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Newer modes of ventilation

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https://www.readbyqxmd.com/read/28659362/volume-guaranteed-accuracy-of-a-volume-targeted-ventilation-mode-in-infants
#1
Olivia Farrell, Elizabeth J Perkins, Don Black, Martijn Miedema, Joel Don Paul, Prue M Pereira-Fantini, David Gerald Tingay
OBJECTIVES: Volume-targeted ventilation (VTV) is widely used and may reduce lung injury, but this assumes the clinically set tidal volume (VTset) is accurately delivered. This prospective observational study aimed to determine the relationship between VTset, expiratory VT (VTe) and endotracheal tube leak in a modern neonatal -volume-targeted ventilator (VTV) and the resultant partial arterial pressure of carbon dioxide (PaCO2) relationship with and without VTV. DESIGN: Continuous inflations were recorded for 24 hours in 100 infants, mean (SD) 34 (4) weeks gestation and 2483 (985) g birth weight, receiving synchronised mechanical ventilation (SLE5000, SLE, UK) with or without VTV and either the manufacturer's V4 (n=50) or newer V5 (n=50) VTV algorithm...
June 28, 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/28149025/comparison-of-patient-ventilator-asynchrony-during-pressure-support-ventilation-and-proportional-assist-ventilation-modes-in-surgical-intensive-care-unit-a-randomized-crossover-study
#2
Parshotam Lal Gautam, Gaganjot Kaur, Sunil Katyal, Ruchi Gupta, Preetveen Sandhu, Nikhil Gautam
BACKGROUND: The patient-ventilator asynchrony is almost observed in all modes of ventilation, and this asynchrony affects lung mechanics adversely resulting in deleterious outcome. Innovations and advances in ventilator technology have been trying to overcome this problem by designing newer modes of ventilation. Pressure support ventilation (PSV) is a commonly used flow-cycled mode where a constant pressure is delivered by ventilator. Proportional assist ventilation (PAV) is a new dynamic inspiratory pressure assistance and is supposed to be better than PSV for synchrony and tolerance, but reports are still controversial...
December 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28000205/early-severe-acute-respiratory-distress-syndrome-what-s-going-on-part-ii-controlled-vs-spontaneous-ventilation
#3
REVIEW
Fabrice Petitjeans, Cyrille Pichot, Marco Ghignone, Luc Quintin
The second part of this overview on early severe ARDS delineates the pros and cons of the following: a) controlled mechanical ventilation (CMV: lowered oxygen consumption and perfect patient-to-ventilator synchrony), to be used during acute cardio-ventilatory distress in order to "buy time" and correct circulatory insufficiency and metabolic defects (acidosis, etc.); b) spontaneous ventilation (SV: improved venous return, lowered intrathoracic pressure, absence of muscle atrophy). Given a stabilized early severe ARDS, as soon as the overall clinical situation improves, spontaneous ventilation will be used with the following stringent conditionalities: upfront circulatory optimization, upright positioning, lowered VO2, lowered acidotic and hypercapnic drives, sedation without ventilatory depression and without lowered muscular tone, as well as high PEEP (titrated on transpulmonary pressure, or as a second best: "trial"-PEEP) with spontaneous ventilation + pressure support (or newer modes of ventilation)...
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28000204/early-severe-acute-respiratory-distress-syndrome-what-s-going-on-part-i-pathophysiology
#4
REVIEW
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/27842747/patient-ventilator-interactions
#5
REVIEW
Daniel Gilstrap, John Davies
Ventilatory muscle fatigue is a reversible loss of the ability to generate force or velocity of contraction in response to increased elastic and resistive loads. Mechanical ventilation should provide support without imposing additional loads from the ventilator (dys-synchrony). Interactive breaths optimize this relationship but require that patient effort and the ventilator response be synchronous during breath initiation, flow delivery, and termination. Proper delivery considers all 3 phases and uses clinical data, ventilator graphics, and sometimes a trial-and-error approach to optimize patient-ventilator interactions...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27581993/synchronized-mechanical-ventilation-for-respiratory-support-in-newborn-infants
#6
REVIEW
Anne Greenough, Thomas E Rossor, Adesh Sundaresan, Vadivelam Murthy, Anthony D Milner
BACKGROUND: During synchronised mechanical ventilation, positive airway pressure and spontaneous inspiration coincide. If synchronous ventilation is provoked, adequate gas exchange should be achieved at lower peak airway pressures, potentially reducing baro/volutrauma, air leak and bronchopulmonary dysplasia. Synchronous ventilation can potentially be achieved by manipulation of rate and inspiratory time during conventional ventilation and employment of patient-triggered ventilation. OBJECTIVES: To compare the efficacy of:(i) synchronised mechanical ventilation, delivered as high-frequency positive pressure ventilation (HFPPV) or patient-triggered ventilation (assist control ventilation (ACV) and synchronous intermittent mandatory ventilation (SIMV)), with conventional ventilation or high-frequency oscillation (HFO);(ii) different types of triggered ventilation (ACV, SIMV, pressure-regulated volume control ventilation (PRVCV), SIMV with pressure support (PS) and pressure support ventilation (PSV))...
September 1, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27539719/synchronized-mechanical-ventilation-for-respiratory-support-in-newborn-infants
#7
REVIEW
Anne Greenough, Vadivelam Murthy, Anthony D Milner, Thomas E Rossor, Adesh Sundaresan
BACKGROUND: During synchronised mechanical ventilation, positive airway pressure and spontaneous inspiration coincide. If synchronous ventilation is provoked, adequate gas exchange should be achieved at lower peak airway pressures, potentially reducing baro/volutrauma, air leak and bronchopulmonary dysplasia. Synchronous ventilation can potentially be achieved by manipulation of rate and inspiratory time during conventional ventilation and employment of patient-triggered ventilation. OBJECTIVES: To compare the efficacy of:(i) synchronised mechanical ventilation, delivered as high-frequency positive pressure ventilation (HFPPV) or patient-triggered ventilation (assist control ventilation (ACV) and synchronous intermittent mandatory ventilation (SIMV)), with conventional ventilation or high-frequency oscillation (HFO);(ii) different types of triggered ventilation (ACV, SIMV, pressure-regulated volume control ventilation (PRVCV), SIMV with pressure support (PS) and pressure support ventilation (PSV))...
August 19, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/26923501/physiology-of-non-invasive-respiratory-support
#8
REVIEW
Stamatia Alexiou, Howard B Panitch
Non-invasive ventilation (NIV) is used in neonates to treat extrathoracic and intrathoracic airway obstruction, parenchymal lung disease and disorders of control of breathing. Avoidance of airway intubation is associated with a reduction in the incidence of chronic lung disease among preterm infants with respiratory distress syndrome. Use of nasal continuous positive airway pressure (nCPAP) may help establish and maintain functional residual capacity (FRC), decrease respiratory work, and improve gas exchange...
June 2016: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/26715607/noninvasive-respiratory-support
#9
James J Cummings, Richard A Polin
Mechanical ventilation is associated with increased survival of preterm infants but is also associated with an increased incidence of chronic lung disease (bronchopulmonary dysplasia) in survivors. Nasal continuous positive airway pressure (nCPAP) is a form of noninvasive ventilation that reduces the need for mechanical ventilation and decreases the combined outcome of death or bronchopulmonary dysplasia. Other modes of noninvasive ventilation, including nasal intermittent positive pressure ventilation, biphasic positive airway pressure, and high-flow nasal cannula, have recently been introduced into the NICU setting as potential alternatives to mechanical ventilation or nCPAP...
January 2016: Pediatrics
https://www.readbyqxmd.com/read/26559968/the-use-of-volume-assured-pressure-support-noninvasive-ventilation-in-acute-and-chronic-respiratory-failure-a-practical-guide-and-literature-review
#10
REVIEW
Mark Pluym, Asad Waseem Kabir, Ashraf Gohar
Noninvasive positive pressure ventilation (NPPV) is an important tool in the management of acute and chronic respiratory failure. Traditionally, continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP) have been the most commonly utilized modes for these purposes. Newer hybrid modes of NPPV, such as average volume-assured pressure support (VAPS), combine the properties of both volume- and pressure-controlled NPPV and represent another tool in the treatment of acute and chronic respiratory failure...
2015: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/26033131/the-role-of-noninvasive-ventilation-in-the-management-and-mitigation-of-exacerbations-and-hospital-admissions-readmissions-for-the-patient-with-moderate-to-severe-copd-multimedia-activity
#11
David P White, Gerard J Criner, Michael Dreher, Nicholas Hart, Fred W Peyerl, Lisa F Wolfe, Suzette A Chin
As seen in this CME online activity (available at http://journal.cme.chestnet.org/home-niv-copd), COPD is a common and debilitating disease and is currently the third leading cause of death in the United States. The role of noninvasive ventilation (NIV) in the management of severe, hypercapnic COPD has been controversial. However, it was concluded that current data would support the following recommendations. Patients with COPD with a waking Paco2 > 50 to 52 mm Hg, an overnight Paco2 > 55 mm Hg, or both who are symptomatic and compliant with other therapies should be eligible for NIV...
June 2015: Chest
https://www.readbyqxmd.com/read/25501776/assisted-ventilation
#12
David J Dries
Controlled Mechanical Ventilation may be essential in the setting of severe respiratory failure but consequences to the patient including increased use of sedation and neuromuscular blockade may contribute to delirium, atelectasis, and diaphragm dysfunction. Assisted ventilation allows spontaneous breathing activity to restore physiological displacement of the diaphragm and recruit better perfused lung regions. Pressure Support Ventilation is the most frequently used mode of assisted mechanical ventilation...
March 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/25385483/approaches-to-ventilation-in-intensive-care
#13
REVIEW
Peter M Spieth, Thea Koch, Marcelo Gama de Abreu
BACKGROUND: Mechanical ventilation is a common and often life-saving intervention in intensive care medicine. About 35% of all patients in intensive care are mechanically ventilated; about 15% of these patients develop a ventilation-associated pneumonia. The goal of ventilation therapy is to lessen the work of respiration and pulmonary gas exchange and thereby maintain or restore an adequate oxygen supply to the body's tissues. Mechanical ventilation can be carried out in many different modes; the avoidance of ventilation-induced lung damage through protective ventilation strategies is currently a major focus of clinical interest...
October 17, 2014: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/25114434/newer-nonconventional-modes-of-mechanical-ventilation
#14
REVIEW
Preet Mohinder Singh, Anuradha Borle, Anjan Trikha
The conventional modes of ventilation suffer many limitations. Although they are popularly used and are well-understood, often they fail to match the patient-based requirements. Over the years, many small modifications in ventilators have been incorporated to improve patient outcome. The ventilators of newer generation respond to patient's demands by additional feedback systems. In this review, we discuss the popular newer modes of ventilation that have been accepted in to clinical practice. Various intensive care units over the world have found these modes to improve patient ventilator synchrony, decrease ventilator days and improve patient safety...
July 2014: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/25074944/home-mechanical-ventilation-for-copd-high-intensity-versus-target-volume-noninvasive-ventilation
#15
RANDOMIZED CONTROLLED TRIAL
Jan H Storre, Elena Matrosovich, Emelie Ekkernkamp, David J Walker, Claudia Schmoor, Michael Dreher, Wolfram Windisch
BACKGROUND: High-intensity noninvasive ventilation (HI-NIV) is the most effective means of improving several physiological and clinical parameters in subjects with chronic hypercapnic COPD. Whether the newer hybrid mode using target tidal volume noninvasive ventilation (target V(T) NIV) provides additional benefits remains unclear. METHODS: Subjects with COPD successfully established on long-term HI-NIV were switched to target V(T) NIV. Optimal target V(T) settings according to nocturnal transcutaneous P(CO2) measurements were achieved following a randomized crossover trial using 8 mL/kg ideal body weight and 110% of individual V(T) during HI-NIV, respectively...
September 2014: Respiratory Care
https://www.readbyqxmd.com/read/24535687/-current-concepts-of-augmented-spontaneous-breathing-new-modes-of-effort-adapted-weaning
#16
REVIEW
T Bein
The use of augmented spontaneous breathing is an important component in a bundle concept of weaning from mechanical ventilation as it was demonstrated that controlled ventilation with diaphragmatic underuse induces rapid muscle atrophy and impairs successful weaning. On the other hand spontaneous breathing is often associated with disturbed patient-ventilator interaction resulting in asynchrony (e.g. ineffective triggering, early termination of inspiration and overflow or underflow). It was shown that asynchrony can impair gas exchange, increase work of breathing and enhance deleterious aspects of mechanical ventilation...
April 2014: Der Anaesthesist
https://www.readbyqxmd.com/read/24249886/anaesthesia-ventilators
#17
REVIEW
Rajnish K Jain, Srinivasan Swaminathan
Anaesthesia ventilators are an integral part of all modern anaesthesia workstations. Automatic ventilators in the operating rooms, which were very simple with few modes of ventilation when introduced, have become very sophisticated with many advanced ventilation modes. Several systems of classification of anaesthesia ventilators exist based upon various parameters. Modern anaesthesia ventilators have either a double circuit, bellow design or a single circuit piston configuration. In the bellows ventilators, ascending bellows design is safer than descending bellows...
September 2013: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/23050248/h1n1-infected-patients-in-icu-and-their-clinical-outcome
#18
Talkad Chandrashekar Nagesh Kumar, Nanjangudu Subramanya Shivakumar, Telugu Sitaram Deepak, Rashmi Krishnappa, Melur Shivakumar Goutam, Vivek Ganigar
BACKGROUND: The swine flu (H1N1) with rapid spread and panic in population is truly global pandemic, affected mainly younger population. There is need to accumulate evidence regarding patient's intensive care parameters for effective management of newer strains of influenza viral infections. Hence an observed retrospective record analysis of confirmed H1N1 patients admitted to intensive care unit (ICU) of a tertiary care centre is done. AIMS: The study was designed to study the profile and pattern of H1N1 patients admitted to ICU and to study the distribution and associated factors with treatment outcomes...
September 2012: North American Journal of Medical Sciences
https://www.readbyqxmd.com/read/22027150/modern-mechanical-ventilation-strategies-in-newborns-a-review
#19
REVIEW
Ramadan A Mahmoud, Gerd Schmalisch
Noninvasive ventilation is increasingly used in newborns, but intubation and mechanical ventilation remain important lifesaving tools for neonatal intensive care. New lung-protective mechanical ventilation technologies were developed in the last few decades and are now commercially available. Nevertheless, a recent survey (van Kaam et al. J Pediatr 2010) reported that time-cycled pressure-limited ventilation is the most common mode in neonatal ventilation and that newer ventilation modes are rarely used. The aim of this survey was to provide an overview of modern ventilation strategies based on available clinical studies...
2011: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
https://www.readbyqxmd.com/read/21166627/a-randomised-crossover-trial-comparing-volume-assured-and-pressure-preset-noninvasive-ventilation-in-stable-hypercapnic-copd
#20
RANDOMIZED CONTROLLED TRIAL
Nicholas Stephen Oscroft, Masood Ali, Atul Gulati, Michael Gordon Davies, Timothy George Quinnell, John Michael Shneerson, Ian Edward Smith
Recent randomised controlled trials suggest non-invasive ventilation may offer benefit in the long-term management of ventilatory failure in stable COPD. The best mode of ventilation is unknown and newer volume assured modes may offer advantages by optimising ventilation overnight when treatment is delivered. This study compares volume assured with pressure preset non-invasive ventilation. Randomised crossover trial including twenty five subjects previously established on long-term non-invasive ventilation to manage COPD with chronic ventilatory failure...
December 2010: COPD
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