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ventilator dyssynchrony

Mark K Friedberg, Steven M Schwartz, Hargen Zhang, Christine Chiu-Man, Cedric Manlhiot, Maria V Ilina, Glen Van Arsdell, Joel A Kirsh, Brian W McCrindle, Elizabeth A Stephenson
BACKGROUND: It is unknown whether continuous cardiac resynchronization therapy (CRT) can lead to sustained improvement in hemodynamics after surgery for congenital heart disease (CHD). OBJECTIVE: We investigated whether CRT improves cardiac index (CI) and blood pressure in infants after biventricular repair of CHD. METHODS: We randomized infants < 4-months of age after biventricular CHD surgery to standard care or standard care plus CRT for 48-hours or until extubation if sooner...
September 26, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
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
Ajay Kumar Jha, Vishwas Malik, Parag Gharde, Sandeep Chauhan, Usha Kiran, Milind P Hote
OBJECTIVES: The postoperative course following on-pump coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) systolic dysfunction is often unpredictable. Therefore, the aim of this study was to identify predictors of poor postoperative outcome in this subset of patients. DESIGN: Prospective observational study SETTING: Single university hospital PARTICIPANTS: Forty patients with severe LV systolic dysfunction undergoing isolated on-pump CABG INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: Comprehensive transesophageal echocardiographic examination was performed to obtain the indices of systolic and diastolic LV function after induction of anesthesia...
April 29, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Priya Prabhakaran, William C Sasser, Yuvrai Kalra, Chrystal Rutledge, Nancy M Tofil
Providing optimal mechanical ventilation to critically-ill children remains a challenge. Patient-ventilator dyssynchrony results frequently with numerous deleterious consequences on patient outcome including increased requirement for sedation, prolonged duration of ventilation, and greater imposed work of breathing. Most currently used ventilators have real-time, continuously-displayed graphics of pressure, volume, and flow versus time (scalars) as well as pressure, and flow versus volume (loops). A clear understanding of these graphics provides a lot of information about the mechanics of the respiratory system and the patient ventilator interaction in a dynamic fashion...
December 2016: Minerva Pediatrica
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
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
Jeremy R Beitler, Scott A Sands, Stephen H Loring, Robert L Owens, Atul Malhotra, Roger G Spragg, Michael A Matthay, B Taylor Thompson, Daniel Talmor
PURPOSE: Breath stacking dyssynchrony generates higher tidal volumes than intended, potentially increasing lung injury risk in acute respiratory distress syndrome (ARDS). Lack of validated criteria to quantify breath stacking dyssynchrony contributes to its under-recognition. This study evaluates performance of novel, objective criteria for quantifying breath stacking dyssynchrony (BREATHE criteria) compared to existing definitions and tests if neuromuscular blockade eliminates high-volume breath stacking dyssynchrony in ARDS...
September 2016: Intensive Care Medicine
A Taha, A Shafie, Y Lavoie, H Hubert, R Marktanner
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
G-C Funk
Avoiding pain, agitation and delirium as well as avoiding unnecessary deep sedation is a powerful yet challenging strategy in critical care medicine. A number of interactions between cerebral function and respiratory function should be regarded in patients with respiratory failure and mechanical ventilation. A cooperative sedation strategy (i.e. patient is awake and free of pain and delirium) is feasible in many patients requiring invasive mechanical ventilation. Especially patients with mild acute respiratory distress syndrome (ARDS) seem to benefit from preserved spontaneous breathing...
February 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Tamami Kono, Akiyoshi Ogimoto, Kazuhisa Nishimura, Toshihiro Yorozuya, Takafumi Okura, Jitsuo Higaki
A 32-year-old man with Duchenne muscular dystrophy (DMD) was admitted to the hospital because of worsening dyspnea and general fatigue. He had received medication therapy for cardiomyopathy with heart failure and home mechanical ventilation for respiratory failure. An electrocardiogram on admission showed intermittent third-degree atrioventricular block. Echocardiography showed global mild left ventricular systolic dysfunction with dyssynchrony (ejection fraction: 45%). He underwent implantation of a cardiac resynchronization therapy-defibrillator...
2015: International Medical Case Reports Journal
Serdar Özkan, Ülkü Yazici, Ertan Aydin, Nurettin Karaoğlanoğlu
BACKGROUND: Diaphragm plication surgery is conducted to remove dyspnea, which results from mediastinal shift, atelectasia, and ventilation/perfusion dyssynchrony in lungs that occur because of an eventrated diaphragm. This study aims to determine whether diaphragm plication has any effect on respiration by analyzing the patients' changing values in the respiratory function test (RFT) after plication surgery. METHODS: Sixteen patients who underwent diaphragm plication surgery in our clinic because of plication eventration or paralysis were examined prospectively...
April 2016: Asian Journal of Surgery
Yi Wang, Hua Li, Honglin Zou, Yaxiong Li
OBJECTIVES: This study analyzed major complaints from patients during mechanical ventilation after cardiac surgery and identified the most common complaints to reduce adverse psychologic responses. DESIGN: Retrospective. SETTING: A single tertiary university hospital. PARTICIPANTS: Patients with heart disease who were on mechanical ventilation after cardiac surgery (N = 800). INTERVENTIONS: The major complaints of the patients during mechanical ventilation after cardiac surgery were analyzed...
August 2015: Journal of Cardiothoracic and Vascular Anesthesia
Devon Lump, Megan Moyer
Paroxysmal sympathetic hyperactivity (PSH) is characterized by the rapid onset and paroxysmal cycling of agitation and dystonia in association with autonomic symptoms. These symptoms may include the following: tachycardia, hypertension, tachypnea, fever, pupil dilation, decreased level of consciousness, diaphoresis, and ventilator dyssynchrony. In a critically ill patient, these are all nonspecific symptoms that may reflect impending sepsis, seizure, or a number of other complications. This can confound and delay the diagnosis and treatment of PSH...
November 2014: Current Neurology and Neuroscience Reports
Robert Joseph Thomas
Divergent approaches to treatment of hypocapnic central sleep apnea syndromes reflect the difficulties in taming a hyperactive respiratory chemoreflex. As both sleep fragmentation and a narrow CO2 reserve or increased loop gain drive the disease, sedatives (to induce longer periods of stable non-rapid eye movement (NREM) sleep and reduce the destabilizing effects of arousals in NREM sleep) and CO2-based stabilization approaches are logical. Adaptive ventilation reduces mean hyperventilation yet can induce ventilator-patient dyssynchrony, while enhanced expiratory rebreathing space (EERS, dead space during positive pressure therapy) and CO2 manipulation directly stabilize respiratory control by moving CO2 above the apnea threshold...
March 1, 2014: Sleep Medicine Clinics
Matthew S Mellema
Ventilator waveforms are graphic representations of changes in pressure, flow, and volume within a ventilator circuit. The changes in these parameters over time may be displayed individually (scalars) or plotted one against another (pressure-volume and flow-volume loops). There are 6 basic shapes of scalar waveforms, but only 3 are functionally distinct (square, ramp, and sine). The pressure scalar is a particularly valuable tool when constant flow (e.g., volume control) modes are employed and an inspiratory pause is added...
August 2013: Topics in Companion Animal Medicine
Christer Sinderby, Songqiao Liu, Davide Colombo, Gianmaria Camarotta, Arthur S Slutsky, Paolo Navalesi, Jennifer Beck
INTRODUCTION: The aim of this study was to validate an automated, objective and standardized algorithm for quantifying and displaying patient-ventilator interaction. METHODS: Using a new method to detect patient-ventilator synchrony, the present study re-analyzed previously acquired and published data from 24 mechanically ventilated adult patients (Colombo et al., Crit Care Med. 2011 Nov;39(11):2452-7). Patient-ventilator interactions were evaluated by comparing ventilator pressure and diaphragm electrical activity (EAdi) waveforms, recorded during pressure support ventilation...
2013: Critical Care: the Official Journal of the Critical Care Forum
Shikha Gupta, Vinay Joshi, Preetha Joshi, Shelley Monkman, Kelly Vaillancourt, Karen Choong
BACKGROUND: The use of airway pressure release ventilation (APRV) in very low birth weight infants is limited. OBJECTIVE: To report the authors' institutional experience and to review the current literature regarding the use of APRV in pediatric populations. METHODS: Neonates <1500 g ventilated using APRV from 2005 to 2006 at McMaster Children's Hospital (Hamilton, Ontario) were retrospectively reviewed. Publications describing APRV in children from 1987 to 2011 were reviewed...
September 2013: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
Daniel Gilstrap, Neil MacIntyre
Assisted/supported modes of mechanical ventilation offer significant advantages over controlled modes in terms of ventilator muscle function/recovery and patient comfort (and sedation needs). However, assisted/supported breaths must interact with patient demands during all three phases of breath delivery: trigger, target, and cycle. Synchronous interactions match ventilator support with patient demands; dyssynchronous interactions do not. Dyssynchrony imposes high pressure loads on ventilator muscles, promoting muscle overload/fatigue and increasing sedation needs...
November 1, 2013: American Journal of Respiratory and Critical Care Medicine
G Murias, A Villagra, L Blanch
Patient-ventilator dyssynchrony is common during mechanical ventilation. Dyssynchrony decreases comfort, prolongs mechanical ventilation and intensive care unit stays, and might lead to worse outcome. Dyssynchrony can occur during the triggering of the ventilator, the inspiration period after triggering, the transition from inspiration to expiration, and the expiratory phase. The most common dyssynchronies are delayed triggering, autotriggering, ineffective inspiratory efforts (which can occur at any point in the respiratory cycle), mismatch between the patient's and ventilator's inspiratory times, and double triggering...
April 2013: Minerva Anestesiologica
Encarna Chacón, Anna Estruga, Gastón Murias, Bernat Sales, Jaume Montanya, Umberto Lucangelo, Oscar Garcia-Esquirol, Ana Villagrá, Jesus Villar, Robert M Kacmarek, María Jose Burgueño, Lluis Blanch, Rosa Jam
UNLABELLED: BACKGROUND PATIENT: ventilator dyssynchrony is common and may influence patients' outcomes. Detection of such dyssynchronies relies on careful observation of patients and airway flow and pressure measurements. Given the shortage of specialists, critical care nurses could be trained to identify dyssynchronies. OBJECTIVE: To evaluate the accuracy of specifically trained critical care nurses in detecting ineffective inspiratory efforts during expiration...
July 2012: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
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