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Optimal PEEP

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https://www.readbyqxmd.com/read/29626267/different-ventilation-techniques-and-hemodynamic-optimization-to-maintain-regional-cerebral-oxygen-saturation-rsco-2-during-laparoscopic-bariatric-surgery-a-prospective-randomized-interventional-study
#1
Osama M Asaad
PURPOSE: The purpose of this study was to assess the changes in regional cerebral oxygen saturation (rScO2 ) in response to different ventilation strategies: inspired oxygen concentration (FiO2 ), end-tidal carbon dioxide (EtCO2 ), and positive end expiratory pressure (PEEP) in addition to optimizing mean arterial pressure (MAP) in obese patients subjected to laparoscopic bariatric surgery in the reverse trendelenburg position. METHODS: 50 obese patients were randomly assigned into one of two groups...
April 6, 2018: Journal of Anesthesia
https://www.readbyqxmd.com/read/29576103/analysing-tidal-volumes-early-after-a-positive-end-expiratory-pressure-increase-a-new-way-to-determine-optimal-peep-in-the-operating-theatre
#2
EDITORIAL
S Shaefi, M Eikermann
No abstract text is available yet for this article.
April 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29492533/is-there-a-relationship-between-optimal-cerebral-perfusion-pressure-guided-management-and-pao-2-fio-2-ratio-after-severe-traumatic-brain-injury
#3
M Moreira, D Fernandes, E Pereira, E Monteiro, R Pascoa, C Dias
OBJECTIVE: Severe traumatic brain injury (TBI) management has been associated with adult respiratory distress syndrome (ARDS) in previous literature. We aimed to investigate the relationships between optimal CPP-guided management, ventilation parameters over time and outcome after severe TBI. MATERIALS AND METHODS: We performed retrospective analysis of recorded data from 38 patients admitted to the NCCU after severe TBI, managed with optimal cerebral perfusion pressure (CPPopt)-guided therapy, calculated using pressure reactivity index (PRx)...
2018: Acta Neurochirurgica. Supplement
https://www.readbyqxmd.com/read/29430443/electrical-impedance-tomography
#4
REVIEW
Beatriz Lobo, Cecilia Hermosa, Ana Abella, Federico Gordo
Continuous assessment of respiratory status is one of the cornerstones of modern intensive care unit (ICU) monitoring systems. Electrical impedance tomography (EIT), although with some constraints, may play the lead as a new diagnostic and guiding tool for an adequate optimization of mechanical ventilation in critically ill patients. EIT may assist in defining mechanical ventilation settings, assess distribution of tidal volume and of end-expiratory lung volume (EELV) and contribute to titrate positive end-expiratory pressure (PEEP)/tidal volume combinations...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29417182/simultaneous-common-bile-duct-clearance-and-laparoscopic-cholecystectomy-experience-of-a-one-stage-approach
#5
Shahin Mohseni, John Ivarsson, Rebecka Ahl, Sinan Dogan, Sten Saar, Arvo Reinsoo, Teesi Sepp, Karl-Gunnar Isand, Edvard Garder, Ilmar Kaur, Heiti Ruus, Peep Talving
INTRODUCTION: The timing and optimal method for common bile duct (CBD) clearance and laparoscopic cholecystectomy remains controversial. Several different approaches are available in clinical practice. The current study presents the experience of two European hospitals of simultaneous laparoscopic cholecystectomy (LC) and intra-operative endoscopic retrograde cholangiopacreatography (IO-ERCP) done by surgeons. METHODS: Retrospective analysis of all consecutive patients subjected to LC + IO-ERCP during their index admission between 4/2014 and 9/2016...
February 7, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29380160/peep-titration-the-effect-of-prone-position-and-abdominal-pressure-in-an-ards-model
#6
Joseph C Keenan, Gustavo A Cortes-Puentes, Lei Zhang, Alex B Adams, David J Dries, John J Marini
BACKGROUND: Prone position and PEEP can both improve oxygenation and other parameters, but their interaction has not been fully described. Limited data directly compare selection of mechanically "optimal" or "best" PEEP in both supine and prone positions, either with or without changes in chest wall compliance. To compare best PEEP in these varied conditions, we used an experimental ARDS model to compare the mechanical, gas exchange, and hemodynamic response to PEEP titration in supine and prone position with varied abdominal pressure...
January 30, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29370755/associations-between-intraoperative-ventilator-settings-during-one-lung-ventilation-and-postoperative-pulmonary-complications-a-prospective-observational-study
#7
Shuji Okahara, Kazuyoshi Shimizu, Satoshi Suzuki, Kenzo Ishii, Hiroshi Morimatsu
BACKGROUND: The interest in perioperative lung protective ventilation has been increasing. However, optimal management during one-lung ventilation (OLV) remains undetermined, which not only includes tidal volume (VT ) and positive end-expiratory pressure (PEEP) but also inspired oxygen fraction (FI O2 ). We aimed to investigate current practice of intraoperative ventilation during OLV, and analyze whether the intraoperative ventilator settings are associated with postoperative pulmonary complications (PPCs) after thoracic surgery...
January 25, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29344446/global-optimal-peep-for-anesthetized-patients
#8
EDITORIAL
Ata Mahmoodpoor, Samad Ej Golzari
No abstract text is available yet for this article.
August 2017: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/29194339/risk-factors-for-the-development-of-acute-respiratory-distress-syndrome-following-hemorrhage
#9
Bryce R H Robinson, Mitchell J Cohen, John B Holcomb, Timothy A Pritts, Dina Gomaa, Erin E Fox, Richard D Branson, Rachael A Callcut, Bryan A Cotton, Martin A Schreiber, Karen J Brasel, Jean-Francois Pittet, Kenji Inaba, Jeffery D Kerby, Thomas M Scalea, Charlie E Wade, Eileen M Bulger
BACKGROUND: The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) study evaluated the effects of plasma and platelets on hemostasis and mortality after hemorrhage. The pulmonary consequences of resuscitation strategies that mimic whole blood, remain unknown. METHODS: A secondary analysis of the PROPPR study was performed. Injured patients predicted to receive a massive transfusion were randomized to 1:1:1 vs. 1:1:2 plasma-platelet-RBC ratios at 12 Level I North American trauma centers...
November 30, 2017: Shock
https://www.readbyqxmd.com/read/29184987/ventilation-during-extracorporeal-support-why-and-how
#10
REVIEW
A Pesenti, E Carlesso, T Langer, T Mauri
The main target of extracorporeal support is to achieve viable gas exchange, while minimizing the risk of ventilator-induced lung injury, achieved through a decreased mechanical ventilation load on the natural lung. However, during veno-venous extracorporeal membrane oxygenation (ECMO), mechanical ventilation is still necessary in order to prevent lung collapse and/or if extracorporeal blood flow is not sufficient to guarantee adequate gas exchange. In this review, we will summarize the physiology of extracorporeal support and the rationale for continuing mechanical ventilation in this context...
February 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29132799/surgical-exploration-for-impalpable-testis-which-should-be-first-inguinal-exploration-or-laparoscopic-abdominal-exploration
#11
Akihiro Igarashi, Kenta Kikuchi, Kenjiro Ogushi, Mariko Hasegawa, Masahiro Hatanaka, Junko Fujino, Yoko Kishi, Hitoshi Ikeda
PURPOSE: To discuss an optimal surgical approach for impalpable testis in children, our own treatment results and those reported in the literature were reviewed. MATERIALS AND METHODS: Seventy-two impalpable testes were diagnosed in 68 patients: unilateral in 64 patients and bilateral in 4 patients. All patients underwent surgical exploration at the ages of 6 to 140months (median, 15months). The inguinal canal was initially explored, and abdominal exploration was performed with laparoscopy when an extra-abdominal testis was not identified...
October 16, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29066588/effect-of-high-flow-nasal-cannula-on-expiratory-pressure-and-ventilation-in-infant-pediatric-and-adult-models
#12
Katie R Nielsen, Laura E Ellington, Alan J Gray, Larissa I Stanberry, Lincoln S Smith, Robert M DiBlasi
BACKGROUND: Heated and humidified high-flow nasal cannula (HFNC) is a widely used form of respiratory support; however, data regarding optimal flows for a given patient size or disease state are lacking. A comprehensive study of the physiologic effects of HFNC is needed to better understand the mechanisms of action. The objective of the current study was to quantify the effect of HFNC settings in age-specific, anatomically correct nasal airways and spontaneously breathing lung models...
February 2018: Respiratory Care
https://www.readbyqxmd.com/read/28875324/-extreme-obesity-particular-aspect-of-invasive-and-noninvasive-ventilation
#13
REVIEW
M Deppe, P Lebiedz
The obesity rate is increasing worldwide and the percentage of obese patients in the intensive care unit (ICU) is rising concomitantly. Ventilatory support strategies in obese patients must take into account the altered pathophysiological conditions. Unfortunately, prospective randomized multicenter trials on this subject are lacking. Therefore, current strategies are based on the individual experiences of ICU physicians and single-center studies. Noninvasive ventilation (NIV) in critically ill patients with acute respiratory failure and obesity hypoventilation syndrome (OHS) is an efficient treatment option and should be provided as early as possible is an effort to avoid intubation...
September 5, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28828363/positive-end-expiratory-pressure-how-to-set-it-at-the-individual-level
#14
REVIEW
Luciano Gattinoni, Francesca Collino, Giorgia Maiolo, Francesca Rapetti, Federica Romitti, Tommaso Tonetti, Francesco Vasques, Michael Quintel
The positive end-expiratory pressure (PEEP), since its introduction in the treatment of acute respiratory failure, up to the 1980s was uniquely aimed to provide a viable oxygenation. Since the first application, a large debate about the criteria for selecting the PEEP levels arose within the scientific community. Lung mechanics, oxygen transport, venous admixture thresholds were all proposed, leading to PEEP recommendations from 5 up to 25 cmH2 O. Throughout this period, the main concern was the hemodynamics...
July 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28800778/effects-of-intraoperative-peep-optimization-on-postoperative-pulmonary-complications-and-the-inflammatory-response-study-protocol-for-a-randomized-controlled-trial
#15
Zoltán Ruszkai, Erika Kiss, Ildikó László, Fanni Gyura, Erika Surány, Péter Töhötöm Bartha, Gergely Péter Bokrétás, Edit Rácz, István Buzogány, Zoltán Bajory, Erzsébet Hajdú, Zsolt Molnár
BACKGROUND: Patients undergoing general anesthesia and mechanical ventilation during major abdominal surgery commonly develop pulmonary atelectasis and/or hyperdistention of the lungs. Recent studies show benefits of lung-protective mechanical ventilation with the use of low tidal volumes, a moderate level of positive end-expiratory pressure (PEEP) and regular alveolar recruitment maneuvers during general anesthesia, even in patients with healthy lungs. The purpose of this clinical trial is to evaluate the effects of intraoperative lung-protective mechanical ventilation, using individualized PEEP values, on postoperative pulmonary complications and the inflammatory response...
August 11, 2017: Trials
https://www.readbyqxmd.com/read/28730574/mechanical-ventilation-guided-by-electrical-impedance-tomography-in-pediatric-acute-respiratory-distress-syndrome
#16
Jeffrey Dmytrowich, Tanya Holt, Karen Schmid, Gregory Hansen
Mechanical ventilation strategies in pediatric acute respiratory distress syndrome (pARDS) continue to advance. Optimizing positive end expiratory pressure (PEEP) and ventilation to recruitable lung can be difficult to clinically achieve. This is in part, due to disease evolution, unpredictable changes in lung compliance, and the inability to assess regional tidal volumes in real time at the bedside. Here we report the utilization of thoracic electrical impedance tomography to guide daily PEEP settings and recruitment maneuvers in a child with pARDS...
July 20, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28730554/bedside-selection-of-positive-end-expiratory-pressure-by-electrical-impedance-tomography-in-hypoxemic-patients-a-feasibility-study
#17
Nilde Eronia, Tommaso Mauri, Elisabetta Maffezzini, Stefano Gatti, Alfio Bronco, Laura Alban, Filippo Binda, Tommaso Sasso, Cristina Marenghi, Giacomo Grasselli, Giuseppe Foti, Antonio Pesenti, Giacomo Bellani
BACKGROUND: Positive end-expiratory pressure (PEEP) is a key element of mechanical ventilation. It should optimize recruitment, without causing excessive overdistension, but controversy exists on the best method to set it. The purpose of the study was to test the feasibility of setting PEEP with electrical impedance tomography in order to prevent lung de-recruitment following a recruitment maneuver. We enrolled 16 patients undergoing mechanical ventilation with PaO2 /FiO2 <300 mmHg...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28716645/update-in-management-of-severe-hypoxemic-respiratory-failure
#18
REVIEW
Dharani Kumari Narendra, Dean R Hess, Curtis N Sessler, Habtamu M Belete, Kalpalatha K Guntupalli, Felix Khusid, Charles Mark Carpati, Mark Elton Astiz, Suhail Raoof
Mortality related to severe-moderate and severe ARDS remains high. We searched the literature to update this topic. We defined severe hypoxemic respiratory failure as Pao2 /Fio2  < 150 mm Hg (ie, severe-moderate and severe ARDS). For these patients, we support setting the ventilator to a tidal volume of 4 to 8 mL/kg predicted body weight (PBW), with plateau pressure (Pplat) ≤ 30 cm H2 O, and initial positive end-expiratory pressure (PEEP) of 10 to 12 cm H2 O. To promote alveolar recruitment, we propose increasing PEEP in increments of 2 to 3 cm provided that Pplat remains ≤ 30 cm H2 O and driving pressure does not increase...
October 2017: Chest
https://www.readbyqxmd.com/read/28707173/intraoperative-ventilation-of-morbidly-obese-patients-guided-by-transpulmonary-pressure
#19
Lars Eichler, Katarzyna Truskowska, A Dupree, P Busch, Alwin E Goetz, Christian Zöllner
BACKGROUND: Bariatric surgery has proven a successful approach in the treatment of morbid obesity and its concomitant diseases such as diabetes mellitus and arterial hypertension. Aiming for optimal management of this challenging patient cohort, tailored concepts directly guided by individual patient physiology may outperform standardized care. Implying esophageal pressure measurement and electrical impedance tomography-increasingly applied monitoring approaches to individually adjust mechanical ventilation in challenging circumstances like acute respiratory distress syndrome (ARDS) and intraabdominal hypertension-we compared our institutions standard ventilator regimen with an individually adjusted positive end expiratory pressure (PEEP) level aiming for a positive transpulmonary pressure (PL ) throughout the respiratory cycle...
January 2018: Obesity Surgery
https://www.readbyqxmd.com/read/28701178/the-future-of-mechanical-ventilation-lessons-from-the-present-and-the-past
#20
REVIEW
Luciano Gattinoni, John J Marini, Francesca Collino, Giorgia Maiolo, Francesca Rapetti, Tommaso Tonetti, Francesco Vasques, Michael Quintel
The adverse effects of mechanical ventilation in acute respiratory distress syndrome (ARDS) arise from two main causes: unphysiological increases of transpulmonary pressure and unphysiological increases/decreases of pleural pressure during positive or negative pressure ventilation. The transpulmonary pressure-related side effects primarily account for ventilator-induced lung injury (VILI) while the pleural pressure-related side effects primarily account for hemodynamic alterations. The changes of transpulmonary pressure and pleural pressure resulting from a given applied driving pressure depend on the relative elastances of the lung and chest wall...
July 12, 2017: Critical Care: the Official Journal of the Critical Care Forum
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