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Ventilator synchrony

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https://www.readbyqxmd.com/read/27866528/-effect-of-non-invasive-nava-on-the-patients-with-acute-exacerbation-of-chronic-obstructive-pulmonary-disease
#1
D Q Wang, J Luo, X H Xiong, L H Zhu, W W Zhang
Objective: To observe the effect of non-invasive neurally adjusted ventilatory assist (NIV-NAVA) on patient-ventilator synchrony and effect of gas exchange in patients with acute exacerbation of chronic obstructive pulmonary disease compared with NIV-pressure support ventilation (PSV). Methods: This was a prospective study of 40 patients with AECOPD given 30-min trials of NIV with NIV-PSV group (n=20) and NAVA group (n=20) in random order. Arterial blood gas analysis (ABGs), main asynchrony events and asynchrony index were quantified...
November 15, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27854117/treatment-of-neonates-with-respiratory-distress-syndrome-by-proportional-assist-ventilation-plus-synchronized-intermittent-mandatory-ventilation-a-comparison-study
#2
Rong Wu, Zhao F Tian, Xiang Y Kong, Shao D Hua, Jin H Hu, Guo F Zhen
BACKGROUND: The proportion assisted ventilation (PAV) can improve patient-ventilator interaction, reduce the incidence of end-expiratory asynchrony and increase the time of synchrony. PAV could compensate for the leaks by Elastic and resistive unloading and thus is ideal for neonates with uncuffed airways. The aim of this study was to compare the relevant clinical parameters of neonates with respiratory distress syndrome(RDS) who are surported by PAV plus synchronized intermittent mandatory ventilation (SIMV) and SIMV...
November 17, 2016: Minerva Pediatrica
https://www.readbyqxmd.com/read/27849239/importance-of-the-use-of-protocols-for-the-management-of-analgesia-and-sedation-in-pediatric-intensive-care-unit
#3
Emiliana Motta, Michele Luglio, Artur Figueiredo Delgado, Werther Brunow de Carvalho
Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols...
September 2016: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/27842752/management-of-sedation-and-paralysis
#4
REVIEW
Michael A Fierro, Raquel R Bartz
Sedatives are administered to decrease patient discomfort and agitation during mechanical ventilation and to maintain patient-ventilator synchrony. Titration of infusions and or bolus dosing to maintain light sedation goals according to validated scales is recommended. However, it is important to consider deeper sedation for patients with refractory patient-ventilator dyssynchrony (PVD) to prevent volutrauma and barotrauma. Deep sedation plus muscle relaxants may be required to treat PVD or to reduce oxygen consumption and carbon dioxide production...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842747/patient-ventilator-interactions
#5
REVIEW
Daniel Gilstrap, John Davies
Ventilatory muscle fatigue is a reversible loss of the ability to generate force or velocity of contraction in response to increased elastic and resistive loads. Mechanical ventilation should provide support without imposing additional loads from the ventilator (dys-synchrony). Interactive breaths optimize this relationship but require that patient effort and the ventilator response be synchronous during breath initiation, flow delivery, and termination. Proper delivery considers all 3 phases and uses clinical data, ventilator graphics, and sometimes a trial-and-error approach to optimize patient-ventilator interactions...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27802956/education-on-patient-ventilator-synchrony-clinicians-knowledge-level-and-duration-of-mechanical-ventilation
#6
Donna Lynch-Smith, Carol Lynn Thompson, Rexann G Pickering, Jim Y Wan
BACKGROUND: Improved recognition of patient-ventilator asynchrony may reduce duration of mechanical ventilation. OBJECTIVE: To evaluate the effects of education about patient-ventilator synchrony on clinicians' level of knowledge and patients' mean duration of mechanical ventilation. METHODS: A quasi-experimental 1-group pretest-posttest study was performed in a 16-bed intensive care unit. Analysis included 33 clinicians and 97 ventilator patients...
November 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/27798315/detection-of-ventilator-autotriggering-by-an-esophageal-catheter-used-to-monitor-the-neural-input-and-diaphragm-excitation
#7
Harbaksh Sangha, Troy Whitacre
Patient-ventilator synchrony has been the focus of attention in the field of mechanical ventilation for quite some time now. Toward that end, the modern ventilators are equipped with very sensitive pneumatic triggering mechanisms, which allow for minimal wasting of patient effort. The increasingly sensitive pneumatic triggers have the potential to cause autotriggering, where stimuli other than neural signals (eg, cardiac oscillations) can trigger the mechanical breath. Although autotriggering has been well documented in brain-dead patients, its existence is difficult to prove in patients who have the ability to trigger breath through neural diaphragmatic activity...
October 25, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27651525/effects-of-leak-compensation-on-patient-ventilator-synchrony-during-premature-neonatal-invasive-and-noninvasive-ventilation-a-lung-model-study
#8
Taiga Itagaki, Christopher T Chenelle, Desmond J Bennett, Daniel F Fisher, Robert M Kacmarek
BACKGROUND: During both nasal noninvasive ventilation (NIV) and invasive ventilation of neonates, the presence of air leaks causes triggering and cycling asynchrony. METHODS: Five ICU ventilators (PB840, PB980, Servo-i, V500, and Avea) were compared in available invasive ventilation and NIV ventilator modes (pressure control continuous spontaneous ventilation [PC-CSV] and pressure control continuous mandatory ventilation [PC-CMV]). The V500 and Avea do not provide PC-CSV and PC-CMV in NIV...
September 20, 2016: Respiratory Care
https://www.readbyqxmd.com/read/27643857/tidal-volume-delivery-and-endotracheal-tube-leak-during-cardiopulmonary-resuscitation-in-intubated-newborn-piglets-with-hypoxic-cardiac-arrest-exposed-to-different-modes-of-ventilatory-support
#9
Marc R Mendler, Claudia Weber, Mohammad A Hassan, Li Huang, Benjamin Mayer, Helmut D Hummler
BACKGROUND: There are few data available on the interaction of inflations, chest compressions (CC), and delivery of tidal volumes in newborn infants undergoing resuscitation in the presence of endotracheal tube (ET) leaks. OBJECTIVES: To determine the effects of different respiratory support strategies along with CC on changes in tidal volume and ET leaks in hypoxic newborn piglets with cardiac arrest. METHODS: Asphyxiated newborn piglets, intubated with weight-adapted uncuffed ET, were randomized into three groups and resuscitated according to ILCOR 2010 guidelines: (1) T-piece resuscitator (TPR) group = peak inspiratory pressure (PIP)/positive end-expiratory pressure (PEEP) 25/5 cm H2O, rate 30/min, inflations interposed between CC (3:1 ratio); (2) self- inflating bag (SIB) group = PIP 25 cm H2O without PEEP, rate 30/min, inflations interposed between CC (3:1 ratio), and (3) ventilator group = PIP/PEEP of 25/5 cm H2O, rate 30/min...
September 20, 2016: Neonatology
https://www.readbyqxmd.com/read/27629375/comparing-changing-neurally-adjusted-ventilatory-assist-nava-levels-in-intubated-and-recently-extubated-neonates
#10
B LoVerde, K S Firestone, H M Stein
OBJECTIVE: Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that delivers ventilatory support in synchrony to the patient's respiratory needs using NAVA level, a proportionality constant that converts the electrical activity of the diaphragm (Edi) into a peak pressure (PIP). Recent published studies suggest that neonates can control the delivered ventilatory support through neural feedback. Systematically increasing the NAVA level initially increases the PIP while maintaining a constant Edi until an inflection point or breakpoint (BrP) is reached, at which time the PIP plateaus and the Edi signal decreases...
December 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/27600420/-the-influence-of-condensate-in-the-piezometric-tube-on-patient-ventilator-interaction-during-noninvasive-positive-pressure-ventilation
#11
J Y Hu, Z G Zheng, H N Lu, N Liu, W L Wu, Y X Li, Y Xiong, X N Wang, R C Chen
OBJECTIVE: To study the effects of condensate in the piezometric tube on patient ventilator interaction during noninvasive positive pressure ventilation. METHODS: Eleven healthy adults volunteered to receive noninvasive positive pressure ventilation. Different capacity of physiological saline was injected gradually into the piezometric tube until the volunteers could not trigger the ventilator or the total volume of the water reached 1.5 ml. The dynamic changes of the pressure of mask(Pmask), piezometric tube near mask (Ppro), piezometric tube near breathing machine(Pdis), and the flow were observed...
September 2016: Chinese Journal of Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/27502948/neurally-adjusted-ventilatory-assist-nava-in-preterm-newborn-infants-with-respiratory-distress-syndrome-a-randomized-controlled-trial
#12
Merja Kallio, Ulla Koskela, Outi Peltoniemi, Tero Kontiokari, Tytti Pokka, Maria Suo-Palosaari, Timo Saarela
UNLABELLED: Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator synchrony during invasive ventilation and leads to lower peak inspiratory pressures (PIP) and oxygen requirements. The aim of this trial was to compare NAVA with current standard ventilation in preterm infants in terms of the duration of invasive ventilation. Sixty infants born between 28 + 0 and 36 + 6 weeks of gestation and requiring invasive ventilation due to neonatal respiratory distress syndrome (RDS) were randomized to conventional ventilation or NAVA...
September 2016: European Journal of Pediatrics
https://www.readbyqxmd.com/read/27390463/neurally-adjusted-ventilation-assist-in-weaning-difficulty-first-case-report-from-india
#13
Milind Baldi, Inderpaul Singh Sehgal, Sahajal Dhooria, Digambar Behera, Ritesh Agarwal
Invasive mechanical ventilation is an integral component in the management of critically ill patients. In certain situations, liberation from mechanical ventilation becomes difficult resulting in prolonged ventilation. Patient-ventilator dyssynchrony is a frequently encountered reason for difficult weaning. Neurally adjusted ventilatory assist (NAVA) is a novel mode of ventilation that utilizes the electrical activity of diaphragm to pick up respiratory signals and delivers assistance in proportion to the ventilatory requirement of a patient...
June 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27368279/effects-of-dexmedetomidine-and-propofol-on-patient-ventilator-interaction-in-difficult-to-wean-mechanically-ventilated-patients-a-prospective-open-label-randomised-multicentre-study
#14
Giorgio Conti, Vito Marco Ranieri, Roberta Costa, Chris Garratt, Andrew Wighton, Giorgia Spinazzola, Rosario Urbino, Luciana Mascia, Giuliano Ferrone, Pasi Pohjanjousi, Gabriela Ferreyra, Massimo Antonelli
BACKGROUND: Dexmedetomidine can be used for sedation of mechanically ventilated patients and has minor respiratory effects. The aim of this study was to compare the incidence of patient-ventilator dyssynchronies during sedation with dexmedetomidine or propofol. METHODS: We conducted a multicentre, prospective, open-label, randomised clinical trial, comparing dexmedetomidine with standard propofol sedation at three intensive care units of university hospitals in Italy...
July 2, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27255913/severe-hypoxemia-which-strategy-to-choose
#15
REVIEW
Davide Chiumello, Matteo Brioni
BACKGROUND: Acute respiratory distress syndrome (ARDS) is characterized by a noncardiogenic pulmonary edema with bilateral chest X-ray opacities and reduction in lung compliance, and the hallmark of the syndrome is hypoxemia refractory to oxygen therapy. Severe hypoxemia (PaO2/FiO2 < 100 mmHg), which defines severe ARDS, can be found in 20-30 % of the patients and is associated with the highest mortality rate. Although the standard supportive treatment remains mechanical ventilation (noninvasive and invasive), possible adjuvant therapies can be considered...
2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27198165/effectiveness-of-inspiratory-termination-synchrony-with-automatic-cycling-during-noninvasive-pressure-support-ventilation
#16
Yuqing Chen, Kewen Cheng, Xin Zhou
BACKGROUND Pressure support ventilation (PSV) is a standard method for non-invasive home ventilation. A bench study was designed to compare the effectiveness of patient-ventilator inspiratory termination synchronization with automated and conventional triggering in various respiratory mechanics models. MATERIAL AND METHODS Two ventilators, the Respironics V60 and Curative Flexo ST 30, connected to a Hans Rudolph Series 1101 lung simulator, were evaluated using settings that simulate lung mechanics in patients with chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS), or normal lungs...
2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/27110108/continuous-quantitative-measurement-of-the-proximal-airway-dimensions-and-lung-density-on-four-dimensional-dynamic-ventilation-ct-in-smokers
#17
Tsuneo Yamashiro, Hiroshi Moriya, Maho Tsubakimoto, Shin Matsuoka, Sadayuki Murayama
PURPOSE: Four-dimensional dynamic-ventilation computed tomography (CT) imaging demonstrates continuous movement of the airways and lungs, which cannot be depicted with conventional CT. We aimed to investigate continuous changes in lung density and airway dimensions and to assess the correlation with spirometric values in smokers. MATERIALS AND METHODS: This retrospective study was approved by the Institutional Review Board, and informed consent was waived. Twenty-one smokers including six patients with COPD underwent four-dimensional dynamic-ventilation CT during free breathing (160 mm in length)...
2016: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/27094392/early-paralysis-for-the-management-of-ards
#18
Erin S Grawe, Suzanne Bennett, William E Hurford
The use of neuromuscular blocking agents (NMBAs) early in the development of ARDS has been a strategy of interest for many years. The use of NMBAs with a concomitant deep sedation strategy can increase oxygenation and possibly decrease mortality when used in the early stages of ARDS. The mechanism by which this occurs is unclear but probably involves a combination of factors, such as improving patient-ventilator synchrony, decreasing oxygen consumption, and decreasing the systemic inflammatory response associated with ARDS...
June 2016: Respiratory Care
https://www.readbyqxmd.com/read/27057312/roles-of-neurally-adjusted-ventilatory-assist-in-improving-gas-exchange-in-a-severe-acute-respiratory-distress-syndrome-patient-after-weaning-from-extracorporeal-membrane-oxygenation-a-case-report
#19
Yuya Goto, Shinshu Katayama, Atsuko Shono, Yosuke Mori, Yuya Miyazaki, Yoko Sato, Makoto Ozaki, Toru Kotani
BACKGROUND: Patient-ventilator asynchrony is a major cause of difficult weaning from mechanical ventilation. Neurally adjusted ventilatory assist (NAVA) is reported useful to improve the synchrony in patients with sustained low lung compliance. However, the role of NAVA has not been fully investigated. CASE PRESENTATION: The patient was a 63-year-old Japanese man with acute respiratory distress syndrome secondary to respiratory infection. He was treated with extracorporeal membrane oxygenation for 7 days and survived...
2016: Journal of Intensive Care
https://www.readbyqxmd.com/read/26923501/physiology-of-non-invasive-respiratory-support
#20
REVIEW
Stamatia Alexiou, Howard B Panitch
Non-invasive ventilation (NIV) is used in neonates to treat extrathoracic and intrathoracic airway obstruction, parenchymal lung disease and disorders of control of breathing. Avoidance of airway intubation is associated with a reduction in the incidence of chronic lung disease among preterm infants with respiratory distress syndrome. Use of nasal continuous positive airway pressure (nCPAP) may help establish and maintain functional residual capacity (FRC), decrease respiratory work, and improve gas exchange...
June 2016: Seminars in Fetal & Neonatal Medicine
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