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Ventilatory modes

Jonne Doorduin, Joeke L Nollet, Lisanne H Roesthuis, Hieronymus W H van Hees, Laurent J Brochard, Christer A Sinderby, Johannes G van der Hoeven, Leo M A Heunks
RATIONALE: Controlled mechanical ventilation is used to deliver lung-protective ventilation in patients with acute respiratory distress syndrome. Despite recognized benefits, such as preserved diaphragm activity, partial support ventilation modes may be incompatible with lung-protective ventilation due to high tidal volume and high transpulmonary pressure. As an alternative to high dose sedatives and controlled mechanical ventilation, pharmacologically induced neuromechanical uncoupling of the diaphragm should facilitate lung-protective ventilation under partial support modes...
October 17, 2016: American Journal of Respiratory and Critical Care Medicine
Juliana Arcanjo Lino, Gabriela Carvalho Gomes, Nancy Delma Silva Vega Canjura Sousa, Andrea K Carvalho, Marcelo Emanoel Bezerra Diniz, Antonio Brazil Viana Junior, Marcelo Alcantara Holanda
BACKGROUND: Teaching mechanical ventilation at the bedside with real patients is difficult with many logistic limitations. Mechanical ventilators virtual simulators (MVVS) may have the potential to facilitate mechanical ventilation (MV) training by allowing Web-based virtual simulation. OBJECTIVE: We aimed to identify and describe the current available MVVS, to compare the usability of their interfaces as a teaching tool and to review the literature on validation studies...
June 14, 2016: JMIR Med Educ
A Demoule, M Clavel, C Rolland-Debord, S Perbet, N Terzi, A Kouatchet, F Wallet, H Roze, F Vargas, C Guerin, J Dellamonica, S Jaber, L Brochard, T Similowski
PURPOSE: Neurally adjusted ventilatory assist (NAVA) is a ventilatory mode that tailors the level of assistance delivered by the ventilator to the electromyographic activity of the diaphragm. The objective of this study was to compare NAVA and pressure support ventilation (PSV) in the early phase of weaning from mechanical ventilation. METHODS: A multicentre randomized controlled trial of 128 intubated adults recovering from acute respiratory failure was conducted in 11 intensive care units...
September 30, 2016: Intensive Care Medicine
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
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...
September 15, 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
Senem Alkan Ozdemir, Esra Arun Ozer, Ozkan Ilhan, Sumer Sutcuoglu
BACKGROUND: Mechanical ventilation is an essential therapy in the treatment of respiratory failure in preterm infants. However, optimal ventilation strategy continues to be difficult to define. OBJECTIVE: To compare the effects of volume guarantee (VG) combined with intermittent mandatory ventilation (SIMV) and VG combined with pressure support ventilation (PSV) on the pulmonary mechanics and short term prognosis in preterm infants with respiratory distress syndrome...
September 13, 2016: Pediatric Pulmonology
Juan B Figueroa-Casas, Ricardo Montoya
RATIONALE: Although increasingly recommended, compliance with low tidal volume ventilation remains suboptimal. Dyssynchrony induced by low tidal volumes may be a reason for it. OBJECTIVES: To determine the effect of tidal volume size, and of the ventilator mode used for its delivery (volume vs pressure control), on the magnitude of patient-ventilator dyssynchrony in patients with or at risk for acute respiratory distress syndrome (ARDS). METHODS: Nineteen mechanically ventilated patients underwent 6 consecutive ventilatory conditions...
September 6, 2016: Annals of the American Thoracic Society
Daniel Klotz, Christoph Schaefer, Dimitra Stavropoulou, Hans Fuchs, Stefan Schumann
OBJECTIVE: Nasal high frequency oscillatory ventilation (nHFOV) is a promising mode of non-invasive neonatal respiratory support. To combine the effects of nasal continuous positive airway pressure (nCPAP) and high frequency oscillatory ventilation, an oscillatory pressure waveform is superposed to a nCPAP via a nasal or nasopharyngeal interface. nHFOV has been described to facilitate carbon dioxide (CO2 ) elimination compared to nCPAP. The influence of unintended leakage on CO2 elimination has not been investigated in nHFOV before...
August 15, 2016: Pediatric Pulmonology
Gastón Murias, Jaume Montanyà, Encarna Chacón, Anna Estruga, Carles Subirà, Rafael Fernández, Bernat Sales, Candelaria de Haro, Josefina López-Aguilar, Umberto Lucangelo, Jesús Villar, Robert M Kacmarek, Lluís Blanch
BACKGROUND: Expert systems can help alleviate problems related to the shortage of human resources in critical care, offering expert advice in complex situations. Expert systems use contextual information to provide advice to staff. In mechanical ventilation, it is crucial for an expert system to be able to determine the ventilatory mode in use. Different manufacturers have assigned different names to similar or even identical ventilatory modes so an expert system should be able to detect the ventilatory mode...
2016: Critical Care: the Official Journal of the Critical Care Forum
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
Nehemiah T Liu, Michael G Salter, Muzna N Khan, Richard D Branson, Perenle Enkheebetaar, George C Kramer, José Salinas, Nicole Riberio Marques, Michael P Kinsky
: Pulmonary injury can be characterized by an increased need for FiO2 to maintain SaO2. We tested a smart oxygenation system (SOS) that utilizes the activity of a closed-loop control FiO2 algorithm (CLC-FiO2) to rapidly assess acute respiratory distress syndrome (ARDS) severity so that rescue ventilation (RscVent) can be initiated earlier. After baseline data, a pulse-oximeter (SpO2) was placed. Sheep were then subjected to burn and smoke inhalation injury and followed for 48 hr. Initially, sheep were spontaneously ventilating and then randomized to: standard of care (SOC) (n = 6), in which RscVent began when PaO2 <90 mmHg or FiO2 <0...
July 7, 2016: Shock
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
R Di Mussi, S Spadaro, C A Volta, T Stripoli, A Armenise, L Pisani, R G Renna, A Civita, G Altamura, F Bruno, S Grasso
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
Nai-Ying Kuo, Mei-Lien Tu, Tsai-Yi Hung, Shih-Feng Liu, Yu-Hsiu Chung, Meng-Chih Lin, Chao-Chien Wu
BACKGROUND: Patient-ventilator asynchrony is a common problem in mechanically ventilated patients; the problem is especially obvious in COPD. Neutrally adjusted ventilatory assist (NAVA) can improve patient-ventilator asynchrony; however, the effect in COPD patients with prolonged mechanical ventilation is still unknown. The goals of this study are to evaluate the effect of NAVA and conventional weaning mode in patients with COPD during prolonged mechanical ventilation. METHODS: The study enrolled a total of 33 COPD patients with ventilator dependency for more than 21 days in the weaning center...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Eduardo Mireles-Cabodevila, Robert M Kacmarek
Airway pressure release ventilation (APRV) was originally described as a mode to treat lung-injured patients with the goal to maintain a level of airway pressure that would not depress the cardiac function, deliver mechanical breaths without excessive airway pressure, and to allow unrestricted spontaneous ventilation. Indeed, based on its design, APRV has technological features that serve the goals of safety and comfort. Animal studies suggest that APRV leads to alveolar stability and recruitment which result in less lung injury...
June 2016: Respiratory Care
Asako Matsuda, Toshiyuki Mizota, Tomoharu Tanaka, Hajime Segawa, Kazuhiko Fukuda
We report a case of difficult ventilation requiring emergency endotracheal intubation during awake craniotomy managed by laryngeal mask airway (LMA). A 45-year-old woman was scheduled to receive awake craniotomy for brain tumor in the frontal lobe. After anesthetic induction, airway was secured using ProSeal LMA and patient was mechanically ventilated in pressure-control mode. Patient's head was fixed with head-pins at anteflex position, and the operation started. About one hour after the start of the operation, tidal volume suddenly decreased...
April 2016: Masui. the Japanese Journal of Anesthesiology
Denise T Fantoni, Keila K Ida, Thomas F T Lopes, Denise A Otsuki, José Otávio C Auler, Aline M Ambrósio
OBJECTIVE: To compare the effects of pressure controlled ventilation (PCV) with volume-controlled ventilation (VCV) on lung compliance, gas exchange, and hemodynamics in isoflurane-anesthetized dogs. DESIGN: Prospective randomized study. SETTING: Veterinary teaching hospital. ANIMALS: Forty client-owned bitches undergoing elective ovariohysterectomy. INTERVENTIONS: Dogs were randomly assigned to be ventilated with 100% oxygen using PCV (n = 20) or VCV (n = 20)...
July 2016: Journal of Veterinary Emergency and Critical Care
Sander Roosens, Frank Derriks, Filip Cools
Diaphragmatic paralysis is a rare cause of respiratory distress in the newborn. In this paper, a patient with unilateral phrenic nerve injury after traumatic delivery is presented. The child inadequately responded to standard respiratory supportive measures. Non-invasive neurally adjusted ventilatory assist (NIV-NAVA®), providing an optimally synchronized respiratory support proportional to the effort of the patient, resulted in prompt clinical and biological improvement of the patient's respiratory condition...
April 19, 2016: Pediatric Pulmonology
Limin Zhu, Zhuoming Xu, Xiaolei Gong, Jinghao Zheng, Yanjun Sun, Liping Liu, Lu Han, Haibo Zhang, Zhiwei Xu, Jinfen Liu, Peter C Rimensberger
We evaluated the effects of different respiratory assist modes on cerebral blood flow (CBF) and arterial oxygenation in single-ventricle patients after bidirectional superior cavopulmonary anastomosis (BCPA). We hypothesized that preserved auto-regulation of respiration during neurally adjusted ventilatory assist (NAVA) may have potential advantages for CBF and pulmonary blood flow regulation after the BCPA procedure. We enrolled 23 patients scheduled for BCPA, who underwent pressure-controlled ventilation (PCV), pressure support ventilation (PSV), and NAVA at two assist levels for all modes in a randomized order...
August 2016: Pediatric Cardiology
Umberto Lucangelo, Miloš Ajčević, Agostino Accardo, Massimo Borelli, Alberto Peratoner, Lucia Comuzzi, Walter A Zin
Recently, the FLOW-i anaesthesia ventilator was developed based on the SERVO-i intensive care ventilator. The aim of this study was to test the FLOW-i's tidal volume delivery in the presence of a leak in the breathing circuit. We ventilated a test lung model in volume-, pressure-, and pressure-regulated volume-controlled modes (VC, PC, and PRVC, respectively) with a FLOW-i. First, the circuit remained airtight and the ventilator was tested with fresh gas flows of 6, 1, and 0.3 L/min in VC, PC, and PRVC modes and facing 4 combinations of different resistive and elastic loads...
April 9, 2016: Journal of Clinical Monitoring and Computing
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