clamping the left hilum of lung for 30 min followed by 180 min of reperfusion...
January 8, 2018: Chinese Journal of Applied Physiology
Won Young Kim, Mi Hyun Kim, Eun Jung Jo, Jung Seop Eom, Jeongha Mok, Ki Uk Kim, Hye Kyung Park, Min Ki Lee, Kwangha Lee
BACKGROUND: Patients with acute respiratory failure secondary to tuberculous destroyed lung (TDL) have a poor prognosis. The aim of the present retrospective study was to develop a mortality prediction model for TDL patients who require mechanical ventilation. METHODS: Data from consecutive TDL patients who had received mechanical ventilation at a single university-affiliated tertiary care hospital in Korea were reviewed. Binary logistic regression was used to identify factors predicting intensive care unit (ICU) mortality...
June 19, 2018: Tuberculosis and Respiratory Diseases
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