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Ventilatory modes

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https://www.readbyqxmd.com/read/28427883/born-not-breathing-a-randomised-trial-comparing-two-self-inflating-bag-masks-during-newborn-resuscitation-in-tanzania
#1
Monica Thallinger, Hege Langli Ersdal, Fortunata Francis, Anita Yeconia, Estomih Mduma, Hussein Kidanto, Jørgen Erland Linde, Joar Eilevstjønn, Nina Gunnes, Ketil Størdal
AIMS: Effective ventilation is crucial to save non-breathing newborns. We compared standard equipment for newborn resuscitation to a new Upright bag, in an area with high neonatal mortality. METHODS: Newborns requiring resuscitation at Haydom Lutheran Hospital, Tanzania, were ventilated with 230ml standard or 320ml Upright bag-mask by weekly non-blinded block randomization. A Laerdal Newborn Resuscitation Monitor collected ventilation data through a flow sensor between mask and bag and heart rate with electrocardiography electrodes...
April 17, 2017: Resuscitation
https://www.readbyqxmd.com/read/28399118/feasibility-and-physiological-effects-of-non-invasive-neurally-adjusted-ventilatory-assist-niv-nava-in-preterm-infants
#2
Christopher Gibu, Phillip Cheng, Raymond J Ward, Benjamin Castro, Gregory P Heldt
BACKGROUND: Non-invasive Neurally Adjusted Ventilator Assist (NIV-NAVA) was introduced to our clinical practice via a pilot and a randomized observational study to assess its safety, feasibility, and short term physiological effects. METHODS: The pilot protocol applied NIV-NAVA to 11 infants on nasal CPAP, high-flow nasal cannula (HFNC), or nasal IMV (NIMV), in multiple 2-4 h periods of NIV-NAVA for comparison. This provided the necessary data to design a randomized, controlled observational cross-over study in 8 additional infants to compare the physiological effects of NIV-NAVA to NIMV during 2-hour steady state conditions...
April 11, 2017: Pediatric Research
https://www.readbyqxmd.com/read/28370024/prefrontal-oxygenation-and-the-acoustic-startle-eyeblink-response-during-exercise-a-test-of-the-dual-mode-model
#3
Gavin D Tempest, Gaynor Parfitt
The interplay between the prefrontal cortex and amygdala is proposed to explain the regulation of affective responses (pleasure/displeasure) during exercise as outlined in the dual-mode model. However, due to methodological limitations the dual-mode model has not been fully tested. In this study, prefrontal oxygenation (using near-infrared spectroscopy) and amygdala activity (reflected by eyeblink amplitude using acoustic startle methodology) were recorded during exercise standardized to metabolic processes: 80% of ventilatory threshold (below VT), at the VT, and at the respiratory compensation point (RCP)...
March 30, 2017: Psychophysiology
https://www.readbyqxmd.com/read/28272069/does-prehospital-time-affect-survival-of-major-trauma-patients-where-there-is-no-prehospital-care
#4
S B Dharap, S Kamath, V Kumar
BACKGROUND: Survival after major trauma is considered to be time dependent. Efficient prehospital care with rapid transport is the norm in developed countries, which is not available in many lower middle and low-income countries. The aim of this study was to assess the effect of prehospital time and primary treatment given on survival of major trauma patients in a setting without prehospital care. MATERIALS AND METHODS: This prospective observational study was carried out in a university hospital in Mumbai, from January to December 2014...
March 3, 2017: Journal of Postgraduate Medicine
https://www.readbyqxmd.com/read/28196820/combined-use-of-neurally-adjusted-ventilatory-assist-nava-and-vertical-expandable-prostethic-titanium-rib-veptr-in-a-patient-with-spondylocostal-dysostosis-and-associated-bronchomalacia
#5
Martí Pons-Odena, Alba Verges, Natalia Arza, Francisco José Cambra
Jarcho-Levin syndrome is a rare disorder characterised by defects in vertebral and costal segmentation of varying severity. Respiratory complications are the main cause of death or severe comorbidity due to a restrictive rib cage. A 3 months old infant with Spondylocostal dysostosis and associated bronchomalacia experiencing severe asynchrony during the weaning process is reported. The Neurally Adjusted Ventilatory Assist (NAVA) mode was used to improve adaptation to mechanical ventilation after Vertical Expandable Prosthetic Titanium Ribs (VEPTRs) were implanted...
February 14, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28180985/crossover-study-of-assist-control-ventilation-and-neurally-adjusted-ventilatory-assist
#6
Sandeep Shetty, Katie Hunt, Janet Peacock, Kamal Ali, Anne Greenough
Some studies of infants with acute respiratory distress have demonstrated that neurally adjusted ventilator assist (NAVA) had better short-term results compared to non-triggered or other triggered models. We determined if very prematurely born infants with evolving or established bronchopulmonary dysplasia (BPD) had a lower oxygenation index (OI) on NAVA compared to assist control ventilation (ACV). Infants were studied for 1 h each on each mode. At the end of each hour, blood gas analysis was performed and the OI calculated...
April 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28153938/exertional-dyspnea-associated-with-chest-wall-strapping-is-reduced-when-external-dead-space-substitutes-for-part-of-the-exercise-stimulus-to-ventilation
#7
Luke Albert Garske, Ravin Lal, Ian Braidwood Stewart, Norman R Morris, Troy James Cross, Lewis Adams
Chest wall strapping has been used to assess mechanisms of dyspnea with restrictive lung disease. This study examined the hypothesis that dyspnea with restriction depends principally on the degree of reflex ventilatory stimulation. We compared dyspnea at the same (iso-)ventilation when added dead space provided a component of the ventilatory stimulus during constant work exercise. Eleven healthy males undertook a randomized controlled cross-over trial which compared four constant work exercise conditions (i) CTRL: unrestricted breathing at 90% Gas Exchange Threshold (GET), (ii) CTRL+DS: unrestricted breathing with 0...
February 2, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28149028/comparative-evaluation-of-central-venous-pressure-and-sonographic-inferior-vena-cava-variability-in-assessing-fluid-responsiveness-in-septic-shock
#8
Manjri Garg, Jyotsna Sen, Sandeep Goyal, Dhruva Chaudhry
OBJECTIVE: Fluid infusion, the most critical step in the resuscitation of patients with septic shock, needs preferably continuous invasive hemodynamic monitoring. The study was planned to evaluate the efficacy of ultrasonographically measured inferior vena cava collapsibility index (IVC CI) in comparison to central venous pressure (CVP) in predicting fluid responsiveness in septic shock. MATERIALS AND METHODS: Thirty-six patients of septic shock requiring ventilatory support (invasive/noninvasive) were included...
December 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28145212/-when-is-a-venous-blood-gas-analysis-sufficient-in-the-emergency-department
#9
J A J M van Exsel, S O Simons, C Kramers, Y F Heijdra
Blood gas analysis plays an important role in the initial assessment of a patient in the emergency ward. We present three different patient cases to illustrate when to opt for a venous or an arterial blood gas analysis. Arterial punctures are more painful and carry a higher risk of complications compared to venous punctures. It is possible to use a venous blood gas to screen for acute acid/base disturbances. Ventilatory compensation or anion gap cannot be calculated reliably with a venous blood gas. On the other hand, the diagnosis diabetic keto-acidosis can be made with a venous blood gas; this mode of sampling can also be used for lactate measurement at the emergency department as an independent prognostic marker for mortality...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28138234/respiratory-muscle-activity-and-patient-ventilator-asynchrony-during-different-settings-of-noninvasive-ventilation-in-stable-hypercapnic-copd-does-high-inspiratory-pressure-lead-to-respiratory-muscle-unloading
#10
Marieke L Duiverman, Anouk S Huberts, Leo A van Eykern, Gerrie Bladder, Peter J Wijkstra
INTRODUCTION: High-intensity noninvasive ventilation (NIV) has been shown to improve outcomes in stable chronic obstructive pulmonary disease patients. However, there is insufficient knowledge about whether with this more controlled ventilatory mode optimal respiratory muscle unloading is provided without an increase in patient-ventilator asynchrony (PVA). PATIENTS AND METHODS: Ten chronic obstructive pulmonary disease patients on home mechanical ventilation were included...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28068958/effects-of-ventilator-settings-nebulizer-and-exhalation-port-position-on-albuterol-delivery-during-non-invasive-ventilation-an-in-vitro-study
#11
Yuda Sutherasan, Lorenzo Ball, Pasquale Raimondo, Valentina Caratto, Elisa Sanguineti, Federico Costantino, Maurizio Ferretti, Robert M Kacmarek, Paolo Pelosi
BACKGROUND: Few studies have investigated the factors affecting aerosol delivery during non-invasive ventilation (NIV). Our aim was to investigate, using a bench-top model, the effect of different ventilator settings and positions of the exhalation port and nebulizer on the amount of albuterol delivered to a lung simulator. METHODS: A lung model simulating spontaneous breathing was connected to a single-limb NIV ventilator, set in bi-level positive airway pressure (BIPAP) with inspiratory/expiratory pressures of 10/5, 15/10, 15/5, and 20/10 cmH2O, or continuous positive airway pressure (CPAP) of 5 and 10 cmH2O...
January 10, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28063223/neurally-adjusted-ventilatory-assist-for-infants-under-prolonged-ventilation
#12
Juyoung Lee, Han-Suk Kim, Young Hwa Jung, Chang Won Choi, Yong Hoon Jun
BACKGROUND: Severe bronchopulmonary dysplasia often leads to prolonged mechanical ventilation lasting several months. Cyanotic episodes frequently occur in these patients, necessitating long-term sedation and/or intermittent muscle paralysis. Neurally adjusted ventilatory assist (NAVA) might provide precisely the amount of support that these patients need without sedation. METHODS: We reviewed the medical records of preterm infants who underwent tracheostomy and required mechanical ventilation for >6 months during a period of 6 years...
January 7, 2017: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/28052047/mechanical-ventilatory-modes-and-cardioventilatory-phase-synchronization-in-acute-respiratory-failure-patients
#13
Claudio Enrico Mazzucco, Andrea Marchi, Vlasta Bari, Beatrice De Maria, Stefano Guzzetti, Ferdinando Raimondi, Emanuele Catena, Davide Ottolina, Carla Amadio, Silvio Cravero, Tommaso Fossali, Riccardo Colombo, Alberto Porta
Cardioventilatory phase synchronization was studied in ten critically ill patients admitted in intensive care unit (ICU) for acute respiratory failure under two mechanical ventilatory modes: i) pressure controlled ventilation (PCV); ii) pressure support ventilation (PSV). The two modalities were administered to the same patient in different times in a random order. Cardioventilatory phase interactions were typified by plotting the relative position of a heartbeat, detected from the electrocardiogram and collected in n groups, within m ventilatory cycles as a function of the progressive cardiac beat number via the synchrogram...
January 4, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/28043661/use-of-noninvasive-and-invasive-mechanical-ventilation-in-cardiogenic-shock-a-prospective-multicenter-study
#14
Mari Hongisto, Johan Lassus, Tuukka Tarvasmaki, Alessandro Sionis, Heli Tolppanen, Matias Greve Lindholm, Marek Banaszewski, John Parissis, Jindrich Spinar, Jose Silva-Cardoso, Valentina Carubelli, Salvatore Di Somma, Josep Masip, Veli-Pekka Harjola
BACKGROUND: Despite scarce data, invasive mechanical ventilation (MV) is widely recommended over non-invasive ventilation (NIV) for ventilatory support in cardiogenic shock (CS). We assessed the real-life use of different ventilation strategies in CS and their influence on outcome focusing on the use of NIV and MV. METHODS: 219 CS patients were categorized by the maximum intensity of ventilatory support they needed during the first 24h into MV (n=137; 63%) , NIV (n=26; 12%), and supplementary oxygen (n=56; 26%) groups...
March 1, 2017: International Journal of Cardiology
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/27932555/mouthpiece-ventilation-and-complementary-techniques-in-patients-with-neuromuscular-disease-a-brief-clinical-review-and-update
#17
Tiago Pinto, Michelle Chatwin, Paolo Banfi, Joao Carlos Winck, Antonello Nicolini
Noninvasive ventilatory support (NVS) is sometimes reported as suboptimal in patients with neuromuscular disease (NMD). The reasons for this include inadequate ventilator settings and/or lack of interface tolerance. NVS has been used for many years in patients with NMD disorders as a viable alternative to continuous ventilatory support via a tracheostomy tube. The mouthpiece ventilation (MPV) is a ventilatory mode that is used as daytime ventilatory support in combination with other ventilatory modalities and interfaces for nocturnal NVS...
December 8, 2016: Chronic Respiratory Disease
https://www.readbyqxmd.com/read/27849235/randomized-controlled-trial-comparing-nasal-intermittent-positive-pressure-ventilation-and-nasal-continuous-positive-airway-pressure-in-premature-infants-after-tracheal-extubation
#18
RANDOMIZED CONTROLLED TRIAL
Daniela Franco Rizzo Komatsu, Edna Maria de Albuquerque Diniz, Alexandre Archanjo Ferraro, Maria Esther Jurvest Rivero Ceccon, Flávio Adolfo Costa Vaz
Objective: To analyze the frequency of extubation failure in premature infants using conventional mechanical ventilation (MV) after extubation in groups subjected to nasal intermittent positive pressure ventilation (nIPPV) and continuous positive airway pressure (nCPAP). Method: Seventy-two premature infants with respiratory failure were studied, with a gestational age (GA) ≤ 36 weeks and birth weight (BW) > 750 g, who required tracheal intubation and mechanical ventilation...
September 2016: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/27842747/patient-ventilator-interactions
#19
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/27821162/physiological-effects-of-invasive-ventilation-with-neurally-adjusted-ventilatory-assist-nava-in-a-crossover-study
#20
Jean-Michel Liet, François Barrière, Bénédicte Gaillard-Le Roux, Pierre Bourgoin, Arnaud Legrand, Nicolas Joram
BACKGROUND: Neurally Adjusted Ventilatory Assist (NAVA) is a mode of assisted mechanical ventilation that delivers inspiratory pressure proportionally to the electrical activity of the diaphragm. To date, no pediatric study has focused on the effects of NAVA on hemodynamic parameters. This physiologic study with a randomized cross-over design compared hemodynamic parameters when NAVA or conventional ventilation (CV) was applied. METHODS: After a baseline period, infants received NAVA and CV in a randomized order during two consecutive 30-min periods...
November 8, 2016: BMC Pediatrics
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