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Pengcheng Xie, Zhanfang Li, Zhongyi Tian
OBJECTIVE: Pulmonary dysfunction after laparoscopic surgery is commonly seen in the high-risk group of obese patients. To reduce or avoid this complication caused by an improper combination of mechanical ventilation parameters, we conducted the following trial of 3 factors with 3 levels of mechanical ventilation, aimed to obtain the low airway pressure with good ventilator effects. METHODS: Patients were randomly allocated as a sample of cases according to the "30≤weight/height(2)<40" obesity index...
November 2016: Journal of Clinical Anesthesia
Steffen Wirth, Luc Seywert, Johannes Spaeth, Stefan Schumann
BACKGROUND: Artificial airway resistance as provided by small-lumen tracheal tubes or catheters increases the risk of intrinsic PEEP (PEEPi). We hypothesized that by active expiration assistance, larger minute volumes could be generated without causing PEEPi compared with conventional mechanical ventilation when using small-lumen tracheal tubes or a cricothyrotomy catheter. METHODS: We investigated the active expiration assistance in a physical model of the respiratory system and estimated its hypothetical performance in terms of maximal flow generated with endotracheal tubes ranging from 3...
August 23, 2016: Respiratory Care
Marco Gemma, Elisa Nicelli, Daniele Corti, Assunta De Vitis, Nicolò Patroniti, Giuseppe Foti, Maria Rosa Calvi, Luigi Beretta
STUDY OBJECTIVE: To assess the safety of mechanical ventilation and effectiveness of extrinsic positive end-expiratory pressure (PEEP) (PEEPe) in improving peripheral oxygen saturation (SpO2) during direct microlaryngeal laser surgery; to assess the incidence, amount, and nature (dynamic hyperinflation or airflow obstruction) of ensuing intrinsic PEEP (PEEPi); and to find a surrogate PEEPi indicator. DESIGN: Quasiexperimental. SETTING: S. Raffaele Hospital (Milano), November 2009 to December 2010...
June 2016: Journal of Clinical Anesthesia
Francois Beloncle, Evangelia Akoumianaki, Nuttapol Rittayamai, Aissam Lyazidi, Laurent Brochard
BACKGROUND: Proportional assist ventilation+ (PAV+) delivers airway pressure (P aw) in proportion to patient effort (P mus) by using the equation of motion of the respiratory system. PAV+ calculates automatically respiratory mechanics (elastance and resistance); the work of breathing (WOB) is estimated by the ventilator. The accuracy of P mus estimation and hence accuracy of the delivered P aw and WOB calculation have not been assessed. This study aimed at assessing the accuracy of delivered P aw and calculated WOB by PAV+ and examining the factors influencing this accuracy...
December 2016: Annals of Intensive Care
Gaetano Perchiazzi, Christian Rylander, Mariangela Pellegrini, Anders Larsson, Göran Hedenstierna
Ventilation treatment of acute lung injury (ALI) requires the application of positive airway pressure at the end of expiration (PEEPapp) to avoid lung collapse. However, the total pressure exerted on the alveolar walls (PEEPtot) is the sum of PEEPapp and intrinsic PEEP (PEEPi), a hidden component. To measure PEEPtot, ventilation must be discontinued with an end-expiratory hold maneuver (EEHM). We hypothesized that artificial neural networks (ANN) could estimate the PEEPtot from flow and pressure tracings during ongoing mechanical ventilation...
April 11, 2016: Journal of Clinical Monitoring and Computing
Lars O Harnisch, Carsten Zippel, Peter Herrmann, Michael Quintel, Onnen Moerer
BACKGROUND: Patient-ventilator asynchrony that prolongs weaning and increases morbidity and mortality is common during invasive ventilation of patients with chronic obstructive pulmonary disease (COPD). In this context, the inspiratory cycling criteria (iCC) of the ventilator during assisted pressure support (PS) ventilation is a poorly acknowledged key factor. We investigated the changes of flow and pressure parameters that resulted from varying the iCC in a simulated COPD lung model...
July 2016: Minerva Anestesiologica
Ling Liu, Feiping Xia, Yi Yang, Federico Longhini, Paolo Navalesi, Jennifer Beck, Christer Sinderby, Haibo Qiu
INTRODUCTION: Intrinsic positive end-expiratory pressure (PEEPi) is a "threshold" load that must be overcome to trigger conventional pneumatically-controlled pressure support (PSP) in chronic obstructive pulmonary disease (COPD). Application of extrinsic PEEP (PEEPe) reduces trigger delays and mechanical inspiratory efforts. Using the diaphragm electrical activity (EAdi), neurally controlled pressure support (PSN) could hypothetically eliminate asynchrony and reduce mechanical inspiratory effort, hence substituting the need for PEEPe...
2015: Critical Care: the Official Journal of the Critical Care Forum
Francisco José Parrilla, Indalecio Morán, Ferran Roche-Campo, Jordi Mancebo
Chronic obstructive pulmonary disease (COPD) is characterized by expiratory flow limitation (EFL) due to progressive airflow obstruction. The various mechanisms that cause EFL are central to understanding the physiopathology of COPD. At the end of expiration, dynamic inflation may occur due to incomplete emptying the lungs. This "extra" volume increases the alveolar pressure at the end of the expiration, resulting in auto-positive end-expiratory pressure (PEEP) or PEEPi. Acute exacerbations of COPD may result in increased airway resistance and inspiratory effort, further leading to dynamic hyperinflation...
August 2014: Seminars in Respiratory and Critical Care Medicine
Claudio M Sanguinetti
Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation caused by bronchial alterations, small airways disease and parenchymal destruction. In patients with COPD the structural and functional lung alterations can progress more or less rapidly from the initial small airways disease to an overt COPD where a severe expiratory flow limitation takes place. In these conditions, lung hyperinflation develops characterized by increase in functional residual capacity (FRC) and decrease in inspiratory capacity (IC)...
2014: Multidisciplinary Respiratory Medicine
Louis Mayaud, Michèle Lejaille, Hélène Prigent, Bruno Louis, Brigitte Fauroux, Frédéric Lofaso
PURPOSE: We have developed a software that automatically calculates respiratory effort indices, including intrinsic end expiratory pressure (PEEPi) and esophageal pressure-time product (PTPeso). MATERIALS AND METHODS: The software first identifies respiratory periods. Clean signals are averaged to provide a reference mean cycle from which respiratory parameters are extracted. The onset of the inspiratory effort is detected automatically by looking backward from the onset of inspiratory flow to the first point where the esophageal pressure derivative is equal to zero (inflection point)...
February 1, 2014: Respiratory Physiology & Neurobiology
Quang-Thang Nguyen, Dominique Pastor, Francois Lellouche, Erwan L'her
Automatic monitoring of mechanical ventilation system becomes more and more important with respect to the number of patients per clinician. In this paper, the automatic detections of dynamic hyperinflation (PEEPi) and asynchrony in a monitoring framework are considered. The proposed detection methods are based on a robust non-parametric hypothesis testing, namely Random Distortion Testing (RDT), that requires no prior information on the signal distribution. The experiment results have shown that the proposed algorithms provide relevant detection of abnormalities during mechanical ventilation...
2013: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Sandrine Essouri, Philippe Durand, Laurent Chevret, Laurent Balu, Denis Devictor, Brigitte Fauroux, Pierre Tissières
PURPOSE: To determine the optimal level of nasal continuous positive airway pressure (nCPAP) in infants with severe hypercapnic viral bronchiolitis as assessed by the maximal unloading of the respiratory muscles and improvement of breathing pattern and gas exchange. METHODS: A prospective physiological study in a tertiary paediatric intensive care unit (PICU). Breathing pattern, gas exchange, intrinsic end expiratory pressure (PEEPi) and respiratory muscle effort were measured in ten infants with severe hypercapnic viral bronchiolitis during spontaneous breathing (SB) and three increasing levels of nCPAP...
December 2011: Intensive Care Medicine
Takeshi Yoshida, Akinori Uchiyama, Takashi Mashimo, Yuji Fujino
BACKGROUND: Using a model lung connected to six different ventilators, with each ventilator in the airway pressure release ventilation mode, we measured differences in intrinsic positive end-expiratory pressure (PEEPi) during the expiratory phase and calculated the inspiratory and expiratory pressure time product (PTP) as an index of work of breathing during the inspiratory phase. METHODS: We compared 6 ventilators: Puritan-Bennett 840, Evita XL, Servo i, Avea, Hamilton G5, and Engström...
September 2011: Anesthesia and Analgesia
Paolo Pelosi, Cesare Gregoretti
Obesity is a metabolic disease that is on the increase all over the world. Up to 35% of the population in North America and 15-20% in Europe can be considered obese. Since these patients are characterised by several systemic physiopathological alterations, the perioperative management may present some problems, mainly related to their respiratory system. Body mass is an important determinant of respiratory function before and during anaesthesia not only in morbidly but also in moderately obese patients. These can manifest as (a) reduced lung volume with increased atelectasis; (b)derangements in respiratory system, lung and chest wall compliance and increased resistance; and (c) moderate to severe hypoxaemia...
June 2010: Best Practice & Research. Clinical Anaesthesiology
Zhi-bo Li, Xin-jing Gao, Ying-zhi Qin
OBJECTIVE: To compare the effect of control mode of pressure and volume of mechanical ventilation on cardiac index (CI), intrathoracic blood volume index (ITBVI) in patients. METHODS: Twenty-four patients in whom mechanical ventilation and pulse indicator continuous cardiac output (PiCCO) monitoring were necessary were involved, and they were divided into normal heart function group (9 cases) and heart dysfunction group (15 cases) on the base of CI. Mechanical ventilation was used with the mode of bi-level positive airway passage (BIPAP), and the inspiratory pressure was maintained at the tidal volume (V(T)) of 6, 10, 15 ml/kg...
October 2009: Zhongguo Wei Zhong Bing Ji Jiu Yi Xue, Chinese Critical Care Medicine, Zhongguo Weizhongbing Jijiuyixue
Meng-Yi Chou, Chih-Ying Ou, Chang-Wen Chen
BACKGROUND/PURPOSE: Bronchoalveolar lavage (BAL) can be used for a variety of diagnostic purposes in mechanically ventilated patients. BAL can cause changes in respiratory mechanics. However, the risk factors associated with these changes remain unknown. The current study tried to identify the risk factors that contribute to changes in respiratory mechanics following BAL. METHODS: Changes in respiratory mechanics were assessed in 56 mechanically ventilated patients who received BAL using an interrupter method under constant flow...
September 2009: Journal of the Formosan Medical Association, Taiwan Yi Zhi
J Steier, C J Jolley, J Seymour, M Roughton, M I Polkey, J Moxham
BACKGROUND: The load imposed on ventilation by increased body mass contributes to the respiratory symptoms caused by obesity. A study was conducted to quantify ventilatory load and respiratory drive in obesity in both the upright and supine postures. METHODS: Resting breathing when seated and supine was studied in 30 obese subjects (mean (SD) body mass index (BMI) 42.8 (8.6) kg/m(2)) and 30 normal subjects (mean (SD) BMI 23.6 (3.7) kg/m(2)), recording the electromyogram of the diaphragm (EMGdi, transoesophageal multipair electrode), gastric and oesophageal pressures...
August 2009: Thorax
Bruce P Krieger
Clinically, the symptoms and limited exercise capabilities of patients with chronic obstructive pulmonary disease (COPD) correlate better with changes in lung volumes than with airflow measurements. The realization of the clinical importance of hyperinflation has been overshadowed for decades by the use of forced expiratory volume during 1 s (FEV(1)) and the ratio of the FEV(1) to the forced expiratory vital capacity (FEV(1)/FVC) to categorize the severity and progression of COPD. Hyperinflation is defined as an elevation in the end-expiratory lung volume or functional residual capacity...
2009: Respiration; International Review of Thoracic Diseases
Andrea Purro, Lorenzo Appendini, Carolina Polillo, Giovanni Musso, Claudio Taliano, Fabio Mecca, Roberto Colombo, Giorgio Carbone
OBJECTIVE: The purpose of this study is to investigate the respiratory mechanics, breathing pattern, and pressure-generating capacity of respiratory muscles during the early phases of an acute exacerbation of COPD. DESIGN: Prospective study. SETTING: Division of Emergency Critical Care and Chronic Ventilator Unit. PATIENTS: A total of 24 COPD patients: nine patients requiring ventilatory support because of acute respiratory acidosis due to COPD exacerbation (NPPV group, pH 7...
April 2009: Intensive Care Medicine
Zhen-Hua Li
A mechanical ventilation trigger way is set forth and a technical analysis on the pressure trigger way and flow trigger way is made in this paper. And it is pointed out that the PEEPi's influence on the human organism is the reason for the latter two kinds of trigger ways' notable differences in the measured values of the inspiration time and breath work.
March 2008: Zhongguo Yi Liao Qi Xie za Zhi, Chinese Journal of Medical Instrumentation
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