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Lung protective strategies using ideal body weight of a patient

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https://www.readbyqxmd.com/read/27576283/-acute-respiratory-distress-syndrome
#1
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
https://www.readbyqxmd.com/read/27545828/airway-driving-pressure-and-lung-stress-in-ards-patients
#2
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
https://www.readbyqxmd.com/read/27513687/poor-adherence-to-lung-protective-mechanical-ventilation-in-pediatric-acute-respiratory-distress-syndrome
#3
Shan L Ward, Carson M Quinn, Stacey L Valentine, Anil Sapru, Martha A Q Curley, Douglas F Willson, Kathleen D Liu, Michael A Matthay, Heidi R Flori
OBJECTIVES: To determine the frequency of low-tidal volume ventilation in pediatric acute respiratory distress syndrome and assess if any demographic or clinical factors improve low-tidal volume ventilation adherence. DESIGN: Descriptive post hoc analysis of four multicenter pediatric acute respiratory distress syndrome studies. SETTING: Twenty-six academic PICU. PATIENTS: Three hundred fifteen pediatric acute respiratory distress syndrome patients...
October 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27392439/-does-intraoperative-lung-protective-ventilation-reduce-postoperative-pulmonary-complications
#4
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
https://www.readbyqxmd.com/read/27011307/management-of-one-lung-ventilation-impact-of-tidal-volume-on-complications-after-thoracic-surgery
#5
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
https://www.readbyqxmd.com/read/25907273/perioperative-lung-protective-ventilation-in-obese-patients
#6
REVIEW
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
https://www.readbyqxmd.com/read/25425842/a-complete-audit-cycle-to-assess-adherence-to-a-lung-protective-ventilation-strategy
#7
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
https://www.readbyqxmd.com/read/25389025/step-by-step-clinical-management-of-one-lung-ventilation-continuing-professional-development
#8
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
https://www.readbyqxmd.com/read/24986596/high-frequency-percussive-ventilation-and-initial-biomarker-levels-of-lung-injury-in-patients-with-minor-burns-after-smoke-inhalation-injury
#9
P Reper, W Heijmans
BACKGROUND: Several biological markers of lung injury are predictors of morbidity and mortality in patients with acute respiratory distress syndrome (ARDS). Some lung-protective ventilation strategies, such as low tidal volume, are associated with a significant decrease in plasma biomarker levels compared to the high tidal volume ventilation strategy. The primary objective of this study was to test whether the institution of high-frequency percussive ventilation (HFPV) to patients with respiratory distress after smoke inhalation injury influenced initial biomarker levels of lung injury (just before and after using percussive ventilation)...
February 2015: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/24640938/mechanical-ventilation-after-lung-transplantation-an-international-survey-of-practices-and-preferences
#10
Alison Beer, Robert M Reed, Servet Bölükbas, Marie Budev, George Chaux, Martin R Zamora, Gregory Snell, Jonathan B Orens, Julia A Klesney-Tait, Gregory A Schmidt, Roy G Brower, Michael Eberlein
RATIONALE: Between 10% and 57% of lung transplant (LTx) recipients develop primary graft dysfunction (PGD) within 72 hours of LTx. PGD is clinically and histologically analogous to the acute respiratory distress syndrome. In patients at risk for or with acute respiratory distress syndrome, lung-protective ventilation strategies (low tidal volume and positive end-expiratory pressure) improve outcomes. There is, however, little information available on mechanical ventilation strategies after LTx...
May 2014: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/23369521/a-5-year-observational-study-of-lung-protective-ventilation-in-the-operating-room-a-single-center-experience
#11
Dean R Hess, Dhimiter Kondili, Edward Burns, Edward A Bittner, Ulrich H Schmidt
PURPOSE: We assessed the evolution of lung-protective ventilation strategies during anesthesia and identified factors associated with the selection of a nonprotective ventilation strategy. METHODS: This retrospective observational study covered a 5-year period from March 2006 to March 2011. It included 45575 adult patients who underwent intubation de novo in the operating room. We considered a tidal volume (VT) greater than 10 mL/kg of ideal body weight (IBW) and/or positive end-expiratory pressure (PEEP) less than 5 cm H2O as not lung protective...
August 2013: Journal of Critical Care
https://www.readbyqxmd.com/read/22008397/approaches-to-conventional-mechanical-ventilation-of-the-patient-with-acute-respiratory-distress-syndrome
#12
Dean R Hess
To minimize ventilator-induced lung injury, attention should be directed toward avoidance of alveolar over-distention and cyclical opening and closure of alveoli. The most impressive study of mechanical ventilation to date is the Acute Respiratory Distress Syndrome (ARDS) Network study of higher versus lower tidal volume (V(T)), which reported a reduction in mortality from 39.8% to 31.0% with 6 mL/kg ideal body weight rather than 12 mL/kg ideal body weight (number-needed-to-treat of 12 patients). To achieve optimal lung protection, the lowest plateau pressure and V(T) possible should be selected...
October 2011: Respiratory Care
https://www.readbyqxmd.com/read/18156881/mechanical-ventilation-with-lower-tidal-volumes-and-positive-end-expiratory-pressure-prevents-pulmonary-inflammation-in-patients-without-preexisting-lung-injury
#13
RANDOMIZED CONTROLLED TRIAL
Esther K Wolthuis, Goda Choi, Mark C Dessing, Paul Bresser, Rene Lutter, Misa Dzoljic, Tom van der Poll, Margreeth B Vroom, Markus Hollmann, Marcus J Schultz
BACKGROUND: Mechanical ventilation with high tidal volumes aggravates lung injury in patients with acute lung injury or acute respiratory distress syndrome. The authors sought to determine the effects of short-term mechanical ventilation on local inflammatory responses in patients without preexisting lung injury. METHODS: Patients scheduled to undergo an elective surgical procedure (lasting > or = 5 h) were randomly assigned to mechanical ventilation with either higher tidal volumes of 12 ml/kg ideal body weight and no positive end-expiratory pressure (PEEP) or lower tidal volumes of 6 ml/kg and 10 cm H2O PEEP...
January 2008: Anesthesiology
https://www.readbyqxmd.com/read/17439026/lung-protective-ventilation-strategies-have-we-applied-them-in-trauma-patients-at-risk-for-acute-lung-injury-and-acute-respiratory-distress-syndrome
#14
Robert C Gillis, Leonard J Weireter, Rebecca C Britt, Frederic J Cole, Jay N Collins, L D Britt
Lung protective ventilation strategies for patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are well documented, and many medical centers fail to apply these strategies in ALI/ARDS. The objective of this study was to determine if we apply these strategies in trauma patients at risk for ALI/ARDS. We undertook a retrospective review of trauma patients mechanically ventilated for > or = 4 days with an ICD-9 for traumatic pneumothorax, hemothorax, lung contusion, and/or fractured ribs admitted from May 1, 1999 through April 30, 2000 (Group 1), the pre-ARDS Network study, and from May 1, 2003 through April 30, 2004 (Group 2), the post-ARDS Network study...
April 2007: American Surgeon
https://www.readbyqxmd.com/read/16956410/biological-markers-of-lung-injury-before-and-after-the-institution-of-positive-pressure-ventilation-in-patients-with-acute-lung-injury
#15
COMPARATIVE STUDY
Magda Cepkova, Sandra Brady, Anil Sapru, Michael A Matthay, Gwynne Church
BACKGROUND: Several biological markers of lung injury are predictors of morbidity and mortality in patients with acute lung injury (ALI). The low tidal volume lung-protective ventilation strategy is associated with a significant decrease in plasma biomarker levels compared to the high tidal volume ventilation strategy. The primary objective of this study was to test whether the institution of lung-protective positive pressure ventilation in spontaneously ventilating patients with ALI exacerbates pre-existing lung injury by using measurements of biomarkers of lung injury before and after intubation...
2006: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/16932229/neuromuscular-blocking-agents-decrease-inflammatory-response-in-patients-presenting-with-acute-respiratory-distress-syndrome
#16
RANDOMIZED CONTROLLED TRIAL
Jean-Marie Forel, Antoine Roch, Valérie Marin, Pierre Michelet, Didier Demory, Jean-Louis Blache, Gilles Perrin, Marc Gainnier, Pierre Bongrand, Laurent Papazian
OBJECTIVE: To evaluate the effects of neuromuscular blocking agents (NMBAs) on pulmonary and systemic inflammation in patients with acute respiratory distress syndrome ventilated with a lung-protective strategy. DESIGN: Multiple-center, prospective, controlled, and randomized trial. SETTING: One medical and two medical-surgical intensive care units. PATIENTS: A total of 36 patients with acute respiratory distress syndrome (Pao2/Fio2 ratio of < or =200 at a positive end-expiratory pressure of > or =5 cm H2O) were included within 48 hrs of acute respiratory distress syndrome onset...
November 2006: Critical Care Medicine
https://www.readbyqxmd.com/read/16132888/mechanical-ventilation-strategies-and-inflammatory-responses-to-cardiac-surgery-a-prospective-randomized-clinical-trial
#17
RANDOMIZED CONTROLLED TRIAL
Hermann Wrigge, Ulrike Uhlig, Georg Baumgarten, Jan Menzenbach, Jörg Zinserling, Martin Ernst, Daniel Drömann, Armin Welz, Stefan Uhlig, Christian Putensen
OBJECTIVE: To examine whether postoperative mechanical ventilation with lower tidal volumes (V(T)) has protective effects on inflammatory responses induced by cardiopulmonary bypass (CPB) surgery in smokers and nonsmokers. DESIGN AND SETTING: Prospective, randomized, controlled clinical trial in the intensive care unit of a university hospital. PATIENTS AND PARTICIPANTS: We examined 44 patients (22 smokers, 22 nonsmokers) immediately after uncomplicated CPB surgery...
October 2005: Intensive Care Medicine
https://www.readbyqxmd.com/read/11874606/setting-the-frequency-tidal-volume-pattern
#18
REVIEW
Neil R MacIntyre
Alveolar (and thus arterial) P(O2) and P(CO2) clearly depend on minute ventilation. However, we need to balance gas exchange goals against the risk of overstretching, especially of the healthier regions of the lung. The plateau pressure is probably the best easily-obtained marker of the risk of stretch in the lung, and a commonly quoted threshold is 30--35 cm H(2)O, the normal maximum transalveolar pressure at total lung capacity. In establishing the proper balance of stretch versus gas exchange, we need to address what levels of pH and P(aO2) we consider acceptable...
March 2002: Respiratory Care
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