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https://www.readbyqxmd.com/read/28051989/minute-ventilation-limitations-of-two-field-transport-ventilators
#1
Dale F Szpisjak, Gregory Horn, Samuel Shalov, Alvin Angelo Abes, Lauren Van Decar
Knowledge of transport ventilator performance impacts patient safety. This study compared minute ventilation (VE) of the MOVES and Uni-Vent 731 when ventilating the VentAid Training Test Lung with compliance (C) ranging from 0.02 to 0.10 L/cm H2O and three different airway resistances (R) (none, Rp5, or Rp20). Tidal volume (VT) was 800 ± 25 mL. Respiratory rate was increased to ventilator's maximum or until auto-PEEP > 5 cm H2O. Respiratory parameters were recorded with the RSS 100HR Research Pneumotach...
January 2017: Military Medicine
https://www.readbyqxmd.com/read/28049742/feasibility-of-mid-frequency-ventilation-among-infants-with-respiratory-distress-syndrome
#2
Ramachandra Bhat, John Kelleher, Namasivayam Ambalavanan, Robert L Chatburn, Eduardo Mireles-Cabodevila, Waldemar A Carlo
BACKGROUND: Mid-frequency ventilation, a strategy of using conventional ventilators at high frequencies, may reduce lung injury but has had limited evaluation in neonates. Hence, a randomized crossover study was designed to assess the feasibility of using mid-frequency ventilation in preterm infants with respiratory distress syndrome. METHODS: Twelve preterm infants (≥500 g and ≥24 weeks gestational age) who were receiving pressure-limited conventional ventilation with frequencies ≤60 breaths/min for respiratory distress syndrome were randomized to periods of mid-frequency ventilation (conventional ventilation with the fastest frequency up to 150 breaths/min that gave complete inspiration and expiration) or conventional ventilation (frequency ≤60 breaths/min), each lasting 2 h using a crossover design...
January 3, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28000204/early-severe-acute-respiratory-distress-syndrome-what-s-going-on-part-i-pathophysiology
#3
Fabrice Petitjeans, Cyrille Pichot, Marco Ghignone, Luc Quintin
Severe acute respiratory distress syndrome (ARDS, PaO₂/FiO₂ < 100 on PEEP ≥ 5 cm H₂O) is treated using controlled mechanical ventilation (CMV), recently combined with muscle relaxation for 48 h and prone positioning. While the amplitude of tidal volume appears set < 6 mL kg⁻¹, the level of positive end-expiratory pressure (PEEP) remains controversial. This overview summarizes several salient points, namely: a) ARDS is an oxygenation defect: consolidation/ difuse alveolar damage is reversed by PEEP and/or prone positioning, at least during the early phase of ARDS b) ARDS is a dynamic disease and partially iatrogenic...
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/27999152/optimizing-peep-by-electrical-impedance-tomography-in-a-porcine-animal-model-of-ards
#4
Nadine Hochhausen, Ingeborg Biener, Rolf Rossaint, Andreas Follmann, Christian Bleilevens, Till Braunschweig, Steffen Leonhardt, Michael Czaplik
BACKGROUND: Mechanical ventilation is necessary in diverse clinical circumstances. Especially in the context of ARDS, so-called protective ventilation strategies must be followed. It is already known that PEEP might enhance oxygenation in ARDS. However, determining the optimal PEEP settings in clinical routines is challenging. Electrical impedance tomography (EIT) is a promising technique with which to adjust ventilator settings. We investigated whether the combination of different EIT parameters, namely the global inhomogeneity and hyperdistension indices, may lead to a feasible and safe PEEP setting...
December 20, 2016: Respiratory Care
https://www.readbyqxmd.com/read/27931033/low-positive-airway-pressure-without-positive-end-expiratory-pressure-decreases-blood-loss-during-hepatectomy-in-living-liver-donors
#5
Tomohiro Iguchi, Toru Ikegami, Tetsuhiro Fujiyoshi, Tomoharu Yoshizumi, Ken Shirabe, Yoshihiko Maehara
BACKGROUND/AIMS: Despite the development of strategies to minimize blood loss during hepatectomy challenges remain. Our aim was to determine whether low positive airway pressure (PAP) without positive end-expiratory pressure (PEEP) could minimize blood loss during hepatectomy. METHODS: Forty-one living liver donors who underwent extended left lobectomy or right lobectomy between December 2012 and November 2013 were retrospectively analyzed. In the standard PAP group (n = 18), tidal volume was 8-10 ml/kg, respiratory rate was 10-12/min and PEEP was maintained at 5 cm H2O...
December 9, 2016: Digestive Surgery
https://www.readbyqxmd.com/read/27923979/functional-respiratory-imaging-regional-strain-and-expiratory-time-constants-at-three-levels-of-positive-end-expiratory-pressure-in-an-ex%C3%A2-vivo-pig-model
#6
William R Henderson, Yannick Molgat-Seon, Wim Vos, Rachel Lipson, Francisca Ferreira, Miranda Kirby, Cedric Van Holsbeke, Paolo B Dominelli, Donald E G Griesdale, Mypinder Sekhon, Harvey O Coxson, John Mayo, A William Sheel
Heterogeneity in regional end expiratory lung volume (EELV) may lead to variations in regional strain (ε). High ε levels have been associated with ventilator-associated lung injury (VALI). While both whole lung and regional EELV may be affected by changes in positive end-expiratory pressure (PEEP), regional variations are not revealed by conventional respiratory system measurements. Differential rates of deflation of adjacent lung units due to regional variation in expiratory time constants (τE) may create localized regions of ε that are significantly greater than implied by whole lung measures...
2016: Physiological Reports
https://www.readbyqxmd.com/read/27914908/association-between-ventilatory-settings-and-development-of-acute-respiratory-distress-syndrome-in-mechanically-ventilated-patients-due-to-brain-injury
#7
Eva Tejerina, Paolo Pelosi, Alfonso Muriel, Oscar Peñuelas, Yuda Sutherasan, Fernando Frutos-Vivar, Nicolás Nin, Andrew R Davies, Fernando Rios, Damian A Violi, Konstantinos Raymondos, Javier Hurtado, Marco González, Bin Du, Pravin Amin, Salvatore M Maggiore, Arnaud W Thille, Marco Antonio Soares, Manuel Jibaja, Asisclo J Villagomez, Michael A Kuiper, Younsuck Koh, Rui P Moreno, Amine Ali Zeggwagh, Dimitrios Matamis, Antonio Anzueto, Niall D Ferguson, Andrés Esteban
PURPOSE: In neurologically critically ill patients with mechanical ventilation (MV), the development of acute respiratory distress syndrome (ARDS) is a major contributor to morbidity and mortality, but the role of ventilatory management has been scarcely evaluated. We evaluate the association of tidal volume, level of PEEP and driving pressure with the development of ARDS in a population of patients with brain injury. MATERIALS AND METHODS: We performed a secondary analysis of a prospective, observational study on mechanical ventilation...
November 18, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27894328/effect-of-driving-pressure-on-mortality-in-ards-patients-during-lung-protective-mechanical-ventilation%C3%A2-in-two-randomized-controlled-trials
#8
Claude Guérin, Laurent Papazian, Jean Reignier, Louis Ayzac, Anderson Loundou, Jean-Marie Forel
BACKGROUND: Driving pressure (ΔPrs) across the respiratory system is suggested as the strongest predictor of hospital mortality in patients with acute respiratory distress syndrome (ARDS). We wonder whether this result is related to the range of tidal volume (VT). Therefore, we investigated ΔPrs in two trials in which strict lung-protective mechanical ventilation was applied in ARDS. Our working hypothesis was that ΔPrs is a risk factor for mortality just like compliance (Crs) or plateau pressure (Pplat,rs) of the respiratory system...
November 29, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27887604/variable-ventilation-improves-pulmonary-function-and-reduces-lung-damage-without-increasing-bacterial-translocation-in-a-rat-model-of-experimental-pneumonia
#9
Raquel F de Magalhães, Cynthia S Samary, Raquel S Santos, Milena V de Oliveira, Nazareth N Rocha, Cintia L Santos, Jamil Kitoko, Carlos A M Silva, Caroline L Hildebrandt, Cassiano F Goncalves-de-Albuquerque, Adriana R Silva, Hugo C Faria-Neto, Vanessa Martins, Vera L Capelozzi, Robert Huhle, Marcelo M Morales, Priscilla Olsen, Paolo Pelosi, Marcelo Gama de Abreu, Patricia R M Rocco, Pedro L Silva
BACKGROUND: Variable ventilation has been shown to improve pulmonary function and reduce lung damage in different models of acute respiratory distress syndrome. Nevertheless, variable ventilation has not been tested during pneumonia. Theoretically, periodic increases in tidal volume (VT) and airway pressures might worsen the impairment of alveolar barrier function usually seen in pneumonia and could increase bacterial translocation into the bloodstream. We investigated the impact of variable ventilation on lung function and histologic damage, as well as markers of lung inflammation, epithelial and endothelial cell damage, and alveolar stress, and bacterial translocation in experimental pneumonia...
November 25, 2016: Respiratory Research
https://www.readbyqxmd.com/read/27881405/effectiveness-of-individualized-lung-recruitment-strategies-at-birth-an-experimental-study-in-preterm-lambs
#10
David G Tingay, Anushi Rajapaksa, Emanuela Zannin, Prue M Pereira-Fantini, Raffaele L Dellaca, Elizabeth J Perkins, Cornelis E E Zonneveld, Andy Adler, Don Black, Inéz Frerichs, Anna Lavizzari, Magdy Sourial, Bartłomiej Grychtol, Fabio Mosca, Peter G Davis
Respiratory transition at birth involves rapidly clearing fetal lung liquid and preventing efflux back into the lung while aeration is established. We have developed a sustained inflation (SIOPT) individualized to volume response and a dynamic tidal positive end-expiratory pressure (PEEP) (open lung volume, OLV) strategy that both enhance this process. We aimed to compare the effect of each with a group managed with PEEP of 8 cmH2O and no recruitment maneuver (No-RM), on gas exchange, lung mechanics, spatiotemporal aeration, and lung injury in 127 ± 1 day preterm lambs...
January 1, 2017: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://www.readbyqxmd.com/read/27879379/performance-of-the-pneux-system-a-bench-study-comparison-with-4-other-endotracheal-tube-cuffs
#11
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...
January 2017: Respiratory Care
https://www.readbyqxmd.com/read/27855477/recruitment-manoeuvres-for-adults-with-acute-respiratory-distress-syndrome-receiving-mechanical-ventilation
#12
REVIEW
Carol Hodgson, Ewan C Goligher, Meredith E Young, Jennifer L Keating, Anne E Holland, Lorena Romero, Scott J Bradley, David Tuxen
BACKGROUND: Recruitment manoeuvres involve transient elevations in airway pressure applied during mechanical ventilation to open ('recruit') collapsed lung units and increase the number of alveoli participating in tidal ventilation. Recruitment manoeuvres are often used to treat patients in intensive care who have acute respiratory distress syndrome (ARDS), but the effect of this treatment on clinical outcomes has not been well established. This systematic review is an update of a Cochrane review originally published in 2009...
17, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27842745/managing-acute-lung-injury
#13
REVIEW
Gregory A Schmidt
The foundation of mechanical ventilation for acute respiratory distress syndrome involves limiting lung overdistention by using small tidal volumes or transpulmonary pressures. Potential for additional lung recruitment with higher positive end-expiratory pressure (PEEP) should be assessed. When stress index indicates tidal recruitment-derecruitment, PEEP is increased to higher values. Alternatively, a high PEEP table is used in all patients. When these conventional approaches are insufficient to sustain acceptable gas exchange, rescue is attempted using extracorporeal therapies, airway pressure-release ventilation, inhaled vasodilators, or high-frequency oscillatory ventilation...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27821162/physiological-effects-of-invasive-ventilation-with-neurally-adjusted-ventilatory-assist-nava-in-a-crossover-study
#14
Jean-Michel Liet, François Barrière, Bénédicte Gaillard-Le Roux, Pierre Bourgoin, Arnaud Legrand, Nicolas Joram
BACKGROUND: Neurally Adjusted Ventilatory Assist (NAVA) is a mode of assisted mechanical ventilation that delivers inspiratory pressure proportionally to the electrical activity of the diaphragm. To date, no pediatric study has focused on the effects of NAVA on hemodynamic parameters. This physiologic study with a randomized cross-over design compared hemodynamic parameters when NAVA or conventional ventilation (CV) was applied. METHODS: After a baseline period, infants received NAVA and CV in a randomized order during two consecutive 30-min periods...
November 8, 2016: BMC Pediatrics
https://www.readbyqxmd.com/read/27795903/effects-of-pressure-controlled-and-volume-controlled-ventilation-on-respiratory-mechanics-and-systemic-stress-response-during-prone-position
#15
Oznur Sen, Mefkur Bakan, Tarik Umutoglu, Nurdan Aydın, Mehmet Toptas, Ibrahim Akkoc
BACKGROUND: Prone position during general anesthesia for special surgical operations may be related with increased airway pressure, decreased pulmonary and thoracic compliance that may be explained by restriction of chest expansion and compression of abdomen. The optimum ventilation mode for anesthetized patients on prone position was not described and studies comparing volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) during prone position are limited. We hypothesized that PCV instead of VCV during prone position could achieve lower airway pressures and reduce the systemic stress response...
2016: SpringerPlus
https://www.readbyqxmd.com/read/27776936/compliance-guided-versus-fio2-driven-positive-end-expiratory-pressure-in-patients-with-moderate-or-severe-acute-respiratory-distress-syndrome-according-to-the-berlin-definition
#16
M-C Pintado, R de Pablo, M Trascasa, J-M Milicua, M Sánchez-García
OBJECTIVE: To study the effect of setting positive end-expiratory pressure (PEEP) in an individualized manner (based on highest static compliance) compared to setting PEEP according to FiO2 upon mortality at 28 and 90 days, in patients with different severity acute respiratory distress syndrome (ARDS). SETTING: A Spanish medical-surgical ICU. DESIGN: A post hoc analysis of a randomized controlled pilot study. PATIENTS: Patients with ARDS...
October 21, 2016: Medicina Intensiva
https://www.readbyqxmd.com/read/27769542/clinical-relevance-of-the-routine-daily-chest-x-ray-in-the-surgical-intensive-care-unit
#17
Shelby Resnick, Kenji Inaba, Efstathios Karamanos, Dimitra Skiada, James A Dollahite, Obi Okoye, Peep Talving, Demetrios Demetriades
INTRODUCTION: A daily Chest X-ray (CXR) is obtained in many surgical intensive care units (SICU). This study implemented a selective CXR protocol in a high volume, academic SICU and evaluated its impact on clinical outcomes. METHODS: All SICU patients admitted in 2/2010 were compared with patients admitted in 2/2012. Between the time periods, a protocol eliminating the routine daily CXRs was instituted. RESULTS: In 02/2010 and 02/2012, 107 and 90 patients were admitted to the SICU, respectively, for a total of 1384 patient days...
October 10, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27757516/potentially-modifiable-factors-contributing-to-outcome-from-acute-respiratory-distress-syndrome-the-lung-safe-study
#18
John G Laffey, Giacomo Bellani, Tài Pham, Eddy Fan, Fabiana Madotto, Ednan K Bajwa, Laurent Brochard, Kevin Clarkson, Andres Esteban, Luciano Gattinoni, Frank van Haren, Leo M Heunks, Kiyoyasu Kurahashi, Jon Henrik Laake, Anders Larsson, Daniel F McAuley, Lia McNamee, Nicolas Nin, Haibo Qiu, Marco Ranieri, Gordon D Rubenfeld, B Taylor Thompson, Hermann Wrigge, Arthur S Slutsky, Antonio Pesenti
PURPOSE: To improve the outcome of the acute respiratory distress syndrome (ARDS), one needs to identify potentially modifiable factors associated with mortality. METHODS: The large observational study to understand the global impact of severe acute respiratory failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across five continents...
October 18, 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27717861/epidemiological-characteristics-practice-of-ventilation-and-clinical-outcome-in-patients-at-risk-of-acute-respiratory-distress-syndrome-in-intensive-care-units-from-16-countries-provent-an-international-multicentre-prospective-study
#19
Ary Serpa Neto, Carmen S V Barbas, Fabienne D Simonis, Antonio Artigas-Raventós, Jaume Canet, Rogier M Determann, James Anstey, Goran Hedenstierna, Sabrine N T Hemmes, Greet Hermans, Michael Hiesmayr, Markus W Hollmann, Samir Jaber, Ignacio Martin-Loeches, Gary H Mills, Rupert M Pearse, Christian Putensen, Werner Schmid, Paolo Severgnini, Roger Smith, Tanja A Treschan, Edda M Tschernko, Marcos F V Melo, Hermann Wrigge, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J Schultz
BACKGROUND: Scant information exists about the epidemiological characteristics and outcome of patients in the intensive care unit (ICU) at risk of acute respiratory distress syndrome (ARDS) and how ventilation is managed in these individuals. We aimed to establish the epidemiological characteristics of patients at risk of ARDS, describe ventilation management in this population, and assess outcomes compared with people at no risk of ARDS. METHODS: PRoVENT (PRactice of VENTilation in critically ill patients without ARDS at onset of ventilation) is an international, multicentre, prospective study undertaken at 119 ICUs in 16 countries worldwide...
October 4, 2016: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/27712774/percutaneous-intervention-for-concurrent%C3%A2-chronic-total-occlusions-in%C3%A2-patients-with%C3%A2-stemi-the-explore-trial
#20
José P S Henriques, Loes P Hoebers, Truls Råmunddal, Peep Laanmets, Erlend Eriksen, Matthijs Bax, Dan Ioanes, Maarten J Suttorp, Bradley H Strauss, Emanuele Barbato, Robin Nijveldt, Albert C van Rossum, Koen M Marques, Joëlle Elias, Ivo M van Dongen, Bimmer E P M Claessen, Jan G Tijssen, René J van der Schaaf
BACKGROUND: In 10% to 15% of patients with ST-segment elevation myocardial infarction (STEMI), concurrent coronary chronic total occlusion (CTO) in a non-infarct-related artery is present and is associated with increased morbidity and mortality. OBJECTIVES: The EXPLORE (Evaluating Xience and Left Ventricular Function in Percutaneous Coronary Intervention on Occlusions After ST-Elevation Myocardial Infarction) trial evaluated whether patients with STEMI and concurrent CTO in a non-infarct-related artery benefit from additional percutaneous coronary intervention (PCI) of CTO shortly after primary PCI...
October 11, 2016: Journal of the American College of Cardiology
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