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Optimal PEEP

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https://www.readbyqxmd.com/read/28584436/titration-of-ideal-positive-end-expiratory-pressure-in-acute-respiratory-distress-syndrome-comparison-between-lower-inflection-point-and-esophageal-pressure-method-using-volumetric-capnography
#1
Nandakishore Baikunje, Inderpaul Singh Sehgal, Sahajal Dhooria, Kuruswamy Thurai Prasad, Ritesh Agarwal
The tenets of mechanical ventilation in acute respiratory distress syndrome (ARDS) include the utilization of low tidal volume and optimal application of positive end-expiratory pressure (PEEP). Optimal PEEP in ARDS is characterized by reduction in alveolar dead space along with improvement in the lung compliance and resultant betterment in oxygenation. There are various methods of setting PEEP in ARDS. Herein, we report a patient of ARDS, wherein we employed measurement of dead space using volumetric capnography to compare two different PEEP strategies, namely, the lower inflection point and transpulmonary pressure monitoring...
May 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28516320/how-does-the-presence-of-a-conspecific-individual-change-the-behavioral-game-that-a-predator-plays-with-its-prey
#2
Reut Vardi, Zvika Abramsky, Burt P Kotler, Ofir Altstein, Michael L Rosenzweig
Behavioral games predators play among themselves may have profound effects on behavioral games predators play with their prey. We studied the behavioral game between predators and prey within the framework of social foraging among predators. We tested how conspecific interactions among predators (little egret) change the predator-prey behavioral game and foraging success. To do so, we examined foraging behavior of egrets alone and in pairs (male and female) in a specially designed aviary consisting of three equally spaced pools with identical initial prey (comet goldfish) densities...
May 17, 2017: Oecologia
https://www.readbyqxmd.com/read/28477341/inflation-pressures-and-times-during-initial-resuscitation-of-preterm-infants
#3
Prashanth Bhat, Katie Hunt, Christopher Harris, Vadivelam Murthy, Anthony D Milner, Anne Greenough
BACKGROUND: The optimal combination of inflation pressures and times to produce adequate expiratory tidal volumes during initial resuscitation in prematurely born infants has not been determined. Our aim was to assess combinations of inflation pressures and times and the resulting expiratory tidal volume levels using a respiratory function monitor. METHODS: Sixty-four infants born before 34 weeks of gestation were studied. The infants were divided according to whether the inflation pressures (PIP-PEEP) were less than or >20 cm H2 O during the first five inflations delivered by a face mask and those groups were subdivided according to whether the inflation times were less than or > 1...
May 6, 2017: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/28459402/-effect-of-different-transpulmonary-pressures-guided-mechanical-ventilation-on-respiratory-and-hemodynamics-of-patients-with-ards-a-prospective-randomized-controlled-trial
#4
Jianqiu Li, Zhihui Luo, Xiaolei Li, Zhongyi Huang, Jie Han, Zifeng Li, Zhaoxiong Zhou, Houwang Chen
OBJECTIVE: To assess the effect of different transpulmonary pressures (Ptp) guided mechanical ventilation (MV) on respiratory function and hemodynamics parameters of patients with acute respiratory distress syndrome (ARDS), and to find out a more optimized Ptp. METHODS: A prospective randomized controlled trial (RCT) was conducted. The ventilated patients with ARDS admitted to Department of Critical Care Medicine (ICU) of Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University and Department of Emergency and Critical Care Medicine (EICU) of Shenzhen Hospital of South Medical University from February 2013 to August 2016 were enrolled...
January 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28413511/application-of-dead-space-fraction-to-titrate-optimal-positive-end-expiratory-pressure-in-an-ards-swine-model
#5
Weishuai Bian, Wei Chen, Yangong Chao, Lan Wang, Liming Li, Jian Guan, Xuefeng Zang, Jie Zhen, Bo Sheng, Xi Zhu
This study aimed to apply the dead space fraction [ratio of dead space to tidal volume (VD/VT)] to titrate the optimal positive end-expiratory pressure (PEEP) in a swine model of acute respiratory distress syndrome (ARDS). Twelve swine models of ARDS were constructed. A lung recruitment maneuver was then conducted and the PEEP was set at 20 cm H2O. The PEEP was reduced by 2 cm H2O every 10 min until 0 cm H2O was reached, and VD/VT was measured after each decrement step. VD/VT was measured using single-breath analysis of CO2, and calculated from arterial CO2 partial pressure (PaCO2) and mixed expired CO2 (PeCO2) using the following formula: VD/VT = (PaCO2 - PeCO2)/PaCO2...
April 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28322413/optimizing-the-settings-on-the-ventilator-high-peep-for-all
#6
EDITORIAL
Ary Serpa Neto, Marcus J Schultz
No abstract text is available yet for this article.
April 11, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28237681/assessment-of-distribution-of-ventilation-and-regional-lung-compliance-by-electrical-impedance-tomography-in-anaesthetized-horses-undergoing-alveolar-recruitment-manoeuvres
#7
Tamas D Ambrisko, Johannes Schramel, Klaus Hopster, Sabine Kästner, Yves Moens
OBJECTIVE: To examine changes in the distribution of ventilation and regional lung compliances in anaesthetized horses during the alveolar recruitment manoeuvre (ARM). STUDY DESIGN: Experimental study in which a series of treatments were administered in a fixed order on one occasion. ANIMALS: Five adult Warmblood horses. METHODS: Animals were anaesthetized (xylazine, midazolam-ketamine, isoflurane), placed in dorsal recumbency and ventilated with 100% oxygen using peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP) of 20 cmH2O and 0 cmH2O, respectively...
March 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28150228/personalizing-mechanical-ventilation-according-to-physiologic-parameters-to-stabilize-alveoli-and-minimize-ventilator-induced-lung-injury-vili
#8
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/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/28142154/a-quality-improvement-initiative-to-reduce-the-need-for-mechanical-ventilation-in-extremely-low-gestational-age-neonates
#10
Ludivine Templin, Camille Grosse, Virginie Andres, Clotilde Des Robert, Laurence Fayol, Umberto Simeoni, Farid Boubred
Objective Limiting early intubation and mechanical ventilation in extremely low gestational age neonates (ELGAN) may decrease neonatal morbidity and mortality. The aim of our study was to demonstrate the feasibility, efficacy, and tolerability of a delivery room respiratory management protocol, including delayed umbilical cord clamping (DUCC) in combination with optimized nCPAP with high PEEP levels and less invasive surfactant administration (LISA). Study Design This cohort quality improvement study analyzed the respiratory and neonatal outcomes of all consecutive infants born between 24(+0) and 26(+6) weeks' gestation before (period 1, n = 40) and after (period 2, n = 52) implementing the new protocol...
July 2017: American Journal of Perinatology
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
#11
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/28103448/bedside-contribution-of-electrical-impedance-tomography-to-set-positive-end-expiratory-pressure-for-ecmo-treated-severe-ards-patients
#12
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
https://www.readbyqxmd.com/read/28056816/optimization-of-pressure-settings-during-adaptive-servo-ventilation-support-using-real-time-heart-rate-variability-assessment-initial-case-report
#13
Teruhiko Imamura, Daisuke Nitta, Koichiro Kinugawa
BACKGROUND: Adaptive servo-ventilation (ASV) therapy is a recent non-invasive positive pressure ventilation therapy that was developed for patients with heart failure (HF) refractory to optimal medical therapy. However, it is likely that ASV therapy at relatively higher pressure setting worsens some of the patients' prognosis compared with optimal medical therapy. Therefore, identification of optimal pressure settings of ASV therapy is warranted. CASE PRESENTATION: We present the case of a 42-year-old male with HF, which was caused by dilated cardiomyopathy, who was admitted to our institution for evaluating his eligibility for heart transplantation...
January 5, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28032763/expanding-the-group-of-porous-interpenetrated-zr-organic-frameworks-pizofs-with-linkers-of-different-lengths
#14
Jann Lippke, Birte Brosent, Tobias von Zons, Erika Virmani, Sebastian Lilienthal, Thomas Preuße, Miriam Hülsmann, Andreas M Schneider, Stefan Wuttke, Peter Behrens, Adelheid Godt
A Zr-based MOF of the PIZOF type, which consists of two independent and mutually interpenetrating UiO-type frameworks with [Zr6O4(OH)4(O2C)12] nodes, does not only form with a PEPEP dicarboxylic acid (P = phenylene, E = ethynylene). Also dicarboxylic acids with the shorter PPPP and PEPP spacers were found to give PIZOFs, denoted PPPP-PIZOF and PEPP-PIZOF, respectively. Reducing the spacer length even further to a PEEP segment caused a switchover to the formation of a UiO framework. The hysteresis in the Ar sorption curve of PEPP-PIZOF-1 and the slightly too large amount of combustion residue from PPPP-PIZOF-1 suggest structural defects...
December 29, 2016: Inorganic Chemistry
https://www.readbyqxmd.com/read/28000205/early-severe-acute-respiratory-distress-syndrome-what-s-going-on-part-ii-controlled-vs-spontaneous-ventilation
#15
REVIEW
Fabrice Petitjeans, Cyrille Pichot, Marco Ghignone, Luc Quintin
The second part of this overview on early severe ARDS delineates the pros and cons of the following: a) controlled mechanical ventilation (CMV: lowered oxygen consumption and perfect patient-to-ventilator synchrony), to be used during acute cardio-ventilatory distress in order to "buy time" and correct circulatory insufficiency and metabolic defects (acidosis, etc.); b) spontaneous ventilation (SV: improved venous return, lowered intrathoracic pressure, absence of muscle atrophy). Given a stabilized early severe ARDS, as soon as the overall clinical situation improves, spontaneous ventilation will be used with the following stringent conditionalities: upfront circulatory optimization, upright positioning, lowered VO2, lowered acidotic and hypercapnic drives, sedation without ventilatory depression and without lowered muscular tone, as well as high PEEP (titrated on transpulmonary pressure, or as a second best: "trial"-PEEP) with spontaneous ventilation + pressure support (or newer modes of ventilation)...
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28000204/early-severe-acute-respiratory-distress-syndrome-what-s-going-on-part-i-pathophysiology
#16
REVIEW
Fabrice Petitjeans, Cyrille Pichot, Marco Ghignone, Luc Quintin
Severe acute respiratory distress syndrome (ARDS, PaO₂/FiO₂ < 100 on PEEP ≥ 5 cm H₂O) is treated using controlled mechanical ventilation (CMV), recently combined with muscle relaxation for 48 h and prone positioning. While the amplitude of tidal volume appears set < 6 mL kg⁻¹, the level of positive end-expiratory pressure (PEEP) remains controversial. This overview summarizes several salient points, namely: a) ARDS is an oxygenation defect: consolidation/ difuse alveolar damage is reversed by PEEP and/or prone positioning, at least during the early phase of ARDS b) ARDS is a dynamic disease and partially iatrogenic...
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/27999152/optimizing-peep-by-electrical-impedance-tomography-in-a-porcine-animal-model-of-ards
#17
Nadine Hochhausen, Ingeborg Biener, Rolf Rossaint, Andreas Follmann, Christian Bleilevens, Till Braunschweig, Steffen Leonhardt, Michael Czaplik
BACKGROUND: Mechanical ventilation is necessary in diverse clinical circumstances. Especially in the context of ARDS, so-called protective ventilation strategies must be followed. It is already known that PEEP might enhance oxygenation in ARDS. However, determining the optimal PEEP settings in clinical routines is challenging. Electrical impedance tomography (EIT) is a promising technique with which to adjust ventilator settings. We investigated whether the combination of different EIT parameters, namely the global inhomogeneity and hyperdistension indices, may lead to a feasible and safe PEEP setting...
December 20, 2016: Respiratory Care
https://www.readbyqxmd.com/read/27984319/optimization-of-positive-end-expiratory-pressure-targeting-the-best-arterial-oxygen-transport-in-the-acute-respiratory-distress-syndrome-the-optipep-study
#18
Loïc Chimot, Yannick Fedun, Arnaud Gacouin, Boris Campillo, Sophie Marqué, Antoine Gros, Pierre Delour, Sandrine Bedon-Carte, Yves Le Tulzo
The optimal setting for positive end-expiratory pressure (PEEP) in mechanical ventilation remains controversial in the treatment of acute respiratory distress syndrome (ARDS). The aim of this study was to determine the optimum PEEP level in ARDS, which we defined as the level that allowed the best arterial oxygen delivery (DO2).We conducted a physiological multicenter prospective study on patients who suffering from ARDS according to standard definition and persistent after 6 hours of ventilation. The PEEP was set to 6 cmH2O at the beginning of the test and then was increased by 2 cmH2O after at least 15 min of being stabilized until the plateau pressure achieved 30 cmH2O...
December 13, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/27903026/-severe-hypercapnic-respiratory-failure-in-acute-exacerbation-of-copd-significance-of-ventilation-and-extracorporal-co2-removal
#19
REVIEW
Michael Westhoff, Martin Bachmann, Stephan Braune, Christian Karagiannidis, Stefan Kluge, Philipp M Lepper, Thomas Müller, Bernd Schönhofer
In acute exacerbations of COPD with acute hypercapnic respiratory failure and a pH 7.25 - 7.35, the initiation of non-invasive ventilation is the gold standard. However, absolute and relative contraindications have to be taken into account. The implementation of non-invasive ventilation in case of a severe respiratory acidosis necessitates a skilled therapeutic team and a close monitoring in order to avoid or perceive a NIV failure in time. In this case, the intubation and invasive mechanical ventilation is recommended...
November 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27888836/limited-predictability-of-maximal-muscular-pressure-using-the-difference-between-peak-airway-pressure-and-positive-end-expiratory-pressure-during-proportional-assist-ventilation-pav
#20
Po-Lan Su, Pei-Shan Kao, Wei-Chieh Lin, Pei-Fang Su, Chang-Wen Chen
BACKGROUND: If the proportional assist ventilation (PAV) level is known, muscular effort can be estimated from the difference between peak airway pressure and positive end-expiratory pressure (PEEP) (ΔP) during PAV. We conjectured that deducing muscle pressure from ΔP may be an interesting method to set PAV, and tested this hypothesis using the oesophageal pressure time product calculation. METHODS: Eleven mechanically ventilated patients with oesophageal pressure monitoring under PAV were enrolled...
November 27, 2016: Critical Care: the Official Journal of the Critical Care Forum
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