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weaning from peep

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https://www.readbyqxmd.com/read/28390643/a-46-year-old-man-with-dyspnea-hypoxemia-and-radiographic-asymmetry-after-redo-bilateral-lung-transplantation
#1
Sofya Tokman, Michael A Smith, A Samad Hashimi, Ashraf Omar
A 46-year-old man underwent redo bilateral sequential lung transplantation for rapidly progressive bronchiolitis obliterans syndrome that developed 3.5 years after initial transplantation. In the operating room, he was sedated and intubated with a dual lumen endotracheal tube with subsequent single right-lung ventilation and left allograft implantation. His pulmonary arterial pressure became elevated with reperfusion of the newly implanted left lung, which required initiation of cardiopulmonary bypass to facilitate implantation of the right lung...
April 2017: Chest
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
#2
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/28230835/sudden-versus-gradual-pressure-wean-from-nasal-cpap-in-preterm-infants-a-randomized-controlled-trial
#3
S Amatya, M Macomber, A Bhutada, D Rastogi, S Rastogi
OBJECTIVE: In preterm infants, nasal continuous positive airway pressure (NCPAP) is widely used for treatment of respiratory distress syndrome. However, the strategies for successfully weaning infants off NCPAP are still not well defined and there remains considerable variation between the methods. The objective of this study is to determine whether gradual weaning of NCPAP pressure is more successful than sudden weaning off NCPAP to room air. STUDY DESIGN: A randomized controlled trial was conducted in a level 3 neonatal intensive care unit on 70 preterm neonates who were born between 26 and 32 weeks gestation and required NCPAP for at least 48 h...
June 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28157140/a-quasi-experimental-before-after-trial-examining-the-impact-of-an-emergency-department-mechanical-ventilator-protocol-on-clinical-outcomes-and-lung-protective-ventilation-in-acute-respiratory-distress-syndrome
#4
Brian M Fuller, Ian T Ferguson, Nicholas M Mohr, Anne M Drewry, Christopher Palmer, Brian T Wessman, Enyo Ablordeppey, Jacob Keeperman, Robert J Stephens, Cristopher C Briscoe, Angelina A Kolomiets, Richard S Hotchkiss, Marin H Kollef
OBJECTIVES: To evaluate the impact of an emergency department mechanical ventilation protocol on clinical outcomes and adherence to lung-protective ventilation in patients with acute respiratory distress syndrome. DESIGN: Quasi-experimental, before-after trial. SETTING: Emergency department and ICUs of an academic center. PATIENTS: Mechanically ventilated emergency department patients experiencing acute respiratory distress syndrome while in the emergency department or after admission to the ICU...
April 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/27784322/spontaneous-breathing-trial-and-post-extubation-work-of-breathing-in-morbidly-obese-critically-ill-patients
#5
Martin Mahul, Boris Jung, Fabrice Galia, Nicolas Molinari, Audrey de Jong, Yannaël Coisel, Rosanna Vaschetto, Stefan Matecki, Gérald Chanques, Laurent Brochard, Samir Jaber
BACKGROUND: Predicting whether an obese critically ill patient can be successfully extubated may be specially challenging. Several weaning tests have been described but no physiological study has evaluated the weaning test that would best reflect the post-extubation inspiratory effort. METHODS: This was a physiological randomized crossover study in a medical and surgical single-center Intensive Care Unit, in patients with body mass index (BMI) >35 kg/m(2) who were mechanically ventilated for more than 24 h and underwent a weaning test...
October 27, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27469940/early-induction-of-direct-hemoperfusion-with-a-polymyxin-b-immobilized-column-is-associated-with-amelioration-of-hemodynamic-derangement-and-mortality-in-patients-with-septic-shock
#6
Shinya Chihara, Yoshiki Masuda, Hiroomi Tatsumi, Kota Nakano, Tomokazu Shimada, Takao Murohashi, Michiaki Yamakage
This study was conducted to clarify the effectiveness of induction timing of direct hemoperfusion with a polymyxin-B immobilized column (PMX-DHP) for amelioration of hemodynamic derangement and outcome in patients with septic shock. Suspected Gram-negative septic shock patients who received PMX-DHP therapy from January 2010 to December 2014 in our ICU were enrolled in this study. The patients were divided into two groups that received PMX-DHP therapy within 8 h (early group) and more than 8 h (late group) from catecholamine administration...
March 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/27445550/effects-of-lung-expansion-therapy-on-lung-function-in-patients-with-prolonged-mechanical-ventilation
#7
RANDOMIZED CONTROLLED TRIAL
Yen-Huey Chen, Ming-Chu Yeh, Han-Chung Hu, Chung-Shu Lee, Li-Fu Li, Ning-Hung Chen, Chung-Chi Huang, Kuo-Chin Kao
Common complications in PMV include changes in the airway clearance mechanism, pulmonary function, and respiratory muscle strength, as well as chest radiological changes such as atelectasis. Lung expansion therapy which includes IPPB and PEEP prevents and treats pulmonary atelectasis and improves lung compliance. Our study presented that patients with PMV have improvements in lung volume and oxygenation after receiving IPPB therapy. The combination of IPPB and PEEP therapy also results in increase in respiratory muscle strength...
2016: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
https://www.readbyqxmd.com/read/27334266/esophageal-and-transpulmonary-pressure-in-the-clinical-setting-meaning-usefulness-and-perspectives
#8
REVIEW
Tommaso Mauri, Takeshi Yoshida, Giacomo Bellani, Ewan C Goligher, Guillaume Carteaux, Nuttapol Rittayamai, Francesco Mojoli, Davide Chiumello, Lise Piquilloud, Salvatore Grasso, Amal Jubran, Franco Laghi, Sheldon Magder, Antonio Pesenti, Stephen Loring, Luciano Gattinoni, Daniel Talmor, Lluis Blanch, Marcelo Amato, Lu Chen, Laurent Brochard, Jordi Mancebo
PURPOSE: Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only. METHODS: This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes. RESULTS: After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning...
September 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27117075/-the-clinical-analysis-of-extracorporeal-membrane-oxygenation-for-adult-severe-acute-respiratory-distress-syndrome
#9
S Y Qi, W T Wang, Z D Chu, C Y Chen, M K Zhou, Y X Ren, X J Liu
OBJECTIVE: To investigate the clinical experience and associated factors of extracorporeal membrane oxygenation(ECMO) for adult patients with severe acute respiratory distress syndrome (ARDS). METHODS: The clinical data of 58 adult patients with severe ARDS, which met the criteria for ECMO and treated in comprehensive intensive care unit of the Second Affiliated Hospital of Zhengzhou University from August 2012 to June 2015, were retrospectively collected and analyzed...
April 12, 2016: Chinese Journal of Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/26861596/feasibility-and-safety-of-low-flow-extracorporeal-carbon-dioxide-removal-to-facilitate-ultra-protective-ventilation-in-patients-with-moderate-acute-respiratory-distress-sindrome
#10
Vito Fanelli, Marco V Ranieri, Jordi Mancebo, Onnen Moerer, Michael Quintel, Scott Morley, Indalecio Moran, Francisco Parrilla, Andrea Costamagna, Marco Gaudiosi, Alain Combes
BACKGROUND: Mechanical ventilation with a tidal volume (VT) of 6 mL/kg/predicted body weight (PBW), to maintain plateau pressure (Pplat) lower than 30 cmH2O, does not completely avoid the risk of ventilator induced lung injury (VILI). The aim of this study was to evaluate safety and feasibility of a ventilation strategy consisting of very low VT combined with extracorporeal carbon dioxide removal (ECCO2R). METHODS: In fifteen patients with moderate ARDS, VT was reduced from baseline to 4 mL/kg PBW while PEEP was increased to target a plateau pressure--(Pplat) between 23 and 25 cmH2O...
February 10, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/23619172/prospective-randomized-crossover-study-of-a-new-closed-loop-control-system-versus-pressure-support-during-weaning-from-mechanical-ventilation
#11
RANDOMIZED CONTROLLED TRIAL
Noémie Clavieras, Marc Wysocki, Yannael Coisel, Fabrice Galia, Matthieu Conseil, Gerald Chanques, Boris Jung, Jean-Michel Arnal, Stefan Matecki, Nicolas Molinari, Samir Jaber
BACKGROUND: Intellivent is a new full closed-loop controlled ventilation that automatically adjusts both ventilation and oxygenation parameters. The authors compared gas exchange and breathing pattern variability of Intellivent and pressure support ventilation (PSV). METHODS: In a prospective, randomized, single-blind design crossover study, 14 patients were ventilated during the weaning phase, with Intellivent or PSV, for two periods of 24 h in a randomized order...
September 2013: Anesthesiology
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