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Expiratory Muscle Relaxation-Induced Ventilator Triggering: A Novel Patient-Ventilator Dyssynchrony.
Annemijn H Jonkman, Minke C Holleboom, Heder J de Vries, Marijn Vriends, Pieter R Tuinman, Leo M A Heunks
In critically ill patients receiving mechanical ventilation, expiratory muscles are recruited with high respiratory loading and/or low inspiratory muscle capacity. In this case report, we describe a previously unrecognized patient-ventilator dyssynchrony characterized by ventilator triggering by expiratory muscle relaxation, an observation that we termed expiratory muscle relaxation-induced ventilator triggering (ERIT). ERIT can be recognized with in-depth respiratory muscle monitoring as (1) an increase in gastric pressure (Pga) during expiration, resulting from expiratory muscle recruitment; (2) a drop in Pga (and hence, esophageal pressure) at the time of ventilator triggering; and (3) diaphragm electrical activity onset occurring after ventilator triggering...
June 2022: Chest
#22
JOURNAL ARTICLE
Maria Yared, Kendall W Headden, William F Barrett, Drew O Boehmer, Patrick E Britell
No abstract text is available yet for this article.
August 2022: Journal of Cardiothoracic and Vascular Anesthesia
#23
JOURNAL ARTICLE
L Felipe Damiani, Doreen Engelberts, Luca Bastia, Kohei Osada, Bhushan H Katira, Gail Otulakowski, Ewan C Goligher, W Darlene Reid, Sebastián Dubo, Alejandro Bruhn, Martin Post, Brian P Kavanagh, Laurent J Brochard
Rationale: Reverse triggering dyssynchrony (RT) is a patient-ventilator interaction where a respiratory muscle contraction is triggered by a passive mechanical insufflation. Its impact on diaphragm structure and function is unknown. Objectives: To establish an animal model of RT with lung injury receiving lung-protective ventilation and to assess its impact on the structure and function of the diaphragm. Methods: Lung injury was induced by surfactant depletion and high-stress ventilation in 32 ventilated pigs...
March 15, 2022: American Journal of Respiratory and Critical Care Medicine
#24
EDITORIAL
Neil MacIntyre
No abstract text is available yet for this article.
December 1, 2021: Critical Care Medicine
#25
JOURNAL ARTICLE
Deepak K Agrawal, Bradford J Smith, Peter D Sottile, David J Albers
Motivated by a desire to understand pulmonary physiology, scientists have developed physiological lung models of varying complexity. However, pathophysiology and interactions between human lungs and ventilators, e.g., ventilator-induced lung injury (VILI), present challenges for modeling efforts. This is because the real-world pressure and volume signals may be too complex for simple models to capture, and while complex models tend not to be estimable with clinical data, limiting clinical utility. To address this gap, in this manuscript we developed a new damaged-informed lung ventilator (DILV) model...
2021: Frontiers in Physiology
#26
REVIEW
Bruno De Oliveira, Nahla Aljaberi, Ahmed Taha, Baraa Abduljawad, Fadi Hamed, Nadeem Rahman, Jihad Mallat
Patient-ventilator dyssynchrony is a mismatch between the patient's respiratory efforts and mechanical ventilator delivery. Dyssynchrony can occur at any phase throughout the respiratory cycle. There are different types of dyssynchrony with different mechanisms and different potential management: trigger dyssynchrony (ineffective efforts, autotriggering, and double triggering); flow dyssynchrony, which happens during the inspiratory phase; and cycling dyssynchrony (premature cycling and delayed cycling). Dyssynchrony has been associated with patient outcomes...
September 30, 2021: Journal of Clinical Medicine
#27
JOURNAL ARTICLE
Heather Carmichael, Franklin L Wright, Robert C McIntyre, Thomas Vogler, Shane Urban, Sarah E Jolley, Ellen L Burnham, Whitney Firth, Catherine G Velopulos, Juan Pablo Idrovo
BACKGROUND: Since the outset of the coronavirus disease 2019 (COVID-19) pandemic, published tracheostomy guidelines have generally recommended deferral of the procedure beyond the initial weeks of intubation given high mortality as well as concerns about transmission of the infection to providers. It is unclear whether tracheostomy in patients with COVID-19 infection facilitates ventilator weaning, and long-term outcomes are not yet reported in the literature. METHODS: This is a retrospective study of tracheostomy outcomes in patients with COVID-19 infection at a single-center academic tertiary referral intensive care unit...
2021: Trauma Surgery & Acute Care Open
#28
JOURNAL ARTICLE
Brandon Oto, Janet Annesi, Raymond J Foley
Patient-ventilator dyssynchrony or asynchrony occurs when, for any parameter of respiration, discordance exists between the patient's spontaneous effort and the ventilator's provided support. If not recognised, it may promote oversedation, prolong the duration of mechanical ventilation, create risk for lung injury, and generally confuse the clinical picture. Seven forms of dyssynchrony are common: (a) ineffective triggering; (b) autotriggering; (c) inadequate flow; (d) too much flow; (e) premature cycling; (f) delayed cycling; and (g) peak pressure apnoea...
March 2021: Anaesthesia and Intensive Care
#29
REVIEW
Lu Chen, Annemijn Jonkman, Sérgio M Pereira, Cong Lu, Laurent Brochard
PURPOSE OF REVIEW: Assess the most recent studies using driving pressure (DP) as a monitoring technique under mechanical ventilation and describe the technical challenges associated with its measurement. RECENT FINDINGS: DP is consistently associated with survival in acute respiratory failure and acute respiratory distress syndrome (ARDS) and can detect patients at higher risk of ventilator-induced lung injury. Its measurement can be challenged by leaks and ventilator dyssynchrony, but is also feasible under pressure support ventilation...
June 1, 2021: Current Opinion in Critical Care
#30
REVIEW
Diaphragm function in acute respiratory failure and the potential role of phrenic nerve stimulation.
Peter M Reardon, Jenna Wong, Aisling Fitzpatrick, Ewan C Goligher
PURPOSE OF REVIEW: The aim of this review was to describe the risk factors for developing diaphragm dysfunction, discuss the monitoring techniques for diaphragm activity and function, and introduce potential strategies to incorporate diaphragm protection into conventional lung-protective mechanical ventilation strategies. RECENT FINDINGS: It is increasingly apparent that an approach that addresses diaphragm-protective ventilations goals is needed to optimize ventilator management and improve patient outcomes...
June 1, 2021: Current Opinion in Critical Care
#31
JOURNAL ARTICLE
Prashant Nasa, Elie Azoulay, Ashish K Khanna, Ravi Jain, Sachin Gupta, Yash Javeri, Deven Juneja, Pradeep Rangappa, Krishnaswamy Sundararajan, Waleed Alhazzani, Massimo Antonelli, Yaseen M Arabi, Jan Bakker, Laurent J Brochard, Adam M Deane, Bin Du, Sharon Einav, Andrés Esteban, Ognjen Gajic, Samuel M Galvagno, Claude Guérin, Samir Jaber, Gopi C Khilnani, Younsuck Koh, Jean-Baptiste Lascarrou, Flavia R Machado, Manu L N G Malbrain, Jordi Mancebo, Michael T McCurdy, Brendan A McGrath, Sangeeta Mehta, Armand Mekontso-Dessap, Mervyn Mer, Michael Nurok, Pauline K Park, Paolo Pelosi, John V Peter, Jason Phua, David V Pilcher, Lise Piquilloud, Peter Schellongowski, Marcus J Schultz, Manu Shankar-Hari, Suveer Singh, Massimiliano Sorbello, Ravindranath Tiruvoipati, Andrew A Udy, Tobias Welte, Sheila N Myatra
BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. METHODS: Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited...
March 16, 2021: Critical Care: the Official Journal of the Critical Care Forum
#32
JOURNAL ARTICLE
Max Potratz, Henrik Fox, Volker Rudolph, Lothar Faber, Daniel Dumitrescu, Thomas Bitter
BACKGROUND: Respiratory dyssynchrony (RD) is a phenomenon that may be reflected by reduced breathing efficiency (CO2 output relative to minute ventilation, V̇E/V̇CO2 slope) or by Exercise oscillatory ventilation (EOV). Low breathing efficiency and EOV indicate a worse prognosis in chronic heart failure patients with reduced ejection fraction (HFrEF). However, only little is known about their role in other forms of structural myocardial diseases. In this study, we assessed the prognostic impact of RD in hypertrophic non-obstructive cardiomyopathy (HNCM) as a subgroup of patients with heart failure and preserved ejection fraction (HFpEF)...
June 1, 2021: International Journal of Cardiology
#33
JOURNAL ARTICLE
Ricard Mellado Artigas, L Felipe Damiani, Thomas Piraino, Tai Pham, Lu Chen, Michela Rauseo, Irene Telias, Ibrahim Soliman, Detajin Junhasavasdikul, César Santis, Orla M Smith, Ewan Goligher, Norman Comtois, Christer Sinderby, Leo Heunks, Laurent Brochard
BACKGROUND: Reverse triggering is a delayed asynchronous contraction of the diaphragm triggered by passive insufflation by the ventilator in sedated mechanically ventilated patients. The incidence of reverse triggering is unknown. This study aimed at determining the incidence of reverse triggering in critically ill patients under controlled ventilation. METHODS: In this ancillary study, patients were continuously monitored with a catheter measuring the electrical activity of the diaphragm...
May 1, 2021: Anesthesiology
#34
JOURNAL ARTICLE
Rana W Kadry, Mir S Adil, Andrea Sikora Newsome, Payaningal R Somanath
Acute respiratory distress syndrome (ARDS) is a life-threatening form of acute lung injury (ALI) associated with hypoxemic lung damage and inflammation. Matrix metalloproteinase protein-3 (MMP3 or Stromelysin-1) is known to promote vascular injury in ALI/ARDS. Cisatracurium, a nicotinic neuromuscular blocker, is used in ARDS patients to decrease mechanical ventilator dyssynchrony, increase oxygenation, and improve mortality. However, the magnitude and the underlying mechanisms of these potential benefits of cisatracurium remains unclear...
March 15, 2021: Bioscience Trends
#35
JOURNAL ARTICLE
Tài Pham, Jaume Montanya, Irene Telias, Thomas Piraino, Rudys Magrans, Rémi Coudroy, L Felipe Damiani, Ricard Mellado Artigas, Matías Madorno, Lluis Blanch, Laurent Brochard
BACKGROUND: Reverse triggering (RT) is a dyssynchrony defined by a respiratory muscle contraction following a passive mechanical insufflation. It is potentially harmful for the lung and the diaphragm, but its detection is challenging. Magnitude of effort generated by RT is currently unknown. Our objective was to validate supervised methods for automatic detection of RT using only airway pressure (Paw) and flow. A secondary objective was to describe the magnitude of the efforts generated during RT...
February 15, 2021: Critical Care: the Official Journal of the Critical Care Forum
#36
REVIEW
Shinichiro Ohshimo
Acute respiratory distress syndrome (ARDS) is a fatal condition with insufficiently clarified etiology. Supportive care for severe hypoxemia remains the mainstay of essential interventions for ARDS. In recent years, adequate ventilation to prevent ventilator-induced lung injury (VILI) and patient self-inflicted lung injury (P-SILI) as well as lung-protective mechanical ventilation has an increasing attention in ARDS.Ventilation-perfusion mismatch may augment severe hypoxemia and inspiratory drive and consequently induce P-SILI...
February 6, 2021: Journal of Intensive Care
#37
Kai M Chan, Yu C Ng, Hing Y So
BACKGROUND: Patient-ventilator dyssynchrony is commonly due to patient pathophysiologic factors and imprecise ventilator settings. In unusual circumstances, such dyssynchrony can also be due to faults within the equipment preventing from its normal operation during assisted mechanical ventilation. CASE DESCRIPTION: We report a patient showing an unusual pattern of dyssynchronous breathing related to a blocked scavenging system caused by the failure of its rod valve to open...
November 2020: Indian Journal of Critical Care Medicine
#38
REVIEW
Peter D Sottile, David Albers, Bradford J Smith, Marc M Moss
Mortality associated with the acute respiratory distress syndrome remains unacceptably high due in part to ventilator-induced lung injury (VILI). Ventilator dyssynchrony is defined as the inappropriate timing and delivery of a mechanical breath in response to patient effort and may cause VILI. Such deleterious patient-ventilator interactions have recently been termed patient self-inflicted lung injury. This narrative review outlines the detection and frequency of several different types of ventilator dyssynchrony, delineates the different mechanisms by which ventilator dyssynchrony may propagate VILI, and reviews the potential clinical impact of ventilator dyssynchrony...
2020: Annals of Thoracic Medicine
#39
REVIEW
Ewan C Goligher, Annemijn H Jonkman, Jose Dianti, Katerina Vaporidi, Jeremy R Beitler, Bhakti K Patel, Takeshi Yoshida, Samir Jaber, Martin Dres, Tommaso Mauri, Giacomo Bellani, Alexandre Demoule, Laurent Brochard, Leo Heunks
Mechanical ventilation may have adverse effects on both the lung and the diaphragm. Injury to the lung is mediated by excessive mechanical stress and strain, whereas the diaphragm develops atrophy as a consequence of low respiratory effort and injury in case of excessive effort. The lung and diaphragm-protective mechanical ventilation approach aims to protect both organs simultaneously whenever possible. This review summarizes practical strategies for achieving lung and diaphragm-protective targets at the bedside, focusing on inspiratory and expiratory ventilator settings, monitoring of inspiratory effort or respiratory drive, management of dyssynchrony, and sedation considerations...
December 2020: Intensive Care Medicine
#40
JOURNAL ARTICLE
Christopher D Adams, Jerry Altshuler, Brooke L Barlow, Deepali Dixit, Christopher A Droege, Muhammad K Effendi, Mojdeh S Heavner, Jackie P Johnston, Amy L Kiskaddon, Diana G Lemieux, Steven M Lemieux, Audrey J Littlefield, Kent A Owusu, Ginger E Rouse, Melissa L Thompson Bastin, Karen Berger
Evidence-based management of analgesia and sedation in COVID-19-associated acute respiratory distress syndrome remains limited. Non-guideline recommended analgesic and sedative medication regimens and deeper sedation targets have been employed for patients with COVID-19 due to exaggerated analgesia and sedation requirements with extended durations of mechanical ventilation. This, coupled with a desire to minimize nurse entry into COVID-19 patient rooms, marked obesity, altered end-organ function, and evolving medication shortages, presents numerous short- and long-term challenges...
December 2020: Pharmacotherapy
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