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https://www.readbyqxmd.com/read/28150228/personalizing-mechanical-ventilation-according-to-physiologic-parameters-to-stabilize-alveoli-and-minimize-ventilator-induced-lung-injury-vili
#1
REVIEW
Gary F Nieman, Joshua Satalin, Penny Andrews, Hani Aiash, Nader M Habashi, Louis A Gatto
It has been shown that mechanical ventilation in patients with, or at high-risk for, the development of acute respiratory distress syndrome (ARDS) can be a double-edged sword. If the mechanical breath is improperly set, it can amplify the lung injury associated with ARDS, causing a secondary ventilator-induced lung injury (VILI). Conversely, the mechanical breath can be adjusted to minimize VILI, which can reduce ARDS mortality. The current standard of care ventilation strategy to minimize VILI attempts to reduce alveolar over-distension and recruitment-derecruitment (R/D) by lowering tidal volume (Vt) to 6 cc/kg combined with adjusting positive-end expiratory pressure (PEEP) based on a sliding scale directed by changes in oxygenation...
December 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28149559/a-bench-evaluation-of-fraction-of-oxygen-in-air-delivery-and-tidal-volume-accuracy-in-home-care-ventilators-available-for-hospital-use
#2
Loredana Baboi, Fabien Subtil, Claude Guérin
BACKGROUND: Turbine-powered ventilators are not only designed for long-term ventilation at home but also for hospital use. It is important to verify their capabilities in delivering fraction of oxygen in air (FIO2) and tidal volume (VT). METHODS: We assessed the FIO2 accuracy and the VT delivery in four home care ventilators (HCV) on the bench. The four HCV were Astral 150, Elisée 150, Monnal T50 and Trilogy 200 HCV, which were connected to a lung model (ASL 5000)...
December 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28118641/effects-of-breathing-and-apnoea-during-sustained-inflations-in-resuscitation-of-preterm-infants
#3
Gianluca Lista, Francesco Cavigioli, Paola Azzurra La Verde, Francesca Castoldi, Ilia Bresesti, Colin J Morley
BACKGROUND: A sustained inflation (SI) at birth in preterm babies may be ineffective unless the infants breathe. Gain in lung volume is associated with breathing during delivery room non-invasive management. OBJECTIVE: To describe the breathing patterns of preterm infants during an SI and correlate to a calculated gain in lung volume. METHODS: Retrospective observational study. Data collected from a respiratory function monitor during SI (25 cmH2O for 15 s then PEEP at 5 cmH2O) through a face mask in preterm infants (gestational age [GA] ≤31 weeks)...
January 25, 2017: Neonatology
https://www.readbyqxmd.com/read/28107408/effect-of-positive-end-expiratory-pressure-on-the-sonographic-optic-nerve-sheath-diameter-as-a-surrogate-for-intracranial-pressure-during-robot-assisted-laparoscopic-prostatectomy-a-randomized-controlled-trial
#4
Ji-Hyun Chin, Wook-Jong Kim, Joonho Lee, Yun A Han, Jinwook Lim, Jai-Hyun Hwang, Seong-Sik Cho, Young-Kug Kim
BACKGROUND: Positive end-expiratory pressure (PEEP) can increase intracranial pressure. Pneumoperitoneum and the Trendelenburg position are associated with an increased intracranial pressure. We investigated whether PEEP ventilation could additionally influence the sonographic optic nerve sheath diameter as a surrogate for intracranial pressure during pneumoperitoneum combined with the Trendelenburg position in patients undergoing robot-assisted laparoscopic prostatectomy. METHODS: After anesthetic induction, 38 patients were randomly allocated to a low tidal volume ventilation (8 ml/kg) without PEEP group (zero end-expiratory pressure [ZEEP] group, n = 19) or low tidal volume ventilation with 8 cmH2O PEEP group (PEEP group, n = 19)...
2017: PloS One
https://www.readbyqxmd.com/read/28103448/bedside-contribution-of-electrical-impedance-tomography-to-set-positive-end-expiratory-pressure-for-ecmo-treated-severe-ards-patients
#5
Guillaume Franchineau, Nicolas Bréchot, Guillaume Lebreton, Guillaume Hekimian, Ania Nieszkowska, Jean-Louis Trouillet, Pascal Leprince, Jean Chastre, Charles-Edouard Luyt, Alain Combes, Matthieu Schmidt
RATIONALE: Optimal positive end-expiratory pressure (PEEP) is unknown in severe acute respiratory distress syndrome (ARDS) patients on extracorporeal membrane oxygenation (ECMO) receiving mechanical ventilation with very low tidal volume. OBJECTIVES: To evaluate electrical impedance tomography's (EIT) ability to monitor a PEEP trial and to derive from EIT the best compromise PEEP in this setting. METHODS: A decremental PEEP trial (20-0 cmH2O) in 5 cmH2O steps was monitored by EIT, with lung images divided into four ventral-to-dorsal horizontal regions of interest...
January 19, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28100723/a-respiratory-gated-micro-ct-comparison-of-respiratory-patterns-in-free-breathing-and-mechanically-ventilated-rats
#6
Nancy L Ford, Lynda McCaig, Andrew Jeklin, James F Lewis, Ruud A W Veldhuizen, David W Holdsworth, Maria Drangova
In this study, we aim to quantify the differences in lung metrics measured in free-breathing and mechanically ventilated rodents using respiratory-gated micro-computed tomography. Healthy male Sprague-Dawley rats were anesthetized with ketamine/xylazine and scanned with a retrospective respiratory gating protocol on a GE Locus Ultra micro-CT scanner. Each animal was scanned while free-breathing, then intubated and mechanically ventilated (MV) and rescanned with a standard ventilation protocol (56 bpm, 8 mL/kg and PEEP of 5 cm H2O) and again with a ventilation protocol that approximates the free-breathing parameters (88 bpm, 2...
January 2017: Physiological Reports
https://www.readbyqxmd.com/read/28094413/electrical-impedance-tomography-for-lung-ventilation-monitoring-of-the-dog
#7
Simon Gloning, Korbinian Pieper, Martin Zoellner, Andrea Meyer-Lindenberg
BACKGROUND: Electrical impedance tomography (EIT) is a radiation free technique which takes advantage of the different electrical conductivities of different tissues. Its main field of application is lung ventilation monitoring. The aim of this prospective study was to evaluate the feasibility of collecting EIT information on a sample of dogs with different thoracic shapes under clinical conditions by connecting an electrode belt without fur clipping. MATERIAL AND METHODS: Fifteen pulmonary healthy dogs were anaesthetized, positioned in sternal recumbency and ventilated in a pressure-controlled mode at three different positive end-expiratory pressure levels (PEEP) of 0, 5 and 10 cmH2O for five breaths each, with a peak inspiratory pressure of 15 cmH2O...
February 9, 2017: Tierärztliche Praxis. Ausgabe K, Kleintiere/Heimtiere
https://www.readbyqxmd.com/read/28093429/paediatric-ed-bipap-continuous-quality-improvement-programme-with-patient-analysis-2005-2013
#8
Thomas Abramo, Abby Williams, Samaiya Mushtaq, Mark Meredith, Rawle Sepaule, Kristen Crossman, Cheryl Burney Jones, Suzanne Godbold, Zhuopei Hu, Todd Nick
OBJECTIVE: In paediatric moderate-to-severe asthmatics, there is significant bronchospasm, airway obstruction, air trapping causing severe hyperinflation with more positive intraplural pressure preventing passive air movement. These effects cause an increased respiratory rate (RR), less airflow and shortened inspiratory breath time. In certain asthmatics, aerosols are ineffective due to their inadequate ventilation. Bilevel positive airway pressure (BiPAP) in acute paediatric asthmatics can be an effective treatment...
January 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/28051989/minute-ventilation-limitations-of-two-field-transport-ventilators
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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