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Volume targeted ventilation

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https://www.readbyqxmd.com/read/29763713/practice-of-mechanical-ventilation-in-cardiac-arrest-patients-and-effects-of-targeted-temperature-management-a-substudy-of-the-targeted-temperature-management-trial
#1
Matthew B A Harmon, David M P van Meenen, Annelou L I P van der Veen, Jan M Binnenkade, Josef Dankiewicz, Florian Ebner, Niklas Nielsen, Paolo Pelosi, Marcus J Schultz, Janneke Horn, Hans Friberg, Nicole P Juffermans
AIMS: Mechanical ventilation practices in patients with cardiac arrest are not well described. Also, the effect of temperature on mechanical ventilation settings is not known. The aims of this study were 1) to describe practice of mechanical ventilation and its relation with outcome 2) to determine effects of different target temperatures strategies (33 °C versus 36 °C) on mechanical ventilation settings. METHODS: This is a substudy of the TTM-trial in which unconscious survivors of a cardiac arrest due to a cardiac cause were randomized to two TTM strategies, 33 °C (TTM33) and 36 °C (TTM36)...
May 12, 2018: Resuscitation
https://www.readbyqxmd.com/read/29734208/improved-lung-recruitment-and-oxygenation-during-mandatory-ventilation-with-a-new-expiratory-ventilation-assistance-device-a-controlled-interventional-trial-in-healthy-pigs
#2
Johannes Schmidt, Christin Wenzel, Marlene Mahn, Sashko Spassov, Heidi Cristina Schmitz, Silke Borgmann, Ziwei Lin, Jörg Haberstroh, Stephan Meckel, Sebastian Eiden, Steffen Wirth, Hartmut Buerkle, Stefan Schumann
BACKGROUND: In contrast to conventional mandatory ventilation, a new ventilation mode, expiratory ventilation assistance (EVA), linearises the expiratory tracheal pressure decline. OBJECTIVE: We hypothesised that due to a recruiting effect, linearised expiration oxygenates better than volume controlled ventilation (VCV). We compared the EVA with VCV mode with regard to gas exchange, ventilation volumes and pressures and lung aeration in a model of peri-operative mandatory ventilation in healthy pigs...
May 4, 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29708892/continuous-negative-abdominal-pressure-reduces-ventilator-induced-lung-injury-in-a-porcine-model
#3
Takeshi Yoshida, Doreen Engelberts, Gail Otulakowski, Bhushan Katira, Martin Post, Niall D Ferguson, Laurent Brochard, Marcelo B P Amato, Brian P Kavanagh
BACKGROUND: In supine patients with acute respiratory distress syndrome, the lung typically partitions into regions of dorsal atelectasis and ventral aeration ("baby lung"). Positive airway pressure is often used to recruit atelectasis, but often overinflates ventral (already aerated) regions. A novel approach to selective recruitment of dorsal atelectasis is by "continuous negative abdominal pressure." METHODS: A randomized laboratory study was performed in anesthetized pigs...
April 27, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29684318/does-size-matter-when-calculating-the-correct-tidal-volume-for-pediatric-mechanical-ventilation-a-hypothesis-based-on-forced-vital-capacity
#4
Gina J Kim, Christopher J L Newth, Robinder G Khemani, Suzy L Wong, Allan L Coates, Patrick A Ross
BACKGROUND: Tidal volumes standardized to predicted body weight are recommended for adult mechanical ventilation, but children are frequently ventilated using measured body weight. Our goal is to examine the difference in forced vital capacity (FVC ml/kg) using measured compared to predicted body weight in children. METHODS: Retrospective analysis of outpatient pulmonary function tests (PFTs) from two datasets. Dataset one: 6 to 19 year old children undergoing PFTs from the nationally-representative Canadian Health Measures Survey...
April 20, 2018: Chest
https://www.readbyqxmd.com/read/29671605/effects-of-budesonide-and-surfactant-in-preterm-fetal-sheep
#5
T Brett Kothe, Emily Royse, Matthew W Kemp, Augusto F Schmidt, Fabrizio Salomone, Masatoshi Saito, Haruo Usuda, Shimpei Watanabe, Gabrielle C Musk, Alan H Jobe, Noah H Hillman
BACKGROUND: Mechanical ventilation causes lung injury and systemic inflammatory responses in preterm sheep, and is associated with bronchopulmonary dysplasia (BPD) in preterm infants. Budesonide added to surfactant decreased BPD by 20% in infants. OBJECTIVE: Determine the effects of budesonide and surfactant on injury from high tidal volume (VT) ventilation in preterm lambs. METHODS: Ewes at 125 {plus minus} 1 day GA had fetal surgery to expose fetal head and chest with placental circulation intact...
April 19, 2018: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://www.readbyqxmd.com/read/29667182/breathing-regulation-and-blood-gas-homeostasis-after-near-complete-lesions-of-the-retrotrapezoid-nucleus-in-adult-rats
#6
George M P R Souza, Roy Kanbar, Daniel S Stornetta, Stephen B G Abbott, Ruth L Stornetta, Patrice G Guyenet
The retrotrapezoid nucleus (RTN) is one of several CNS nuclei that contribute, in various capacities (e.g. CO2 detection, neuronal modulation) to the central respiratory chemoreflex (CRC). Here we test how important the RTN is to PCO2 homeostasis and breathing during sleep or wake. RTN Nmb positive neurons were killed with targeted microinjections of substance-P-saporin conjugate in adult rats. Under normoxia, rats with large RTN lesions (92 ± 4 % cell loss) had normal blood pressure (BP) and arterial pH but were hypoxic (-8 mmHg PaO2 ) and hypercapnic (+10 mmHg PaCO2 )...
April 18, 2018: Journal of Physiology
https://www.readbyqxmd.com/read/29666293/fast-or-slow-rescue-ventilations-a-predictive-model-of-gastric-inflation
#7
John R Fitz-Clarke
BACKGROUND: Rescue ventilations are given during respiratory and cardiac arrest. Tidal volume must assure oxygen delivery; however, excessive pressure applied to an unprotected airway can cause gastric inflation, regurgitation, and pulmonary aspiration. The optimal technique provides mouth pressure and breath duration that minimize gastric inflation. It remains unclear if breath delivery should be fast or slow, and how inflation time affects the division of gas flow between the lungs and esophagus...
May 2018: Respiratory Care
https://www.readbyqxmd.com/read/29659626/influence-of-respiratory-mechanics-and-drive-on-genioglossus-movement-under-ultrasound-imaging
#8
Benjamin C H Kwan, Rachel A McBain, Billy L Luu, Jane E Butler, Lynne E Bilston, Simon C Gandevia
METHODS: Twenty healthy subjects (10 males, age 28±5 years [mean ± SD]) lay supine, awake, with the head in a neutral position. Ventilation was monitored with inductance bands. Real-time B-mode ultrasound movies were analysed. We measured genioglossus motion (i) during spontaneous breathing, voluntary targeted breathing (normal tidal volume Vt), and voluntary hyperpnoea (at 1.5Vt and 2 Vt); (ii) during inspiratory flow resistive loading; (iii) with changes in end-expiratory lung volume (EELV)...
2018: PloS One
https://www.readbyqxmd.com/read/29597042/nasal-dilation-effects-on-olfactory-deposition-in-unilateral-and-bi-directional-deliveries-in-vitro-tests-and-numerical-modeling
#9
Jinxiang Xi, Zhaoxuan Wang, Xiuhua April Si, Yue Zhou
The human nose can expand either actively or passively to increase airflow. Nasal dilation may alter drug delivery efficiencies in the nasal airway or olfactory region. However, the dosage enhancement from nasal dilations has not been quantified. The mechanisms underlying the dilation-induced deposition variation are also not clear. This study aims to quantify the nasal dilation effects on drug delivery in the nasal airway and olfactory region using in vitro tests and numerical analysis. Two variants of an existing normal nasal airway model were developed with different levels of airway dilation...
March 26, 2018: European Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/29512020/noninvasive-auto-titrating-ventilation-avaps-ae-versus-average-volume-assured-pressure-support-avaps-ventilation-in-hypercapnic-respiratory-failure-patients
#10
Gul Gursel, Avsar Zerman, Burcu Basarik, Kamil Gonderen, Muge Aydogdu, Serriyye Memmedova
Auto-titrating noninvasive ventilation (NIV) has been developed as a new mode applying variable expiratory-positive airway pressure (EPAP) in addition to variable inspiratory pressures (IPAP), both to deliver targeted tidal volume (VT) and to eliminate upper airway resistance. The purpose of this study is to evaluate whether NIV with auto-titrating mode will decrease more PaCO2 within a shorter time compared to volume-assured mode in hypercapnic intensive care unit (ICU) patients. The hypercapnic respiratory failure patients treated with average volume assured pressure support- automated EPAP mode (group1) were compared with those treated with average volume-assured pressure support mode (group2)...
April 2018: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29499978/evaluation-of-implementation-of-fasting-guidelines-for-enterally-fed-critical-care-patients
#11
Bethan Jenkins, Philip C Calder, Luise V Marino
BACKGROUND & AIMS: Critically ill adults have increased nutrition risk. Prior to procedures patients are often fasted, leading to nutritional deficits. The use of fasting guidelines may therefore help reduce deficits from accumulating. The aim of this work was to determine the impact on nutrition support delivery following the implementation of fasting guidelines in addition to characterizing staff knowledge of the guidelines. DESIGN: Retrospective data were collected on n = 74 patients at two different time points; prior to launch of fasting guidelines and post launch, with regards to estimated nutritional requirements, nutritional targets, volume of enteral nutrition (EN) delivered and periods of fasting...
February 15, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/29485489/biological-response-to-time-controlled-adaptive-ventilation-depends-on-acute-respiratory-distress-syndrome-etiology
#12
Pedro Leme Silva, Fernanda Ferreira Cruz, Cynthia Dos Santos Samary, Lillian Moraes, Raquel Ferreira de Magalhães, Marcos Vinicius de S Fernandes, Rebeca Bose, Vitor B Pelegati, Hernandes F Carvalho, Vera Luiza Capelozzi, Joshua Satalin, Louis Gatto, Penny Andrews, Nader Habashi, Gary Nieman, Patricia R M Rocco
OBJECTIVES: To compare a time-controlled adaptive ventilation strategy, set in airway pressure release ventilation mode, versus a protective mechanical ventilation strategy in pulmonary and extrapulmonary acute respiratory distress syndrome with similar mechanical impairment. DESIGN: Animal study. SETTING: Laboratory investigation. SUBJECTS: Forty-two Wistar rats. INTERVENTIONS: Pulmonary acute respiratory distress syndrome and extrapulmonary acute respiratory distress syndrome were induced by instillation of Escherichia coli lipopolysaccharide intratracheally or intraperitoneally, respectively...
February 26, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29484196/targeted-full-energy-and-protein-delivery-in-critically-ill-patients-a-study-protocol-for-a-pilot-randomised-control-trial-feed-trial
#13
Kate Fetterplace, Adam M Deane, Audrey Tierney, Lisa Beach, Laura D Knight, Thomas Rechnitzer, Adrienne Forsyth, Marina Mourtzakis, Jeffrey Presneill, Christopher MacIsaac
Background: Current guidelines for the provision of protein for critically ill patients are based on incomplete evidence, due to limited data from randomised controlled trials. The present pilot randomised controlled trial is part of a program of work to expand knowledge about the clinical effects of protein delivery to critically ill patients. The primary aim of this pilot study is to determine whether an enteral feeding protocol using a volume target, with additional protein supplementation, delivers a greater amount of protein and energy to mechanically ventilated critically ill patients than a standard nutrition protocol...
2018: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/29479941/current-views-of-complications-associated-with-neonatal-ventilation-a-review
#14
Gang Liu, Hongwei Wu, Zhenguang Li
Infants born prematurely require external respiratory support device like ventilation for the purpose of life saving. However, these ventilation machines have complications that sometimes unfortunately result in morbidity. New ventilation techniques have been developed to prevent morbidity, but have yet to be fully evaluated. The present review article would discuss current aspects of this life saving gear especially for pediatric patients in clinical setting. Besides basic ventilation apparatus, advancements in the filed like Proportional assist ventilation , Volume Targeted Ventilation would be discussed...
February 23, 2018: Minerva Pediatrica
https://www.readbyqxmd.com/read/29474201/mechanical-ventilation-induces-desensitization-of-lung-axl-tyrosine-kinase-receptors
#15
Gail Otulakowski, Doreen Engelberts, Martin Post, Claire Masterson, Brian P Kavanagh
BACKGROUND: Lower tidal volumes are increasingly used in acute respiratory distress syndrome, but mortality has changed little in the last 20 yr. Therefore, in addition to ventilator settings, it is important to target molecular mediators of injury. Sepsis and other inflammatory states increase circulating concentrations of Gas6, a ligand for the antiinflammatory receptor Axl, and of a soluble decoy form of Axl. We investigated the effects of lung stretch on Axl signaling. METHODS: We used a mouse model of early injury from high tidal volume and assessed the effects of inhibiting Axl on in vivo lung injury (using an antagonist R428, n = 4/group)...
February 23, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29466596/acute-respiratory-distress-syndrome-advances-in-diagnosis-and-treatment
#16
REVIEW
Eddy Fan, Daniel Brodie, Arthur S Slutsky
Importance: Acute respiratory distress syndrome (ARDS) is a life-threatening form of respiratory failure that affects approximately 200 000 patients each year in the United States, resulting in nearly 75 000 deaths annually. Globally, ARDS accounts for 10% of intensive care unit admissions, representing more than 3 million patients with ARDS annually. Objective: To review advances in diagnosis and treatment of ARDS over the last 5 years. Evidence Review: We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from 2012 to 2017 focusing on randomized clinical trials, meta-analyses, systematic reviews, and clinical practice guidelines...
February 20, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29461464/protective-effects-of-the-complement-inhibitor-compstatin-cp40-in-hemorrhagic-shock
#17
Martijn van Griensven, Daniel Ricklin, Stephanie Denk, Rebecca Halbgebauer, Christian K Braun, Anke Schultze, Felix Hönes, Sofia Koutsogiannaki, Alexandra Primikyri, Edimara Reis, David Messerer, Sebastian Hafner, Peter Radermacher, Ali-Reza Biglarnia, Ranillo R G Resuello, Joel V Tuplano, Benjamin Mayer, Kristina Nilsson, Bo Nilsson, John D Lambris, Markus Huber-Lang
Trauma-induced hemorrhagic shock (HS) plays a decisive role in the development of immune, coagulation, and organ dysfunction often resulting in a poor clinical outcome. Imbalanced complement activation is intricately associated with the molecular danger response and organ damage after HS. Thus, inhibition of the central complement component C3 as turnstile of both inflammation and coagulation is hypothesized as a rational strategy to improve the clinical course after HS.Applying intensive care conditions, anaesthetized, monitored, and protectively ventilated non-human primates (NHP; cynomolgus monkeys) received a pressure-controlled severe HS (60 min at MAP 30 mmHg) with subsequent volume resuscitation...
February 14, 2018: Shock
https://www.readbyqxmd.com/read/29455032/sevoflurane-for-procedural-sedation-in-critically-ill-patients-a-pharmacokinetic-comparative-study-between-burn-and-non-burn-patients
#18
Sebastien Perbet, Daniel Bourdeaux, Alexandre Lenoire, Claire Biboulet, Bruno Pereira, Malha Sadoune, Benoit Plaud, Jean-Marie Launay, Jean-Etienne Bazin, Valerie Sautou, Alexandre Mebazaa, Pascal Houze, Jean-Michel Constantin, Matthieu Legrand
BACKGROUND: Sevoflurane has anti-inflammatory proprieties and short lasting effects making it of interest for procedural sedation in critically ill patients. We evaluated the pharmacokinetics of sevoflurane and metabolites in severely ill burn patients and controls. The secondary objective was to assess potential kidney injury. METHODS: Prospective interventional study in a burn and a surgical intensive care unit; 24 mechanically ventilated critically ill patients (12 burns, 12 controls) were included...
February 15, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29404183/effects-of-modes-obesity-and-body-position-on-non-invasive-positive-pressure-ventilation-success-in-the-intensive-care-unit-a-randomized-controlled-study
#19
Murat Türk, Müge Aydoğdu, Gül Gürsel
OBJECTIVES: Different outcomes and success rates of non-invasive positive pressure ventilation (NPPV) in patients with acute hypercapnic respiratory failure (AHRF) still pose a significant problem in intensive care units. Previous studies investigating different modes, body positioning, and obesity-associated hypoventilation in patients with chronic respiratory failure showed that these factors may affect ventilator mechanics to achieve a better minute ventilation. This study tried to compare pressure support (BiPAP-S) and average volume targeted pressure support (AVAPS-S) modes in patients with acute or acute-on-chronic hypercapnic respiratory failure...
January 2018: Turkish Thoracic Journal
https://www.readbyqxmd.com/read/29385861/admission-volume-is-associated-with-mortality-of-neonatal-respiratory-failure-in-emerging-neonatal-intensive-care-units
#20
Huanhuan Wang, Ying Dong, Bo Sun
OBJECTIVE: The aim of this survey was to explore the relationship between admission volume and mortality of neonates with hypoxemic respiratory failure (NRF) in emerging neonatal intensive care units (NICUs). METHODS: NRF from 55 NICUs were retrospectively included with death risk as the major outcome. Perinatal comorbidities, underlying disease severity, respiratory support, facility utilization, and economic burden in the early postnatal period were compared among five NICU admission volume categories defined by NRF incidence, with score for neonatal acute physiology perinatal extension II (SNAPPE-II) also assessed as initial severity...
January 31, 2018: Journal of Maternal-fetal & Neonatal Medicine
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