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Using ideal body weight tidal volume on ventilated patient

Thomas Godet, Matthieu Jabaudon, Raïko Blondonnet, Aymeric Tremblay, Jules Audard, Benjamin Rieu, Bruno Pereira, Jean-Marc Garcier, Emmanuel Futier, Jean-Michel Constantin
BACKGROUND: High frequency percussive ventilation (HFPV) combines diffusive (high frequency mini-bursts) and convective ventilation patterns. Benefits include enhanced oxygenation and hemodynamics, and alveolar recruitment, while providing hypothetic lung-protective ventilation. No study has investigated HFPV-induced changes in lung aeration in patients with early acute respiratory distress syndrome (ARDS). METHODS: Eight patients with early non-focal ARDS were enrolled and five swine with early non-focal ARDS were studied in prospective computed tomography (CT) scan and animal studies, in a university-hospital tertiary ICU and an animal laboratory...
January 11, 2018: Critical Care: the Official Journal of the Critical Care Forum
Sophie Perinel-Ragey, Loredana Baboi, Claude Guérin
BACKGROUND: Limiting tidal volume (VT) in patients with ARDS may not be achieved once patient-triggered breaths occur. Furthermore, ICU ventilators offer numerous patient-triggered modes that work differently across brands. We systematically investigated, using a bench model, the effect of patient-triggered modes on the size and variability of VT at different breathing frequencies (f), patient effort, and ARDS severity. METHODS: We used a V500 Infinity ICU ventilator connected to an ASL 5000 lung model whose compliance was mimicking mild, moderate, and severe ARDS...
November 2017: Respiratory Care
Elena Bignami, Marcello Guarnieri, Francesco Saglietti, Enivarco Massimo Maglioni, Sabino Scolletta, Stefano Romagnoli, Stefano De Paulis, Gianluca Paternoster, Cinzia Trumello, Roberta Meroni, Antonio Scognamiglio, Alessandro Maria Budillon, Vincenzo Pota, Alberto Zangrillo, Ottavio Alfieri
BACKGROUND: There is no consensus on which lung-protective strategies should be used in cardiac surgery patients. Sparse and small randomized clinical and animal trials suggest that maintaining mechanical ventilation during cardiopulmonary bypass is protective on the lungs. Unfortunately, such evidence is weak as it comes from surrogate and minor clinical endpoints mainly limited to elective coronary surgery. According to the available data in the academic literature, an unquestionable standardized strategy of lung protection during cardiopulmonary bypass cannot be recommended...
June 7, 2017: Trials
Lorenzo Ball, Federico Costantino, Giulia Orefice, Karthikka Chandrapatham, Paolo Pelosi
Mechanical ventilation is a cornerstone of the intraoperative management of the surgical patient and is still mandatory in several surgical procedures. In the last decades, research focused on preventing postoperative pulmonary complications (PPCs), both improving risk stratification through the use of predictive scores and protecting the lung adopting so-called protective ventilation strategies. The aim of this review was to give an up-to-date overview of the currently suggested intraoperative ventilation strategies, along with their pathophysiologic rationale, with a focus on challenging conditions, such as obesity, one-lung ventilation and cardiopulmonary bypass...
October 2017: Minerva Anestesiologica
Shin Sato, Makoto Hasegawa, Megumi Okuyama, Junko Okazaki, Yuji Kitamura, Yumi Sato, Teruhiko Ishikawa, Yasunori Sato, Shiroh Isono
BACKGROUND: Depending on upper airway patency during anesthesia induction, tidal volume achieved by mask ventilation may vary. In 80 adult patients undergoing general anesthesia, the authors tested a hypothesis that tidal volume during mask ventilation is smaller in patients with sleep-disordered breathing priorly defined as apnea hypopnea index greater than 5 per hour. METHODS: One-hand mask ventilation with a constant ventilator setting (pressure-controlled ventilation) was started 20 s after injection of rocuronium and maintained for 1 min during anesthesia induction...
January 2017: Anesthesiology
Elisa Estenssoro, Arnaldo Dubin
Acute respiratory distress syndrome (ARDS) is an acute respiratory failure produced by an inflammatory edema secondary to increased lung capillary permeability. This causes alveolar flooding and subsequently deep hypoxemia, with intrapulmonary shunt as its most important underlying mechanism. Characteristically, this alteration is unresponsive to high FIO2 and only reverses with end-expiratory positive pressure (PEEP). Pulmonary infiltrates on CXR and CT are the hallmark, together with decreased lung compliance...
2016: Medicina
Davide Chiumello, Eleonora Carlesso, Matteo Brioni, Massimo Cressoni
BACKGROUND: Lung-protective ventilation strategy suggests the use of low tidal volume, depending on ideal body weight, and adequate levels of PEEP. However, reducing tidal volume according to ideal body weight does not always prevent overstress and overstrain. On the contrary, titrating mechanical ventilation on airway driving pressure, computed as airway pressure changes from PEEP to end-inspiratory plateau pressure, equivalent to the ratio between the tidal volume and compliance of respiratory system, should better reflect lung injury...
August 22, 2016: Critical Care: the Official Journal of the Critical Care Forum
T Kiss, T Bluth, M Gama de Abreu
BACKGROUND: Recent studies show that intraoperative protective ventilation is able to reduce postoperative pulmonary complications (PPC). OBJECTIVES: This article provides an overview of the definition and ways to predict PPC. We present different factors that lead to ventilator-induced lung injury and explain the concepts of stress and strain as well as driving pressure. Different strategies of mechanical ventilation to avoid PPC are discussed in light of clinical evidence...
August 2016: Der Anaesthesist
Christopher P Bourdeaux, Matthew Jc Thomas, Timothy H Gould, Gaurav Malhotra, Andreas Jarvstad, Timothy Jones, Iain D Gilchrist
OBJECTIVES: Low tidal volume (TVe) ventilation improves outcomes for ventilated patients, and the majority of clinicians state they implement it. Unfortunately, most patients never receive low TVes. 'Nudges' influence decision-making with subtle cognitive mechanisms and are effective in many contexts. There have been few studies examining their impact on clinical decision-making. We investigated the impact of 2 interventions designed using principles from behavioural science on the deployment of low TVe ventilation in the intensive care unit (ICU)...
2016: BMJ Open
T V Klypa, I O Antonov, A S Vavakin
UNLABELLED: AIM OF RESEARCH: To estimate the cognitive status dynamics ofpatients during the early postoperative period after cardiac interventions and to reveal predictors of cognitive functions deterioration at this category of patients. MATERIALS AND METHODS: 118 cardiac patients were tested of neurocognitive functions one days before operation, and then for the 2-3rd days after operation by means of the MMSE test, the FAB test, Shulte's test, a questionnaire of a depression of CES-D, the BATTERY OF FRONTAL DYSFUNCTION TEST...
January 2016: Anesteziologiia i Reanimatologiia
Randal S Blank, Douglas A Colquhoun, Marcel E Durieux, Benjamin D Kozower, Timothy L McMurry, S Patrick Bender, Bhiken I Naik
BACKGROUND: The use of lung-protective ventilation (LPV) strategies may minimize iatrogenic lung injury in surgical patients. However, the identification of an ideal LPV strategy, particularly during one-lung ventilation (OLV), remains elusive. This study examines the role of ventilator management during OLV and its impact on clinical outcomes. METHODS: Data were retrospectively collected from the hospital electronic medical record and the Society of Thoracic Surgery database for subjects undergoing thoracic surgery with OLV between 2012 and 2014...
June 2016: Anesthesiology
Carmen Sílvia Valente Barbas, Ary Serpa Neto
On October 27, 2015, Lemile and colleagues published an article in JAMA entitled "Effect of Noninvasive Ventilation vs. Oxygen Therapy on Mortality among Immunocompromised Patients with Acute Respiratory Failure: A Randomized Clinical Trial", which investigated the effects of non-invasive ventilation (NIV) in 28-day mortality of 374 critically ill immunosuppressed patients. The authors found that among immunosuppressed patients admitted to the intensive care unit (ICU) with hypoxemic acute respiratory failure, early NIV compared with oxygen therapy alone did not reduce 28-day mortality...
January 2016: Journal of Thoracic Disease
Ana Fernandez-Bustamante, Soshi Hashimoto, Ary Serpa Neto, Pierre Moine, Marcos F Vidal Melo, John E Repine
The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increasing, and facing these challenges is common in the operating rooms and critical care units worldwide...
May 6, 2015: BMC Anesthesiology
Arie Soroksky, Julia Kheifets, Zehava Girsh Solomonovich, Emad Tayem, Balmor Gingy Ronen, Boris Rozhavsky
PURPOSE: Patients with severe acute respiratory distress syndrome (ARDS) and hypercapnia present a formidable treatment challenge. We examined the use of esophageal balloon for assessment of transpulmonary pressures to guide mechanical ventilation for successful management of severe hypercapnia. MATERIALS AND METHODS: Patients with severe ARDS and hypercapnia were studied. Esophageal balloon was inserted and mechanical ventilation was guided by assessment of transpulmonary pressures...
2015: BioMed Research International
Bradford J Smith, Lennart K A Lundblad, Michaela Kollisch-Singule, Joshua Satalin, Gary Nieman, Nader Habashi, Jason H T Bates
Mechanical ventilation is a crucial component of the supportive care provided to patients with acute respiratory distress syndrome. Current practice stipulates the use of a low tidal volume (VT) of 6 ml/kg ideal body weight, the presumptive notion being that this limits overdistension of the tissues and thus reduces volutrauma. We have recently found, however, that airway pressure release ventilation (APRV) is efficacious at preventing ventilator-induced lung injury, yet APRV has a very different mechanical breath profile compared with conventional low-VT ventilation...
April 1, 2015: Journal of Applied Physiology
Jin Hye Min, Sang Eun Lee, Hong Sik Lee, Young Keun Chae, Yong Kyung Lee, Yoo Kang, Ui Jin Je
BACKGROUND: The stroke volume variation (SVV), based on lung-heart interaction during mechanical ventilation, is a useful dynamic parameter for fluid responsiveness. However, it is affected by many factors. The aim of this study was to evaluate the effects of SVV on Trendelenburg (T) and reverse Trendelenburg (RT) position and to further elaborate on the patterns of the SVV with position. METHODS: Forty-two patients undergoing elective surgery were enrolled in this study...
December 2014: Korean Journal of Anesthesiology
Emma Joynes, Satinder Dalay, Jaimin M Patel, Samia Fayek
There is clear evidence for the use of a protective ventilation protocol in patients with acute respiratory distress syndrome (ARDS). There is evidence to suggest that protective ventilation is beneficial in patients at risk of ARDS. A protective ventilation strategy was implemented on our intensive care unit in critical care patients who required mechanical ventilation for over 48 h, with and at risk for ARDS. A complete audit cycle was performed over 13 months to assess compliance with a safe ventilation protocol in intensive care...
November 2014: Indian Journal of Critical Care Medicine
Charles L Brassard, Jens Lohser, François Donati, Jean S Bussières
PURPOSE: The purpose of this Continuing Professional Development Module is to review the issues pertinent to one-lung ventilation (OLV) and to propose a management strategy for ventilation before, during, and after lung isolation. PRINCIPAL FINDINGS: The need for optimal lung isolation has increased with the advent of video-assisted thoracoscopic surgery, as surgical exposure is critical for successful surgery. Continuous positive airway pressure applied to the operative lung or intermittent two-lung ventilation should therefore be avoided if possible...
December 2014: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Norbert Schwabbauer, Björn Berg, Gunnar Blumenstock, Michael Haap, Jürgen Hetzel, Reimer Riessen
BACKGROUND: Aim of the study was to compare the short-term effects of oxygen therapy via a high-flow nasal cannula (HFNC) on functional and subjective respiratory parameters in patients with acute hypoxic respiratory failure in comparison to non-invasive ventilation (NIV) and standard treatment via a Venturi mask. METHODS: Fourteen patients with acute hypoxic respiratory failure were treated with HFNC (FiO2 0.6, gas flow 55 l/min), NIV (FiO2 0.6, PEEP 5 cm H2O Hg, tidal volume 6-8 ml/kg ideal body weight,) and Venturi mask (FiO2 0...
2014: BMC Anesthesiology
Jan H Storre, Elena Matrosovich, Emelie Ekkernkamp, David J Walker, Claudia Schmoor, Michael Dreher, Wolfram Windisch
BACKGROUND: High-intensity noninvasive ventilation (HI-NIV) is the most effective means of improving several physiological and clinical parameters in subjects with chronic hypercapnic COPD. Whether the newer hybrid mode using target tidal volume noninvasive ventilation (target V(T) NIV) provides additional benefits remains unclear. METHODS: Subjects with COPD successfully established on long-term HI-NIV were switched to target V(T) NIV. Optimal target V(T) settings according to nocturnal transcutaneous P(CO2) measurements were achieved following a randomized crossover trial using 8 mL/kg ideal body weight and 110% of individual V(T) during HI-NIV, respectively...
September 2014: Respiratory Care
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