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https://www.readbyqxmd.com/read/28413511/application-of-dead-space-fraction-to-titrate-optimal-positive-end-expiratory-pressure-in-an-ards-swine-model
#1
Weishuai Bian, Wei Chen, Yangong Chao, Lan Wang, Liming Li, Jian Guan, Xuefeng Zang, Jie Zhen, Bo Sheng, Xi Zhu
This study aimed to apply the dead space fraction [ratio of dead space to tidal volume (VD/VT)] to titrate the optimal positive end-expiratory pressure (PEEP) in a swine model of acute respiratory distress syndrome (ARDS). Twelve swine models of ARDS were constructed. A lung recruitment maneuver was then conducted and the PEEP was set at 20 cm H2O. The PEEP was reduced by 2 cm H2O every 10 min until 0 cm H2O was reached, and VD/VT was measured after each decrement step. VD/VT was measured using single-breath analysis of CO2, and calculated from arterial CO2 partial pressure (PaCO2) and mixed expired CO2 (PeCO2) using the following formula: VD/VT = (PaCO2 - PeCO2)/PaCO2...
April 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28413273/intraoperative-low-tidal-volume-ventilation-strategy-has-no-benefits-during-laparoscopic-cholecystectomy
#2
Vandna Arora, Asha Tyagi, Surendra Kumar, Aanchal Kakkar, Shukla Das
BACKGROUND AND AIMS: Benefits of intraoperative low tidal volume ventilation during laparoscopic surgery are not conclusively proven, even though its advantages were seen in other situations with intraoperative respiratory compromise such as one-lung ventilation. The present study compared the efficacy of intraoperative low tidal volume ventilatory strategy (6 ml/kg along with positive end-expiratory pressure [PEEP] of 10 cmH2O) versus one with higher tidal volume (10 ml/kg with no PEEP) on various clinical parameters and plasma levels of interleukin (IL)-6 in patients undergoing laparoscopic cholecystectomy...
January 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/28350644/disassociating-lung-mechanics-and-oxygenation-in-pediatric-acute-respiratory-distress-syndrome
#3
Nadir Yehya, Neal J Thomas
OBJECTIVES: Both oxygenation and peak inspiratory pressure are associated with mortality in pediatric acute respiratory distress syndrome. Since oxygenation and respiratory mechanics are linked, it is difficult to identify which variables, pressure or oxygenation, are independently associated with outcome. We aimed to determine whether respiratory mechanics (peak inspiratory pressure, positive end-expiratory pressure, ΔP [PIP minus PEEP], tidal volume, dynamic compliance [Cdyn]) or oxygenation (PaO2/FIO2) was associated with mortality...
March 27, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28340306/the-effects-of-positive-end-expiratory-pressure-at-different-levels-on-postoperative-respiration-parameters-in-patients-undergoing-laparoscopic-cholecystectomy
#4
Bahadır Ciftci, Mehmet Aksoy, Ilker Ince, Ali Ahıskalıoglu, Elif Yılmazel Ucar
Purpose/Aim of the study: We investigated the effects of different positive end-expiratory pressure (PEEP) levels on postoperative respiration parameters in patients undergoing laparoscopic cholecystectomy. MATERIALS AND METHODS: One hundred and five consecutive patients were randomly divided to three groups (n = 35, for each group). Group I did not receive PEEP whereas group II received PEEP as 5 cmH2O and group III received PEEP as 8 cm H2O. Measurements with spirometer were taken 1 hour before the operation (T1) and, 1 (T2), 6 (T3), and 24 hours (T4) after extubation by an anesthetist...
March 24, 2017: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
https://www.readbyqxmd.com/read/28338504/ventilation-with-high-or-low-tidal-volume-with-peep-does-not-influence-lung-function-after-spinal-surgery-in-prone-position-a-randomized-controlled-trial
#5
Sarah Soh, Jae-Kwang Shim, Yoon Ha, Young-Sam Kim, Hyelin Lee, Young-Lan Kwak
BACKGROUND: Spinal surgery in the prone position is accompanied by increased intrathoracic pressure and decreased respiratory compliance. This study investigated whether intraoperative lung protective mechanical ventilation improved lung function evaluated with pulmonary function tests in patients at risk of postoperative pulmonary complications (PPCs) after major spinal surgery in the prone position. METHODS: Seventy-eight patients at potential risk of PPCs were randomly assigned to the protective group (tidal volume; 6 mL/kg predicted body weight, 6 cm H2O positive end-expiratory pressure with recruitment maneuvers) or the conventional group (10 mL/kg predicted body weight, no positive end-expiratory pressure)...
March 23, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28333703/higher-fresh-gas-flow-rates-decrease-tidal-volume-during-pressure-control-ventilation
#6
Shazia Mohammad, Nikolaus Gravenstein, Drew Gonsalves, Terrie Vasilopoulos, Samsun Lampotang
BACKGROUND: We observed that increasing fresh gas flow (FGF) decreased exhaled tidal volume (VT) during pressure control ventilation (PCV). A literature search produced no such description whereby unintended VT changes occur with FGF changes during PCV. METHODS: To model an infant's lungs, 1 lung of a mechanical lung model (Dual Adult TTL 1600; Michigan Instruments, Inc, Grand Rapids, MI) was set at a compliance of 0.0068 L/cm H2O. An Rp50 resistor (27.2 cm H2O/L/s at 15 L/min) simulated normal bronchial resistance...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28323236/rationale-study-design-and-analysis-plan-of-the-lung-imaging-morphology-for-ventilator-settings-in-acute-respiratory-distress-syndrome-study-live-study-study-protocol-for-a-randomised-controlled-trial
#7
Matthieu Jabaudon, Thomas Godet, Emmanuel Futier, Jean-Etienne Bazin, Vincent Sapin, Laurence Roszyk, Bruno Pereira, Jean-Michel Constantin
Different acute respiratory distress syndrome (ARDS) phenotypes may explain controversial results in clinical trials. Lung-morphology is one of the ARDS-phenotypes and physiological studies suggest different responses in terms of positive-end-expiratory-pressure (PEEP) and recruitment-manoeuvres (RM) according to loss of aeration. To evaluate whether tailored ventilator regimens may impact ARDS outcomes, our group has designed a randomised-clinical-trial of ventilator settings according to lung morphology in moderate-to-severe ARDS (LIVE study)...
March 17, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28315940/a-multi-faceted-strategy-to-reduce-ventilation-associated-mortality-in-brain-injured-patients-the-bi-vili-project-a-nationwide-quality-improvement-project
#8
Karim Asehnoune, Ségolène Mrozek, Pierre François Perrigault, Philippe Seguin, Claire Dahyot-Fizelier, Sigismond Lasocki, Anne Pujol, Mathieu Martin, Russel Chabanne, Laurent Muller, Jean Luc Hanouz, Emmanuelle Hammad, Bertrand Rozec, Thomas Kerforne, Carole Ichai, Raphael Cinotti, Thomas Geeraerts, Djillali Elaroussi, Paolo Pelosi, Samir Jaber, Marie Dalichampt, Fanny Feuillet, Véronique Sebille, Antoine Roquilly
PURPOSE: We assessed outcomes in brain-injured patients after implementation of a multi-faceted approach to reduce respiratory complications in intensive care units. METHODS: Prospective nationwide before-after trial. Consecutive adults with acute brain injury requiring mechanical ventilation for ≥24 h in 20 French intensive care units (ICUs) were included. The management of invasive ventilation in brain-injured patients admitted between 1 July 2013 and 31 October 2013 (4 months) was monitored and analysed...
March 18, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28306591/ventilation-with-high-versus-low-peep-levels-during-general-anaesthesia-for-open-abdominal-surgery-does-not-affect-postoperative-spirometry-a-randomised-clinical-trial
#9
Tanja A Treschan, Maximilian Schaefer, Johann Kemper, Bea Bastin, Peter Kienbaum, Benedikt Pannen, Sabrine N Hemmes, Marcelo G de Abreu, Paolo Pelosi, Marcus J Schultz
BACKGROUND: Invasive mechanical ventilation during general anaesthesia for surgery typically causes atelectasis and impairs postoperative lung function. OBJECTIVE: We investigated the effect of intraoperative ventilation with high positive end-expiratory pressure (PEEP) and recruitment manoeuvres (RMs) on postoperative spirometry. DESIGN: This was a preplanned, single-centre substudy of an international multicentre randomised controlled trial, the PROVHILO trial...
March 16, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28272226/different-characteristics-of-ventilator-application-between-tracheostomy-and-noninvasive-positive-pressure-ventilation-patients-with-amyotrophic-lateral-sclerosis
#10
Donghwi Park, Goo Joo Lee, Ha Young Kim, Ju Seok Ryu
The aim of the study was to investigate the appropriate home ventilator settings for patients with amyotrophic lateral sclerosis (ALS).In total, 71 patients with ALS, who had received either a noninvasive positive pressure ventilation (NIPPV) or tracheostomy positive pressure ventilation (TPPV), were included. Accordingly, patients were divided into 2 groups (the TPPV and NIPPV groups). We retrospectively evaluated the values used in home ventilators for patients with ALS, who had maintained a stable level of CO2 on both the arterial blood gas analysis (ABGA) and transcutaneous blood gas monitoring...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28268159/protective-lung-strategies-a-cross-sectional-survey-of-nurses-knowledge-and-use-in-the-emergency-department
#11
Sarah Cornish, Rochelle Wynne, Sharon Klim, Anne-Maree Kelly
BACKGROUND: Mechanical ventilation (MV) is commonly used in emergency departments (EDs). Protective lung strategies (PLS), comprising of low tidal volume (6mL/kg), control of oxygen and plateau pressures, and administration of positive end expiratory pressure (PEEP) has been shown to reduces the risks associated with MV but there is little evidence exists about nurses' knowledge or application of PLS. Our aim was to explore nurses knowledge and application of PLS in Australian EDs. METHODS: Descriptive, exploratory design utilising an online questionnaire...
March 3, 2017: Australasian Emergency Nursing Journal: AENJ
https://www.readbyqxmd.com/read/28261294/influence-of-intraoperative-positive-end-expiratory-pressure-level-on-pulmonary-complications-in-emergency-major-trauma-surgery
#12
Thomas Stueber, Jan Karsten, Nikolas Voigt, Michaela Wilhelmi
INTRODUCTION: Pulmonary complications have a major impact on the morbidity and mortality of critically ill patients with multiple trauma. Intraoperative protective ventilation with low tidal volume may prevent lung injury and infection, whereas the role of positive end-expiratory pressure (PEEP) levels is unclear. The aim of this study was to evaluate the influence of different intraoperative PEEP levels on incidence of pulmonary complications after emergency trauma surgery. MATERIAL AND METHODS: We retrospectively analysed data of multiple trauma patients who underwent emergency surgery within 24 h after injury in our level I trauma centre (n = 86)...
March 1, 2017: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/28237681/assessment-of-distribution-of-ventilation-and-regional-lung-compliance-by-electrical-impedance-tomography-in-anaesthetized-horses-undergoing-alveolar-recruitment-manoeuvres
#13
Tamas D Ambrisko, Johannes Schramel, Klaus Hopster, Sabine Kästner, Yves Moens
OBJECTIVE: To examine changes in the distribution of ventilation and regional lung compliances in anaesthetized horses during the alveolar recruitment manoeuvre (ARM). STUDY DESIGN: Experimental study in which a series of treatments were administered in a fixed order on one occasion. ANIMALS: Five adult Warmblood horses. METHODS: Animals were anaesthetized (xylazine, midazolam-ketamine, isoflurane), placed in dorsal recumbency and ventilated with 100% oxygen using peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP) of 20 cmH2O and 0 cmH2O, respectively...
January 12, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28150228/personalizing-mechanical-ventilation-according-to-physiologic-parameters-to-stabilize-alveoli-and-minimize-ventilator-induced-lung-injury-vili
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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