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Pressure support ventilation

Jaime Retamal, Daniel Hurtado, Nicolás Villarroel, Alejandro Bruhn, Guillermo Bugedo, Marcelo Britto Passos Amato, Eduardo Leite Vieira Costa, Göran Hedenstierna, Anders Larsson, João Batista Borges
OBJECTIVE: It is known that ventilator-induced lung injury causes increased pulmonary inflammation. It has been suggested that one of the underlying mechanisms may be strain. The aim of this study was to investigate whether lung regional strain correlates with regional inflammation in a porcine model of acute respiratory distress syndrome. DESIGN: Retrospective analysis of CT images and positron emission tomography images using [F]fluoro-2-deoxy-D-glucose. SETTING: University animal research laboratory...
March 9, 2018: Critical Care Medicine
S Hoang, A Georget, J Asselineau, A-G Venier, C Leroyer, A M Rogues, R Thiébaut
OBJECTIVE: To assess the role of environment, medical care and individual risks factors for P. aeruginosa colonization and infection. STUDY DESIGN AND SETTING: A French multicentric prospective study involved ten ICUs for a five months period. Every adult patient newly hospitalized in ICUs with no P. aeruginosa carriage up to 48 hours after admission was included and weekly screened before discharge or death. Screening swabs were either rectal, sputum or oropharyngeal samples...
2018: PloS One
Michael P Meyer, Elizabeth Nevill, Maisie M Wong
BACKGROUND: Placental transfusion (by means of delayed cord clamping (DCC), cord milking, or cord stripping) confers benefits for preterm infants. It is not known if providing respiratory support to preterm infants before cord clamping improves outcomes. OBJECTIVES: To assess the efficacy and safety of respiratory support provided during DCC compared with no respiratory support during placental transfusion (in the form of DCC, milking, or stripping) in preterm infants immediately after delivery...
March 8, 2018: Cochrane Database of Systematic Reviews
Gul Gursel, Avsar Zerman, Burcu Basarik, Kamil Gonderen, Muge Aydogdu, Serriyye Memmedova
Auto-titrating noninvasive ventilation (NIV) has been developed as a new mode applying variable expiratory-positive airway pressure (EPAP) in addition to variable inspiratory pressures (IPAP), both to deliver targeted tidal volume (VT) and to eliminate upper airway resistance. The purpose of this study is to evaluate whether NIV with auto-titrating mode will decrease more PaCO2 within a shorter time compared to volume-assured mode in hypercapnic intensive care unit (ICU) patients. The hypercapnic respiratory failure patients treated with average volume assured pressure support- automated EPAP mode (group1) were compared with those treated with average volume-assured pressure support mode (group2)...
March 6, 2018: Internal and Emergency Medicine
Karen E A Burns, Stavroula Raptis, Rosane Nisenbaum, Leena Rizvi, Andrew Jones, Jyoti Bakshi, Wylie Tan, Aleksander Meret, Deborah J Cook, Francois Lellouche, Scott K Epstein, David Gattas, Farhad N Kapadia, Jesús Villar, Laurent Brochard, Martin R Lessard, Maureen O Meade
RATIONALE: Randomized trials and meta-analyses have informed several aspects of weaning. Results are rarely replicated in practice as evidence is applied in intensive care units (ICUs) that differ from the settings in which it was generated. OBJECTIVES: We aimed to (i) describe weaning practice variation (identifying weaning candidates, conducting spontaneous breathing trials (SBTs), using ventilator modes, other aspects of care during weaning); (ii) characterize regional differences in weaning practices; and (iii) identify predictors of common practices...
March 6, 2018: Annals of the American Thoracic Society
Hyun Choi, Dinesh Krishnamoorthy
BACKGROUND: Pulmonary embolism (PE) during pregnancy remains one of the leading causes of maternal morbidity and mortality in the developed world. However, there is a paucity of high-quality evidence resulting in a lack of consensus in managing this group of patients. The aims of the study were to address the diagnostic utility of D-dimer for suspected PE in pregnant and post-partum patients and to identify any clinical presentation variables that are predictors of PE in this group of patients...
March 5, 2018: International Journal of Emergency Medicine
Ponraj Kamatchi Sundaram, Pankaj Arora, Jinendrakumar Ramalingam, Jorson D'Costa
Background: Severe head injury (SHI) is a major cause of mortality and morbidity across the world. The current paradigm of management of SHI involves admission in Intensive Care Unit (ICU), mechanical ventilation (MV), and intracranial pressure (ICP) monitoring. Such resources are expensive and often unavailable in the developing world. Objective: MV or ICP monitoring was unavailable for our patients due to the scarcity of resources. Hence, other alternatives were considered to prevent secondary brain injury due to hypoxia...
January 2018: Asian Journal of Neurosurgery
Yoshihiro Nozaki, Lisheng Lin, Yoshiaki Kato
Diaphragm excursion method is unsuitable for diagnosis of diaphragm paralysis during positive pressure ventilation. We diagnosed diaphragm paralysis in a neonate, without interrupting positive pressure respiratory support after cardiac surgery, using the diaphragm thickness fraction, which could be evaluated during mechanical ventilation and was unaffected by bowel gases. The diaphragm thickness fraction method can help diagnose diaphragm dysfunction using only echography.
March 1, 2018: Cardiology in the Young
Laurent Brochard, Irene Telias
No abstract text is available yet for this article.
March 2018: Critical Care Medicine
Stacey Gunn, Sreelatha Naik, Matt Travis Bianchi, Robert Joseph Thomas
Study Objectives: Adaptive servo ventilation (ASV) devices provide anti-cyclic pressure support for treatment of central/complex sleep apnea, including in heart failure patients. Variability in responses in the clinic and negative clinical trials motivated assessment of standard and novel signal biomarkers for ASV efficacy. Methods: Multiple clinical databases were queried to assess potential signal biomarkers of ASV effectiveness, including 1) Attended laboratory adaptive ventilation titrations: 108, of which 66 had mainstream ETCO2 measurements...
February 17, 2018: Sleep
N Delvau, A Penaloza, G Liistro, F Thys, I K Delattre, Philippe Hantson, P Gianello, P M Roy
INTRODUCTION: In an experimental study on carbon monoxide (CO) exposure in swine, we aimed to compare the influence of oxygen therapy using a non-rebreathing mask (NRM) to continuous positive airway pressure (CPAP) and two pressure support ventilation (PSV) devices on the decrease of the terminal elimination half-life of carboxyhemoglobin (COHb t1/2 ). This was the primary outcome. METHODS: Eight spontaneously breathing pigs were sedated by propofol and exposed to 940 ppm CO several times (n = 25) to obtain COHb levels of 30%...
February 21, 2018: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
Eddy Fan, Daniel Brodie, Arthur S Slutsky
Importance: Acute respiratory distress syndrome (ARDS) is a life-threatening form of respiratory failure that affects approximately 200 000 patients each year in the United States, resulting in nearly 75 000 deaths annually. Globally, ARDS accounts for 10% of intensive care unit admissions, representing more than 3 million patients with ARDS annually. Objective: To review advances in diagnosis and treatment of ARDS over the last 5 years. Evidence Review: We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from 2012 to 2017 focusing on randomized clinical trials, meta-analyses, systematic reviews, and clinical practice guidelines...
February 20, 2018: JAMA: the Journal of the American Medical Association
Isabelle Vivodtzev, Renaud Tamisier, Marilie Croteau, Jean-Christian Borel, Angélique Grangier, Bernard Wuyam, Patrick Lévy, Caroline Minville, Frédéric Sériès, François Maltais, Jean-Louis Pépin
BACKGROUND: Obstructive sleep apnoea (OSA) and obesity are interdependent chronic diseases sharing reduced exercise tolerance and high cardiovascular risk. INTERVENTION: A 3-month intervention with innovative training modalities would further improve functional capacity and cardiovascular health than usual cycle exercise training in already continuous positive airway pressure (CPAP)-treated obese patients with OSA. METHODS: Fifty three patients (35<body mass index (BMI) <45 kg/m2 ) were randomly allocated to exercise training on a cycle ergometer, either alone (ERGO) or with respiratory muscle training (ERGO+RMT) or non-invasive ventilation (ERGO+NIV)...
February 20, 2018: Thorax
Martin J Tobin
The primary purpose of mechanical ventilation is to decrease work of breathing. Achieving this goal requires that cycling of the ventilator be carefully aligned with the intrinsic rhythm of a patient's respiratory center output. Problems arise at the point of ventilator triggering, post-trigger inflation, and inspiration-expiration switchover. Careful, iterative adjustments of ventilator settings are required to minimize work of breathing. Use of protocols for the selection of ventilator settings can lead to complications (including alveolar overdistention) and risk of death...
February 2018: Annals of the American Thoracic Society
John Botha, Cameron Green, Ian Carney, Kavi Haji, Sachin Gupta, Ravindranath Tiruvoipati
OBJECTIVE: Proportional assist ventilation with load-adjustable gain factors (PAV+) is a mode of ventilation that provides assistance in proportion to patient effort. This may have physiological and clinical advantages when compared with pressure support ventilation (PSV). Our objective was to compare these two modes in patients being weaned from mechanical ventilation. DESIGN: Prospective randomised controlled trial comparing PSV with PAV+. SETTING: University-affiliated, tertiary referral intensive care unit (ICU)...
March 2018: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Jaye Hampson, Cameron Green, Joanne Stewart, Lauren Armitstead, Gemma Degan, Andrea Aubrey, Eldho Paul, Ravindranath Tiruvoipati
Background: Endotracheal tube (ETT) fasteners such as the AnchorFast™ claim to assist with the prevention of oral pressure injuries in intubated patients, however evidence to support their clinical efficacy is limited. This retrospective observational study aimed to investigate the impact of the introduction of the AnchorFast™ device on the incidence of oral pressure injuries in mechanically ventilated patients. Methods: Data was collected from patient case notes and clinical incident reports for October 2010 to June 2013 ( pre-AnchorFast) and July 2013 to March 2016 ( post-AnchorFast) ...
2018: BMC Nursing
Gregory J Stevens, Joel W Warfel, James K Aden, Scott D Blackwell
Introduction: Endotracheal intubation is a medical procedure that is often indicated in both the perioperative and critical care environments. Cuffed endotracheal tubes (ETT) allow for safer and more efficient delivery of positive pressure ventilation, as well as create a barrier to reduce the risk of micro-aspiration and anesthetic pollution in the operating room environment. Over-inflation of the endotracheal cuff can lead to serious and harmful sequelae. This study aimed to assess if departmental education paired with ready access to a manometer to assess cuff pressure would result in an improvement in the proportion of ETT cuff pressures in the goal range...
February 13, 2018: Military Medicine
P Palumbo, S Usai, C Amatucci, B Perotti, L Ruggeri, G Illuminati, G Tellan
BACKGROUND: The extension of indications for procedures in a Day Surgery (DS) setting has led to changes in the anesthetic and surgical treatment of Inguinal Hernias (IH). According to the recommendations of the European Hernia Society, the treatment of IH in DS units should be performed under Monitored Anesthesia Care (MAC). PATIENTS AND METHODS: 960 patients underwent IH repairs over a period of 24 months. The patients were randomly divided into two groups: R (remifentanil) and F (fentanyl); the group F was considered as a control group...
November 2017: Il Giornale di Chirurgia
Jennifer M Guay, Dru Carvi, Deborah A Raines, Wendy A Luce
Respiratory distress continues to be a major cause of neonatal morbidity. Current neonatal practice recommends the use of nasal continuous positive airway pressure (nCPAP) in the immediate resuscitation and continued support of neonates of all gestations with clinical manifestations of respiratory distress. Despite the many short- and long-term benefits of nCPAP, many neonatal care units have met resistance in its routine use. Although there have been numerous recent publications investigating the use and outcomes of various modes of nCPAP delivery, surfactant administration, mechanical ventilation, and other forms of noninvasive respiratory support (high-flow nasal cannula, nasal intermittent positive pressure ventilation), there has been a relative lack of publications addressing the practical bedside care of infants managed on nCPAP...
January 1, 2018: Neonatal Network: NN
Zhihai Ju, Jinhui Ma, Chen Wang, Jie Yu, Yeru Qiao, Feilong Hei
Pumpless extracorporeal lung assist (pECLA) has been reported to efficiently remove the systemic CO 2 production and provide mild to moderate oxygenation, thereby allowing for ventilator settings and modes prioritizing oxygenation and lung protection. However, an adequate bypass flow, the capacity to provide respiratory support and the effect on the inflammatory cascade response and tissue perfusion require further study to be determined. After induction of acute lung injury (ALI) by oleic acid injection, pECLA was implemented in 12 anaesthetized and mechanically ventilated dogs for 48 h...
February 2018: Experimental and Therapeutic Medicine
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