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Pressure support ventilation

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https://www.readbyqxmd.com/read/27898439/limiting-sedation-for-patients-with-acute-respiratory-distress-syndrome-time-to-wake-up
#1
Faraaz Ali Shah, Timothy D Girard, Sachin Yende
PURPOSE OF REVIEW: Critically ill patients with acute respiratory distress syndrome (ARDS) may require sedation in their clinical care. The goals of sedation in ARDS patients are to improve patient comfort and tolerance of supportive and therapeutic measures without contributing to adverse outcomes. This review discusses the current evidence for sedation management in patients with ARDS. RECENT FINDINGS: Deep sedation strategies should be avoided in the care of patients with ARDS because deep sedation has been associated with increased time on mechanical ventilation, longer ICU and hospital length of stay, and higher mortality in critically ill patients...
November 24, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27898437/how-best-to-set-the-ventilator-on-extracorporeal-membrane-lung-oxygenation
#2
Luciano Gattinoni, Tommaso Tonetti, Michael Quintel
PURPOSE OF REVIEW: Extracorporeal respiratory support in patients with acute respiratory distress syndrome is applied either as rescue maneuver for life-threatening hypoxemia or as a tool to reduce the harm of mechanical ventilation. Depending on the blood and gas flow, extracorporeal support may completely substitute the natural lung as a gas exchanger (high-flow venovenous bypass) or reduce the need for mechanical ventilation, enabling the removal of a fraction of the metabolically produced CO2...
November 24, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27892756/use-of-high-non-invasive-respiratory-support-pressures-in-preterm-neonates-a-single-centre-experience
#3
Abdulaziz Binmanee, Salhab El Helou, Sandesh Shivananda, Christoph Fusch, Amit Mukerji
PURPOSE: To describe the incidence, indications and clinical outcomes following high pressures on non-invasive respiratory support (NRS) in preterm neonates. STUDY DESIGN: Retrospective cohort study of all neonates with BW < 1,500 g admitted from July 2012 to June 2014 and placed on high NRS, defined as mean airway pressure ≥ 10 cm H2O for at least 12 continuous hours using NCPAP and/or nasal high frequency ventilation (NIHFV). Clinical and physiological outcomes following high NRS were ascertained...
November 28, 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27884349/endotoxemia-accelerates-diaphragm-dysfunction-in-ventilated-rabbits
#4
Yi Yang, Tao Yu, Chun Pan, Federico Longhini, Ling Liu, Yingzi Huang, Fengmei Guo, Haibo Qiu
BACKGROUND: Ventilators may induce diaphragm dysfunction, and most of the septic population who are admitted to the intensive care unit require mechanical ventilation. However, there is no evidence that sepsis accelerates the onset of ventilator-induced diaphragm dysfunction or affects the microcirculation. Our study investigated whether lipopolysaccharide (LPS)-induced endotoxemia accelerated diaphragm dysfunction in ventilated rabbits by evaluating microcirculation, lipid accumulation, and diaphragm contractility...
December 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27879379/performance-of-the-pneux-system-a-bench-study-comparison-with-4-other-endotracheal-tube-cuffs
#5
Christopher T Chenelle, Taiga Itagaki, Daniel F Fisher, Lorenzo Berra, Robert M Kacmarek
BACKGROUND: Cuff design affects microaspiration, a risk factor for pneumonia. We questioned whether the PneuX low-volume fold-free cuff design would prevent cuff leakage and maintain the same tracheal wall pressure as high-volume, low-pressure (HVLP) cuffs. METHODS: We evaluated 4 HVLP-cuffed endotracheal tubes (ETTs), Hi-Lo (polyvinyl chloride [PVC]), Microcuff (polyurethane [PU]), SealGuard (PU+tapered), and TaperGuard (PVC+tapered), and the PneuX with its dedicated tracheal seal monitor...
November 22, 2016: Respiratory Care
https://www.readbyqxmd.com/read/27878445/can-non-invasive-ventilation-modify-central-venous-pressure-comparison-between-invasive-measurement-and-ultrasonographic-evaluation
#6
Maurizio Zanobetti, Alessio Prota, Alessandro Coppa, Laura Giordano, Sofia Bigiarini, Peiman Nazerian, Francesca Innocenti, Alberto Conti, Federica Trausi, Simone Vanni, Giuseppe Pepe, Riccardo Pini
Central venous pressure (CVP) is primarily measured to assess intravascular volume status and heart preload. In clinical practice, the measuring device most commonly used in emergency departments and intensive care units, is an electronic transducer that interconnects a central venous catheter (CVC) with a monitoring system. Non-invasive ventilation (NIV) consists in a breathing support that supplies a positive pressure in airways through a mask or a cask though not using an endotracheal prosthesis. In emergency settings, non-invasive ultrasonography evaluation of CVP, and hence of intravascular volume status entail the measurement by a subxiphoid approach of inferior vena cava diameter and its variations in relation to respiratory activity...
November 22, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27875408/diagnosing-acute-respiratory-distress-syndrome-in-resource-limited-settings-the-kigali-modification-of-the-berlin-definition
#7
Elisabeth D Riviello, Egide Buregeya, Theogene Twagirumugabe
PURPOSE OF REVIEW: The acute respiratory distress syndrome (ARDS) was re-defined by a panel of experts in Berlin in 2012. Although the Berlin criteria improved upon the validity and reliability of the definition, it did not make diagnosis of ARDS in resource limited settings possible. Mechanical ventilation, arterial blood gas measurements, and chest radiographs are not feasible in many regions of the world. In 2014, we proposed and applied the Kigali modification of the Berlin definition in a hospital in Rwanda...
November 19, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27875282/metabolic-requirement-of-septic-shock-patients-before-and-after-liberation-from-mechanical-ventilation
#8
Peggy Siu-Pik Lee, Kar Lung Lee, James A Betts, Kin Ip Law
OBJECTIVES: This study identified the difference in energy expenditure and substrate utilization of patients during and upon liberation from mechanical ventilation. METHODS: Patients under intensive care who were diagnosed with septic shock and dependent on mechanical ventilation were recruited. Indirect calorimetry measurements were performed during and upon liberation from mechanical ventilation. RESULTS: Thirty-five patients were recruited (20 men and 15 women; mean age, 69 ± 10 years)...
October 3, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/27871584/a-comparison-of-3-ventilation-strategies-in-children-younger-than-1-year-using-a-proseal-laryngeal-mask-airway-a-randomized-controlled-trial
#9
T Wesley Templeton, Lauren K Hoke, Leah B Templeton, Douglas G Ririe, Danielle M Rose, Yvon F Bryan
STUDY OBJECTIVE: To determine quantitative differences in several routinely measured ventilation parameters using a standardized anesthetic technique and 3 different ventilation modalities in patients younger than 1 year with a ProSeal laryngeal mask airway (PLMA). DESIGN: Randomized prospective study. SETTING: Tertiary care pediatric hospital. PATIENTS: Thirty-nine American Society Anesthesiologists classifications 1 to 2, pediatric patients younger than 1 year...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27866528/-effect-of-non-invasive-nava-on-the-patients-with-acute-exacerbation-of-chronic-obstructive-pulmonary-disease
#10
D Q Wang, J Luo, X H Xiong, L H Zhu, W W Zhang
Objective: To observe the effect of non-invasive neurally adjusted ventilatory assist (NIV-NAVA) on patient-ventilator synchrony and effect of gas exchange in patients with acute exacerbation of chronic obstructive pulmonary disease compared with NIV-pressure support ventilation (PSV). Methods: This was a prospective study of 40 patients with AECOPD given 30-min trials of NIV with NIV-PSV group (n=20) and NAVA group (n=20) in random order. Arterial blood gas analysis (ABGs), main asynchrony events and asynchrony index were quantified...
November 15, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27865481/the-influence-of-tethering-and-gravity-on-the-stability-of-compliant-liquid-lined-airways
#11
Jeremy Whang, Chandler Faulman, Thomas A Itin, Donald P Gaver
This study revolves around two simple questions: 1) how does pulmonary airway recruitment/de-recruitment (RecDer) depend on the tethering support provided by surrounding airways and alveoli, and 2) does airway angle of inclination (θ) influence airway stability? These two questions are critical to understanding the existence and prevention of atelectrauma, which may contribute to ventilator-induced lung injury (VILI). To address these questions, we develop PDMS 2mm ID compliant tubes that mimic pulmonary airways...
November 11, 2016: Journal of Biomechanics
https://www.readbyqxmd.com/read/27861467/antenatal-dexamethasone-vs-betamethasone-dosing-for-lung-maturation-in-fetal-sheep
#12
Augusto F Schmidt, Matthew W Kemp, Paranthaman S Kannan, Boris W Kramer, John P Newnham, Suhas G Kallapur, Alan H Jobe
BackgroundDexamethasone-phosphate (Dex-PO4) and the combination betamethasone-phosphate (Beta-PO4) + betamethasone-acetate (Beta-Ac) are the most used antenatal corticosteroids to promote fetal lung maturation . We compared fetal lung maturation induced by Beta-Ac+Beta-PO4, Dex-PO4, or Beta-PO4 alone.MethodsPregnant ewes received 2 intramuscular doses 24h apart of 0.25mg/kg/dose of Beta-Ac+Beta-PO4, Dex-PO4 or Beta-PO4; or 2 doses of 0.125mg/kg/dose of Beta-PO4 at 6h, 12h, or 24h intervals. Fetuses were delivered 48h after the first dose and ventilated for 30min...
November 18, 2016: Pediatric Research
https://www.readbyqxmd.com/read/27858374/prediction-of-fluid-responsiveness-an-update
#13
REVIEW
Xavier Monnet, Paul E Marik, Jean-Louis Teboul
In patients with acute circulatory failure, the decision to give fluids or not should not be taken lightly. The risk of overzealous fluid administration has been clearly established. Moreover, volume expansion does not always increase cardiac output as one expects. Thus, after the very initial phase and/or if fluid losses are not obvious, predicting fluid responsiveness should be the first step of fluid strategy. For this purpose, the central venous pressure as well as other "static" markers of preload has been used for decades, but they are not reliable...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27853329/high-flow-nasal-cannulae-versus-nasal-continuous-positive-airway-pressure-in-neonates-with-respiratory-distress-syndrome-managed-with-insure-method-a-randomized-clinical-trial
#14
Maliheh Kadivar, Ziba Mosayebi, Nosrat Razi, Shahin Nariman, Razieh Sangsari
BACKGROUND: In recent years, various noninvasive respiratory support (NRS) of ventilation has been provided more in neonates. The aim of this study was to compare the effect of HFNC with NCPAP in post-extubation of preterm infants with RDS after INSURE method (intubation, surfactant, extubation). METHODS: A total of 54 preterm infants with RDS (respiratory distress syndrome) were enrolled in this study. Using a randomized sequence, they were assigned into two groups after INSURE method...
November 2016: Iranian Journal of Medical Sciences
https://www.readbyqxmd.com/read/27849235/randomized-controlled-trial-comparing-nasal-intermittent-positive-pressure-ventilation-and-nasal-continuous-positive-airway-pressure-in-premature-infants-after-tracheal-extubation
#15
Daniela Franco Rizzo Komatsu, Edna Maria de Albuquerque Diniz, Alexandre Archanjo Ferraro, Maria Esther Jurvest Rivero Ceccon, Flávio Adolfo Costa Vaz
Objective: To analyze the frequency of extubation failure in premature infants using conventional mechanical ventilation (MV) after extubation in groups subjected to nasal intermittent positive pressure ventilation (nIPPV) and continuous positive airway pressure (nCPAP). Method: Seventy-two premature infants with respiratory failure were studied, with a gestational age (GA) ≤ 36 weeks and birth weight (BW) > 750 g, who required tracheal intubation and mechanical ventilation...
September 2016: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/27842750/ventilatory-management-of-the-noninjured-lung
#16
REVIEW
David L Bowton, Louis Keith Scott
This article reviews aspects of mechanical ventilation in patients without lung injury, patients in the perioperative period, and those with neurologic injury or disease including spinal cord injury. Specific emphasis is placed on ventilator strategies, including timing and indications for tracheostomy. Lung protective ventilation, using low tidal volumes and modest levels of positive end-expiratory pressure, should be the default consideration in all patients requiring mechanical ventilatory support. The exception may be the patient with high cervical spinal cord injuries who requires mechanical ventilatory support...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27836647/corrective-effect-of-diaphragm-pacing-on-the-decrease-in-cardiac-output-induced-by-positive-pressure-mechanical-ventilation-in-anesthetized-sheep
#17
Hicham Masmoudi, Romain Persichini, Jérôme Cecchini, Julie Delemazure, Martin Dres, Julien Mayaux, Alexandre Demoule, Jalal Assouad, Thomas Similowski
Positive pressure ventilation (PPV) is a fundamental life support measure, but it decreases cardiac output (CO). Diaphragmatic contractions produce negative intrathoracic and positive abdominal pressures, promoting splanchnic venous return. We hypothesized that: 1) diaphragm pacing alone could produce adequate ventilation without decreasing CO; 2) diaphragm pacing on top of PPV could improve CO. Of 11 anesthetized and mechanically ventilated ewes (39.6±5.9kg), 3 were discarded from analysis because of hemodynamic instability during the experiment, and 8 retained for analysis...
November 9, 2016: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/27836099/-management-of-cardiogenic-shock-results-from-a-survey-in-france-and-belgium
#18
S Champion, N Deye
PURPOSE: Physician survey on cardiogenic shock management; recommendations for the management of patients with cardiogenic shock are based mostly on experts' opinion. METHODS: Overall 1585 emails were sent to "senior" intensive care physicians from France and Belgium from September 2014 to march 2015. Response rate was 10% (157 respondents). Agreement was assessed based on RAND/UCLA methodology. RESULTS: Continuous monitoring of cardiac output, vascular filling, noninvasive ventilation were deemed appropriate...
November 8, 2016: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/27826324/respiratory-support-with-heated-humidified-high-flow-nasal-cannula-in-preterm-infants
#19
REVIEW
Ga Won Jeon
The incidence of bronchopulmonary dysplasia (BPD) has not decreased over the last decade. The most important way to decrease BPD is by weaning the patient from the ventilator as soon as possible in order to reduce ventilator-induced lung injury that underlies BPD, and by using a noninvasive ventilator (NIV). Use of a heated, humidified, high flow nasal cannula (HHHFNC), which is the most recently introduced NIV mode for respiratory support in preterm infants, is rapidly increasing in many neonatal intensive care units due to the technical ease of use without sealing, and the attending physician's preference compared to other NIV modes...
October 2016: Korean Journal of Pediatrics
https://www.readbyqxmd.com/read/27825893/evaluating-the-efficacy-safety-and-tolerability-of-serelaxin-when-added-to-standard-therapy-in-asian-patients-with-acute-heart-failure-the-design-and-rationale-of-relax-ahf-asia-trial
#20
Naoki Sato, Carolyn S P Lam, John R Teerlink, Barry H Greenberg, Hiroyuki Tsutsui, Byung-Hee Oh, Jian Zhang, Martin Lefkowitz, Tsushung A Hua, Thomas Holbro, Miriam Marshood, Xing Li Wang, Junbo Ge
BACKGROUND: Acute heart failure (AHF), a common and growing health-concern worldwide, is associated with high risk of post-discharge rehospitalization and mortality. Existing evidence indicates potential therapeutic benefits of serelaxin in Caucasian AHF patients, while corresponding data in Asians remain scarce. RELAX-AHF-ASIA, a multinational, randomized, double-blind, placebo-controlled, phase-III trial, will evaluate the effects of serelaxin on symptom relief and clinical outcomes in Asian AHF patients, using novel assessments...
November 4, 2016: Journal of Cardiac Failure
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