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ventilator dyssynchrony

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https://www.readbyqxmd.com/read/28870355/mechanical-ventilation-state-of-the-art
#1
REVIEW
Tài Pham, Laurent J Brochard, Arthur S Slutsky
Mechanical ventilation is the most used short-term life support technique worldwide and is applied daily for a diverse spectrum of indications, from scheduled surgical procedures to acute organ failure. This state-of-the-art review provides an update on the basic physiology of respiratory mechanics, the working principles, and the main ventilatory settings, as well as the potential complications of mechanical ventilation. Specific ventilatory approaches in particular situations such as acute respiratory distress syndrome and chronic obstructive pulmonary disease are detailed along with protective ventilation in patients with normal lungs...
September 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28802791/difference-in-inspiratory-flow-between-volume-and-pressure-control-ventilation-in-patients-with-flow-dyssynchrony
#2
Juan B Figueroa-Casas, Ricardo Montoya
PURPOSE: Flow dyssynchrony is common during volume control ventilation but minimized during pressure control. Characterizing inspiratory flow during pressure control breaths can inform adjustments of the fixed flow of volume control to address flow dyssynchrony. This study compared inspiratory flow peak and pattern between volume control and adaptive pressure control breaths. MATERIAL AND METHODS: Subjects with or at risk for ARDS were ventilated with volume control decreasing ramp flow at different tidal volumes and subsequently with adaptive pressure control targeting those same tidal volumes...
August 5, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28547318/a-systematic-review-of-alpha-2-agonists-for-sedation-in-mechanically-ventilated-neurocritical-care-patients
#3
Alexandre Tran, Henrietta Blinder, Brian Hutton, Shane W English
The use of sedative medications is commonplace in intensive care units (ICUs) and an invaluable clinical tool for the intensive care physician. Sedation for critically ill, mechanically ventilated patients provides an opportunity to reduce anxiety, discomfort as well as ventilator intolerance and dyssynchrony. Alpha-2 agonists in particular have become increasingly popular for use in the neurocritical care population due to their proposed effectiveness in facilitating examinations and procedures as well as reducing the need for adjunctive agents...
May 25, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28152385/propofol-fentanyl-interaction-in-beagles-apnea-response-to-mechanical-ventilation-endotracheal-tube-and-tetanic-stimulation
#4
T Iizuka, K Masui, T Miyabe-Nishiwaki, H Kanazawa, R Nishimura
The objective of this study was to characterize the propofol-fentanyl interaction in Beagles for four pharmacodynamic endpoints: apnea, response to mechanical ventilation, endotracheal tube, and tetanic stimulation. After anesthesia was induced with varying combinations of propofol and fentanyl, the pharmacodynamic endpoints were assessed in intubated dogs (n=6) using the cross-over design. Effective concentrations of propofol plasma concentration (Cp) and fentanyl Cp were assessed using additive, reduced Greco, Minto, and hierarchical interaction models...
January 23, 2017: Research in Veterinary Science
https://www.readbyqxmd.com/read/28012426/perceived-safety-and-efficacy-of-neuromuscular-blockers-for-acute-respiratory-distress-syndrome-among-medical-intensive-care-unit-practitioners-a-multicenter-survey
#5
Heather Torbic, Seth R Bauer, Heather A Personett, Amy L Dzierba, Joanna L Stollings, Lindsay P Ryder, Craig E Daniels, Sean M Caples, Erin N Frazee
PURPOSE: Neuromuscular blocking agents (NMBAs) are frequently used in patients with acute respiratory distress syndrome (ARDS). The purpose of this survey is to describe providers' knowledge and perceived efficacy and safety of NMBAs in patients with ARDS. MATERIALS AND METHODS: We performed a prospective, multicenter survey of medical intensive care unit intensivists, fellows, nurse practitioners (NPs), physician's assistants (PAs), and pharmacists at 5 tertiary care centers between July 2012 and May 2013...
April 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/27842752/management-of-sedation-and-paralysis
#6
REVIEW
Michael A Fierro, Raquel R Bartz
Sedatives are administered to decrease patient discomfort and agitation during mechanical ventilation and to maintain patient-ventilator synchrony. Titration of infusions and or bolus dosing to maintain light sedation goals according to validated scales is recommended. However, it is important to consider deeper sedation for patients with refractory patient-ventilator dyssynchrony (PVD) to prevent volutrauma and barotrauma. Deep sedation plus muscle relaxants may be required to treat PVD or to reduce oxygen consumption and carbon dioxide production...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842746/managing-respiratory-failure-in-obstructive-lung-disease
#7
REVIEW
Stephen P Bergin, Craig R Rackley
Exacerbations of obstructive lung disease are common causes of acute respiratory failure. Short-acting bronchodilators and systemic glucocorticoids are the foundation of pharmacologic management. For patients requiring ventilator support, use of noninvasive ventilation reduces the risk of mortality and progression to invasive mechanical ventilation. Challenges associated with invasive ventilation include ventilator dyssynchrony, air trapping, and dynamic hyperinflation. Careful monitoring and adjustment of ventilatory support parameters helps to optimize the patient-ventilator interaction and minimizes the risk of associated morbidity...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27792267/very-low-birthweight-bronchopulmonary-dysplasia-survivors-had-similar-cardiac-outcomes-to-controls-at-six-years-to-14-years-of-age
#8
Piia Suursalmi, Anneli Eerola, Tuija Poutanen, Päivi Korhonen, Tarja Kopeli, Outi Tammela
AIM: This study evaluated cardiac function and its associations with lung function and neonatal pulmonary morbidity in very low birthweight (VLBW) children, with and without severe radiographic bronchopulmonary dysplasia (radBPD), at school age. METHODS: We examined 18 VLBW children with radBPD, 17 VLBW children without radBPD and 18 healthy term-born children using conventional echocardiography, tissue Doppler imaging, speckle tracking echocardiography and real-time three-dimensional echocardiography at six years to 14 years of age...
February 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/27687644/hemodynamic-effects-of-sustained-postoperative-cardiac-resynchronization-therapy-in-infants-after-repair-of-congenital-heart-disease-results-of-a-randomized-clinical-trial
#9
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 younger than 4 months after biventricular CHD surgery to standard care or standard care plus CRT for 48 hours or until extubation if sooner...
February 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/27598383/effect-of-tidal-volume-size-and-its-delivery-mode-on-patient-ventilator-dyssynchrony
#10
Juan B Figueroa-Casas, Ricardo Montoya
RATIONALE: Although increasingly recommended, compliance with low Vt ventilation remains suboptimal. Dyssynchrony induced by low Vts may be a reason for it. OBJECTIVES: To determine the effect of Vt 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. METHODS: Nineteen mechanically ventilated patients underwent six consecutive ventilatory conditions: three on volume assist-control (VC) mode, each with set Vt of 6, 7...
December 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27546830/echocardiographic-predictors-of-immediate-postoperative-outcomes-in-patients-with-severe-left-ventricular-systolic-dysfunction-undergoing-on-pump-coronary-artery-bypass-grafting
#11
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...
February 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27471820/ventilator-graphics
#12
REVIEW
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
https://www.readbyqxmd.com/read/27390463/neurally-adjusted-ventilation-assist-in-weaning-difficulty-first-case-report-from-india
#13
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
https://www.readbyqxmd.com/read/27368279/effects-of-dexmedetomidine-and-propofol-on-patient-ventilator-interaction-in-difficult-to-wean-mechanically-ventilated-patients-a-prospective-open-label-randomised-multicentre-study
#14
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
https://www.readbyqxmd.com/read/27342819/quantifying-unintended-exposure-to-high-tidal-volumes-from-breath-stacking-dyssynchrony-in-ards-the-breathe-criteria
#15
MULTICENTER STUDY
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
https://www.readbyqxmd.com/read/27290416/adaptive-support-ventilation-as-an-acceptable-mode-to-prevent-airflow-limitation-air-entrapment-dynamic-hyperinflation-and-patient-ventilator-dyssynchrony
#16
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
https://www.readbyqxmd.com/read/26817653/-pain-agitation-and-delirium-in-acute-respiratory-failure
#17
REVIEW
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
https://www.readbyqxmd.com/read/26346252/cardiac-resynchronization-therapy-in-a-young-patient-with-duchenne-muscular-dystrophy
#18
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
https://www.readbyqxmd.com/read/26117205/is-surgical-plication-necessary-in-diaphragm-eventration
#19
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
https://www.readbyqxmd.com/read/25939965/analysis-of-complaints-from-patients-during-mechanical-ventilation-after-cardiac-surgery-a-retrospective-study
#20
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
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