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Sample records for ards mechanical ventilation

  1. Mechanical Ventilation as a Therapeutic Tool to Reduce ARDS Incidence.

    Science.gov (United States)

    Nieman, Gary F; Gatto, Louis A; Bates, Jason H T; Habashi, Nader M

    2015-12-01

    Trauma, hemorrhagic shock, or sepsis can incite systemic inflammatory response syndrome, which can result in early acute lung injury (EALI). As EALI advances, improperly set mechanical ventilation (MV) can amplify early injury into a secondary ventilator-induced lung injury that invariably develops into overt ARDS. Once established, ARDS is refractory to most therapeutic strategies, which have not been able to lower ARDS mortality below the current unacceptably high 40%. Low tidal volume ventilation is one of the few treatments shown to have a moderate positive impact on ARDS survival, presumably by reducing ventilator-induced lung injury. Thus, there is a compelling case to be made that the focus of ARDS management should switch from treatment once this syndrome has become established to the application of preventative measures while patients are still in the EALI stage. Indeed, studies have shown that ARDS incidence is markedly reduced when conventional MV is applied preemptively using a combination of low tidal volume and positive end-expiratory pressure in both patients in the ICU and in surgical patients at high risk for developing ARDS. Furthermore, there is evidence from animal models and high-risk trauma patients that superior prevention of ARDS can be achieved using preemptive airway pressure release ventilation with a very brief duration of pressure release. Preventing rather than treating ARDS may be the way forward in dealing with this recalcitrant condition and would represent a paradigm shift in the way that MV is currently practiced. PMID:26135199

  2. Upright position mechanical ventilation: an alternative strategy for ALI/ARDS patients?

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    Zhu, Min; Zhang, Wei; Wang, Jia-Ning; Yan, Hua; Li, Yang-Kai; Ai, Bo; Fu, Sheng-Lin; Fu, Xiang-Ning

    2009-11-01

    Use of body positioning to improve oxygenation in mechanically ventilated patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) has been well documented. However, neither prone position ventilation nor side lying ventilation has been reported to improve the survival. Whether there is a body position superior to routine supine position or other positions as therapeutic adjunct for ventilated patients with ALI and ARDS? We propose the hypothesis that upright position ventilation may be helpful to improve oxygenation and benefit patients with ALI/ARDS. According to the existing physiologic and pathophysiologic data of upright position investigation, we suppose that improvement of V/Q matching, increased functional residual capacity, alveolar recruitment, accelerated diaphragm recovery, early gastric emptying and enteric feeding may be a potential protect mechanism of upright position ventilation. Whether this can be translated into improvement in patient outcome should be further tested in clinical trial. PMID:19683402

  3. Non-conventional mechanical ventilation in severe ARDS, illustrated by a complicated case

    NARCIS (Netherlands)

    Tulleken, JE; van der Werf, TS; Ligtenberg, JJM; Zijlstra, JG

    1998-01-01

    When conventional respiratory strategies fail to maintain adequate oxygenation treatment of severe ARDS is largely empirical. Modern techniques such as inverse ratio ventilation, permissive hypercapnia, NO inhalation and lowering tidal volumes/pressures are advocated. We report on a patient with sev

  4. Ventilatory strategy in ARDS focusing on pressure controlled ventilation

    NARCIS (Netherlands)

    J. Kesecioglu (Jozef)

    1994-01-01

    textabstractThis thesis focuses on comparison of different modes of ventilation in animals and patients with ARDS. The aim is to determine the immediate advantages of one mode over the other in terms of gas exchange, airway pressures,' hemodynamics and ventilation inhomogeneity.

  5. Ventilator-Induced Lung Injury (VILI) in Acute Respiratory Distress Syndrome (ARDS): Volutrauma and Molecular Effects

    OpenAIRE

    Carrasco Loza, R; Villamizar Rodríguez, G; Medel Fernández, N

    2015-01-01

    Acute Respiratory Distress Syndrome (ARDS) is a clinical condition secondary to a variety of insults leading to a severe acute respiratory failure and high mortality in critically ill patients. Patients with ARDS generally require mechanical ventilation, which is another important factor that may increase the ALI (acute lung injury) by a series of pathophysiological mechanisms, whose common element is the initial volutrauma in the alveolar units, and forming part of an entity known clinically...

  6. Study on nursing of sequential mechanical ventilation treatment of ALI/ARDS%序贯性机械通气治疗ALI/ARDS的护理探讨

    Institute of Scientific and Technical Information of China (English)

    梁梅英; 陈广雪; 梁永祥; 黄富; 韦幼苗; 严文红

    2016-01-01

    ObjectiveTo study the nursing methods of sequential mechanical ventilation in the treatment of acute lung injury and acute respiratory distress syndrome.Methods40 patients with ALI/ARDS,who were treated with sequential mechanical ventilation and were hospitalized in respiratory medicine department of our hospital from June 2014 to August 2015,were selected as the research objects, and were adopted by comprehensive nursing methods of psychological nursing, infection prevention nursing, airway nursing, nasal feeding nursing, grasped the best sequential opportunity of mechanical ventilation.To record the cases of successful offline,the index of blood gas analysis,pH,heart rate,respiratory rate before mechanical ventilation,4h after mechanical ventilation, before tube drawing,4h noninvasive ventilation of patients.Results After sequential mechanical ventilation treatment and nursing on 40 patients,there were 35 cases clinical cured with successful offline,and 5 cases dead.The index of blood gas analysis,pH,heart rate,respiratory rate after mechanical ventilation was better than which before mechanical ventilation,and which in study group was better than which in control group,the differences was statically significant(P<0.05),which 4h after mechanical ventilation was obviously better than which before tube drawing, the differences was statically significant (P<0.05).ConclusionThe effective implementation of positive nursing methods is much important, is basic condition to ensure sequential mechanical ventilation in the treatment of ALI/ARDS,could reduce the VAP incidence, shorten MV time and hospitalization time,reduce patients' hospitalization expenses and economic burden.%目的:探讨序贯性机械通气治疗急性肺损伤/急性呼吸窘迫综合征护理措施。方法选择2014年6月~2015年8月本院呼吸内科住院序贯性机械通气治疗ALI/ARDS患者40例为研究对象,采取心理护理、预防感染护理、气道护理、鼻饲饮食护

  7. Rationale and Description of Right Ventricle-Protective Ventilation in ARDS.

    Science.gov (United States)

    Paternot, Alexis; Repessé, Xavier; Vieillard-Baron, Antoine

    2016-10-01

    Pulmonary vascular dysfunction is associated with ARDS and leads to increased right-ventricular afterload and eventually right-ventricular failure, also called acute cor pulmonale. Interest in acute cor pulmonale and its negative impact on outcome in patients with ARDS has grown in recent years. Right-ventricular function in these patients should be closely monitored, and this is helped by the widespread use of echocardiography in intensive care units. Because mechanical ventilation may worsen right-ventricular failure, the interaction between the lungs and the right ventricle appears to be a key factor in the ventilation strategy. In this review, a rationale for a right ventricle-protective ventilation approach is provided, and such a strategy is described, including the reduction of lung stress (ie, the limitation of plateau pressure and driving pressure), the reduction of PaCO2 , and the improvement of oxygenation. Prone positioning seems to be a crucial part of this strategy by protecting both the lungs and the right ventricle, resulting in increased survival of patients with ARDS. Further studies are required to validate the positive impact on prognosis of right ventricle-protective mechanical ventilation.

  8. 临床护理路径在ARDS患者机械通气中的效果评价%Effect of clinical nursing pathway on the mechanical ventilation effect of ARDS patients

    Institute of Scientific and Technical Information of China (English)

    陈莲芳; 陶方萍; 史倩; 魏登慧

    2011-01-01

    目的 探讨临床护理路径(clinical nursing pathway,CNP)护理模式在ARDS机械通气中的应用效果.方法 选择2008年6月至2010年12月入住ICU的59例实施机械通气的ARDS患者,随机分为观察组30例和对照组29例,对照组采用传统的整体护理模式,按常规进行机械通气的监测、治疗和护理;观察组按制订好的临床护理路径进行护理.比较2组患者呼吸机应用时间、机械通气并发症发生率、患者及家属满意度等指标.结果 观察组患者呼吸机应用时间少于对照组,机械通气并发症发生率低于对照组,患者及家属满意度优于对照组.结论 临床护理路径用于ARDS机械通气中,能缩短机械通气时间,降低机械通气并发症发生率,提高患者及家属对护理工作的满意度.%Objective To investigate the effect of clinical nursing pathway on mechanical ventilation effect of ARDS patients. Methods 59 ARDS patients with mechanical ventilation from June 2008 to December 2010 were randomly divided into the observation group (30 cases)and the control group (29 cases). The control group used the traditional care model, conventional mechanical ventilation monitoring,treatment and care according to routine measures; the observation group used clinical nursing pathway. The mechanical ventilation time, complication rate of mechanical ventilation, and the gratification level of patients in the two groups of patients were observed. Results The mechanical ventilation time in the observation group was less than the control group, and incidence of complications was lower, and satisfaction degree of patients and their families was better, the difference was statistically significant. Conclusions The clinical nursing pathway can shorten the time of mechanical ventilation, lower incidence of complications of mechanical ventilation, and it improves satisfaction degree of patients and their families.

  9. COMPARISON OF HIGH-FREQUENCY OSCILLATION VENTILATION WITH CONVENTIONAL MANDATORY VENTILATION IN ANIMAL ARDS MODEL

    Institute of Scientific and Technical Information of China (English)

    SHI Guo-chao; HUANG Shao-guang; LI Min; DENG Wei-wu; WAN Huan-ying

    2005-01-01

    Objective To compare effect of high-frequency oscillation ventilation (HFOV) and conventional mandatory ventilation (CMV) on lung injury development in rabbit with acute respiratory distress syndrome (ARDS). Methods Animals that underwent saline lung lavage to produce lung injury were randomized to one of the two treatment groups (HFOV or CMV, n=6). PaCO2 was maintained between 35-45mmHg and arterial oxygen saturation (SaO2) was maintain >88% by adjusting corresponding ventilator parameters. Ventilation period was 6h. Lung fluids were aspirated before and at the end of ventilation for cell analysis. Then the animals were euthanized, lung tissue was removed for wet/dry weight measurement, light and electron microscopic examination.Results The difference of artery blood gas analyses(pH, PaO2, PaCO2) between HFOV and CMV was insignificant. The difference between HFOV and CMV in cytological examination of lung fluids, wet/dry weight measurement was also insignificant. But compared with CMV,HFOV not only reduced the area of lung injury, but also reduced lung injury score in light and electron microscopic examination. Conclusion When same artery blood gas analysis was obtained, HFOV significantly reduced lung injury development in ARDS animal than CMV. As a lung protection strategy, HFOV can be used in the treatment of ARDS.

  10. Preemptive mechanical ventilation can block progressive acute lung injury.

    Science.gov (United States)

    Sadowitz, Benjamin; Jain, Sumeet; Kollisch-Singule, Michaela; Satalin, Joshua; Andrews, Penny; Habashi, Nader; Gatto, Louis A; Nieman, Gary

    2016-02-01

    Mortality from acute respiratory distress syndrome (ARDS) remains unacceptable, approaching 45% in certain high-risk patient populations. Treating fulminant ARDS is currently relegated to supportive care measures only. Thus, the best treatment for ARDS may lie with preventing this syndrome from ever occurring. Clinical studies were examined to determine why ARDS has remained resistant to treatment over the past several decades. In addition, both basic science and clinical studies were examined to determine the impact that early, protective mechanical ventilation may have on preventing the development of ARDS in at-risk patients. Fulminant ARDS is highly resistant to both pharmacologic treatment and methods of mechanical ventilation. However, ARDS is a progressive disease with an early treatment window that can be exploited. In particular, protective mechanical ventilation initiated before the onset of lung injury can prevent the progression to ARDS. Airway pressure release ventilation (APRV) is a novel mechanical ventilation strategy for delivering a protective breath that has been shown to block progressive acute lung injury (ALI) and prevent ALI from progressing to ARDS. ARDS mortality currently remains as high as 45% in some studies. As ARDS is a progressive disease, the key to treatment lies with preventing the disease from ever occurring while it remains subclinical. Early protective mechanical ventilation with APRV appears to offer substantial benefit in this regard and may be the prophylactic treatment of choice for preventing ARDS. PMID:26855896

  11. Combined Negative- and Positive-Pressure Ventilation for the Treatment of ARDS

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    Konstantinos Raymondos

    2015-01-01

    Full Text Available Objective. Tracheal intubation and positive-pressure ventilation as the current standard of care for the adult respiratory distress syndrome (ARDS seem to have reached their limit in terms of a further relevant reduction of the still very high mortality. Case Presentation. A 75-year-old male patient developed ARDS after abscess drainage with deteriorating oxygenation, despite positive end-expiratory pressure (PEEP values above 15 cm H2O. We applied external negative-pressure ventilation with a chamber respirator using −33 cm H2O at inspiration and −15 cm H2O at expiration, combined with conventional pressure support using a PEEP of about 8 cm H2O and a pressure support of 4–12 cm H2O. Alveolar infiltrates disappeared rapidly and PaO2/FiO2 values surpassed 300 mmHg after the first application and 500 mmHg after the second. Negative-pressure ventilation was used for 6–18 hours/day over five days. Now, 13 years later, the patient is still alive and has a good quality of life. Conclusion. Using this or similar concepts, not only in intubated patients but also as a noninvasive approach in patients with ARDS, offers new options that may genuinely differ from the present therapeutic approaches and may, therefore, have the potential to decrease the present high mortality from ARDS.

  12. Ventilator-associated lung injury during assisted mechanical ventilation.

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    Saddy, Felipe; Sutherasan, Yuda; Rocco, Patricia R M; Pelosi, Paolo

    2014-08-01

    Assisted mechanical ventilation (MV) may be a favorable alternative to controlled MV at the early phase of acute respiratory distress syndrome (ARDS), since it requires less sedation, no paralysis and is associated with less hemodynamic deterioration, better distal organ perfusion, and lung protection, thus reducing the risk of ventilator-associated lung injury (VALI). In the present review, we discuss VALI in relation to assisted MV strategies, such as volume assist-control ventilation, pressure assist-control ventilation, pressure support ventilation (PSV), airway pressure release ventilation (APRV), APRV with PSV, proportional assist ventilation (PAV), noisy ventilation, and neurally adjusted ventilatory assistance (NAVA). In summary, we suggest that assisted MV can be used in ARDS patients in the following situations: (1) Pao(2)/Fio(2) >150 mm Hg and positive end-expiratory pressure ≥ 5 cm H(2)O and (2) with modalities of pressure-targeted and time-cycled breaths including more or less spontaneous or supported breaths (A-PCV [assisted pressure-controlled ventilation] or APRV). Furthermore, during assisted MV, the following parameters should be monitored: inspiratory drive, transpulmonary pressure, and tidal volume (6 mL/kg). Further studies are required to determine the impact of novel modalities of assisted ventilation such as PAV, noisy pressure support, and NAVA on VALI. PMID:25105820

  13. Plasma CC16 levels are associated with development of ALI/ARDS in patients with ventilator-associated pneumonia: a retrospective observational study

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    Lutter Rene

    2009-12-01

    Full Text Available Abstract Background Despite consensus criteria, diagnosing acute lung injury, or its more severe form acute respiratory distress syndrome (ALI/ARDS remains challenging. Adding objective measures, such as plasma levels of biological markers could facilitate recognition of ALI/ARDS. This study was designed to assess and compare the diagnostic accuracy of biological markers for ALI/ARDS with ventilator-associated pneumonia (VAP. Methods We performed serial measurements of Clara cell protein (CC16, soluble receptor for advanced glycation end products (sRAGE, surfactant protein D (SP-D and Krebs von den Lungen (KL-6 in plasma of patients with VAP and mechanically ventilated control patients without VAP. ALI/ARDS was diagnosed using the criteria of the North-American European consensus conference. Results Thirty-seven patients were enrolled - 22 patients with VAP and 15 control patients. Ten patients with pneumonia met the ALI/ARDS consensus criteria. Control patients never met these criteria. Plasma CC16 had a good diagnostic capacity for ALI/ARDS as shown by the receiver operating characteristic curve with an area under the curve of 0.91 (95% confidence interval (CI 0.79 - 1.00; p p = 0.02. The diagnostic accuracies of KL-6 and sRAGE were low. Conclusion Plasma CC16 seems a potential biological marker for ALI/ARDS in patients with VAP. Plasma levels of sRAGE, SP-D and KL-6 have limited discriminative power for diagnosing ALI/ARDS in VAP.

  14. Total Liquid Ventilation Provides Superior Respiratory Support to Conventional Mechanical Ventilation in a Large Animal Model of Severe Respiratory Failure

    OpenAIRE

    Pohlmann, Joshua R.; Brant, David O; Daul, Morgan A; Reoma, Junewai L; Kim, Anne C; Osterholzer, Kathryn R.; Johnson, Kent J.; Bartlett, Robert H.; Cook, Keith E.; Hirschl, Ronald B.

    2011-01-01

    Total liquid ventilation (TLV) has the potential to provide respiratory support superior to conventional mechanical ventilation (CMV) in the acute respiratory distress syndrome (ARDS). However, laboratory studies are limited to trials in small animals for no longer than 4 hours. The objective of this study was to compare TLV and CMV in a large animal model of ARDS for 24 hours. Ten sheep weighing 53 ± 4 (SD) kg were anesthetized and ventilated with 100% oxygen. Oleic acid was injected into th...

  15. Use of dynamic CT in acute respiratory distress syndrome (ARDS) with comparison of positive and negative pressure ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Helm, Emma; Babyn, Paul [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto (Canada); Talakoub, Omid; Alirezaie, Javad [Ryerson University, Department of Electrical and Computer Engineering, Toronto, ON (Canada); Grasso, Francesco; Engelberts, Doreen; Kavanagh, Brian P. [Hospital for Sick Children and the University of Toronto, Departments of Anesthesia and Critical Care Medicine and the Program in Pulmonary and Experimental Medicine, Toronto (Canada)

    2009-01-15

    Negative pressure ventilation via an external device ('iron lung') has the potential to provide better oxygenation with reduced barotrauma in patients with ARDS. This study was designed to see if oxygenation differences between positive and negative ventilation could be explained by CT. Six anaesthetized rabbits had ARDS induced by repeated saline lavage. Rabbits were ventilated with positive pressure ventilation (PPV) and negative pressure ventilation (NPV) in turn. Dynamic CT images were acquired over the respiratory cycle. A computer-aided method was used to segment the lung and calculate the range of CT densities within each slice. Volumes of ventilated lung and atelectatic lung were measured over the respiratory cycle. NPV was associated with an increased percentage of ventilated lung and decreased percentage of atelectatic lung. The most significant differences in ventilation and atelectasis were seen at mid-inspiration and mid-expiration (ventilated lung NPV=61%, ventilated lung PPV=47%, p<0.001; atelectatic lung NPV=10%, atelectatic lung PPV 19%, p<0.001). Aeration differences were not significant at end-inspiration. Dynamic CT can show differences in lung aeration between positive and negative ventilation in ARDS. These differences would not be appreciated if only static breath-hold CT was used. (orig.)

  16. How ARDS should be treated.

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    Gattinoni, Luciano; Quintel, Michael

    2016-01-01

    The Berlin definition criteria applied at positive end-expiratory pressure (PEEP) 5 cm H2O reasonably predict lung edema and recruitabilty. To maintain viable gas exchange, the mechanical ventilation becomes progressively more risky going from mild to severe acute respiratory distress syndrome (ARDS). Tidal volume, driving pressure, flow, and respiratory rate have been identified as causes of ventilation-induced lung injury. Taken together, they represent the mechanical power applied to the lung parenchyma. In an inhomogeneous lung, stress risers locally increase the applied mechanical power. Increasing lung homogeneity by PEEP and prone position decreases the harm of mechanical ventilation, particularly in severe ARDS. PMID:27048605

  17. [Acute respiratory failure (ARDS) in a young child after drowning accident: therapy with exogenous surfactant and high frequency oscillatory ventilation].

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    Marx, M; Golej, J; Fürst, G; Hermon, M; Trittenwein, G

    1995-01-01

    The adult respiratory distress syndrome (ARDS) in children has a very poor prognosis with a mortality risk of between 55 and 85%, in spite of improvements due to the introduction of positive endexpiratory pressure ventilation. We describe the clinical course of a not yet 3 year-old boy with severe ARDS following near-drowing. Treatment with exogenous surfactant and high frequency oscillatory ventilation, a well-established procedure in neonatology, was responsible for the favorable outcome. The high cost of surfactant therapy, however, is the main limiting factor for this kind of treatment in children beyond the neonatal period, but it may be the last therapeutic resort in the management of severe ARDS.

  18. Complications of mechanical ventilation

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    Drašković Biljana

    2011-01-01

    Full Text Available Mechanical ventilation of the lungs, as an important therapeutic measure, cannot be avoided in critically ill patients. However, when machines take over some of vital functions there is always a risk of complications and accidents. Complications associated with mechanical ventilation can be divided into: 1 airway-associated complications; 2 complications in the response of patients to mechanical ventilation; and 3 complications related to the patient’s response to the device for mechanical ventilation. Complications of artificial airway may be related to intubation and extubation or the endotracheal tube. Complications of mechanical ventilation, which arise because of the patient’s response to mechanical ventilation, may primarily cause significant side effects to the lungs. During the last two decades it was concluded that mechanical ventilation can worsen or cause acute lung injury. Mechanical ventilation may increase the alveolar/capillary permeability by overdistension of the lungs (volutrauma, it can exacerbate lung damage due to the recruitment/derecruitment of collapsed alveoli (atelectrauma and may cause subtle damages due to the activation of inflammatory processes (biotrauma. Complications caused by mechanical ventilation, beside those involving the lungs, can also have significant effects on other organs and organic systems, and can be a significant factor contributing to the increase of morbidity and mortality in critically ill of mechanically ventilated patients. Complications are fortunately rare and do not occur in every patient, but due to their seriousness and severity they require extensive knowledge, experience and responsibility by health-care workers.

  19. A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study.

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    Lall, Ranjit; Hamilton, Patrick; Young, Duncan; Hulme, Claire; Hall, Peter; Shah, Sanjoy; MacKenzie, Iain; Tunnicliffe, William; Rowan, Kathy; Cuthbertson, Brian; McCabe, Chris; Lamb, Sallie

    2015-01-01

    BACKGROUND Patients with the acute respiratory distress syndrome (ARDS) require artificial ventilation but this treatment may produce secondary lung damage. High-frequency oscillatory ventilation (HFOV) may reduce this damage. OBJECTIVES To determine the clinical benefit and cost-effectiveness of HFOV in patients with ARDS compared with standard mechanical ventilation. DESIGN A parallel, randomised, unblinded clinical trial. SETTING UK intensive care units. PARTICIPANTS Mechanically ventilated patients with a partial pressure of oxygen in arterial blood/fractional concentration of inspired oxygen (P : F) ratio of 26.7 kPa (200 mmHg) or less and an expected duration of ventilation of at least 2 days at recruitment. INTERVENTIONS Treatment arm HFOV using a Novalung R100(®) ventilator (Metran Co. Ltd, Saitama, Japan) ventilator until the start of weaning. Control arm Conventional mechanical ventilation using the devices available in the participating centres. MAIN OUTCOME MEASURES The primary clinical outcome was all-cause mortality at 30 days after randomisation. The primary health economic outcome was the cost per quality-adjusted life-year (QALY) gained. RESULTS One hundred and sixty-six of 398 patients (41.7%) randomised to the HFOV group and 163 of 397 patients (41.1%) randomised to the conventional mechanical ventilation group died within 30 days of randomisation (p = 0.85), for an absolute difference of 0.6% [95% confidence interval (CI) -6.1% to 7.5%]. After adjustment for study centre, sex, Acute Physiology and Chronic Health Evaluation II score, and the initial P : F ratio, the odds ratio for survival in the conventional ventilation group was 1.03 (95% CI 0.75 to 1.40; p = 0.87 logistic regression). Survival analysis showed no difference in the probability of survival up to 12 months after randomisation. The average QALY at 1 year in the HFOV group was 0.302 compared to 0.246. This gives an incremental cost-effectiveness ratio (ICER) for the cost to

  20. Plasma CC16 levels are associated with development of ALI/ARDS in patients with ventilator-associated pneumonia: a retrospective observational study

    OpenAIRE

    Lutter Rene; Waddy Sam; Millo Julian L; Determann Rogier M; Garrard Chris S; Schultz Marcus J

    2009-01-01

    Abstract Background Despite consensus criteria, diagnosing acute lung injury, or its more severe form acute respiratory distress syndrome (ALI/ARDS) remains challenging. Adding objective measures, such as plasma levels of biological markers could facilitate recognition of ALI/ARDS. This study was designed to assess and compare the diagnostic accuracy of biological markers for ALI/ARDS with ventilator-associated pneumonia (VAP). Methods We performed serial measurements of Clara cell protein (C...

  1. Acute lung injury and ARDS in acute pancreatitis: Mechanisms and potential intervention

    Institute of Scientific and Technical Information of China (English)

    Roland; Andersson

    2010-01-01

    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in acute pancreatitis still represents a substantial problem,with a mortality rate in the range of 30%-40%.The present review evaluates underlying pathophysiological mechanisms in both ALI and ARDS and potential clinical implications.Several mediators and pathophysiological pathways are involved during the different phases of ALI and ARDS.The initial exudative phase is characterized by diffuse alveolar damage,microvascular injury and inf...

  2. Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients

    OpenAIRE

    Hann Christopher E; Chase J; Sundaresan Ashwath; Shaw Geoffrey M

    2010-01-01

    Abstract The application of positive end expiratory pressure (PEEP) in mechanically ventilated (MV) patients with acute respiratory distress syndrome (ARDS) decreases cardiac output (CO). Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link between the PEEP used in MV, and CO provides an opportunity to assess CO via MV therapy and other existing measurements, creating a CO measure without further invasiveness. This paper examines...

  3. Plasma levels of surfactant protein D and KL-6 for evaluation of lung injury in critically ill mechanically ventilated patients

    OpenAIRE

    Slutsky Arthur S; Zhang Haibo; Haitsma Jack J; Royakkers Annick ANM; Determann Rogier M; Ranieri V Marco; Schultz Marcus J

    2010-01-01

    Abstract Background Preventing ventilator-associated lung injury (VALI) has become pivotal in mechanical ventilation of patients with acute lung injury (ALI) or its more severe form, acute respiratory distress syndrome (ARDS). In the present study we investigated whether plasma levels of lung-specific biological markers can be used to evaluate lung injury in patients with ALI/ARDS and patients without lung injury at onset of mechanical ventilation. Methods Plasma levels of surfactant protein ...

  4. Conventional mechanical ventilation

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    Tobias Joseph

    2010-01-01

    Full Text Available The provision of mechanical ventilation for the support of infants and children with respiratory failure or insufficiency is one of the most common techniques that are performed in the Pediatric Intensive Care Unit (PICU. Despite its widespread application in the PICUs of the 21st century, before the 1930s, respiratory failure was uniformly fatal due to the lack of equipment and techniques for airway management and ventilatory support. The operating rooms of the 1950s and 1960s provided the arena for the development of the manual skills and the refinement of the equipment needed for airway management, which subsequently led to the more widespread use of endotracheal intubation thereby ushering in the era of positive pressure ventilation. Although there seems to be an ever increasing complexity in the techniques of mechanical ventilation, its successful use in the PICU should be guided by the basic principles of gas exchange and the physiology of respiratory function. With an understanding of these key concepts and the use of basic concepts of mechanical ventilation, this technique can be successfully applied in both the PICU and the operating room. This article reviews the basic physiology of gas exchange, principles of pulmonary physiology, and the concepts of mechanical ventilation to provide an overview of the knowledge required for the provision of conventional mechanical ventilation in various clinical arenas.

  5. Automated Rotational Percussion Bed and Bronchoscopy Improves Respiratory Mechanics and Oxygenation in ARDS Patients Supported with Extracorporeal Membrane Oxygenation.

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    Sharma, Nirmal S; Wille, Keith M; Bellot, S Christopher; Diaz-Guzman, Enrique

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) has been used to provide "lung rest" through the use of low tidal volume (6 ml/kg) and ultralow tidal volume (respiratory distress syndrome (ARDS). Low and ultralow tidal volume ventilation can result in low dynamic respiratory compliance and potentially increased retention of airway secretions. We present our experience using automated rotational percussion beds (ARPBs) and bronchoscopy in four ARDS patients to manage increased pulmonary secretions. These beds performed automated side-to-side tilt maneuver and intermittent chest wall percussion. Their use resulted in substantial reduction in peak and plateau pressures in two patients on volume control ventilation, while the driving pressures (inspiratory pressure) to attain the desired tidal volumes in patients on pressure control ventilation also decreased. In addition, mean partial pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FiO2) ratio (109 pre-ARPB vs. 157 post-ARPB), positive end-expiratory pressure (10 cm H2O vs. 8 cm H2O), and FiO2 (0.88 vs. 0.52) improved after initiation of ARPB. The improvements in the respiratory mechanics and oxygenation helped us to initiate early ECMO weaning. Based on our experience, the use of chest physiotherapy, frequent body repositioning, and bronchoscopy may be helpful in the management of pulmonary secretions in patients supported with ECMO. PMID:26771392

  6. Clinical challenges in mechanical ventilation.

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    Goligher, Ewan C; Ferguson, Niall D; Brochard, Laurent J

    2016-04-30

    Mechanical ventilation supports gas exchange and alleviates the work of breathing when the respiratory muscles are overwhelmed by an acute pulmonary or systemic insult. Although mechanical ventilation is not generally considered a treatment for acute respiratory failure per se, ventilator management warrants close attention because inappropriate ventilation can result in injury to the lungs or respiratory muscles and worsen morbidity and mortality. Key clinical challenges include averting intubation in patients with respiratory failure with non-invasive techniques for respiratory support; delivering lung-protective ventilation to prevent ventilator-induced lung injury; maintaining adequate gas exchange in severely hypoxaemic patients; avoiding the development of ventilator-induced diaphragm dysfunction; and diagnosing and treating the many pathophysiological mechanisms that impair liberation from mechanical ventilation. Personalisation of mechanical ventilation based on individual physiological characteristics and responses to therapy can further improve outcomes. PMID:27203509

  7. Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury.

    Science.gov (United States)

    Nieman, Gary F; Gatto, Louis A; Habashi, Nader M

    2015-12-01

    The earliest description of what is now known as the acute respiratory distress syndrome (ARDS) was a highly lethal double pneumonia. Ashbaugh and colleagues (Ashbaugh DG, Bigelow DB, Petty TL, Levine BE Lancet 2: 319-323, 1967) correctly identified the disease as ARDS in 1967. Their initial study showing the positive effect of mechanical ventilation with positive end-expiratory pressure (PEEP) on ARDS mortality was dampened when it was discovered that improperly used mechanical ventilation can cause a secondary ventilator-induced lung injury (VILI), thereby greatly exacerbating ARDS mortality. This Synthesis Report will review the pathophysiology of ARDS and VILI from a mechanical stress-strain perspective. Although inflammation is also an important component of VILI pathology, it is secondary to the mechanical damage caused by excessive strain. The mechanical breath will be deconstructed to show that multiple parameters that comprise the breath-airway pressure, flows, volumes, and the duration during which they are applied to each breath-are critical to lung injury and protection. Specifically, the mechanisms by which a properly set mechanical breath can reduce the development of excessive fluid flux and pulmonary edema, which are a hallmark of ARDS pathology, are reviewed. Using our knowledge of how multiple parameters in the mechanical breath affect lung physiology, the optimal combination of pressures, volumes, flows, and durations that should offer maximum lung protection are postulated. PMID:26472873

  8. Conventional mechanical ventilation

    OpenAIRE

    Tobias Joseph

    2010-01-01

    The provision of mechanical ventilation for the support of infants and children with respiratory failure or insufficiency is one of the most common techniques that are performed in the Pediatric Intensive Care Unit (PICU). Despite its widespread application in the PICUs of the 21st century, before the 1930s, respiratory failure was uniformly fatal due to the lack of equipment and techniques for airway management and ventilatory support. The operating rooms of the 1950s and 1960s provided the ...

  9. Biomarkers in Pediatric ARDS: Future Directions

    Directory of Open Access Journals (Sweden)

    Benjamin E Orwoll

    2016-06-01

    Full Text Available Acute respiratory distress syndrome (ARDS is common among mechanically ventilated children, and accompanies up to 30% of all PICU deaths. Though ARDS diagnosis is based on clinical criteria, biological markers of acute lung damage have been extensively studied in adults and children. Biomarkers of inflammation, alveolar epithelial and capillary endothelial disruption, disordered coagulation, and associated derangements measured in the circulation and other body fluids such as brochoalveolar lavage have improved our understanding of pathobiology of ARDS. The biochemical signature of ARDS has been increasingly well described in adult populations, and this has led to the identification of molecular phenotypes to augment clinical classifications. However, there is a paucity of data from pediatric ARDS patients. Biomarkers and molecular phenotypes have the potential to identify patients at high risk of poor outcomes, and perhaps inform the development of targeted therapies for specific groups of patients. Additionally, because of the lower incidence of and mortality from ARDS in pediatric patients relative to adults and lack of robust clinical predictors of outcome, there is an ongoing interest in biological markers as surrogate outcome measures. The recent definition of pediatric ARDS (pARDS provides additional impetus for measurement of established and novel biomarkers in future pediatric studies in order to further characterize this disease process. This chapter will review the currently available literature and discuss potential future directions for investigation into biomarkers in ARDS among children.

  10. Mechanical ventilation in neurosurgical patients

    OpenAIRE

    Keshav Goyal; Ranadhir Mitra; Shweta Kedia

    2013-01-01

    Mechanical ventilation significantly affects cerebral oxygenation and cerebral blood flow through changes in arterial carbon dioxide levels. Neurosurgical patients might require mechanical ventilation for correction and maintenance of changes in the pulmonary system that occur either due to neurosurgical pathology or following surgery during the acute phase. This review discusses the basics of mechanical ventilation relevant to the neurosurgeon in the day-to-day management of neurosurgical pa...

  11. Mechanical ventilation in neurosurgical patients

    Directory of Open Access Journals (Sweden)

    Keshav Goyal

    2013-01-01

    Full Text Available Mechanical ventilation significantly affects cerebral oxygenation and cerebral blood flow through changes in arterial carbon dioxide levels. Neurosurgical patients might require mechanical ventilation for correction and maintenance of changes in the pulmonary system that occur either due to neurosurgical pathology or following surgery during the acute phase. This review discusses the basics of mechanical ventilation relevant to the neurosurgeon in the day-to-day management of neurosurgical patient requiring artificial support of the respiration.

  12. Lung stress, strain, and energy load: engineering concepts to understand the mechanism of ventilator-induced lung injury (VILI)

    OpenAIRE

    Nieman, Gary F.; Satalin, Joshua; Andrews, Penny; Habashi, Nader M.; Gatto, Louis A.

    2016-01-01

    It was recently shown that acute respiratory distress syndrome (ARDS) mortality has not been reduced in over 15 years and remains ~40 %, even with protective low tidal volume (LVt) ventilation. Thus, there is a critical need to develop novel ventilation strategies that will protect the lung and reduce ARDS mortality. Protti et al. have begun to analyze the impact of mechanical ventilation on lung tissue using engineering methods in normal pigs ventilated for 54 h. They used these methods to a...

  13. Treatment of sepsis and ARDS with extracorporeal membrane oxygenation and interventional lung assist membrane ventilator in a patient with acute lymphoblastic leukemia.

    Science.gov (United States)

    Gorjup, Vojka; Fister, Misa; Noc, Marko; Rajic, Vladan; Ribaric, Suada Filekovic

    2012-07-01

    We report an 18-year-old ice skater with acute lymphoblast leukemia. She developed Staphylococcus epidermidis bacteremia, severe sepsis, septic shock, and ARDS following chemotherapy-induced severe bone marrow failure. She was successfully treated with extraordinary life support measures, which included extracorporeal membrane oxygenation, double lumen lung ventilation for management of hemoptysis, and lung assist membrane ventilation. After 57 days of ICU treatment and a year of rehabilitation, the patient has fully regained her functional status, is now finishing high school, and is ice skating again.

  14. Mechanical ventilation with lower tidal volumes does not influence the prescription of opioids or sedatives

    NARCIS (Netherlands)

    Wolthuis, Esther K; Veelo, Denise P; Choi, Goda; Determann, Rogier M; Korevaar, Johanna C; Spronk, Peter E; Kuiper, Michael A; Schultz, Marcus J

    2007-01-01

    INTRODUCTION: We compared the effects of mechanical ventilation with a lower tidal volume (V(T)) strategy versus those of greater V(T) in patients with or without acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) on the use of opioids and sedatives. METHODS: This is a secondary anal

  15. Optimizing Mechanical Ventilation by Bedside Lung Monitoring Systems in Critically ill Patients

    NARCIS (Netherlands)

    I.G. Bikker (Ido)

    2015-01-01

    markdownabstract__Abstract__ Since the original description of the acute respiratory distress syndrome (ARDS) in the Lancet by Ashbaugh et al. in 1967, numerous studies have aimed to improve mechanical ventilation in order to prevent the associated ventilatorinduced lung injury (VILI). In 2000, the

  16. Low-energy mechanical ventilation

    DEFF Research Database (Denmark)

    Andersen, Claus Wessel; Hviid, Christian Anker

    2014-01-01

    and with as little energy consumption as 41.1 kWh/m2/year including heating and all building services with no use of renewable energy such as PVcells or solar heating. One of the key means of reaching the objectives was to implement mechanical ventilation with low pressure loss and therefore low energy consumption....... The project consists of two buildings, building one is 6 stories high, and building two is 4 stories high. The buildings have a gross area of 50,500 m2 including underground parking. The ventilation and indoor climate concept was to use mechanical ventilation together with mechanical cooling and fanassisted......, with an average of 1.1 kJ/m3. The yearly mean SFP based on estimated runtime is approx. 0.8 kJ/m3. The case shows the unlocked potential that lies within mechanical ventilation for nearzero energy consuming buildings....

  17. Mechanical ventilation for severe asthma.

    Science.gov (United States)

    Leatherman, James

    2015-06-01

    Acute exacerbations of asthma can lead to respiratory failure requiring ventilatory assistance. Noninvasive ventilation may prevent the need for endotracheal intubation in selected patients. For patients who are intubated and undergo mechanical ventilation, a strategy that prioritizes avoidance of ventilator-related complications over correction of hypercapnia was first proposed 30 years ago and has become the preferred approach. Excessive pulmonary hyperinflation is a major cause of hypotension and barotrauma. An appreciation of the key determinants of hyperinflation is essential to rational ventilator management. Standard therapy for patients with asthma undergoing mechanical ventilation consists of inhaled bronchodilators, corticosteroids, and drugs used to facilitate controlled hypoventilation. Nonconventional interventions such as heliox, general anesthesia, bronchoscopy, and extracorporeal life support have also been advocated for patients with fulminant asthma but are rarely necessary. Immediate mortality for patients who are mechanically ventilated for acute severe asthma is very low and is often associated with out-of-hospital cardiorespiratory arrest before intubation. However, patients who have been intubated for severe asthma are at increased risk for death from subsequent exacerbations and must be managed accordingly in the outpatient setting. PMID:26033128

  18. Identification of regional overdistension, recruitment and cyclic alveolar collapse with electrical impedance tomography in an experimental ARDS model

    OpenAIRE

    Liu, Songqiao; Tan, Li; Möller, Knut; Frerichs, Inez; Yu, Tao; Liu, Ling; Huang, Yingzi; Guo, Fengmei; Xu, Jingyuan; Yang, Yi; Qiu, Haibo; Zhao, Zhanqi

    2016-01-01

    Background Information on regional ventilation distribution in mechanically ventilated patients is important to develop lung protective ventilation strategies. In the present prospective animal study, we introduce an electrical impedance tomography (EIT)-based method to classify lungs into normally ventilated, overinflated, tidally recruited/derecruited and recruited regions. Methods Acute respiratory distress syndrome (ARDS) was introduced with repeated bronchoalveolar lavage in ten healthy ...

  19. ARDS in pregnancy.

    Science.gov (United States)

    Duarte, Alexander G

    2014-12-01

    Acute respiratory distress syndrome (ARDS) is an uncommon condition in pregnant patients. The causes of ARDS are associated with obstetric causes such as amniotic fluid embolism, preeclampsia, septic abortion, and retained products of conception or nonobstetric causes that include sepsis, aspiration pneumonitis, influenza pneumonia, blood transfusions, and trauma. An essential component in management of ARDS involves good communication between the obstetrics team and critical care specialist and a fundamental understanding of mechanical ventilatory support. Medical therapies such as nitric oxide and corticosteroids play a complimentary role. Extracorporeal life support is beneficial in the management of the parturient with severe ARDS. PMID:25314088

  20. Acute lung injury/acute respiratory distress syndrome (ALI/ARDS): the mechanism, present strategies and future perspectives of therapies

    OpenAIRE

    Luh, Shi-Ping; Chiang, Chi-huei

    2006-01-01

    Acute lung injury/acute respiratory distress syndrome (ALI/ARDS), which manifests as non-cardiogenic pulmonary edema, respiratory distress and hypoxemia, could be resulted from various processes that directly or indirectly injure the lung. Extensive investigations in experimental models and humans with ALI/ARDS have revealed many molecular mechanisms that offer therapeutic opportunities for cell or gene therapy. Herein the present strategies and future perspectives of the treatment for ALI/AR...

  1. Clinical review: Liberation from mechanical ventilation

    OpenAIRE

    El-Khatib, Mohamad F; Bou-Khalil, Pierre

    2008-01-01

    Mechanical ventilation is the defining event of intensive care unit (ICU) management. Although it is a life saving intervention in patients with acute respiratory failure and other disease entities, a major goal of critical care clinicians should be to liberate patients from mechanical ventilation as early as possible to avoid the multitude of complications and risks associated with prolonged unnecessary mechanical ventilation, including ventilator induced lung injury, ventilator associated p...

  2. Mechanical ventilation and intra-abdominal hypertension: 'Beyond Good and Evil'.

    Science.gov (United States)

    Pelosi, Paolo; Vargas, Maria

    2012-01-01

    Intra-abdominal hypertension is frequent in surgical and medical critically ill patients. Intra-abdominal hypertension has a serious impact on the function of respiratory as well as peripheral organs. In the presence of alveolar capillary damage, which occurs in acute respiratory distress syndrome (ARDS), intra-abdominal hypertension promotes lung injury as well as edema, impedes the pulmonary lymphatic drainage, and increases intra-thoracic pressures, leading to atelectasis, airway closure, and deterioration of respiratory mechanics and gas exchange. The optimal setting of mechanical ventilation and its impact on respiratory function and hemodynamics in ARDS associated with intra-abdominal hypertension are far from being assessed. We suggest that the optimal ventilator management of patients with ARDS and intra-abdominal hypertension would include the following: (a) intra-abdominal, esophageal pressure, and hemodynamic monitoring; (b) ventilation setting with protective tidal volume, recruitment maneuver, and level of positive end-expiratory pressure set according to the 'best' compliance of the respiratory system or the lung; (c) deep sedation with or without neuromuscular paralysis in severe ARDS; and (d) open abdomen in selected patients with severe abdominal compartment syndrome. PMID:23256904

  3. Radiological diagnosis of adult respiratory distress syndrome (ARDS)

    International Nuclear Information System (INIS)

    The bedside chest radiograph represents the imaging modality of choice for diagnosis and monitoring of adult respiratory distress syndrome (ARDS). Imaging findings are strongly influenced by means of mechanical ventilation therapy. The chest radiograph is relatively insensitive and not specific for the diagnosis of complications such as pneumonia or interstitial emphysema. Computed tomography (CT) is suitable for quantitative assessment of lung compartments with respect to the underlying pathophysiology and the effects of ventilation therapy (PEEP) could be improved. The role of CT in the clinical routine is still limited due to the high risk to transport patients with ARDS. (author)

  4. Iatrogenic pneumothorax related to mechanical ventilation

    OpenAIRE

    Hsu, Chien-Wei; Sun, Shu-Fen

    2014-01-01

    Pneumothorax is a potentially lethal complication associated with mechanical ventilation. Most of the patients with pneumothorax from mechanical ventilation have underlying lung diseases; pneumothorax is rare in intubated patients with normal lungs. Tension pneumothorax is more common in ventilated patients with prompt recognition and treatment of pneumothorax being important to minimize morbidity and mortality. Underlying lung diseases are associated with ventilator-related pneumothorax with...

  5. Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients

    Directory of Open Access Journals (Sweden)

    Hann Christopher E

    2010-11-01

    Full Text Available Abstract The application of positive end expiratory pressure (PEEP in mechanically ventilated (MV patients with acute respiratory distress syndrome (ARDS decreases cardiac output (CO. Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link between the PEEP used in MV, and CO provides an opportunity to assess CO via MV therapy and other existing measurements, creating a CO measure without further invasiveness. This paper examines combining models of diffusion resistance and lung mechanics, to help predict CO changes due to PEEP. The CO estimator uses an initial measurement of pulmonary shunt, and estimations of shunt changes due to PEEP to predict CO at different levels of PEEP. Inputs to the cardiac model are the PV loops from the ventilator, as well as the oxygen saturation values using known respiratory inspired oxygen content. The outputs are estimates of pulmonary shunt and CO changes due to changes in applied PEEP. Data from two published studies are used to assess and initially validate this model. The model shows the effect on oxygenation due to decreased CO and decreased shunt, resulting from increased PEEP. It concludes that there is a trade off on oxygenation parameters. More clinically importantly, the model also examines how the rate of CO drop with increased PEEP can be used as a method to determine optimal PEEP, which may be used to optimise MV therapy with respect to the gas exchange achieved, as well as accounting for the impact on the cardiovascular system and its management.

  6. Decisional responsibility for mechanical ventilation and weaning

    DEFF Research Database (Denmark)

    Rose, Louise; Blackwood, Bronagh; Egerod, Ingrid;

    2011-01-01

    Optimal management of mechanical ventilation and weaning requires dynamic and collaborative decision making to minimize complications and avoid delays in the transition to extubation. In the absence of collaboration, ventilation decision making may be fragmented, inconsistent, and delayed. Our...... objective was to describe the professional group with responsibility for key ventilation and weaning decisions and to examine organizational characteristics associated with nurse involvement....

  7. Obesity and ARDS

    OpenAIRE

    Hibbert, Kathryn; Rice, Mary; Malhotra, Atul

    2012-01-01

    Obesity prevalence continues to increase globally, with figures exceeding 30% of some populations. Patients who are obese experience alterations in baseline pulmonary mechanics, including airflow obstruction, decreased lung volumes, and impaired gas exchange. These physiologic changes have implications in many diseases, including ARDS. The unique physiology of patients who are obese affects the presentation and pathophysiology of ARDS, and patients who are obese who have respiratory failure p...

  8. Abdominal Muscle Activity during Mechanical Ventilation Increases Lung Injury in Severe Acute Respiratory Distress Syndrome.

    Directory of Open Access Journals (Sweden)

    Xianming Zhang

    Full Text Available It has proved that muscle paralysis was more protective for injured lung in severe acute respiratory distress syndrome (ARDS, but the precise mechanism is not clear. The purpose of this study was to test the hypothesis that abdominal muscle activity during mechanically ventilation increases lung injury in severe ARDS.Eighteen male Beagles were studied under mechanical ventilation with anesthesia. Severe ARDS was induced by repetitive oleic acid infusion. After lung injury, Beagles were randomly assigned into spontaneous breathing group (BIPAPSB and abdominal muscle paralysis group (BIPAPAP. All groups were ventilated with BIPAP model for 8h, and the high pressure titrated to reached a tidal volume of 6ml/kg, the low pressure was set at 10 cmH2O, with I:E ratio 1:1, and respiratory rate adjusted to a PaCO2 of 35-60 mmHg. Six Beagles without ventilator support comprised the control group. Respiratory variables, end-expiratory volume (EELV and gas exchange were assessed during mechanical ventilation. The levels of Interleukin (IL-6, IL-8 in lung tissue and plasma were measured by qRT-PCR and ELISA respectively. Lung injury scores were determined at end of the experiment.For the comparable ventilator setting, as compared with BIPAPSB group, the BIPAPAP group presented higher EELV (427±47 vs. 366±38 ml and oxygenation index (293±36 vs. 226±31 mmHg, lower levels of IL-6(216.6±48.0 vs. 297.5±71.2 pg/ml and IL-8(246.8±78.2 vs. 357.5±69.3 pg/ml in plasma, and lower express levels of IL-6 mRNA (15.0±3.8 vs. 21.2±3.7 and IL-8 mRNA (18.9±6.8 vs. 29.5±7.9 in lung tissues. In addition, less lung histopathology injury were revealed in the BIPAPAP group (22.5±2.0 vs. 25.2±2.1.Abdominal muscle activity during mechanically ventilation is one of the injurious factors in severe ARDS, so abdominal muscle paralysis might be an effective strategy to minimize ventilator-induce lung injury.

  9. Pneumothorax after Mechanical Ventilation in Newborns

    OpenAIRE

    Abdolreza Malek; Nargess Afzali; Mojtaba Meshkat; Nadieh Yazdi Hosseini

    2011-01-01

    Objective:Air leak syndromes including pneumothorax, pneumomediastinum and pulmonary interstitial emphysema are frequent in neonatal period. Mechanical ventilation with positive pressure is one of the most common causes of these syndromes. The aim of this study was to evaluate predisposing factors and incidence of pneumothorax in newborns under mechanical ventilation. Methods:This descriptive cross sectional study was performed in 400 newborns under mechanical ventilation in intensive care un...

  10. Recent updates in mechanical ventilation

    OpenAIRE

    Bergamaschi, Valentina; Paolo, Navalesi

    2009-01-01

    Recently, several studies have been performed to better outline the pathophysiology of acute respiratory failure and evaluate the therapeutic profile of different modes of ventilation and ventilator settings. Here we briefly report those we consider most relevant for daily intensive care unit clinical practice.

  11. [Pathophysiology of gas exchange in ARDS].

    Science.gov (United States)

    Fernández Fernández, R

    2006-11-01

    ARDS is produced in a pulmonary edema picture due to increased vascular patency. In this way, the initial alteration consists in an alveolar occupation due to protein rich edema. This occupation reduces the alveolar surface available for gas exchange, increasing the pulmonary areas with poor or null V/Q ratio. As ARDS progresses, vascular phenomena occur that affect the gas exchange differently, giving rise to heterogeneity in the V/Q ratio. This situation worsens due to the appearance of areas with null ventilation in relationship with the appearance of atelectasis in lung dependent zones. All these factors form the hypoxemia picture refractory to the increase of the inspired oxygen fraction characteristic of this clinical entity. In this article, we make a review of these physiological mechanisms and the effect on the oxygenation of different ventilatory and drug maneuvers. PMID:17129535

  12. Carbon dioxide production during mechanical ventilation

    DEFF Research Database (Denmark)

    Henneberg, S; Söderberg, D; Groth, T;

    1987-01-01

    studied CO2 production (VCO2) and oxygen consumption (VO2) in mechanically ventilated ICU patients, where CO2 stores were altered by: a) changing minute ventilation by 15%, b) reducing body temperature, and c) changing the level of sedation. Expired gases went through a mixing chamber and were analyzed...

  13. Clinical Practice Guidelines for Early Weaning from Mechanical Ventilation.

    OpenAIRE

    Eddy Pereira Valdés

    2009-01-01

    Clinical Practice Guidelines for Early Weaning from Mechanical Ventilation. Weaning is the process, gradual or rapid, that leads to the turn off of mechanical ventilation and allows restoring spontaneous ventilation. The guidelines describe the procedure for rapid weaning from mechanical ventilation and emphasizes on spontaneous ventilation test. It includes assessment guidelines focused on the most important aspects to be accomplished.

  14. Echocardiographic evaluation during weaning from mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Luciele Medianeira Schifelbain

    2011-01-01

    Full Text Available INTRODUCTION: Echocardiographic, electrocardiographic and other cardiorespiratory variables can change during weaning from mechanical ventilation. OBJECTIVES: To analyze changes in cardiac function, using Doppler echocardiogram, in critical patients during weaning from mechanical ventilation, using two different weaning methods: pressure support ventilation and T-tube; and comparing patient subgroups: success vs. failure in weaning. METHODS: Randomized crossover clinical trial including patients under mechanical ventilation for more than 48 h and considered ready for weaning. Cardiorespiratory variables, oxygenation, electrocardiogram and Doppler echocardiogram findings were analyzed at baseline and after 30 min in pressure support ventilation and T-tube. Pressure support ventilation vs. T-tube and weaning success vs. failure were compared using ANOVA and Student's t-test. The level of significance was p<0.05. RESULTS: Twenty-four adult patients were evaluated. Seven patients failed at the first weaning attempt. No echocardiographic or electrocardiographic differences were observed between pressure support ventilation and T-tube. Weaning failure patients presented increases in left atrium, intraventricular septum thickness, posterior wall thickness and diameter of left ventricle and shorter isovolumetric relaxation time. Successfully weaned patients had higher levels of oxygenation. CONCLUSION: No differences were observed between Doppler echocardiographic variables and electrocardiographic and other cardiorespiratory variables during pressure support ventilation and T-tube. However cardiac structures were smaller, isovolumetric relaxation time was larger, and oxygenation level was greater in successfully weaned patients

  15. Pneumothorax After Mechanical Ventilation in Newborns

    Directory of Open Access Journals (Sweden)

    Nadieh Yazdi Hosseini

    2011-03-01

    Full Text Available Objective:Air leak syndromes including pneumothorax, pneumomediastinum and pulmonary interstitial emphysema are frequent in neonatal period. Mechanical ventilation with positive pressure is one of the most common causes of these syndromes. The aim of this study was to evaluate predisposing factors and incidence of pneumothorax in newborns under mechanical ventilation. Methods:This descriptive cross sectional study was performed in 400 newborns under mechanical ventilation in intensive care unit of a teaching hospital in Iran from April 2004 to December 2008. Predisposing factors leading to ventilation and incidence of air leak syndromes were studied. Sex, gestational age, birth weight, type of delivery, history of surfactant replacement therapy, ventilator settings and mortality rate were recorded. Statistical analysis was done using SPSS software. Univariate analysis and regression analysis were considered. Findings:Among 400 patients under mechanical ventilation, 102 neonates developed pneumothorax (26%. Fifty six (54.9% of them were boys and 46 (45.1% girls. 54.9% of newborns with pneumothorax were preterm and 45.1% term. Birth weight less than 2500g was recorded in 59.8%. Fifty two percent of these neonates were born by cesarean section vs. 32% of newborns without pneumothorax. The most common type (62.7% of ventilation leading to pneumothorax was Inspiratory Positive Pressure Ventilation (IPPV. Surfactant replacement therapy was recorded in 32.4% of cases with pneumothorax compared to 60.4% of neonates under ventilation without pneumothorax, which was significantly different (P= 0.017. Conclusion:In newborns surfactant replacement therapy can reduce the risk of pneumothorax caused by mechanical ventilation.

  16. Low Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome: A Paradigm Shift in Mechanical Ventilation

    OpenAIRE

    Jed Lipes; Francois Lellouche; Azadeh Bojmehrani

    2012-01-01

    Protective ventilation with low tidal volume has been shown to reduce morbidity and mortality in patients suffering from acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Low tidal volume ventilation is associated with particular clinical challenges and is therefore often underutilized as a therapeutic option in clinical practice. Despite some potential difficulties, data have been published examining the application of protective ventilation in patients without lung inj...

  17. Inspiratory times when weaning from mechanical ventilation.

    OpenAIRE

    Greenough, A; Greenall, F; Gamsu, H R

    1987-01-01

    Two inspiratory times (0.5 and 1.0 seconds) were compared when weaning infants from mechanical ventilation. The shorter inspiratory time was associated with significant increases in minute volume and reduction in active expiration.

  18. Secretion management in the mechanically ventilated patient

    OpenAIRE

    Mantellini E.; Perrero L.; Provenzano G.; Petrozzino S.

    2012-01-01

    Purpose: the aim of this work is to highlight the importance of a correct management of the secretions in the patient submitted to mechanical ventilation (MV). Methods: analysis of the current bibliography related to respiratory infections and secretion in patients with mechanically ventilation. We focus on the use of in-ex suflator achine (cough machine) associated with High Frequency Chest Wall Oscillation (HFCWO).Results: we observe a reduction of pulmonary infection and a better managemen...

  19. Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus ‘conventional’ protective ventilation (6 ml/kg) in severe ARDS

    OpenAIRE

    Bein, Thomas; Weber-Carstens, Steffen; Goldmann, Anton; Müller, Thomas; Staudinger, Thomas; Brederlau, Jörg; Muellenbach, Ralf; Dembinski, Rolf; Graf, Bernhard M.; Wewalka, Marlene; Philipp, Alois; Wernecke, Klaus-Dieter; Lubnow, Matthias; Slutsky, Arthur S

    2013-01-01

    Background Acute respiratory distress syndrome is characterized by damage to the lung caused by various insults, including ventilation itself, and tidal hyperinflation can lead to ventilator induced lung injury (VILI). We investigated the effects of a low tidal volume (V T) strategy (V T ≈ 3 ml/kg/predicted body weight [PBW]) using pumpless extracorporeal lung assist in established ARDS. Methods Seventy-nine patients were enrolled after a ‘stabilization period’ (24 h with optimized therapy an...

  20. Electrical Impedance Tomography During Mechanical Ventilation.

    Science.gov (United States)

    Walsh, Brian K; Smallwood, Craig D

    2016-10-01

    Electrical impedance tomography (EIT) is a noninvasive, non-radiologic imaging modality that may be useful for the quantification of lung disorders and titration of mechanical ventilation. The principle of operation is based on changes in electrical conductivity that occur as a function of changes in lung volume during ventilation. EIT offers potentially important benefits over standard imaging modalities because the system is portable and non-radiologic and can be applied to patients for long periods of time. Rather than providing a technical dissection of the methods utilized to gather, compile, reconstruct, and display EIT images, the present article seeks to provide an overview of the clinical application of this technology as it relates to monitoring mechanical ventilation and providing decision support at the bedside. EIT has been shown to be useful in the detection of pneumothoraces, quantification of pulmonary edema and comparison of distribution of ventilation between different modes of ventilation and may offer superior individual titration of PEEP and other ventilator parameters compared with existing approaches. Although application of EIT is still primarily done within a research context, it may prove to be a useful bedside tool in the future. However, head-to-head comparisons with existing methods of mechanical ventilation titration in humans need to be conducted before its application in general ICUs can be recommended. PMID:27682815

  1. Effects of high-frequency oscillatory ventilation and conventional mechanical ventilation on oxygen metabolism and tissue perfusion in sheep models of acute respiratory distress syndrome

    Institute of Scientific and Technical Information of China (English)

    Liu Songqiao; Huang Yingzi; Wang Maohua; Chen Qiuhua; Liu Ling; Xie Jianfeng; Tan Li

    2014-01-01

    Background High-frequency oscillatory ventilation (HFOV) allows for small tidal volumes at mean airway pressures (mPaw) above that of conventional mechanical ventilation (CMV),but the effect of HFOV on hemodynamics,oxygen metabolism,and tissue perfusion in acute respiratory distress syndrome (ARDS) remains unclear.We investigated the effects of HFOV and CMV in sheep models with ARDS.Methods After inducing ARDS by repeated lavage,twelve adult sheep were randomly divided into a HFOV or CMV group.After stabilization,standard lung recruitments (40 cmH2O × 40 seconds) were performed.The optimal mPaw or positive end-expiratory pressure was obtained by lung recruitment and decremental positive end-expiratory pressure titration.The animals were then ventilated for 4 hours.The hemodynamics,tissue perfusion (superior mesenteric artery blood flow,pHi,and Pg-aCO2),oxygen metabolism and respiratory mechanics were examined at baseline before saline lavage,in the ARDS model,after model stabilization,and during hourly mechanical ventilation for up to 4 hours.A two-way repeated measures analysis of variance was applied to evaluate differences between the groups.Results The titrated mPaw was higher and the tidal volumes lower in the HFOV group than the positive end-expiratory pressure in the CMV group.There was no significant difference in hemodynamic parameters between the HFOV and CMV groups.There was no difference in the mean alveolar pressure between the two groups.After lung recruitment,both groups showed an improvement in the oxygenation,oxygen delivery,and DO2.Lactate levels increased in both groups after inducing the ARDS model.Compared with the CMV group,the superior mesenteric artery blood flow and pHi were significantly higher in the HFOV group,but the Pg-aCO2 decreased in the HFOV group.Conclusion Compared with CMV,HFOV with optimal mPaw has no significant side effect on hemodynamics or oxygen metabolism,and increases gastric tissue blood perfusion.

  2. 46 CFR 154.1200 - Mechanical ventilation system: General.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Mechanical ventilation system: General. 154.1200 Section... Equipment Cargo Area: Mechanical Ventilation System § 154.1200 Mechanical ventilation system: General. (a... cargo handling equipment must have a fixed, exhaust-type mechanical ventilation system. (b)...

  3. Model-based PEEP optimisation in mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Chiew Yeong Shiong

    2011-12-01

    Full Text Available Abstract Background Acute Respiratory Distress Syndrome (ARDS patients require mechanical ventilation (MV for breathing support. Patient-specific PEEP is encouraged for treating different patients but there is no well established method in optimal PEEP selection. Methods A study of 10 patients diagnosed with ALI/ARDS whom underwent recruitment manoeuvre is carried out. Airway pressure and flow data are used to identify patient-specific constant lung elastance (Elung and time-variant dynamic lung elastance (Edrs at each PEEP level (increments of 5cmH2O, for a single compartment linear lung model using integral-based methods. Optimal PEEP is estimated using Elung versus PEEP, Edrs-Pressure curve and Edrs Area at minimum elastance (maximum compliance and the inflection of the curves (diminishing return. Results are compared to clinically selected PEEP values. The trials and use of the data were approved by the New Zealand South Island Regional Ethics Committee. Results Median absolute percentage fitting error to the data when estimating time-variant Edrs is 0.9% (IQR = 0.5-2.4 and 5.6% [IQR: 1.8-11.3] when estimating constant Elung. Both Elung and Edrs decrease with PEEP to a minimum, before rising, and indicating potential over-inflation. Median Edrs over all patients across all PEEP values was 32.2 cmH2O/l [IQR: 26.1-46.6], reflecting the heterogeneity of ALI/ARDS patients, and their response to PEEP, that complicates standard approaches to PEEP selection. All Edrs-Pressure curves have a clear inflection point before minimum Edrs, making PEEP selection straightforward. Model-based selected PEEP using the proposed metrics were higher than clinically selected values in 7/10 cases. Conclusion Continuous monitoring of the patient-specific Elung and Edrs and minimally invasive PEEP titration provide a unique, patient-specific and physiologically relevant metric to optimize PEEP selection with minimal disruption of MV therapy.

  4. Outcome of mechanical ventilation in Sri Lanka.

    OpenAIRE

    Rajapakse, V. P.; Wijesekera, S

    1989-01-01

    The outcome of mechanical ventilation is reported in a series of 43 patients managed in an intensive care unit in Sri Lanka. Eighteen patients (42%) survived. Of these, all except one were discharged from hospital. Patients with organophosphate poisoning and Guillain-Barré polyneuritis had a mortality of 47% and 50% respectively. Patients who were ventilated postoperatively as a result of anaesthetic complications during surgery had a mortality rate of 20%. Patients with tetanus and myastheni...

  5. Mechanical ventilation in emergency departments: Non invasive or invasive mechanical ventilation. Where is the answer?

    OpenAIRE

    Esquinas Rodriguez Antonio M; Cosentini Roberto; Papadakos Peter J

    2012-01-01

    The Emergency Department length of stay for patients requiring mechanical ventilation paper in this issue is very illustrative of many variables that still confound the way we treat patients that may not require endotracheal intubation (ETI) but may benefit from non-invasive mechanical ventilation (NIV) [1].

  6. Indoxacarb-Related ARDS, Neurotoxicity and Orange Urine

    OpenAIRE

    Viswanathan, Stalin; Kumar, Shanthi; Kandan, Balamurugesan

    2013-01-01

    A 17 year old male developed adult respiratory distress syndrome (ARDS), seizures, intravascular hemolysis and peripheral neuropathy following self-poisoning with a pesticide containing 14.5% indoxacarb. He was managed conservatively with fluid management, antibiotics, mechanical ventilation and physiotherapy. There is limited data concerning the human toxicity of indoxacarb. This case demonstrates that findings from animal studies, such as seizures, respiratory distress, and intravascular he...

  7. Healthcare Technology Management (HTM) of mechanical ventilators by clinical engineers

    OpenAIRE

    Yoshioka, Jun; Nakane, Masaki; Kawamae, Kaneyuki

    2014-01-01

    Mechanical ventilator failures expose patients to unacceptable risks, and maintaining mechanical ventilator safety is an important issue. We examined the usefulness of maintaining mechanical ventilators by clinical engineers (CEs) using a specialized calibrator. These evaluations and the ability to make in-house repairs proved useful for obviating the need to rent ventilators which, in turn, might prove faulty themselves. The CEs' involvement in maintaining mechanical ventilators is desirable...

  8. Secretion management in the mechanically ventilated patient

    Directory of Open Access Journals (Sweden)

    Mantellini E.

    2012-01-01

    Full Text Available Purpose: the aim of this work is to highlight the importance of a correct management of the secretions in the patient submitted to mechanical ventilation (MV. Methods: analysis of the current bibliography related to respiratory infections and secretion in patients with mechanically ventilation. We focus on the use of in-ex suflator achine (cough machine associated with High Frequency Chest Wall Oscillation (HFCWO.Results: we observe a reduction of pulmonary infection and a better management of bronchial secretion in patient undergone to the use of in-ex suflator machine (cough machine associated with High Frequency Chest Wall Oscillation (HFCWO.Conclusions: the correct approach to patients submitted to mechanical ventilation (MV expect the use of High Frequency Chest Wall Oscillation (HFCWO (VEST and in-ex suflator machine (cough machine to decrease pulmonary infection thank to a reduction of permanence of bronchial secretions in the lungs .

  9. No-sedation during mechanical ventilation

    DEFF Research Database (Denmark)

    Laerkner, Eva; Stroem, Thomas; Toft, Palle

    2016-01-01

    BACKGROUND: Evidence is growing that less or no-sedation is possible and beneficial for patients during mechanical ventilation. AIM: To investigate if there was a difference in patient consciousness and nursing workload comparing a group of patients receiving no-sedation with a group of sedated...... patients with daily wake up, and also to estimate economic consequences of a no-sedation strategy. DESIGN AND METHODS: Data were collected during a prospective trial of 140 mechanically ventilated patients randomized to either no-sedation or to sedation with daily wake up. From day 1 to 7 in the intensive...

  10. Flow measurement in mechanical ventilation: a review.

    Science.gov (United States)

    Schena, Emiliano; Massaroni, Carlo; Saccomandi, Paola; Cecchini, Stefano

    2015-03-01

    Accurate monitoring of flow rate and volume exchanges is essential to minimize ventilator-induced lung injury. Mechanical ventilators employ flowmeters to estimate the amount of gases delivered to patients and use the flow signal as a feedback to adjust the desired amount of gas to be delivered. Since flowmeters play a crucial role in this field, they are required to fulfill strict criteria in terms of dynamic and static characteristics. Therefore, mechanical ventilators are equipped with only the following kinds of flowmeters: linear pneumotachographs, fixed and variable orifice meters, hot wire anemometers, and ultrasonic flowmeters. This paper provides an overview of these sensors. Their working principles are described together with their relevant advantages and disadvantages. Furthermore, the most promising emerging approaches for flowmeters design (i.e., fiber optic technology and three dimensional micro-fabrication) are briefly reviewed showing their potential for this application. PMID:25659299

  11. Modelling and Simulation of Volume Controlled Mechanical Ventilation System

    Directory of Open Access Journals (Sweden)

    Yan Shi

    2014-01-01

    Full Text Available Volume controlled mechanical ventilation system is a typical time-delay system, which is applied to ventilate patients who cannot breathe adequately on their own. To illustrate the influences of key parameters of the ventilator on the dynamics of the ventilated respiratory system, this paper firstly derived a new mathematical model of the ventilation system; secondly, simulation and experimental results are compared to verify the mathematical model; lastly, the influences of key parameters of ventilator on the dynamics of the ventilated respiratory system are carried out. This study can be helpful in the VCV ventilation treatment and respiratory diagnostics.

  12. Predicting the lung compliance of mechanically ventilated patients via statistical modeling

    International Nuclear Information System (INIS)

    To avoid ventilator associated lung injury (VALI) during mechanical ventilation, the ventilator is adjusted with reference to the volume distensibility or ‘compliance’ of the lung. For lung-protective ventilation, the lung should be inflated at its maximum compliance, i.e. when during inspiration a maximal intrapulmonary volume change is achieved by a minimal change of pressure. To accomplish this, one of the main parameters is the adjusted positive end-expiratory pressure (PEEP). As changing the ventilator settings usually produces an effect on patient's lung mechanics with a considerable time delay, the prediction of the compliance change associated with a planned change of PEEP could assist the physician at the bedside. This study introduces a machine learning approach to predict the nonlinear lung compliance for the individual patient by Gaussian processes, a probabilistic modeling technique. Experiments are based on time series data obtained from patients suffering from acute respiratory distress syndrome (ARDS). With a high hit ratio of up to 93%, the learned models could predict whether an increase/decrease of PEEP would lead to an increase/decrease of the compliance. However, the prediction of the complete pressure–volume relation for an individual patient has to be improved. We conclude that the approach is well suitable for the given problem domain but that an individualized feature selection should be applied for a precise prediction of individual pressure–volume curves. (paper)

  13. Histopathologic pulmonary changes from mechanical ventilation at high peak airway pressures.

    Science.gov (United States)

    Tsuno, K; Miura, K; Takeya, M; Kolobow, T; Morioka, T

    1991-05-01

    We investigated the histopathologic pulmonary changes induced by mechanical pulmonary ventilation (MV) with a high peak airway pressure and a large tidal volume in healthy baby pigs. Eleven animals were mechanically ventilated at a peak inspiratory pressure (PIP) of 40 cm H2O, a respiratory rate (RR) of 20 min-1, a positive end-expiratory pressure (PEEP) of 3 to 5 cm H2O, and an FIO2 of 0.4. High airway pressure MV was terminated in 22 +/- 11 h because of severe hypoxemia in the animals. Five of the baby pigs were killed for gross and light microscope studies. The pulmonary changes consisted of alveolar hemorrhage, alveolar neutrophil infiltration, alveolar macrophage and type II pneumocyte proliferation, interstitial congestion and thickening, interstitial lymphocyte infiltration, emphysematous change, and hyaline membrane formation. Those lesions were similar to that seen in the early stage of the adult respiratory distress syndrome (ARDS). The remaining six animals were treated for 3 to 6 days with conventional respiratory care with appropriate ventilator settings. Prominent organized alveolar exudate in addition to lesions was also found in the five animals. These findings were indistinguishable from the clinical late stage of ARDS. Six control animals were mechanically ventilated at a PIP of less than 18 cm H2O, a RR of 20 min-1, a PEEP of 3 to 5 cm H2O, and an FIO2 of 0.4 for 48 h. They showed no notable changes in lung functions and histopathologic findings. Aggressive MV with a high PIP is often applied to patients with respiratory distress to attain adequate pulmonary gas exchange.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2024823

  14. A Medical Student Workshop in Mechanical Ventilation.

    Science.gov (United States)

    And Others; Kushins, Lawrence G.

    1980-01-01

    In order to teach applied respiratory physiology to medical students, the anesthesiology faculty at the University of Florida College of Medicine has designed and implemented a course that includes a laboratory workshop in mechanical ventilation of an animal model that allows students to apply and expand their knowledge. (JMD)

  15. Dispersion mechanics in underground mine ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Standish, P.N.

    1988-01-01

    Application of Dispersion Mechanics to mine ventilation surveys is studied using C/sub 2/H/sub 2/ tracer release and detection on the 2 Drill level at Elura Mine, Cobar, NSW. Preliminary calibration work of the measuring systems in the laboratory and in a large test rig together with the results obtained is reported. It is found that the results in these non-mining systems closely follow the results of Dispersion Mechanics theory for a dispersed plug flow model. For the underground conditions studied the results of tracer studies show that the ventilating air flow is layered or segregated in a tube bundle pattern. These tracer results are reproduced by the results of traditional anemometer readings obtained under the same flow conditions. The results also show that the ventilating air flow under actual underground conditions is characterized by transient behavior which appears to be normal behavior of the ventilating air in underground workings. Application of the results to practice is included.

  16. Frequency of hypoxic events in patients on a mechanical ventilator

    OpenAIRE

    Mahmood, Nader A; Chaudry, Fawad A.; Azam, Hamad; Ali, M. Imran; Khan, M. Anees

    2013-01-01

    Background: Mechanical ventilation is an important tool in the management of respiratory failure in the critically ill patient. Although mechanical ventilation can be a life-saving intervention, it is also known to carry several side-effects and risks. Adequate oxygenation is one of the primary goals of mechanical ventilation. However, while on mechanical ventilation, patients frequently experience hypoxic events resulting from various causes, which need to be properly evaluated and treated. ...

  17. Modelling and Simulation of Volume Controlled Mechanical Ventilation System

    OpenAIRE

    2014-01-01

    Volume controlled mechanical ventilation system is a typical time-delay system, which is applied to ventilate patients who cannot breathe adequately on their own. To illustrate the influences of key parameters of the ventilator on the dynamics of the ventilated respiratory system, this paper firstly derived a new mathematical model of the ventilation system; secondly, simulation and experimental results are compared to verify the mathematical model; lastly, the influences of key parameters of...

  18. Bilateral Scapulohumeral Ankylosis after Prolonged Mechanical Ventilation.

    Science.gov (United States)

    van Lotten, Manon L; Schreinemakers, J Rieneke; van Noort, Arthur; Rademakers, Maarten V

    2016-09-01

    This case demonstrates a rarely reported bilateral scapulohumeral bony ankylosis. A young woman developed extensive heterotopic ossifications (HOs) in both shoulder joints after being mechanically ventilated for several months at the intensive care unit in a comatose status. She presented with a severe movement restriction of both shoulder joints. Surgical resection of the bony bridges was performed in 2 separate sessions with a significant improvement of shoulder function afterwards. No postoperative complications, pain, or recurrence of HOs were noted at 1-year follow-up. Mechanical ventilation, immobilization, neuromuscular blockage, and prolonged sedation are known risk factors for the development of HOs in the shoulder joints. Relatively early surgical resection of the HOs can be performed safely in contrary to earlier belief. Afterwards, nonsteroidal anti-inflammatory drugs and/or radiation therapy can be possible treatment modalities to prevent recurrence of HOs. PMID:27583120

  19. Airway Strain during Mechanical Ventilation in an Intact Animal Model

    OpenAIRE

    Sinclair, Scott E.; Molthen, Robert C.; Haworth, Steve T.; Dawson, Christopher A.; Waters, Christopher M.

    2007-01-01

    Rationale: Mechanical ventilation with large tidal volumes causes ventilator-induced lung injury in animal models. Little direct evidence exists regarding the deformation of airways in vivo during mechanical ventilation, or in the presence of positive end-expiratory pressure (PEEP).

  20. Academic Emergency Medicine Physicians’ Knowledge of Mechanical Ventilation

    OpenAIRE

    Wilcox, Susan R.; Tania D. Strout; Jeffrey I. Schneider; Mitchell, Patricia M.; Smith, Jessica; Lutfy-Clayton, Lucienne; Marcolini, Evie G.; Aydin, Ani; Seigel, Todd A.; Jeremy B. Richards

    2016-01-01

    Introduction: Although emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM) education or clinical practice. The objective of this study was to quantify EM attendings’ education, experience, and knowledge regarding mechanical ventilation in the emergency department. Methods: We developed a survey of academic EM attendings’ educational experiences with ventilators and a knowledge assessme...

  1. Academic Emergency Medicine Physicians’ Knowledge of Mechanical Ventilation

    OpenAIRE

    Wilcox, Susan R.; Tania D. Strout; Jeffrey I. Schneider; Mitchell, Patricia M.; Jessica Smith; Lucienne Lutfy-Clayton; Marcolini, Evie G.; Ani Aydin; Seigel, Todd A.; Jeremy B. Richards

    2016-01-01

    Introduction: Although emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM) education or clinical practice. The objective of this study was to quantify EM attendings’ education, experience, and knowledge regarding mechanical ventilation in the emergency department. Methods: We developed a survey of academic EM attendings’ educational experiences with ventilators and a knowledge assessment tool with nine ...

  2. Volumetric capnography in the mechanically ventilated patient.

    Science.gov (United States)

    Blanch, L; Romero, P V; Lucangelo, U

    2006-06-01

    Expiratory capnogram provides qualitative information on the waveform patterns associated with mechanical ventilation and quantitative estimation of expired CO2. Volumetric capnography simultaneously measures expired CO2 and tidal volume and allows identification of CO2 from 3 sequential lung compartments: apparatus and anatomic dead space, from progressive emptying of alveoli and alveolar gas. Lung heterogeneity creates regional differences in CO2 concentration and sequential emptying contributes to the rise of the alveolar plateau and to the steeper the expired CO2 slope. The concept of dead space accounts for those lung areas that are ventilated but not perfused. In patients with sudden pulmonary vascular occlusion due to pulmonary embolism, the resultant high V/Q mismatch produces an increase in alveolar dead space. Calculations derived from volumetric capnography are useful to suspect pulmonary embolism at the bedside. Alveolar dead space is large in acute lung injury and when the effect of positive end-expiratory pressure (PEEP) is to recruit collapsed lung units resulting in an improvement of oxygenation, alveolar dead space may decrease, whereas PEEP-induced overdistension tends to increase alveolar dead space. Finally, measurement of physiologic dead space and alveolar ejection volume at admission or the trend during the first 48 hours of mechanical ventilation might provide useful information on outcome of critically ill patients with acute lung injury or acute respiratory distress syndrome. PMID:16682932

  3. Analysis of trials comparing High Frequency Ventilation with Conventional Mechanical Ventilation : Clinical Epidemiology in Intensive Care

    OpenAIRE

    Bollen, C W

    2006-01-01

    An abundance of experimental and clinical evidence indicates that mechanical ventilation can cause ventilator induced lung damage (VILI). Primary mechanisms leading to VILI are volutrauma, i.e. use of large tidal volumes resulting in over-distension, and atelectotrauma, i.e. repetitive closing and opening of alveoli, causing shear stress. Ideally, mechanical ventilation should supply enough airway pressure, even in the end-expiratory phase of breathing, to prevent collapse of the lungs. On th...

  4. Recent advances in mechanical ventilation in patients with acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Nuttapol Rittayamai

    2015-03-01

    Full Text Available Acute respiratory distress syndrome (ARDS is characterised by different degrees of severity and different stages. Understanding these differences can help to better adapt the ventilatory settings to protect the lung from ventilator-induced lung injury by reducing hyperinflation or keeping the lung open when it is possible. The same therapies may be useful and beneficial in certain forms of ARDS, and risky or harmful at other stages: this includes high positive end-expiratory pressure, allowance of spontaneous breathing activity or use of noninvasive ventilation. The severity of the disease is the primary indicator to individualise treatment. Monitoring tools such as oesophageal pressure or lung volume measurements may also help to set the ventilator. At an earlier stage, an adequate lung protective strategy may also help to prevent the development of ARDS.

  5. Recent advances in mechanical ventilation in patients with acute respiratory distress syndrome.

    Science.gov (United States)

    Rittayamai, Nuttapol; Brochard, Laurent

    2015-03-01

    Acute respiratory distress syndrome (ARDS) is characterised by different degrees of severity and different stages. Understanding these differences can help to better adapt the ventilatory settings to protect the lung from ventilator-induced lung injury by reducing hyperinflation or keeping the lung open when it is possible. The same therapies may be useful and beneficial in certain forms of ARDS, and risky or harmful at other stages: this includes high positive end-expiratory pressure, allowance of spontaneous breathing activity or use of noninvasive ventilation. The severity of the disease is the primary indicator to individualise treatment. Monitoring tools such as oesophageal pressure or lung volume measurements may also help to set the ventilator. At an earlier stage, an adequate lung protective strategy may also help to prevent the development of ARDS. PMID:25726563

  6. Collective fluid mechanics of honeybee nest ventilation

    Science.gov (United States)

    Gravish, Nick; Combes, Stacey; Wood, Robert J.; Peters, Jacob

    2014-11-01

    Honeybees thermoregulate their brood in the warm summer months by collectively fanning their wings and creating air flow through the nest. During nest ventilation workers flap their wings in close proximity in which wings continuously operate in unsteady oncoming flows (i.e. the wake of neighboring worker bees) and near the ground. The fluid mechanics of this collective aerodynamic phenomena are unstudied and may play an important role in the physiology of colony life. We have performed field and laboratory observations of the nest ventilation wing kinematics and air flow generated by individuals and groups of honeybee workers. Inspired from these field observations we describe here a robotic model system to study collective flapping wing aerodynamics. We microfabricate arrays of 1.4 cm long flapping wings and observe the air flow generated by arrays of two or more fanning robotic wings. We vary phase, frequency, and separation distance among wings and find that net output flow is enhanced when wings operate at the appropriate phase-distance relationship to catch shed vortices from neighboring wings. These results suggest that by varying position within the fanning array honeybee workers may benefit from collective aerodynamic interactions during nest ventilation.

  7. A Patient-Specific Airway Branching Model for Mechanically Ventilated Patients

    Directory of Open Access Journals (Sweden)

    Nor Salwa Damanhuri

    2014-01-01

    Full Text Available Background. Respiratory mechanics models have the potential to guide mechanical ventilation. Airway branching models (ABMs were developed from classical fluid mechanics models but do not provide accurate models of in vivo behaviour. Hence, the ABM was improved to include patient-specific parameters and better model observed behaviour (ABMps. Methods. The airway pressure drop of the ABMps was compared with the well-accepted dynostatic algorithm (DSA in patients diagnosed with acute respiratory distress syndrome (ARDS. A scaling factor (α was used to equate the area under the pressure curve (AUC from the ABMps to the AUC of the DSA and was linked to patient state. Results. The ABMps recorded a median α value of 0.58 (IQR: 0.54–0.63; range: 0.45–0.66 for these ARDS patients. Significantly lower α values were found for individuals with chronic obstructive pulmonary disease (P<0.001. Conclusion. The ABMps model allows the estimation of airway pressure drop at each bronchial generation with patient-specific physiological measurements and can be generated from data measured at the bedside. The distribution of patient-specific α values indicates that the overall ABM can be readily improved to better match observed data and capture patient condition.

  8. Newer nonconventional modes of mechanical ventilation.

    Science.gov (United States)

    Singh, Preet Mohinder; Borle, Anuradha; Trikha, Anjan

    2014-07-01

    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. The various modes discusses in this review are: Dual control modes (volume assured pressure support, volume support), Adaptive support ventilation, proportional assist ventilation, mandatory minute ventilation, Bi-level airway pressure release ventilation, (BiPAP), neurally adjusted ventilatory assist and NeoGanesh. Their working principles with their advantages and clinical limitations are discussed in brief. PMID:25114434

  9. Newer nonconventional modes of mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Preet Mohinder Singh

    2014-01-01

    Full Text Available 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. The various modes discusses in this review are: Dual control modes (volume assured pressure support, volume support, Adaptive support ventilation, proportional assist ventilation, mandatory minute ventilation, Bi-level airway pressure release ventilation, (BiPAP, neurally adjusted ventilatory assist and NeoGanesh. Their working principles with their advantages and clinical limitations are discussed in brief.

  10. Intraoperative mechanical ventilation strategies for one-lung ventilation.

    Science.gov (United States)

    Şentürk, Mert; Slinger, Peter; Cohen, Edmond

    2015-09-01

    One-lung ventilation (OLV) has two major challenges: oxygenation and lung protection. The former is mainly because the ventilation of one lung is stopped while the perfusion continues; the latter is mainly because the whole ventilation is applied to only one lung. Recommendations for maintaining the oxygenation and methods of lung protection can contradict each other (such as high vs. low inspiratory oxygen fraction (FiO2), high vs. low tidal volume (TV), etc.). In light of the (very few) randomized clinical trials, this review focuses on a recent strategy for OLV, which includes a possible decrease in FiO2, lower TVs, positive end-expiratory pressure (PEEP) to the dependent lung, continuous positive airway pressure (CPAP) to the non-dependent lung and recruitment manoeuvres. Other applications such as anaesthetic choice and fluid management can affect the success of ventilatory strategy; new developments have changed the classical approach in this respect. PMID:26643100

  11. Multicenter Evaluation of a Novel Surveillance Paradigm for Complications of Mechanical Ventilation

    Science.gov (United States)

    Klompas, Michael; Khan, Yosef; Kleinman, Kenneth; Evans, R. Scott; Lloyd, James F.; Stevenson, Kurt; Samore, Matthew; Platt, Richard

    2011-01-01

    Background Ventilator-associated pneumonia (VAP) surveillance is time consuming, subjective, inaccurate, and inconsistently predicts outcomes. Shifting surveillance from pneumonia in particular to complications in general might circumvent the VAP definition's subjectivity and inaccuracy, facilitate electronic assessment, make interfacility comparisons more meaningful, and encourage broader prevention strategies. We therefore evaluated a novel surveillance paradigm for ventilator-associated complications (VAC) defined by sustained increases in patients' ventilator settings after a period of stable or decreasing support. Methods We assessed 600 mechanically ventilated medical and surgical patients from three hospitals. Each hospital contributed 100 randomly selected patients ventilated 2–7 days and 100 patients ventilated >7 days. All patients were independently assessed for VAP and for VAC. We compared incidence-density, duration of mechanical ventilation, intensive care and hospital lengths of stay, hospital mortality, and time required for surveillance for VAP and for VAC. A subset of patients with VAP and VAC were independently reviewed by a physician to determine possible etiology. Results Of 597 evaluable patients, 9.3% had VAP (8.8 per 1,000 ventilator days) and 23% had VAC (21.2 per 1,000 ventilator days). Compared to matched controls, both VAP and VAC prolonged days to extubation (5.8, 95% CI 4.2–8.0 and 6.0, 95% CI 5.1–7.1 respectively), days to intensive care discharge (5.7, 95% CI 4.2–7.7 and 5.0, 95% CI 4.1–5.9), and days to hospital discharge (4.7, 95% CI 2.6–7.5 and 3.0, 95% CI 2.1–4.0). VAC was associated with increased mortality (OR 2.0, 95% CI 1.3–3.2) but VAP was not (OR 1.1, 95% CI 0.5–2.4). VAC assessment was faster (mean 1.8 versus 39 minutes per patient). Both VAP and VAC events were predominantly attributable to pneumonia, pulmonary edema, ARDS, and atelectasis. Conclusions Screening ventilator settings for VAC captures a

  12. The influence of music during mechanical ventilation and weaning from mechanical ventilation: A review.

    Science.gov (United States)

    Hetland, Breanna; Lindquist, Ruth; Chlan, Linda L

    2015-01-01

    Mechanical ventilation (MV) causes many distressing symptoms. Weaning, the gradual decrease in ventilator assistance leading to termination of MV, increases respiratory effort, which may exacerbate symptoms and prolong MV. Music, a non-pharmacological intervention without side effects may benefit patients during weaning from mechanical ventilatory support. A narrative review of OVID Medline, PsychINFO, and CINAHL databases was conducted to examine the evidence for the use of music intervention in MV and MV weaning. Music intervention had a positive impact on ventilated patients; 16 quantitative and 2 qualitative studies were identified. Quantitative studies included randomized clinical trials (10), case controls (3), pilot studies (2) and a feasibility study. Evidence supports music as an effective intervention that can lesson symptoms related to MV and promote effective weaning. It has potential to reduce costs and increase patient satisfaction. However, more studies are needed to establish its use during MV weaning.

  13. The influence of music during mechanical ventilation and weaning from mechanical ventilation: A review.

    Science.gov (United States)

    Hetland, Breanna; Lindquist, Ruth; Chlan, Linda L

    2015-01-01

    Mechanical ventilation (MV) causes many distressing symptoms. Weaning, the gradual decrease in ventilator assistance leading to termination of MV, increases respiratory effort, which may exacerbate symptoms and prolong MV. Music, a non-pharmacological intervention without side effects may benefit patients during weaning from mechanical ventilatory support. A narrative review of OVID Medline, PsychINFO, and CINAHL databases was conducted to examine the evidence for the use of music intervention in MV and MV weaning. Music intervention had a positive impact on ventilated patients; 16 quantitative and 2 qualitative studies were identified. Quantitative studies included randomized clinical trials (10), case controls (3), pilot studies (2) and a feasibility study. Evidence supports music as an effective intervention that can lesson symptoms related to MV and promote effective weaning. It has potential to reduce costs and increase patient satisfaction. However, more studies are needed to establish its use during MV weaning. PMID:26227333

  14. Pro-inflammatory responses in BALB/c and C57BL/6 mice and the role of the Nrf2-amphiregulin axis in ventilator induced lung injury

    OpenAIRE

    Siegl, Stephanie

    2012-01-01

    Patients with acute respiratory distress syndrome (ARDS) normally require mechanical ventilation and are thus at risk for ventilator induced lung injury (VILI). High strain and stress can result in physical injury termed barotrauma/volutrauma and atelectotrauma as well as in exaggerated inflammatory responses termed biotrauma. In the ARDSnet study from the year 2000, which set the current standard of ventilation of ARDS patients, mortality correlated with inflammation, but not with barotrauma...

  15. [Mechanical ventilation in chronic ventilatory insufficiency].

    Science.gov (United States)

    Schucher, B; Magnussen, H

    2007-10-01

    Mechanical ventilation has become an important treatment option in chronic ventilatory failure. There are different diseases which lead to ventilatory failure and to home mechanical ventilation (HMV). A primary loss of in- and expiratory muscle strength is the reason for respiratory deterioration in neuromuscular disease. In most of these diseases ventilatory failure develops because of the progressive character of muscular damage. Initially, ventilatory failure can be found during night-time. In the case of hypercapnia at daytime, life expectancy is strongly reduced, especially in amyotrophic lateral sclerosis and Duchenne muscular dystrophy. HMV leads to a prolongation of life and to an increase in quality of life, if bulbar involvement is not severe. Impressive clinical improvements under HMV have been found in restrictive disorders of the rib cage like kyphoscoliosis or posttuberculosis sequelae, with an increase of quality of life, walking distance and a decrease in pulmonary hypertension. Only few data are published about long-term results of HMV in Obesity Hypoventilation. In terms of retrospective analyses of clinical data HMV seems to improve survival in this population. Some patients only need CPAP treatment, but most patients have to be treated with ventilatory support. The application of HMV in patients with chronic ventilatory failure due to chronic obstructive pulmonary disease (COPD) is growing, but there are controversial results in randomised clinical trials. Analysis of these data suggest better results of HMV in patients with severe hypercapnia, with the application of higher effective ventilatory pressure and a ventilator mode with a significant reduction in the work of breathing. Under such conditions HMV leads to a reduction of hypercapnia, an improvement in sleep quality, walking distance and quality of life, but until now there is no evidence in reduction of mortality in COPD. PMID:17620231

  16. Academic Emergency Medicine Physicians’ Knowledge of Mechanical Ventilation

    Directory of Open Access Journals (Sweden)

    Susan R. Wilcox

    2016-05-01

    Full Text Available Introduction: Although emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM education or clinical practice. The objective of this study was to quantify EM attendings’ education, experience, and knowledge regarding mechanical ventilation in the emergency department. Methods: We developed a survey of academic EM attendings’ educational experiences with ventilators and a knowledge assessment tool with nine clinical questions. EM attendings at key teaching hospitals for seven EM residency training programs in the northeastern United States were invited to participate in this survey study. We performed correlation and regression analyses to evaluate the relationship between attendings’ scores on the assessment instrument and their training, education, and comfort with ventilation. Results: Of 394 EM attendings surveyed, 211 responded (53.6%. Of respondents, 74.5% reported receiving three or fewer hours of ventilation-related education from EM sources over the past year and 98 (46% reported receiving between 0-1 hour of education. The overall correct response rate for the assessment tool was 73.4%, with a standard deviation of 19.9. The factors associated with a higher score were completion of an EM residency, prior emphasis on mechanical ventilation during one’s own residency, working in a setting where an emergency physician bears primary responsibility for ventilator management, and level of comfort with managing ventilated patients. Physicians’ comfort was associated with the frequency of ventilator changes and EM management of ventilation, as well as hours of education. Conclusion: EM attendings report caring for mechanically ventilated patients frequently, but most receive fewer than three educational hours a year on mechanical ventilation, and nearly half receive 0-1 hour. Physicians’ performance on an assessment tool for mechanical ventilation is

  17. Ventilator-induced mediator release: role of PEEP and surfactant

    NARCIS (Netherlands)

    J.J. Haitsma

    2002-01-01

    textabstractLung protective ventilation such as the ARDSnet low tidal volumes strategy can reduce mortality in ARDS patients. The lmowledge that an essential therapy such as mechanical ventilation on the intensive care influences patient outcome has given rise to the re-evaluation of current ventila

  18. The Use of Noninvasive Mechanical Ventilation in Myasthenic Crisis

    OpenAIRE

    Mustafa Said Aydoğan; M. Ali Erdoğan; Aytaç Yücel; Ülkü Özgül; Hüseyin Konur; Türkan Toğal; Mahmut Durmuş

    2012-01-01

    Myasthenia gravis is an autoimmune disease of the nicotinic acetylcholin receptors at the postsynaptic membrane of the neuromuscular junction. Myasthenic crisis, defined as respiratory failure requiring mechanical ventilation is a common life-threatening complication that occur approximately 15% to 20% of patients with MG. Endotracheal intubation and invasive mechanical ventilation have a number of complications and a high mortality. On the other hand, noninvasive mechanical ventilation is be...

  19. Pulmonary deposition of a nebulised aerosol during mechanical ventilation.

    OpenAIRE

    Thomas, S. H.; O'Doherty, M J; Fidler, H M; Page, C J; Treacher, D F; Nunan, T. O.

    1993-01-01

    BACKGROUND: There is increasing use of therapeutic aerosols in patients undergoing mechanical ventilation. Few studies have measured aerosol delivery to the lungs under these conditions with adequate experimental methods. Hence this study was performed to measure pulmonary aerosol deposition and to determine the reproducibility of the method of measurement during mechanical ventilation. METHODS: Nine male patients were studied during mechanical ventilation after open heart surgery and two exp...

  20. Mechanical ventilation interacts with endotoxemia to induce extrapulmonary organ dysfunction

    OpenAIRE

    O'Mahony, D. Shane; Liles, W. Conrad; William A Altemeier; Dhanireddy, Shireesha; Frevert, Charles W.; Liggitt, Denny; Martin, Thomas R.; Matute-Bello, Gustavo

    2006-01-01

    Introduction Multiple organ dysfunction syndrome (MODS) is a common complication of sepsis in mechanically ventilated patients with acute respiratory distress syndrome, but the links between mechanical ventilation and MODS are unclear. Our goal was to determine whether a minimally injurious mechanical ventilation strategy synergizes with low-dose endotoxemia to induce the activation of pro-inflammatory pathways in the lungs and in the systemic circulation, resulting in distal organ dysfunctio...

  1. Home Mechanical Ventilation: A Canadian Thoracic Society Clinical Practice Guideline

    OpenAIRE

    McKim, Douglas A.; Jeremy Road; Monica Avendano; Steve Abdool; Fabien Côté; Nigel Duguid; Janet Fraser; François Maltais; Morrison, Debra L.; Colleen O’Connell; Petrof, Basil J.; Karen Rimmer; Robert Skomro; Canadian Thoracic Society Home Mechanical Ventilation Committee

    2011-01-01

    Increasing numbers of patients are surviving episodes of prolonged mechanical ventilation or benefitting from the recent availability of user-friendly noninvasive ventilators. Although many publications pertaining to specific aspects of home mechanical ventilation (HMV) exist, very few comprehensive guidelines that bring together all of the current literature on patients at risk for or using mechanical ventilatory support are available. The Canadian Thoracic Society HMV Guideline Committee ha...

  2. Course of Weaning from Prolonged Mechanical Ventilation after Cardiac Surgery

    OpenAIRE

    Herlihy, James P.; Koch, Stephen M.; Jackson, Robert; Nora, Hope

    2006-01-01

    In order to determine the temporal pattern of weaning from mechanical ventilation for patients undergoing prolonged mechanical ventilation after cardiac surgery, we performed a retrospective review of 21 patients' weaning courses at our long-term acute care hospital. Using multiple regression analysis of an estimate of individual patients' percentage of mechanical ventilator support per day (%MVSD), we determined that 14 of 21 patients (67%) showed a statistically significant quadratic or cub...

  3. Ventilator assessment of respiratory mechanics in paediatric intensive care

    OpenAIRE

    Harikumar, Gopinathannair; Greenough, Anne; Rafferty, Gerrard F.

    2007-01-01

    Many modern “paediatric” mechanical ventilators have in-built features for estimation of respiratory mechanics which could be useful in the management of ventilated infants and children. The aim of this study was to determine if such measurements were reproducible and accurate. Ventilator (Draeger Evita 4) displayed compliance (Cvent) and resistance (Rvent) values were assessed and compared to the results of respiratory system mechanics (respiratory system compliance (Crs) and resistance (Rrs...

  4. Newer nonconventional modes of mechanical ventilation

    OpenAIRE

    Preet Mohinder Singh; Anuradha Borle; Anjan Trikha

    2014-01-01

    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. ...

  5. Evaluation of the predictors for duration of mechanical ventilation in respiratory intensive care unit

    Directory of Open Access Journals (Sweden)

    Hira H

    2006-01-01

    Full Text Available Background: Mechanical ventilation (MV is a life saving modality. Till no method is evolved to predict the duration of this treatment. This study is undertaken to evaluate the clinical and laboratory parameters at initiation and 48 hour of the patient being treated by mechanical ventilation; and correlate these parameters with the duration of MV required. Methods: It was prospective observational study conducted in the respiratory intensive care unit (RICU of a tertiary referral and teaching hospital. Thirty consecutive patients suffering from various medical diseases requiring MV were the participants. Clinical, laboratory, ventilatory parameters and six severity scores viz.; GCS, APACHE-II, SAPS, OSF, ALI/ARDS and Sepsis/Septic shock criteria of each patient, both at initiation and at 48 hour of MV were recorded. Correlation between various severity scores at initiation and at 48 hour of initiation with duration of mechanical ventilation was computed. Results: Based on the duration of mechanical ventilation required, the patients were divided in two groups. Those requiring mechanical ventilation < 7 days and> 7 days were designated Group I and Group II respectively. Three out of 6 severity scores (GCS, APACHE-II, SAPS recorded at 48 hour of MV showed statistically significant difference between the both groups with p value of 0.010, 0.009 and 0.006 respectively. Further stepwise logistic regression analysis showed that SAPS score at 48 hour of initiation was the best predictor of duration of MV. It was found that a cut off value of 15 for SAPS score at 48 hour might predict the duration of MV i.e. < 7days or> 7 days. Based on linear regression analysis a simple equation was formulated by putting the SAPS value at 48 hour, the value of Y was computed. If MV required was less than 7 days, the value of Y was more than - 0.172 and if need of mechanical ventilation was more than 7 days, Y was less than -0.1720. Conclusions: For patients requiring

  6. Mechanical ventilation in patients with most severe forms of influenza a H1N1

    Directory of Open Access Journals (Sweden)

    Romić Predrag

    2011-01-01

    Full Text Available Background/Aim. Pandemic of A H1N1 influenza is noted for its rapid spreading and life-threatening consequences like acute respiratory distress syndrome (ARDS which requires mechanical ventilation (MV and intensive therapy (IT. The aim of the study was to determine the significance of mechanical ventilation application in the presence of comorbidities on the outcome of the disease and patients with severe forms of acute influenza caused by A H1N1 virus. Methods. Five patients with acute respiratory failure caused by A H1N1 influenza that required MV were included in the study. Course and outcome of the treatment were monitored in relation to age and sex of the patients, concomitant diseases, time of influenza beginning, a time of admittance in an intensive care unit, a time of an endotracheal intubation and MV beginning, MV duration and occurrence of secondary infections. Results. Three patients were on a very prolonged MV (39, 43 and 20 days, respectively and they all survived. Two patients with a significantly shorter duration of MV (14 and 12 days, respectively died because of a very severe clinical course and concomitant diseases. Unexpectedly, we found a positive correlation between duration of MV and survival although two patients, who were on MV for the longest period of time (43 and 39 days, respectively, developed, as a complication, secondary bacterial pneumonia. Conclusion. Intensive therapy of patients with ARDS due to A H1N1 influenza virus requires MV which should be carried out according to guidelines of international expert forums. That is in accordance with our unexpected observation on negative correlation between duration of MV and fatal outcome. Intensive treatment of these patients, specially MV, can be very prolonged and, therefore, requires specialized teams of anesthesiologists, separate, isolated intensive therapy units and high level of medical staff protection, as was the case in this study, so no member of medical

  7. Trend of Maximal Inspiratory Pressure in Mechanically Ventilated Patients: Predictors

    OpenAIRE

    Pedro Caruso; Denise Simão Carnieli; Keila Harue Kagohara; Adriana Anciães; Jacqueline Santos Segarra; Daniel Deheinzelin

    2008-01-01

    INTRODUCTION: It is known that mechanical ventilation and many of its features may affect the evolution of inspiratory muscle strength during ventilation. However, this evolution has not been described, nor have its predictors been studied. In addition, a probable parallel between inspiratory and limb muscle strength evolution has not been investigated. OBJECTIVE: To describe the variation over time of maximal inspiratory pressure during mechanical ventilation and its predictors. We also stud...

  8. Non-invasive mechanic ventilation in treating acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Federico Lari

    2009-12-01

    Full Text Available Non invasive ventilation (NIV in acute respiratory failure (ARF improve clinical parameters, arterial blood gases, decrease mortality and endo tracheal intubation (ETI rate also outside the intensive care units (ICUs. Objective of this study is to verify applicability of NIV in a general non respiratory medical ward. We enrolled 68 consecutive patients (Pts with Hypoxemic or Hyper capnic ARF: acute cardiogenic pulmonary edema (ACPE, exacerbation of chronic obstructive pulmonary disease (COPD, Pneu - monia, acute lung injury / acute respiratory distress syndrome (ALI/ARDS. NIV treatment was CPAP or PSV + PEEP. 12 Pts (18,5% met primary endpoint (NIV failure: 11 Pts (17% needed ETI (5ALI/ARDS p < 0,0001, 6COPD 16,6%, 1 Patient (1,5% died (Pneumonia. No Pts with ACPE failed (p = 0,0027. Secondary endpoints: significant improvement in Respiratory Rate (RR, Kelly Score, pH, PaCO2, PaO2 vs baseline. Median duration of treatment: 16:06 hours: COPD 18:54, ACPE 4:15. Mean length of hospitalisation: 8.66 days. No patients discontinued NIV, no side effects. Results are consistent with literature. Hypoxemic ARF related to ALI/ARDS and pneumonia show worst outcome: it is not advisable to manage these conditions with NIV outside the ICU. NIV for ARF due to COPD and ACPE is feasible, safe and effective in a general medical ward if selection of Pts, staff’s training and monitoring are appropriate. This should encourage the diffusion of NIV in this specific setting. According to strong evidences in literature, NIV should be considered a first line and standard treatment in these clinical conditions irrespective of the setting.

  9. Mortality in mechanically ventilated patients of Guillain Barré Syndrome

    Directory of Open Access Journals (Sweden)

    Archana B Netto

    2011-01-01

    Full Text Available Background: The mortality of patients with Guillain Barré syndrome (GBS has varied widely with rates between 1-18%. Death results from pneumonia, sepsis, adult respiratory distress syndrome (ARDS and less frequently due to autonomic dysfunction or pulmonary embolism. There are only few studies which have used a large sample and have in detail analyzed the circumstances relating to death and the prognostic factors for the same in a cohort, including only mechanically ventilated patients. Objective: The objective of our study was to analyze the circumstances and factors related to mortality in mechanically ventilated patients of GBS. Materials and Methods: Case records of patients of GBS, satisfying National Institute of Neurological and Communicative Disorders and Stroke (NINCDS criteria, and requiring mechanical ventilation from 1984 to 2007, were analyzed. Results: A total of 273 GBS patients were managed with ventilatory support (190 men and 83 women during the period. Besides symmetrical paralysis in all patients, bulbar palsy was present in 186 (68.1%, sensory involvement in 88 (32.2% and symptomatic autonomic dysfunction in 72 (26.4% patients. The mortality was 12.1%. The factors determining mortality were elderly age group (P=0.03, autonomic dysfunction (P=0.03, pulmonary complications (P=0.001, hypokalemia (P=0.001 and bleeding (P=0.001 from any site. Logistic regression analysis showed the risk of mortality was 4.69 times more when pneumonia was present, 2.44 times more when hypokalemia was present, and 3.14 times more when dysautonomia was present. The odds ratio for age was 0.97 indicating that a higher age was associated with a higher risk of mortality. Conclusions: Ventilator associated pulmonary complications, bleeding and hypokalemia especially in elderly patients require optimal surveillance and aggressive therapy at the earliest for reducing the mortality in this group of GBS patients.

  10. Humidification during invasive and noninvasive mechanical ventilation: 2012.

    Science.gov (United States)

    Restrepo, Ruben D; Walsh, Brian K

    2012-05-01

    We searched the MEDLINE, CINAHL, and Cochrane Library databases for articles published between January 1990 and December 2011. The update of this clinical practice guideline is based on 184 clinical trials and systematic reviews, and 10 articles investigating humidification during invasive and noninvasive mechanical ventilation. The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scoring system: 1. Humidification is recommended on every patient receiving invasive mechanical ventilation. 2. Active humidification is suggested for noninvasive mechanical ventilation, as it may improve adherence and comfort. 3. When providing active humidification to patients who are invasively ventilated, it is suggested that the device provide a humidity level between 33 mg H(2)O/L and 44 mg H(2)O/L and gas temperature between 34°C and 41°C at the circuit Y-piece, with a relative humidity of 100%. 4. When providing passive humidification to patients undergoing invasive mechanical ventilation, it is suggested that the HME provide a minimum of 30 mg H(2)O/L. 5. Passive humidification is not recommended for noninvasive mechanical ventilation. 6. When providing humidification to patients with low tidal volumes, such as when lung-protective ventilation strategies are used, HMEs are not recommended because they contribute additional dead space, which can increase the ventilation requirement and P(aCO(2)). 7. It is suggested that HMEs are not used as a prevention strategy for ventilator-associated pneumonia.

  11. Prone positioning improves survival in severe ARDS: a pathophysiologic review and individual patient meta-analysis.

    Science.gov (United States)

    Gattinoni, L; Carlesso, E; Taccone, P; Polli, F; Guérin, C; Mancebo, J

    2010-06-01

    Prone positioning has been used for over 30 years in the management of patients with acute respiratory distress syndrome (ARDS). This maneuver has consistently proven capable of improving oxygenation in patients with acute respiratory failure. Several mechanisms can explain this observation, including possible intervening net recruitment and more homogeneously distributed alveolar inflation. It is also progressively becoming clear that prone positioning may reduce the nonphysiological stress and strain associated with mechanical ventilation, thus decreasing the risk of ventilator-induced lung injury, which is known to adversely impact patient survival. The available randomized clinical trials, however, have failed to demonstrate that prone positioning improves the outcomes of patients with ARDS overall. In contrast, the individual patient meta-analysis of the four major clinical trials available clearly shows that with prone positioning, the absolute mortality of severely hypoxemic ARDS patients may be reduced by approximately 10%. On the other hand, all data suggest that long-term prone positioning may expose patients with less severe ARDS to unnecessary complications. PMID:20473258

  12. Prolonged Glucocorticoid Treatment in ARDS: Impact on Intensive Care Unit-Acquired Weakness

    Science.gov (United States)

    Meduri, Gianfranco Umberto; Schwingshackl, Andreas; Hermans, Greet

    2016-01-01

    Systemic inflammation and duration of immobilization are strong independent risk factors for the development of intensive care unit-acquired weakness (ICUAW). Activation of the pro-inflammatory transcription factor nuclear factor-κB (NF-κB) results in muscle wasting during disuse-induced skeletal muscle atrophy (ICU bed rest) and septic shock. In addition, NF-κB-mediated signaling plays a significant role in mechanical ventilation-induced diaphragmatic atrophy and contractile dysfunction. Older trials investigating high dose glucocorticoid treatment reported a lack of a sustained anti-inflammatory effects and an association with ICUAW. However, prolonged low-to-moderate dose glucocorticoid treatment of sepsis and ARDS is associated with a reduction in NF-κB DNA-binding, decreased transcription of inflammatory cytokines, enhanced resolution of systemic and pulmonary inflammation, leading to fewer days of mechanical ventilation, and lower mortality. Importantly, meta-analyses of a large number of randomized controlled trials investigating low-to-moderate glucocorticoid treatment in severe sepsis and ARDS found no increase in ICUAW. Furthermore, while the ARDS network trial investigating methylprednisolone treatment in persistent ARDS is frequently cited to support an association with ICUAW, a reanalysis of the data showed a similar incidence with the control group. Our review concludes that in patients with sepsis and ARDS, any potential direct harmful neuromuscular effect of glucocorticoids appears outweighed by the overall clinical improvement and reduced duration of organ failure, in particular ventilator dependency and associated immobilization, which are key risk factors for ICUAW. PMID:27532030

  13. Prolonged Glucocorticoid Treatment in ARDS: Impact on Intensive Care Unit-Acquired Weakness.

    Science.gov (United States)

    Meduri, Gianfranco Umberto; Schwingshackl, Andreas; Hermans, Greet

    2016-01-01

    Systemic inflammation and duration of immobilization are strong independent risk factors for the development of intensive care unit-acquired weakness (ICUAW). Activation of the pro-inflammatory transcription factor nuclear factor-κB (NF-κB) results in muscle wasting during disuse-induced skeletal muscle atrophy (ICU bed rest) and septic shock. In addition, NF-κB-mediated signaling plays a significant role in mechanical ventilation-induced diaphragmatic atrophy and contractile dysfunction. Older trials investigating high dose glucocorticoid treatment reported a lack of a sustained anti-inflammatory effects and an association with ICUAW. However, prolonged low-to-moderate dose glucocorticoid treatment of sepsis and ARDS is associated with a reduction in NF-κB DNA-binding, decreased transcription of inflammatory cytokines, enhanced resolution of systemic and pulmonary inflammation, leading to fewer days of mechanical ventilation, and lower mortality. Importantly, meta-analyses of a large number of randomized controlled trials investigating low-to-moderate glucocorticoid treatment in severe sepsis and ARDS found no increase in ICUAW. Furthermore, while the ARDS network trial investigating methylprednisolone treatment in persistent ARDS is frequently cited to support an association with ICUAW, a reanalysis of the data showed a similar incidence with the control group. Our review concludes that in patients with sepsis and ARDS, any potential direct harmful neuromuscular effect of glucocorticoids appears outweighed by the overall clinical improvement and reduced duration of organ failure, in particular ventilator dependency and associated immobilization, which are key risk factors for ICUAW. PMID:27532030

  14. Systemic inflammation associated with mechanical ventilation among extremely preterm infants

    OpenAIRE

    Bose, Carl L.; Laughon, Matthew M; Allred, Elizabeth N.; O’Shea, T. Michael; Van Marter, Linda J; Ehrenkranz, Richard A.; Raina N Fichorova; Leviton, Alan

    2012-01-01

    Little evidence is available to document that mechanical ventilation is an antecedent of systemic inflammation in preterm humans. We obtained blood on postnatal day 14 from 726 infants born before the 28th week of gestation and measured the concentrations of 25 inflammation-related proteins. We created multivariable models to assess the relationship between duration of ventilation and protein concentrations in the top quartile. Compared to newborns ventilated for fewer than 7 days (N=247), th...

  15. Survival Predictors for Severe ARDS Patients Treated with Extracorporeal Membrane Oxygenation: A Retrospective Study in China

    Science.gov (United States)

    Liu, Xiaoqing; Xu, Yonghao; Zhang, Rong; Huang, Yongbo; He, Weiqun; Sang, Ling; Chen, Sibei; Nong, Lingbo; Li, Xi; Mao, Pu

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) is increasingly being applied as life support for acute respiratory distress syndrome (ARDS) patients. However, the outcomes of this procedure have not yet been characterized in severe ARDS patients. The aim of this study was to evaluate the outcomes of severe ARDS patients supported with ECMO and to identify potential predictors of mortality in these patients. A total of 38 severe ARDS patients (aged 51.39±13.27 years, 32 males) who were treated with ECMO in the specialized medical intensive care unit of Guangzhou Institute of Respiratory Diseases from July 2009 to December 2014 were retrospectively reviewed. The clinical data of the patients on the day before ECMO initiation, on the first day of ECMO treatment and on the day of ECMO removal were collected and analyzed. All patients were treated with veno-venous ECMO after a median mechanical ventilation duration of 6.4±7.6 days. Among the 20 patients (52.6%) who were successfully weaned from ECMO, 16 patients (42.1%) survived to hospital discharge. Of the identified pre-ECMO factors, advanced age, a long duration of ventilation before ECMO, a higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score, underlying lung disease, and pulmonary barotrauma prior to ECMO were associated with unsuccessful weaning from ECMO. Furthermore, multiple logistic regression analysis indicated that both barotrauma pre-ECMO and underlying lung disease were independent predictors of hospital mortality. In conclusion, for severe ARDS patients treated with ECMO, barotrauma prior to ECMO and underlying lung disease may be major predictors of ARDS prognosis based on multivariate analysis. PMID:27336170

  16. The effect of mechanical ventilator settings during ventilator hyperinflation techniques: a bench-top analysis.

    Science.gov (United States)

    Thomas, P J

    2015-01-01

    Ventilator hyperinflations are used by physiotherapists for the purpose of airway clearance in intensive care. There is limited data to guide the selection of mechanical ventilator modes and settings that may achieve desired flow patterns for ventilator hyperinflation. A mechanical ventilator was connected to two lung simulators and a respiratory mechanics monitor. Peak inspiratory (PIFR) and expiratory flow rates (PEFR) were measured during manipulation of ventilator modes (pressure support ventilation [PSV], volume-controlled synchronised intermittent mandatory ventilation [VC-SIMV] and pressure-controlled synchronised intermittent mandatory ventilation [PC-SIMV]) and ventilator settings (including set tidal volume, positive end-expiratory pressure, inspiratory flow rate, inspiratory pause, pressure support, inspiratory time and/or inflation pressure). Additionally, each trial was conducted with high (0.05 l/cmH2O) and low (0.01 l/cmH2O) compliance settings on the lung simulators. Each trial was dichotomised into success or failure under three categories (attainment of PIFR-PEFR less than or equal to 0.9, PEFR/PIFR greater than 17 l/min, PEFR greater than or equal to 40 l/min). A total of 232 trials were conducted (96 VC-SIMV, 96 PC-SIMV, 40 PSV). A greater proportion of VC-SIMV trials were ceased due to high peak inspiratory pressures (35%). However, VC-SIMV trials were more likely to be successful at meeting all three outcome measures (26 VC-SIMV trials, 7 PC-SIMV trials, 0 PSV trials). It was found that manipulation of settings in VC-SIMV mode appears more successful than PSV and PC-SIMV for ventilator hyperinflations. PMID:25579293

  17. A taxonomy for mechanical ventilation: 10 fundamental maxims.

    Science.gov (United States)

    Chatburn, Robert L; El-Khatib, Mohamad; Mireles-Cabodevila, Eduardo

    2014-11-01

    The American Association for Respiratory Care has declared a benchmark for competency in mechanical ventilation that includes the ability to "apply to practice all ventilation modes currently available on all invasive and noninvasive mechanical ventilators." This level of competency presupposes the ability to identify, classify, compare, and contrast all modes of ventilation. Unfortunately, current educational paradigms do not supply the tools to achieve such goals. To fill this gap, we expand and refine a previously described taxonomy for classifying modes of ventilation and explain how it can be understood in terms of 10 fundamental constructs of ventilator technology: (1) defining a breath, (2) defining an assisted breath, (3) specifying the means of assisting breaths based on control variables specified by the equation of motion, (4) classifying breaths in terms of how inspiration is started and stopped, (5) identifying ventilator-initiated versus patient-initiated start and stop events, (6) defining spontaneous and mandatory breaths, (7) defining breath sequences (8), combining control variables and breath sequences into ventilatory patterns, (9) describing targeting schemes, and (10) constructing a formal taxonomy for modes of ventilation composed of control variable, breath sequence, and targeting schemes. Having established the theoretical basis of the taxonomy, we demonstrate a step-by-step procedure to classify any mode on any mechanical ventilator.

  18. Corticosteroids and ARDS: A review of treatment and prevention evidence

    Directory of Open Access Journals (Sweden)

    G C Khilnani

    2011-01-01

    Full Text Available To systematically review the role of corticosteroids in prevention of acute respiratory distress syndrome (ARDS in high-risk patients, and in treatment of established ARDS. Primary articles were identified by English-language Pubmed/MEDLINE, Cochrane central register of controlled trials, and Cochrane systemic review database search (1960-June 2009 using the MeSH headings: ARDS, adult respiratory distress syndrome, ARDS, corticosteroids, and methylprednisolone (MP. The identified studies were reviewed and information regarding role of corticosteroids in prevention and treatment of ARDS was evaluated. Nine trials have evaluated the role of corticosteroid drugs in management of ARDS at various stages. Of the 9, 4 trials evaluated role of corticosteroids in prevention of ARDS, while other 5 trials were focused on treatment after variable periods of onset of ARDS. Trials with preventive corticosteroids, mostly using high doses of MP, showed negative results with patients in treatment arm, showing higher mortality and rate of ARDS development. While trials of corticosteroids in early ARDS showed variable results, somewhat, favoring use of these agents to reduce associated morbidities. In late stage of ARDS, these drugs have no benefits and are associated with adverse outcome. Use of corticosteroids in patients with early ARDS showed equivocal results in decreasing mortality; however, there is evidence that these drugs reduce organ dysfunction score, lung injury score, ventilator requirement, and intensive care unit stay. However, most of these trials are small, having a significant heterogeneity regarding study design, etiology of ARDS, and dosage of corticosteroids. Further research involving large-scale trials on relatively homogeneous cohort is necessary to establish the role of corticosteroids for this condition.

  19. Protective Mechanical Ventilation in Inflammatory and Ventilator-Associated Pneumonia Models

    OpenAIRE

    Sperber, Jesper

    2016-01-01

    Severe infections, trauma or major surgery can each cause a state of systemic inflammation. These causes for systemic inflammation often coexist and complicate each other. Mechanical ventilation is commonly used during major surgical procedures and when respiratory functions are failing in the intensive care setting. Although necessary, the use of mechanical ventilation can cause injury to the lungs and other organs especially under states of systemic inflammation. Moreover, a course of mecha...

  20. Lung stress, strain, and energy load: engineering concepts to understand the mechanism of ventilator-induced lung injury (VILI).

    Science.gov (United States)

    Nieman, Gary F; Satalin, Joshua; Andrews, Penny; Habashi, Nader M; Gatto, Louis A

    2016-12-01

    It was recently shown that acute respiratory distress syndrome (ARDS) mortality has not been reduced in over 15 years and remains ~40 %, even with protective low tidal volume (LVt) ventilation. Thus, there is a critical need to develop novel ventilation strategies that will protect the lung and reduce ARDS mortality. Protti et al. have begun to analyze the impact of mechanical ventilation on lung tissue using engineering methods in normal pigs ventilated for 54 h. They used these methods to assess the impact of a mechanical breath on dynamic and static global lung strain and energy load. Strain is the change in lung volume in response to an applied stress (i.e., Tidal Volume-Vt). This study has yielded a number of exciting new concepts including the following: (1) Individual mechanical breath parameters (e.g., Vt or Plateau Pressure) are not directly correlated with VILI but rather any combination of parameters that subject the lung to excessive dynamic strain and energy/power load will cause VILI; (2) all strain is not equal; dynamic strain resulting in a dynamic energy load (i.e., kinetic energy) is more damaging to lung tissue than static strain and energy load (i.e., potential energy); and (3) a critical consideration is not just the size of the Vt but the size of the lung that is being ventilated by this Vt. This key concept merits attention since our current protective ventilation strategies are fixated on the priority of keeping the Vt low. If the lung is fully inflated, a large Vt is not necessarily injurious. In conclusion, using engineering concepts to analyze the impact of the mechanical breath on the lung is a novel new approach to investigate VILI mechanisms and to help design the optimally protective breath. Data generated using these methods have challenged some of the current dogma surrounding the mechanisms of VILI and of the components in the mechanical breath necessary for lung protection. PMID:27316442

  1. 在ARDS中开放的肺部%Open lung in ARDS

    Institute of Scientific and Technical Information of China (English)

    Haitsma JJ; Lachmann RA; Lachmann B

    2003-01-01

    Every year, millions of patients worldwide receive ventilator support during surgery. Mechanical ventilation has become an important therapy in the treatment of patients with impaired pulmonary function and particularly in patients suffering from adult respiratory distress syndrome (ARDS). ARDS is caused by multiple factors and is characterized by respiratory dysfunction including hypoxemia and decreased lung compliance. It is known that the decrease in lung distensibility is due to a disturbed surfactant system with an elevated surface tension. This increase in surface tension leads to an increase in forces acting at the air-liquid interface, resulting finally in endexpiratory collapse, atelectasis, an increase in right-to-left shunt and a decrease in PaO2.

  2. Amyotrophic Lateral Sclerosis Patients' Perspectives on Use of Mechanical Ventilation.

    Science.gov (United States)

    Young, Jenny M.; And Others

    1994-01-01

    Interviewed 13 amyotrophic lateral sclerosis patients. All believed that they alone should make decision regarding use of mechanical ventilation. Factors they considered important were quality of life, severity of disability, availability of ventilation by means of nasal mask, possible admission to long-term care facility, ability to discontinue…

  3. Mechanical ventilation drives inflammation in severe viral bronchiolitis.

    Directory of Open Access Journals (Sweden)

    Marije P Hennus

    Full Text Available INTRODUCTION: Respiratory insufficiency due to severe respiratory syncytial virus (RSV infection is the most frequent cause of paediatric intensive care unit admission in infants during the winter season. Previous studies have shown increased levels of inflammatory mediators in airways of mechanically ventilated children compared to spontaneous breathing children with viral bronchiolitis. In this prospective observational multi-center study we aimed to investigate whether this increase was related to disease severity or caused by mechanical ventilation. MATERIALS AND METHODS: Nasopharyngeal aspirates were collected <1 hour before intubation and 24 hours later in RSV bronchiolitis patients with respiratory failure (n = 18 and non-ventilated RSV bronchiolitis controls (n = 18. Concentrations of the following cytokines were measured: interleukin (IL-1α, IL-1β, IL-6, monocyte chemotactic protein (MCP-1 and macrophage inflammatory protein (MIP-1α. RESULTS: Baseline cytokine levels were comparable between ventilated and non-ventilated infants. After 24 hours of mechanical ventilation mean cytokine levels, except for MIP-1α, were elevated compared to non-ventilated infected controls: IL-1α (159 versus 4 pg/ml, p<0.01, IL-1β (1068 versus 99 pg/ml, p<0.01, IL-6 (2343 versus 958 pg/ml, p<0.05 and MCP-1 (174 versus 26 pg/ml, p<0.05. CONCLUSIONS: Using pre- and post-intubation observations, this study suggests that endotracheal intubation and subsequent mechanical ventilation cause a robust pulmonary inflammation in infants with RSV bronchiolitis.

  4. Titin and diaphragm dysfunction in mechanically ventilated rats.

    NARCIS (Netherlands)

    Hees, H.W.H. van; Schellekens, W.J.M.; Andrade Acuna, G.L.; Linkels, M.; Hafmans, T.G.M.; Ottenheijm, C.A.C.; Granzier, H.L.; Scheffer, G.J.; Hoeven, J.G. van der; Dekhuijzen, P.N.R.; Heunks, L.M.A.

    2012-01-01

    PURPOSE: Diaphragm weakness induced by mechanical ventilation may contribute to difficult weaning from the ventilator. For optimal force generation the muscle proteins myosin and titin are indispensable. The present study investigated if myosin and titin loss or dysfunction are involved in mechanica

  5. Changes in lung parenchyma after acute respiratory distress syndrome (ARDS): assessment with high-resolution computed tomography

    International Nuclear Information System (INIS)

    The aim of this study was to evaluate the appearance, extent, and distribution of parenchymal changes in the lung after acute respiratory distress syndrome (ARDS) as a function of disease severity and therapeutic procedures. High-resolution computed tomography (HRCT), clinical examination, and lung function tests were performed in 15 patients, 6-10 months after ARDS. The appearance and extent of parenchymal changes were compared with the severity of ARDS, as well as with clinical and therapeutic data. Lung parenchymal changes resembling those found in the presence of pulmonary fibrosis were observed in 13 of 15 patients (87%). The changes were significantly more frequent and more pronounced in the ventral than in the dorsal portions of the lung (p<0.01). A significant correlation was observed between the extent of lung alterations and the severity of ARDS (p<0.01), and the duration in which patients had received mechanical ventilation either with a peak inspiratory pressure greater than 30 mmHg (p<0.05), or with more than 70% oxygen (p<0.01). Acute respiratory distress syndrome frequently is followed by fibrotic changes in lung parenchyma. The predominantly ventral distribution of these changes indicates that they may be caused by the ventilation regimen and the oxygen therapy rather than by the ARDS. (orig.)

  6. Effect of spontaneous breathing on ventilator-induced lung injury in mechanically ventilated healthy rabbits: a randomized, controlled, experimental study

    OpenAIRE

    Xia, Jingen; Sun, Bing; He, Hangyong; Zhang, Heng; Wang, Chunting; Zhan, Qingyuan

    2011-01-01

    Introduction Ventilator-induced lung injury (VILI), one of the most serious complications of mechanical ventilation (MV), can impact patients' clinical prognoses. Compared to control ventilation, preserving spontaneous breathing can improve many physiological features in ventilated patients, such as gas distribution, cardiac performance, and ventilation-perfusion matching. However, the effect of spontaneous breathing on VILI is unknown. The goal of this study was to compare the effects of spo...

  7. Clinical characteristics and outcomes of patients with acute lung injury and ARDS

    Directory of Open Access Journals (Sweden)

    R R Bhadade

    2011-01-01

    Full Text Available Background : Acute lung injury (ALI and acute respiratory distress syndrome (ARDS are critical illnesses associated with significant morbidity and mortality. Aims : This was designed to assess various etiologies of ALI/ARDS, to determine the correlation between the diagnostic criteria and need of mechanical ventilation, and to correlate biochemical factors with the outcome of patients. Settings and Design : An observational, prospective study was conducted in a medical intensive care unit (MICU of a tertiary care hospital, for a period of 1 year. Materials and Methods : This study encompassed 58 consecutive cases of ALI/ARDS admitted to a MICU as per AECC guidelines. Patients excluded were with cardiac failure, chronic kidney diseases with fluid overload, and age below 12 years. Statistical Analysis : The data were analysed applying χ2 -test, multivariate logistic regression analysis of significance, using computer-based program SPSS. Results : There were more males (74% than females, and presentation was more common in the younger age group, with a total mortality of 57%. Factors attributable for ALI/ARDS were malaria in 16 patients (27.6%, leptospirosis in 12 (20.7%, malaria with dengue in 3 (5.2%, undiagnosed fever in 16 (27.6%, pneumonia in 8 (13.8%, urinary tract infection in 2 (3.4%, and pancreatitis in 1 (1.7% patient. Out of 41 patients with PaO 2 /FiO 2 200, 11 patients though initially managed on noninvasive ventilation (NIV subsequently required invasive ventilation, and remaining six were successfully managed on NIV. Out of 41 patients requiring mechanical ventilation, 36 had LIS >2.5, whereas only 3 out of 17 patients with LIS <2.5 required mechanical ventilation. Conclusion : Malaria, leptospirosis, and undiagnosed fever were the main etiologies followed by pneumonia, urinary tract infections, and pancreatitis. Both the PaO 2 /FiO 2 ratio and lung injury score (LIS at the time of admission were significant predictors of the

  8. Regional Lung Kinetics of Ventilator-Induced Lung Injury and Protective-Ventilation Strategies Studied by Dynamic Positron Emission Tomography

    OpenAIRE

    Borges, João Batista

    2014-01-01

    Mechanical ventilation in itself can harm the lung and cause ventilator-induced lung injury (VILI), which can induce or aggravate acute respiratory distress syndrome (ARDS). Much debate remains over pivotal concepts regarding the pathophysiology of VILI, especially about the precise contribution, kinetics, and primary role of potential VILI mechanisms. Consequently, it remains largely unknown how best to design a well-timed and full-bodied mechanical ventilation strategy. Little is known also...

  9. ARDS: contemporary management and challenges%ARDS:现状与挑战

    Institute of Scientific and Technical Information of China (English)

    黄伟; 张久之; 万献尧

    2012-01-01

    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are mainly characterized by refractory hypoxia respiratory failure, and essentially present as one of the most challengeable area of critical care medicine. Recently, its definition already is upgraded as "Berlin criteria". Besides conventional mechanical ventilation, High frequency oscillation ventilation (HFOV) and extracorporeal membrane oxygenation (ECMO) have increasingly aroused a great deal of interests owing of potential survival benefits. Meanwhile, Macrolide Antibiotics and stem cell gene therapies became the hot areas of medication treatments. Based on the current trends, it is believed that the mortality of ALI/ARDS would be gradually reduced with the progress of researches and developing of new therapies.%ALI/ARDS是以难治性低氧性呼吸衰竭为主要临床特点的症候群,是重症医学最具挑战性的领域之一.近期其诊断标准更新为“柏林标准”;治疗方面除了常规机械通气策略之外,因潜在的降低病死率的作用,高频震荡通气(HFOV)、体外膜肺氧合(ECMO)的价值越来越受到重视,而大环内酯类抗生素和干细胞基因治疗则成为药物治疗的热点.根据现有趋势,相信未来ALI/ARDS的病死率将会随着研究的深入和新疗法的开展而逐渐降低.

  10. Do all mechanically ventilated pediatric patients require continuous capnography?

    Science.gov (United States)

    Hamel, Donna S; Cheifetz, Ira M

    2006-09-01

    With most patients in modern ICUs requiring mechanical ventilation, any technology that may lead to more optimal ventilatory strategies would be invaluable in the management of critically ill patients. The focus of most ventilator strategies is protecting the lung from the deleterious effects of mechanical ventilation. Every effort is made to minimize the duration of mechanical ventilation while optimizing the potential for successful extubation. A concise organized plan based on objective criteria that is adjusted to meet changes in patient status is clearly recommended. Continuous capnographic monitoring provides clinicians with clear, precise, objective data that may prove beneficial in the design and implementation of mechanical ventilatory strategies. There are no clear-cut methods for achieving the optimal ventilator strategy for a specific patient. Although guidelines and management theories exist throughout the medical literature, in practice, they often merely serve as loose guidelines. The dynamic properties of an acutely ill patient make the management of mechanical ventilation an ongoing process requiring clinical assessment and planning by multidisciplinary members of the patient care team. Comprehensive evaluation of ventilatory management strategies and patient responses must be made by a collaborative effort of physicians, respiratory care practitioners, and nurses. An objective, consistent approach to the overall management is essential. Although still controversial, it is the authors' opinion that volumetric capnograph provides the data necessary to establish adequate gas delivery, optimal PEEP, and effective ventilation with the least amount of mechanical assistance, regardless of clinician or institutional preferences. PMID:16952808

  11. Invasive home mechanical ventilation, mainly focused on neuromuscular disorders

    Directory of Open Access Journals (Sweden)

    Börger, Sandra

    2010-01-01

    Full Text Available Introduction and background: Invasive home mechanical ventilation is used for patients with chronic respiratory insufficiency. This elaborate and technology-dependent ventilation is carried out via an artificial airway (tracheal cannula to the trachea. Exact numbers about the incidence of home mechanical ventilation are not available. Patients with neuromuscular diseases represent a large portion of it. Research questions: Specific research questions are formulated and answered concerning the dimensions of medicine/nursing, economics, social, ethical and legal aspects. Beyond the technical aspect of the invasive home, mechanical ventilation, medical questions also deal with the patient’s symptoms and clinical signs as well as the frequency of complications. Economic questions pertain to the composition of costs and the differences to other ways of homecare concerning costs and quality of care. Questions regarding social aspects consider the health-related quality of life of patients and caregivers. Additionally, the ethical aspects connected to the decision of home mechanical ventilation are viewed. Finally, legal aspects of financing invasive home mechanical ventilation are discussed. Methods: Based on a systematic literature search in 2008 in a total of 31 relevant databases current literature is viewed and selected by means of fixed criteria. Randomized controlled studies, systematic reviews and HTA reports (health technology assessment, clinical studies with patient numbers above ten, health-economic evaluations, primary studies with particular cost analyses and quality-of-life studies related to the research questions are included in the analysis. Results and discussion: Invasive mechanical ventilation may improve symptoms of hypoventilation, as the analysis of the literature shows. An increase in life expectancy is likely, but for ethical reasons it is not confirmed by premium-quality studies. Complications (e. g. pneumonia are rare

  12. Indications and strategies for Mechanical Ventilation in the Burned Patients

    Directory of Open Access Journals (Sweden)

    Murat Yılmaz

    2011-07-01

    Full Text Available Respiratory tract is one of the most seriously injured system in burned patients. Besides the direct inhalation injury, respiratory organs may be effected by the inflammatory mediators released due to systemic inflammatory response syndrome. As a result, many severely burned patients are needed to be intubated and mechanically ventilated after admitted to ICU. For this purpose, the medical staff working in the ICU’s which admit severely burned patients should be experienced in mechanical ventilation modes, complications related to mechanical ventilation and weaning strategies. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 31-6

  13. Ethical challenges in home mechanical ventilation: A secondary analysis

    OpenAIRE

    Dybwik, Knut; Nielsen, Erik Waage; Brinchmann, Berit Støre

    2012-01-01

    The aim of this study was to explore the ethical challenges in home mechanical ventilation based on a secondary analysis of qualitative empirical data. The data included perceptions of healthcare professionals in hospitals and community health services and family members of children and adults using home mechanical ventilation. The findings show that a number of ethical challenges, or dilemmas, arise at all levels in the course of treatment: deciding who should be offered home mechanical v...

  14. Mechanical ventilation causes airway distension with proinflammatory sequelae in mice.

    Science.gov (United States)

    Nickles, Hannah T; Sumkauskaite, Migle; Wang, Xin; Wegner, Ingmar; Puderbach, Michael; Kuebler, Wolfgang M

    2014-07-01

    The pathogenesis of ventilator-induced lung injury has predominantly been attributed to overdistension or mechanical opening and collapse of alveoli, whereas mechanical strain on the airways is rarely taken into consideration. Here, we hypothesized that mechanical ventilation may cause significant airway distension, which may contribute to the pathological features of ventilator-induced lung injury. C57BL/6J mice were anesthetized and mechanically ventilated at tidal volumes of 6, 10, or 15 ml/kg body wt. Mice were imaged by flat-panel volume computer tomography, and central airways were segmented and rendered in 3D for quantitative assessment of airway distension. Alveolar distension was imaged by intravital microscopy. Functional dead space was analyzed in vivo, and proinflammatory cytokine release was analyzed in isolated, ventilated tracheae. CT scans revealed a reversible, up to 2.5-fold increase in upper airway volume during mechanical ventilation compared with spontaneous breathing. Airway distension was most pronounced in main bronchi, which showed the largest volumes at tidal volumes of 10 ml/kg body wt. Conversely, airway distension in segmental bronchi and functional dead space increased almost linearly, and alveolar distension increased even disproportionately with higher tidal volumes. In isolated tracheae, mechanical ventilation stimulated the release of the early-response cytokines TNF-α and IL-1β. Mechanical ventilation causes a rapid, pronounced, and reversible distension of upper airways in mice that is associated with an increase in functional dead space. Upper airway distension is most pronounced at moderate tidal volumes, whereas higher tidal volumes redistribute preferentially to the alveolar compartment. Airway distension triggers proinflammatory responses and may thus contribute relevantly to ventilator-induced pathologies. PMID:24816486

  15. Factors associated with failure to wean children from mechanical ventilators

    Directory of Open Access Journals (Sweden)

    Dyah Kanya Wati

    2013-03-01

    Full Text Available Background Patients with failure to wean from mechanical ventilators in 48 hours have increased risk of morbidity, however only a few protocols can be used for children. Objective To assess possible factors associated with failure to wean from mechanical ventilators in the pediatric intensive care unit (PICU. Methods This cross sectional study performed from June 2011 to June 2012 had 124 subjects with 79 patients who were successfully weaned and 45 patients who fail to be weaned from mechanical ventilators. Data was analyzed by 2x2 contingency tables. Rresults with P value <0.05 were further analysis by logistic regression multivariate analysis. Results Factors associated with failure to wean from mechanical ventilators were abnormal electrolyte (P=0.001 and acid base status (P<0.001, lower ratio between tidal volume (TV/inspiration time (IT (P<0.001, lower mechanical load (P<0.001, and longer duration of mechanical ventilator use (P<0.001. Multivariate analyses revealed that the significant risk factors for failure to wean were TV/IT (OR 6.0; 95%CI 3.5 to 7.5; P=0.001, mechanical load (OR 11.5, 95%CI 10.3 to 15.5; P=0.002, and duration of mechanical ventilator use (OR 12.5; 95%CI 8.5 to 14.9; P=0.026. Conclusions Lower ratio of TV/IT and mechanical load, as well as longer duration of ventilator use are factors associated with failure to wean from a mechanical ventilator. [Paediatr Indones. 2013;53:59-64.].

  16. Effects of Acute Administration of Corticosteroids during Mechanical Ventilation on Rat Diaphragm

    OpenAIRE

    Maes, Karen; Testelmans, Dries; Cadot, Pascal; DeRuisseau, Keith; Powers, Scott K.; Decramer, Marc; Gayan-Ramirez, Ghislaine

    2008-01-01

    Rationale: Mechanical ventilation is known to induce ventilator-induced diaphragm dysfunction. Patients submitted to mechanical ventilation often receive massive doses of corticosteroids that may cause further deterioration of diaphragm function.

  17. Surfactant Therapy of ALI and ARDS

    OpenAIRE

    Raghavendran, K; Willson, D; Notter, RH

    2011-01-01

    This article examines exogenous lung surfactant replacement therapy and its utility in mitigating clinical acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). Biophysical research has documented that lung surfactant dysfunction can be reversed or mitigated by increasing surfactant concentration, and multiple studies in animals with ALI/ARDS have shown that respiratory function and pulmonary mechanics in vivo can be improved by exogenous surfactant administration. Exoge...

  18. A complete audit cycle to assess adherence to a lung protective ventilation strategy

    Directory of Open Access Journals (Sweden)

    Emma Joynes

    2014-01-01

    Full Text Available There is clear evidence for the use of a protective ventilation protocol in patients with acute respiratory distress syndrome (ARDS. There is evidence to suggest that protective ventilation is beneficial in patients at risk of ARDS. A protective ventilation strategy was implemented on our intensive care unit in critical care patients who required mechanical ventilation for over 48 h, with and at risk for ARDS. A complete audit cycle was performed over 13 months to assess compliance with a safe ventilation protocol in intensive care. The ARDS network mechanical ventilation protocol was used as the standard for our protective ventilation strategy. This recommends ventilation with a tidal volume (Vt of 6 ml/kg of ideal body weight (IBW and plateau airway pressure of ≤30 cm H 2 O. The initial audit failed to meet this standard with Vt ′s of 9.5 ml/kg of IBW. Following the implementation of a ventilation strategy and an educational program, we demonstrate a significant improvement in practice with Vt ′s of 6.6 ml/kg of IBW in the re-audit. This highlights the importance of simple interventions and continuous education in maintaining high standards of care.

  19. Injurious mechanical ventilation in the normal lung causes a progressive pathologic change in dynamic alveolar mechanics

    OpenAIRE

    Pavone, Lucio A; Albert, Scott; Carney, David; Gatto, Louis A; Halter, Jeffrey M; Nieman, Gary F.

    2007-01-01

    Introduction Acute respiratory distress syndrome causes a heterogeneous lung injury, and without protective mechanical ventilation a secondary ventilator-induced lung injury can occur. To ventilate noncompliant lung regions, high inflation pressures are required to 'pop open' the injured alveoli. The temporal impact, however, of these elevated pressures on normal alveolar mechanics (that is, the dynamic change in alveolar size and shape during ventilation) is unknown. In the present study we ...

  20. Heliox Improves Carbon Dioxide Removal during Lung Protective Mechanical Ventilation

    Directory of Open Access Journals (Sweden)

    Charlotte J. Beurskens

    2014-01-01

    Full Text Available Introduction. Helium is a noble gas with low density and increased carbon dioxide (CO2 diffusion capacity. This allows lower driving pressures in mechanical ventilation and increased CO2 diffusion. We hypothesized that heliox facilitates ventilation in patients during lung-protective mechanical ventilation using low tidal volumes. Methods. This is an observational cohort substudy of a single arm intervention study. Twenty-four ICU patients were included, who were admitted after a cardiac arrest and mechanically ventilated for 3 hours with heliox (50% helium; 50% oxygen. A fixed protective ventilation protocol (6 mL/kg was used, with prospective observation for changes in lung mechanics and gas exchange. Statistics was by Bonferroni post-hoc correction with statistical significance set at P<0.017. Results. During heliox ventilation, respiratory rate decreased (25±4 versus 23±5 breaths min−1, P=0.010. Minute volume ventilation showed a trend to decrease compared to baseline (11.1±1.9 versus 9.9±2.1 L min−1, P=0.026, while reducing PaCO2 levels (5.0±0.6 versus 4.5±0.6 kPa, P=0.011 and peak pressures (21.1±3.3 versus 19.8±3.2 cm H2O, P=0.024. Conclusions. Heliox improved CO2 elimination while allowing reduced minute volume ventilation in adult patients during protective mechanical ventilation.

  1. Heliox Improves Carbon Dioxide Removal during Lung Protective Mechanical Ventilation.

    Science.gov (United States)

    Beurskens, Charlotte J; Brevoord, Daniel; Lagrand, Wim K; van den Bergh, Walter M; Vroom, Margreeth B; Preckel, Benedikt; Horn, Janneke; Juffermans, Nicole P

    2014-01-01

    Introduction. Helium is a noble gas with low density and increased carbon dioxide (CO2) diffusion capacity. This allows lower driving pressures in mechanical ventilation and increased CO2 diffusion. We hypothesized that heliox facilitates ventilation in patients during lung-protective mechanical ventilation using low tidal volumes. Methods. This is an observational cohort substudy of a single arm intervention study. Twenty-four ICU patients were included, who were admitted after a cardiac arrest and mechanically ventilated for 3 hours with heliox (50% helium; 50% oxygen). A fixed protective ventilation protocol (6 mL/kg) was used, with prospective observation for changes in lung mechanics and gas exchange. Statistics was by Bonferroni post-hoc correction with statistical significance set at P < 0.017. Results. During heliox ventilation, respiratory rate decreased (25 ± 4 versus 23 ± 5 breaths min(-1), P = 0.010). Minute volume ventilation showed a trend to decrease compared to baseline (11.1 ± 1.9 versus 9.9 ± 2.1 L min(-1), P = 0.026), while reducing PaCO2 levels (5.0 ± 0.6 versus 4.5 ± 0.6 kPa, P = 0.011) and peak pressures (21.1 ± 3.3 versus 19.8 ± 3.2 cm H2O, P = 0.024). Conclusions. Heliox improved CO2 elimination while allowing reduced minute volume ventilation in adult patients during protective mechanical ventilation. PMID:25548660

  2. Carbon monoxide transfer in pig lungs during mechanical ventilation

    OpenAIRE

    Nijenhuis, Frances

    1996-01-01

    textabstractThis thesis comprises studies of gas transfer in the lungs during mechanical ventilation, which have been obtained in healthy pigs. The objectives of this thesis were: I) to adapt the breath-holding teclmique, as used during spontaneous breathing for estimation of gas transfer, to conditions of mechanical ventilation; and 2) to evaluate the effect of changes in lung volume on pulmonary gas transfer and capillary blood volume.

  3. Fuzzy Logic and Mechanical Ventilation of COPD Patients

    OpenAIRE

    Hatzakis, George; Olivenstein, Ronald; Bates, Jason H. T.

    2001-01-01

    Weaning from mechanical ventilation typically follows a course determined by the experience of the attending physician. However, despite the currently subjective nature of the weaning process and the many factors involved in its success, there is a wide consensus that this procedure could be automated somehow. We have developed a fuzzy logic based controller of pressure support mechanical ventilation (AJRCCM, 1999 Aug 160:2 550-6) and are now evaluating its performance in a prospective trial ...

  4. Non-invasive Mechanic Ventilation During the “Weaning

    OpenAIRE

    Murat Ünsel,; Perihan Ergin Özcan

    2016-01-01

    SUMMARY Weaning of the patients from mechanical ventilation is a clinically important subject. Recently, applications of non-invasive mechanic ventilation (NIV) are increasing in post extubation respiratory failure. Studies show that NIV is effective in the weaning of chronic obstructive pulmonary disease, presenting with hypercapneic respiratory failure and in the attacks of other chronic respiratory failure, but efficacy and reliability in the other patient ...

  5. Performance potential of mechanical ventilation systems with minimized pressure loss

    DEFF Research Database (Denmark)

    Terkildsen, Søren; Svendsen, Svend

    2013-01-01

    In many locations mechanical ventilation has been the most widely used principle of ventilation over the last 50 years but the conventional system design must be revised to comply with future energy requirements. This paper examines the options and describes a concept for the design of mechanical......-control ventilation with static pressure set-point reset. All the equipment has been designed to minimize pressure losses and thereby the fan power needed to operate the system. The total pressure loss is 30-75 Pa depending on the operating conditions. The annual average specific fan power is 330 J/m3 of airflow rate....... This corresponds to 10-15% of the power consumption for conventional mechanical ventilation systems thus enabling the system to fulfil future energy requirements in buildings....

  6. Perceived decisional responsibility for mechanical ventilation and weaning

    DEFF Research Database (Denmark)

    Haugdahl, Hege S; Storli, Sissel; Rose, Louise;

    2014-01-01

    AIM: To explore variability in perceptions of nurse managers and physician directors regarding roles, responsibilities and clinical-decision making related to mechanical ventilator weaning in Norwegian intensive care units (ICUs). BACKGROUND: Effective teamwork is crucial for providing optimal...... patient care in ICU. More knowledge on nurses' and physicians' perceptions of responsibility in clinical decision-making for mechanical ventilation is needed. METHODS: Self-administered survey of mechanical ventilation and weaning responsibilities was sent to nurse managers and physician directors...... ventilator settings: 92% of nurses and 87% of physicians, (p = 0·46), and recognizing weaning failure 84% of nurses and 84% of physicians, (p = 0·96). Physician directors perceived significantly less collaborative decision-making on weaning method (p = 0·01), weaning readiness (p = 0·04) and readiness...

  7. Numerical investigation of pulmonary drug delivery under mechanical ventilation conditions

    Science.gov (United States)

    Banerjee, Arindam; van Rhein, Timothy

    2012-11-01

    The effects of mechanical ventilation waveform on fluid flow and particle deposition were studied in a computer model of the human airways. The frequency with which aerosolized drugs are delivered to mechanically ventilated patients demonstrates the importance of understanding the effects of ventilation parameters. This study focuses specifically on the effects of mechanical ventilation waveforms using a computer model of the airways of patient undergoing mechanical ventilation treatment from the endotracheal tube to generation G7. Waveforms were modeled as those commonly used by commercial mechanical ventilators. Turbulence was modeled with LES. User defined particle force models were used to model the drag force with the Cunningham correction factor, the Saffman lift force, and Brownian motion force. The endotracheal tube (ETT) was found to be an important geometric feature, causing a fluid jet towards the right main bronchus, increased turbulence, and a recirculation zone in the right main bronchus. In addition to the enhanced deposition seen at the carinas of the airway bifurcations, enhanced deposition was also seen in the right main bronchus due to impaction and turbulent dispersion resulting from the fluid structures created by the ETT. Authors acknowledge financial support through University of Missouri Research Board Award.

  8. Acute respiratory distress syndrome (ARDS) complicating influenza A/H1N1v infection--a clinical approach.

    Science.gov (United States)

    Witczak, Agnieszka; Prystupa, Andrzej; Kurys-Denis, Ewa; Borys, Michał; Czuczwar, Mirosław; Niemcewicz, Marcin; Kocik, Janusz; Michalak, Anna; Pietrzak, Aldona; Chodorowska, Grażyna; Krupski, Witold; Mosiewicz, Jerzy; Tomasiewicz, Krzysztof

    2013-01-01

    ARDS is defined as an acute inflammatory syndrome characterized with bilateral parenchymal lung infiltrates on chest radiograph and PaO2/FiO2 ratiofat embolism, surface burn, massive blood transfusion. Influenza A/H1N1 infection seems to be responsible for the development of extremely severe type of ARDS with poor response to routine treatment. Despite great progress in the management of ARDS with novel agents and sophisticated techniques, including antimicrobial drugs, extracorporeal membrane oxygenation, prostaglandins, nitric oxide, prostacyclin, exogenous surfactant administration and activated protein C, supportive treatment based mostly on advanced mechanical ventilation in the intensive care units seems to be the most important for the prognosis. PMID:24364461

  9. 高频震荡通气治疗先天性心脏病术后重症ARDS32例效果观察%Observations on high-frequency oscillatory ventilation effects in pediatric patients with acute respiratory distress syndrome after congenital heart surgery

    Institute of Scientific and Technical Information of China (English)

    王旭; 张燕搏; 曾敏; 段雷雷; 李胜利; 王珊

    2012-01-01

    Objective To evaluate the effectiveness of high-frequency oscillatory ventilation (HFOV) in pediatric pa-tients with acute respiratory distress syndrome (ARDS) after congenital heart surgery. Methods Thirty-two pediatric pa-tients were treated with HFOV for failing conventional mechanical ventilation (CMV) , ventilation and oxygen parameters were adjusted, and lung recruitment maneuvers was applied after tracheal suction. Changes of blood gas indexes, HFOV treating time, changes of cycle indexes during re-ex-pansion of the lung, complications and survival rate were observed. Results After 12 to 48 hs of HFOV, PaO2, PaCO2, FiO2 and PaO2/FiO2 were all improved significantly and remained within the target range thereafter. The mean duration of HFOV was 43-238 ( 128. 5 ±67. 49) hs. Barotrauma necessitating the insertion of the chest tube were appeared in 9 children. Twenty-one children (65. 6% ) were successfully weaned and survived to discharge, 11 children died . Conclusion In pediatric patients with acute respiratory distress syndrome failing conventional ventilation, HFOV can improve ventilation and gas exchange in a rapid fashion, and can be used as rescue treatment for some pediatric ARDS patients after congenital heart surgery.%目的 探讨高频震荡通气( HFOV)对小儿心脏手术后重症ARDS的治疗效果.方法 对32例心脏手术后常频通气(CMV)治疗无效的重症ARDS患儿行HFOV治疗,设置相应的参数并行氧合、通气管理,每次吸痰后行肺复张.观察治疗前后血气指标变化、HFOV治疗时间、肺复张期间循环指标变化、整体治疗期间并发症发生情况及患儿存活情况.结果 HFOV治疗后通气及气体交换在较短的时间内改善,12~48 h血气相关指标PaO2、PaCO2、吸人氧浓度(FiO2)、氧合指数(PaO2/FiO2)均明显改善且稳定.HFOV治疗时间43 ~238(128.5±67.49)h,肺复张期间循环指标未出现异常变化,末梢血氧饱和度快速恢复至吸痰前水平,呼吸机

  10. Clinical management of stressors perceived by patients on mechanical ventilation.

    Science.gov (United States)

    Thomas, Loris A

    2003-02-01

    Psychological and psychosocial stressors perceived by the mechanically ventilated patient include intensive care unit environmental factors, communication factors, stressful symptoms, and the effectiveness of interventions. The studies reviewed in this article showed four stressors commonly identified by mechanically ventilated patients including dyspnea, anxiety, fear, and pain. Few interventional studies to reduce these stressors are available in the literature. Four interventions including hypnosis and relaxation, patient education and information sharing, music therapy, and supportive touch have been investigated in the literature and may be helpful in reducing patient stress. The advanced practice nurse is instrumental in the assessment of patient-perceived stressors while on the ventilator, and in the planning and implementation of appropriate interventions to reduce stressors and facilitate optimal ventilation, weaning, or both. PMID:12574705

  11. Respiratory mechanics in ventilated preterm infants : early determinants and outcome

    OpenAIRE

    Snepvangers, Dimphn Adriana Cornelia Maria

    2004-01-01

    The studies in this thesis show that in the current surfactant era, the majority of ventilated preterm infants are still suffering from respiratory morbidity and substantial respiratory function abnormalities throughout the early years of life. Since respiratory function testing during mechanical ventilation does have important limitations, certain preparatives have to be made before reliable results can be obtained and patients are not getting extra disturbed. Inborn resistive properties of ...

  12. Prevention of Ventilator-Induced Lung Edema by Inhalation of Nanoparticles Releasing Ruthenium Red

    OpenAIRE

    Jurek, Samuel C.; Hirano-Kobayashi, Mariko; Chiang, Homer; Kohane, Daniel S.; Matthews, Benjamin D.

    2014-01-01

    The acute respiratory distress syndrome (ARDS), a devastating lung disease that has no cure, is exacerbated by life-supportive mechanical ventilation that worsens lung edema and inflammation through the syndrome of ventilator-induced lung injury. Recently, the membrane ion channel transient receptor potential vanilloid 4 (TRPV4) on alveolar macrophages was shown to mediate murine lung vascular permeability induced by high-pressure mechanical ventilation. The objective of this study was to det...

  13. Year in review 2005: Critical Care – Respirology: mechanical ventilation, infection, monitoring, and education

    OpenAIRE

    Haitsma, Jack J; Villar, Jesús; Slutsky, Arthur S.

    2006-01-01

    We summarize all original research in the field of respiratory intensive care medicine published in 2005 in Critical Care. Twenty-seven articles were grouped into the following categories and subcategories to facilitate rapid overview: mechanical ventilation (physiology, spontaneous breathing during mechanical ventilation, high frequency oscillatory ventilation, side effects of mechanical ventilation, sedation, and prone positioning); infection (pneumonia and sepsis); monitoring (ventilatory ...

  14. Trend of maximal inspiratory pressure in mechanically ventilated patients: predictors

    Directory of Open Access Journals (Sweden)

    Pedro Caruso

    2008-01-01

    Full Text Available INTRODUCTION: It is known that mechanical ventilation and many of its features may affect the evolution of inspiratory muscle strength during ventilation. However, this evolution has not been described, nor have its predictors been studied. In addition, a probable parallel between inspiratory and limb muscle strength evolution has not been investigated. OBJECTIVE: To describe the variation over time of maximal inspiratory pressure during mechanical ventilation and its predictors. We also studied the possible relationship between the evolution of maximal inspiratory pressure and limb muscle strength. METHODS: A prospective observational study was performed in consecutive patients submitted to mechanical ventilation for > 72 hours. The maximal inspiratory pressure trend was evaluated by the linear regression of the daily maximal inspiratory pressure and a logistic regression analysis was used to look for independent maximal inspiratory pressure trend predictors. Limb muscle strength was evaluated using the Medical Research Council score. RESULTS: One hundred and sixteen patients were studied, forty-four of whom (37.9% presented a decrease in maximal inspiratory pressure over time. The members of the group in which maximal inspiratory pressure decreased underwent deeper sedation, spent less time in pressure support ventilation and were extubated less frequently. The only independent predictor of the maximal inspiratory pressure trend was the level of sedation (OR=1.55, 95% CI 1.003 - 2.408; p = 0.049. There was no relationship between the maximal inspiratory pressure trend and limb muscle strength. CONCLUSIONS: Around forty percent of the mechanically ventilated patients had a decreased maximal inspiratory pressure during mechanical ventilation, which was independently associated with deeper levels of sedation. There was no relationship between the evolution of maximal inspiratory pressure and the muscular strength of the limb.

  15. Humidification during mechanical ventilation in the adult patient.

    Science.gov (United States)

    Al Ashry, Haitham S; Modrykamien, Ariel M

    2014-01-01

    Humidification of inhaled gases has been standard of care in mechanical ventilation for a long period of time. More than a century ago, a variety of reports described important airway damage by applying dry gases during artificial ventilation. Consequently, respiratory care providers have been utilizing external humidifiers to compensate for the lack of natural humidification mechanisms when the upper airway is bypassed. Particularly, active and passive humidification devices have rapidly evolved. Sophisticated systems composed of reservoirs, wires, heating devices, and other elements have become part of our usual armamentarium in the intensive care unit. Therefore, basic knowledge of the mechanisms of action of each of these devices, as well as their advantages and disadvantages, becomes a necessity for the respiratory care and intensive care practitioner. In this paper, we review current methods of airway humidification during invasive mechanical ventilation of adult patients. We describe a variety of devices and describe the eventual applications according to specific clinical conditions.

  16. Humidification during Mechanical Ventilation in the Adult Patient

    Directory of Open Access Journals (Sweden)

    Haitham S. Al Ashry

    2014-01-01

    Full Text Available Humidification of inhaled gases has been standard of care in mechanical ventilation for a long period of time. More than a century ago, a variety of reports described important airway damage by applying dry gases during artificial ventilation. Consequently, respiratory care providers have been utilizing external humidifiers to compensate for the lack of natural humidification mechanisms when the upper airway is bypassed. Particularly, active and passive humidification devices have rapidly evolved. Sophisticated systems composed of reservoirs, wires, heating devices, and other elements have become part of our usual armamentarium in the intensive care unit. Therefore, basic knowledge of the mechanisms of action of each of these devices, as well as their advantages and disadvantages, becomes a necessity for the respiratory care and intensive care practitioner. In this paper, we review current methods of airway humidification during invasive mechanical ventilation of adult patients. We describe a variety of devices and describe the eventual applications according to specific clinical conditions.

  17. Aerosol ventilation scintigraphy in mechanically ventilated patients in the intensive care unit

    International Nuclear Information System (INIS)

    A simple economical apparatus was constructed to permit 99m technetium aerosol lung scanning in intubated patients requiring mechanical ventilation. A study was then undertaken which showed the technique to be feasible, reliable and to provide information leading to changes in diagnosis and management in patients in the Intensive Care Unit (ICU). The technique can identify pure ventilatory abnormalities particularly endobronchial obstruction. The technique does not require computer manipulation of images and allows the ready acquisition of ventilation scans in multiple projections which is a distinct advantage over radio xenon scanning

  18. Basement depressurization using dwelling mechanical exhaust ventilation system

    International Nuclear Information System (INIS)

    The mechanical ventilation exhaust system is commonly used in France to generate air renewal into building and especially into dwelling. It consists of a permanent mechanical air extraction from technical rooms (kitchen, bathrooms and toilets) using a unique fan connected to exhaust ducts. Natural air inlets in living room and bed rooms ensure an air flow from living spaces towards technical rooms. To fight against radon into building, the most recognised efficient technique is the Soil Depressurization System (S.D.S.) consisting in depressurizing the house basement. The aim of this study is to test the ability of the dwelling mechanical ventilation system to depressurize the basement in conjunction with air renewal of a house. For that purpose, a S.D.S. has been installed in an experimental house at CSTB during its construction. At first, tests undertaken with a variable velocity fan connected to the S.D.S. have characterised the permeability of the basement. It is shown that basement can be depressurized adequately with a relatively low air flow rate. At a second stage, S.D.S. has been connected to the exhaust ventilation fan used for the mechanical ventilation of the house. Results obtained show the ability of such ventilation system to generate sufficient depressurization in the basement and to ensure simultaneously adequate air change rate in the dwelling. (author)

  19. Severe acute respiratory failure secondary to acute fibrinous and organizing pneumonia requiring mechanical ventilation: a case report and literature review.

    Science.gov (United States)

    López-Cuenca, Sonia; Morales-García, Silvia; Martín-Hita, Ana; Frutos-Vivar, Fernando; Fernández-Segoviano, Pilar; Esteban, Andrés

    2012-08-01

    A 27-year-old woman was admitted to our ICU with acute hypoxemic respiratory failure and criteria for ARDS. Despite an F(IO(2)) of 1.0 and a lung protective strategy, the patient died on day 15 without any improvement. The relatives gave consent for post-mortem analysis. The histopathologic study of the lung showed findings typical of an acute fibrinous and organizing pneumonia. Apropos of this case we performed a PubMed search. We found 13 articles, including a total of 29 patients. Acute fibrinous and organizing pneumonia is an unusual cause of acute lung injury. The diagnostic criterion is histopathologic. There is little information regarding the pathophysiology of this illness. Important questions remain regarding this disease, including predisposing factors and management. Patients who require mechanical ventilation have poor outcomes.

  20. Cardiopulmonary interactions during mechanical ventilation in critically ill patients

    NARCIS (Netherlands)

    T.G.V. Cherpanath (Thomas); W.K. Lagrand (Wim); M.J. Schultz (Marcus); A.B.J. Groeneveld (Johan)

    2013-01-01

    textabstractCardiopulmonary interactions induced by mechan-ical ventilation are complex and only partly understood. Ap-plied tidal volumes and/or airway pressures largely mediate changes in right ventricular preload and afterload. Effects on left ventricular function are mostly secondary to changes

  1. Spontaneous blood pressure oscillations in mechanically ventilated patients with sepsis

    DEFF Research Database (Denmark)

    Berg, Ronan M G; Plovsing, Ronni R; Greve, Anders M;

    2016-01-01

    OBJECTIVE: In the present hypothesis-generating study, we investigated whether spontaneous blood pressure oscillations are suppressed to lower frequencies, and whether abolished oscillations are associated with an adverse outcome in mechanically ventilated patients with sepsis. METHODS: We.......006-0.010). The absence of LF' oscillations was associated with a higher 30-day mortality [50 vs. 18%, hazard ratio, 3.6 (95% confidence interval: 1.4-9.8), P=0.01]. CONCLUSION: Spontaneous blood pressure oscillations in mechanically ventilated septic patients may be suppressed to lower frequencies than previously...... retrospectively subjected invasive steady-state blood pressure recordings from 65 mechanically ventilated patients with sepsis to spectral analysis. Modified spectral bands were visually identified by plotting spectral power against frequency. RESULTS: Modified middle-frequency and low-frequency (MF' and LF...

  2. Non-invasive Mechanic Ventilation During the “Weaning

    Directory of Open Access Journals (Sweden)

    Murat Ünsel,

    2016-04-01

    Full Text Available SUMMARY Weaning of the patients from mechanical ventilation is a clinically important subject. Recently, applications of non-invasive mechanic ventilation (NIV are increasing in post extubation respiratory failure. Studies show that NIV is effective in the weaning of chronic obstructive pulmonary disease, presenting with hypercapneic respiratory failure and in the attacks of other chronic respiratory failure, but efficacy and reliability in the other patient group is limited. NIV must be applied by the experienced team in the selected patient group.

  3. Noninvasive Positive Pressure Ventilation or Conventional Mechanical Ventilation for Neonatal Continuous Positive Airway Pressure Failure

    Directory of Open Access Journals (Sweden)

    Zohreh Badiee

    2014-01-01

    Full Text Available Background: The aim of this study was to assess the success rate of nasal intermittent positive pressure ventilation (NIPPV for treatment of continuous positive airway pressure (CPAP failure and prevention of conventional ventilation (CV in preterm neonates. Methods: Since November 2012 to April 2013, a total number of 55 consecutive newborns with gestational ages of 26-35 weeks who had CPAP failure were randomly assigned to one of the two groups. The NIPPV group received NIPPV with the initial peak inspiratory pressure (PIP of 16-20 cmH 2 O and frequency of 40-60 breaths/min. The CV group received PIP of 12-20 cmH 2 O and frequency of 40-60 breaths/min. Results: About 74% of newborns who received NIPPV for management of CPAP failure responded to NIPPV and did not need intubation and mechanical ventilation. Newborns with lower postnatal age at entry to the study and lower 5 min Apgar score more likely had NIPPV failure. In addition, treatment failure was higher in newborns who needed more frequent doses of surfactant. Duration of oxygen therapy was 9.28 days in CV group and 7.77 days in NIPPV group (P = 0.050. Length of hospital stay in CV group and NIPPV groups were 48.7 and 41.7 days, respectively (P = 0.097. Conclusions: NIPPV could decrease the need for intubation and mechanical ventilation in preterm infants with CPAP failure.

  4. Mitochondrial Transfer via Tunneling Nanotubes is an Important Mechanism by Which Mesenchymal Stem Cells Enhance Macrophage Phagocytosis in the In Vitro and In Vivo Models of ARDS

    Science.gov (United States)

    Jackson, Megan V.; Morrison, Thomas J.; Doherty, Declan F.; McAuley, Daniel F.; Matthay, Michael A.; Kissenpfennig, Adrien; O'Kane, Cecilia M.

    2016-01-01

    Abstract Mesenchymal stromal cells (MSC) have been reported to improve bacterial clearance in preclinical models of Acute Respiratory Distress Syndrome (ARDS) and sepsis. The mechanism of this effect is not fully elucidated yet. The primary objective of this study was to investigate the hypothesis that the antimicrobial effect of MSC in vivo depends on their modulation of macrophage phagocytic activity which occurs through mitochondrial transfer. We established that selective depletion of alveolar macrophages (AM) with intranasal (IN) administration of liposomal clodronate resulted in complete abrogation of MSC antimicrobial effect in the in vivo model of Escherichia coli pneumonia. Furthermore, we showed that MSC administration was associated with enhanced AM phagocytosis in vivo. We showed that direct coculture of MSC with monocyte‐derived macrophages enhanced their phagocytic capacity. By fluorescent imaging and flow cytometry we demonstrated extensive mitochondrial transfer from MSC to macrophages which occurred at least partially through tunneling nanotubes (TNT)‐like structures. We also detected that lung macrophages readily acquire MSC mitochondria in vivo, and macrophages which are positive for MSC mitochondria display more pronounced phagocytic activity. Finally, partial inhibition of mitochondrial transfer through blockage of TNT formation by MSC resulted in failure to improve macrophage bioenergetics and complete abrogation of the MSC effect on macrophage phagocytosis in vitro and the antimicrobial effect of MSC in vivo. Collectively, this work for the first time demonstrates that mitochondrial transfer from MSC to innate immune cells leads to enhancement in phagocytic activity and reveals an important novel mechanism for the antimicrobial effect of MSC in ARDS. Stem Cells 2016;34:2210–2223 PMID:27059413

  5. Mitochondrial Transfer via Tunneling Nanotubes is an Important Mechanism by Which Mesenchymal Stem Cells Enhance Macrophage Phagocytosis in the In Vitro and In Vivo Models of ARDS.

    Science.gov (United States)

    Jackson, Megan V; Morrison, Thomas J; Doherty, Declan F; McAuley, Daniel F; Matthay, Michael A; Kissenpfennig, Adrien; O'Kane, Cecilia M; Krasnodembskaya, Anna D

    2016-08-01

    Mesenchymal stromal cells (MSC) have been reported to improve bacterial clearance in preclinical models of Acute Respiratory Distress Syndrome (ARDS) and sepsis. The mechanism of this effect is not fully elucidated yet. The primary objective of this study was to investigate the hypothesis that the antimicrobial effect of MSC in vivo depends on their modulation of macrophage phagocytic activity which occurs through mitochondrial transfer. We established that selective depletion of alveolar macrophages (AM) with intranasal (IN) administration of liposomal clodronate resulted in complete abrogation of MSC antimicrobial effect in the in vivo model of Escherichia coli pneumonia. Furthermore, we showed that MSC administration was associated with enhanced AM phagocytosis in vivo. We showed that direct coculture of MSC with monocyte-derived macrophages enhanced their phagocytic capacity. By fluorescent imaging and flow cytometry we demonstrated extensive mitochondrial transfer from MSC to macrophages which occurred at least partially through tunneling nanotubes (TNT)-like structures. We also detected that lung macrophages readily acquire MSC mitochondria in vivo, and macrophages which are positive for MSC mitochondria display more pronounced phagocytic activity. Finally, partial inhibition of mitochondrial transfer through blockage of TNT formation by MSC resulted in failure to improve macrophage bioenergetics and complete abrogation of the MSC effect on macrophage phagocytosis in vitro and the antimicrobial effect of MSC in vivo. Collectively, this work for the first time demonstrates that mitochondrial transfer from MSC to innate immune cells leads to enhancement in phagocytic activity and reveals an important novel mechanism for the antimicrobial effect of MSC in ARDS. Stem Cells 2016;34:2210-2223.

  6. Patients' experiences of being mechanically ventilated in an ICU

    DEFF Research Database (Denmark)

    Baumgarten, Mette; Poulsen, Ingrid

    2015-01-01

    BACKGROUND: Being a patient in an intensive care unit (ICU) and being mechanically ventilated is a scary and unpleasant experience to many patients. Qualitative studies describe these Patients' experiences, but the findings have not yet been synthesised. AIM: The aim of this study was to gather...... and synthesise interpreted knowledge from qualitative studies about Patients' experiences of being mechanically ventilated in an ICU. METHOD: A qualitative metasynthesis was conducted on findings from nine qualitative studies performed in the period from 1994 to 2012. The studies were critically appraised...... patients admitted to an ICU, while they were not ventilated. RESULTS: Fifteen abstracted findings appeared from the metasynthesis and led to the synthesised finding: 'Being dependent on health professionals, without being able to communicate, causes experiences with anxiety, fear and loneliness. How...

  7. The Mechanical Impact of Aerodynamic Stall on Tunnel Ventilation Fans

    Directory of Open Access Journals (Sweden)

    A. G. Sheard

    2012-01-01

    Full Text Available This paper describes work aimed at establishing the ability of a tunnel ventilation fan to operate without risk of mechanical failure in the event of aerodynamic stall. The research establishes the aerodynamic characteristics of a typical tunnel ventilation fan when operated in both stable and stalled aerodynamic conditions, with and without an anti-stall stabilisation ring, with and without a “nonstalling” blade angle and at full, half, and one quarter design speed. It also measures the fan’s peak stress, thus facilitating an analysis of the implications of the experimental results for mechanical design methodology. The paper concludes by presenting three different strategies for tunnel ventilation fan selection in applications where the selected fan will most likely stall. The first strategy selects a fan with a low-blade angle that is nonstalling. The second strategy selects a fan with a high-pressure developing capability. The third strategy selects a fan with a fitted stabilisation ring. Tunnel ventilation system designers each have their favoured fan selection strategy. However, all three strategies can produce system designs within which a tunnel ventilation fan performs reliably in-service. The paper considers the advantages and disadvantages of each selection strategy and considered the strengths and weaknesses of each.

  8. Effect of high tidal volume ventilation and lipopolysaccharide on mitogen-activated protein kinase in rat lung tissue

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Mechanical ventilation, a crucial therapy to acute respiratory distress syndrome (ARDS), could exacerbate lung injury, and even result in ventilator-induced lung injury (VILI) if misused in some condition1. Over-activating inflammatory cells and expanding inflammatory responses, which are induced by infection, are fundamental reasons for ARDS. Among them, mitogen-activated protein kinase (MAPK) intracellular signal transduction pathways are key processes. This study aimed to investigate the time course of MAPK activation in rat lung tissue after high tidal volume (VT) ventilation and the role of lipopolysaccharide (LPS) in high-sensitivity, and to elucidate the effect of the pathway on VILI.

  9. Mitigation of indoor radon using balanced mechanical ventilation

    International Nuclear Information System (INIS)

    Previous research has shown that, for a given source strength, the concentration of Rn222 in the home is inversely proportional to the ventilation rate. Further reductions in the concentration of the decay products of radon can be achieved due to the decrease in residence time of the parent gas as well as increased plate-out of the progeny. Natural and mechanical ventilation can affect the distribution of pressure across the building envelope potentially increasing the flow of radon bearing soil gas into the home gas into the home and/or promoting mixing of areas of higher and lower concentration. Balanced heat recovery ventilation systems were installed in ten homes in the Boyertown, Pennsylvania area. Ventilation was restricted initially to the basement area. Five installations were later modified to introduce supply air to upstairs living spaces while continuing to exhaust from the basement. An independent contractor measured Rn222 concentrations and decay product activity in the basement and first floor living area before and after installation or modification of the heat recovery ventilation system. Additional experiments to evaluate the effect of house tightening techniques and positive pressurization of the basement were conducted. With balanced ventilation of the basement only, the mean reduction in Working Level was 92.8% with a high of 98% and a low of 76%. Mean reduction of radon gas concentration was 79.1%. When modified to supply air upstairs, mean reduction in Working Level in the living area was 90%. House tightening measures to reduce stack effect were observed to reduce radon concentration. Results indicate that balanced ventilation is an effective strategy for radon mitigation and can be expected to achieve recommended levels in a majority of homes. 9 references, 2 figures, 2 tables

  10. Nonassociative learning promotes respiratory entrainment to mechanical ventilation.

    Directory of Open Access Journals (Sweden)

    Shawna M MacDonald

    Full Text Available BACKGROUND: Patient-ventilator synchrony is a major concern in critical care and is influenced by phasic lung-volume feedback control of the respiratory rhythm. Routine clinical application of positive end-expiratory pressure (PEEP introduces a tonic input which, if unopposed, might disrupt respiratory-ventilator entrainment through sustained activation of the vagally-mediated Hering-Breuer reflex. We suggest that this potential adverse effect may be averted by two differentiator forms of nonassociative learning (habituation and desensitization of the Hering-Breuer reflex via pontomedullary pathways. METHODOLOGY/PRINCIPAL FINDINGS: We tested these hypotheses in 17 urethane-anesthetized adult Sprague-Dawley rats under controlled mechanical ventilation. Without PEEP, phrenic discharge was entrained 1:1 to the ventilator rhythm. Application of PEEP momentarily dampened the entrainment to higher ratios but this effect was gradually adapted by nonassociative learning. Bilateral electrolytic lesions of the pneumotaxic center weakened the adaptation to PEEP, whereas sustained stimulation of the pneumotaxic center weakened the entrainment independent of PEEP. In all cases, entrainment was abolished after vagotomy. CONCLUSIONS/SIGNIFICANCE: Our results demonstrate an important functional role for pneumotaxic desensitization and extra-pontine habituation of the Hering-Breuer reflex elicited by lung inflation: acting as buffers or high-pass filters against tonic vagal volume input, these differentiator forms of nonassociative learning help to restore respiratory-ventilator entrainment in the face of PEEP. Such central sites-specific habituation and desensitization of the Hering-Breuer reflex provide a useful experimental model of nonassociative learning in mammals that is of particular significance in understanding respiratory rhythmogenesis and coupled-oscillator entrainment mechanisms, and in the clinical management of mechanical ventilation in

  11. Respiratory mechanics in ventilated preterm infants : early determinants and outcome

    NARCIS (Netherlands)

    Snepvangers, Dimphn Adriana Cornelia Maria

    2004-01-01

    The studies in this thesis show that in the current surfactant era, the majority of ventilated preterm infants are still suffering from respiratory morbidity and substantial respiratory function abnormalities throughout the early years of life. Since respiratory function testing during mechanical ve

  12. Carbon monoxide transfer in pig lungs during mechanical ventilation

    NARCIS (Netherlands)

    F.C.A.M. te Nijenhuis (Frances)

    1996-01-01

    textabstractThis thesis comprises studies of gas transfer in the lungs during mechanical ventilation, which have been obtained in healthy pigs. The objectives of this thesis were: I) to adapt the breath-holding teclmique, as used during spontaneous breathing for estimation of gas transfer, to condit

  13. Comparison of conventional mechanical ventilation and synchronous independent lung ventilation (SILV) in the treatment of unilateral lung injury.

    Science.gov (United States)

    Hurst, J M; DeHaven, C B; Branson, R D

    1985-08-01

    Eight patients presenting with severe unilateral pulmonary injury responded poorly to conventional mechanical ventilation. Synchronous independent lung ventilation (SILV) was employed to provide support of ventilation and oxygenation without creating the ventilation/perfusion (V/Q) mismatch observed during conventional ventilation. All patients demonstrated improved oxygenation (mean increase, 80 torr) during SILV with the FIO2 unchanged from previous therapy. Invasive hemodynamic monitoring in five of eight patients showed no difference in the commonly measured cardiopulmonary parameters with the two forms of mechanical ventilation. Peak inspiratory pressure (PIP), continuous positive airway pressure (CPAP), and pressure change secondary to tidal volume delivery to the uninvolved lung were significantly less during SILV. SILV is an effective method of improving oxygenation in patients with severe unilateral pulmonary injury. PMID:3894680

  14. Diaphragm Unloading via Controlled Mechanical Ventilation Alters the Gene Expression Profile

    OpenAIRE

    DeRuisseau, Keith C.; Shanely, R Andrew; Akunuri, Nagabhavani; Hamilton, Marc T.; Van Gammeren, Darin; Zergeroglu, A. Murat; McKenzie, Michael; Powers, Scott K.

    2005-01-01

    Rationale: Prolonged controlled mechanical ventilation results in diaphragmatic inactivity and promotes oxidative injury, atrophy, and contractile dysfunction in this important inspiratory muscle. However, the impact of controlled mechanical ventilation on global mRNA alterations in the diaphragm remains unknown.

  15. Benefits of Spontaneous Breathing : Compared with Mechanical Ventilation

    OpenAIRE

    Vimláti, László

    2012-01-01

    When spontaneous breathing (SB) is allowed during mechanical ventilation (MV), atelectatic lung areas are recruited and oxygenation improves thereby. Whether unsupported SB at its natural pattern (without PEEP and at low pressure/small tidal volume) equally recruits and improves oxygenation, and if so by which mechanism, has not been studied. A porcine lung collapse model was designed to study this question. The cardiac output dependency of the pulmonary shunt was investigated with healthy lu...

  16. Complementary home mechanical ventilation techniques. SEPAR Year 2014.

    Science.gov (United States)

    Chiner, Eusebi; Sancho-Chust, José N; Landete, Pedro; Senent, Cristina; Gómez-Merino, Elia

    2014-12-01

    This is a review of the different complementary techniques that are useful for optimizing home mechanical ventilation (HMV). Airway clearance is very important in patients with HMV and many patients, particularly those with reduced peak cough flow, require airway clearance (manual or assisted) or assisted cough techniques (manual or mechanical) and suctioning procedures, in addition to ventilation. In the case of invasive HMV, good tracheostomy cannula management is essential for success. HMV patients may have sleep disturbances that must be taken into account. Sleep studies including complete polysomnography or respiratory polygraphy are helpful for identifying patient-ventilator asynchrony. Other techniques, such as bronchoscopy or nutritional support, may be required in patients on HMV, particularly if percutaneous gastrostomy is required. Information on treatment efficacy can be obtained from HMV monitoring, using methods such as pulse oximetry, capnography or the internal programs of the ventilators themselves. Finally, the importance of the patient's subjective perception is reviewed, as this may potentially affect the success of the HMV. PMID:25138799

  17. The reality of patients requiring prolonged mechanical ventilation: a multicenter study

    OpenAIRE

    Loss, Sérgio Henrique; de Oliveira, Roselaine Pinheiro; Maccari, Juçara Gasparetto; Savi, Augusto; Boniatti, Marcio Manozzo; Hetzel, Márcio Pereira; Dallegrave, Daniele Munaretto; Balzano, Patrícia de Campos; Oliveira, Eubrando Silvestre; Höher, Jorge Amilton; Torelly, André Peretti; Teixeira, Cassiano

    2015-01-01

    Objective The number of patients who require prolonged mechanical ventilation increased during the last decade, which generated a large population of chronically ill patients. This study established the incidence of prolonged mechanical ventilation in four intensive care units and reported different characteristics, hospital outcomes, and the impact of costs and services of prolonged mechanical ventilation patients (mechanical ventilation dependency ≥ 21 days) compared with non-prolonged mech...

  18. High-frequency oscillatory ventilation is not superior to conventional mechanical ventilation in surfactant-treated rabbits with lung injury

    NARCIS (Netherlands)

    D.A.M.P.J. Gommers (Diederik); A. Hartog (Anneke); R. Schnabel; A. de Jaegere (Anne); B.F. Lachmann (Burkhard)

    1999-01-01

    textabstractThe aim of this study was to compare high-frequency oscillatory ventilation (HFOV) with conventional mechanical ventilation (CMV) with and without surfactant in the treatment of surfactant-deficient rabbits. A previously described saline lung lavage model of

  19. Effect of PEEP on regional ventilation and perfusion in the mechanically ventilated preterm lamb

    International Nuclear Information System (INIS)

    Improvement of gas exchange through closer matching of regional ventilation (V) and lung perfusion (Q) with the application of positive end-expiratory pressure (PEEP) was evaluated in vivo in six mechanically ventilated preterm lambs (107-126 days/145 days gestation). Changes in V and Q were determined from in vivo scintigraphic measurements in four lung regions with inhaled radioactive 81mKr, and infused 81mKr/dextrose and/or [99mTc]MAA as PEEP was applied at 2, 4, and 6 cm H2O in each animal. Dynamic compliance varied between 0.02 and 0.40 ml/cm H2O, which was consistent with surfactant deficiency. As PEEP was increased, the regional distribution of Q shifted from the rostral to the caudal lung regions (p less than 0.02 to less than 0.05), while that of V remained unchanged. Regional V/Q matching improved together with a trend towards improvement of arterial blood gases as PEEP was increased from 2 to 4 cm H2O. Pulmonary scintigraphy offers a noninvasive methodology for the quantitative assessment of regional V and Q matching in preterm lambs and may be clinically applicable to ventilated neonates

  20. Effect of PEEP on regional ventilation and perfusion in the mechanically ventilated preterm lamb

    Energy Technology Data Exchange (ETDEWEB)

    Schlessel, J.S.; Susskind, H.; Joel, D.D.; Bossuyt, A.; Harrold, W.H.; Zanzi, I.; Chanana, A.D. (Cornell Univ. Medical College, Manhasset, NY (USA))

    1989-08-01

    Improvement of gas exchange through closer matching of regional ventilation (V) and lung perfusion (Q) with the application of positive end-expiratory pressure (PEEP) was evaluated in vivo in six mechanically ventilated preterm lambs (107-126 days/145 days gestation). Changes in V and Q were determined from in vivo scintigraphic measurements in four lung regions with inhaled radioactive 81mKr, and infused {sup 81m}Kr/dextrose and/or ({sup 99m}Tc)MAA as PEEP was applied at 2, 4, and 6 cm H{sub 2}O in each animal. Dynamic compliance varied between 0.02 and 0.40 ml/cm H{sub 2}O, which was consistent with surfactant deficiency. As PEEP was increased, the regional distribution of Q shifted from the rostral to the caudal lung regions (p less than 0.02 to less than 0.05), while that of V remained unchanged. Regional V/Q matching improved together with a trend towards improvement of arterial blood gases as PEEP was increased from 2 to 4 cm H{sub 2}O. Pulmonary scintigraphy offers a noninvasive methodology for the quantitative assessment of regional V and Q matching in preterm lambs and may be clinically applicable to ventilated neonates.

  1. Changes in respiratory mechanics during respiratory physiotherapy in mechanically ventilated patients

    OpenAIRE

    Moreira, Fernanda Callefe; Teixeira, Cassiano; Savi, Augusto; Xavier, Rogério

    2015-01-01

    Objective To evaluate the changes in ventilatory mechanics and hemodynamics that occur in patients dependent on mechanical ventilation who are subjected to a standard respiratory therapy protocol. Methods This experimental and prospective study was performed in two intensive care units, in which patients dependent on mechanical ventilation for more than 48 hours were consecutively enrolled and subjected to an established respiratory physiotherapy protocol. Ventilatory variables (dynamic lung ...

  2. NanoClusters Enhance Drug Delivery in Mechanical Ventilation

    Science.gov (United States)

    Pornputtapitak, Warangkana

    The overall goal of this thesis was to develop a dry powder delivery system for patients on mechanical ventilation. The studies were divided into two parts: the formulation development and the device design. The pulmonary system is an attractive route for drug delivery since the lungs have a large accessible surface area for treatment or drug absorption. For ventilated patients, inhaled drugs have to successfully navigate ventilator tubing and an endotracheal tube. Agglomerates of drug nanoparticles (also known as 'NanoClusters') are fine dry powder aerosols that were hypothesized to enable drug delivery through ventilator circuits. This Thesis systematically investigated formulations of NanoClusters and their aerosol performance in a conventional inhaler and a device designed for use during mechanical ventilation. These engineered powders of budesonide (NC-Bud) were delivered via a MonodoseRTM inhaler or a novel device through commercial endotracheal tubes, and analyzed by cascade impaction. NC-Bud had a higher efficiency of aerosol delivery compared to micronized stock budesonide. The delivery efficiency was independent of ventilator parameters such as inspiration patterns, inspiration volumes, and inspiration flow rates. A novel device designed to fit directly to the ventilator and endotracheal tubing connections and the MonodoseRTM inhaler showed the same efficiency of drug delivery. The new device combined with NanoCluster formulation technology, therefore, allowed convenient and efficient drug delivery through endotracheal tubes. Furthermore, itraconazole (ITZ), a triazole antifungal agent, was formulated as a NanoCluster powder via milling (top-down process) or precipitation (bottom-up process) without using any excipients. ITZ NanoClusters prepared by wet milling showed better aerosol performance compared to micronized stock ITZ and ITZ NanoClusters prepared by precipitation. ITZ NanoClusters prepared by precipitation methods also showed an amorphous state

  3. Patient Machine Interface for the Control of Mechanical Ventilation Devices

    Directory of Open Access Journals (Sweden)

    Rolando Grave de Peralta

    2013-11-01

    Full Text Available The potential of Brain Computer Interfaces (BCIs to translate brain activity into commands to control external devices during mechanical ventilation (MV remains largely unexplored. This is surprising since the amount of patients that might benefit from such assistance is considerably larger than the number of patients requiring BCI for motor control. Given the transient nature of MV (i.e., used mainly over night or during acute clinical conditions, precluding the use of invasive methods, and inspired by current research on BCIs, we argue that scalp recorded EEG (electroencephalography signals can provide a non-invasive direct communication pathway between the brain and the ventilator. In this paper we propose a Patient Ventilator Interface (PVI to control a ventilator during variable conscious states (i.e., wake, sleep, etc.. After a brief introduction on the neural control of breathing and the clinical conditions requiring the use of MV we discuss the conventional techniques used during MV. The schema of the PVI is presented followed by a description of the neural signals that can be used for the on-line control. To illustrate the full approach, we present data from a healthy subject, where the inspiration and expiration periods during voluntary breathing were discriminated with a 92% accuracy (10-fold cross-validation from the scalp EEG data. The paper ends with a discussion on the advantages and obstacles that can be forecasted in this novel application of the concept of BCI.

  4. Mechanical ventilation in ICUs in Poland: A multi-center point-prevalence study

    OpenAIRE

    Kübler, Andrzej; Maciejewski, Dariusz; Adamik, Barbara; Kaczorowska, Małgorzata

    2013-01-01

    Background Mechanical ventilation is the primary method of supporting organ function in patients treated in intensive care units (ICUs). Lung damage from mechanical ventilation can be avoided by using the correct ventilation modes. This study was designed to assess the epidemiology and treatment strategies of patients receiving mechanical ventilation in ICUs in Poland. Material/Methods This study was done using a point-prevalence methodology. Questionnaires requesting demographic data, indica...

  5. Respiratory mechanics studied by forced oscillations during artificial ventilation.

    Science.gov (United States)

    Peslin, R; Felicio da Silva, J; Duvivier, C; Chabot, F

    1993-06-01

    Potential advantages of the forced oscillation technique over other methods for monitoring total respiratory mechanics during artificial ventilation are that it does not require patient relaxation, and that additional information may be derived from the frequency dependence of the real (Re) and imaginary (Im) parts of respiratory impedance. We wanted to assess feasibility and usefulness of the forced oscillation technique in this setting and therefore used the approach in 17 intubated patients, mechanically ventilated for acute respiratory failure. Sinusoidal pressure oscillations at 5, 10 and 20 Hz were applied at the airway opening, using a specially devised loudspeaker-type generator placed in parallel with the ventilator. Real and imaginary parts were corrected for the flow-dependent impedance of the endotracheal tube; they usually exhibited large variations during the respiratory cycle, and were computed separately for the inspiratory and expiratory phases. In many instances the real part was larger during inspiration, probably due to the larger respiratory flow, and decreased with increasing frequency. The imaginary part of respiratory impedance usually increased with increasing frequency during expiration, as expected for a predominately elastic system, but often varied little, or even decreased, with increasing frequency during inspiration. In most patients, the data were inconsistent with the usual resistance-inertance-compliance model. A much better fit was obtained with a model featuring central airways and a peripheral pathway in parallel with bronchial compliance. The results obtained with the latter model suggest that dynamic airway compression occurred during passive expiration in a number of patients. We conclude that the use of forced oscillation is relatively easy to implement during mechanical ventilation, that it allows the study of respiratory mechanics at various points in the respiratory cycle, and may help in detecting expiratory flow

  6. Phosphorylation of ARD1 by IKKβ contributes to its destabilization and degradation

    International Nuclear Information System (INIS)

    IκB kinase β (IKKβ), a major kinase downstream of various proinflammatory signals, mediates multiple cellular functions through phosphorylation and regulation of its substrates. On the basis of protein sequence analysis, we identified arrest-defective protein 1 (ARD1), a protein involved in apoptosis and cell proliferation processes in many human cancer cells, as a new IKKβ substrate. We provided evidence showing that ARD1 is indeed a bona fide substrate of IKKβ. IKKβ physically associated with ARD1 and phosphorylated it at Ser209. Phosphorylation by IKKβ destabilized ARD1 and induced its proteasome-mediated degradation. Impaired growth suppression was observed in ARD1 phosphorylation-mimic mutant (S209E)-transfected cells as compared with ARD1 non-phosphorylatable mutant (S209A)-transfected cells. Our findings of molecular interactions between ARD1 and IKKβ may enable further understanding of the upstream regulation mechanisms of ARD1 and of the diverse functions of IKKβ.

  7. Care-related pain in critically ill mechanically ventilated patients.

    Science.gov (United States)

    Ayasrah, S

    2016-07-01

    Despite advances in pain management, critically ill patients continue to have unacceptably high rates of uncontrolled pain. Using the Behavioural Pain Scale and physiological indicators of pain, this study examines pain levels in mechanically ventilated patients prior to and during routine nursing procedures. A prospective descriptive design was used to assess and describe care-related pain associated with nociceptive procedures (repositioning, endotracheal suctioning, and vascular punctures) and non-nociceptive procedures (mouth care, eye care and dressing change). A sample of 247 mechanically ventilated Jordanian patients was recruited from intensive care units in a military hospital. The overall mean procedural pain score of 6.34 (standard deviation [SD] 2.36) was significantly higher than the mean preprocedural pain score of 3.43 (SD 0.67, t[246]=20.82, Pindicating that patients were either anxious or responsive to command only. The mean physiological indicators of pain increased during repositioning and endotracheal suctioning and decreased during the rest of the procedures. Mechanically ventilated patients experience pain prior to and during routine nursing procedures. Harmless and comfort procedures are actually painful. When caring for nonverbal critically ill patients, clinicians need to consider care-related pain associated with their interventions. Relying on changes in vital signs as a primary indicator of pain can be misleading. PMID:27456175

  8. Home Mechanical Ventilation: A Canadian Thoracic Society Clinical Practice Guideline

    Directory of Open Access Journals (Sweden)

    Douglas A McKim

    2011-01-01

    Full Text Available Increasing numbers of patients are surviving episodes of prolonged mechanical ventilation or benefitting from the recent availability of user-friendly noninvasive ventilators. Although many publications pertaining to specific aspects of home mechanical ventilation (HMV exist, very few comprehensive guidelines that bring together all of the current literature on patients at risk for or using mechanical ventilatory support are available. The Canadian Thoracic Society HMV Guideline Committee has reviewed the available English literature on topics related to HMV in adults, and completed a detailed guideline that will help standardize and improve the assessment and management of individuals requiring noninvasive or invasive HMV. The guideline provides a disease-specific review of illnesses including amyotrophic lateral sclerosis, spinal cord injury, muscular dystrophies, myotonic dystrophy, kyphoscoliosis, post-polio syndrome, central hypoventilation syndrome, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease as well as important common themes such as airway clearance and the process of transition to home. The guidelines have been extensively reviewed by international experts, allied health professionals and target audiences. They will be updated on a regular basis to incorporate any new information.

  9. ACCESSION TO PREVENTIVE MEASURES OF PNEUMONIA ASSOCIATED WITH MECHANICAL VENTILATION

    Directory of Open Access Journals (Sweden)

    Luany Caroline Adamovicz Bork

    2015-07-01

    Full Text Available Justification and Objective: Emphasizing the importance of adopting measures for infection preventive for the realization of a free tour of damage emerged the need to observe how the health team has been applying bundle. Aimed to investigate the adhesion of preventive measures for pneumonia by health professionals, the Intensive Care Unit of a general adult public hospital, Ponta Grossa - PR. Methods. Transversal research, quantitative, prospective and observational approach, carried out in the period April-July 2013. The sample consisted of 33 patients who were on mechanical ventilation, totaling a record 1522 times application of preventive measures for pneumonia ventilator-associated (VAP. Results: Of 33 patients, 13 developed pneumonia, the mean age was 59.72 years and the prevalence was female (44.44 %. It was found that health professional sattended high head board of bed averaged 69.89 %, and join ed the interruption of sedation in averaged 66.66 % , performed oral hygiene with chlorhexidine 94.61 % , keptthe cuff the endotracheal tube (between 20 and 25mmH2O 64.44 % , have adapted filter nebulizerto staywithin the validity of 89.50 % and 93.4 % of the observation sleft the circuit free of condensate. Analyzed the average amount of day sonme chanical ventilation of patients who acquired infection was 15.85 (SD = 8.65. Conclusion: Reveal that when the team applies all preventive patientonme chanical ventilation measures are reduced the risko facquiringan infection in the respiratory tract. Keywords: Intensive Care, Pneumonia, Ventilator- Associated, Cross Infection, Patient Care Team

  10. Comparison of Active and Passive Humidifiers on Mechanical Ventilation

    Directory of Open Access Journals (Sweden)

    H. Dilek Mersin Özcanoğlu

    2010-12-01

    Full Text Available Objective: To research the effectiveness on humidifying, respiratory mechanics, bacterial colonization and infection rates of continuous usage for 96 hours of active and passive humidifiers which are used for heating and moisturizing the inspired gases in patients under mechanical ventilation. Materials and Methods: Adult patients who are expected to support at least 4 days under mechanical ventilation, excluding patients with primary lung disease and sepsis, are included in the research. Patients are separated in two groups as a passive humidifier group (heat moisture exchange filter (n=16 and an active humidifier group (n=14. In passive humidifier group, humidifier is used continuously for 96 hours without change. In active humidifier group moisturizing is obtained by using sterile distilled water in heated humidifier. Patients whose demographic characteristics were recorded and first 24 hour APACHE II scores were calculated, were taking chest X-Ray’s daily. Respiratory mechanics measurements were recorded twice a day which were watched in Servo300A ventilators respiratory mechanics monitor, in patients under volume controlled ventilation. The amount of moisture and liquidity of the secretion in endotracheal tube were recorded and scored visually. The endotracheal aspiration samples at the beginning and at the end of 96th hour and respiratory circuits ventilator side sample taken at 96th hour were studied microbiologically. Cultures and colonial counts were studied at Cerrahpasa Medical Faculty Microbiology Laboratory. Results: There were no significant difference in two groups by demographic data, APACHE II scores and illness diagnoses. In passive humidifier group, respiratory mechanics showed no significant difference between the beginning and the 4th day (p>0.05. In active humidifier group when MAP, PEEPtot, EEF, Rins, Rexp values showed no significant difference between the beginning and the 4th day but PIP values showed significant

  11. The impacts of balanced and exhaust mechanical ventilation on indoor radon

    International Nuclear Information System (INIS)

    Models for estimating radon entry rates, indoor radon concentrations, and ventilation rates in houses with a basement or a vented crawl-space and ventilated by natural infiltration, mechanical exhaust ventilation, or balanced mechanical ventilation are described. Simulations are performed for a range of soil and housing characteristics using hourly weather data for the heating season in Spokane, WA. For a house with a basement, we show that any ventilation technique should be acceptable when the soil permeability is less than approximately 10-12m2. However, exhaust ventilation leads to substantially higher indoor radon concentrations than infiltration or balanced ventilation with the same average air exchange rate when the soil permeability is 10-10m2 or greater. For houses with a crawl-space, indoor radon concentrations are lowest with balanced ventilation, intermediate with exhaust ventilation, and highest with infiltration

  12. Respiratory Impairment after Early Red Cell Transfusion in Pediatric Patients with ALI/ARDS

    Directory of Open Access Journals (Sweden)

    Surender Rajasekaran

    2012-01-01

    Full Text Available Introduction. In the first 48 hours of ventilating patients with acute lung injury (ALI/acute respiratory distress syndrome (ARDS, a multipronged approach including packed red blood cell (PRBC transfusion is undertaken to maintain oxygen delivery. Hypothesis. We hypothesized children with ALI/ARDS transfused within 48 hours of initiating mechanical ventilation would have worse outcome. The course of 34 transfused patients was retrospectively compared to 45 nontransfused control patients admitted to the PICU at Helen DeVos Children’s Hospital between January 1st 2008 and December 31st 2009. Results. Mean hemoglobin (Hb prior to transfusion was 8.2 g/dl compared to 10.1 g/dl in control. P/F ratio decreased from 135.4±7.5 to 116.5±8.8 in transfused but increased from 148.0±8.0 to 190.4±17.8 (P<0.001 in control. OI increased in the transfused from 11.7±0.9 to 18.7±1.6 but not in control. Ventilator days in the transfused were 15.6±1.7 versus 9.5±0.6 days in control (P<0.001. There was a trend towards higher rates of MODS in transfused patients; 29.4% versus 17.7%, odds ratio 1.92, 95% CI; 0.6–5.6 Fisher exact P<0.282. Conclusion. This study suggests that early transfusions of patients with ALI/ARDS were associated with increased ventilatory needs.

  13. Automatic detection of AutoPEEP during controlled mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Nguyen Quang-Thang

    2012-06-01

    Full Text Available Abstract Background Dynamic hyperinflation, hereafter called AutoPEEP (auto-positive end expiratory pressure with some slight language abuse, is a frequent deleterious phenomenon in patients undergoing mechanical ventilation. Although not readily quantifiable, AutoPEEP can be recognized on the expiratory portion of the flow waveform. If expiratory flow does not return to zero before the next inspiration, AutoPEEP is present. This simple detection however requires the eye of an expert clinician at the patient’s bedside. An automatic detection of AutoPEEP should be helpful to optimize care. Methods In this paper, a platform for automatic detection of AutoPEEP based on the flow signal available on most of recent mechanical ventilators is introduced. The detection algorithms are developed on the basis of robust non-parametric hypothesis testings that require no prior information on the signal distribution. In particular, two detectors are proposed: one is based on SNT (Signal Norm Testing and the other is an extension of SNT in the sequential framework. The performance assessment was carried out on a respiratory system analog and ex-vivo on various retrospectively acquired patient curves. Results The experiment results have shown that the proposed algorithm provides relevant AutoPEEP detection on both simulated and real data. The analysis of clinical data has shown that the proposed detectors can be used to automatically detect AutoPEEP with an accuracy of 93% and a recall (sensitivity of 90%. Conclusions The proposed platform provides an automatic early detection of AutoPEEP. Such functionality can be integrated in the currently used mechanical ventilator for continuous monitoring of the patient-ventilator interface and, therefore, alleviate the clinician task.

  14. APRV Mode in Ventilator Induced Lung Injury (VILI

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    Ata Mahmoodpoor

    2014-01-01

    Full Text Available Ventilator-Induced Lung Injury (VILI, being a significant iatrogenic complication in the ICU patients, is associated with high morbidity and mortality. Numerous approaches, protocols and ventilation modes have been introduced and examined to decrease the incidence of VILI in the ICU patients. Airway pressure release ventilation (APRV, firstly introduced by Stock and Downs in 1987, applies higher Continuous Positive Airway Pressure (CPAP levels in prolonged periods (P and T high in order to preserve satisfactory lung volume and consequently alveolar recruitment. This mode benefits a time-cycled release phase to a lower set of pressure for a short period of time (P and T low i.e. release time (1,2. While some advantages have been introduced for APRV such as efficiently recruited alveoli over time, more homogeneous ventilation, less volutrauma, probable stabilization of patent alveoli and reduction in atelectrauma, protective effects of APRV on lung damage only seem to be substantial if spontaneous breathing responds to more than 30% of total minute ventilation (3. APRV in ARDS patients should be administered cautiously; T low<0.6 seconds, for recruiting collapsed alveoli; however overstretching of alveoli especially during P high should not be neglected and appropriate sedation considered. The proposed advantages for APRV give the impression of being outstanding; however, APRV, as a non-physiologic inverse ratio mode of ventilation, might result in inflammation mainly due to impaired patient-ventilator interaction explaining the negative or minimally desirable effects of APRV on inflammation (4. Consequently, continuous infusion of neuromuscular blocking drugs during ARDS has been reported to reduce mortality (5. There are insufficient confirming data on the superiority of APRV above other ventilatory methods in regard to oxygenation, hemodynamics, regional blood flow, patient comfort and length of mechanical ventilation. Based on current findings

  15. Spatial distribution of sequential ventilation during mechanical ventilation of the uninjured lung: an argument for cyclical airway collapse and expansion

    Directory of Open Access Journals (Sweden)

    Altemeier William A

    2010-05-01

    Full Text Available Abstract Background Ventilator-induced lung injury (VILI is a recognized complication of mechanical ventilation. Although the specific mechanism by which mechanical ventilation causes lung injury remains an active area of study, the application of positive end expiratory pressure (PEEP reduces its severity. We have previously reported that VILI is spatially heterogeneous with the most severe injury in the dorsal-caudal lung. This regional injury heterogeneity was abolished by the application of PEEP = 8 cm H2O. We hypothesized that the spatial distribution of lung injury correlates with areas in which cyclical airway collapse and recruitment occurs. Methods To test this hypothesis, rabbits were mechanically ventilated in the supine posture, and regional ventilation distribution was measured under four conditions: tidal volumes (VT of 6 and 12 ml/kg with PEEP levels of 0 and 8 cm H2O. Results We found that relative ventilation was sequentially redistributed towards dorsal-caudal lung with increasing tidal volume. This sequential ventilation redistribution was abolished with the addition of PEEP. Conclusions These results suggest that cyclical airway collapse and recruitment is regionally heterogeneous and spatially correlated with areas most susceptible to VILI.

  16. Recurrent Recruitment Manoeuvres Improve Lung Mechanics and Minimize Lung Injury during Mechanical Ventilation of Healthy Mice

    OpenAIRE

    Reiss, Lucy Kathleen; Kowallik, Anke; Uhlig, Stefan

    2011-01-01

    Introduction Mechanical ventilation (MV) of mice is increasingly required in experimental studies, but the conditions that allow stable ventilation of mice over several hours have not yet been fully defined. In addition, most previous studies documented vital parameters and lung mechanics only incompletely. The aim of the present study was to establish experimental conditions that keep these parameters within their physiological range over a period of 6 h. For this purpose, we also examined t...

  17. Comparative Study of pressure-control ventilation and volume-control ventilation in treating traumatic acute respiratory distress syndrome

    Institute of Scientific and Technical Information of China (English)

    杨云梅; 黄卫东; 沈美亚; 徐哲荣

    2005-01-01

    Objective: To observe the clinical therapeutic effect and side effect of pressure-control ventilation (PCV) on traumatic acute respiratory distress syndrome (ARDS) compared with volume-control ventilation (VCV).Methods: Forty patients with traumatic ARDS were hospitalized in our department from June 1996 to December 2002. Twenty were treated with PCV (PCV group) and 20 with VCV (VCV group). The changes of the peak inflating pressure and the mean pressure of the airway were observed at the very beginning of the mechanical ventilation and the following 12 and 24 hours, respectively. The transcutaneous saturation of oxygen pressure, the pressure of oxygen in artery, the mean blood pressure, the central venous pressure, the heart rate and the incidence of the pressure injury were also monitored before ventilation and 12 hours after ventilation.Results: The pressure of oxygen in artery, the transcutaneous saturation of oxygen pressure, the heart rate and the respiratory rate in the PCV group were obviously improved after ventilation treatment. The peak inflating pressure, the mean pressure of the airway and the central venous pressure in the PCV group were lower than in the VCV group. The incidence of pressure injury was 0 in the PCV group while 10% in the VCV group. Conclusions: The clinical effect of PCV on traumatic ARDS is better and the incidence rate of pressure injury is lower than that of VCV. PCV has minimal effects on the hemodynamics.

  18. Noninvasive Mechanical Ventilation in Acute Respiratory Failure Patients: A Respiratory Therapist Perspective

    OpenAIRE

    Hidalgo, V.; Giugliano-Jaramillo, C; Pérez, R.; Cerpa, F; Budini, H; Cáceres, D.; Gutiérrez, T.; Molina, J; Keymer, J; Romero-Dapueto, C

    2015-01-01

    Physiotherapist in Chile and Respiratory Therapist worldwide are the professionals who are experts in respiratory care, in mechanical ventilation (MV), pathophysiology and connection and disconnection criteria. They should be experts in every aspect of the acute respiratory failure and its management, they and are the ones who in medical units are able to resolve doubts about ventilation and the setting of the ventilator. Noninvasive mechanical ventilation should be the first-line of treatmen...

  19. Helium-oxygen mixture does not improve gas exchange in mechanically ventilated children with bronchiolitis

    OpenAIRE

    Gross, Matthew F; Spear, Robert M.; Peterson, Bradley M

    2000-01-01

    Introduction: Heliox has been found to reduce both the arterial carbon dioxide tension (PaCO2) and work of breathing in children and adults with status asthmaticus. We hypothesized that, in mechanically ventilated children with bronchiolitis, increasing the ratio of helium:oxygen concentrations would improve both ventilation and oxygenation. Objective: To examine the effect of varying concentrations of heliox mixtures on ventilation and oxygenation in mechanically ventilated children with bro...

  20. Recurrent recruitment manoeuvres improve lung mechanics and minimize lung injury during mechanical ventilation of healthy mice.

    Directory of Open Access Journals (Sweden)

    Lucy Kathleen Reiss

    Full Text Available INTRODUCTION: Mechanical ventilation (MV of mice is increasingly required in experimental studies, but the conditions that allow stable ventilation of mice over several hours have not yet been fully defined. In addition, most previous studies documented vital parameters and lung mechanics only incompletely. The aim of the present study was to establish experimental conditions that keep these parameters within their physiological range over a period of 6 h. For this purpose, we also examined the effects of frequent short recruitment manoeuvres (RM in healthy mice. METHODS: Mice were ventilated at low tidal volume V(T = 8 mL/kg or high tidal volume V(T = 16 mL/kg and a positive end-expiratory pressure (PEEP of 2 or 6 cm H(2O. RM were performed every 5 min, 60 min or not at all. Lung mechanics were followed by the forced oscillation technique. Blood pressure (BP, electrocardiogram (ECG, heart frequency (HF, oxygen saturation and body temperature were monitored. Blood gases, neutrophil-recruitment, microvascular permeability and pro-inflammatory cytokines in bronchoalveolar lavage (BAL and blood serum as well as histopathology of the lung were examined. RESULTS: MV with repetitive RM every 5 min resulted in stable respiratory mechanics. Ventilation without RM worsened lung mechanics due to alveolar collapse, leading to impaired gas exchange. HF and BP were affected by anaesthesia, but not by ventilation. Microvascular permeability was highest in atelectatic lungs, whereas neutrophil-recruitment and structural changes were strongest in lungs ventilated with high tidal volume. The cytokines IL-6 and KC, but neither TNF nor IP-10, were elevated in the BAL and serum of all ventilated mice and were reduced by recurrent RM. Lung mechanics, oxygenation and pulmonary inflammation were improved by increased PEEP. CONCLUSIONS: Recurrent RM maintain lung mechanics in their physiological range during low tidal volume ventilation of healthy mice by

  1. Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): study protocol for a randomized controlled trial

    OpenAIRE

    Cavalcanti, AB; Suzumura, ÉA; Amato, MB; Tallo, FS; Rezende, AC; Telles, MM; Takahashi, LN; Carvalho, VO; Díaz-Quijano, FA; Berwanger, O; Kodama, AA; Ribeiro, GF; Abreu, MO; Oliveira, IM; Guyatt, G

    2012-01-01

    Background Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design ART is a pragmatic, multicenter...

  2. Protective lung ventilation in operating room: a systematic review.

    Science.gov (United States)

    Futier, E; Constantin, J M; Jaber, S

    2014-06-01

    Postoperative pulmonary and extrapulmonary complications adversely affect clinical outcomes and healthcare utilization, so that prevention has become a measure of the quality of perioperative care. Mechanical ventilation is an essential support therapy to maintain adequate gas exchange during general anesthesia for surgery. Mechanical ventilation using high tidal volume (VT) (between 10 and 15 mL/kg) has been historically encouraged to prevent hypoxemia and atelectasis formation in anesthetized patients undergoing abdominal and thoracic surgery. However, there is accumulating evidence from both experimental and clinical studies that mechanical ventilation, especially the use of high VT and plateau pressure, may potentially aggravate or even initiate lung injury. Ventilator-associated lung injury can result from cyclic alveolar overdistension of non-dependent lung tissue, and repetitive opening and closing of dependent lung tissue resulting in ultrastructural damage at the junction of closed and open alveoli. Lung-protective ventilation, which refers to the use of lower VT and limited plateau pressure to minimize overdistension, and positive end-expiratory pressure to prevent alveolar collapse at end-expiration, was shown to improve outcome in critically ill patients with acute respiratory distress syndrome (ARDS). It has been recently suggested that this approach might also be beneficial in a broader population, especially in critically ill patients without ARDS at the onset of mechanical ventilation. There is, however, little evidence regarding a potential beneficial effect of lung protective ventilation during surgery, especially in patients with healthy lungs. Although surgical patients are frequently exposed to much shorter periods of mechanical ventilation, this is an important gap in knowledge given the number of patients receiving mechanical ventilation in the operating room. This review developed the benefits of lung protective ventilation during surgery

  3. Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART: Study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    2012-08-01

    Full Text Available Abstract Background Acute respiratory distress syndrome (ARDS is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART. Methods/Design ART is a pragmatic, multicenter, randomized (concealed, controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy. We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH2O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet. In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight and targeting plateau pressure ≤30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion If the ART strategy with maximum recruitment and PEEP titration improves

  4. Variable versus conventional lung protective mechanical ventilation during open abdominal surgery

    OpenAIRE

    Peter M Spieth; Güldner, Andreas; Uhlig, Christopher; Bluth, Thomas; Kiss, Thomas; Schultz, Marcus J.; Pelosi, Paolo; Koch, Thea; Gamba de Abreu, Marcelo

    2015-01-01

    Background: General anesthesia usually requires mechanical ventilation, which is traditionally accomplished with constant tidal volumes in volume- or pressure-controlled modes. Experimental studies suggest that the use of variable tidal volumes (variable ventilation) recruits lung tissue, improves pulmonary function and reduces systemic inflammatory response. However, it is currently not known whether patients undergoing open abdominal surgery might benefit from intraoperative variable ventil...

  5. Effects of manual hyperinflation in preterm newborns under mechanical ventilation

    Science.gov (United States)

    Viana, Camila Chaves; Nicolau, Carla Marques; Juliani, Regina Celia Turola Passos; de Carvalho, Werther Brunow; Krebs, Vera Lucia Jornada

    2016-01-01

    Objective To assess the effects of manual hyperinflation, performed with a manual resuscitator with and without the positive end-expiratory pressure valve, on the respiratory function of preterm newborns under mechanical ventilation. Methods Cross-sectional study of hemodynamically stable preterm newborns with gestational age of less than 32 weeks, under mechanical ventilation and dependent on it at 28 days of life. Manual hyperinflation was applied randomly, alternating the use or not of the positive end-expiratory pressure valve, followed by tracheal aspiration for ending the maneuver. For nominal data, the two-tailed Wilcoxon test was applied at the 5% significance level and 80% power. Results Twenty-eight preterm newborns, with an average birth weight of 1,005.71 ± 372.16g, an average gestational age of 28.90 ± 1.79 weeks, an average corrected age of 33.26 ± 1.78 weeks, and an average mechanical ventilation time of 29.5 (15 - 53) days, were studied. Increases in inspiratory and expiratory volumes occurred between time-points A5 (before the maneuver) and C1 (immediately after tracheal aspiration) in both the maneuver with the valve (p = 0.001 and p = 0.009) and without the valve (p = 0.026 and p = 0.001), respectively. There was also an increase in expiratory resistance between time-points A5 and C1 (p = 0.044). Conclusion Lung volumes increased when performing the maneuver with and without the valve, with a significant difference in the first minute after aspiration. There was a significant difference in expiratory resistance between the time-points A5 (before the maneuver) and C1 (immediately after tracheal aspiration) in the first minute after aspiration within each maneuver. PMID:27737427

  6. Hyperpolarized 3He magnetic resonance imaging ventilation defects in asthma: relationship to airway mechanics

    OpenAIRE

    Leary, Del; Svenningsen, Sarah; Guo, Fumin; Bhatawadekar, Swati; Parraga, Grace; Maksym, Geoffrey N.

    2016-01-01

    Abstract In patients with asthma, magnetic resonance imaging (MRI) provides direct measurements of regional ventilation heterogeneity, the etiology of which is not well‐understood, nor is the relationship of ventilation abnormalities with lung mechanics. In addition, respiratory resistance and reactance are often abnormal in asthmatics and the frequency dependence of respiratory resistance is thought to reflect ventilation heterogeneity. We acquired MRI ventilation defect maps, forced expirat...

  7. Monitoring carbon dioxide in mechanically ventilated patients during hyperbaric treatment

    DEFF Research Database (Denmark)

    Bjerregård, Asger; Jansen, Erik

    2012-01-01

    Measurement of the arterial carbon dioxide (P(a)CO(2)) is an established part of the monitoring of mechanically ventilated patients. Other ways to get information about carbon dioxide in the patient are measurement of end-tidal carbon dioxide (P(ET)CO(2)) and transcutaneous carbon dioxide (PTCCO2......). Carbon dioxide in the blood and cerebral tissue has great influence on vasoactivity and thereby blood volume of the brain. We have found no studies on the correlation between P(ET)CO(2) or P(TC)CO(2), and P(a)CO(2) during hyperbaric oxygen therapy (HBOT)....

  8. 肺源性与肺外源性急性呼吸窘迫综合征呼吸力学的异同及机械通气策略%Respiratory mechanic differences and mechanical ventilation strategy for acute respiratory distress syndrome caused by pulmonary and extrapulmonary Injury

    Institute of Scientific and Technical Information of China (English)

    喻文亮

    2010-01-01

    Acute respiratory distress syndrome(ARDS) can be divided into pulmonary ARDS and extrapulmonary ARDS according to its origin.The prevalent damage in early stages of pulmonary ARDS is intra-alveolar,whereas in extra-pulmonary ARDS it is the interstitial edema.In pulmonary ARDS,lung compliance is worse than in extrapulmonary ARDS,whereas the main abnormality is the decrease in chest Wall compliance.due to abnormally high intra-abdominal pressure.Positive end expiratory pressure,recruitment maneuver and prone position ventilation are more effective in extrapulmonary ARDS,whereas low tidal volume ventilation play equal role in rescuing the two types of ARDS.%急性呼吸窘迫综合征(ARDS)按其病因可分为肺源性ARDS和肺外源性ARDS.肺源性ARDS早期多为肺泡损害,而肺外源性ARDS多为间质性肺水肿.肺源性ARDS患儿肺顺应性降低,而肺外源性ARDS由于腹腔内压增高其胸壁顺应性更低.肺外源性ARDS中应用呼气末正压、肺复张手法及俯卧位通气效果更好,而两者的小潮气量通气效果相似.

  9. The Study of Pulmonary Complication of Neonatal Mechanical Ventilation in NICU

    OpenAIRE

    M.K. Sabzeie; T. Sabouri; M. Sokri; B. Basiri; M Khazaei

    2016-01-01

    Introduction & Objective: The main indication of mechanical ventilation is in the treatment of neonates with respiratory failure. With the increased use of mechanical ventilation, its complications have increased too. The aim of this study was to evaluate the prevalence of complications and short-term improvement in infants undergoing mechanical ventilation in the neonatal intensive care unit (NICU). Materials & Methods: In this prospective-analytic study, all infants requiring mechanical ...

  10. Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

    OpenAIRE

    Emília Nozawa; Eliane Kobayashi; Marta Erika Matsumoto; Maria Ignêz Zanetti Feltrim; Maria José Carvalho Carmona; José Otávio Costa Auler Júnior

    2003-01-01

    OBJECTIVE: To analyze parameters of respiratory system mechanics and oxygenation and cardiovascular alterations involved in weaning tracheostomized patients from long-term mechanical ventilation after cardiac surgery. METHODS: We studied 45 patients in their postoperative period of cardiac surgery, who required long-term mechanical ventilation for more than 10 days and had to undergo tracheostomy due to unsuccessful weaning from mechanical ventilation. The parameters of respiratory system mec...

  11. How is mechanical ventilation employed in a pediatric intensive care unit in Brazil?

    Directory of Open Access Journals (Sweden)

    Dafne Cardoso Bourguignon da Silva

    2009-01-01

    Full Text Available OBJECTIVE: to investigate the relationship between mechanical ventilation and mortality and the practice of mechanical ventilation applied in children admitted to a high-complexity pediatric intensive care unit in the city of São Paulo, Brazil. DESIGN: Prospective cohort study of all consecutive patients admitted to a Brazilian high-complexity PICU who were placed on mechanical ventilation for 24 hours or more, between October 1st, 2005 and March 31st, 2006. RESULTS: Of the 241 patients admitted, 86 (35.7% received mechanical ventilation for 24 hours or more. Of these, 49 met inclusion criteria and were thus eligible to participate in the study. Of the 49 patients studied, 45 had chronic functional status. The median age of participants was 32 months and the median length of mechanical ventilation use was 6.5 days. The major indication for mechanical ventilation was acute respiratory failure, usually associated with severe sepsis / septic shock. Pressure ventilation modes were the standard ones. An overall 10.37% incidence of Acute Respiratory Distress Syndrome was found, in addition to tidal volumes > 8 ml/kg, as well as normo- or hypocapnia. A total of 17 children died. Risk factors for mortality within 28 days of admission were initial inspiratory pressure, pH, PaO2/FiO2 ratio, oxygenation index and also oxygenation index at 48 hours of mechanical ventilation. Initial inspiratory pressure was also a predictor of mechanical ventilation for periods longer than 7 days. CONCLUSION: Of the admitted children, 35.7% received mechanical ventilation for 24 h or more. Pressure ventilation modes were standard. Of the children studied, 91% had chronic functional status. There was a high incidence of Acute Respiratory Distress Syndrome, but a lung-protective strategy was not fully implemented. Inspiratory pressure at the beginning of mechanical ventilation was a predictor of mortality within 28 days and of a longer course of mechanical ventilation.

  12. Management of critically ill patients receiving noninvasive and invasive mechanical ventilation in the emergency department

    Directory of Open Access Journals (Sweden)

    Rose L

    2012-03-01

    Full Text Available Louise RoseLawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, CanadaAbstract: Patients requiring noninvasive and invasive ventilation frequently present to emergency departments, and may remain for prolonged periods due to constrained critical care services. Emergency clinicians often do not receive the same education on management of mechanical ventilation or have similar exposure to these patients as do their critical care colleagues. The aim of this review was to synthesize the evidence on management of patients requiring noninvasive and invasive ventilation in the emergency department including indications, clinical applications, monitoring priorities, and potential complications. Noninvasive ventilation is recommended for patients with acute exacerbation of chronic obstructive pulmonary disease or cardiogenic pulmonary edema. Less evidence supports its use in asthma and other causes of acute respiratory failure. Use of noninvasive ventilation in the prehospital setting is relatively new, and some evidence suggests benefit. Monitoring priorities for noninvasive ventilation include response to treatment, respiratory and hemodynamic stability, noninvasive ventilation tolerance, detection of noninvasive ventilation failure, and identification of air leaks around the interface. Application of injurious ventilation increases patient morbidity and mortality. Lung-protective ventilation with low tidal volumes based on determination of predicted body weight and control of plateau pressure has been shown to reduce mortality in patients with acute respiratory distress syndrome, and some evidence exists to suggest this strategy should be used in patients without lung injury. Monitoring of the invasively ventilated patient should focus on assessing response to mechanical ventilation and other interventions, and avoiding complications, such as ventilator-associated pneumonia. Several key aspects of management of noninvasive

  13. Closure mechanisms of ventilated supercavities under steady and unsteady flows

    Science.gov (United States)

    Karn, Ashish; De, Rohan; Hong, Jiarong; Arndt, Roger E. A.

    2015-12-01

    The present work reports some interesting experimental results for ventilated supercavitation in steady and unsteady flows. First, a variety of closure modes obtained as a result of systematic variation in Froude number and air entrainment, are reported. The closure mechanisms were found to differ from the standard criterion reported in the literature. Further, the occurrence of a variety of stable and unstable closure mechanisms were discovered that have not been reported in the literature. Next, a hypothesis is presented to explain the cause behind these different closure mechanisms. The proposed hypothesis is then validated by synchronized high-speed imaging and pressure measurements inside and outside of the supercavity. These measurements show that the supercavity closure is a function of instantaneous cavitation number under unsteady flow conditions. (Research sponsored by Office of Naval Research, USA)

  14. Mechanical ventilation modulates TLR4 and IRAK-3 in a non-infectious, ventilator-induced lung injury model

    Directory of Open Access Journals (Sweden)

    Casula Milena

    2010-03-01

    Full Text Available Abstract Background Previous experimental studies have shown that injurious mechanical ventilation has a direct effect on pulmonary and systemic immune responses. How these responses are propagated or attenuated is a matter of speculation. The goal of this study was to determine the contribution of mechanical ventilation in the regulation of Toll-like receptor (TLR signaling and interleukin-1 receptor associated kinase-3 (IRAK-3 during experimental ventilator-induced lung injury. Methods Prospective, randomized, controlled animal study using male, healthy adults Sprague-Dawley rats weighing 300-350 g. Animals were anesthetized and randomized to spontaneous breathing and to two different mechanical ventilation strategies for 4 hours: high tidal volume (VT (20 ml/kg and low VT (6 ml/kg. Histological evaluation, TLR2, TLR4, IRAK3 gene expression, IRAK-3 protein levels, inhibitory kappa B alpha (IκBα, tumor necrosis factor-alpha (TNF-α and interleukin-6 (IL6 gene expression in the lungs and TNF-α and IL-6 protein serum concentrations were analyzed. Results High VT mechanical ventilation for 4 hours was associated with a significant increase of TLR4 but not TLR2, a significant decrease of IRAK3 lung gene expression and protein levels, a significant decrease of IκBα, and a higher lung expression and serum concentrations of pro-inflammatory cytokines. Conclusions The current study supports an interaction between TLR4 and IRAK-3 signaling pathway for the over-expression and release of pro-inflammatory cytokines during ventilator-induced lung injury. Our study also suggests that injurious mechanical ventilation may elicit an immune response that is similar to that observed during infections.

  15. A control system for mechanical ventilation of passive and active subjects.

    Science.gov (United States)

    Tehrani, Fleur T

    2013-06-01

    Synchronization of spontaneous breathing with breaths supplied by the ventilator is essential for providing optimal ventilation to patients on mechanical ventilation. Some ventilation techniques such as Adaptive Support Ventilation (ASV), Proportional Assist Ventilation (PAV), and Neurally Adjusted Ventilatory Assist (NAVA) are designed to address this problem. In PAV, the pressure support is proportional to the patient's ongoing effort during inspiration. However, there is no guarantee that the patient receives adequate ventilation. The system described in this article is designed to automatically control the support level in PAV to guarantee delivery of patient's required ventilation. This system can also be used to control the PAV support level based on the patient's work of breathing. This technique further incorporates some of the features of ASV to deliver mandatory breaths for passive subjects. The system has been tested by using computer simulations and the controller has been implemented by using a prototype.

  16. Changes in respiratory and circulatory functions during sequential invasive-noninvasive mechanical ventilation

    Institute of Scientific and Technical Information of China (English)

    商鸣宇; 王辰; 代华平; 杨媛华; 姜超美

    2003-01-01

    Objective To investigate the changes in respiratory and circulatory functions in chronic obstructive pulmonary disease (COPD) patients during sequential invasive-noninvasive mechanical ventilation therapy, and evaluate the effects of this new technique.Methods Twelve COPD patients with type Ⅱ respiratory failure due to severe pulmonary infection were ventilated through an endotracheal tube. When the pulmonary infection control window (PIC-Window) occurred, the patients were extubated and were ventilated with a facial mask using pressure support ventilation combined with positive end-expiratory pressure. The parameters of hemodynamics, oxygen dynamics, and esophageal pressure were measured at the PIC-Window during invasive mechanical ventilation, one hour after oxygen therapy via a naso-tube, and three hours after non-invasive mechanical ventilation. Results The variation in esophageal pressure was 20.0±6 cmH2O during naso-tube oxygen therapy, and this variation was higher than that during non-invasive mechanical ventilation (10±6 cmH2O, P0.05).Conclusions The respiratory and circulatory functions of COPD patients remained stable during sequential invasive-noninvasive mechanical ventilation therapy using PIC-Window as a switch point for early extubation. The COPD patients can tolerated the transition from invasive mechanical ventilation to noninvasive mechanical ventilation.

  17. Advanced lung ventilation system (ALVS) with linear respiratory mechanics assumption for waveform optimization of dual-controlled ventilation.

    Science.gov (United States)

    Montecchia, F; Guerrisi, M; Canichella, A

    2007-03-01

    The present paper describes the functional features of an advanced lung ventilation system (ALVS) properly designed for the optimization of conventional dual-controlled ventilation (DCV), i.e. with pressure-controlled ventilation with ensured tidal or minute volume. Considering the particular clinical conditions of patients treated with controlled ventilation the analysis and synthesis of ALVS control have been performed assuming a linear respiratory mechanics. Moreover, new airways pressure waveforms with more physiological shape can be tested on simulators of respiratory system in order to evaluate their clinical application. This is obtained through the implementation of a compensation procedure making the desired airways pressure waveform independent on patient airways resistance and lung compliance variations along with a complete real-time monitoring of respiratory system parameters leading the ventilator setting. The experimental results obtained with a lung simulator agree with the theoretical ones and show that ALVS performance is useful for the research activity aiming at the improvement of both diagnostic evaluation and therapeutic outcome relative to mechanical ventilation treatments.

  18. Social and practical representations in pneumonia associated to ventilation mechanics

    Directory of Open Access Journals (Sweden)

    Giovane Mendieta I

    2009-05-01

    Full Text Available Objective: To identify the practice and social representations of the respiratory therapists, on the strategies of prevention of pneumonia associated to mechanical ventilation, of the unit intensive care of the Kennedy Hospital. Methodology:Qualitative inquiry, descriptive and explanatory character, the population, respiratorys therapist of the unit’s intensives cares, with a sample of captive type for convenience, conformed by seventeen respiratorys therapists who were applied a semistructured interview, applying the content analysis technique for their study. Results: Practices and social representations, are given around the patient, and therefore avoid prolonged mechanical ventilation, the suction procedure should be carried out by means of aseptic technique, on the other and, the strict execution of handling protocols of airway; as long as it should be norm for the whole personnel, hand washing. Conclusions:it is observed the strategies of prevention are influenced by the theoretical references, however, these actors don’t know the full prevention strategies, likewise the represented practices are related with the prevention through asepsis transmission of pathogens, and has an effect on the construction of social representations and therefore the knowledge of new practices will change the structure of representation.

  19. Critical Pertussis in a Young Infant Requiring Mechanical Ventilation

    Directory of Open Access Journals (Sweden)

    Heda Melinda Nataprawira

    2013-01-01

    Full Text Available Pertussis may likely be misdiagnosed in its initial or catarrhal phase as a common respiratory infection. The earlier diagnosis of pertussis really depends on the capability of the medical professional especially in the first line public health services. The lack of awareness in diagnosis of severe pertussis as one of the causes of severe respiratory problems may likely misdiagnose pertussis as respiratory failure or even septic shock. In fact, pertussis may manifest as a critical pertussis which can be fatal due to the respiratory failure that require pediatric intensive care unit using mechanical ventilation. We reported a confirmed pertussis case of a 7-weeks-old female infant referred to our tertiary hospital with gasping leading to respiratory failure and septic shock requiring mechanical ventilation, aggressive fluid therapy, and antibiotics. Pertussis was diagnosed late during the course of illness when the patient was hospitalized. Improvement was noted after administering macrolide which gave a good response. Bordetella pertussis isolation from Bordet-Gengou media culture yielded positive result.

  20. How is mechanical ventilation employed in a pediatric intensive care unit in Brazil?

    OpenAIRE

    Dafne Cardoso Bourguignon da Silva; Audrey Rie Ogawa Shibata; Farias, Julio A; Eduardo Juan Troster

    2009-01-01

    OBJECTIVE: to investigate the relationship between mechanical ventilation and mortality and the practice of mechanical ventilation applied in children admitted to a high-complexity pediatric intensive care unit in the city of São Paulo, Brazil. DESIGN: Prospective cohort study of all consecutive patients admitted to a Brazilian high-complexity PICU who were placed on mechanical ventilation for 24 hours or more, between October 1st, 2005 and March 31st, 2006. RESULTS: Of the 241 patients admit...

  1. Evaluation of delivery of enteral nutrition in mechanically ventilated Malaysian ICU patients

    OpenAIRE

    Yip, Keng F; Rai, Vineya; Wong, Kang K

    2014-01-01

    Background There are numerous challenges in providing nutrition to the mechanically ventilated critically ill ICU patient. Understanding the level of nutritional support and the barriers to enteral feeding interruption in mechanically ventilated patients are important to maximise the nutritional benefits to the critically ill patients. Thus, this study aims to evaluate enteral nutrition delivery and identify the reasons for interruptions in mechanically ventilated Malaysian patients receiving...

  2. Indoor Environmental Quality in Mechanically Ventilated, Energy-Efficient Buildings vs. Conventional Buildings.

    Science.gov (United States)

    Wallner, Peter; Munoz, Ute; Tappler, Peter; Wanka, Anna; Kundi, Michael; Shelton, Janie F; Hutter, Hans-Peter

    2015-11-06

    Energy-efficient buildings need mechanical ventilation. However, there are concerns that inadequate mechanical ventilation may lead to impaired indoor air quality. Using a semi-experimental field study, we investigated if exposure of occupants of two types of buildings (mechanical vs. natural ventilation) differs with regard to indoor air pollutants and climate factors. We investigated living and bedrooms in 123 buildings (62 highly energy-efficient and 61 conventional buildings) built in the years 2010 to 2012 in Austria (mainly Vienna and Lower Austria). Measurements of indoor parameters (climate, chemical pollutants and biological contaminants) were conducted twice. In total, more than 3000 measurements were performed. Almost all indoor air quality and room climate parameters showed significantly better results in mechanically ventilated homes compared to those relying on ventilation from open windows and/or doors. This study does not support the hypothesis that occupants in mechanically ventilated low energy houses are exposed to lower indoor air quality.

  3. Indoor Environmental Quality in Mechanically Ventilated, Energy-Efficient Buildings vs. Conventional Buildings

    Directory of Open Access Journals (Sweden)

    Peter Wallner

    2015-11-01

    Full Text Available Energy-efficient buildings need mechanical ventilation. However, there are concerns that inadequate mechanical ventilation may lead to impaired indoor air quality. Using a semi-experimental field study, we investigated if exposure of occupants of two types of buildings (mechanical vs. natural ventilation differs with regard to indoor air pollutants and climate factors. We investigated living and bedrooms in 123 buildings (62 highly energy-efficient and 61 conventional buildings built in the years 2010 to 2012 in Austria (mainly Vienna and Lower Austria. Measurements of indoor parameters (climate, chemical pollutants and biological contaminants were conducted twice. In total, more than 3000 measurements were performed. Almost all indoor air quality and room climate parameters showed significantly better results in mechanically ventilated homes compared to those relying on ventilation from open windows and/or doors. This study does not support the hypothesis that occupants in mechanically ventilated low energy houses are exposed to lower indoor air quality.

  4. 机械通气在急性呼吸窘迫综合征中的应用进展%Application progress of mechanical ventilation in acute respiratory distress syndrome

    Institute of Scientific and Technical Information of China (English)

    章仲恒; 朱红阳

    2010-01-01

    在治疗急性呼吸窘迫综合征的各种手段中,呼吸机机械通气是至关重要的.各种机械通气方式及参数的设置对于改善患者预后极为重要.从现有的研究资料来看,小潮气量机械通气(<6 ml/kg预计体质量,并使平台压小于30 cm H_2O)能减少死亡率,是急性呼吸窘迫综合征治疗的标准疗法.而个体化的呼气末正压通气也是一个有前途的值得研究的方向.其他一些方法例如俯卧位通气、肺复张等不能作为常规的一线治疗,而只能作为严重情况下低氧血症的挽救治疗.另外本文也就机械通气在2009年甲型H1N1流感所致急性呼吸窘迫综合征的治疗方面做了简单综述.%Mechanical ventilation is essential in the treatment of acute respiratory distress syndrome(ARDS).Mechanical ventilation mode and parameter set are extremely important for improving the prognosis of patients.Research data have shown that low tidal volume ventilation(< 6 ml/kg predicted body weight,and plateau pressure is less than 30 cm H_2O)can reduce mortality and is standard treatment for ARDS.The individualized positive end expiratory pressure ventilation is also a promising study direction.Other methods such as prone position ventilation,alveolar recruitment can not be used as routine first-line treatment,but only be used.as rescue treatment under severe hypoxemia.Additionally,this article also reviews some characteristics of mechanical ventilation on the treatment of ARDS induced by H1N1 influenza in 2009.

  5. Development of mechanical ventilation system with low energy consumption for renovation of buildings

    DEFF Research Database (Denmark)

    Terkildsen, Søren

    III reports on an investigation into the performance of diffuse ceiling ventilation in a school classroom. The investigation included tracer gas, air velocity and temperature measurements and showed perfect mixing of the air in the room without any discomfort issues. The diffuse ceiling ventilation...... of natural and hybrid ventilation systems is intended to reduce the energy consumption for ventilation, specifically the power consumption of fans in mechanical systems, but these alternative systems have other flaws, e.g. higher ventilation heat loss. Meanwhile, little has been done to improve......’s, and the objective was to provide comfort ventilation all year round and avoid overheating through increased ventilation and night cooling. This would mean that only one system needs to be installed and mechanical cooling is unnecessary. The potential to reduce pressure losses was examined for the main constituting...

  6. Radon mitigation with pressure-controlled mechanical ventilation

    International Nuclear Information System (INIS)

    Effective ventilation and positive or low negative pressure indoors are suggested to achieve low indoor radon levels. The aim of this study was to develop and to test equipment which makes it possible to achieve simultaneously effective ventilation and minimum indoor-outdoor pressure difference. The unit included mechanical supply and exhaust air fans, a heat-exchanger and a pressure control unit in direct digital control (DDC), which continuously adjusted air flows based on the pressure difference transmitter information. Indoor radon level decreased from 501 ± 95 Bq/m3 to 202 ± 54 Bq/m3 after two weeks of the equipment's installation during winter conditions. The arithmetic week average of indoor radon level was 135 Bq/m3 from May to August. When the set value of pressure difference adjustment was slightly positive (0.2 Pa) and in-out temperature difference was small in August, the minimum level (38 ± 28 Bq/m3) was obtained. (author)

  7. Clinical and microbiological characterization of pneumonia in mechanically ventilated patients

    Directory of Open Access Journals (Sweden)

    Manuel Medell

    2012-10-01

    Full Text Available OBJECTIVE: To characterize mechanical ventilation-associated pneumonia (MVAP. METHOD: This is an observational descriptive study to characterize MVAP in 61 ventilated patients admitted in the intensive care units of the Hermanos Ameijeiras hospital during 2011. This study also aimed to isolate the bacteria causing MVAP and characterize their resistance to antibiotics. RESULTS: 51 (83.60% patients presented pulmonary infiltrates and 35 (50.81% presented a clinical score > 6 according to the Clinical Pulmonary Infection Score. Acinetobacter baumannii and Pseudomonas aeruginosa were the most frequently isolated microorganisms from patients with MVAP. Both microorganisms showed a high resistance to antibiotics. Carbapenems were the most frequent used antimicrobial therapeutic agents; elective antibiotic combinations were directed against both bacterial wall structure and nucleic acid synthesis. CONCLUSION: Patients with MVAP identified during the studied period showed similar frequency to those reported in medical literature. Thus, this study corroborated that this is still a relevant medical problem in this hospital. Acinetobacter baumannii and Pseudomonas aeruginosa were the most frequently isolated microorganisms from patients with MVAP. Antimicrobial treatment, empirical or not, are still the main risk factors for the development of multidrug-resistant strains of bacteria. The rate of resistance to antibiotics of Acinetobacter baumannii and Pseudomonas aeruginosa strains isolated from patients with MVAP was higher than those isolated from infected patients without MAVP. Tigecycline and colistin were the only antibiotics fully effective against Acinetobacter baumannii strains isolated in 2011 from patients with MVAP; against Pseudomonas aeruginosa strains, only colistin was fully effective.

  8. Characterization of the mechanical behavior of intrapulmonary percussive ventilation

    International Nuclear Information System (INIS)

    A new device delivering intrapulmonary percussive ventilation (IPV), called Impulsator® (Percussionaire Corporation, Sandpoint, ID, USA), has recently been introduced in an effort to provide effective clearance and to promote homogeneity of ventilation in the lungs of patients with cystic fibrosis. In order to optimize the treatment based on its use, a better understanding of its functioning is still necessary. In fact, up to now, a complete characterization of this device has not been carried out, thus reducing its effective utilization in clinical practice. With the aim of overcoming this lack, in this study, data concerning flow and pressure delivered during in vitro IPV were acquired under different combinations of device settings and respiratory loads. Quantitative information was obtained about the physical variables administered by the device like percussive frequency, ratio of inspiratory to expiratory time, flow and pressure magnitudes and volume exchanged. The analysis of the data determined the relations among these variables and between them and the mechanical loads, laying the basis for an optimal clinical application of the device. (paper)

  9. The growing role of noninvasive ventilation in patients requiring prolonged mechanical ventilation.

    Science.gov (United States)

    Hess, Dean R

    2012-06-01

    For many patients with chronic respiratory failure requiring ventilator support, noninvasive ventilation (NIV) is preferable to invasive support by tracheostomy. Currently available evidence does not support the use of nocturnal NIV in unselected patients with stable COPD. Several European studies have reported benefit for high intensity NIV, in which setting of inspiratory pressure and respiratory rate are selected to achieve normocapnia. There have also been studies reporting benefit for the use of NIV as an adjunct to exercise training. NIV may be useful as an adjunct to airway clearance techniques in patients with cystic fibrosis. Accumulating evidence supports the use of NIV in patients with obesity hypoventilation syndrome. There is considerable observational evidence supporting the use of NIV in patients with chronic respiratory failure related to neuromuscular disease, and one randomized controlled trial reported that the use of NIV was life-prolonging in patients with amyotrophic lateral sclerosis. A variety of interfaces can be used to provide NIV in patients with stable chronic respiratory failure. The mouthpiece is an interface that is unique in this patient population, and has been used with success in patients with neuromuscular disease. Bi-level pressure ventilators are commonly used for NIV, although there are now a new generation of intermediate ventilators that are portable, have a long battery life, and can be used for NIV and invasive applications. Pressure support ventilation, pressure controlled ventilation, and volume controlled ventilation have been used successfully for chronic applications of NIV. New modes have recently become available, but their benefits await evidence to support their widespread use. The success of NIV in a given patient population depends on selection of an appropriate patient, selection of an appropriate interface, selection of an appropriate ventilator and ventilator settings, the skills of the clinician, the

  10. A Comprehensive Review of Prone Position in ARDS.

    Science.gov (United States)

    Kallet, Richard H

    2015-11-01

    Prone position (PP) has been used since the 1970s to treat severe hypoxemia in patients with ARDS because of its effectiveness at improving gas exchange. Compared with the supine position (SP), placing patients in PP effects a more even tidal volume distribution, in part, by reversing the vertical pleural pressure gradient, which becomes more negative in the dorsal regions. PP also improves resting lung volume in the dorsocaudal regions by reducing the superimposed pressure of both the heart and the abdomen. In contrast, pulmonary perfusion remains preferentially distributed to the dorsal lung regions, thus improving overall alveolar ventilation/perfusion relationships. Moreover, the larger tissue mass suspended from a wider dorsal chest wall effects a more homogeneous distribution of pleural pressures throughout the lung that reduces abnormal strain and stress development. This is believed to ameliorate the severity or development of ventilator-induced lung injury and may partly explain why PP reduces mortality in severe ARDS. Over 40 years of clinical trials have consistently reported improved oxygenation in approximately 70% of subjects with ARDS. Early initiation of PP is more likely to improve oxygenation than initiation during the subacute phase. Maximal oxygenation improvement occurs over a wide time frame ranging from several hours to several days. Meta-analyses of randomized controlled trials suggest that PP provides a survival advantage only in patients with relatively severe ARDS (PaO2 /FIO2 10-12 h/session). Combining adjunctive therapies (high PEEP, recruitment maneuvers, and inhaled vasodilators) with PP has an additive effect in improving oxygenation and may be particularly helpful in stabilizing gas exchange in very severe ARDS. PMID:26493592

  11. The Extent of Ventilator-Induced Lung Injury in Mice Partly Depends on Duration of Mechanical Ventilation

    Directory of Open Access Journals (Sweden)

    Maria A. Hegeman

    2013-01-01

    Full Text Available Background. Mechanical ventilation (MV has the potential to initiate ventilator-induced lung injury (VILI. The pathogenesis of VILI has been primarily studied in animal models using more or less injurious ventilator settings. However, we speculate that duration of MV also influences severity and character of VILI. Methods. Sixty-four healthy C57Bl/6 mice were mechanically ventilated for 5 or 12 hours, using lower tidal volumes with positive end-expiratory pressure (PEEP or higher tidal volumes without PEEP. Fifteen nonventilated mice served as controls. Results. All animals remained hemodynamically stable and survived MV protocols. In both MV groups, PaO2 to FiO2 ratios were lower and alveolar cell counts were higher after 12 hours of MV compared to 5 hours. Alveolar-capillary permeability was increased after 12 hours compared to 5 hours, although differences did not reach statistical significance. Lung levels of inflammatory mediators did not further increase over time. Only in mice ventilated with increased strain, lung compliance declined and wet to dry ratio increased after 12 hours of MV compared to 5 hours. Conclusions. Deleterious effects of MV are partly dependent on its duration. Even lower tidal volumes with PEEP may initiate aspects of VILI after 12 hours of MV.

  12. Outcome at school-age after neonatal mechanical ventilation.

    Science.gov (United States)

    Gunn, T R; Lepore, E; Outerbridge, E W

    1983-06-01

    103 school-age children (5 to 12 years) who survived mechanical ventilation for neonatal respiratory failure were evaluated for growth, neurological, intellectual, psychological and school function in order to determine those children most at risk for handicap. A major handicap occurred in seven children, preventing attendance at normal school or normal classes. Neurological sequelae were significantly associated with perinatal asphyxia and with birthweights of 1500g or less, and neurological sequelae and socio-economic factors were the major determinants of ability. The effects of the Neonatal Intensive Care Unit (NICU) experience on parents and subsequent parent-child relationships were also investigated: 67 per cent of the mothers were very upset by the experience and many continue to worry excessively about the health of their child. Parents who visited their child in the NICU frequently were significantly more anxious and overprotective, restricting many activities even when the child was of school age. PMID:6873492

  13. Quantitative investigation of alveolar structures with OCT using total liquid ventilation during mechanical ventilation

    Science.gov (United States)

    Schnabel, Christian; Gaertner, Maria; Meissner, Sven; Koch, Edmund

    2012-02-01

    To develop new treatment possibilities for patients with severe lung diseases it is crucial to understand the lung function on an alveolar level. Optical coherence tomography (OCT) in combination with intravital microscopy (IVM) are used for imaging subpleural alveoli in animal models to gain information about dynamic and morphological changes of lung tissue during mechanical ventilation. The image content suitable for further analysis is influenced by image artifacts caused by scattering, refraction, reflection, and absorbance. Because the refractive index varies with each air-tissue interface in lung tissue, these effects decrease OCT image quality exceedingly. The quality of OCT images can be increased when the refractive index inside the alveoli is matched to the one of tissue via liquid-filling. Thereby, scattering loss can be decreased and higher penetration depth and tissue contrast can be achieved. To use the advantages of liquid-filling for in vivo imaging of small rodent lungs, a suitable breathing fluid (perfluorodecalin) and a special liquid respirator are necessary. Here we show the effect of liquid-filling on OCT and IVM image quality of subpleural alveoli in a mouse model.

  14. Advances in mechanical ventilation onrespiratoryfailure as a result of chronic obstructive pulmonary disease and bronchial asthma

    Directory of Open Access Journals (Sweden)

    Zhuang MA

    2011-08-01

    Full Text Available Over years,great strides have been made in theories and practices of mechanical ventilation.The indications of non-invasive ventilation have been increasing,while invasive ventilation has been playing a vital role in patients who are critically ill with inadequate drainage of sputum and fail to benefit from non-invasive ventilation.Chronic diseases,including chronic obstructive pulmonary disease(COPD,one of the most common chronic diseases,and bronchial asthma,the incidence of which is ascending recent years,are main causes for respiratory failure.Accordingly,we focus in the present paper on discussion and elaboration of respiratory failure as a result of COPD and bronchial asthma.Type II respiratory failure is the major type of respiratory failure induced by COPD,both in acute exacerbation and stable stage,and mechanical ventilation is one of the most common treatments.Severe acute bronchial asthma complicated with respiratory failure is an emergency.In this situation,primary goal of mechanical ventilation is to make an efficient oxygenation and ventilation of patients,and to avoid hyperinflation to the utmost.For patients who are able to cooperate,non-invasive ventilation in early stage may be beneficial,avoiding tracheal intubation and application of invasive ventilation.But in those who can not achieve remission in a short term,an artificial airway should be established for invasive ventilation as soon as possible.

  15. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults

    OpenAIRE

    Hodgson, Carol L; Stiller, Kathy; Needham, Dale M.; Tipping, Claire J; Harrold, Megan; Baldwin, Claire E; Bradley, Scott; Berney, Sue; Caruana, Lawrence R; Elliott, Doug; Green, Margot; Haines, Kimberley; Higgins, Alisa M; Kaukonen, Kirsi-Maija; Leditschke, Isabel Anne

    2014-01-01

    Introduction The aim of this study was to develop consensus recommendations on safety parameters for mobilizing adult, mechanically ventilated, intensive care unit (ICU) patients. Methods A systematic literature review was followed by a meeting of 23 multidisciplinary ICU experts to seek consensus regarding the safe mobilization of mechanically ventilated patients. Results Safety considerations were summarized in four categories: respiratory, cardiovascular, neurological and other. Consensus ...

  16. Inadequate humidification of respiratory gases during mechanical ventilation of the newborn.

    OpenAIRE

    Tarnow-Mordi, W O; Sutton, P; Wilkinson, A R

    1986-01-01

    Proximal airway humidity was measured during mechanical ventilation in 14 infants using an electronic hygrometer. Values below recommended minimum humidity of adult inspired gas were recorded on 251 of 396 occasions. Inadequate humidification, largely due to inadequate proximal airway temperature, is commoner than recognised in infants receiving mechanical ventilation.

  17. Randomised controlled trial of respiratory system compliance measurements in mechanically ventilated neonates

    OpenAIRE

    Stenson, B.; Glover, R.; Wilkie, R; Laing, I; TARNOW-MORDI, W

    1998-01-01

    AIM—To determine whether outcomes of neonatal mechanical ventilation could be improved by regular pulmonary function testing.
METHODS—Two hundred and forty five neonates, without immediately life threatening congenital malformations, were mechanically ventilated in the newborn period. Infants were randomly allocated to conventional clinical management (control group) or conventional management supplemented by regular measurements of static respiratory system compliance, usin...

  18. Infants with severe respiratory syncytial virus needed less ventilator time with nasal continuous airways pressure then invasive mechanical ventilation

    NARCIS (Netherlands)

    Borckink, Ilse; Essouri, Sandrine; Laurent, Marie; Albers, Marcel J. I. J.; Burgerhof, Johannes G. M.; Tissieres, Pierre; Kneyber, Martin C. J.

    2014-01-01

    AIM: Nasal continuous positive airway pressure (NCPAP) has been proposed as an early first-line support for infants with severe respiratory syncytial virus (RSV) infection. We hypothesised that infants <6 months with severe RSV would require shorter ventilator support on NCPAP than invasive mechanic

  19. BSim models for 2 case-studies of naturally and mechanically ventilated daycare institutions

    Energy Technology Data Exchange (ETDEWEB)

    Kalyanova, O.; Heiselberg, P.

    2009-06-15

    The report intends to provide complete information necessary for evaluation of assumptions made in the models and conclusions derived from the results of simulation of two different institutions in various operational modes. Thermal models are prepared for two day-care buildings, one which is mechanically ventilated and one which is naturally ventilated. All simulations were preformed in BSim, and all the models are simulated in the current version og BSim which is version 6,8,9,8. The results of the simulations showed that it is possible to reduce energy use for ventilation, both in mechanically and naturally ventilated child care center without compromising indoor air quality. (ln)

  20. The effects of posture, airway pressure and anesthesia on regulation of the regional ventilation and perfusion distribution in healthy humans

    OpenAIRE

    Nyrén, Sven

    2010-01-01

    Gas exchange has been observed to vary with posture in adult respiratory distress syndrome (ARDS) patients. In this thesis, the effect of posture on theregional distribution of ventilation (V) and perfusion (Q) in the lungs under normal breathing with and without continuous positive airway pressure (CPAP) and during general anesthesia with mechanical ventilation was studied. Additionally, endogenously produced nitric oxide (NO) may influence the effect of posture on the Q di...

  1. Management of critically ill patients receiving noninvasive and invasive mechanical ventilation in the emergency department

    OpenAIRE

    Rose, Louise

    2012-01-01

    Patients requiring noninvasive and invasive ventilation frequently present to emergency departments, and may remain for prolonged periods due to constrained critical care services. Emergency clinicians often do not receive the same education on management of mechanical ventilation or have similar exposure to these patients as do their critical care colleagues. The aim of this review was to synthesize the evidence on management of patients requiring noninvasive and invasive ventilation in the ...

  2. 46 CFR 154.1205 - Mechanical ventilation system: Standards.

    Science.gov (United States)

    2010-10-01

    ... duct under paragraph (a) of this section must be at least 10 m (32.8 ft.) from ventilation intakes and... have any combination of fixed or rotating components made of an aluminum or magnesium alloy and ferrous fixed or rotating components. (k) Each ventilation intake and exhaust must have a protective...

  3. Effects of vitamin E administration on APACHE II Score in ARDS patients

    OpenAIRE

    M. Hajimahmoodi; Mojtahedzadeh, M.; N GhaffarNatanzi; Sadrai, S.; N. Sadeghi; Najafi, A.; MR Khajavi; Hadadi, A; "Oveisi MR; Kanani, M.

    2009-01-01

    ABSTRACT Background and purpose of the study: The acute respiratory distress syndrome (ARDS) is a common clinical disorder caused by injury to the alveolar epithelial and endothelial barriers of lung. In ARDS patients, oxidative stress is increased and plasma antioxidant levels are reduced. Vitamin E has an important role in antioxidant defense mechanisms. In this study the effect of vitamin E on decrease of APACHE II score in ARDS patients was investigated.  Materials and methods: T...

  4. Sequential non-invasive mechanical ventilation following short-term invasive mechanical ventilation in COPD induced hypercapnic respiratory failure

    Institute of Scientific and Technical Information of China (English)

    王辰; 商鸣宇; 黄克武; 童朝晖; 孔维民; 姜超美; 代华平; 张洪玉; 翁心植

    2003-01-01

    Objective To estimate the feasibility and the efficacy of early extubation and sequential non-invasive mechanical ventilation (MV) in chronic obstructive pulmonary disease (COPD) with exacerbated hypercapnic respiratory failure.Methods Twenty-two intubated COPD patients with severe hypercapnic respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study. At the time of pulmonary infection control window (PIC window) appeared, when pulmonary infection had been significantly controlled (resolution of fever and decrease in purulent sputum, radiographic infiltrations, and leukocytosis) after the antibiotic and the comprehensive therapy, the early extubation was conducted and followed by non-invasive MV via facial mask immediately in 11 cases (study group). Other 11 COPD cases with similar clinical characteristics who continuously received invasive MV after PIC window were recruited as control group.Results All patients had similar clinical characteristics and gas exchange before treatment, as well as the initiating time and all indices at the time of the PIC window. For study group and control group, the duration of invasive MV was (7.1±2.9) vs (23.0±14.0) days, respectively, P<0.01. The total duration of ventilatory support was (13±7) vs (23±14) days, respectively, P<0.05. The incidence of ventilator associated pneumonia (VAP) were 0/11 vs 6/11, respectively, P<0.01. The duration of intensive care unit (ICU) stay was (13±7) vs (26±14) days, respectively, P<0.05. Conclusions In COPD patients requiring intubation and MV for pulmonary infection and hypercapnic respiratory failure, early extubation followed by non-invasive MV initiated at the point of PIC window significantly decreases the invasive and total durations of ventilatory support, the risk of VAP, and the duration of ICU stay.

  5. Inhibition of HMGCoA reductase by simvastatin protects mice from injurious mechanical ventilation

    OpenAIRE

    Manitsopoulos, Nikolaos; Orfanos, Stylianos E; Kotanidou, Anastasia; Nikitopoulou, Ioanna; Siempos, Ilias; Magkou, Christina; Dimopoulou, Ioanna; Zakynthinos, Spyros G.; Armaganidis, Apostolos; Maniatis, Nikolaos A.

    2015-01-01

    Background Mortality from severe acute respiratory distress syndrome exceeds 40% and there is no available pharmacologic treatment. Mechanical ventilation contributes to lung dysfunction and mortality by causing ventilator-induced lung injury. We explored the utility of simvastatin in a mouse model of severe ventilator-induced lung injury. Methods Male C57BL6 mice (n = 7/group) were pretreated with simvastatin or saline and received protective (8 mL/kg) or injurious (25 mL/kg) ventilation for...

  6. Advances in mechanical ventilation onrespiratoryfailure as a result of chronic obstructive pulmonary disease and bronchial asthma

    OpenAIRE

    Ma, Zhuang

    2011-01-01

    Over years,great strides have been made in theories and practices of mechanical ventilation.The indications of non-invasive ventilation have been increasing,while invasive ventilation has been playing a vital role in patients who are critically ill with inadequate drainage of sputum and fail to benefit from non-invasive ventilation.Chronic diseases,including chronic obstructive pulmonary disease(COPD),one of the most common chronic diseases,and bronchial asthma,the incidence of which is ascen...

  7. Numerical investigation of aerosolized drug delivery in the human lungs under mechanical ventilator conditions

    Science.gov (United States)

    Vanrhein, Timothy; Banerjee, Arindam

    2010-11-01

    Particle deposition for aerosolized drug delivery in the human airways is heavily dependent upon flow conditions. Numerical modeling techniques have proven valuable for determining particle deposition characteristics under steady flow conditions. For the case of patients under mechanical ventilation, however, flow conditions change drastically and there is an increased importance to understand particle deposition characteristics. This study focuses on mechanically ventilated conditions in the upper trachea-bronchial (TB) region of the human airways. Solution of the continuous phase flow is done under ventilator waveform conditions with a suitable turbulence model in conjunction with a realistic model of upper TB airways. A discrete phase Euler-Lagrange approach is applied to solve for particle deposition characteristics with a focus on the effect of the ventilator inlet waveform. The purpose of this study is to accurately model flow conditions in the upper TB airways under mechanically ventilated conditions with a focus on real-time patient specific targeted aerosolized drug delivery.

  8. The Design of Future Pediatric Mechanical Ventilation Trials for Acute Lung Injury

    OpenAIRE

    Robinder G Khemani; Newth, Christopher J.L.

    2010-01-01

    Pediatric practitioners face unique challenges when attempting to translate or adapt adult-derived evidence regarding ventilation practices for acute lung injury or acute respiratory distress syndrome into pediatric practice. Fortunately or unfortunately, there appears to be selective adoption of adult practices for pediatric mechanical ventilation, many of which pose considerable challenges or uncertainty when translated to pediatrics. These differences, combined with heterogeneous managemen...

  9. Aggravation of myocardial dysfunction by injurious mechanical ventilation in LPS-induced pneumonia in rats

    NARCIS (Netherlands)

    L. Smeding (Lonneke); J.W. Kuiper; F.B. Plötz (Frans); M.C.J. Kneyber (Martin); A.B.J. Groeneveld (Johan)

    2013-01-01

    textabstractBackground: Mechanical ventilation (MV) may cause ventilator-induced lung injury (VILI) and may thereby contribute to fatal multiple organ failure. We tested the hypothesis that injurious MV of lipopolysaccharide (LPS) pre-injured lungs induces myocardial inflammation and further dysfunc

  10. Aggravation of myocardial dysfunction by injurious mechanical ventilation in LPS-induced pneumonia in rats

    NARCIS (Netherlands)

    Smeding, Lonneke; Kuiper, Jan Willem; Plotz, Frans B.; Kneyber, Martin C. J.; Groeneveld, A. B. Johan

    2013-01-01

    Background: Mechanical ventilation (MV) may cause ventilator-induced lung injury (VILI) and may thereby contribute to fatal multiple organ failure. We tested the hypothesis that injurious MV of lipopolysaccharide (LPS) pre-injured lungs induces myocardial inflammation and further dysfunction ex vivo

  11. Measurement of end-expiratory lung volume in intubated children without interruption of mechanical ventilation

    NARCIS (Netherlands)

    I.G. Bikker (Ido); T.V. Scohy (Thierry); A.J.J.C. Bogers (Ad); J. Bakker (Jan); D.A.M.P.J. Gommers (Diederik)

    2009-01-01

    textabstractPurpose: Monitoring end-expiratory lung volume (EELV) is a valuable tool to optimize respiratory settings that could be of particular importance in mechanically ventilated pediatric patients. We evaluated the feasibility and precision of an intensive care unit (ICU) ventilator with an in

  12. [Ventilation strategies in the child with severe hypoxemic respiratory failure].

    Science.gov (United States)

    Donoso F, Alejandro; Arriagada S, Daniela; Díaz R, Franco; Cruces R, Pablo

    2015-01-01

    In this review, we assemble the fundamental concepts of the use of mechanical ventilation (MV) in children with acute respiratory failure (ARDS) and refractory hypoxemia. We also discusses topics of protective ventilation and recruitment potential, and specifically examine the options of ventilation and/or maneuvers designed to optimize the non-aerated lung tissue: alveolar recruitment maneuvers, positive end-expiratory pressure (PEEP) titulation, high frequency oscillatory ventilation (HFOV), airway pressure release ventilation (APRV), aimed at correcting the mismatch ventilation/perfusion (V/Q): use of prone position. The only pharmacological intervention analyzed is the use of neuromuscular blockers. In clinical practice, the protective MV concept involves using an individual adjustment of the PEEP and volume tidal (V(T)). Use of recruitment maneuvers and PEEP downward titration can improve lung function in patients with ARDS and severe hypoxemia. We must keep in mind HFOV instauration as early as possible in response to failure of MV. The use of early and prolonged prone can improve gas exchange in hopes of a better control of what caused the use of MV. PMID:25739487

  13. Autophagy in pulmonary macrophages mediates lung inflammatory injury via NLRP3 inflammasome activation during mechanical ventilation

    OpenAIRE

    Zhang, Yang; Liu, Gongjian; Dull, Randal O; Schwartz, David E; Hu, Guochang

    2014-01-01

    The inflammatory response is a primary mechanism in the pathogenesis of ventilator-induced lung injury. Autophagy is an essential, homeostatic process by which cells break down their own components. We explored the role of autophagy in the mechanisms of mechanical ventilation-induced lung inflammatory injury. Mice were subjected to low (7 ml/kg) or high (28 ml/kg) tidal volume ventilation for 2 h. Bone marrow-derived macrophages transfected with a scrambled or autophagy-related protein 5 smal...

  14. Experimental evaluation of air distribution in mechanically ventilated residential rooms

    DEFF Research Database (Denmark)

    Tomasi, R.; Krajčík, M.; Simone, A.;

    2013-01-01

    The effect of low ventilation rates (1 or 0.5 air change per hour) on thermal comfort and ventilation effectiveness was experimentally studied in a simulated residential room equipped with radiant floor heating/cooling and mixing ventilation systems. The tests were performed for various positions...... on the positions of supply and extract air terminals and on the difference between the supply and the room air temperature, and it could be as low as 0.5, where 1 is complete mixing. © 2013 Elsevier B.V.......The effect of low ventilation rates (1 or 0.5 air change per hour) on thermal comfort and ventilation effectiveness was experimentally studied in a simulated residential room equipped with radiant floor heating/cooling and mixing ventilation systems. The tests were performed for various positions...... of supply and extract air terminals and different winter and summer boundary conditions. Vertical air temperature, operative temperature and air velocity profiles were measured in different positions in the room, and equivalent temperatures were derived, in order to characterize thermal comfort. Contaminant...

  15. Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation

    OpenAIRE

    Michard, Frédéric; Teboul, Jean-Louis

    2000-01-01

    According to the Frank-Starling relationship, a patient is a 'responder' to volume expansion only if both ventricles are preload dependent. Mechanical ventilation induces cyclic changes in left ventricular (LV) stroke volume, which are mainly related to the expiratory decrease in LV preload due to the inspiratory decrease in right ventricular (RV) filling and ejection. In the present review, we detail the mechanisms by which mechanical ventilation should result in greater cyclic changes in LV...

  16. Effects of surfactant depletion on regional pulmonary metabolic activity during mechanical ventilation

    OpenAIRE

    De Prost, Nicolas; Costa, Eduardo L.; Wellman, Tyler; Musch, Guido; Winkler, Tilo; Tucci, Mauro R.; Harris, R. Scott; Venegas, Jose G.; Vidal Melo, Marcos F.

    2011-01-01

    Inflammation during mechanical ventilation is thought to depend on regional mechanical stress. This can be produced by concentration of stresses and cyclic recruitment in low-aeration dependent lung. Positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) allows for noninvasive assessment of regional metabolic activity, an index of neutrophilic inflammation. We tested the hypothesis that, during mechanical ventilation, surfactant-depleted low-aeration lung regions present inc...

  17. Review of ventilatory techniques to optimize mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease

    OpenAIRE

    Reddy, Raghu M.; Guntupalli, Kalpalatha K.

    2007-01-01

    Chronic obstructive pulmonary disease (COPD) is a major global healthcare problem. Studies vary widely in the reported frequency of mechanical ventilation in acute exacerbations of COPD. Invasive intubation and mechanical ventilation may be associated with significant morbidity and mortality. A good understanding of the airway pathophysiology and lung mechanics in COPD is necessary to appropriately manage acute exacerbations and respiratory failure. The basic pathophysiology in COPD exacerbat...

  18. Can selection of mechanical ventilation mode prevent increased intra-abdominal pressure in patients admitted to the intensive care unit?

    OpenAIRE

    Mohammad Reza Rafiei; Omid Aghadavoudi; Babak Shekarchi; Seyed Sajed Sajjadi; Mehrdad Masoudifar

    2013-01-01

    Background: Increased intra-abdominal pressure (IAP) results in dysfunction of vital organs. The aim of the present study was to evaluate the effect of mechanical ventilation mode on IAP. Methods: In a cohort study, a total of 60 patients aged 20-70 years who were admitted to the ICU and underwent mechanical ventilation were recruited. Mechanical ventilation included one of the three modes: Biphasic positive airway pressure (BIPAP) group, synchronize intermittent mandatory ventilation (SI...

  19. Chronic Obstructive Pulmonary Disease and Weaning of Difficult-to-wean Patients from Mechanical Ventilation: Randomized Prospective Study

    OpenAIRE

    Matić, Ivo; Đanić, Davorin; MAJERIĆ-KOGLER, VIŠNJA; Jurjević, Matija; Mirković, Ivan; Mrzljak Vučinić, Natalija

    2007-01-01

    Aim To compare T-tube and pressure support ventilation (PSV) as two methods of mechanical ventilation weaning of patients with chronic obstructive pulmonary disease (COPD) after failed extubation. Methods A prospective randomized trial carried out at the multidisciplinary intensive care unit (ICU) over 2 years included 136 patients with COPD who required mechanical ventilation longer than 24 h. The patients who could be weaned from mechanical ventilation were randomized to either a T-tube ...

  20. The mechanical ventilation of suspended timber floors for radon remediation - a simple analysis

    International Nuclear Information System (INIS)

    Mechanical ventilation of the underfloor space is one of the most effective ways of reducing radon levels in buildings with suspended timber floors. There is a question, however, whether this ventilation should be supply or extract, sometimes extract is more effective, sometimes supply is more effective. This report presents a simple analysis of the problem and suggests the hypothesis that the relative effectiveness of supply or extract ventilation to the underfloor space depends on the relative airtightness of the floor and the soil or oversite surface. The analysis suggests that if the floor is relatively tight then supply ventilation may be more effective whereas if the floor is relatively leaky or there is oversite concrete then extract may be better. It is suggested that in either case it is better to keep the underfloor pressure low and that when mechanical ventilation is provided to the underfloor space it may be necessary to increase the number of airbricks. (author)

  1. The Effect of Pressure-Controlled Ventilation and Volume-Controlled Ventilation in Prone Position on Pulmonary Mechanics and Inflammatory Markers.

    Science.gov (United States)

    Şenay, Hasan; Sıvacı, Remziye; Kokulu, Serdar; Koca, Buğra; Bakı, Elif Doğan; Ela, Yüksel

    2016-08-01

    The aim of this present study is to compare the effect of pressure-controlled ventilation and volume-controlled ventilation on pulmonary mechanics and inflammatory markers in prone position. The study included 41 patients undergoing to vertebrae surgery. The patients were randomized into two groups: Group 1 received volume-controlled ventilation, while group 2 received pressure-controlled ventilation. The demographic data, pulmonary mechanics, the inflammatory marker levels just after the induction of anesthetics, at the 6th and 12th hours, and gas analysis from arterial blood samples taken at the beginning and the 30th minute were recorded. The inflammatory marker levels increased in both groups, without any significant difference among groups. Peak inspiratory pressure level was higher in the volume-controlled ventilation group. This study revealed that there is no difference regarding inflammatory marker levels between volume- and pressure-controlled ventilation.

  2. The association between fluid balance and mortality in patients with ARDS was modified by serum potassium levels: a retrospective study

    Directory of Open Access Journals (Sweden)

    Zhongheng Zhang

    2015-02-01

    Full Text Available Background and Objective. Acute respiratory distress syndrome (ARDS is characterized by pulmonary edema and may benefit from conservative fluid management. However, conflicting results exist in the literature. The study aimed to investigate the association between mean fluid balance and mortality outcome in ARDS patients who required invasive mechanical ventilation. Methods. The study was a secondary analysis of a prospectively collected dataset obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center. ARDS patients with invasive mechanical ventilation were eligible. Demographic and laboratory data were extracted from the dataset. Multivariable regression model was built by stepwise selection of covariates. A fractional polynomial approach was used to test the linearity of mean fluid balance in the model. The potential interactions of mean fluid balance with other variables were tested. Main Results. A total of 282 patients were eligible for the analysis, including 61 non-survivors with a mortality rate of 21.6%. After stepwise regression analysis, mean fluid balance remained to be an independent predictor of death (OR: 1.00057; 95% CI [1.00034–1.00080]. The two-term model obtained using fractional polynomial analysis was not superior to the linear model. There was significant interaction between mean fluid balance and serum potassium levels (p = 0.011. While the risk of death increased with increasing mean fluid balance at potassium levels of 1.9, 2.9 , 3.9 and 4.9 mmol/l, the risk decreased at potassium level of 5.9 mmol/l. Conclusion. The present study demonstrates that more positive fluid balance in the first 8 days is significantly associated with increased risk of death. However, the relationship between mean fluid balance and mortality can be modified by serum potassium levels. With hyperkalemia, more positive fluid balance is associated with reduced risk of death.

  3. Changes of dipalmitoyl phosphatidyl choline after mechanical ventilation in patients with acute cerebral injury

    Institute of Scientific and Technical Information of China (English)

    HUANG Wei-dong; ZHOU Dao-yang; YANG Yun-mei; XU Zhe-rong; SHEN Mei-ya; SU Wei

    2006-01-01

    Objective: To detect the levels of dipalmitoyl phosphatidyl choline (DPPC) in the sputum of the patients with acute cerebral injury without primary pulmonary injury after mechanical ventilation treatment.Methods: DPPC levels in sputum of 35 patients with acute cerebral injury but without pulmonary injury were detected with high performance liquid chromatography at the beginning of ventilation and 16-20 days, 21-40 days,and 41-60 days after ventilation, respectively.Results: There was no significant difference of the DPPC levels between 16-20 days after ventilation (3.36 ±0.49) and at the beginning of ventilation ( 3.37 ± 0.58 )(P>0.05). The mean levels of DPPC decreased significantly at 21-40 days (2.87 mg/ml ±0.26 mg/ml, P <0.05) and 41-60 days (1.93 mg/ml ±0.21 mg/ml, P <0.01) after ventilation compared with that at the beginning of ventilation. At the same period, the peak inspiratory pressure and the mean pressure of airway increas ed significantly, whereas the static compliance and the partial pressure of oxygen in artery decreased significantly. Among the 25 patients who received ventilation for more than 20days, 8 (32%) had slightly-decreased partial pressure of oxygen in artery compared with that at the beginning of ventilation.Conclusions: Mechanical ventilation can decrease the DPPC levels, decrease the lung compliance and increase the airway pressure, even impair the oxygenation function in patients with acute cerebral injury. Abnormal DPPC is one of the major causes of ventilator-associated lung injury.

  4. Multivariable fractional polynomial interaction to investigate continuous effect modifiers in a meta-analysis on higher versus lower PEEP for patients with ARDS

    Science.gov (United States)

    Kasenda, Benjamin; Sauerbrei, Willi; Royston, Patrick; Mercat, Alain; Slutsky, Arthur S; Cook, Deborah; Guyatt, Gordon H; Brochard, Laurent; Richard, Jean-Christophe M; Stewart, Thomas E; Meade, Maureen; Briel, Matthias

    2016-01-01

    Objectives A recent individual patient data (IPD) meta-analysis suggested that patients with moderate or severe acute respiratory distress syndrome (ARDS) benefit from higher positive end-expiratory pressure (PEEP) ventilation strategies. However, thresholds for continuous variables (eg, hypoxaemia) are often arbitrary and linearity assumptions in regression approaches may not hold; the multivariable fractional polynomial interaction (MFPI) approach can address both problems. The objective of this study was to apply the MFPI approach to investigate interactions between four continuous patient baseline variables and higher versus lower PEEP on clinical outcomes. Setting Pooled data from three randomised trials in intensive care identified by a systematic review. Participants 2299 patients with acute lung injury requiring mechanical ventilation. Interventions Higher (N=1136) versus lower PEEP (N=1163) ventilation strategy. Outcome measures Prespecified outcomes included mortality, time to death and time-to-unassisted breathing. We examined the following continuous baseline characteristics as potential effect modifiers using MFPI: PaO2/FiO2 (arterial partial oxygen pressure/ fraction of inspired oxygen), oxygenation index, respiratory system compliance (tidal volume/(inspiratory plateau pressure−PEEP)) and body mass index (BMI). Results We found that for patients with PaO2/FiO2 below 150 mm Hg, but above 100 mm Hg or an oxygenation index above 12 (moderate ARDS), higher PEEP reduces hospital mortality, but the beneficial effect appears to level off for patients with very severe ARDS. Patients with mild ARDS (PaO2/FiO2 above 200 mm Hg or an oxygenation index below 10) do not seem to benefit from higher PEEP and might even be harmed. For patients with a respiratory system compliance above 40 mL/cm H2O or patients with a BMI above 35 kg/m2, we found a trend towards reduced mortality with higher PEEP, but there is very weak statistical confidence in

  5. Mechanical ventilation and sepsis impair protein metabolism in the diaphragm of neonatal pigs

    Science.gov (United States)

    Mechanical ventilation (MV) impairs diaphragmatic function and diminishes the ability to wean from ventilatory support in adult humans. In normal neonatal pigs, animals that are highly anabolic, endotoxin (LPS) infusion induces sepsis, reduces peripheral skeletal muscle protein synthesis rates, but ...

  6. Assessing the influence of mechanical ventilation on blood gases and blood pressure in rattlesnakes

    DEFF Research Database (Denmark)

    Bertelsen, Mads Frost; Buchanan, Rasmus; Jensen, Heidi Meldgaard;

    2014-01-01

    OBJECTIVE: To characterize the impact of mechanical positive pressure ventilation on heart rate (HR), arterial blood pressure, blood gases, lactate, glucose, sodium, potassium and calcium concentrations in rattlesnakes during anesthesia and the subsequent recovery period. STUDY DESIGN: Prospectiv...

  7. MEASUREMENT OF AMMONIA EMISSIONS FROM MECHANICALLY VENTILATED POULTRY HOUSES USING MULTIPATH TUNABLE DIODE LASER SPECTROSCOPY

    Science.gov (United States)

    Ammonia emissions from mechanically ventilated poultry operations are an important environmental concern. Open Path Tunable Diode Laser Absorption Spectroscopy has emerged as a robust real-time method for gas phase measurement of ammonia concentrations in agricultural settings. ...

  8. Respiratory mechanics measured by forced oscillations during mechanical ventilation through a tracheal tube

    International Nuclear Information System (INIS)

    The forced oscillation technique (FOT) allows the measurement of respiratory mechanics in the intensive care setting. The aim of this study was to compare the FOT with a reference method during mechanical ventilation through a tracheal tube. The respiratory impedance spectra were measured by FOT in nine anaesthetized pigs, and resistance and compliance were estimated on the basis of a linear resistance–compliance inertance model. In comparison, resistance and compliance were quantified by the multiple linear regression analysis (LSF) of conventional ventilator waveforms to the equation of motion. The resistance of the sample was found to range from 6 to 21 cmH2O s l−1 and the compliance from 12 to 32 ml cmH2O−1. A Bland–Altman analysis of the resistance resulted in a sufficient agreement (bias −0.4 cmH2O s l−1; standard deviation of differences 1.4 cmH2O s l−1; correlation coefficient 0.93) and test–retest reliability (coefficient of variation of repeated measurements: FOT 2.1%; LSF 1.9%). The compliance, however, was poor in agreement (bias −8 ml cmH2O−1, standard deviation of differences 7 ml cmH2O−1, correlation coefficient 0.74) and repeatability (coefficient of variation: FOT 23%; LSF 1.7%). In conclusion, FOT provides an alternative for monitoring resistance, but not compliance, in tracheally intubated and ventilated subjects

  9. Cerebral Arterial Air Embolism Associated with Mechanical Ventilation and Deep Tracheal Aspiration

    OpenAIRE

    Gursoy, S.; Duger, C.; Kaygusuz, K.; Ozdemir Kol, I.; Gurelik, B.; Mimaroglu, C.

    2012-01-01

    Arterial air embolism associated with pulmonary barotrauma has been considered a rare but a well-known complication of mechanical ventilation. A 65-year-old man, who had subarachnoid hemorrhage with Glasgow coma scale of 8, was admitted to intensive care unit and ventilated with the help of mechanical ventilator. Due to the excessive secretions, deep tracheal aspirations were made frequently. GCS decreased from 8–10 to 4-5, and the patient was reevaluated with cranial CT scan. In CT scan, air...

  10. The Study of Pulmonary Complication of Neonatal Mechanical Ventilation in NICU

    Directory of Open Access Journals (Sweden)

    M.K. Sabzeie

    2016-01-01

    Full Text Available Introduction & Objective: The main indication of mechanical ventilation is in the treatment of neonates with respiratory failure. With the increased use of mechanical ventilation, its complications have increased too. The aim of this study was to evaluate the prevalence of complications and short-term improvement in infants undergoing mechanical ventilation in the neonatal intensive care unit (NICU. Materials & Methods: In this prospective-analytic study, all infants requiring mechanical ventilation and admitted in the neonatal intensive care unit of Fatemiyeh and Be’sat hospitals, have been evaluated for one year (2012. Their data included: neonatal age, sex, gestational age, birth weight, weight at admission, diagnosis, length of hospitalization, disease outcome (improvement-died, need for mechanical ventilation, complications and culture results (blood, endotracheal tube, urine, CSF insert in check list. The data were analysed by SPSS and c2 statistical test. Results: In this study, a total of 114 infants hospitalized in intensive care unit and needed mechanical ventilation was studied of whom 72 were male and 42 were female. The mean of gestational age in the admitted neonates was 32.9 ± 0.85 weeks. The majority of neonates (80.70% were undergoing mechanical ventilation with respiratory distress syndrome (RDS. 67% of neonates were suffering from complications of mechanical ventilation. The prevalent complication was seen in the neonates was narrowing or obstruction of the endotracheal tube (52.63%. 47.37% of infants died and respiratory distress syndrome was the common cause of death in these neonates (46.29%. In our study, there was significant relationship between resuscitation at birth (P=0.002, time required for mechanical ventilation (P=0.0000 and Apgar score (P=0.0000 and complications of mechanical ventilation. Conclusions: The results show that the high prevalence of pulmonary complications is associated with mechanical

  11. Air Distribution Effectiveness for Different MechanicalVentilation Systems

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, Max H.; Walker, Iain S.

    2007-08-01

    The purpose of ventilation is to dilute indoor contaminants that an occupant is exposed to. In a multi-zone environment such as a house, there will be different dilution rates and different source strengths in every zone. Most US homes have central HVAC systems, which tend to mix conditions between zones. Different types of ventilation systems will provide different amounts of dilution depending on the effectiveness of their air distribution systems and the location of sources and occupants. This paper will report on work being done to both model the impact of different systems and measurements using a new multi-tracer measurement system that has the capacity to measure not only the flow of outdoor air to each zone, but zone-to-zone transport. The ultimate objective of this project is to determine the effectiveness of different systems so that appropriate adjustments can be made in residential ventilation standards such as ASHRAE Standard 62.2.

  12. Myocardial perfusion as assessed by thallium-201 scintigraphy during the discontinuation of mechanical ventilation in ventilator-dependent patients

    International Nuclear Information System (INIS)

    Patients who cannot be separated from mechanical ventilation (MV) after an episode of acute respiratory failure often have coexisting coronary artery disease. The authors hypothesized that increased left ventricular (LV) wall stress during periods of spontaneous ventilation (SV) could alter myocardial perfusion in these patients. Using thallium-201 (201TI) myocardial scintigraphy, the authors studied the occurrence of myocardial perfusion abnormalities during periods of SV in 15 MV-dependent patients (nine women, six men; aged 71 ± 7 yr, mean ± SD). Fourteen of these patients were studied once with 201TI myocardial scintigraphy during intermittent mechanical ventilation (IMV) and again on another day, after at least 10 min of SV through a T-piece. One patient was studied during SV only. Thirteen of 14 of the patients (93%) studied during MV had abnormal patterns of initial myocardial 201TI uptake, but only 1 patient demonstrated redistribution of 201TI on delayed images. The remainder of the abnormalities observed during MV were fixed defects. SV produced significant alterations of myocardial 201TI distribution or transient LV dilation, or both, in 7 of the 15 patients (47%). Four patients demonstrated new regional decreases of LV myocardial thallium concentration with redistribution of the isotope on delayed images. The patient studied only during SV also had myocardial 201TI defects with redistribution. Five patients (3 also having areas of 201TI redistribution) had transient LV dilation during SV

  13. Pulmonary function after prolonged mechanical ventilation with high concentrations of oxygen.

    OpenAIRE

    Gillbe, C. E.; Salt, J C; Branthwaite, M A

    1980-01-01

    The mortality and morbidity resulting from mechanical ventilation with high concentrations of inspired oxygen has been investigated in two groups of patients. Ninety-one patients requiring mechanical ventilation for pulmonary disease included six (group 1) in whom death was attributed directly to respiratory failure but only three in whom oxygen toxicity might have been relevant. Review of the clinical and postmortem findings suggests that oxygen was probably not a contributory factor in two ...

  14. Predictors of sleep quality and successful weaning from mechanical ventilation among patients in respiratory care centers

    OpenAIRE

    Chen, C-J; Hsu, L-N; McHugh, G.; Campbell, M.; Tzeng, Y-L

    2015-01-01

    Background: Poor quality of sleep may result in more problems for patients who undergo weaning from mechanical ventilation because it could result in disabled muscle relaxation and affect the function of the respiratory muscles. Few studies have specifically investigated what factors contributed to quality of sleep and weaning outcomes. Purpose: This study investigates the predictors of quality of sleep and successful weaning from mechanical ventilation in patients at respiratory care centers...

  15. Sedation and memories of patients subjected to mechanical ventilation in an intensive care unit

    OpenAIRE

    Jaquilene Barreto da Costa; Sonia Silva Marcon; Claudia Rejane Lima de Macedo; Amaury Cesar Jorge; Péricles Almeida Delfino Duarte

    2014-01-01

    Objective To investigate the relationship between sedation and the memories reported by patients subjected to mechanical ventilation following discharge from the intensive care unit. Methods This prospective, observational, cohort study was conducted with individuals subjected to mechanical ventilation who remained in the intensive care unit for more than 24 hours. Clinical statistics and sedation records were extracted from the participants' clinical records; the data relative to the partici...

  16. Comparison of Invasive and Noninvasive Mechanical Ventilation for Patients with COPD:Randomised Prospective Study

    OpenAIRE

    Ivo Matic; Visnja Majeric-Kogler; Katarina Sakic-Zdravcevic; Matija Jurjevic; Ivan Mirkovic; Zlatko Hrgovic

    2008-01-01

    Acute respiratory failure due to chronic obstructive pulmonary disease presents an increasing problem for both health and economics in the modern world. The goal of this study was to compare invasive and noninvasive mechani-cal ventilation for patients with COPD. A prospective, randomized trial was performed in a multidisciplinary intensive care unit. Of 614 patients requiring mechanical ventilation (MV) longer than 24h, after excluding those who didn′t meet the inclusion criteria, 72 patient...

  17. Non-invasive mechanical ventilation in hematology patients: let's agree on several things first

    OpenAIRE

    Schnell, David; Lemiale, Virginie; Azoulay, Élie

    2012-01-01

    Acute respiratory failure is a dreaded and life-threatening event that represents the main reason for ICU admission. Respiratory events occur in up to 50% of hematology patients, including one-half of those admitted to the ICU. Mortality from acute respiratory failure in hematology patients depends on the patient's general status, acute respiratory failure etiology, need for mechanical ventilation and associated organ dysfunction. Non-invasive mechanical ventilation is clearly beneficial for ...

  18. Impact of Residential Mechanical Ventilation on Energy Cost and Humidity Control

    Energy Technology Data Exchange (ETDEWEB)

    Martin, Eric [Building Science Corporation, Westford, MA (United States)

    2014-01-01

    Optimizing whole house mechanical ventilation as part of the Building Ameerica program's systems engineered approach to constructing housing has been an important subject of the program's research. Ventilation in residential buildings is one component of an effective, comprehensive strategy for creation and maintenance of a comfortable and healthy indoor air environment. The study described in this report is based on building energy modeling with an important focus on the indoor humidity impacts of ventilation. The modeling tools used were EnergyPlus version 7.1 (E+) and EnergyGauge USA (EGUSA). Twelve U.S. cities and five climate zones were represented. A total of 864 simulations (2*2*3*3*12= 864) were run using two building archetypes, two building leakage rates, two building orientations, three ventilation systems, three ventilation rates, and twelve climates.

  19. Assisted Ventilation.

    Science.gov (United States)

    Dries, David J

    2016-01-01

    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. However, this mode continues to provide a monotonous pattern of support for respiration which is normally a dynamic process. Noisy Pressure Support Ventilation where tidal volume is varied randomly by the ventilator may improve ventilation and perfusion matching but the degree of support is still determined by the ventilator. Two more recent modes of ventilation, Proportional Assist Ventilation and Neurally Adjusted Ventilatory Assist (NAVA), allow patient determination of the pattern and depth of ventilation. Proposed advantages of Proportional Assist Ventilation and NAVA include decrease in patient ventilator asynchrony and improved adaptation of ventilator support to changing patient demand. Work of breathing can be normalized with these modes as well. To date, however, a clear pattern of clinical benefit has not been demonstrated. Existing challenges for both of the newer assist modes include monitoring patients with dynamic hyperinflation (auto-positive end expiratory pressure), obstructive lung disease, and air leaks in the ventilator system. NAVA is dependent on consistent transduction of diaphragm activity by an electrode system placed in the esophagus. Longevity of effective support with this technique is unclear. PMID:25501776

  20. Hyperpolarized 3He magnetic resonance imaging ventilation defects in asthma: relationship to airway mechanics.

    Science.gov (United States)

    Leary, Del; Svenningsen, Sarah; Guo, Fumin; Bhatawadekar, Swati; Parraga, Grace; Maksym, Geoffrey N

    2016-04-01

    In patients with asthma, magnetic resonance imaging (MRI) provides direct measurements of regional ventilation heterogeneity, the etiology of which is not well-understood, nor is the relationship of ventilation abnormalities with lung mechanics. In addition, respiratory resistance and reactance are often abnormal in asthmatics and the frequency dependence of respiratory resistance is thought to reflect ventilation heterogeneity. We acquiredMRIventilation defect maps, forced expiratory volume in one-second (FEV1), and airways resistance (Raw) measurements, and used a computational airway model to explore the relationship of ventilation defect percent (VDP) with simulated measurements of respiratory system resistance (Rrs) and reactance (Xrs).MRIventilation defect maps were experimentally acquired in 25 asthmatics before, during, and after methacholine challenge and these were nonrigidly coregistered to the airway tree model. Using the model coregistered to ventilation defect maps, we narrowed proximal (9th) and distal (14th) generation airways that were spatially related to theMRIventilation defects. The relationships forVDPwith Raw measured using plethysmography (r = 0.79), and model predictions of Rrs>14(r = 0.91,P 9(r = 0.88,P mechanics measurements were different (P mechanics and ventilation defects, impedance predictions were made using a computational airway tree model with simulated constriction of airways related to ventilation defects measured in mild-moderate asthmatics.

  1. Veno-venous extracorporeal CO2 removal improves pulmonary hemodynamics in a porcine ARDS model

    OpenAIRE

    Morimont, Philippe; GUIOT, Julien; Desaive, Thomas; Tchana-Sato, Vincent; Janssen, Nathalie; CAGNINA, A; HELLA, Dominique; Blaffart, Francine; Defraigne, Jean-Olivier; Lambermont, Bernard

    2015-01-01

    BACKGROUND: Protective lung ventilation is recommended in patients with acute respiratory distress syndrome (ARDS) to minimize additional injuries to the lung. However, hypercapnic acidosis resulting from ventilation at lower tidal volume enhances pulmonary hypertension and might induce right ventricular (RV) failure. We investigated if extracorporeal veno-venous CO2 removal therapy could have beneficial effects on pulmonary circulation and RV function. METHODS: This study was per...

  2. Infiltration Effects on Residential Pollutant Concentrations for Continuous and Intermittent Mechanical Ventilation Approaches

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, Max; Logue, Jennifer; Singer, Brett

    2010-06-01

    The prevailing residential ventilation standard in North America, American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Standard 62.2, specifies volumetric airflow requirements as a function of the overall size of the home and the number of bedrooms, assumes a fixed, minimal amount of infiltration, and requires mechanical ventilation to achieve the remainder. The standard allows for infiltration credits and intermittent ventilation patterns that can be shown to provide comparable performance. Whole-house ventilation methods have a substantial effect on time-varying indoor pollutant concentrations. If alternatives specified by Standard 62.2, such as intermittent ventilation, are used, short-term pollutant concentrations could exceed acute health standards even if chronic health standards are met.The authors present a methodology for comparing ASHRAE- and non-ASHRAE-specified ventilation scenarios on relative indoor pollutant concentrations. We use numerical modeling to compare the maximum time-averaged concentrations for acute exposure relevant (1-hour, 8-hour, 24-hour ) and chronic exposure relevant (1-year) time periods for four different ventilation scenarios in six climates with a range of normalized leakage values. The results suggest that long-term concentrations are the most important metric for assessing the effectiveness of whole-house ventilation systems in meeting exposure standards and that, if chronic health exposure standards are met, acute standards will also be met.

  3. Measured Air Distribution Effectiveness for Residential Mechanical Ventilation Systems

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, Max; Sherman, Max H.; Walker, Iain S.

    2008-05-01

    The purpose of ventilation is dilute or remove indoor contaminants that an occupant is exposed to. In a multi-zone environment such as a house, there will be different dilution rates and different source strengths in every zone. Most US homes have central HVAC systems, which tend to mix the air thus the indoor conditions between zones. Different types of ventilation systems will provide different amounts of exposure depending on the effectiveness of their air distribution systems and the location of sources and occupants. This paper will report on field measurements using a unique multi-tracer measurement system that has the capacity to measure not only the flow of outdoor air to each zone, but zone-to-zone transport. The paper will derive seven different metrics for the evaluation of air distribution. Measured data from two homes with different levels of natural infiltration will be used to evaluate these metrics for three different ASHRAE Standard 62.2 compliant ventilation systems. Such information can be used to determine the effectiveness of different systems so that appropriate adjustments can be made in residential ventilation standards such as ASHRAE Standard 62.2.

  4. Mechanical ventilation with heat recovery in cold climates

    DEFF Research Database (Denmark)

    Kragh, Jesper; Rose, Jørgen; Svendsen, Svend

    2005-01-01

    like the Northern Europe or in arctic climate like in Greenland or Alaska these ventilation systems will typically face problems with ice formation in the heat exchanger. When the warm humid room air comes in contact with the cold surfaces inside the exchanger (cooled by the outside air), the moisture...

  5. Experimental Assessment of Mechanical Night Ventilation on Inner Wall Surfaces

    DEFF Research Database (Denmark)

    Wenhui, Ji; Heiselberg, Per Kvols; Wang, Houhua;

    2016-01-01

    The cooling potential of night ventilation largely depends on the heat exchange at the internal room surfaces. During night time, increased heat transfer on a vertical wall is expected due to cool supply air that flows along the internal wall surface from the top of the wall. This paper presents ...

  6. Non-invasive versus invasive mechanical ventilation for respiratory failure in severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    Loretta YC Yam; Alfred YF Chan; Thomas MT Cheung; Eva LH Tsui; Jane CK Chan; Vivian CW Wong

    2005-01-01

    Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support. We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease. Methods Retrospective analysis was conducted on all respiratory failure patients identified from the Hong Kong Hospital Authority Severe Acute Respiratory Syndrome Database. Intubation rate, mortality and secondary outcome of a hospital utilizing non-invasive ventilation under standard infection control conditions (NIV Hospital) were compared against 13 hospitals using solely invasive ventilation (IMV Hospitals). Multiple logistic regression analyses with adjustments for confounding variables were performed to test for association between outcomes and hospital groups. Results Both hospital groups had comparable demographics and clinical profiles, but NIV Hospital (42 patients) had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement. Compared to IMV Hospitals (451 patients), NIV Hospital had lower adjusted odds ratios for intubation (0.36, 95% CI 0.164-0.791, P=0.011) and death (0.235, 95% CI 0.077-0.716, P=0.011), and improved earlier after pulsed steroid rescue. There were no instances of transmission of severe acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation, non-invasive ventilation as initial ventilatory support for acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated with reduced intubation need and mortality.

  7. Acute respiratory distress syndrome (ARDS): HRCT findings in survivors

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jung Im; Park, Seog Hee; Lee, Jae Mun; Song, Jeong Sup; Lee, Kyo Young [The Catholic Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-08-01

    The purpose of this report is to describe the high-resolution computed tomography (HRCT) findings of the lung in survivors of acute respiratory distress syndrome (ARDS). Among eleven patients who survived ARDS for one year, chest radiography and HRCT revealed pulmonary fibrosis in four. Causes of ARDS included pneumonia during pregnancy, near drowning, pneumonia during liver cirrhosis, and postoperative sepsis. Thoracoscopic biopsy and histopathologic correlation were available in one patient. HRCT showed diffuse interlobular septal thickening, ground glass opacity, parenchymal distortion, and traction bronchiectasis. Fuzzy centrilobular nodules were seen in two patients and one patient had multiple, large bullae in the left hemithorax. In all patients, lesions affected the upper and anterior zones of the lung more prominently. The distribution of pulmonary fibrosis was characteristic and reflected the pathogenesis of lung injury; fibrosis was largely due to hyperoxia caused by ventilator care. In one patient, histopathologic correlation showed that imaging findings were accounted for by thickening of the alveolar septum along with infiltration of chronic inflammatory cells and fibrosis. Fuzzy centrilobular nodules corresponded with bronchiolitis.

  8. Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Emília Nozawa

    2003-03-01

    Full Text Available OBJECTIVE: To analyze parameters of respiratory system mechanics and oxygenation and cardiovascular alterations involved in weaning tracheostomized patients from long-term mechanical ventilation after cardiac surgery. METHODS: We studied 45 patients in their postoperative period of cardiac surgery, who required long-term mechanical ventilation for more than 10 days and had to undergo tracheostomy due to unsuccessful weaning from mechanical ventilation. The parameters of respiratory system mechanics, oxigenation and the following factors were analyzed: type of surgical procedure, presence of cardiac dysfunction, time of extracorporeal circulation, and presence of neurologic lesions. RESULTS: Of the 45 patients studied, successful weaning from mechanical ventilation was achieved in 22 patients, while the procedure was unsuccessful in 23 patients. No statistically significant difference was observed between the groups in regard to static pulmonary compliance (p=0.23, airway resistance (p=0.21, and the dead space/tidal volume ratio (p=0.54. No difference was also observed in regard to the variables PaO2/FiO2 ratio (p=0.86, rapid and superficial respiration index (p=0.48, and carbon dioxide arterial pressure (p=0.86. Cardiac dysfunction and time of extracorporeal circulation showed a significant difference. CONCLUSION: Data on respiratory system mechanics and oxygenation were not parameters for assessing the success or failure. Cardiac dysfunction and time of cardiopulmonary bypass, however, significantly interfered with the success in weaning patients from mechanical ventilation.

  9. Clinical efficacy of nitroglycerin in patients with septic shock with ARDS

    Directory of Open Access Journals (Sweden)

    Li-ping LIU

    2015-10-01

    Full Text Available Objective To evaluate the clinical efficacy of nitroglycerin in patients with septic shock with ARDS, and explore its possible mechanism. Methods From January 2013 to January 2014, patients with septic shock with ARDS were included in the study in the department of critical care medicine in our hospital. Patients who met the criteria were randomly divided into the control group and the nitroglycerin group. The standard treatment was given in control group, and nitroglycerin 0.5-1.0mg/h was given in nitroglycerin group on basis of standard treatment. Monitoring indexes were recorded at 0, 6, 24 and 72h, including general condition, APACHE Ⅱ score, hemodynamic indexes (HR, MAP, CVP, CI, SVRI, PAWP, PAP, Lac, volume of fluid resuscitation, quantity of vasopressor drugs, ventilator condition (PH, PO2, PCO2, RR, PEEP, VT, FiO2, oxygenation index, airway resistance, lung compliance, mechanical ventilation time, ICU stay time, hospital follow-up, 28-day follow-up, immune index (CD4+/CD8+, inflammatory markers (CRP, PCT, IL-6, WBC. Results Forty-three patients were included in this study, with 21 in control group and 22 in nitroglycerin group. At 24 and 72h after the treatment, APACHEⅡ score, heart rate, pulmonary artery pressure (PAP, lactic acid and dopamine, norepinephrine, respiratory rate (RR, inspired oxygen concentration (FiO2, airway resistance, C reactive protein (CRP, procalcitonin (PCT, interleukin-6 (IL-6, white blood cell count (WBC significantly decreased as compared with those at 0 and 6 h, and these parameters in nitroglycerin group were lower than these in the control group at the 72h (P<0.05; at the same time, those indexes such as peripheral vascular resistance index (SVRI, pH value, arterial partial pressure of oxygen (PaO2, tidal volume (VT, lung compliance, oxygenation index, CD4+/CD8+ more significantly increased in the treatment group at 24 and 72h than those at 0 and 6h, especially at 72h, and these values were

  10. Plasma biomarker analysis in pediatric ARDS: generating future framework from a pilot randomized control trial of methylprednisoloneA framework for identifying plasma biomarkers related to clinical outcomes in pediatric ARDS

    Directory of Open Access Journals (Sweden)

    Dai eKimura

    2016-03-01

    Full Text Available Objective: Lung injury activates multiple pro-inflammatory pathways, including neutrophils, epithelial and endothelial injury, and coagulation factors leading to acute respiratory distress syndrome (ARDS. Low-dose methylprednisolone therapy (MPT improved oxygenation and ventilation in early pediatric ARDS without altering duration of mechanical ventilation or mortality. We evaluated the effects of MPT on biomarkers of endothelial (Ang-2, sICAM-1 or epithelial (sRAGE injury, neutrophil activation (MMP-8, and coagulation (PAI-1. Design: Double-blind, placebo-controlled randomized trialSetting: Tertiary-care Pediatric Intensive Care Unit Patients: Mechanically ventilated children (0-18 years with early ARDS.Interventions: Blood samples were collected on Days 0 (before MPT, 7, and 14 during low-dose MPT (n=17 vs. placebo (n=18 therapy. The MPT group received a 2mg/kg loading dose followed by 1mg/kg/day continuous infusions from days 1-7, tapered off over 7 days; placebo group received equivalent amounts of 0.9% saline. We analyzed plasma samples using a multiplex assay for 5 biomarkers of ARDS. Multiple regression models were constructed to predict associations between changes in biomarkers and the clinical outcomes reported earlier including: P/F ratio on days 8&9, plateau pressure on days 1&2, PaCO2 on days 2&3, racemic epinephrine following extubation, and supplemental oxygen at ICU discharge.Results: No differences occurred in biomarker concentrations between the groups on Day 0. On Day 7, reduction in MMP-8 levels (p=0.0016 occurred in the MPT group, whereas increases in sICAM-1 levels (p=0.0005 occurred in the placebo group (no increases in sICAM-1 in the MPT group. sRAGE levels decreased in both MPT and placebo groups (p<0.0001 from Day 0 to Day 7. On Day 7, sRAGE levels were positively correlated with MPT group PaO2/FiO2 ratios on Day 8 (r=0.93, p=0.024. O2 requirements at ICU transfer positively correlated with Day 7 MMP-8 (r=0.85, p=0

  11. Very Low Birth Weight Infant Necessitating Nissen Fundoplication for Weaning off the Mechanical Ventilator

    Directory of Open Access Journals (Sweden)

    İpek Güney Varal

    2014-05-01

    Full Text Available Gastro-esophageal reflux (GER is one of the common problems of neonatal intensive care units. Although this condition does not always need to be treated, it occasionally causes clinically serious consequences. Initial management is medical; however, in some cases surgery might be required. A premature neonate with birth weight of 1370 grams was managed in our ICU. The patient was mechanical ventilator dependent due to GER. The patient needed Nissen fundoplication for successfully weaning off the ventilator.

  12. Radon mitigation with mechanical supply and exhaust ventilation adjusted by a pressure control unit

    International Nuclear Information System (INIS)

    Effective ventilation and positive or low negative pressure indoors are suggested to low indoor radon levels. The aim of this study is to develop and to test an equipment, which makes it possible to achieve simultaneously effective ventilation and minimum outdoor-pressure difference. The unit includes mechanical supply and exhaust air fans, a exchanger and a pressure control unit in direct digital control (DDC), which adjusts continuously air exchange based on the pressure difference transmitter information. (orig.). (8 refs., 6 figs.)

  13. Management of critically ill patients receiving noninvasive and invasive mechanical ventilation in the emergency department

    OpenAIRE

    Rose, Louise

    2012-01-01

    Louise RoseLawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, CanadaAbstract: Patients requiring noninvasive and invasive ventilation frequently present to emergency departments, and may remain for prolonged periods due to constrained critical care services. Emergency clinicians often do not receive the same education on management of mechanical ventilation or have similar exposure to these patients as do their critical care colleagues. The aim of this review wa...

  14. Anticipation of distress after discontinuation of mechanical ventilation in the ICU at the end of life

    OpenAIRE

    Kompanje, Erwin; Hoven, Ben; Bakker, Jan

    2008-01-01

    textabstractBackground: A considerable number of patients admitted to the intensive care unit (ICU) die following withdrawal of mechanical ventilation. After discontinuation of ventilation without proper preparation, excessive respiratory secretion is common, resulting in a 'death rattle'. Post-extubation stridor can give rise to the relatives' perception that the patient is choking and suffering. Existing protocols lack adequate anticipatory preparation to respond to all distressing symptoms...

  15. Altered diaphragmatic contractile properties after high airway pressure controlled mechanical ventilation

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Acute respiratory failure is the most frequent indication for the application of mechanical ventilation. 1 As commonly used in clinical settings, lung protective strategies and recruitment manoeuvres are applications of higher than normal airway pressure to open the collapsed alveoli and prevent lung atelectasis caused by minimal vital ventilation. Under those conditions, we pay more attention to the lung injury and circulatory failure, and less attention to the diaphragmatic structure and function.

  16. Mechanical Ventilator for Delivery of 17O2 in Brief Pulses

    OpenAIRE

    Baumgardner, J.E; Mellon, E.A; Tailor, D.R; Mallikarjunarao, K; Borthakur, A.; Reddy, R

    2008-01-01

    The 17O nucleus has been used recently by several groups for magnetic resonance (MR) imaging of cerebral metabolism. Inhalational delivery of 17O2 in very brief pulses could, in theory, have significant advantages for determination of the cerebral metabolic rate for oxygen (CMRO2) with MR imaging. Mechanical ventilators, however, are not typically capable of creating step changes in gas concentration at the airway. We designed a ventilator for large animal and human studies that provides mech...

  17. Brazilian recommendations of mechanical ventilation 2013. Part I

    OpenAIRE

    Barbas, Carmen Sílvia Valente; Ísola, Alexandre Marini; Farias, Augusto Manoel de Carvalho; Cavalcanti, Alexandre Biasi; Gama, Ana Maria Casati; Duarte, Antonio Carlos Magalhães; Vianna, Arthur; Serpa, Ary; Bravim, Bruno de Arruda; Pinheiro, Bruno do Valle; Mazza, Bruno Franco; Carvalho, Carlos Roberto Ribeiro; Toufen, Carlos; David, Cid Marcos Nascimento; Taniguchi, Corine

    2014-01-01

    Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented b...

  18. Brazilian recommendations of mechanical ventilation 2013. Part 2

    OpenAIRE

    Barbas, Carmen Sílvia Valente; Ísola, Alexandre Marini; Farias, Augusto Manoel de Carvalho; Cavalcanti, Alexandre Biasi; Gama, Ana Maria Casati; Duarte, Antonio Carlos Magalhães; Vianna, Arthur; Serpa Neto, Ary; Bravim, Bruno de Arruda; Pinheiro, Bruno do Valle; Mazza, Bruno Franco; Carvalho, Carlos Roberto Ribeiro; Toufen Júnior, Carlos; David, Cid Marcos Nascimento; Taniguchi, Corine

    2014-01-01

    Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented b...

  19. Non-invasive mechanic ventilation in treating acute respiratory failure

    OpenAIRE

    Federico Lari; Novella Scandellari; Ferdinando De Maria; Virna Zecchi; Gianpaolo Bragagni; Fabrizio Giostra; Nicola DiBattista

    2009-01-01

    Non invasive ventilation (NIV) in acute respiratory failure (ARF) improve clinical parameters, arterial blood gases, decrease mortality and endo tracheal intubation (ETI) rate also outside the intensive care units (ICUs). Objective of this study is to verify applicability of NIV in a general non respiratory medical ward. We enrolled 68 consecutive patients (Pts) with Hypoxemic or Hyper capnic ARF: acute cardiogenic pulmonary edema (ACPE), exacerbation of chronic obstructive pulmonary disease ...

  20. [Noninvasive mechanical ventilation in patients with stable severe COPD].

    Science.gov (United States)

    Schucher, B; Zerbst, J; Baumann, H J

    2004-06-01

    Noninvasive positive pressure ventilation in patients with stable chronic obstructive pulmonary disease. The role of non-invasive positive pressure ventilation (NIPPV) is well documented in patients with restrictive thoracic diseases like kyphoscoliosis, tuberculosis sequelae or neuromuscular disease. There is also a good evidence for the use of NIPPV in acute respiratory failure in patients with an exacerbation of COPD. The application of NIPPV in patients with chronic respiratory failure is growing, but there is less evidence than in restrictive disorders. NIPPV can unload the respiratory muscles in patients with chronic hypercapnic COPD and so alleviates fatigue of the respiratory pump, but improvement in the maximal inspiratory pressure (Pi (max)) is small or even absent. An improvement of sleep quality has also postulated, there was an increase in total sleep time and sleep effectiveness when using higher inspiratory pressure. An increase of the walking distance was shown in short term studies, only. In most studies, there was an increase in quality of life as a main topic. Mortality was unchanged in the two long-term randomised controlled studies. Current data suggest a possible role of NIPPV in patients with severe hypercapnia. A high effective inspiratory pressure and a ventilator mode with a significant reduction in the work of breathing should be choosen. NIPPV should be started in hospital, a close reassessment must be performed. Patients who accepted NIPPV in the first weeks had a good compliance for long-term use. PMID:15216436

  1. Clinical predictors of mechanical ventilation in Guillain-Barré syndrome

    Directory of Open Access Journals (Sweden)

    Birinder S Paul

    2012-01-01

    Full Text Available Background: Patients with Guillain-Barré syndrome (GBS require assisted ventilation frequently. However, no single factor can predict ventilator requirement. Aims: To identify clinical variables which could predict the need for mechanical ventilation in GBS. Settings and Design: Tertiary hospital-based retrospective and prospective study. Materials and Methods: One hundred and thirty-eight GBS patients studied were divided into two groups ventilated (Group 1 and non-ventilated (Group 2. Parameters assessed included age, gender, associated illness(es, antecedent events, first symptom at onset, time from onset to bulbar involvement, confinement to bed and peak disability, upper limb power and reflexes at nadir, presence of facial weakness, neck muscle weakness and autonomic dysfunction. Statistical Analysis: Multivariate predictors of ventilation were assessed using logistic regression analysis. Results: There were 53 patients in Group 1 and 85 in Group 2. The mean age in the two groups was comparable. On bivariate analysis, simultaneous weakness of upper (UL and lower (LL limbs as the initial symptom (P<0.001; UL power less than Grade 3/5 at nadir (P<0.001; presence of neck and bulbar weakness (P<0.001; shorter duration from onset to bulbar weakness and confinement to bed (P=0.001 and bilateral facial involvement (P<0.01 were more frequently associated with the need for ventilation. Preserved reflexes in UL at nadir was significantly associated with absence of the need for mechanical ventilation (P<0.01. On multivariate analysis, factors independently associated with the need for mechanical ventilation included simultaneous motor weakness in UL and LL as the initial symptom (P=0.02, UL power<3/5 (Medical Research Council grade at nadir (P=0.013 and presence of bulbar weakness (P<0.001. Preserved reflexes in the UL at nadir was independently associated with a lesser need for ventilation (P=0.001. Conclusions: Comprehensive assessment of clinical

  2. The rapid shallow breathing index as a predictor of successful mechanical ventilation weaning: clinical utility when calculated from ventilator data

    Science.gov (United States)

    de Souza, Leonardo Cordeiro; Lugon, Jocemir Ronaldo

    2015-01-01

    ABSTRACT OBJECTIVE: The use of the rapid shallow breathing index (RSBI) is recommended in ICUs, where it is used as a predictor of mechanical ventilation (MV) weaning success. The aim of this study was to compare the performance of the RSBI calculated by the traditional method (described in 1991) with that of the RSBI calculated directly from MV parameters. METHODS: This was a prospective observational study involving patients who had been on MV for more than 24 h and were candidates for weaning. The RSBI was obtained by the same examiner using the two different methods (employing a spirometer and the parameters from the ventilator display) at random. In comparing the values obtained with the two methods, we used the Mann-Whitney test, Pearson's linear correlation test, and Bland-Altman plots. The performance of the methods was compared by evaluation of the areas under the ROC curves. RESULTS: Of the 109 selected patients (60 males; mean age, 62 ± 20 years), 65 were successfully weaned, and 36 died. There were statistically significant differences between the two methods for respiratory rate, tidal volume, and RSBI (p < 0.001 for all). However, when the two methods were compared, the concordance and the intra-observer variation coefficient were 0.94 (0.92-0.96) and 11.16%, respectively. The area under the ROC curve was similar for both methods (0.81 ± 0.04 vs. 0.82 ± 0.04; p = 0.935), which is relevant in the context of this study. CONCLUSIONS: The satisfactory performance of the RSBI as a predictor of weaning success, regardless of the method employed, demonstrates the utility of the method using the mechanical ventilator. PMID:26785962

  3. Open lung concept in high risk anaesthesia : Optimizing mechanical ventilation in morbidly obese patients and during one lung ventilation with capnothorax

    OpenAIRE

    Reinius, Henrik

    2016-01-01

    Formation of atelectasis, defined as reversible collapse of aerated lung, often occurs after induction of anaesthesia with mechanical ventilation. As a consequence, there is a risk for hypoxemia, altered hemodynamics and impaired respiratory system mechanics. In certain situations, the risk for atelectasis formation is increased and its consequences may also be more difficult to manage. Anesthesia for bariatric surgery in morbidly obese patients and surgery requiring one-lung ventilation (OLV...

  4. Assessment of Indoor Air Quality Benefits and Energy Costs of Mechanical Ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Logue, J.M.; Price, P.N.; Sherman, M.H.; Singer, B.C.

    2011-07-01

    Intake of chemical air pollutants in residences represents an important and substantial health hazard. Sealing homes to reduce air infiltration can save space conditioning energy, but can also increase indoor pollutant concentrations. Mechanical ventilation ensures a minimum amount of outdoor airflow that helps reduce concentrations of indoor emitted pollutants while requiring some energy for fan(s) and thermal conditioning of the added airflow. This work demonstrates a physics based, data driven modeling framework for comparing the costs and benefits of whole-house mechanical ventilation and applied the framework to new California homes. The results indicate that, on a population basis, the health benefits from reduced exposure to indoor pollutants in New California homes are worth the energy costs of adding mechanical ventilation as specified by ASHRAE Standard 62.2.This study determines the health burden for a subset of pollutants in indoor air and the costs and benefits of ASHRAE's mechanical ventilation standard (62.2) for new California homes. Results indicate that, on a population basis, the health benefits of new home mechanical ventilation justify the energy costs.

  5. Pulmonary blood flow distribution in sheep: effects of anesthesia, mechanical ventilation, and change in posture

    Science.gov (United States)

    Walther, S. M.; Domino, K. B.; Glenny, R. W.; Hlastala, M. P.

    1997-01-01

    BACKGROUND: Recent studies providing high-resolution images of pulmonary perfusion have questioned the classical zone model of pulmonary perfusion. Hence the present work was undertaken to provide detailed maps of regional pulmonary perfusion to examine the influence of anesthesia, mechanical ventilation, and posture. METHODS: Pulmonary perfusion was analyzed with intravenous fluorescent microspheres (15 microm) in six sheep studied in four conditions: prone and awake, prone with pentobarbital-anesthesia and breathing spontaneously, prone with anesthesia and mechanical ventilation, and supine with anesthesia and mechanical ventilation. Lungs were air dried at total lung capacity and sectioned into approximately 1,100 pieces (about 2 cm3) per animal. The pieces were weighed and assigned spatial coordinates. Fluorescence was read on a spectrophotometer, and signals were corrected for piece weight and normalized to mean flow. Pulmonary blood flow heterogeneity was assessed using the coefficient of variation of flow data. RESULTS: Pentobarbital anesthesia and mechanical ventilation did not influence perfusion heterogeneity, but heterogeneity increased when the animals were in the supine posture (P mechanical ventilation on pulmonary perfusion heterogeneity is small compared with the effect of changes in posture. Analysis of flow gradients indicate that gravity plays a small role in determining pulmonary blood flow distribution.

  6. Pulmonary blood flow distribution in sheep: effects of anesthesia, mechanical ventilation, and change in posture

    Science.gov (United States)

    Walther, S. M.; Domino, K. B.; Glenny, R. W.; Hlastala, M. P.

    1997-01-01

    BACKGROUND: Recent studies providing high-resolution images of pulmonary perfusion have questioned the classical zone model of pulmonary perfusion. Hence the present work was undertaken to provide detailed maps of regional pulmonary perfusion to examine the influence of anesthesia, mechanical ventilation, and posture. METHODS: Pulmonary perfusion was analyzed with intravenous fluorescent microspheres (15 microm) in six sheep studied in four conditions: prone and awake, prone with pentobarbital-anesthesia and breathing spontaneously, prone with anesthesia and mechanical ventilation, and supine with anesthesia and mechanical ventilation. Lungs were air dried at total lung capacity and sectioned into approximately 1,100 pieces (about 2 cm3) per animal. The pieces were weighed and assigned spatial coordinates. Fluorescence was read on a spectrophotometer, and signals were corrected for piece weight and normalized to mean flow. Pulmonary blood flow heterogeneity was assessed using the coefficient of variation of flow data. RESULTS: Pentobarbital anesthesia and mechanical ventilation did not influence perfusion heterogeneity, but heterogeneity increased when the animals were in the supine posture (P Pulmonary perfusion was distributed with a hilar-to-peripheral gradient in animals breathing spontaneously (P mechanical ventilation on pulmonary perfusion heterogeneity is small compared with the effect of changes in posture. Analysis of flow gradients indicate that gravity plays a small role in determining pulmonary blood flow distribution.

  7. Effect of noninvasive positive pressure ventilation on weaning success in patients receiving invasive mechanical ventilation: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    ZHU Fen; LIU Zi-long; LONG Xuan; WU Xiao-dan; ZHOU Jing; BAI Chun-xue; LI Shan-qun

    2013-01-01

    Background Noninvasive positive pressure ventilation (NIPPV) has been proposed to shorten the duration of mechanical ventilation in intubated patients,especially those who fail initial weaning from invasive mechanical ventilation (IMV).However,there are also some discrepancies in terms of weaning success or failure,incidence of re-intubation,complications observed during study and patient outcomes.The primary objective of this update was to specifically investigate the role of NIPPV on facilitating weaning and avoiding re-intubation in patients intubated for different etiologies of acute respiratory failure,by comparing with conventional invasive weaning approach.Methods We searched randomized controlled trials (RCTs) comparing noninvasive weaning of early extubation and immediate application of NIPPV with invasive weaning in intubated patients from PubMed,Embase,Cochrane Central Register of Controlled Trials,Web of Knowledge and Springerlink databases.Records from conference proceedings and reference lists of relevant studies were also identified.Results A total of 11 RCTs with 623 patients were available for the present analysis.Compared with IMV,NIPPV significantly increased weaning success rates (odds ratio (OR):2.50,95% confidence interval (C/):1.46-4.30,P=0.0009),decreased mortality (OR:0.39,95% CI:0.20-0.75,P=0.005),and reduced the incidence of ventilator associated pneumonia (VAP) (OR:0.17,95% CI:0.08-0.37,P <0.00001) and complications (OR:0.22,95% CI:0.07-0.72,P=0.01).However,effect of NIPPV on re-intubation did not reach statistical difference (OR:0.61,95% CI:0.33-1.11,P=0.11).Conclusions Early extubation and immediate application of NIPPV is superior to conventional invasive weaning approach in increasing weaning success rates,decreasing the risk of mortality and reducing the incidence of VAP and complications,in patients who need weaning from IMV.However,it should be applied with caution,as there is insufficient beneficial evidence to

  8. Lung distortion during high-pressure mechanical ventilation

    International Nuclear Information System (INIS)

    The authors studied high pressure ventilation (HPV) as a potential cause of lung damage in patients with acute respiratory failure (ARF) due to severe abdominal distension. Radiographic signs of hyperinflationary intercostal lung distortion developed in 14 patients when mean peak inspiratory/end-expiratory pressures increased from 32.8/6.2 to 50.7/12.4 cm H/sub 2/O, resolved when pressures fell to predistortion levels (n = 9), and were attenuated in regions of pleural/lung disease (n = 4). The authors attribute transient distortion to the partition of disparate compliances of the lung and chest wall, not to ''air-trapping.''

  9. Non invasive monitoring in mechanically ventilated pediatric patients.

    Science.gov (United States)

    Al-Subu, Awni M; Rehder, Kyle J; Cheifetz, Ira M; Turner, David A

    2014-12-01

    Cardiopulmonary monitoring is a key component in the evaluation and management of critically ill patients. Clinicians typically rely on a combination of invasive and non-invasive monitoring to assess cardiac output and adequacy of ventilation. Recent technological advances have led to the introduction: of continuous non-invasive monitors that allow for data to be obtained at the bedside of critically ill patients. These advances help to identify hemodynamic changes and allow for interventions before complications occur. In this manuscript, we highlight several important methods of non-invasive cardiopulmonary monitoring, including capnography, transcutaneous monitoring, pulse oximetry, and near infrared spectroscopy. PMID:25119483

  10. Nebulised heparin is associated with fewer days of mechanical ventilation in critically ill patients: a randomised controlled trial

    OpenAIRE

    Dixon, B; Schultz, M.J; Smith, R.; Fink, J.B.; Santamaria, J.D.; Campbell, D J

    2010-01-01

    INTRODUCTION: Prolonged mechanical ventilation has the potential to aggravate or initiate pulmonary inflammation and cause lung damage through fibrin deposition. Heparin may reduce pulmonary inflammation and fibrin deposition. We therefore assessed whether nebulised heparin improved lung function in patients expected to require prolonged mechanical ventilation. METHODS: Fifty patients expected to require mechanical ventilation for more than 48 hours were enrolled in a double-blind randomised ...

  11. Nebulized heparin is associated with fewer days of mechanical ventilation in critically ill patients: a randomized controlled trial

    OpenAIRE

    Dixon, Barry; Schultz, Marcus J.; Smith, Roger; Fink, James B.; Santamaria, John D; Duncan J Campbell

    2010-01-01

    Introduction Prolonged mechanical ventilation has the potential to aggravate or initiate pulmonary inflammation and cause lung damage through fibrin deposition. Heparin may reduce pulmonary inflammation and fibrin deposition. We therefore assessed whether nebulized heparin improved lung function in patients expected to require prolonged mechanical ventilation. Methods Fifty patients expected to require mechanical ventilation for more than 48 hours were enrolled in a double-blind randomized pl...

  12. Comparison of INSURE method with conventional mechanical ventilation after surfactant administration in preterm infants with respiratory distress syndrome: therapeutic challenge.

    OpenAIRE

    Fatemeh Sadat Nayeri; Tahereh Esmaeilnia Shirvani; Majid Aminnezhad; Elaheh Amini; Hossein Dalili; Faezeh Moghimpour Bijani

    2014-01-01

    Administration of endotracheal surfactant is potentially the main treatment for neonates suffering from RDS (Respiratory Distress Syndrome), which is followed by mechanical ventilation. Late and severe complications may develop as a consequence of using mechanical ventilation. In this study, conventional methods for treatment of RDS are compared with surfactant administration, use of mechanical ventilation for a brief period and NCPAP (Nasal Continuous Positive Airway Pressure), (INSURE metho...

  13. Non-invasive mechanical ventilation and mortality in elderly immunocompromised patients hospitalized with pneumonia: a retrospective cohort study

    OpenAIRE

    Johnson, Christopher S; Frei, Christopher R; Metersky, Mark L.; Anzueto, Antonio R.; Mortensen, Eric M

    2014-01-01

    Background Mortality after pneumonia in immunocompromised patients is higher than for immunocompetent patients. The use of non-invasive mechanical ventilation for patients with severe pneumonia may provide beneficial outcomes while circumventing potential complications associated with invasive mechanical ventilation. The aim of our study was to determine if the use of non-invasive mechanical ventilation in elderly immunocompromised patients with pneumonia is associated with higher all-cause m...

  14. Clinical observation on effects of high frequency oscillating ventilation on patients with early acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Zhi-gang ZHANG

    2013-01-01

    Full Text Available Objective  To investigate the effect of high frequency oscillating ventilation (HFOV on patients with early acute respiratory distress syndrome (ARDS and its mechanism. Methods  Through self controlled study, in 25 patients who met criteria of ARDS, their PaO2/FiO2, Paw, arterial blood pH, PaCO2, Cst, cadiac index (CI, heart rate (HR, central venous pressure (CVP, percentage pulmonary shunt (QS/QT, oxygen index (OI and incidence rate of ventilator associated lung injury (VALI, ventilator associated pneumonia (VAP were recorded 1, 3, 5 days before and after HFOV. Results  Five days later, X ray examination showed that all of the patients got better. Seven days later, 3 patients died because of original diseases, but their symptoms of ARDS improved. Three days after HFOV treatment, the value of PaO2/FiO2 (172.5±69.8 and Cst (63.4±10.5 increased compared with baseline (95.5±29.5, 31.5±4.5, P0.05. Conclusion  HFOV can improve oxygenation index and pulmonary complications of patients with early ARDS.

  15. Effect of regional lung inflation on ventilation heterogeneity at different length scales during mechanical ventilation of normal sheep lungs.

    Science.gov (United States)

    Wellman, Tyler J; Winkler, Tilo; Costa, Eduardo L V; Musch, Guido; Harris, R Scott; Venegas, Jose G; Vidal Melo, Marcos F

    2012-09-01

    Heterogeneous, small-airway diameters and alveolar derecruitment in poorly aerated regions of normal lungs could produce ventilation heterogeneity at those anatomic levels. We modeled the washout kinetics of (13)NN with positron emission tomography to examine how specific ventilation (sV) heterogeneity at different length scales is influenced by lung aeration. Three groups of anesthetized, supine sheep were studied: high tidal volume (Vt; 18.4 ± 4.2 ml/kg) and zero end-expiratory pressure (ZEEP) (n = 6); low Vt (9.2 ± 1.0 ml/kg) and ZEEP (n = 6); and low Vt (8.2 ± 0.2 ml/kg) and positive end-expiratory pressure (PEEP; 19 ± 1 cmH(2)O) (n = 4). We quantified fractional gas content with transmission scans, and sV with emission scans of infused (13)NN-saline. Voxel (13)NN-washout curves were fit with one- or two-compartment models to estimate sV. Total heterogeneity, measured as SD[log(10)(sV)], was divided into length-scale ranges by measuring changes in variance of log(10)(sV), resulting from progressive filtering of sV images. High-Vt ZEEP showed higher sV heterogeneity at 36-mm (r = -0.72) length scales (P < 0.001). We conclude that sV heterogeneity at length scales <60 mm increases in poorly aerated regions of mechanically ventilated normal lungs, likely due to heterogeneous small-airway narrowing and alveolar derecruitment. PEEP reduces sV heterogeneity by maintaining lung expansion and airway patency at those small length scales.

  16. Efficacy of Hi-Lo Evac Endotracheal Tube in Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Poisoned Patients

    Science.gov (United States)

    Mashayekhian, Mohammad; Rahimi, Mitra; Aghabiklooei, Abbas

    2016-01-01

    Background. Ventilator-associated pneumonia (VAP) is the most common health care-associated infection. To prevent this complication, aspiration of subglottic secretions using Hi-Lo Evac endotracheal tube (Evac ETT) is a recommended intervention. However, there are some reports on Evac ETT dysfunction. We aimed to compare the incidence of VAP (per ventilated patients) in severely ill poisoned patients who were intubated using Evac ETT versus conventional endotracheal tubes (C-ETT) in our toxicology ICU. Materials and Methods. In this clinical randomized trial, 91 eligible patients with an expected duration of mechanical ventilation of more than 48 hours were recruited and randomly assigned into two groups: (1) subglottic secretion drainage (SSD) group who were intubated by Evac ETT (n = 43) and (2) control group who were intubated by C-ETT (n = 48). Results. Of the 91 eligible patients, 56 (61.5%) were male. VAP was detected in 24 of 43 (55.8%) patients in the case group and 23 of 48 (47.9%) patients in the control group (P = 0.45). The most frequently isolated microorganisms were S. aureus (54.10%) and Acinetobacter spp. (19.68%). The incidence of VAP and ICU length of stay were not significantly different between the two groups, but duration of intubation was statistically different and was longer in the SSD group. Mortality rate was less in SSD group but without a significant difference (P = 0.68). Conclusion. The SSD procedure was performed intermittently with one-hour intervals using 10 mL syringe. Subglottic secretion drainage does not significantly reduce the incidence of VAP in patients receiving MV. This strategy appears to be ineffective in preventing VAP among ICU patients. PMID:27651976

  17. Efficacy of Hi-Lo Evac Endotracheal Tube in Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Poisoned Patients.

    Science.gov (United States)

    Ghoochani Khorasani, Ahmad; Shadnia, Shahin; Mashayekhian, Mohammad; Rahimi, Mitra; Aghabiklooei, Abbas

    2016-01-01

    Background. Ventilator-associated pneumonia (VAP) is the most common health care-associated infection. To prevent this complication, aspiration of subglottic secretions using Hi-Lo Evac endotracheal tube (Evac ETT) is a recommended intervention. However, there are some reports on Evac ETT dysfunction. We aimed to compare the incidence of VAP (per ventilated patients) in severely ill poisoned patients who were intubated using Evac ETT versus conventional endotracheal tubes (C-ETT) in our toxicology ICU. Materials and Methods. In this clinical randomized trial, 91 eligible patients with an expected duration of mechanical ventilation of more than 48 hours were recruited and randomly assigned into two groups: (1) subglottic secretion drainage (SSD) group who were intubated by Evac ETT (n = 43) and (2) control group who were intubated by C-ETT (n = 48). Results. Of the 91 eligible patients, 56 (61.5%) were male. VAP was detected in 24 of 43 (55.8%) patients in the case group and 23 of 48 (47.9%) patients in the control group (P = 0.45). The most frequently isolated microorganisms were S. aureus (54.10%) and Acinetobacter spp. (19.68%). The incidence of VAP and ICU length of stay were not significantly different between the two groups, but duration of intubation was statistically different and was longer in the SSD group. Mortality rate was less in SSD group but without a significant difference (P = 0.68). Conclusion. The SSD procedure was performed intermittently with one-hour intervals using 10 mL syringe. Subglottic secretion drainage does not significantly reduce the incidence of VAP in patients receiving MV. This strategy appears to be ineffective in preventing VAP among ICU patients. PMID:27651976

  18. Risk factors for endotracheal intubation and mechanical ventilation in patients with opioids intoxication

    International Nuclear Information System (INIS)

    Objectives: Patients poisoned with opioids sometimes need endotracheal intubation with or without the use of mechanical ventilation. This study was done to determine the prognostic risk factors for of the need for endotracheal intubation and mechanical ventilation. Methodology: In this cross-sectional study which was performed in Isfahan (Iran), one hundred (n=100) opioid poisoned patients whom their overdoses were diagnosed by their full and reliable history, physical examination and positive response to naloxone; vital signs at the hospital admission, blood biochemistry, ABG details and also the type and estimated dosage of opioid, route of consumption, and their need to mechanical ventilation were evaluated. Results: Patients were mostly aged between 20-40 years old. Seventy nine patients were male and 26 cases (21 men) required endotracheal intubation and 15 cases (14 men) needed both intubation and mechanical ventilation. The most consumed opiates among the poisoned patients were opium (35%), heroin (16%), Tramadol (15%), Methadone (9%), crack (6%), Diphenoxylate (4%) and others (15%). There was a significant difference between the mean heart rates and respiratory rate of the patients who were connected to the ventilator and others (99.8 +- 21.8 and 87.3 +- 16.3; p=0.01). The lower level of consciousness [OR: 2.2 95% Confidence Interval (CI): 1.2-4.2], and lower admission level of hemoglobin (OR: 3.6; CI:1.2-10.8) were among the factors for predicting the need for intubation and ventilation. Conclusion: Determining the risk factors with prognostic value for the need to intubation or ventilation seems to be necessary for improving the standard of therapy in opioids poisoned patients. (author)

  19. Pulmonary blood flow distribution in sheep: effects of anesthesia, mechanical ventilation, and change in posture

    Science.gov (United States)

    Walther, S. M.; Domino, K. B.; Glenny, R. W.; Hlastala, M. P.

    1997-01-01

    BACKGROUND: Recent studies providing high-resolution images of pulmonary perfusion have questioned the classical zone model of pulmonary perfusion. Hence the present work was undertaken to provide detailed maps of regional pulmonary perfusion to examine the influence of anesthesia, mechanical ventilation, and posture. METHODS: Pulmonary perfusion was analyzed with intravenous fluorescent microspheres (15 microm) in six sheep studied in four conditions: prone and awake, prone with pentobarbital-anesthesia and breathing spontaneously, prone with anesthesia and mechanical ventilation, and supine with anesthesia and mechanical ventilation. Lungs were air dried at total lung capacity and sectioned into approximately 1,100 pieces (about 2 cm3) per animal. The pieces were weighed and assigned spatial coordinates. Fluorescence was read on a spectrophotometer, and signals were corrected for piece weight and normalized to mean flow. Pulmonary blood flow heterogeneity was assessed using the coefficient of variation of flow data. RESULTS: Pentobarbital anesthesia and mechanical ventilation did not influence perfusion heterogeneity, but heterogeneity increased when the animals were in the supine posture (P Pulmonary perfusion was distributed with a hilar-to-peripheral gradient in animals breathing spontaneously (P ventilation on pulmonary perfusion heterogeneity is small compared with the effect of changes in posture. Analysis of flow gradients indicate that gravity plays a small role in determining pulmonary blood flow distribution.

  20. Pulmonary blood flow distribution in sheep: effects of anesthesia, mechanical ventilation, and change in posture

    Science.gov (United States)

    Walther, S. M.; Domino, K. B.; Glenny, R. W.; Hlastala, M. P.

    1997-01-01

    BACKGROUND: Recent studies providing high-resolution images of pulmonary perfusion have questioned the classical zone model of pulmonary perfusion. Hence the present work was undertaken to provide detailed maps of regional pulmonary perfusion to examine the influence of anesthesia, mechanical ventilation, and posture. METHODS: Pulmonary perfusion was analyzed with intravenous fluorescent microspheres (15 microm) in six sheep studied in four conditions: prone and awake, prone with pentobarbital-anesthesia and breathing spontaneously, prone with anesthesia and mechanical ventilation, and supine with anesthesia and mechanical ventilation. Lungs were air dried at total lung capacity and sectioned into approximately 1,100 pieces (about 2 cm3) per animal. The pieces were weighed and assigned spatial coordinates. Fluorescence was read on a spectrophotometer, and signals were corrected for piece weight and normalized to mean flow. Pulmonary blood flow heterogeneity was assessed using the coefficient of variation of flow data. RESULTS: Pentobarbital anesthesia and mechanical ventilation did not influence perfusion heterogeneity, but heterogeneity increased when the animals were in the supine posture (P perfusion was distributed with a hilar-to-peripheral gradient in animals breathing spontaneously (P ventilation on pulmonary perfusion heterogeneity is small compared with the effect of changes in posture. Analysis of flow gradients indicate that gravity plays a small role in determining pulmonary blood flow distribution.

  1. Noninvasive mechanical ventilation with high pressure strategy remains a “double edged sword”?

    Directory of Open Access Journals (Sweden)

    Esquinas AM

    2013-05-01

    Full Text Available Antonio M Esquinas,1 Gherardo Siscaro,2 Enrico M Clini21Intensive Care Unit, Hospital Morales Meseguer, Murcia, 2Department of Medical and Surgical Sciences, University of Modena, Pavullo-Modena, ItalyWe read with great interest the original work by Murphy et al analyzing the effects of two treatment strategies for delivery of noninvasive mechanical ventilation in hypercapnic patients with chronic obstructive pulmonary disease.1 High pressure and high intensity noninvasive mechanical ventilation were compared in a short-term crossover trial to assess whether high intensity noninvasive mechanical ventilation (inspiratory pressure > 25 cm H2O associated with a high backup ventilator rate may improve adherence, physiological, and subjective outcomes when compared with delivery of high pressure noninvasive mechanical ventilation (without elevated backup respiratory rate. The authors concluded that both strategies are equivalent in all the recorded outcomes, showing thus that driving pressure, but not backup respiratory rate, is essential to gain physiological and clinical benefits in this population when in a chronic stable condition.View original paper by Murphy and colleagues.

  2. Localized persistent pulmonary interstitial emphysema in a preterm infant in the absence of mechanical ventilation

    International Nuclear Information System (INIS)

    Localized persistent pulmonary interstitial emphysema has rarely been reported in preterm infants in the absence of utilization of mechanical ventilation or continuous positive airway pressure. The relative rarity of this condition might preclude rendering of the correct diagnosis, making patients susceptible to unnecessary surgery and increased morbidity and mortality associated with such intervention. We present a preterm infant who developed respiratory distress and radiographic findings of pulmonary interstitial emphysema on the first day after birth, prior to receiving continuous positive airway pressure or mechanical ventilation. It is important for radiologists to consider localized persistent pulmonary interstitial emphysema in the differential diagnosis of cystic lung lesions in preterm infants, even in the absence of mechanical ventilation. In cases where there is uncertainty, CT imaging can be useful in making the correct diagnosis. (orig.)

  3. Localized persistent pulmonary interstitial emphysema in a preterm infant in the absence of mechanical ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Berk, David R. [Stanford University School of Medicine, Division of Pediatric Radiology, CA (United States); Lucile Packard Children' s Hospital, Stanford, CA (United States); Varich, Laura J. [Stanford University School of Medicine, Division of Pediatric Radiology, CA (United States); Stanford University School of Medicine, Department of Radiology, CA (United States); Lucile Packard Children' s Hospital, Stanford, CA (United States)

    2005-12-01

    Localized persistent pulmonary interstitial emphysema has rarely been reported in preterm infants in the absence of utilization of mechanical ventilation or continuous positive airway pressure. The relative rarity of this condition might preclude rendering of the correct diagnosis, making patients susceptible to unnecessary surgery and increased morbidity and mortality associated with such intervention. We present a preterm infant who developed respiratory distress and radiographic findings of pulmonary interstitial emphysema on the first day after birth, prior to receiving continuous positive airway pressure or mechanical ventilation. It is important for radiologists to consider localized persistent pulmonary interstitial emphysema in the differential diagnosis of cystic lung lesions in preterm infants, even in the absence of mechanical ventilation. In cases where there is uncertainty, CT imaging can be useful in making the correct diagnosis. (orig.)

  4. Univariate Risk Factors for Prolonged Mechanical Ventilation in Patients Undergoing Prosthetic Heart Valves Replacement Surgery

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Data from 736 patients undergoing prosthetic heart valve replacement surgery and concomitant surgery (combined surgery) from January 1998 to January 2004 at Union Hospital were retrospectively reviewed. Univariate logistic regression analyses were conducted to identify risk factors for prolonged mechanical ventilation. The results showed that prolonged cardiopulmonary bypass duration, prolonged aortic cross clamp time and low ejection fraction less than 50 percent (50 %)were found to be independent predictors for prolonged mechanical ventilation. Meanwhile age,weight, and preoperative hospital stay (days) were not found to be associated with prolonged mechanical ventilation. It was concluded that, for age and weight, this might be due to the lower number of old age patients (70 years and above) included in our study and genetic body structure of majority Chinese population that favor them to be in normal weight, respectively.

  5. Music preferences of mechanically ventilated patients participating in a randomized controlled trial

    Science.gov (United States)

    Heiderscheit, Annie; Breckenridge, Stephanie J.; Chlan, Linda L.; Savik, Kay

    2014-01-01

    Mechanical ventilation (MV) is a life-saving measure and supportive modality utilized to treat patients experiencing respiratory failure. Patients experience pain, discomfort, and anxiety as a result of being mechanically ventilated. Music listening is a non-pharmacological intervention used to manage these psychophysiological symptoms associated with mechanical ventilation. The purpose of this secondary analysis was to examine music preferences of 107 MV patients enrolled in a randomized clinical trial that implemented a patient-directed music listening protocol to help manage the psychophysiological symptom of anxiety. Music data presented includes the music genres and instrumentation patients identified as their preferred music. Genres preferred include: classical, jazz, rock, country, and oldies. Instrumentation preferred include: piano, voice, guitar, music with nature sounds, and orchestral music. Analysis of three patients’ preferred music received throughout the course of the study is illustrated to demonstrate the complexity of assessing MV patients and the need for an ongoing assessment process. PMID:25574992

  6. Preventing Ventilator Associated Lung Injury: A Perioperative Perspective

    Directory of Open Access Journals (Sweden)

    Satoshi eKimura

    2016-05-01

    Full Text Available Introduction: Research into the prevention of ventilator-associated lung injury (VALI in patients with acute respiratory distress syndrome (ARDS in the intensive care unit (ICU has resulted in the development of a number of lung protective strategies, which have become commonplace in the treatment of critically ill patients. An increasing number of studies have applied lung protective ventilation in the operating room to otherwise healthy individuals. We review the history of lung protective strategies in patients with acute respiratory failure and explore their use patients undergoing mechanical ventilation during general anesthesia to provide context for a discussion of the benefits and drawbacks, as well as inform future areas of inquiry.Methods: We completed a database search and reviewed articles investigating lung protective ventilation in both the ICU and in patients receiving general anesthesia through May 2015. Results: Lung protective ventilation was associated with improved outcomes in patients with acute respiratory failure in the ICU. Clinical evidence is less clear regarding lung protective ventilation for patients undergoing surgery. Conclusion: Lung protective ventilation strategies including low tidal volume ventilation and moderate positive end-expiratory pressure (PEEP are well established therapies to minimize lung injury in critically ill patients with and without lung disease, and may provide benefit to patients undergoing general anesthesia.

  7. Clinic analysis of sequential noninvasive-invasve mechanical ventilation in treating acute respiratory distress syndrome%无创-有创序贯通气治疗急性呼吸窘迫综合症的临床分析

    Institute of Scientific and Technical Information of China (English)

    李文元; 王淑华; 丁士芳; 张堃慧

    2014-01-01

    Objective To investigate the treatment efficiency of acute respiratory distress syndrome ,with the application of direct invasive ventilation and forced in-vasive ventilation after the failure of no -invasive positive pressure ventilation.Methods The clinical data of ARDS patients with the application of direct IV and NIPPV-IV were retrospectively analyzed from January 2008 to January 2011.Results direct IV group was 90 patients and NIPPV -IV group was 47 patients,the analysis showed that sexual,age,the acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)scores,sequential organ failure assessment(SOFA)scores,simple acute physical(SAPⅡ)scores,lung injury scores,the original of ARDS,sepsis severity were no significant between direct IV group and NIPPV -IV group(p>0.05),after the different mechanical ventilation,the number of organ dysfunction,treatment days in ICU and mortality were significant between direct IV group and NIPPV -IV group(p<0.05).Conclusions ARDS patients should be established artificial airway directly for the application of invasive ventilation ,NIPPV should be used with caution in ARDS patients in order to avoid poor prognosis by its failure .%目的:评价无创正压通气失败后被迫有创通气( NIPPV-IV)和直接有创通气( IV)治疗急性呼吸窘迫综合征( ARDS)的疗效和安全性。方法回顾性分析2008年1月至2011年1月综合ICU的ARDS患者的临床资料,分为无创正压通气失败后进行有创通气治疗( NIPPV-IV)组和直接有创通气治疗( IV)组。结果 NIPPV-IV组47例,IV组90例,两组患者之间性别、年龄、APACHEⅡ评分、SOFA评分、SAPⅡ评分、肺损伤评分( Lis)、ARDS来源、脓毒症严重程度无统计学意义(P>0.05),经过治疗后,直接IV组中的器官功能不全数目、ICU住院时间和死亡率低于NIPPV-IV组,差异有统计学意义(P<0.05)。结论 ARDS患者应慎用无创通气治疗,防止无创

  8. Effects of assisted and variable mechanical ventilation on cardiorespiratory interactions in anesthetized pigs

    International Nuclear Information System (INIS)

    The physiological importance of respiratory sinus arrhythmia (RSA) and cardioventilatory coupling (CVC) has not yet been fully elucidated, but these phenomena might contribute to improve ventilation/perfusion matching, with beneficial effects on gas exchange. Furthermore, decreased RSA amplitude has been suggested as an indicator of impaired autonomic control and poor clinical outcome, also during positive-pressure mechanical ventilation (MV). However, it is currently unknown how different modes of MV, including variable tidal volumes (VT), affect RSA and CVC during anesthesia. We compared the effects of pressure controlled (PCV) versus pressure assisted (PSV) ventilation, and of random variable versus constant VT, on RSA and CVC in eight anesthetized pigs. At comparable depth of anesthesia, global hemodynamics, and ventilation, RSA amplitude increased from 20 ms in PCV to 50 ms in PSV (p < 0.05). CVC was detected (using proportional Shannon entropy of the interval between each inspiration onset and the previous R-peak in ECG) in two animals in PCV and seven animals in PSV. Variable VT did not significantly influence these phenomena. Furthermore, heart period and systolic arterial pressure oscillations were in phase during PCV but in counter-phase during PSV. At the same depth of anesthesia in pigs, PSV increases RSA amplitude and CVC compared to PCV. Our data suggest that the central respiratory drive, but not the baroreflex or the mechano-electric feedback in the heart, is the main mechanism behind the RSA increase. Hence, differences in RSA and CVC between mechanically ventilated patients might reflect the difference in ventilation mode rather than autonomic impairment. Also, since gas exchange did not increase from PCV to PSV, it is questionable whether RSA has any significance in improving ventilation/perfusion matching during MV. (paper)

  9. Chest compression with a higher level of pressure support ventilation: effects on secretion removal, hemodynamics, and respiratory mechanics in patients on mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Wagner da Silva Naue

    2014-01-01

    Full Text Available OBJECTIVE: To determine the efficacy of chest compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation, in comparison with that of aspiration alone, in removing secretions, normalizing hemodynamics, and improving respiratory mechanics in patients on mechanical ventilation. METHODS: This was a randomized crossover clinical trial involving patients on mechanical ventilation for more than 48 h in the ICU of the Porto Alegre Hospital de Clínicas, in the city of Porto Alegre, Brazil. Patients were randomized to receive aspiration alone (control group or compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation (intervention group. We measured hemodynamic parameters, respiratory mechanics parameters, and the amount of secretions collected. RESULTS: We included 34 patients. The mean age was 64.2 ± 14.6 years. In comparison with the control group, the intervention group showed a higher median amount of secretions collected (1.9 g vs. 2.3 g; p = 0.004, a greater increase in mean expiratory tidal volume (16 ± 69 mL vs. 56 ± 69 mL; p = 0.018, and a greater increase in mean dynamic compliance (0.1 ± 4.9 cmH2O vs. 2.8 ± 4.5 cmH2O; p = 0.005. CONCLUSIONS: In this sample, chest compression accompanied by an increase in pressure support significantly increased the amount of secretions removed, the expiratory tidal volume, and dynamic compliance. (ClinicalTrials.gov Identifier:NCT01155648 [http://www.clinicaltrials.gov/

  10. Outcome of Concurrent Occult Hemothorax and Pneumothorax in Trauma Patients Who Required Assisted Ventilation

    Science.gov (United States)

    Mahmood, Ismail; Tawfeek, Zainab; El-Menyar, Ayman; Zarour, Ahmad; Afifi, Ibrahim; Kumar, Suresh; Latifi, Rifat; Al-Thani, Hassan

    2015-01-01

    Background. The management and outcomes of occult hemopneumothorax in blunt trauma patients who required mechanical ventilation are not well studied. We aimed to study patients with occult hemopneumothorax on mechanical ventilation who could be carefully managed without tube thoracostomy. Methods. Chest trauma patients with occult hemopneumothorax who were on mechanical ventilation were prospectively evaluated. The presence of hemopneumothorax was confirmed by CT scanning. Hospital length of stay, complications, and outcome were recorded. Results. A total of 56 chest trauma patients with occult hemopneumothorax who were on ventilatory support were included with a mean age of 36 ± 13 years. Hemopneumothorax was managed conservatively in 72% cases and 28% underwent tube thoracostomy as indicated. 29% of patients developed pneumonia, 16% had Acute Respiratory Distress Syndrome (ARDS), and 7% died. Thickness of hemothorax, duration of mechanical ventilation, and development of ARDS were significantly associated with tube thoracostomy in comparison to no-chest tube group. Conclusions. The majority of occult hemopneumothorax can be carefully managed without tube thoracostomy in patients who required positive pressure ventilation. Tube thoracotomy could be restricted to those who had evidence of increase in the size of the hemothorax or pneumothorax on follow-up chest radiographs or developed respiratory compromise. PMID:25785199

  11. Comparison of mechanical and manual ventilation during transport of patients to the intensive care unit after cardiac surgery

    OpenAIRE

    Canbulat, Atilla; Goren, Suna; Moğol, Elif Başağan; Kaya, Fatma Nur

    2012-01-01

    Objectives: We compared effects of mechanical and manual ventilation during transport to the intensive care unit(ICU) in cardiac surgeries. Materials and methods: After ethical approval, 66 patients (ASAgrade II and III, 20-80years) were assigned randomly. Ventilation during transport to ICU was performed manual (Group EV; n=36) or mechanical ventilation (Group MV; n=30). Measurements were recorded: operation room (A), during transport (T) and in ICU (YB). Systolic, diastolic pressures (S...

  12. Comparison of mechanical and manual ventilation during transport of patients to the intensive care unit after cardiac surgery

    OpenAIRE

    Atilla Canbulat; Suna Gören; Elif Başağan Moğol; Fatma Nur Kaya

    2012-01-01

    Objectives: We compared effects of mechanical andmanual ventilation during transport to the intensive careunit(ICU) in cardiac surgeries.Materials and methods: After ethical approval, 66 patients(ASAgrade II and III, 20-80years) were assignedrandomly. Ventilation during transport to ICU was performedmanual (Group EV; n=36) or mechanical ventilation(Group MV; n=30). Measurements were recorded:operation room (A), during transport (T) and in ICU (YB).Systolic, diastolic pressures (SAP, DAP), pul...

  13. Cerebral Arterial Air Embolism Associated with Mechanical Ventilation and Deep Tracheal Aspiration

    Directory of Open Access Journals (Sweden)

    S. Gursoy

    2012-01-01

    Full Text Available Arterial air embolism associated with pulmonary barotrauma has been considered a rare but a well-known complication of mechanical ventilation. A 65-year-old man, who had subarachnoid hemorrhage with Glasgow coma scale of 8, was admitted to intensive care unit and ventilated with the help of mechanical ventilator. Due to the excessive secretions, deep tracheal aspirations were made frequently. GCS decreased from 8–10 to 4-5, and the patient was reevaluated with cranial CT scan. In CT scan, air embolism was detected in the cerebral arteries. The patient deteriorated and spontaneous respiratory activity lost just after the CT investigation. Thirty minutes later cardiac arrest appeared. Despite the resuscitation, the patient died. We suggest that pneumonia and frequent tracheal aspirations are predisposing factors for cerebral vascular air embolism.

  14. Aerosol delivery of antimicrobial agents during mechanical ventilation: current practice and perspectives.

    Science.gov (United States)

    Michalopoulos, Argyris; Metaxas, Eugenios I; Falagas, Matthew E

    2011-03-01

    Critically ill patients, who develop ventilator-associated pneumonia during prolonged mechanical ventilation, often require antimicrobial agents administered through the endotracheal or the tracheotomy tube. The delivery of antibiotics via the respiratory tract has been established over the past years as an alternative route in order to deliver high concentrations of antimicrobial agents directly to the lungs and avoid systemic toxicity. Since the only formal indications for inhaled/aerosolized antimicrobial agents is for patients suffering from cystic fibrosis, consequently the majority of research and published studies concerns this group of patients. Newer devices and new antibiotic formulations are currently off-label used in ambulatory cystic fibrosis patients whereas similar data for the mechanically ventilated patients do not yet exist. PMID:21235473

  15. Modifiable risk factors for mechanical ventilator-associated pneumonia in intensive care

    Directory of Open Access Journals (Sweden)

    Raquel de Mendonça Nepomuceno

    2014-06-01

    Full Text Available Backgound and Objectives: Ventilator-associated pneumonia is a pulmonary infection that occurs 48 to 72 hours after endotracheal intubation and institution of mechanical ventilation, being considered one of the most feared adverse effects of intensive care therapy. Its incidence affects 10-30% of patients as an important cause of morbidity and mortality, of which mortality rate can exceed 25%. Modifiable risk factors are seen as crucial in decision-making for its treatment and prevention. Thus, the modifiable risk factors for pneumonia associated with invasive mechanical ventilation in patients admitted to the intensive care unit were described. Methods: This is a literature review carried out at Lilacs, SciELO, MEDLINE and Bdenf databases, to collect and summarize publications and subsequently, critically evaluate the risk factors for ventilator-associated pneumonia. Results: The inappropriate or indiscriminate use of antibiotics, lack of knowledge about the microbiota of the ICU and non compliance of the team regarding preventive measures predominated. Conclusion: Professionals must be made aware of the identified risk factors in order to carry out direct actions with short-term impact in the prevention and effective control of ventilator-associated pneumonia.

  16. Assessment of a volume-dependent dynamic respiratory system compliance in ALI/ARDS by pooling breathing cycles

    International Nuclear Information System (INIS)

    New methods were developed to calculate the volume-dependent dynamic respiratory system compliance (Crs) in mechanically ventilated patients. Due to noise in respiratory signals and different characteristics of the methods, their results can considerably differ. The aim of the study was to establish a practical procedure to validate the estimation of intratidal dynamic Crs. A total of 28 patients from intensive care units of eight German university hospitals with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) were studied retrospectively. Dynamic volume-dependent Crs was determined during ongoing mechanical ventilation with the SLICE method, dynostatic algorithm and adaptive slice method. Conventional two-point compliance C2P was calculated for comparison. A number of consecutive breathing cycles were pooled to reduce noise in the respiratory signals. Crs-volume curves produced with different methods converged when the number of pooling cycles increased (n ≥ 7). The mean volume-dependent Crs of 20 breaths was highly correlated with mean C2P (C2P,mean = 0.945 × Crs,mean − 0.053, r2 = 0.968, p < 0.0001). The Bland–Altman analysis indicated that C2P,mean was lower than Crs,mean (−2.4 ± 6.4 ml cm−1 H2O, mean bias ± 2 SD), but not significant according to the paired t-test (p > 0.05). Methods for analyzing dynamic respiratory mechanics are sensitive to noise and will converge to a unique solution when the number of pooled cycles increases. Under steady-state conditions, assessment of the volume-dependent Crs in ALI/ARDS patients can be validated by pooling respiratory data of consecutive breaths regardless of which method is applied. Confidence in dynamic Crs determination may be increased with the proposed pooling. (note)

  17. 围生期ARDS

    Institute of Scientific and Technical Information of China (English)

    陈倩

    2004-01-01

    1 ARDS的定义、发病诱因及发病率 急性呼吸窘迫综合征(acute respiratory distresss yndrome,ARDS)于1967年Ashboush首次报道,其定义是指因多种病因所引起的急性呼吸衰竭综合征,以非心源性肺水肿、低氧血症和弥漫性肺间质实变为主要特征。近年来研究表明,ARDS是急性肺损伤(acute lung injury,Au)发展到后期的典型表现。Au和ARDS有相同的定义和内涵,区别在于Au代表早期的阶段,ARDS代表晚期的阶段。有关ARDS的命名有史以来大约有30余种,如畸形肺泡衰竭、急性肺损伤、进行性呼吸窘迫、

  18. Mechanical ventilation and sepsis induce skeletal muscle catabolism in neonatal pigs

    Science.gov (United States)

    Reduced rates of skeletal muscle accretion are a prominent feature of the metabolic response to sepsis in infants and children. Septic neonates often require medical support with mechanical ventilation (MV). The combined effects of MV and sepsis in muscle have not been examined in neonates, in whom ...

  19. Bed Microenvironment in Hospital Patient Rooms with Natural or Mechanical Ventilation

    DEFF Research Database (Denmark)

    Melikov, Arsen Krikor; Li, Yuguo; Georgiev, Emanuil;

    2012-01-01

    We studied how to provide patients in bed with thermally comfortable microenvironment in both naturally and mechanically ventilated hospital rooms for both winter and summer seasons. A climate chamber was used to resemble a hospital room and thermal manikin to simulate a patient lying in a bed. The...

  20. Mechanical ventilation induces myokine expression and catabolism in peripheral skeletal muscle in pigs

    Science.gov (United States)

    Endotoxin (LPS)-induced sepsis increases circulating cytokines which have been associated with skeletal muscle catabolism. During critical illness, it has been postulated that muscle wasting associated with mechanical ventilation (MV) occurs due to inactivity. We hypothesize that MV and sepsis promo...

  1. Mechanical ventilation alone, and in the presence sepsis, induces peripheral skeletal muscle catabolism in neonatal pigs

    Science.gov (United States)

    Reduced rates of skeletal muscle accretion are a prominent feature of the metabolic response to sepsis in infants and children. Septic neonates often require medical support with mechanical ventilation (MV). The combined effects of MV and sepsis in muscle have not been examined in neonates, in whom ...

  2. Mechanical ventilation enhances lung inflammation and caspase activity in a model of mouse pneumovirus infection

    NARCIS (Netherlands)

    R.A. Bem; J.B.M. van Woensel; A.P. Bos; A. Koski; A.W. Farnand; J.B. Domachowske; H.F. Rosenberg; T.R. Martin; G. Matute-Bello

    2009-01-01

    Severe infection with respiratory syncytial virus (RSV) in children can progress to respiratory distress and acute lung injury (ALI). Accumulating evidence suggests that mechanical ventilation (MV) is an important cofactor in the development of ALI by modulating the host immune responses to bacteria

  3. Using passive flux samplers to determine the ammonia emission from mechanically ventilated animal houses

    NARCIS (Netherlands)

    Mosquera Losada, J.; Ogink, N.W.M.; Scholtens, R.

    2003-01-01

    Ammonia emissions from animal houses are an important environmental issue in the Netherlands. The current technique in the Netherlands to measure ammonia emissions in mechanically ventilated animal houses is the chemiluminescence method (using a NOx monitor after conversion of NH3 to NO). During cam

  4. A pseudo-Rumsfeldian approach to pleural effusions in mechanically ventilated patients

    OpenAIRE

    Ball, Jonathan

    2011-01-01

    Pleural effusions are common in mechanically ventilated patients but what is their significance and how should we manage them? What do we know? What don't we know? What didn't we know we knew? How should we resolve the unknowns?

  5. Moxifloxacin Penetration in Bronchial Secretions of Mechanically Ventilated Patients with Pneumonia

    OpenAIRE

    Leone, Marc; Albanèse, Jacques; Sampol-Manos, Emmanuelle; Simon, Nicolas; Lacarelle, Bruno; Bruguerolle, Bernard; Martin, Claude

    2004-01-01

    The pharmacokinetics of moxifloxacin was studied in 17 mechanically ventilated patients with pneumonia. Patients were given 400 mg of moxifloxacin intravenously. Blood samples and bronchial secretions were taken on days 1 and 4. A dose of 400 mg of moxifloxacin allows one to achieve efficient concentrations in bronchial secretions and plasma.

  6. A student paper: music in critical care setting for clients on mechanical ventilators: a student perspective.

    Science.gov (United States)

    Ho, Van; Chang, Sue; Olivas, Rosa; Almacen, Catherine; Dimanlig, Marbert; Rodriguez, Heather

    2012-01-01

    This article written by baccalaureate nursing students briefly discusses the use of music therapy in clients on mechanical ventilation in intensive care units. The article explores the possible benefits of music therapy and its use in other aspects of health care. PMID:23042464

  7. Biophysical determinants of alveolar epithelial plasma membrane wounding associated with mechanical ventilation.

    Science.gov (United States)

    Hussein, Omar; Walters, Bruce; Stroetz, Randolph; Valencia, Paul; McCall, Deborah; Hubmayr, Rolf D

    2013-10-01

    Mechanical ventilation may cause harm by straining lungs at a time they are particularly prone to injury from deforming stress. The objective of this study was to define the relative contributions of alveolar overdistension and cyclic recruitment and "collapse" of unstable lung units to membrane wounding of alveolar epithelial cells. We measured the interactive effects of tidal volume (VT), transpulmonary pressure (PTP), and of airspace liquid on the number of alveolar epithelial cells with plasma membrane wounds in ex vivo mechanically ventilated rat lungs. Plasma membrane integrity was assessed by propidium iodide (PI) exclusion in confocal images of subpleural alveoli. Cyclic inflations of normal lungs from zero end-expiratory pressure to 40 cmH2O produced VT values of 56.9 ± 3.1 ml/kg and were associated with 0.12 ± 0.12 PI-positive cells/alveolus. A preceding tracheal instillation of normal saline (3 ml) reduced VT to 49.1 ± 6 ml/kg but was associated with a significantly greater number of wounded alveolar epithelial cells (0.52 ± 0.16 cells/alveolus; P < 0.01). Mechanical ventilation of completely saline-filled lungs with saline (VT = 52 ml/kg) to pressures between 10 and 15 cmH2O was associated with the least number of wounded epithelial cells (0.02 ± 0.02 cells/alveolus; P < 0.01). In mechanically ventilated, partially saline-filled lungs, the number of wounded cells increased substantially with VT, but, once VT was accounted for, wounding was independent of maximal PTP. We found that interfacial stress associated with the generation and destruction of liquid bridges in airspaces is the primary biophysical cell injury mechanism in mechanically ventilated lungs. PMID:23997173

  8. Quantitative imaging of alveolar recruitment with hyperpolarized gas MRI during mechanical ventilation

    OpenAIRE

    Cereda, Maurizio; Emami, Kiarash; Kadlecek, Stephen; Xin, Yi; Mongkolwisetwara, Puttisarn; Profka, Harrilla; Barulic, Amy; Pickup, Stephen; Månsson, Sven; Wollmer, Per; Ishii, Masaru; Deutschman, Clifford S.; Rizi, Rahim R.

    2010-01-01

    The aim of this study was to assess the utility of 3He MRI to noninvasively probe the effects of positive end-expiratory pressure (PEEP) maneuvers on alveolar recruitment and atelectasis buildup in mechanically ventilated animals. Sprague-Dawley rats (n = 13) were anesthetized, intubated, and ventilated in the supine position (4He-to-O2 ratio: 4:1; tidal volume: 10 ml/kg, 60 breaths/min, and inspiration-to-expiration ratio: 1:2). Recruitment maneuvers consisted of either a stepwise increase o...

  9. [Vegetable oil-induced acute respiratory distress syndrome (ARDS) in near drowning: evaluation based on extravascular lung water index].

    Science.gov (United States)

    Yoshida, Takeshi; Rinka, Hiroshi; Kaji, Arito

    2008-06-01

    Lipoid pneumonia usually presents after chronic recurrent ingestion of oily substances or accidental aspiration during "fire-eating" demonstrations. Massive exposure by near drowning extremely rare and potentially fatal. We present here a case of survival after total immersion in oil in her workplace. A 66-year-old woman who nearly drowned in a vat of vegetable oil was admitted as an emergency case with severe hypoxia after rescue. Chest computed tomography (CT) findings showed bilateral ground-glass opacity, consolidation, and the case fulfilled the criteria for acute respiratory distress syndrome (ARDS). Bronchoscopy and bronchoalveolar lavage performed on admission indicated oil droplets and marked neutrophilia (67%), which made us diagnose ARDS induced by lipoid pneumonia. We commenced treatment with pulsed steroids and strictly managed fluid balance under mechanical ventilation. Despite immediate improvement in oxygenation, the value of extravascular lung water index (EVLWI) measured by the PiCCO system consistently remained over 30 ml/Kg through her clinical course. We concluded that lipoid pneumonia is characterized by prolonged elevatation of pulmonary vascular permeability.

  10. Cytomegalovirus and herpes simplex virus effect on the prognosis of mechanically ventilated patients suspected to have ventilator-associated pneumonia.

    Directory of Open Access Journals (Sweden)

    Yannael Coisel

    Full Text Available OBJECTIVE: Cytomegalovirus (CMV and herpes simplex virus (HSV are common viruses that can affect critically ill patients who are not immunocompromised. The aim of this study was to determine whether the identification of CMV and/or HSV in mechanically ventilated critically ill patients suspected of having pneumonia was associated with an increased mortality. DESIGN: Prospective epidemiological study. SETTING: Medical intensive care unit of a tertiary medical center. PATIENTS: Ninety-three patients with suspected pneumonia. INTERVENTIONS: Patients with suspected pneumonia had bronchoalveolar lavage and blood samples taken to confirm the diagnosis. Antigenemia was used to detect CMV in the blood. Bronchoalveolar lavage samples were submitted to testing using quantitative real-time Polymerase Chain Reaction. MEASUREMENTS AND MAIN RESULTS: We identified 22 patients with a CMV infection, 26 patients with an HSV infection and 45 patients without CMV or HSV infection (control group. Mortality at day 60 was higher in patients with a CMV infection than in patients from the control group (55% vs. 20%, P<0.01. Mortality at day 60 was not significantly increased in the group with HSV infection. Duration of ICU stay and ICU mortality were significantly higher in patients with CMV infections when compared to patients from the control group, whereas ventilator free days were significantly lower in patients with CMV infections when compared to patients from the control group. CONCLUSIONS: In critically ill patients, a CMV infection is associated with an increased mortality. Further interventional studies are needed to evaluate whether treatment could improve the prognosis.

  11. Fluid flow and particle transport in mechanically ventilated airways. Part I. Fluid flow structures.

    Science.gov (United States)

    Van Rhein, Timothy; Alzahrany, Mohammed; Banerjee, Arindam; Salzman, Gary

    2016-07-01

    A large eddy simulation-based computational study of fluid flow and particle transport in upper tracheobronchial airways is carried out to investigate the effect of ventilation parameters on pulmonary fluid flow. Respiratory waveforms commonly used by commercial mechanical ventilators are used to study the effect of ventilation parameters and ventilation circuit on pulmonary fluid dynamics. A companion paper (Alzahrany et al. in Med Biol Eng Comput, 2014) reports our findings on the effect of the ventilation parameters and circuit on particle transport and aerosolized drug delivery. The endotracheal tube (ETT) was found to be an important geometric feature and resulted in a fluid jet that caused an increase in turbulence and created a recirculation zone with high wall shear stress in the main bronchi. Stronger turbulence was found in lower airways than would be found under normal breathing conditions due to the presence of the jet caused by the ETT. The pressure-controlled sinusoidal waveform induced the lowest wall shear stress on the airways wall. PMID:26563199

  12. Impact of Residential Mechanical Ventilation on Energy Cost and Humidity Control

    Energy Technology Data Exchange (ETDEWEB)

    Martin, E.

    2014-01-01

    The DOE Building America program has been conducting research leading to cost effective high performance homes since the early 1990's. Optimizing whole house mechanical ventilation as part of the program's systems engineered approach to constructing housing has been an important subject of the program's research. Ventilation in residential buildings is one component of an effective, comprehensive strategy for creation and maintenance of a comfortable and healthy indoor air environment. The study described in this white paper is based on building energy modeling with an important focus on the indoor humidity impacts of ventilation. The modeling tools used were EnergyPlus version 7.1 (E+) and EnergyGauge USA (EGUSA). Twelve U.S. cities and five climate zones were represented. A total of 864 simulations (2*2*3*3*12= 864) were run using two building archetypes, two building leakage rates, two building orientations, three ventilation systems, three ventilation rates, and twelve climates.

  13. Dynamic Characteristics of Mechanical Ventilation System of Double Lungs with Bi-Level Positive Airway Pressure Model

    Directory of Open Access Journals (Sweden)

    Dongkai Shen

    2016-01-01

    Full Text Available In recent studies on the dynamic characteristics of ventilation system, it was considered that human had only one lung, and the coupling effect of double lungs on the air flow can not be illustrated, which has been in regard to be vital to life support of patients. In this article, to illustrate coupling effect of double lungs on flow dynamics of mechanical ventilation system, a mathematical model of a mechanical ventilation system, which consists of double lungs and a bi-level positive airway pressure (BIPAP controlled ventilator, was proposed. To verify the mathematical model, a prototype of BIPAP system with a double-lung simulators and a BIPAP ventilator was set up for experimental study. Lastly, the study on the influences of key parameters of BIPAP system on dynamic characteristics was carried out. The study can be referred to in the development of research on BIPAP ventilation treatment and real respiratory diagnostics.

  14. Trends in conventional mechanical ventilation and pulmonary graphics in the newborn

    Institute of Scientific and Technical Information of China (English)

    Kris C.Sekar

    2010-01-01

    @@ The optimal treatment for respiratory distress syndrome (RDS) in extremely low birth weight newborn infants now consists of surfactant therapy,ventilator support and aggressive nutritional support.1,2Introduction of surfactant therapy has significantly reduced both the mortality and morbidity in premature infants. However, despite all the preventive efforts the prematurity rate has increased in the United States. As a result of this trend the majority of the infants requiring mechanical ventilation in the current neonatal intensive care units are less than 1000 g. This has created new challenges in managing these infants respiratory distress to reduce mortality, morbidity and improve neurological outcome. Advances in optimal resuscitation, maintenance of thermal environment, early surfactant therapy, gentle ventilation, aggressive nutritional support, early treatment of patent ductus arteriosus, control of infection etc. have been adopted to reduce mortality and morbidity. However,despite all these advancements in neonatal care the incidence of bronchopulmonary dysplasia (BPD) has not decreased.3'4

  15. Effect of N-Acetylcystein in ICU patients with acute lung injury requiring mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Mojtahed Zadeh

    2008-08-01

    Full Text Available "n Background: Acute lung injury (ALI is a pulmonary pathology occuring in context of infection, trauma, burn, and sepsis. Tissue injury and release of chemical mediators result in tissue damage and organ failure especially respiratory failure. Many therapeutic modalities including vitamin E, allopurinol, and N-acetylcystein (NAC have been used to decrease levels of inflammatory factors and to control and improve signs and symptoms. The antioxidant feature of NAC induces synthesis of glutathione- the scavenger of free radicals- and increase respiratory drive and PaO2. In time diagnosis of ALI, prompt institution of treatment will reduce mortality and morbidity in critical illness."n"nMethods: This open label analytical clinical trial included a total of 50 patients admitted in the ICU ward of Sina University Hospital. They were randomly divided into two groups of 25, the case group received NAC 150mg/kg in 100ml Normal saline within 20 minutes then 50mg/kg in 100ml Normal saline within 4 hr after that 50mg/kg daily for three days. The controls received only normal saline. Oxygenation and ventilation parameters were studied In both groups."n"nResults: There were no significant difference between the groups in terms of demographic indices, mean SpO2, ABG values, mortality rates, and clearing of chest x-rays. The best outcome was seen in young traumatic patients."n"nConclusion: In this relatively small group of patients presenting with an established ALI/ ARDS subsequent to a variety of underlying disease, intravenous NAC treatment during first four days neither significantly improved systemic oxygenation nor reduced the need for ventilatory support.

  16. Sustained inflation at birth did not alter lung injury from mechanical ventilation in surfactant-treated fetal lambs.

    Directory of Open Access Journals (Sweden)

    Noah H Hillman

    Full Text Available BACKGROUND: Sustained inflations (SI are used with the initiation of ventilation at birth to rapidly recruit functional residual capacity and may decrease lung injury and the need for mechanical ventilation in preterm infants. However, a 20 second SI in surfactant-deficient preterm lambs caused an acute phase injury response without decreasing lung injury from subsequent mechanical ventilation. HYPOTHESIS: A 20 second SI at birth will decrease lung injury from mechanical ventilation in surfactant-treated preterm fetal lambs. METHODS: The head and chest of fetal sheep at 126±1 day GA were exteriorized, with tracheostomy and removal of fetal lung fluid prior to treatment with surfactant (300 mg in 15 ml saline. Fetal lambs were randomized to one of four 15 minute interventions: 1 PEEP 8 cmH2O; 2 20 sec SI at 40 cmH2O, then PEEP 8 cmH2O; 3 mechanical ventilation with 7 ml/kg tidal volume; or 4 20 sec SI then mechanical ventilation at 7 ml/kg. Fetal lambs remained on placental support for the intervention and for 30 min after the intervention. RESULTS: SI recruited a mean volume of 6.8±0.8 mL/kg. SI did not alter respiratory physiology during mechanical ventilation. Heat shock protein (HSP 70, HSP60, and total protein in lung fluid similarly increased in both ventilation groups. Modest pro-inflammatory cytokine and acute phase responses, with or without SI, were similar with ventilation. SI alone did not increase markers of injury. CONCLUSION: In surfactant treated fetal lambs, a 20 sec SI did not alter ventilation physiology or markers of lung injury from mechanical ventilation.

  17. A Prognostic Model for One-year Mortality in Patients Requiring Prolonged Mechanical Ventilation

    Science.gov (United States)

    Carson, Shannon S.; Garrett, Joanne; Hanson, Laura C.; Lanier, Joyce; Govert, Joe; Brake, Mary C.; Landucci, Dante L.; Cox, Christopher E.; Carey, Timothy S.

    2009-01-01

    Objective A measure that identifies patients who are at high risk of mortality after prolonged ventilation will help physicians communicate prognosis to patients or surrogate decision-makers. Our objective was to develop and validate a prognostic model for 1-year mortality in patients ventilated for 21 days or more. Design Prospective cohort study. Setting University-based tertiary care hospital Patients 300 consecutive medical, surgical, and trauma patients requiring mechanical ventilation for at least 21 days were prospectively enrolled. Measurements and Main Results Predictive variables were measured on day 21 of ventilation for the first 200 patients and entered into logistic regression models with 1-year and 3-month mortality as outcomes. Final models were validated using data from 100 subsequent patients. One-year mortality was 51% in the development set and 58% in the validation set. Independent predictors of mortality included requirement for vasopressors, hemodialysis, platelet count ≤150 ×109/L, and age ≥50. Areas under the ROC curve for the development model and validation model were 0.82 (se 0.03) and 0.82 (se 0.05) respectively. The model had sensitivity of 0.42 (se 0.12) and specificity of 0.99 (se 0.01) for identifying patients who had ≥90% risk of death at 1 year. Observed mortality was highly consistent with both 3- and 12-month predicted mortality. These four predictive variables can be used in a simple prognostic score that clearly identifies low risk patients (no risk factors, 15% mortality) and high risk patients (3 or 4 risk factors, 97% mortality). Conclusions Simple clinical variables measured on day 21 of mechanical ventilation can identify patients at highest and lowest risk of death from prolonged ventilation. PMID:18552692

  18. Clinical review: Respiratory mechanics in spontaneous and assisted ventilation

    OpenAIRE

    Grinnan, Daniel C; Truwit, Jonathon Dean

    2005-01-01

    Pulmonary disease changes the physiology of the lungs, which manifests as changes in respiratory mechanics. Therefore, measurement of respiratory mechanics allows a clinician to monitor closely the course of pulmonary disease. Here we review the principles of respiratory mechanics and their clinical applications. These principles include compliance, elastance, resistance, impedance, flow, and work of breathing. We discuss these principles in normal conditions and in disease states. As the sev...

  19. Energy and exergy performance of residential heating systems with separate mechanical ventilation

    International Nuclear Information System (INIS)

    The paper brings new evidence on the impact of separate mechanical ventilation system on the annual energy and exergy performance of several design alternatives of residential heating systems, when they are designed for a house in Montreal. Mathematical models of residential heating, ventilation and domestic hot water (HVAC-DHW) systems, which are needed for this purpose, are developed and furthermore implemented in the Engineering Equation Solver (EES) environment. The Coefficient of Performance and the exergy efficiency are estimated as well as the entropy generation and exergy destruction of the overall system. The equivalent greenhouse gas emissions due to the on-site and off-site use of primary energy sources are also estimated. The addition of a mechanical ventilation system with heat recovery to any HVAC-DHW system discussed in the paper increases the energy efficiency; however, it decreases the exergy efficiency, which indicates a potential long-term damaging impact on the natural environment. Therefore, the use of a separate mechanical ventilation system in a house should be considered with caution, and recommended only when other means for controlling the indoor air quality cannot be applied

  20. Cellular and molecular mechanisms of ACE2/Ang1-7/Mas in ALI/ARDS%ACE2/Ang1-7/Mas在ALI/ARDS中作用机制研究

    Institute of Scientific and Technical Information of China (English)

    孙佳; 朱彪

    2016-01-01

    Renin-angiotensin system(RAS)plays important roles in the pathogenesis of acute lung injury(ALI)/acute respiratory distress syndrome(ARDS).About 60% of ARDS patients are shown to develop pulmonary fibrosis with increased mortality rate.Recent researches have demonstrated potent inhibitory of angiotensin-converting enzyme 2 (ACE2)/angiotensin 1-7 (Ang1-7)/Mas axis on ALI/ARDS.This review summarizes the beneficial action of ACE2/Ang1-7/Mas on ALI/ARDS and research progress on relative signaling pathway.%肾素-血管紧张素系统在 ALI/ARDS的病理过程中有重要作用。大约60% ARDS患者进展成肺纤维化且其病死率明显增加。目前研究显示 ACE/AngⅡ/AT1 R 与 ALI/ARDS 发病机制有关,而ACE2/Ang1-7/Mas起负向调节作用———ACE2和Ang1-7对ALI/ARDS有保护作用。因此,本文就 ACE2/Ang1-7/Mas在 ALI/ARDS中的保护作用和相关信号传导通路等方面最新研究进展作一阐述。

  1. Correlation between timing of tracheostomy and duration of mechanical ventilation in patients with potentially normal lungs admitted to intensive care unit

    Directory of Open Access Journals (Sweden)

    Mehrdad Masoudifar

    2012-01-01

    Conclusion: Our study with mentioned sample size could not show any relationship between timing of tracheostomy and duration of mechanical ventilation in patients under mechanical ventilation with good pulmonary function in ICU.

  2. Noninvasive mechanical ventilation with high pressure strategy remains a “double edged sword”?

    OpenAIRE

    Esquinas AM; Siscaro G; Clini EM

    2013-01-01

    Antonio M Esquinas,1 Gherardo Siscaro,2 Enrico M Clini21Intensive Care Unit, Hospital Morales Meseguer, Murcia, 2Department of Medical and Surgical Sciences, University of Modena, Pavullo-Modena, ItalyWe read with great interest the original work by Murphy et al analyzing the effects of two treatment strategies for delivery of noninvasive mechanical ventilation in hypercapnic patients with chronic obstructive pulmonary disease.1 High pressure and high intensity noninvasive mechanical ventilat...

  3. Noninvasive mechanical ventilation with high pressure strategy remains a “double edged sword”?

    OpenAIRE

    Esquinas, Antonio M.

    2013-01-01

    Antonio M Esquinas,1 Gherardo Siscaro,2 Enrico M Clini21Intensive Care Unit, Hospital Morales Meseguer, Murcia, 2Department of Medical and Surgical Sciences, University of Modena, Pavullo-Modena, ItalyWe read with great interest the original work by Murphy et al analyzing the effects of two treatment strategies for delivery of noninvasive mechanical ventilation in hypercapnic patients with chronic obstructive pulmonary disease.1 High pressure and high intensity noninvasive mechanical ventilat...

  4. Lung and chest wall mechanics in ventilated patients with end stage idiopathic pulmonary fibrosis

    OpenAIRE

    Nava, S.; Rubini, F.

    1999-01-01

    BACKGROUND—Idiopathic pulmonary fibrosis is an inflammatory disease which leads to chronic ventilatory insufficiency and is characterised by a reduction in pulmonary static and dynamic volumes. It has been suggested that lung elastance may also be abnormally increased, particularly in end stage disease, but this has not been systematically tested. The aim of this study was to assess the respiratory mechanics during mechanical ventilation in patients affected by end stage ...

  5. Microbial composition and antibiotic resistance of biofilms recovered from endotracheal tubes of mechanically ventilated patients.

    Science.gov (United States)

    Vandecandelaere, Ilse; Coenye, Tom

    2015-01-01

    In critically ill patients, breathing is impaired and mechanical ventilation, using an endotracheal tube (ET) connected to a ventilator, is necessary. Although mechanical ventilation is a life-saving procedure, it is not without risk. Because of several reasons, a biofilm often forms at the distal end of the ET and this biofilm is a persistent source of bacteria which can infect the lungs, causing ventilator-associated pneumonia (VAP). There is a link between the microbial flora of ET biofilms and the microorganisms involved in the onset of VAP. Culture dependent and independent techniques were already used to identify the microbial flora of ET biofilms and also, the antibiotic resistance of microorganisms obtained from ET biofilms was determined. The ESKAPE pathogens play a dominant role in the onset of VAP and these organisms were frequently identified in ET biofilms. Also, antibiotic resistant microorganisms were frequently present in ET biofilms. Members of the normal oral flora were also identified in ET biofilms but it is thought that these organisms initiate ET biofilm formation and are not directly involved in the development of VAP.

  6. The use of mechanical ventilation with heat recovery for controlling radon and radon-daughter concentrations

    International Nuclear Information System (INIS)

    An energy research house in Maryland was found to have radon concentrations far in excess of recommended guidelines. A mechanical ventilation system with heat recovery was installed in this house to test its effectiveness as an energy-efficient control technique for indoor radon. Radon concentration was monitored continuously for two weeks under varying ventilation conditions (0.07 to 0.8 air changes per hour (ach)) and radon daughter concentrations were measured by grab-sample techniques about nine times daily during this period. At ventilation rates of 0.6 ach and higher radon and radon daughter levels dropped below guidelines for indoor concentrations. Comparison with other studies indicates that indoor radon buildup may be a problem in a considerable portion of houses characterized by their low infiltration rates. The use of mechanical ventilation systems with air-to-air heat exchangers may offer a practical, cost-effective, and energy-efficient means of alleviating not only the radon problem specifically but also the general deterioration of indoor air quality in houses designed or retrofitted to achieve low infiltration

  7. Simulation of ventilation networks: presentation of the safety code PIAF complementary with fluid mechanics codes

    International Nuclear Information System (INIS)

    The response of a ventilation network to disturbances either mechanical or thermal is difficult to evaluate when the network becomes complex as is the case in nuclear power plants and other nuclear facilities. Several teams from the CEA GROUP have joined together to elaborate a computation code able to simulate the behavior of any classical ventilation network. Such a code allows the study of a ventilation system in its design stage, pointing out safety problems and helping to solve them; the basis model generated in the design stage may be used to follow the operating life of the system, up to dismantling. The code, called PIAF, solves the set of equations which simulate a ventilation network in steady state: the numerical network is composed of nodes connected with various components. The unknowns of such a problem are pressure and temperature at the nodes and flow rates in the links. The problem induces a weakly nonlinear system, that PIAF solves by an iterative matricial newtonian method. PIAF has been validated in several facilities in France for various mechanical disturbances: some of those validation cases are considered

  8. Alveolar recruitment maneuver in mechanic ventilation pediatric intensive care unit children.

    Science.gov (United States)

    Neves, Valéria Cabral; Koliski, Adriana; Giraldi, Dinarte José

    2009-12-01

    Recent changes were introduced in acute hypoxemic respiratory failure children ventilation methods. There are evidences that less aggressive ventilation strategies can improve severe pulmonary injury survival. Experimental trials evidenced a relationship between inappropriate ventilatory measures and delayed acute pulmonary injury improvement, or even worsening. From this, a protective ventilatory measure arises in combination with alveolar recruitment maneuver. This association is believed in clinical practice to determine importantly reduced morbidity and mortality as well as reduced mechanic ventilation-induced injuries. It is indicated for acute lung injury patients, generally from pneumonia or sepsis, with severe hypoxemia. Its main contraindications are homodynamic instability, pneumothorax and intracranial hypertension. Experimental trials showed beneficial maneuver effects on both oxygenation and alveolar collapse. Adult studies showed improved pulmonary function with hypoxemia reversion. In children, the maneuver lead to significant inspired oxygen fraction and alveolar collapse reductions, less oxygen dependency, improved pulmonary complacency, and reduced bronchopulmonary dysplasia. However, studies in children are limited. Additional investigation is warranted on this matter, and its clinical application evidence. A literature review was conducted based on textbooks and MEDLINE, Pubmed, Cochrane library, SciELO, and Ovid databases, from 1998 to 2009, both in Portuguese and English. Publications on alveolar recruitment maneuver both in adults and children, review articles, experimental and clinical trials were included using the key words: protective ventilatory strategy, alveolar recruitment maneuver, pediatrics and mechanic ventilation. PMID:25307339

  9. Liquid Ventilation

    OpenAIRE

    Tawfic, Qutaiba A.

    2011-01-01

    Mammals have lungs to breathe air and they have no gills to breath liquids. When the surface tension at the air-liquid interface of the lung increases, as in acute lung injury, scientists started to think about filling the lung with fluid instead of air to reduce the surface tension and facilitate ventilation. Liquid ventilation (LV) is a technique of mechanical ventilation in which the lungs are insufflated with an oxygenated perfluorochemical liquid rather than an oxygen-containing gas mixt...

  10. Helium-oxygen reduces the production of carbon dioxide during weaning from mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Flynn Gordon

    2010-08-01

    Full Text Available Abstract Background Prolonged weaning from mechanical ventilation has a major impact on ICU bed occupancy and patient outcome, and has significant cost implications. There is evidence in patients around the period of extubation that helium-oxygen leads to a reduction in the work of breathing. Therefore breathing helium-oxygen during weaning may be a useful adjunct to facilitate weaning. We hypothesised that breathing helium-oxygen would reduce carbon dioxide production during the weaning phase of mechanical ventilation. Materials/patients and methods We performed a prospective randomised controlled single blinded cross-over trial on 19 adult intensive care patients without significant airways disease who fulfilled criteria for weaning with CPAP. Patients were randomised to helium-oxygen and air-oxygen delivered during a 2 hour period of CPAP ventilation. Carbon dioxide production (VCO2 was measured using a near patient main stream infrared carbon dioxide sensor and fixed orifice pneumotachograph. Results Compared to air-oxygen, helium-oxygen significantly decreased VCO2 production at the end of the 2 hour period of CPAP ventilation; there was a mean difference in CO2 production of 48.9 ml/min (95% CI 18.7-79.2 p = 0.003 between the groups. There were no significant differences in other respiratory and haemodynamic parameters. Conclusion This study shows that breathing a helium-oxygen mixture during weaning reduces carbon dioxide production. This physiological study supports the need for a clinical trial of helium-oxygen mixture during the weaning phase of mechanical ventilation with duration of weaning as the primary outcome. Trial registration ISRCTN56470948

  11. Development of Localized Pulmonary Interstitial Emphysema in a Late Preterm Infant without Mechanical Ventilation

    Directory of Open Access Journals (Sweden)

    Pritish Bawa

    2014-01-01

    Full Text Available Pulmonary interstitial emphysema (PIE is not an uncommon finding in premature infants with respiratory distress who need respiratory support by mechanical ventilation. PIE has been reported in a few cases of neonates in whom either no treatment other than room air was given or they were given continuous positive end-expiratory pressure (CPAP support. We present a case of a premature neonate who presented with respiratory distress, in whom PIE and spontaneous pneumothorax (PTX developed while on CPAP therapy only. The patient was treated conservatively with subsequent resolution of the radiological findings and clinical improvement. No surgical intervention was required. It is important to know that PIE may develop independently of mechanical ventilation. We would like to add this case to the literature and describe the pertinent plain film and computed tomography (CT findings of this entity, the possible mechanism of development, and the differential diagnosis. A review of the literature is also provided.

  12. Variable versus conventional lung protective mechanical ventilation during open abdominal surgery: study protocol for a randomized controlled trial

    OpenAIRE

    Peter M Spieth; Güldner, Andreas; Uhlig, Christopher; Bluth, Thomas; Kiss, Thomas; Schultz, Marcus J.; Pelosi, Paolo; Koch, Thea; Gama de Abreu, Marcelo

    2014-01-01

    Background General anesthesia usually requires mechanical ventilation, which is traditionally accomplished with constant tidal volumes in volume- or pressure-controlled modes. Experimental studies suggest that the use of variable tidal volumes (variable ventilation) recruits lung tissue, improves pulmonary function and reduces systemic inflammatory response. However, it is currently not known whether patients undergoing open abdominal surgery might benefit from intraoperative variable ventila...

  13. Actual performance of mechanical ventilators in ICU: a multicentric quality control study

    Directory of Open Access Journals (Sweden)

    Govoni L

    2012-12-01

    Full Text Available Leonardo Govoni,1 Raffaele L Dellaca,1 Oscar Peñuelas,2,3 Giacomo Bellani,4,5 Antonio Artigas,3,6 Miquel Ferrer,3,7 Daniel Navajas,3,8,9 Antonio Pedotti,1 Ramon Farré3,81TBM-Lab, Dipartimento di Bioingegneria, Politecnico di Milano University, Milano, Italy; 2Hospital Universitario de Getafe – CIBERES, Madrid, Spain; 3CIBER de Enfermedades Respiratorias, Bunyola, Spain; 4Department of Experimental Medicine, University of Milan, Bicocca, Italy; 5Department of Perioperative Medicine and Intensive Care, San Gerardo Hospital, Monza (MI, Italy; 6Critical Care Center, Sabadell Hospital, Corporació Sanitaria Universitaria Parc Tauli, Universitat Autonoma de Barcelona, CIBERES, Spain; 7Department of Pneumology, Hospital Clinic, IDIBAPS, Barcelona, Spain; 8Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universidad de Barcelona-IDIBAPS, Barcelona, Spain; 9Institut de Bioenginyeria de Catalunya, Barcelona, SpainAbstract: Even if the performance of a given ventilator has been evaluated in the laboratory under very well controlled conditions, inappropriate maintenance and lack of long-term stability and accuracy of the ventilator sensors may lead to ventilation errors in actual clinical practice. The aim of this study was to evaluate the actual performances of ventilators during clinical routines. A resistance (7.69 cmH2O/L/s – elastance (100 mL/cmH2O test lung equipped with pressure, flow, and oxygen concentration sensors was connected to the Y-piece of all the mechanical ventilators available for patients in four intensive care units (ICUs; n = 66. Ventilators were set to volume-controlled ventilation with tidal volume = 600 mL, respiratory rate = 20 breaths/minute, positive end-expiratory pressure (PEEP = 8 cmH2O, and oxygen fraction = 0.5. The signals from the sensors were recorded to compute the ventilation parameters. The average ± standard deviation and range (min–max of the ventilatory parameters were the following: inspired

  14. Heliox improves pulmonary mechanics in a pediatric porcine model of induced severe bronchospasm and independent lung mechanical ventilation

    OpenAIRE

    Orsini, Anthony J; Stefano, John L; Leef, Kathleen H; Jasani, Melinda; Ginn, Andrew; Tice, Lisa; Nadkarni, Vinay M.

    1999-01-01

    Background: A helium-oxygen gas mixture (heliox) has low gas density and low turbulence and resistance through narrowed airways. The effects of heliox on pulmonary mechanics following severe methacholine-induced bronchospasm were investigated and compared to those of a nitrogen-oxygen gas mixture (nitrox) in an innovative pediatric porcine, independent lung, mechanical ventilation model. Results: All of the lungs showed evidence of severe bronchospasm after methacholine challenge. Prospective...

  15. Comparison of INSURE method with conventional mechanical ventilation after surfactant administration in preterm infants with respiratory distress syndrome: therapeutic challenge.

    Directory of Open Access Journals (Sweden)

    Fatemeh Sadat Nayeri

    2014-08-01

    Full Text Available Administration of endotracheal surfactant is potentially the main treatment for neonates suffering from RDS (Respiratory Distress Syndrome, which is followed by mechanical ventilation. Late and severe complications may develop as a consequence of using mechanical ventilation. In this study, conventional methods for treatment of RDS are compared with surfactant administration, use of mechanical ventilation for a brief period and NCPAP (Nasal Continuous Positive Airway Pressure, (INSURE method ((Intubation, Surfactant administration and extubation. A randomized clinical trial study was performed, including all newborn infants with diagnosed RDS and a gestational age of 35 weeks or less, who were admitted in NICU of Valiasr hospital. The patients were then divided randomly into two CMV (Conventional Mechanical Ventilation and INSURE groups. Surfactant administration and consequent long-term mechanical ventilation were done in the first group (CMV group. In the second group (INSURE group, surfactant was administered followed by a short-term period of mechanical ventilation. The infants were then extubated, and NCPAP was embedded. The comparison included crucial duration of mechanical ventilation and oxygen therapy, IVH (Intraventricular Hemorrhage, PDA (Patent Ductus Arteriosus, air-leak syndromes, BPD (Broncho-Pulmonary Dysplasia and mortality rate. The need for mechanical ventilation in 5th day of admission was 43% decreased (P=0.005 in INSURE group in comparison to CMV group. A decline (P=0.01 in the incidence of IVH and PDA was also achieved. Pneumothorax, chronic pulmonary disease and mortality rates, were not significantly different among two groups. (P=0.25, P=0.14, P=0.25, respectively. This study indicated that INSURE method in the treatment of RDS decreases the need for mechanical ventilation and oxygen-therapy in preterm neonates. Moreover, relevant complications as IVH and PDA were observed to be reduced. Thus, it seems rationale to

  16. The role of exogenous surfactant in the treatment of ARDS%外源性肺表面活性物质在ARDS中的治疗作用

    Institute of Scientific and Technical Information of China (English)

    陆月明

    2004-01-01

    Several studies have demonstrated that alterations of pulmonary surfactant system contribute to the lung dysfunction associated with acute respiratory distress syndrome (ARDS). There have been many animal experiments and clinical investigations evaluating exogenous surfactant in ARDS models or patients. Exogenous surfactant administration has proven inconsistent as a therapeutic modality for patients with ARDS. Various factors that may influence a host response to exogenous surfactant, these factots include: the nature and severity of the underlying injury,the surfactant preparation utilized, the amount, frequency, and method of surfactant administration, the mode of ventilation used during and after surfactant delivery, and the timing or surfactant administration over the course of the illness

  17. Can Tracheostomy Improve Outcome and Lower Resource Utilization for Patients with Prolonged Mechanical Ventilation?

    Institute of Scientific and Technical Information of China (English)

    Ciou-Rong Yuan; Tzuo-Yun Lan; Gau-Jun Tang

    2015-01-01

    Background:It is not clear whether the benefits oftracheostomy remain the same in the population.This study aimed to better examine the effect of tracheostomy on clinical outcome among prolonged ventilator patients.Methods:Data were from the medical claims data in Taiwan.A total of 3880 patients with ventilator use for more than 14 days between 2005 and 2009 were identified.Among them,645 patients with tracheostomy conducted within 30 days of ventilator use were compared to 2715 patients without tracheostomy on death during hospitalization and study period,and successful weaning and medical utilization during hospitalization.Cox proportional hazards and linear regression models were used to examine the associations between tracheostomy and the main outcomes.Results:The tracheostomy rate was 30%,and 55% of tracheostomies were performed within 30 days of mechanical ventilation.After adjustments,patients with tracheostomy were at a lower risk of death during hospitalization (hazard ratio [HR] =0.51;95% confidence interval [CI] =0.43-0.61) and 5-year observation (HR =0.73;95% CI =0.66-0.81),and a lower probability of successful weaning (HR =0.88;95% CI =0.79-0.99).Higher medical use was also observed in patients with tracheostomy.Conclusions:The beneficial effect for tracheostomy observed in our data was the reduction of death.However,patients with tracheostomy were less likely to wean and more likely to consume medical resources.

  18. Performance of a demand controlled mechanical extract ventilation system for dwellings

    Directory of Open Access Journals (Sweden)

    I. Pollet

    2013-10-01

    Full Text Available The main aim of ventilation is to guarantee a good indoor air quality, related to the energy consumed for heating and fan(s. Active or passive heat recovery systems seem to focus on the reduction of heating consumption at the expense of fan electricity consumption and maintenance. In this study, demandcontrolled mechanical extract ventilation systems of Renson (DCV1 and DCV2, based on natural supply in the habitable rooms and mechanical extraction in the wet rooms (or even the bedrooms, was analysed for one year by means of multi-zone Contam simulations on a reference detached house and compared with standard MEV and mechanical extract ventilation systems with heat recovery (MVHR. To this end, IAQ, total energy consumption, CO2 emissions and total cost of the systems are determined. The results show that DCV systems with increased supply air flow rates or direct mechanical extract from bedrooms can significantly improve IAQ, while reducing total energy consumption compared to MEV. Applying DCV reduces primary heating energy consumption and yearly fan electricity consumption at most by 65% to 50% compared to MEV. Total operational energy costs and CO2 emissions of DCV are similar when compared to MVHR. Total costs of DCV systems over 15 years are smaller when compared to MVHR due to lower investment and maintenance costs.

  19. Chest radiological patterns predict the duration of mechanical ventilation in children with RSV infection

    International Nuclear Information System (INIS)

    RSV-infected children demonstrate various radiographic features, some of which are associated with worse clinical outcomes. To investigate whether specific chest radiological patterns in RSV-infected children with acute respiratory failure (ARF) in the peri-intubation period are associated with prolonged duration of mechanical ventilation. We included RSV-infected children 8 days, a backward stepwise regression arrived at a model that included age and right and left lung atelectasis. Using day 2 chest radiograph results, the best model included age and left lung atelectasis. A model combining the two days' findings yielded an area under the ROC curve of 0.92 with a satisfactory fit (P = 0.95). Chest radiological patterns around the time of intubation can identify children with RSV-associated ARF who would require prolonged mechanical ventilation. (orig.)

  20. Effects of surfactant depletion on regional pulmonary metabolic activity during mechanical ventilation.

    Science.gov (United States)

    de Prost, Nicolas; Costa, Eduardo L; Wellman, Tyler; Musch, Guido; Winkler, Tilo; Tucci, Mauro R; Harris, R Scott; Venegas, Jose G; Vidal Melo, Marcos F

    2011-11-01

    Inflammation during mechanical ventilation is thought to depend on regional mechanical stress. This can be produced by concentration of stresses and cyclic recruitment in low-aeration dependent lung. Positron emission tomography (PET) with (18)F-fluorodeoxyglucose ((18)F-FDG) allows for noninvasive assessment of regional metabolic activity, an index of neutrophilic inflammation. We tested the hypothesis that, during mechanical ventilation, surfactant-depleted low-aeration lung regions present increased regional (18)F-FDG uptake suggestive of in vivo increased regional metabolic activity and inflammation. Sheep underwent unilateral saline lung lavage and were ventilated supine for 4 h (positive end-expiratory pressure = 10 cmH(2)O, tidal volume adjusted to plateau pressure = 30 cmH(2)O). We used PET scans of injected (13)N-nitrogen to compute regional perfusion and ventilation and injected (18)F-FDG to calculate (18)F-FDG uptake rate. Regional aeration was quantified with transmission scans. Whole lung (18)F-FDG uptake was approximately two times higher in lavaged than in nonlavaged lungs (2.9 ± 0.6 vs. 1.5 ± 0.3 10(-3)/min; P < 0.05). The increased (18)F-FDG uptake was topographically heterogeneous and highest in dependent low-aeration regions (gas fraction 10-50%, P < 0.001), even after correction for lung density and wet-to-dry lung ratios. (18)F-FDG uptake in low-aeration regions of lavaged lungs was higher than that in low-aeration regions of nonlavaged lungs (P < 0.05). This occurred despite lower perfusion and ventilation to dependent regions in lavaged than nonlavaged lungs (P < 0.001). In contrast, (18)F-FDG uptake in normally aerated regions was low and similar between lungs. Surfactant depletion produces increased and heterogeneously distributed pulmonary (18)F-FDG uptake after 4 h of supine mechanical ventilation. Metabolic activity is highest in poorly aerated dependent regions, suggesting local increased inflammation.

  1. Indoor air quality and occupant satisfaction in five mechanically and four naturally ventilated open-plan office buildings

    DEFF Research Database (Denmark)

    Hummelgarrd, John; Juhl, Peter; Sæbjörnsson, Kristian;

    2005-01-01

    The indoor air quality and occupant satisfaction was studied in five mechanically ventilated and four naturally ventilated open-plan office buildings in Copenhagen, using a simplified assessment procedure. Temperature and the concentration of CO2 were monitored in 2-10 locations per office to...... evaluate the variation throughout the offices. A representative measurement point was subsequently selected and measurements of the same parameters were made during one week. All offices were monitored during the same week and occupant responses to the indoor environment were collected via the Internet on...... the same day within that week. The study indicated that occupants in naturally ventilated offices have a lower prevalence of symptoms than those in mechanically ventilated offices. Although the room air temperature varied more and the concentration of CO2 was higher in the naturally ventilated offices...

  2. Role of Ventilation in Cases of Acute Respiratory Distress Syndrome /Acute Lung injury

    Directory of Open Access Journals (Sweden)

    Hemant M Shah

    2014-02-01

    Conclusion: Early application of Non-invasive ventilation in patients of ARDS/ALI, in form of high PEEP and low Tidal Volume, which helps in clearance of secretion and prevents collapse of alveoli and thereby decreases need of invasive ventilation as well as decreases the mortality due to ARDS/ALI;and thereby 100% chances of improvement. In invasive ventilation, outcome of the patients is not favorable. [Natl J Med Res 2014; 4(1.000: 48-52

  3. Perceptions of Patients and Families who Received a Music Intervention During Mechanical Ventilation

    OpenAIRE

    Tracy, Mary Fran; Chlan, Linda; Staugaitis, Abbey

    2015-01-01

    The intensive care unit (ICU) is a technologically-driven environment where critically ill patients and their families have significant physical and emotional experiences. Mechanically ventilated (MV) patients can experience significant distress from anxiety and pain. Music listening is one integrative intervention that has been shown to reduce anxiety as well as other symptoms that contribute to distress in MV patients. This is a report of MV patient and family experiences from a larger rese...

  4. Effects of hand massage and acupressure therapy for mechanically ventilated patients

    OpenAIRE

    Şebnem Çınar Yücel; İsmet Eser

    2015-01-01

    Purpose: This research is an experimental study (randomized controlled) which is carried out to investigate the effect on anxiety of hand massage and acupressure therapy in patients having mechanical ventilation support. Method and material: This randomized controlled research was conducted in Intensive care units of Ege University Faculty of Medicine, Department of Chest Diseases and Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital between the dates 18 June ...

  5. Mechanical ventilation in patients with chronic obstructive pulmonary disease and bronchial asthma

    OpenAIRE

    Ahmed, Syed Moied; Athar, Manazir

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) and bronchial asthma often complicate the surgical patients, leading to post-operative morbidity and mortality. Many authors have tried to predict post-operative pulmonary complications but not specifically in COPD. The aim of this review is to provide recent evidence-based guidelines regarding predictors and ventilatory strategies for mechanical ventilation in COPD and bronchial asthma patients. Using Google search for indexing databases, a search...

  6. Development of Localized Pulmonary Interstitial Emphysema in a Late Preterm Infant without Mechanical Ventilation

    OpenAIRE

    Pritish Bawa; Kultida Soontarapornchai; Agnes Perenyi; Rachelle Goldfisher; John Amodio

    2014-01-01

    Pulmonary interstitial emphysema (PIE) is not an uncommon finding in premature infants with respiratory distress who need respiratory support by mechanical ventilation. PIE has been reported in a few cases of neonates in whom either no treatment other than room air was given or they were given continuous positive end-expiratory pressure (CPAP) support. We present a case of a premature neonate who presented with respiratory distress, in whom PIE and spontaneous pneumothorax (PTX) developed whi...

  7. Invasive pulmonary aspergillosis caused by Aspergillus versicolor in a patient on mechanical ventilation

    OpenAIRE

    MV Pravin Charles; M Ravishankar; Easow, Joshy M; Noyal Mariya Joseph

    2011-01-01

    Aspergillus spp. often colonise the respiratory tract of critically ill patients in intensive care units and subsequently cause invasive disease. The risk of developing invasive disease is more in immunocompromised patients. Here we report a case of fatal invasive pulmonary aspergillosis caused by Aspergillus versicolor in a post-operative patient on mechanical ventilation, who did not respond to intravenous itraconazole. We then discuss the challenges involved in the accurate diagnosis of th...

  8. Helium-oxygen reduces the production of carbon dioxide during weaning from mechanical ventilation

    OpenAIRE

    Flynn Gordon; Mandersloot Gerlinde; Healy Marie; Saville Mark; McAuley Daniel F

    2010-01-01

    Abstract Background Prolonged weaning from mechanical ventilation has a major impact on ICU bed occupancy and patient outcome, and has significant cost implications. There is evidence in patients around the period of extubation that helium-oxygen leads to a reduction in the work of breathing. Therefore breathing helium-oxygen during weaning may be a useful adjunct to facilitate weaning. We hypothesised that breathing helium-oxygen would reduce carbon dioxide production during the weaning phas...

  9. Association of C - Reactive Protein and Body Mass Index with Duration of Mechanical Ventilation in

    OpenAIRE

    M. Safavi, M.D; A. Honarmand, M.D

    2007-01-01

    AbstractBackground and purpose: The aim of this study was to determine the incidence and presence of a relationship between predictors of body mass index (BMI) or C-reactive protein (CRP) and duration of mechanical ventilation, in trauma patients who were admitted to the intensive care unite (ICU). Furthermore, we compared their prognostic significance, with known indicators such as, the Sequential Organ Failure Assessment (SOFA) score.Materials and Methods: This prospective observational stu...

  10. Decreasing the need for mechanical ventilation after surgery forretinopathy of prematurity: sedoanalgesia vs. general anesthesia

    OpenAIRE

    Ülgey, Ayşe; GÜNEŞ, IŞIN; BAYRAM, ADNAN; Aksu, Recep; BİÇER, CİHANGİR; UĞUR, FATİH; KARACA, ÇAĞATAY; Boyaci, Adem

    2015-01-01

    Background/aim: Premature infants experience more respiratory problems after surgical procedures. We aimed to compare general anesthesia with sedation regarding the need for postoperative mechanical ventilation in infants undergoing retinopathy of prematurity (ROP) surgery. Materials and methods: Sixty patients who underwent laser surgery for ROP were included in this study. This study was performed between October 2010 and December 2012. The sedation group (Group S, n = 30) received 1 mg/kg...

  11. Characterisation of manual chest physiotherapy and respiratory response in mechanically ventilated children

    OpenAIRE

    Gregson, Rachael Kathleen

    2008-01-01

    Chest physiotherapy is integral to the management of mechanically ventilated children and previous research has confirmed that chest wall vibrations are the manual techniques used most frequently by physiotherapists in this population. Chest wall vibrations involve the application of a compressive force to the chest during expiration, with the aim of removing accumulated secretions and improving lung aeration. However, these techniques are largely unquantified and may vary grea...

  12. Effects of hand massage and acupressure therapy for mechanically ventilated patients

    Directory of Open Access Journals (Sweden)

    Şebnem Çınar Yücel

    2015-10-01

    Results: According to the research findings, it wasn’t found significant as clinical which is the statistically significant difference in the physiological indicators of anxiety, perceived anxiety and dyspnoea except from oxygen saturation. Conclusion: In conclusion, our results suggest that hand massage and acupressure therapy might effectively relieve perceived dyspnoea and anxiety and reduce physiological indicators of anxiety in patients having mechanical ventilation support. The study provides a research-based intervention model for clinicians caring for MVP.

  13. Biophysical determinants of alveolar epithelial plasma membrane wounding associated with mechanical ventilation

    OpenAIRE

    Hussein, Omar; Walters, Bruce; Stroetz, Randolph; Valencia, Paul; McCall, Deborah; Hubmayr, Rolf D.

    2013-01-01

    Mechanical ventilation may cause harm by straining lungs at a time they are particularly prone to injury from deforming stress. The objective of this study was to define the relative contributions of alveolar overdistension and cyclic recruitment and “collapse” of unstable lung units to membrane wounding of alveolar epithelial cells. We measured the interactive effects of tidal volume (VT), transpulmonary pressure (PTP), and of airspace liquid on the number of alveolar epithelial cells with p...

  14. Higher Pulmonary Dead Space May Predict Prolonged Mechanical Ventilation After Cardiac Surgery

    OpenAIRE

    Ong, Thida; Stuart-Killion, Regan B.; Daniel, Brian M.; Presnell, Laura B.; Zhuo, Hanjing; Matthay, Michael A; Liu, Kathleen D

    2009-01-01

    Children undergoing congenital heart surgery are at risk for prolonged mechanical ventilation and length of hospital stay. We investigated the prognostic value of pulmonary dead space fraction as a non-invasive, physiologic marker in this population. In a prospective, cross-sectional study, we measured pulmonary dead space fraction in 52 intubated, pediatric patients within 24 hr postoperative from congenital heart surgery. Measurements were obtained with a bedside, non-invasive cardiac outpu...

  15. Intrapulmonary haematoma complicating mechanical ventilation in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Bonmarchand, G; Lefebvre, E; Lerebours-Pigeonnière, G; Genevois, A; Massari, P; Leroy, J

    1988-01-01

    Intrapulmonary haematomas occurred during mechanical ventilation of two patients with advanced chronic obstructive pulmonary disease and bullous dystrophy. In both cases, the haematomas were revealed by blood-stained aspirates, a fall in haemoglobin level, and the appearance of radiological opacities. Haematoma occurrence in the area of a bulla which recently has rapidly increased in size, suggests that the haematoma is due to the rupture of stretched vessels embedded in the wall of the bulla. PMID:3379188

  16. Static respiratory compliance in the newborn. I: A clinical and prognostic index for mechanically ventilated infants.

    OpenAIRE

    Tarnow-Mordi, W O; Wilkie, R A; Reid, E

    1994-01-01

    Accurate measures of the severity of respiratory disease are important, both clinically and epidemiologically. The apparent prognostic value of static respiratory system compliance (Crs) on the first day and mean appropriate fractional inspired oxygen (FIO2) in the first 12 hours of life were compared in 48 infants who received mechanical ventilation in a regional neonatal unit. Their median (range) gestation was 30 (25-41) weeks and they were representative of all 140 newborn infants born to...

  17. Early Rehabilitation Therapy Is Beneficial for Patients With Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery.

    Science.gov (United States)

    Dong, Zehua; Yu, Bangxu; Zhang, Quanfang; Pei, Haitao; Xing, Jinyan; Fang, Wei; Sun, Yunbo; Song, Zhen

    2016-01-01

    We investigated the effects of early rehabilitation therapy on prolonged mechanically ventilated patients after coronary artery bypass surgery (CABG).A total of 106 patients who underwent CABG between June 2012 and May 2015 were enrolled and randomly assigned into an early rehabilitation group (53 cases) and a control group (53 cases). The rehabilitation therapy consisted of 6 steps including head up, transferring from supination to sitting, sitting on the edge of bed, sitting in a chair, transferring from sitting to standing, and walking along a bed. The patients received rehabilitation therapy in the intensive care unit (ICU) after CABG in the early rehabilitation group. The control group patients received rehabilitation therapy after leaving the ICU.The results showed that the early rehabilitation therapy could significantly decrease the duration of mechanical ventilation (early rehabilitation group: 8.1 ± 3.3 days; control group: 13.9 ± 4.1 days, P rehabilitation group: 22.0 ± 3.8 days; control group: 29.1 ± 4.6 days, P ICU stay (early rehabilitation group: 11.7 ± 3.2 days; control group: 18.3 ± 4.2 days, P rehabilitation group were larger than that in the control group after 7 days of rehabilitation therapy (logrank test: P rehabilitation therapy in patients requiring prolonged mechanical ventilation after CABG. PMID:26973269

  18. Simultaneous tracheal and oesophageal pH monitoring during mechanical ventilation.

    Science.gov (United States)

    Hue, V; Leclerc, F; Gottrand, F; Martinot, A; Crunelle, V; Riou, Y; Deschildre, A; Fourier, C; Turck, D

    1996-01-01

    OBJECTIVE: To simultaneously record tracheal and oesophageal pH in mechanically ventilated children to determine: (1) the feasibility and safety of the method; (2) the incidence of gastro-oesophageal reflux (GOR) and pulmonary contamination; and (3) their associated risk factors. DESIGN: Prospective study. SETTING: Paediatric intensive care unit in a university hospital. PATIENTS: Twenty mechanically ventilated children (mean age 6.7 years) who met the following inclusion criteria: endotracheal tube with an internal diameter of 4 mm or more (cuffed or uncuffed), mechanical ventilation for an acute disease, no treatment with antiacids, prokinetics, or H2-receptor blockers, and no nasogastric or orogastric tube. METHODS: The tracheal antimony pH probe was positioned 1 cm below the distal end of the endotracheal tube. The oesophageal antimony pH probe was positioned at the lower third of the oesophagus. pH was recorded on a double channel recorder and analysed with EsopHogram 5.01 software and by examination of the trace. The following definitions were used: GOR index, percentage of time pH 4.8%; tracheal reflux, fall in tracheal pH Tracheal reflux (pH aspiration. Episodes of tracheal reflux were associated with a GOR index > 10% (p tracheal and oesophageal pH monitoring was feasible in the setting of this study. Tracheal reflux can occur without pathological GOR, and GOR may occur without tracheal reflux. Further prospective studies in larger groups of patients are now justified. PMID:8813870

  19. Analysis of thermal comfort and indoor air quality in a mechanically ventilated theatre

    Energy Technology Data Exchange (ETDEWEB)

    Kavgic, M.; Mumovic, D.; Young, A. [The Bartlett School of Graduate Studies, University College London, Gower Street, London, WC1E 6BT, England (United Kingdom); Stevanovic, Z. [Institute of Nuclear Sciences - Vinca, P.O. Box 522, 11001 Belgrade (RS)

    2008-07-01

    Theatres are the most complex of all auditorium structures environmentally. They usually have high heat loads, which are of a transient nature as audiences come and go, and from lighting which changes from scene to scene, and they generally have full or nearly full occupancy. Theatres also need to perform well acoustically, both for the spoken word and for music, and as sound amplification is less used than in other auditoria, background noise control is critically important. All these factors place constraints on the ventilation design, and if this is poor, it can lead to the deterioration of indoor air quality and thermal comfort. To analyse the level of indoor air quality and thermal comfort in a typical medium-sized mechanically ventilated theatre, and to identify where improvements could typically be made, a comprehensive post-occupancy evaluation study was carried out on a theatre in Belgrade. The evaluation, based on the results of monitoring (temperature, relative humidity, CO{sub 2}, air speed and heat flux) and modelling (CFD), as well as the assessment of comfort and health as perceived by occupants, has shown that for most of the monitored period the environmental parameters were within the standard limits of thermal comfort and IAQ. However, two important issues were identified, which should be borne in mind by theatre designers in the future. First, the calculated ventilation rates showed that the theatre was over-ventilated, which will have serious consequences for its energy consumption, and secondly, the displacement ventilation arrangement employed led to higher than expected complaints of cold discomfort, probably due to cold draughts around the occupants' feet. (author)

  20. The FiO2 is associated with the successful extubation of mechanically ventilated neonates

    Directory of Open Access Journals (Sweden)

    Shepherd EG

    2011-09-01

    Full Text Available Edward G Shepherd1, Lori J Alexander2, Brandon Kuehne2, Kristina M Reber1, Leif D Nelin1,31Department of Pediatrics, The Ohio State University, Columbus, OH, USA; 2Neonatal Respiratory Therapy, Nationwide Children's Hospital, Columbus, OH, USA; 3Center for Perinatal Research, Research Institute at Nationwide Children's Hospital, Columbus, OH, USAAbstract: Early extubation may be beneficial in preventing or attenuating the development of bronchopulmonary dysplasia (BPD. We tested the hypothesis that patients extubated from higher ventilator pressures would be more likely to fail extubation. To determine the relationship between peak inspiratory pressure (PIP, positive end expiratory pressure (PEEP, and fraction of inspired oxygen (FiO2 at the time of extubation and success of extubation, we reviewed the charts of all patients extubated in our neonatal intensive care unit (NICU over two time periods; April 4, 2005–May 7, 2005 and November 14, 2005–January 7, 2006. Successful extubation was defined as not requiring re-intubation within 36 hours of extubation. There were 67 patients extubated during the study periods, and 58 patients (88% were successfully extubated. There was no difference in the ventilator settings (PIP, PEEP, mean airway pressure, ventilator rate, or inspiratory time between the patients with successful vs unsuccessful extubations. However, the FiO2 was significantly (P = 0.011 lower in the successful extubations (median 24, intraquartile range 21–31 than in the unsuccessful extubations (median 33, intraquartile range 28–43. The median PIP was 22 cm H2O (intraquartile range 20–24 in the patients successfully extubated. Our data suggest that the FiO2 may be the only ventilator setting associated with successful extubations in this patient population. Randomized control trials are needed to determine if extubating neonatal patients from relatively high PIP using FiO2 will shorten the duration of mechanical ventilation

  1. Ventilator-driven xenon ventilation studies

    International Nuclear Information System (INIS)

    A modification of a common commerical Xe-133 ventilation device is described for mechanically assisted ventilation imaging. The patient's standard ventilator serves as the power source controlling the ventilator rate and volume during the xenon study, but the gases in the two systems are not intermixed. This avoids contamination of the ventilator with radioactive xenon. Supplemental oxygen and positive end-expiratory pressure (PEEP) are provided if needed. The system can be converted quickly for conventional studies with spontaneous respiration

  2. Oral care in patients on mechanical ventilation in intensive care unit: literature review

    Directory of Open Access Journals (Sweden)

    Selma Atay

    2014-06-01

    Full Text Available intensive care patients needs to oral assessment and oral care for avoid complications caused by orafarengeal bacteria. In this literature review, it is aimed to determine the practice over oral hygiene in mechanical ventilator patients in intensive care unit. For the purpose of collecting data, Medline/pub MED and EBSCO HOST databases were searched with the keywords and lsquo;oral hygiene, oral hygiene practice, mouth care, mouth hygiene, intubated, mechanical ventilation, intensive care and critical care and rdquo; between the years of 2000- 2012. Inclusion criteria for the studies were being performed in adult intensive care unit patients on mechanical ventilation, published in peer-reviewed journals in English between the years of 2000-2012, included oral care practice and presence of a nurse among researchers. A total of 304 articles were identified. Six descriptive evaluation studies, three randomised controlled trials, four literature reviews, three meta-Analysis randomized clinical trials, one qualitative study and one semi-experimental study total 18 papers met all of the inclusion criteria. Oral care is emphasized as an infection control practice for the prevention of Ventilator-Associated Pneumonia (VAP. In conclusion, we mention that oral care is an important nursing practice to prevent VAP development in intensive care unit patients; however, there is no standard oral evaluation tool and no clarity on oral care practice frequency, appropriate solution and appropriate material. It can be recommended that the study projects on oral care in intensive care patients to have high proof level and be experimental, and longitudinal. [Int J Res Med Sci 2014; 2(3.000: 822-829

  3. Can selection of mechanical ventilation mode prevent increased intra-abdominal pressure in patients admitted to the intensive care unit?

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Rafiei

    2013-01-01

    Conclusions: There is a significant relationship between respiratory modes and IAP; therefore, it is better to utilize those types of mechanical ventilation like CPAP and BIPAP mode in patients who are prone to Intra-abdominal hypertension.

  4. Mechanical ventilation alone, and in the presence of sepsis, impair protein metabolism in the diaphragm of neonatal pigs

    Science.gov (United States)

    Mechanical ventilation (MV) impairs diaphragmatic function and diminishes the ability to wean from ventilatory support in adult humans. In normal neonatal pigs, animals that are highly anabolic, endotoxin (LPS) infusion induces sepsis, reduces peripheral skeletal muscle protein synthesis rates, but ...

  5. Respiratory mechanics and plasma levels of tumor necrosis factor alpha and interleukin 6 are affected by gas humidification during mechanical ventilation in dogs.

    Directory of Open Access Journals (Sweden)

    Claudia Hernández-Jiménez

    Full Text Available The use of dry gases during mechanical ventilation has been associated with the risk of serious airway complications. The goal of the present study was to quantify the plasma levels of TNF-alpha and IL-6 and to determine the radiological, hemodynamic, gasometric, and microscopic changes in lung mechanics in dogs subjected to short-term mechanical ventilation with and without humidification of the inhaled gas. The experiment was conducted for 24 hours in 10 dogs divided into two groups: Group I (n = 5, mechanical ventilation with dry oxygen dispensation, and Group II (n = 5, mechanical ventilation with oxygen dispensation using a moisture chamber. Variance analysis was used. No changes in physiological, hemodynamic, or gasometric, and radiographic constants were observed. Plasma TNF-alpha levels increased in group I, reaching a maximum 24 hours after mechanical ventilation was initiated (ANOVA p = 0.77. This increase was correlated to changes in mechanical ventilation. Plasma IL-6 levels decreased at 12 hours and increased again towards the end of the study (ANOVA p>0.05. Both groups exhibited a decrease in lung compliance and functional residual capacity values, but this was more pronounced in group I. Pplat increased in group I (ANOVA p = 0.02. Inhalation of dry gas caused histological lesions in the entire respiratory tract, including pulmonary parenchyma, to a greater extent than humidified gas. Humidification of inspired gases can attenuate damage associated with mechanical ventilation.

  6. Combination therapy with sivelestat and recombinant human soluble thrombomodulin for ARDS and DIC patients

    Directory of Open Access Journals (Sweden)

    Miyoshi S

    2014-09-01

    Full Text Available Seigo Miyoshi,1 Ryoji Ito,1 Hitoshi Katayama,1 Kentaro Dote,2 Mayuki Aibiki,3 Hironobu Hamada,1,4 Takafumi Okura,1 Jitsuo Higaki1 1Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, 2Intensive Care Division, Ehime University Hospital, 3Department of Emergency and Critical Care Medicine, School of Medicine, Ehime University, Shitsukawa, Toon, Ehime, 4Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minami-ku, Hiroshima, Japan Background: Neutrophil elastase, alveolar thrombin generation, and fibrin deposition play crucial roles in the development of acute respiratory distress syndrome (ARDS and disseminated intravascular coagulation (DIC. However, the usefulness of combination therapy with a selective neutrophil elastase inhibitor, sivelestat, and recombinant human soluble thrombomodulin (rhTM for patients with ARDS and DIC remains unknown. Methods: We conducted a retrospective data analysis of 142 ARDS patients with DIC to assess the effects of sivelestat combined with rhTM. Patients were divided into four groups: control (no sivelestat or rhTM treatment, sivelestat treatment alone, rhTM treatment alone, and combined treatment with sivelestat and rhTM. A Cox proportional hazard model was used to assess subject mortality rates. The efficacy of these drugs was evaluated based on survival rate, number of ventilator-free days, and change in PaO2/FIO2 (P/F ratios and DIC scores before and at 7 days after a diagnosis of ARDS with DIC. Results: Multivariate analysis showed that patient age, combination therapy, gas exchange, organ failure, cause, associated disease score, and serum C-reactive protein levels were predictors of mortality for patients with ARDS and DIC. As compared with untreated controls, combination therapy significantly improved the 60-day survival rate of patients with ARDS and DIC

  7. Gastro-oesophageal reflux in mechanically ventilated patients: effects of an oesophageal balloon.

    Science.gov (United States)

    Orozco-Levi, M; Félez, M; Martínez-Miralles, E; Solsona, J F; Blanco, M L; Broquetas, J M; Torres, A

    2003-08-01

    Gastro-oesophageal reflux (GOR) and bronchoaspiration of gastric content are risk factors linked with ventilator-associated pneumonia. This study was aimed at evaluating the effect of a nasogastric tube (NGT) incorporating a low-pressure oesophageal balloon on GOR and bronchoaspiration in patients receiving mechanical ventilation. Fourteen patients were studied in a semi-recumbent position for 2 consecutive days. Inflation or deflation of the oesophageal balloon was randomised. Samples of blood, gastric content, and oropharyngeal and bronchial secretions were taken every 2 h over a period of 8 h. A radioactively labelled nutritional solution was continuously administered through the NGT. The magnitude of both the GOR and bronchoaspiration was measured by radioactivity counting of oropharyngeal and bronchial secretion samples, respectively. Inflation of the oesophageal balloon resulted in a significant decrease of both GOR and bronchoaspiration of gastric content. This protective effect was statistically significant from 4 h following inflation throughout the duration of the study. This study demonstrates that an inflated oesophageal balloon delays and decreases gastro-oesophageal and bronchial aspiration of gastric content in patients carrying a nasogastric tube and receiving enteral nutrition during mechanical ventilation. Although the method was found to be safe when applied for 8 h, longer times should be considered with caution. PMID:12952272

  8. A sigmoidal fit for pressure-volume curves of idiopathic pulmonary fibrosis patients on mechanical ventilation: clinical implications

    OpenAIRE

    Juliana C. Ferreira; Fabio E. M. Benseñor; Rocha, Marcelo J J; Joao M. Salge; R. Scott Harris; Atul Malhotra; Kairalla, Ronaldo A; Kacmarek, Robert M; Carlos R. R. Carvalho

    2011-01-01

    OBJECTIVE: Respiratory pressure-volume curves fitted to exponential equations have been used to assess disease severity and prognosis in spontaneously breathing patients with idiopathic pulmonary fibrosis. Sigmoidal equations have been used to fit pressure-volume curves for mechanically ventilated patients but not for idiopathic pulmonary fibrosis patients. We compared a sigmoidal model and an exponential model to fit pressure-volume curves from mechanically ventilated patients with idiopathi...

  9. Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success.

    OpenAIRE

    Ambrosino, N; Foglio, K; Rubini, F.; Clini, E.; Nava, S.; M. Vitacca

    1995-01-01

    BACKGROUND--Non-invasive mechanical ventilation is increasingly used in the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to identify simple parameters to predict the success of this technique. METHODS--Fifty nine episodes of acute respiratory failure in 47 patients with COPD treated with non-invasive mechanical ventilation were analysed, considering each one as successful (78%) or unsuccessful (22%) according t...

  10. Mechanical ventilation in patients in the intensive care unit of a general university hospital in southern Brazil: an epidemiological study

    OpenAIRE

    Fialkow, Léa; Farenzena, Maurício; Wawrzeniak, Iuri Christmann; Brauner, Janete Salles; Vieira, Sílvia Regina Rios; Vigo, Alvaro; Bozzetti, Mary Clarisse

    2016-01-01

    OBJECTIVES: To determine the characteristics, the frequency and the mortality rates of patients needing mechanical ventilation and to identify the risk factors associated with mortality in the intensive care unit (ICU) of a general university hospital in southern Brazil. METHOD: Prospective cohort study in patients admitted to the ICU who needed mechanical ventilation for at least 24 hours between March 2004 and April 2007. RESULTS: A total of 1,115 patients admitted to the ICU needed mechani...

  11. EFFECTS OF THRESHOLD INSPIRATORY MUSCLE TRAINING VERSUS CONVENTIONAL PHYSIOTHERAPY ON THE WEANING PERIOD OF MECHANICALLY VENTILATED PATIENTS: A COMPARATIVE STUDY

    OpenAIRE

    Akansha Dixit; Shashwat Prakash

    2014-01-01

    Objective: To check the effectiveness of Conventional Physiotherapy and Threshold Inspiratory Muscle Training (TIMT) on the weaning period of mechanically ventilated patients. Background: Prolonged Mechanical ventilation (MV) of ICU patients is associated with high health care costs and respiratory muscle weakness which also has been suggested as a possible cause of delayed weaning from MV. Hence, TIMT may be seen as a possible accelerator for successful weaning. Study Design: ...

  12. Mechanical ventilation in patients in the intensive care unit of a general university hospital in southern Brazil: an epidemiological study

    OpenAIRE

    Léa Fialkow; Maurício Farenzena; Iuri Christmann Wawrzeniak; Janete Salles Brauner; Sílvia Regina Rios Vieira; Alvaro Vigo; Mary Clarisse Bozzetti

    2016-01-01

    OBJECTIVES: To determine the characteristics, the frequency and the mortality rates of patients needing mechanical ventilation and to identify the risk factors associated with mortality in the intensive care unit (ICU) of a general university hospital in southern Brazil. METHOD: Prospective cohort study in patients admitted to the ICU who needed mechanical ventilation for at least 24 hours between March 2004 and April 2007. RESULTS: A total of 1,115 patients admitted to the ICU needed mecha...

  13. The effect of open and closed endotracheal tube suctioning system on respiratory parameters of infants undergoing mechanical ventilation

    OpenAIRE

    Taheri, Parvin; Asgari, Narges; Mohammadizadeh, Majid; Golchin, Mehri

    2012-01-01

    Aims: Mechanical ventilation is used for some infants in neonatal intensive care units (NICU) due to many physiological and clinical causes. Since these patients have endotracheal tubes, cleaning and keeping the airways open through suctioning should be done to increase oxygenation. This study aimed to evaluate effect of open and closed suctioning methods on respiratory parameters of infants undergoing mechanical ventilation. Materials and Methods: In this crossover clinical trial, 44 infants...

  14. Individuality of breathing patterns in patients under noninvasive mechanical ventilation evidenced by chaotic global models

    Science.gov (United States)

    Letellier, Christophe; Rodrigues, Giovani G.; Muir, Jean-François; Aguirre, Luis A.

    2013-03-01

    Autonomous global models based on radial basis functions were obtained from data measured from patients under noninvasive mechanical ventilation. Some of these models, which are discussed in the paper, turn out to have chaotic or quasi-periodic solutions, thus providing a first piece of evidence that the underlying dynamics of the data used to estimate the global models are likely to be chaotic or, at least, have a chaotic component. It is explicitly shown that one of such global models produces attractors characterized by a Horseshoe map, two models produce toroidal chaos, and one model produces a quasi-periodic regime. These topologically inequivalent attractors evidence the individuality of breathing profiles observed in patient under noninvasive ventilation.

  15. Exercise testing of patients after a period of prolonged mechanical ventilation

    Directory of Open Access Journals (Sweden)

    R. Roos

    2004-02-01

    Full Text Available In this study, physical recovery of patients who received prolonged mechanical ventilation (PMV was assessed with a six-phase functional exercise test after the period of ventilation. A prospective correlation study using a consecutive sampling method was carried out over a six-month period. Thirty-one patients were tested but five were lost to follow-up Statistical tests included the Pearson’s correlation coefficient, student’s paired t-test and Kaplan-Meier survival estimate. Subjective perceived effort changed significantly from phase to phase in the exercise test and over time (p < 0.00 Heart rate and respiratory rate responses indicated increased cardio-respiratory effort during the test. No correlation existed between subjective perceived

  16. Typical patterns of expiratory flow and carbon dioxide in mechanically ventilated patients with spontaneous breathing

    DEFF Research Database (Denmark)

    Rees, Stephen Edward; Larraza Rico, Sebastián; Dey, N.;

    2016-01-01

    ) a large number of incomplete expirations (IncExp > 18) and small varETCO2. IncExp and varETCO2 were calculated from data describing respiratory flow and CO2 signals in 11 patients mechanically ventilated at 5 levels of pressure support. Data analysis showed that the three patterns presented systematically......Incomplete expiration of tidal volume can lead to dynamic hyperinflation and auto-PEEP. Methods are available for assessing these, but are not appropriate for patients with respiratory muscle activity, as occurs in pressure support. Information may exist in expiratory flow and carbon dioxide...... in expiration (IncExp), and the end tidal CO2 variability (varETCO2), over 20 breaths. Using these variables, three patterns of ventilation are postulated: (a) few incomplete expirations (IncExp

  17. Mortality and morbidity analysis in neonates supported by invasive mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Azer Kılıç Başkan

    2012-12-01

    Full Text Available Objectives: To evaluate mortality, morbidity, and invasivemechanical ventilation complications in mechanicallyventilated neonates in a tertiary care hospital, Istanbul,Turkey.Materials and methods: The neonates followed on invasivemechanical ventilation from January 2008 to December2009 were included in the study. A chart is formed foreach patient to record patient delivery room and clinicaldata prospectively.Results: The study population consisted of 236 neonates.Eighty-five percent were born at ≤37 completed weeks ofgestation (n=201. Fifty-two percent (n=123 were males.The mean gestational age was 31.9±5 weeks. The meanbirthweight was 1870.8±921.8 g. Antenatal steroid ratewas 13.3% (n=20 in 150 cases born at ≤34 weeks of gestation.Respiratory distress syndrome (n=100, 42,3%,perinatal depression and asphyxia (n=51, 21,6%, andsepsis (n=47, 19.9% were the commonest indications.Mechanical ventilation related complications (nosocomialinfection (n=57, pulmonary hemorrhage (n=30,pneumonia (n=10, pneumothorax (n=9, and atelectasis(n=4 developed in 33.5% of neonates (n=79. Bronchopulmonarydysplasia was 9.3%, intracranial hemorrhage(≥grade 3 8.47%, periventricular leukomalacia 5.93%,necrotizing enterocolitis (>stage 2 0.42%, and retinopathyof prematurity (>stage 2 2.96%. Mortality rate was30.17%. Neonates born at 1000 gram (p<0.05, p<0.05,respectively.Conclusions: Low birthweight and low gestational ageare important risk factors for neonatal mortality and morbidity.Low frequency of antenatal steroid use may be acontributing factor to increase neonatal mortality and morbidity.J Clin Exp Invest 2012; 3(4: 483-492Key words: Neonate, invasive mechanical ventilation,mortality, morbidity

  18. Re-inspiration of CO2 from ventilator circuit: effects of circuit flushing and aspiration of dead space up to high respiratory rate

    OpenAIRE

    De Robertis, Edoardo; Uttman, Leif; Jonson, Björn

    2010-01-01

    Introduction Dead space negatively influences carbon dioxide (CO2) elimination, particularly at high respiratory rates (RR) used at low tidal volume ventilation in acute respiratory distress syndrome (ARDS). Aspiration of dead space (ASPIDS), a known method for dead space reduction, comprises two mechanisms activated during late expiration: aspiration of gas from the tip of the tracheal tube and gas injection through the inspiratory line - circuit flushing. The objective was to study the effi...

  19. Mechanical Ventilation

    Science.gov (United States)

    ... hole placed in their neck and a tube (tracheostomy or “trach” tube ) is connected through that hole. ... Source: Manthous, C., Tobin, MJ. A Primer on Critical Care for Patients and Their Families Additional Resources American ...

  20. [The prone position in ARDS. A successful therapeutic strategy].

    Science.gov (United States)

    Hörmann, C; Benzer, H; Baum, M; Wicke, K; Putensen, C; Putz, G; Hartlieb, S

    1994-07-01

    As early as 1974, Brian advocated the prone position for ventilated patients. He suggested that this position might enhance ventilation of the dorsal parts of the lungs, thereby improving oxygenation. These considerations have been confirmed by several experimental and clinical studies. Better secretion removal, decreased intrapulmonary shunting, and an increased FRC are thought to be responsible for the observed improvement of oxygenation. However, the prone position never became very popular in the clinical treatment of the adult respiratory distress syndrome (ARDS). Routine performance of thoracic CT scans in ARDS patients demonstrated preferential distribution of pathological densities in the dependent lung areas. The prone position therefore could possibly benefit these patients, as shown by two recent studies. The aim of our study was to evaluate the influence of repeatedly turning the patient to the prone position on gas exchange and thoracic CT findings in multiple-trauma patients. METHODS. Seven ventilated intensive care patients with severe ARDS (Murray Score > 2.5, Quotient > 0.7, mean airway pressure > 18 cm H2O, thoracic CT scan showing dorsal atelectases) were included in the study. Patients were turned from the supine to the prone position at 12-h intervals using an air-cushion bed (Mediscus, Austria). Redistribution of dystelectatic or atelectatic dependent lung areas was verified by means of repeated thoracic CT scans (Figs. 1, 8). RESULTS. The patients were intermittently turned for 6.5 +/- 1.1 days. The course of gas exchange is shown in Figs. 2 and 3. Initially, improvement of the respiratory quotient could only be achieved during prone positioning, from the 2nd day in the supine position as well. Intrapulmonary shunting showed a similar trend (Figs. 4 and 5). No significant changes in cardiovascular parameters could be observed. Control thoracic CT scans showed uniform reduction of atelectases in dependent lung areas (Figs. 1 and 8). The

  1. Respiratory Mechanics and Plasma Levels of Tumor Necrosis Factor Alpha and Interleukin 6 Are Affected by Gas Humidification during Mechanical Ventilation in Dogs

    OpenAIRE

    HERNÁNDEZ-JIMÉNEZ, CLAUDIA; García-Torrentera, Rogelio; Olmos-Zúñiga, J. Raúl; Jasso-Victoria, Rogelio; Miguel O Gaxiola-Gaxiola; Baltazares-Lipp, Matilde; Gutiérrez-González, Luis H.

    2014-01-01

    The use of dry gases during mechanical ventilation has been associated with the risk of serious airway complications. The goal of the present study was to quantify the plasma levels of TNF-alpha and IL-6 and to determine the radiological, hemodynamic, gasometric, and microscopic changes in lung mechanics in dogs subjected to short-term mechanical ventilation with and without humidification of the inhaled gas. The experiment was conducted for 24 hours in 10 dogs divided into two groups: Group ...

  2. Acute effects of nitric oxide inhalation in ARDS: A dose finding study at steady state kinetics

    Directory of Open Access Journals (Sweden)

    Hari M

    2006-01-01

    Full Text Available Background: Inhaled Nitric oxide (INO decreases pulmonary artery pressures and improves oxygenation in patients with ARDS. Aim: To evaluate the dose response to 1-20 parts per million (ppm INO in ARDS, by noting changes in oxygenation, pulmonary artery systolic pressures (PASP and to determine optimum dose. Methodology and Design: Prospective study. Setting: 10 bed general intensive care unit. Patients: 13 consecutive patients with ARDS. Interventions: INO was given between 1-20 ppm with 15 minutes at each concentration via an insufflator from a high pressure source, to the inspiratory limb of the ventilator. Study had ascending and descending phase. Results and Conclusions: The optimum dose of INO to improve oxygenation was between 3 and 10 ppm. PaO2 improvement was independent of pulmonary haemodynamic changes. The pulmonary haemodynamic changes needed higher INO initially. Once stabilized, INO could be brought down to concentrations at which maximum improvement in PaO2 occurred. The ′responders′ had lesser duration of pre INO ventilation and lower PaO2/FiO2.

  3. Liquid Ventilation

    Directory of Open Access Journals (Sweden)

    Qutaiba A. Tawfic

    2011-01-01

    Full Text Available Mammals have lungs to breathe air and they have no gills to breath liquids. When the surface tension at the air-liquid interface of the lung increases, as in acute lung injury, scientists started to think about filling the lung with fluid instead of air to reduce the surface tension and facilitate ventilation. Liquid ventilation (LV is a technique of mechanical ventilation in which the lungs are insufflated with an oxygenated perfluorochemical liquid rather than an oxygen-containing gas mixture. The use of perfluorochemicals, rather than nitrogen, as the inert carrier of oxygen and carbon dioxide offers a number of theoretical advantages for the treatment of acute lung injury. In addition, there are non-respiratory applications with expanding potential including pulmonary drug delivery and radiographic imaging. The potential for multiple clinical applications for liquid-assisted ventilation will be clarified and optimized in future. Keywords: Liquid ventilation; perfluorochemicals; perfluorocarbon; respiratory distress; surfactant.

  4. The long-term mechanically ventilated patient. An outcomes management approach.

    Science.gov (United States)

    Burns, S M

    1998-03-01

    -management model, we recognize that other models may also result in comparable, favorable outcomes. It is important that those who adopt similar models of care delivery for managing patients requiring prolonged ventilation be scientific in their approach. Long-term studies of the efficacy of these models are essential if we are to truly provide quality care for our patients in the future. Unfortunately, as noted earlier, bias will be hard to overcome. Hospitals vested in rapidly establishing a stable financial bottom-line are likely to embrace quick applications. Projects with a true experimental design to evaluate efficacy, such as this one, will be rare in these organizations. Finally, it is critical that variables of interest be inclusive of specific quality indicators such as ventilator duration and complications rather than global institutional markers such as LOS. Standardization of variables of interest is imperative if outcomes are to be compared. For example, patients requiring long-term mechanical ventilation are identified by the AACN's Third National Study Group on weaning as those who require mechanical ventilation for more than 3 days. If we are to compare other variables of interest such as total ventilator duration, such as definition is essential or we will be comparing apples and oranges in the future. Provision of quality, cost-effective care for patients requiring prolonged ventilation is a true clinical challenge. Outcomes management is a multidisciplinary method of care delivery that is systematic and comprehensive in approach. Although little science exists related to the application of the model for patients requiring prolonged ventilation, preliminary reports are promising and warrant future applications and evaluation of the same.

  5. A micromechanical model for estimating alveolar wall strain in mechanically ventilated edematous lungs.

    Science.gov (United States)

    Chen, Zheng-long; Chen, Ya-zhu; Hu, Zhao-yan

    2014-09-15

    To elucidate the micromechanics of pulmonary edema has been a significant medical concern, which is beneficial to better guide ventilator settings in clinical practice. In this paper, we present an adjoining two-alveoli model to quantitatively estimate strain and stress of alveolar walls in mechanically ventilated edematous lungs. The model takes into account the geometry of the alveolus, the effect of surface tension, the length-tension properties of parenchyma tissue, and the change in thickness of the alveolar wall. On the one hand, our model supports experimental findings (Perlman CE, Lederer DJ, Bhattacharya J. Am J Respir Cell Mol Biol 44: 34-39, 2011) that the presence of a liquid-filled alveolus protrudes into the neighboring air-filled alveolus with the shared septal strain amounting to a maximum value of 1.374 (corresponding to the maximum stress of 5.12 kPa) even at functional residual capacity; on the other hand, it further shows that the pattern of alveolar expansion appears heterogeneous or homogeneous, strongly depending on differences in air-liquid interface tension on alveolar segments. The proposed model is a preliminary step toward picturing a global topographical distribution of stress and strain on the scale of the lung as a whole to prevent ventilator-induced lung injury. PMID:24947025

  6. Ammonia emissions from a naturally and a mechanically ventilated broiler house in Brazil

    Directory of Open Access Journals (Sweden)

    Luciano B. Mendes

    2014-11-01

    Full Text Available This study was conducted with the aim of monitoring NH3 emissions from a mechanically and a naturally ventilated broiler house (MVB and NVB, respectively and calculate their ammonia emission factors (fNH3. Bird stocking density was 13.5 and 11.1 birds m-2 for the MVB and NVB, respectively. The marketing age was 43 days and bedding consisted of dried coffee husks in its first time of use. Ventilation rates were calculated with the metabolic carbon dioxide mass balance method. Values of fNH3 were 0.32 ± 0.10 and 0.27 ± 0.07 g bird-1 d-1 for the MVB and NVB, respectively, and are in agreement to what was presented in other studies performed under similar conditions. The fNH3 estimated on yearly basis was 58 g bird-place-1 year-1. It was concluded that the different types of ventilation system between the studied broiler barns did not significantly affect emissions in the modeling process. The results obtained help providing reliable methodology for the determination of a solid database on NH3 emission factors for tropical conditions that can be used for future inventories, when performed in a sufficient number of barns that is representative for the Brazilian scenario.

  7. Effect of percutaneous endoscopic gastrostomy on gastro-esophageal reflux in mechanically-ventilated patients

    Institute of Scientific and Technical Information of China (English)

    Emmanuel E Douzinas; Andreas Tsapalos; Antonios Dimitrakopoulos; Evanthia Diamanti-Kandarakis; Alexandros D Rapidis; Charis Roussos

    2006-01-01

    AIM: To investigate the effect of percutaneous endoscopic gastrostomy (PEG) on gastroesophageal reflux (GER) in mechanically-ventilated patients.METHODS: In a prospective, randomized, controlled study 36 patients with recurrent or persistent ventilatorassociated pneumonia (VAP) and GER > 6% were divided into PEG group (n=16) or non-PEG group (n = 20).Another 11 ventilated patients without reflux (GER<3%) served as control group. Esophageal pH-metry was performed by the "pull through" method at baseline, 2and 7 d after PEG. Patients were strictly followed up for semi-recumbent position and control of gastric nutrient residue.RESULTS: A significant decrease of median (range) reflux was observed in PEG group from 7.8 (6.2-15.6) at baseline to 2.7 (0-10.4) on d 7 post-gastrostomy (P<0.01), while the reflux increased from 9 (6.2-22) to 10.8(6.3-36.6) (P<0.01) in non-PEG group. A significant correlation between GER (%) and the stay of nasogastric tube was detected (r=0.56, P<0.01).CONCLUSION: Gastrostomy when combined with semirecumbent position and absence of nutrient gastric residue reduces the gastroesophageal reflux in ventilated patients.

  8. A knowledge- and model-based system for automated weaning from mechanical ventilation: technical description and first clinical application.

    Science.gov (United States)

    Schädler, Dirk; Mersmann, Stefan; Frerichs, Inéz; Elke, Gunnar; Semmel-Griebeler, Thomas; Noll, Oliver; Pulletz, Sven; Zick, Günther; David, Matthias; Heinrichs, Wolfgang; Scholz, Jens; Weiler, Norbert

    2014-10-01

    To describe the principles and the first clinical application of a novel prototype automated weaning system called Evita Weaning System (EWS). EWS allows an automated control of all ventilator settings in pressure controlled and pressure support mode with the aim of decreasing the respiratory load of mechanical ventilation. Respiratory load takes inspired fraction of oxygen, positive end-expiratory pressure, pressure amplitude and spontaneous breathing activity into account. Spontaneous breathing activity is assessed by the number of controlled breaths needed to maintain a predefined respiratory rate. EWS was implemented as a knowledge- and model-based system that autonomously and remotely controlled a mechanical ventilator (Evita 4, Dräger Medical, Lübeck, Germany). In a selected case study (n = 19 patients), ventilator settings chosen by the responsible physician were compared with the settings 10 min after the start of EWS and at the end of the study session. Neither unsafe ventilator settings nor failure of the system occurred. All patients were successfully transferred from controlled ventilation to assisted spontaneous breathing in a mean time of 37 ± 17 min (± SD). Early settings applied by the EWS did not significantly differ from the initial settings, except for the fraction of oxygen in inspired gas. During the later course, EWS significantly modified most of the ventilator settings and reduced the imposed respiratory load. A novel prototype automated weaning system was successfully developed. The first clinical application of EWS revealed that its operation was stable, safe ventilator settings were defined and the respiratory load of mechanical ventilation was decreased.

  9. Role of Ventilation in Cases of Acute Respiratory Distress Syndrome /Acute Lung injury

    OpenAIRE

    Hemant M Shah; Shilpa B Sutariya; Parul M Bhatt; Nishil Shah; Shweta Gamit

    2014-01-01

    Introduction: Acute lung injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) are characterized by refractory hypoxemia that develops secondary to high-permeability pulmonary edema. These syndromes are gaining more attention as a means of better comprehending the pathophysiology of ARDS and possiblyfor modifying ventilatory management. In this context a study was done to compare role of invasive and non-invasive ventilation in cases of ARDS/ALI. Methods: in this study patients of AR...

  10. Stable Small Animal Mechanical Ventilation for Dynamic Lung Imaging to Support Computational Fluid Dynamics Models

    Energy Technology Data Exchange (ETDEWEB)

    Jacob, Rick E.; Lamm, W. J.

    2011-11-08

    Pulmonary computational fluid dynamics models require 3D images to be acquired over multiple points in the dynamic breathing cycle, with no breath holds or changes in ventilatory mechanics. With small animals, these requirements result in long imaging times ({approx}90 minutes), over which lung mechanics, such as compliance, can gradually change if not carefully monitored and controlled. These changes, caused by derecruitment of parenchymal tissue, are manifested as an upward drift in peak inspiratory pressure or by changes in the pressure waveform and/or lung volume over the course of the experiment. We demonstrate highly repeatable mechanical ventilation in anesthetized rats over a long duration for pulmonary CT imaging throughout the dynamic breathing cycle. We describe significant updates to a basic commercial ventilator that was acquired for these experiments. Key to achieving consistent results was the implementation of periodic deep breaths, or sighs, of extended duration to maintain lung recruitment. In addition, continuous monitoring of breath-to-breath pressure and volume waveforms and long-term trends in peak inspiratory pressure and flow provide diagnostics of changes in breathing mechanics.

  11. Acute respiratory distress syndrome (ARDS) treated successfully by veno-venous extracorporeal membrane oxygenation (ECMO) in a nearly drowned patient.

    Science.gov (United States)

    Sonoo, Tomohiro; Ohshima, Kazuma; Kobayashi, Hiroaki; Asada, Toshifumi; Hiruma, Takahiro; Doi, Kento; Gunshin, Masataka; Murakawa, Tomohiro; Anraku, Masaki; Nakajima, Susumu; Nakajima, Jun; Yahagi, Naoki

    2014-09-01

    This report highlights about one acute respiratory distress syndrome (ARDS) case after near-drowning resuscitated using extracorporeal membrane oxygenation (ECMO). Few cases have been reported about ECMO use for near-drowning and in most of these cases, ECMO was initiated within the first week. However, in our report, we would like to emphasize that seemingly irreversible secondary worsening of ARDS after nearly drowned patient was successfully treated by ECMO use more than 1 week after near-drowning followed by discharge without home oxygen therapy, social support, or any complication. This is probably due to sufficient lung rest for ventilator-associated lung injury during ECMO use. Based on our case's clinical course, intensive care unit physicians must consider ECMO even in the late phase of worsened ARDS after near-drowning.

  12. Non-invasive mechanical ventilation in internal medicine departments: a pilot study

    Directory of Open Access Journals (Sweden)

    Micaela La Regina

    2013-09-01

    Full Text Available Non-invasive mechanical ventilation (NIMV has been shown to be an effective treatment in chronic and acute lung failure. Until a few years ago, all the different forms of mechanical ventilation were managed exclusively in intensive care units (ICU. However, the reduction in the number of ICU beds available and the high costs involved in running such units, together with the aging of the general population and the co-morbidities associated with this have meant that forms of mechanical ventilation are also used outside ICUs. In addition to emergency physicians and pneumologists, also internists have started to use NIMV on their wards in order to start treatment as early as possible and reduce costs. This is a preliminary study to explore the effectiveness, safety and feasibility of NIMV on a medical ward. The overall success rate was 68.8%; the likelihood of success was higher in patients who started NIMV earlier. The success rate was quite high (62% also among do-not-intubate patients, despite their poorer clinical condition. Few complications were reported and there was no increase in staff workload. No significant differences were found in in-hospital mortality between hypercapnic patients with chronic obstructive pulmonary disease (COPD exacerbation and hypercapnic patients with COPD plus pneumonia (27% vs 25% or between patients with pneumonia and patients with COPD plus pneumonia (26% vs 25%. These results are encouraging for the successful use of NIMV on medical wards. A careful selection of patients, educating and motivating staff in NIMV use, and close collaboration with resuscitators are all essential for this to be achieved.

  13. Validity and reliability of “Persian Weaning Tool” in mechanically ventilated patients

    Science.gov (United States)

    Bazrafshan, Fatemeh; Irajpour, Alireza; Abbasi, Saeed; Mahaki, Behzad

    2016-01-01

    Background: “Persian Weaning Tool” (PWT) is the only specific, national protocol designed to assess patients’ readiness for weaning from mechanical ventilation in Iran. This study was developed to determine the validity and reliability of this protocol. Materials and Methods: This is a psychometric study conducted on 31 patients connected to mechanical ventilation were ready from weaning according to anesthesiologist's diagnosis and was selected through convenient sampling. The patients selected from Intensive Care Units (ICUs) of Al-Zahra Hospital in Isfahan. The sheet data collection includes demographic data, PWT; Burn's Wean Assessment Program (BWAP), and Morganroth's scale. To determine the inter-rater reliability between researcher and his partner, Pearson correlation and paired t-test were used. To assess the criterion validity of the PWT in relation to Burn's and Morganroth's weaning scales (as criteria), Pearson correlation and McNemar tests were used. To specify a minimum acceptable score of the PWT for weaning from mechanical ventilation, receiver operating characteristic curve was used. Results: The results showed that there was statistically significant correlation between score of PWT and BWAP (r = 0.370 with P < 0.05) and there were no statistically significant differences between these tools in terms of identification of patients’ readiness for weaning (P = 0.453). There was statistically significant correlation between PWT score obtained by researcher and his colleague (r = 0.928), and the reliability of this tool was approved. The PWTs cut of point was calculated as 57 (sensitivity = 0.679, specificity = 1). Conclusions: The reliability and validity of the PWT were confirmed for this study's sample size. Consequently, the findings of this study can be used to measure the PWTs effectiveness and applicability in ICUs.

  14. Noninvasive Mechanical Ventilation Improves Breathing-Swallowing Interaction of Ventilator Dependent Neuromuscular Patients: A Prospective Crossover Study

    OpenAIRE

    Marine Garguilo; Michèle Lejaille; Isabelle Vaugier; David Orlikowski; Nicolas Terzi; Frédéric Lofaso; Hélène Prigent

    2016-01-01

    Background Respiratory involvement in neuromuscular disorders may contribute to impaired breathing-swallowing interactions, swallowing disorders and malnutrition. We investigated whether the use of non-invasive ventilation (NIV) controlled by the patient could improve swallowing performances in a population of neuromuscular patients requiring daytime NIV. Methods Ten neuromuscular patients with severe respiratory failure requiring extensive NIV use were studied while swallowing without and wi...

  15. Functional residual capacity tool: A practical method to assess lung volume changes during pulmonary complications in mechanically ventilated patients

    OpenAIRE

    Veena S; Palepu Sudeep; Umamaheswara Rao G; Ramesh V

    2010-01-01

    In this report, we describe a patient in whom we used a functional residual capacity (FRC) tool available on a critical care ventilator to identify the loss of lung volume associated with pulmonary complications and increase in FRC with the application of a recruitment maneuver. The case report underlines the utility of the FRC tool in rapid visualization of the lung volume changes and the effects of application of corrective strategies in patients receiving mechanical ventilation.

  16. Functional residual capacity tool: A practical method to assess lung volume changes during pulmonary complications in mechanically ventilated patients

    Directory of Open Access Journals (Sweden)

    Veena S

    2010-01-01

    Full Text Available In this report, we describe a patient in whom we used a functional residual capacity (FRC tool available on a critical care ventilator to identify the loss of lung volume associated with pulmonary complications and increase in FRC with the application of a recruitment maneuver. The case report underlines the utility of the FRC tool in rapid visualization of the lung volume changes and the effects of application of corrective strategies in patients receiving mechanical ventilation.

  17. Short-term effects of positive expiratory airway pressure in patients being weaned from mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Marcelo de Mello Rieder

    2009-05-01

    Full Text Available OBJECTIVE: To investigate the feasibility and the cardiorespiratory effects of using positive expiratory airway pressure, a physiotherapeutic tool, in comparison with a T-tube, to wean patients from mechanical ventilation. METHODS/DESIGN: A prospective, randomized, cross-over study. SETTING: Two intensive care units. PATIENTS AND INTERVENTIONS: We evaluated forty patients who met weaning criteria and had been mechanically-ventilated for more than 48 hours, mean age 59 years, including 23 males. All patients were submitted to the T-tube and Expiratory Positive Airway Pressure devices, at 7 cm H2O, during a 30-minute period. Cardiorespiratory variables including work of breathing, respiratory rate (rr, peripheral oxygen saturation (SpO2, heart rate (hr, systolic, diastolic and mean arterial pressures (SAP, DAP, MAP were measured in the first and thirtieth minutes. The condition was analyzed as an entire sample set (n=40 and was also divided into subconditions: chronic obstructive pulmonary disease (n=14 and non-chronic obstructive pulmonary disease (non- chronic obstructive pulmonary disease (n=26 categories. Comparisons were made using a t-test and Analysis of Variance. The level of significance was p < 0.05. RESULTS: Our data showed an increase in work of breathing in the first and thirtieth minutes in the EPAP condition (0.86+ 0.43 and 1.02+1.3 as compared with the T-tube condition (0.25+0.26 and 0.26+0.35 (p<0.05, verified by the flow-sensor monitor (values in J/L. No statistical differences were observed when comparing the Expiratory Positive Airway Pressure and T-tube conditions with regard to cardiorespiratory measurements. The same result was observed for both chronic obstructive pulmonary disease and non- chronic obstructive pulmonary disease subconditions. CONCLUSIONS: Our study demonstrated that, in weaning patients from mechanical ventilation, the use of a fixed level of Expiratory Positive Airway Pressure caused an increase in work of

  18. Microdoses uses of iodine in the contamination prevention of mechanical ventilators

    International Nuclear Information System (INIS)

    Nosocomial respiratory tract infections due to contamination of mechanical ventilators is a major problem complicating the management of intensive care unit patients. A significant source of such infection seems to be water contained in the nebulizers. Its decontamination by various means has been unsatisfactory up to date. In order to control this source of infection, the authors suggest the utilization of a small dose of a 2% iodine alcoholic solution added to the water of the nebulizers in the proportion of 0.125ml of iodine solution to 500ml of water. The results show that the procedure is safe, efficient and unexpensive. (author)

  19. Heart Rate Variability in Patients with Chronic Obstructive Pulmonary Disease Treated by Noninvasive Mechanic Ventilation

    OpenAIRE

    Zekeriya Küçükdurmaz; İbrahim Gül; Hasan Kaya; Zekeriya Kaya; Alim Erdem; Zuhal Karakurt; Hekim Karapınar; Yusuf Karavelioğlu; Özlem Yazıcıoğlu Moçin; Cevat Kırma

    2011-01-01

    Aims: This study aimed to investigate heart rate variability (HRV) of patients with severe COPD who are treated by noninvasive mechanic ventilation (NIMV).Patients and Method: Twenty-seven patient (58±8 years, 9 F) with severe COPD treated by nocturnal NIMV at home and 23 sex and age matched volunteers (56±8 years, 11 F) who has not dyspnea as a control group recruited in the study. Subjects underwent spirometry, blood gas analysis, transthoracic echocardiography, 24 hours ambulatory ECG anal...

  20. Heart Rate Variability in Patients with Chronic Obstructive Pulmonary Disease Treated by Noninvasive Mechanic Ventilation

    OpenAIRE

    Karavelioğlu, Yusuf; Karapınar, Hekim; Karakurt, Zuhal; Erdem, Alim; Kaya, Zekeriya; Gül, İbrahim; Küçükdurmaz, Zekeriya; Moçin, Özlem Yazıcıoğlu; Kırma, Cevat

    2010-01-01

    Aims: This study aimed to investigate heart rate variability (HRV) of patients with severe COPD who are treated by noninvasive mechanic ventilation (NIMV). Patients and Method: Twenty-seven patient (58±8 years, 9 F) with severe COPD treated by nocturnal NIMV at home and 23 sex and age matched volunteYusuf ers (56±8 years, 11 F) who has not dyspnea as a control group recruited in the study. Subjects underwent spirometry, blood gas analysis, transthoracic echocardiography, 24 hours ambulatory...

  1. International perspectives on the influence of structure and process of weaning from mechanical ventilation

    DEFF Research Database (Denmark)

    Rose, Louise; Blackwood, Bronagh; Burns, Suzanne M;

    2011-01-01

    Recently, clinical and research attention has been focused on refining weaning processes to improve outcomes for critically ill patients who require mechanical ventilation. One such process, use of a weaning protocol, has yielded conflicting results, arguably because of the influence of existing...... context and processes. Objective To compare international data to assess differences in context and processes in intensive care units that could influence weaning. Methods Review of existing national data on provision of care for critically ill patients, including structure, staffing, skill mix, education...

  2. Simulation on dissolute and dust dispersion in comprehensive mechanized heading face with forced-exhaust ventilation

    Institute of Scientific and Technical Information of China (English)

    NIE Wen; CHENG Wei-min; HAN Li; ZHOU Sheng-ju; YU Yan-bin; ZHAO Shan-shan

    2011-01-01

    According to the characteristics of comprehensive mechanized heading face,established the mathematical model of single-phase air flow with k-e two equations model,and have established k-e-(O)-kp mathematic model to solve two-phase flow of gas and particles in dust space with eulefian-eulerian method and eulerian-lagrangian method.Numerical solution of gas-particle two-phase flow was put forward based on collocated grid SIMPLE algorithm.Moreover,numerical simulation of dust concentration in fully mechanized caving face was carried out by using Fluent software.Finally,when in forced-exhaust ventilation circumstance,drawer type fan drum have less dust absorption,and most of dust spread to the other site; the dust concentration is inversely proportional to the distance from tunneling head,and the dust concentration has already diffused to decrease below 102 mg/m3 at the position ofx=12 m.Dust are more focused on relative side(in the range about y from 0 to 2 meter) of roadway space of press-ventilated fan drum,especially between tunneling place and drawer type fan drum; the roadway with road header have a higher dust concentration.These conclusions provide reliable theory basis for the dust prevention in comprehensive mechanized heading face.

  3. Comparison of Invasive and Noninvasive Mechanical Ventilation for Patients with COPD:Randomised Prospective Study

    Directory of Open Access Journals (Sweden)

    Ivo Matic

    2008-01-01

    Full Text Available Acute respiratory failure due to chronic obstructive pulmonary disease presents an increasing problem for both health and economics in the modern world. The goal of this study was to compare invasive and noninvasive mechani-cal ventilation for patients with COPD. A prospective, randomized trial was performed in a multidisciplinary intensive care unit. Of 614 patients requiring mechanical ventilation (MV longer than 24h, after excluding those who didn′t meet the inclusion criteria, 72 patients with COPD remained the research sample. The MV procedure was per-formed using standard methods, applying two MV methods: invasive MV and noninvasive MV. Patients were ran-domized into two groups for MV application using closed, non transparent envelopes. Comparison was made based on patient characteristics, objective parameters 1h, 4h, 24h, and 48h after admission and finally treatment outcome. In patients with COPD NIMV had statistically better outcome compared to IMV with MV duration NIMV:IMV 102:187h, p < 0.001, time spent in ICU 127:233h, p < 0.001. Need for intubation/reintubation 16 (42.1%:34 (100%/4 (11.8%, p < 0.001, hospital pneumonia 2 (5.3%:18 (52.9%, p =0.001. Applying strict application protocols, and based on com-parison of objective parameters of pulmonary mechanics, biochemistry and finally treatment outcome, high advantage of NIMV method was confirmed.

  4. Invasive and Noninvasive Mechanical Ventilation For Acute Exacerbations Of Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Abd-Hay I. Abd-Hay; Ahmed S. Alsaily* and Essam A. El-Moselhy

    2011-04-01

    Full Text Available Introduction: Acute exacerbation of chronic obstructive pulmonary disease (COPD is a frequent cause of hospitalization and intensive care unit admission. Respiratory failure from airflow obstruction is a direct consequence of acute airway narrowing. Aim of the study: It was to compare the efficacy of noninvasive mechanical ventilation (NIMV against conventional mechanical ventilation (CMV in patients with acute exacerbation of COPD. Patients and methods: Forty patients with acute exacerbation of COPD were recruited in the present study. A comparative, hospital based study design was used. All the cases were examined; clinically and laboratory. The patients were divided into two groups each include 20 patients. Group A received NIMV in the form of continuous positive airway pressure (CPAP and group B with CMV. Results: There were statistically significant decreases in respiratory rate, heart rate and diastolic blood pressure after 6 hours of CPAP in comparison to baseline parameters in group A. While, there were statistically significant increases in PaO2 and SaO2 after 6 hours of CPAP in comparison to baseline parameters. In group B there were statistically significant decreases in respiratory rate, heart rate, systolic blood pressure and diastolic blood pressure after 6 hours of CMV in comparison to baseline parameters. While, there were statistically significant increases in pH, PaO2, and SaO2 and a statistically significant decrease in PaCO2 after 6 hours of CMV in comparison to baseline parameters. Further, comparison of respiratory rate and hemodynamic parameters in both groups showed statistically significant decreases in respiratory rate, heart rate, systolic blood pressure and diastolic blood pressure in group A in comparison to group B. Finally, failure rate was 35.0% in group A (NIMV compared to 5.0% in group B (CMV with statistically significant difference. Conclusions and recommendations: Noninvasive mechanical ventilation is a safe

  5. Prognosis and weaning of elderly multiple organ dysfunction syndrome patients with invasive mechanical ventilation

    Institute of Scientific and Technical Information of China (English)

    Xiao Kun; Su Longxiang; Han Bingchao; Guo Chao; Feng Lin; Jiang Zhaoxu; Wang Huijuan

    2014-01-01

    Background Elderly multiple organ dysfunction syndrome (MODS) patients receiving invasive mechanical ventilation have poor prognosis in intensive care units (ICUs).We studied the usefulness of four commonly used severity scores and extrapulmonary factors that affected weaning to predict outcome of such patients.Methods Clinical data of 197 patients on admission to ICUs (from January 2009 to June 2012) were used retrospectively.The Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ,APACHE Ⅲ,Sample Acute Physiological Score (SAPS) Ⅱ and MODS scores were calculated.All the patients were grouped into survivors and nonsurvivors according to the prognosis.Patients,who weaned from ventilator (n=154),were subdivided into a successful weaning group and a failed weaning group.The receiver operating characteristic (ROC) curves and Logistic regression was used for prognostic and weaning assessment.Results Based on the outcomes,the areas under the ROC of APACHE Ⅱ,APACHE Ⅲ,SAPS Ⅱ,and MODS were 0.837,0.833,0.824,and 0.837,respectively.The Logistic regression analysis revealed that the odds ratio (OR) of underlying lung diseases,serum albumin and creatinine,and the number of organ failures was 2.374,0.920,1.003,and 1.547.APACHE Ⅱ scores on admission performed excellent (ROC:0.921) on the weaning assessments.Conclusions APACHE Ⅱ and MODS systems were marginally better for evaluating the prognosis of elderly MODS patients who received invasive mechanical ventilation.Underlying lung diseases,serum albumin,serum creatinine and the number of organ failures were independent prognostic factors.Using the APACHE Ⅱ scores on admission before weaning may increase the likelihood of successful weaning.(ClinicalTrial.gov identifier NCT01802983).

  6. Moderately high frequency ventilation with a conventional ventilator allows reduction of tidal volume without increasing mean airway pressure

    OpenAIRE

    Cordioli, Ricardo Luiz; Park, Marcelo; Costa, Eduardo Leite Vieira; Gomes, Susimeire; Brochard, Laurent; Amato, Marcelo Britto Passos; Azevedo, Luciano Cesar Pontes

    2014-01-01

    Background The aim of this study was to explore if positive-pressure ventilation delivered by a conventional ICU ventilator at a moderately high frequency (HFPPV) allows a safe reduction of tidal volume (V T) below 6 mL/kg in a porcine model of severe acute respiratory distress syndrome (ARDS) and at a lower mean airway pressure than high-frequency oscillatory ventilation (HFOV). Methods This is a prospective study. In eight pigs (median weight 34 [29,36] kg), ARDS was induced by pulmonary la...

  7. Effects of vitamin E administration on APACHE II Score in ARDS patients

    Directory of Open Access Journals (Sweden)

    M Hajimahmoodi

    2009-03-01

    Full Text Available ABSTRACT Background and purpose of the study: The acute respiratory distress syndrome (ARDS is a common clinical disorder caused by injury to the alveolar epithelial and endothelial barriers of lung. In ARDS patients, oxidative stress is increased and plasma antioxidant levels are reduced. Vitamin E has an important role in antioxidant defense mechanisms. In this study the effect of vitamin E on decrease of APACHE II score in ARDS patients was investigated.  Materials and methods: Twenty patients [mean (SE: age = 51.2 ± 6.41 years] with ARDS were enrolled. After diagnosis based on inclusion and exclusion criteria, ten patients as treatment group received 600 IU vitamin E daily intramuscularly. Control group received normal saline as placebo. Plasma samples and Acute Physiology and Chronic Health Evaluation (APACHE II score were obtained before administration, 4hrs and 12hrs after each intervention and repeated three days for each patient. Results were analyzed by use of an SPSS software package with a repeated-measures analysis of variance (ANOVA. Results: Significant changes were observed in APACHE II score from first to seventh measurement (p=0.0001 in treatment group, but vitamin E concentration altered significantly in only first to seventh measurement (p= 0.019. Conclusion: From the results of this study, it seems that the use of vitamin E as a lipid-soluble antioxidant along with other supportive measures is beneficial in decreasing APACHE II score in ARDS patients.

  8. Reasons of PEG failure to eliminate gastroesophageal reflux in mechanically ventilated patients

    Institute of Scientific and Technical Information of China (English)

    Emmanuel E Douzinas; Ilias Andrianakis; Olga Livaditi; Dimitrios Bakos; Katerina Flevari; Nikos Goutas; Dimitrios Vlachodimitropoulos; Marios-Konstantinos Tasoulis; Alex P Betrosian

    2009-01-01

    AIM: To investigate factors predicting failure of percutaneous endoscopic gastrostomy (PEG) to eliminate gastroesophageal reflux (GER).METHODS: Twenty-nine consecutive mechanically ventilated patients were investigated.Patients were evaluated for GER by pH-metry pre-PEG and on the 7th post-PEG day.Endoscopic and histologic evidence of reflux esophagitis was also carried out.A beneficial response to PEG was considered when pH-metry on the 7th post-PEG day showed that GER was below 4%.RESULTS: Seventeen patients responded (RESP group) and 12 did not respond (N-RESP) to PEG.The mean age, sex, weight and APACHE Ⅱ score were similar in both groups.GER (%) values were similar in both groups at baseline, but were significantly reduced in the RESP group compared with the N-RESP group on the 7th post-PEG day [2.5 (0.6-3.8) vs 8.1 (7.4-9.2, P < 0.001)].Reflux esophagitis and the gastroesophageal flap valve (GEFV) grading differed significantly between the two groups ( P = 0.031 and P = 0.020, respectively).Histology revealed no significant differences between the two groups.CONCLUSION: Endoscopic grading of GEFV and the presence of severe reflux esophagitis are predisposing factors for failure of PEG to reduce GER in mechanically ventilated patients.

  9. Fluid flow and particle transport in mechanically ventilated airways. Part II: particle transport.

    Science.gov (United States)

    Alzahrany, Mohammed; Van Rhein, Timothy; Banerjee, Arindam; Salzman, Gary

    2016-07-01

    The flow mechanisms that play a role on aerosol deposition were identified and presented in a companion paper (Timothy et al. in Med Biol Eng Comput. doi: 10.1007/s11517-015-1407-3 , 2015). In the current paper, the effects of invasive conventional mechanical ventilation waveforms and endotracheal tube (ETT) on the aerosol transport were investigated. In addition to the enhanced deposition seen at the carinas of the airway bifurcations, enhanced deposition was also seen in the right main bronchus due to impaction and turbulent dispersion resulting from the fluid structures created by jet caused by the ETT. The orientation of the ETT toward right bronchus resulted in a substantial deposition inside right lung compared to left lung. The deposition inside right lung was ~12-fold higher than left lung for all considered cases, except for the case of using pressure-controlled sinusoidal waveform where a reduction of this ratio by ~50 % was found. The total deposition during pressure constant, volume ramp, and ascending ramp waveforms was similar and ~1.44 times higher than deposition fraction when using pressure sinusoidal waveform. Varying respiratory waveform demonstrated a significant role on the deposition enhancement factors and give evidence of drug aerosol concentrations in key deposition sites, which may be significant for drugs with negative side effects in high concentrations. These observations are thought to be important for ventilation treatment strategy. PMID:26541600

  10. A 17 year-old girl with a demyelinating disease requiring mechanical ventilation: a case report

    Directory of Open Access Journals (Sweden)

    Katsenos Chrysostomos

    2013-01-01

    Full Text Available Abstract Background Demyelinating diseases cause destruction of the myelin sheath, while axons are relatively spared. Pathologically, demyelination can be the result of an inflammatory process, viral infection, acquired metabolic derangement and ischemic insult. Three diseases that can cause inflammatory demyelination of the CNS are: Multiple sclerosis (MS, Acute disseminated encephalomyelitis (ADEM and Acute hemorrhagic leucoencephalitis. Differentiation is not always easy and there is considerable overlaping. Data about adults with acute demyelination requiring ICU admission is limited. Case presentation A 17 year old Greek female was hospitalised in the ICU because of acute respiratory failure requiring mechanical ventilation. She had a history of febrile disease one month before, acute onset of paraplegia, diplopia, progressive arm weakness and dyspnea. Her consciousness was not impaired. A demyelinating central nervous system (CNS disease, possibly post infectious encephalomyelitis (ADEM was the underlying condition. The MRI of the brain disclosed diffused expanded cerebral lesions involving the optic nerve, basal ganglia cerebellum, pons and medulla oblongata. There was also extended involvement of the cervical and thoracic part of the spinal cord. CSF leukocyte count was elevated with lymphocyte predominance. The patient required mechanical ventilation for two months. Then she was transferred to a rehabilitation centre. Three years later she remains paraplegic. Since then she has not suffered any other demyelination attack. Conclusions Demyelinating diseases can cause acute respiratory failure when the spinal cord is affected. Severe forms of these diseases, making necessary ICU admission, is less frequently reported. Intensivists should be aware of the features of these rare diseases.

  11. Characterization of parameters and strategies used by physical therapists in difficult mechanical ventilation weaning

    Directory of Open Access Journals (Sweden)

    Fabíola Maria Sabino Meireles

    2013-03-01

    Full Text Available Objective: To characterize the main strategies and parameters used by physical therapists in difficult mechanical ventilation weaning. Methods: Cross-sectional study including all the physical therapists working in adult Intensive Care Units in three public hospitals in Fortaleza-CE. A questionnaire with closed questions related to difficult mechanical ventilation weaning was applied, with either one or multiple answers. The data was treated with descriptive and non-parametric analysis. Results: Among the parameters mostly used by the 56 interviewed physical therapists for the difficult weaning, were found: current volume reduction (26 - 46.4% and desaturation during aspiration (17 - 30.4%. It was observed that 38 (67.9% alternate T-tube and continuous positive airway pressure (CPAP as strategies for difficult weaning, and 28 (50% reported reducing the pressure support. There was no statistical difference between the strategies used in the studied hospitals, neither correlation between strategies and parameters. Conclusion: It was found that physical therapists have been performing similar strategies, which are also shown in the literature, but this is not the case with the parameters. The parameters used are not supported by the literature.

  12. Driving pressure during assisted mechanical ventilation: Is it controlled by patient brain?

    Science.gov (United States)

    Georgopoulos, Dimitris; Xirouchaki, Nectaria; Tzanakis, Nikolaos; Younes, Magdy

    2016-07-01

    Tidal volume (VT) is the controlled variable during passive mechanical ventilation (CMV) in order to avoid ventilator-induced-lung-injury. However, recent data indicate that the driving pressure [ΔP; VT to respiratory system compliance (Crs) ratio] is the parameter that best stratifies the risk of death. In order to study which variable (VT or ΔP) is controlled by critically ill patients, 108 previously studied patients were assigned to receive PAV+ (a mode that estimates Crs and permits the patients to select their own breathing pattern) after CMV, were re-analyzed. When patients were switched from CMV to PAV+ they controlled ΔP without constraining VT to narrow limits. VT was increased when the resumption of spontaneous breathing was associated with an increase in Crs. When ΔP was high during CMV, the patients (n=12) decreased it in 58 out of 67 measurements. We conclude that critically ill patients control the driving pressure by sizing the tidal volume to individual respiratory system compliance using appropriate feedback mechanisms aimed at limiting the degree of lung stress.

  13. Comparison of exogenous surfactant therapy, mechanical ventilation with high end-expiratory pressure and partial liquid ventilation in a model of acute lung injury

    OpenAIRE

    Hartog, Anneke; Vazquez de Anda, G.F.; Gommers, Diederik; Kaisers, U; Verbrugge, Serge; Schnabel, R.; Lachmann, Burkhard

    1999-01-01

    textabstractWe have compared three treatment strategies, that aim to prevent repetitive alveolar collapse, for their effect on gas exchange, lung mechanics, lung injury, protein transfer into the alveoli and surfactant system, in a model of acute lung injury. In adult rats, the lungs were ventilated mechanically with 100% oxygen and a PEEP of 6 cm H2O, and acute lung injury was induced by repeated lung lavage to obtain a PaO2 value < 13 kPa. Animals were then allocated randomly (n = 12 in eac...

  14. Early versus late percutaneous dilational tracheostomy in critically ill patients anticipated requiring prolonged mechanical ventilation

    Institute of Scientific and Technical Information of China (English)

    ZHENG Yue; LI Wen-xiong; SUI Feng; CHEN Xiu-kai; ZHANG Gui-chen; WANG Xiao-wen; ZHAO Song; SONG Yang; LIU Wei; XIN Xin

    2012-01-01

    Background Tracheostomy should be considered to replace endotracheal intubation in patients requiring prolonged mechanical ventilation (MV).However,the optimal timing for tracheostomy is still a topic of debate.The present study aimed to investigate whether early percutaneous dilational tracheostomy (PDT) can reduce duration of MV,and to further verify whether early PDT can reduce sedative use,shorten intensive care unit (ICU) stay,decrease the incidence of ventilator associated pneumonia (VAP),and increase successful weaning and ICU discharge rate.Methods A prospective,randomized controlled trial was carried out in a surgical ICU from July 2008 to June 2011 in adult patients anticipated requiring prolonged MV via endotracheal intubation.Patients meeting the inclusion criteria were randomly assigned to the early PDT group or the late PDT group on day 3 of MV.The patients in the early PDT group were tracheostomized with PDT on day 3 of MV.The patients in the late PDT group were tracheostomized with PDT on day 15 of MV if they still needed MV.The primary endpoint was ventilator-free days at day 28 after randomization.The secondary endpoints were sedation-free days,ICU-free days,successful weaning and ICU discharge rate,and incidence of VAP at day 28 after randomization.The cumulative 60-day incidence of death after randomization was also analyzed.Results Total 119 patients were randomized to either the early PDT group (n=58) or the late PDT group (n=61).The ventilator-free days was significantly increased in the early PDT group than in the late PDT group ((9.57±5.64) vs.(7.38±6.17) days,P <0.05).The sedation-free days and ICU-free days were also significantly increased in the early PDT group than in the late PDT group (20.84±2.35 vs.17.05±2.30 days,P <0.05; and 8.0 (interquartile range (IQR):5.0-12.0)vs.3.0 (IQR:0-12.0) days,P <0.001 respectively).The successful weaning and ICU discharge rate was significantly higher in early PDT group than in late PDT

  15. Mechanical ventilation strategy following Glenn and Fontan surgeries: On going challenge!

    OpenAIRE

    Al-Eyadhy, Ayman

    2009-01-01

    The Glenn and Fontan operations put the pulmonary and systemic circulations in series. It has been shown that positive pressure ventilation (PPV) decreases pulmonary blood flow (PBF) and cardiac output (CO), and negative pressure ventilation (NPV) significantly improves PBF and CO. If early extubation is not achievable, the postoperative ventilator management strategy should aim at promoting PBF and CO by lowering pulmonary vascular resistance (PVR) and intrathoracic pressure. Multiple ventil...

  16. Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review

    Directory of Open Access Journals (Sweden)

    Antonio M. Esquinas

    2014-12-01

    Full Text Available The aim of this article was to review the role of noninvasive ventilation (NIV in acute pulmonary infectious diseases, such as severe acute respiratory syndrome (SARS, H1N1 and tuberculosis, and to assess the risk of disease transmission with the use of NIV from patients to healthcare workers. We performed a clinical review by searching Medline and EMBASE. These databases were searched for articles on ‘‘clinical trials’’ and ‘‘randomised controlled trials’’. The keywords selected were non-invasive ventilation pulmonary infections, influenza-A (H1N1, SARS and tuberculosis. These terms were cross-referenced with the following keywords: health care workers, airborne infections, complications, intensive care unit and pandemic. The members of the International NIV Network examined the major results regarding NIV applications and SARS, H1N1 and tuberculosis. Cross-referencing mechanical ventilation with SARS yielded 76 studies, of which 10 studies involved the use of NIV and five were ultimately selected for inclusion in this review. Cross-referencing with H1N1 yielded 275 studies, of which 27 involved NIV. Of these, 22 were selected for review. Cross-referencing with tuberculosis yielded 285 studies, of which 15 involved NIV and from these seven were selected. In total 34 studies were selected for this review. NIV, when applied early in selected patients with SARS, H1N1 and acute pulmonary tuberculosis infections, can reverse respiratory failure. There are only a few reports of infectious disease transmission among healthcare workers.

  17. Effectiveness of Inspiratory Termination Synchrony with Automatic Cycling During Noninvasive Pressure Support Ventilation.

    Science.gov (United States)

    Chen, Yuqing; Cheng, Kewen; Zhou, Xin

    2016-01-01

    BACKGROUND Pressure support ventilation (PSV) is a standard method for non-invasive home ventilation. A bench study was designed to compare the effectiveness of patient-ventilator inspiratory termination synchronization with automated and conventional triggering in various respiratory mechanics models. MATERIAL AND METHODS Two ventilators, the Respironics V60 and Curative Flexo ST 30, connected to a Hans Rudolph Series 1101 lung simulator, were evaluated using settings that simulate lung mechanics in patients with chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS), or normal lungs. Ventilators were operated with automated (Auto-Trak) or conventional high-, moderate-, and low-sensitivity flow-cycling software algorithms, 5 cmH2O or 15 cmH2O pressure support, 5 cmH2O positive end-expiratory pressure (PEEP), and an air leak of 25-28 L/min. RESULTS Both ventilators adapted to the system leak without requiring adjustment of triggering settings. In all simulated lung conditions, automated cycling resulted in shorter triggering delay times (<100 ms) and lower triggering pressure-time product (PTPt) values. Tidal volumes (VT) increased with lower conventional cycling sensitivity level. In the COPD model, automated cycling had higher leak volumes and shorter cycling delay times than in conventional cycling. Asynchronous events were rare. Inspiratory time (Tinsp), peak expiratory flow (PEF), and cycling off delay time (Cdelay) increased as a result of reduction in conventional cycling sensitivity level. In the ARDS and normal adult lung models, premature cycling was frequent at the high-sensitive cycling level. CONCLUSIONS Overall, the Auto-Trak protocol showed better patient-machine cycling synchronization than conventional triggering. This was evident by shorter triggering time delays and lower PTPt. PMID:27198165

  18. Bedside measurement of changes in lung impedance to monitor alveolar ventilation in dependent and non-dependent parts by electrical impedance tomography during a positive end-expiratory pressure trial in mechanically ventilated intensive care unit patients

    NARCIS (Netherlands)

    I.G. Bikker (Ido); S. Leonhardt (Steffen); D. dos Reis Miranda; J. Bakker (Jan); D.A.M.P.J. Gommers (Diederik)

    2010-01-01

    textabstractIntroduction: As it becomes clear that mechanical ventilation can exaggerate lung injury, individual titration of ventilator settings is of special interest. Electrical impedance tomography (EIT) has been proposed as a bedside, regional monitoring tool to guide these settings. In the pre

  19. Design Principles for Hybrid Ventilation

    DEFF Research Database (Denmark)

    Heiselberg, Per

    For many years mechanical and natural ventilation systems have developed separately. Naturally, the next step in this development is the development of ventilation concepts that utilize and combine the best features from each system to create a new type of ventilation system -Hybrid Ventilation....... The hybrid ventilation concepts, design challenges and - principles are discussed and illustrated by four building examples....

  20. A Multicenter Retrospective Review of Prone Position Ventilation (PPV in Treatment of Severe Human H7N9 Avian Flu.

    Directory of Open Access Journals (Sweden)

    Yuanda Xu

    Full Text Available Patients with H7N9 avian flu concurrent with severe acute respiratory distress syndrome (ARDS usually have a poor clinical outcome. Prone position ventilation (PPV has been shown to improve the prognosis of patients with severe ARDS. This study explored the effects of PPV on the respiratory and circulatory mechanics of H7N9-infected patients with severe ARDS.Individuals admitted to four hospitals designated for H7N9 patients in Guangdong province were treated with PPV, and their clinical data were recorded before and after receiving PPV.Six of 20 critically ill patients in the ICU received PPV. After treatment with 35 PPV sessions, the oxygenation index (OI values of the six patients when measured post-PPV and post-supine position ventilation (SPV were significantly higher than those measured pre-PPV (P < 0.05.The six patients showed no significant differences in their values for respiratory rate (RR, peak inspiratory pressure (PIP, tidal volume (TV or arterial partial pressure of carbon dioxide (PaCO2 when compared pre-PPV, post-PPV, and post-SPV. Additionally, there were no significant differences in the mean values for arterial pressure (MAP, cardiac index (CI, central venous pressure (CVP, heart rate (HR, lactic acid (LAC levels or the doses of norepinephrine (NE administered when compared pre-PPV, post-PPV, and post-SPV.PPV provided improved oxygenation that was sustained after returning to a supine position, and resulted in decreased carbon dioxide retention. PPV can thus serve as an alternative lung protective ventilation strategy for use in patients with H7N9 avian flu concurrent with severe ARDS.

  1. Positive end expiratory pressure titrated by transpulmonary pressure improved oxygenation and respiratory mechanics in acute respiratory distress syndrome patients with intra-abdominal hypertension

    Institute of Scientific and Technical Information of China (English)

    YANG Yi; LI Yang; LIU Song-qiao; LIU Ling; HUANG Ying-zi; GUO Feng-mei; QIU Hai-bo

    2013-01-01

    Background Intra-abdominal hypertension (IAH) is common in acute respiratory distress syndrome (ARDS) patients and when resulting in decrease of chest wall compliance will weaken the effect of positive end expiratory pressure (PEEP).We investigated the effect of PEEP titrated by transpulmonary pressure (Ptp) on oxygenation and respiratory mechanics in ARDS patients with IAH compared with PEEP titrated by ARDSnet protocol.Methods ARDS patients admitted to the intensive care unit (ICU) of the Zhongda Hospital were enrolled.Patients were ventilated with volume control mode with tidal volume of 6 ml/kg under two different PEEP levels titrated by Ptp method and ARDSnet protocol.Respiratory mechanics,gas exchange and haemodynamics were measured after 30 minutes of ventilation in each round.IAH was defined as intra-abdominal pressure of 12 mmHg or more.Results Seven ARDS patients with IAH and 8 ARDS patients without IAH were enrolled.PEEP titrated by Ptp were significant higher than PEEP titrated by ARDSnet protocol in both ARDS patients with IAH ((17.3±2.6) cmH2O vs.(6.3±1.6)cmH2O and without IAH ((9.5±2.1) cmH2O vs.(7.8±1.9) cmH2O).Arterial pressure of O2/fraction of inspired oxygen (PaO2/FiO2)was much higher under PEEP titrated by Ptp when compared with PEEP titrated by ARDSnet protocol in ARDS patients with IAH ((27.2±4.0) cmHg vs.(20.9± 5.0) cmHg.But no significant difference of PaO2/FiO2 between the two methods was found in ARDS patients without IAH.In ARDS patients with IAH,static compliance of lung and respiratory system were higher under PEEP titrated by Ptp than by ARDSnet protocol.In ARDS patients with IAH,central venous pressure (CVP) was higher during PEEP titrated by Ptp than byARDSnet protocol.Conclusion Positive end expiratory pressure titrated by transpulmonary pressure was higher than PEEP titrated by ARDSnet protocol and improved oxygenation and respiratory mechanics in ARDS patients with IAH.

  2. Thallium myocardial tomoscintigraphy: detection of ischemia during weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease

    International Nuclear Information System (INIS)

    In order to evidence myocardial ischemia-leading to ventricular dysfunction-during weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease, thallium myocardial tomography and gated blood pool studies were performed in 9 patients during mechanical ventilation and during weaning from mechanical ventilation. During the latter, results of gated blood pool studies showed a diffuse homogeneous left ventricular dysfunction. A fixed lower thallium uptake in the septum than in the lateral wall was found with the quantitative analysis of myocardial tomograms. Partial volume effect is likely the cause of this septal defect. The hypothesis of a diffuse ischemia cannot be excluded; but, without the absolute quantification of tomographic data, it cannot be proven

  3. [The effectiveness of music therapy in reducing physiological and psychological anxiety in mechanically ventilated patients].

    Science.gov (United States)

    Wu, Shiau-Jiun; Chou, Fan-Hao

    2008-10-01

    Anxiety, a common reaction in patients receiving ventilation therapy, often impacts negatively on patient recovery. Music therapy, a non-invasion intervention, is readily accepted by patients and has been used to relieve patient anxiety with encouraging results. The purpose of this study was to investigate the effectiveness of music therapy on reducing anxiety in patients on mechanical ventilators. An experimental design was used and all cases were collected from a medical center in southern Taiwan. While the experimental group patients took a 30-minute music therapy session, control group patients were asked to rest. Both facility anxiety and anxiety visual scales were used as research tools, with other non-invasive medical instruments employed to measure heartbeat and breathing, blood pressure and blood oxygen saturation in both patient groups. When compared with the control group, patients in the experimental group showed significant improvement in sense of anxiety (Brief Anxiety Scale, BAS, t(29) = -4.80, p music therapy. Study results are hoped to serve as an important reference for clinical nursing staff. Also, it is hoped that the music therapy method may help facilitate achievement of broader humanized nursing goals. PMID:18836973

  4. Cardiorespiratory Mechanical Simulator for In Vitro Testing of Impedance Minute Ventilation Sensors in Cardiac Pacemakers.

    Science.gov (United States)

    Marcelli, Emanuela; Cercenelli, Laura

    2016-01-01

    We developed a cardiorespiratory mechanical simulator (CRMS), a system able to reproduce both the cardiac and respiratory movements, intended to be used for in vitro testing of impedance minute ventilation (iMV) sensors in cardiac pacemakers. The simulator consists of two actuators anchored to a human thorax model and a software interface to control the actuators and to acquire/process impedance signals. The actuators can be driven separately or simultaneously to reproduce the cardiac longitudinal shortening at a programmable heart rate and the diaphragm displacement at a programmable respiratory rate (RR). A standard bipolar pacing lead moving with the actuators and a pacemaker case fixed to the thorax model have been used to measure impedance (Z) variations during the simulated cardiorespiratory movements. The software is able to discriminate the low-frequency component because of respiration (Z(R)) from the high-frequency ripple because of cardiac effect (Z(C)). Impedance minute ventilation is continuously calculated from Z(R) and RR. From preliminary tests, the CRMS proved to be a reliable simulator for in vitro evaluation of iMV sensors. Respiration impedance recordings collected during cardiorespiratory movements reproduced by the CRMS were comparable in morphology and amplitude with in vivo assessments of transthoracic impedance variations. PMID:26501915

  5. A novel preterm respiratory mechanics active simulator to test the performances of neonatal pulmonary ventilators

    Science.gov (United States)

    Cappa, Paolo; Sciuto, Salvatore Andrea; Silvestri, Sergio

    2002-06-01

    A patient active simulator is proposed which is capable of reproducing values of the parameters of pulmonary mechanics of healthy newborns and preterm pathological infants. The implemented prototype is able to: (a) let the operator choose the respiratory pattern, times of apnea, episodes of cough, sobs, etc., (b) continuously regulate and control the parameters characterizing the pulmonary system; and, finally, (c) reproduce the attempt of breathing of a preterm infant. Taking into account both the limitation due to the chosen application field and the preliminary autocalibration phase automatically carried out by the proposed device, accuracy and reliability on the order of 1% is estimated. The previously indicated value has to be considered satisfactory in light of the field of application and the small values of the simulated parameters. Finally, the achieved metrological characteristics allow the described neonatal simulator to be adopted as a reference device to test performances of neonatal ventilators and, more specifically, to measure the time elapsed between the occurrence of a potentially dangerous condition to the patient and the activation of the corresponding alarm of the tested ventilator.

  6. Wind- and stack-assisted mechanical ventilation with heat recovery and night cooling

    DEFF Research Database (Denmark)

    Hviid, Christian Anker; Svendsen, Svend

    presented the outline of a heat recovery concept suitable for stack and wind-assisted mechanical ventilation systems with total system pressure losses of 74Pa. The heat recovery concept is based on two air-to-water exchangers connected by a liquid loop powered by a pump. The core element of the concept......The dual-sided issue of indoor environment and energy consumption have become increasingly important in building design. One possible solution is to ventilate by passive means, such as by stack eect and wind pressure, but this requires the development of new concepts and components. Here we have...... teaching rooms with fresh air. The mean specific fan power (SFP, in Danish: SEL-værdi) is measured to be approx. 240 J=m3. The SFP of the entire system including fans, pump and controls is measured to be approx. 600-700 J=m3. The total heat recovery efficiency of the system was measured to be 63%. Night...

  7. Recommendations for hygiene of masks and circuits in mechanically home ventilated patients

    Directory of Open Access Journals (Sweden)

    Michel Toussaint

    2010-08-01

    Full Text Available Home mechanical ventilation requires equipment, consisting of a generator of pressure, a tubing and an interface to deliver air to the patient. Instructions for equipment maintenance are generally not based on scientific evidence. Studies however have reported that tubing and masks used at home are the most commonly found as very dirty and contaminated. Dirtiness and contamination of equipment potentially expose patients to a higher risk of airway colonization, which, in turn, should cause respiratory infections. For this reason, published hygiene instructions include the use of disinfectant solution. Nevertheless, they generally fail to explain how basic maintenance may be achieved by simple cleaning with soap and water. The instructions for post-cleaning disinfection will depend upon the relative sensitivity of patients to respiratory tract infections and the related risks for bacterial colonization of the airways. Restrictive and obstructive disease patients are not equally sensitive to infections and, as a consequence, should not require similarly elaborate disinfection level. According with the restrictive or obstructive origin of respiratory insufficiency, the current educational review suggests simple and adequate rules for hygiene of tubing and masks in the home setting. Written instructions on how to clean the equipment for home ventilation are useful and sufficient in restrictive patients. In obstructive patients, cleaning always precedes disinfection. After cleaning, rinsing and drying are important. An effective weekly 20-minute disinfection may be achieved by using an hypochlorite solution of soaking in a concentration of 0.5%.

  8. Role of mechanical ventilation in the airborne transmission of infectious agents in buildings.

    Science.gov (United States)

    Luongo, J C; Fennelly, K P; Keen, J A; Zhai, Z J; Jones, B W; Miller, S L

    2016-10-01

    Infectious disease outbreaks and epidemics such as those due to SARS, influenza, measles, tuberculosis, and Middle East respiratory syndrome coronavirus have raised concern about the airborne transmission of pathogens in indoor environments. Significant gaps in knowledge still exist regarding the role of mechanical ventilation in airborne pathogen transmission. This review, prepared by a multidisciplinary group of researchers, focuses on summarizing the strengths and limitations of epidemiologic studies that specifically addressed the association of at least one heating, ventilating and/or air-conditioning (HVAC) system-related parameter with airborne disease transmission in buildings. The purpose of this literature review was to assess the quality and quantity of available data and to identify research needs. This review suggests that there is a need for well-designed observational and intervention studies in buildings with better HVAC system characterization and measurements of both airborne exposures and disease outcomes. Studies should also be designed so that they may be used in future quantitative meta-analyses.

  9. Cardiorespiratory Mechanical Simulator for In Vitro Testing of Impedance Minute Ventilation Sensors in Cardiac Pacemakers.

    Science.gov (United States)

    Marcelli, Emanuela; Cercenelli, Laura

    2016-01-01

    We developed a cardiorespiratory mechanical simulator (CRMS), a system able to reproduce both the cardiac and respiratory movements, intended to be used for in vitro testing of impedance minute ventilation (iMV) sensors in cardiac pacemakers. The simulator consists of two actuators anchored to a human thorax model and a software interface to control the actuators and to acquire/process impedance signals. The actuators can be driven separately or simultaneously to reproduce the cardiac longitudinal shortening at a programmable heart rate and the diaphragm displacement at a programmable respiratory rate (RR). A standard bipolar pacing lead moving with the actuators and a pacemaker case fixed to the thorax model have been used to measure impedance (Z) variations during the simulated cardiorespiratory movements. The software is able to discriminate the low-frequency component because of respiration (Z(R)) from the high-frequency ripple because of cardiac effect (Z(C)). Impedance minute ventilation is continuously calculated from Z(R) and RR. From preliminary tests, the CRMS proved to be a reliable simulator for in vitro evaluation of iMV sensors. Respiration impedance recordings collected during cardiorespiratory movements reproduced by the CRMS were comparable in morphology and amplitude with in vivo assessments of transthoracic impedance variations.

  10. Tc-99m DTPA aerosol lung scintigraphy in patients requiring mechanical ventilation

    International Nuclear Information System (INIS)

    Xenon ventilation images are of limited diagnostic value in intubated patients since only posterior views can be readily obtained. In this study, Mallinckrodt Tc-99m DTPA aerosol was evaluated for its ability to provide six ventilation projections comparable to MAA perfusion images. Earlier particles have had the drawback to impacting in either ventilator tubing or the patient's major bronchi, limiting clinical utility. Nine patients were studied. Eight had good aerosol distribution without significant particle impaction. In the remaining patient, decreased aeration and holdup of activity beyond the area of impaction was confirmed by xenon ventilation images. Comparable ventilation and perfusion projections were obtained in every patient studied

  11. High frequency oscillatory and conventional mechanical ventilation in experimental surfactant deficiency: a study using a new infant ventilator technique.

    Science.gov (United States)

    Schulze, A; Schaller, P; Gehrhardt, B; Mädler, H J; Dinger, J; Gmyrek, D; Winkler, U; Nitzsche, H; Mehler, H J

    1989-01-01

    The performance of a new infant ventilator system had to be evaluated. Technically it is characterized by flow (V)- and pressure (P)-transducers mounted immediately near the endotracheal tube. A microcomputer works as a function generator and governs servo-controllers for V and P thus offering a multiplicity of different modes both of the conventional (CMV) and high frequency oscillatory (HFO) type. The additional dead space imposed by the system is identical with its internal compressible volume of 2 ml. Serial pulmonary lavages were performed in 17 adult rabbits while on CMV. PaO2 per unit of mean airway pressure (MAP) decreased thereby from 95.9 +/- 29.3 to 9.0 +/- 6.7 (kPa/kPa). The animals were then alternately ventilated by HFO (5, 10, or 20 Hz) and CMV, at matched MAP's. No significant difference in PaO2 between the two methods was revealed in intra-animal comparisons except a slight superiority of CMV at MAP's above 1.7 kPa (P less than 0.05). There was no clear linear relationship between PaO2 and MAP both at CMV and HFO. A strong increase in PaO2 often occurred beyond a MAP threshold. In 37 postlavage HFO runs at 5 Hz in 13 animals volume amplitudes of 3.19 +/- 0.5 ml/kg of bodyweight resulted in PaCO2 levels of 6.29 +/- 1.87 kPa. Except in one experiment (10 Hz) volume amplitudes below the natural dead space produced arterial hypercapnia. PMID:2508336

  12. Lipid metabolism disturbances and AMPK activation in prolonged propofol-sedated rabbits under mechanical ventilation

    Institute of Scientific and Technical Information of China (English)

    Wei JIANG; Zheng-bo YANG; Quan-hong ZHOU; Xiang HUAN; Li WANG

    2012-01-01

    To explore the mechanisms underlying the propofol infusion syndrome (PRIS),a potentially fatal complication during prolonged propofol infusion.Methods:Male rabbits urider mechanical ventilation through endotracheal intubation were divided into 3 groups (n=6 for each) that were sedated with 1% propofol (Group P),isoflurane (Group Ⅰ) or isoflurane while receiving 10% intralipid (Group Ⅱ),respectively.Blood biochemical parameters were collected at O,6,12,18,24,and 30-36 h after the initiation of treatments.The hearts were removed out immediately after the experiments,and the level of tumor necrosis factor (TNF)-α in the hearts were studied using immunohistochemistry.AMP-activated protein kinase (AMPK) and phospho-AMPK in the hearts were assessed using Western blotting.Results:The mortality rate was 50% in Group P,and 0% in Groups Ⅰ and Ⅱ.The serum lipids and liver function indices in Group P were significantly increased,but moderately increased in Group Ⅱ.Significant decreases in these indices were found in Groups Ⅰ.All the groups showed dramatically increased release of creatine kinase (CK).Intense positive staining of TNF-c was found in all the heart samples in Group P,but only weak and neglectful staining was found in the hearts from Group Ⅱ and Group Ⅰ,respectively.AMPK phosphorylation was significantly increased in the hearts of Group P.Conclusion:Continuous infusion of large dose of propofol in rabbits undergoing prolonged mechanical ventilation causes hyperlipidemia,liver dysfunction,increased CK levels,AMPK activation and myocardial injury.The imbalance between energy demand and utilization may contribute to PRIS.

  13. Mechanical ventilation and intra-abdominal hypertension: 'Beyond Good and Evil'

    OpenAIRE

    Pelosi, Paolo; Vargas, Maria

    2012-01-01

    Intra-abdominal hypertension is frequent in surgical and medical critically ill patients. Intra-abdominal hypertension has a serious impact on the function of respiratory as well as peripheral organs. In the presence of alveolar capillary damage, which occurs in acute respiratory distress syndrome (ARDS), intra-abdominal hypertension promotes lung injury as well as edema, impedes the pulmonary lymphatic drainage, and increases intra-thoracic pressures, leading to atelectasis, airway closure, ...

  14. Acute respiratory failure induced by mechanical pulmonary ventilation at a peak inspiratory pressure of 40 cmH2O.

    Science.gov (United States)

    Tsuno, K; Sakanashi, Y; Kishi, Y; Urata, K; Tanoue, T; Higashi, K; Yano, T; Terasaki, H; Morioka, T

    1988-09-01

    The effects of high pressure mechanical pulmonary ventilation at a peak inspiratory pressure of 40 cmH(2)O were studied on the lungs of healthy newborn pigs (14-21 days after birth). Forty percent oxygen in nitrogen was used for ventilation to prevent oxygen intoxication. The control group (6 pigs) was ventilated for 48 hours at a peak inspiratory pressure less than 18 cmH(2)O and a PEEP of 3-5 cmH(2)O with a normal tidal volume, and a respiratory rate of 20 times/min. The control group showed few deleterious changes in the lungs for 48 hours. Eleven newborn pigs were ventilated at a peak inspiratory pressure of 40 cmH(2)O with a PEEP of 3-5 cmH(2)O and a respiratory rate of 20 times/min. To avoid respiratory alkalosis, a dead space was placed in the respiratory circuit, and normocarbia was maintained by adjusting dead space volume. In all cases in the latter group, severe pulmonary impairments, such as abnormal chest roentgenograms, hypoxemia, decreased total static lung compliance, high incidence of pneumothorax, congestive atelectasis, and increased lung weight were found within 48 hours of ventilation. When the pulmonary impairments became manifest, 6 of the 11 newborn pigs were switched to the conventional medical and ventilatory therapies for 3-6 days. However, all of them became ventilator dependent, and severe lung pathology was found at autopsy. These pulmonary insults by high pressure mechanical pulmonary ventilation could be occurring not infrequently in the respiratory management of patients with respiratory failure. PMID:15236077

  15. Ventilação de alta freqüência em crianças e adolescentes com síndrome do desconforto respiratório agudo (impacto sobre o uso de ecmo High-frequency ventilation in children and adolescents with acute respiratory distress syndrome (impact on the use of ecmo

    Directory of Open Access Journals (Sweden)

    Lucília Santana Faria

    2007-06-01

    and adolescents with ARDS. METHODS: a systematic review of medical literature on the use of HFV and ECMO in children and adolescents with ARDS was carried out. Medline, Lilacs and Embase databases were searched for the following terms: adult respiratory distress syndrome, ARDS, acute respiratory distress syndrome, respiratory distress syndrome, extracorporeal membrane oxygenation, ECMO, high-frequency ventilation, high-frequency jet ventilation and high-frequency oscillatory ventilation. Search was conducted for controlled and randomized clinical trials, cohort studies and a series of cases which compared HFV with conventional mechanic ventilation (CMV, ECMO with CMV, or HFV preceding the use of ECMO. RESULTS: Two hundred eighty nine publications related to HFV, ARDS and ECMO were found. Of these, only nine matched pre-established selection criteria which refer to use of HFV and/or ECMO in children and adolescents with ARDS. CONCLUSION: It was not possible to determine if use of HFV improves the survical rate of children and adolescent with ARDS. Regarding ventilation time, there is no study that confirms, with statistical significance, its increase or decrease. Whether HFV reduces or not indication of ECMO for children and adolescents with ARDS was also determined.

  16. Should High-Frequency Ventilation in the Adult Be Abandoned?

    Science.gov (United States)

    Nguyen, Albert P; Schmidt, Ulrich H; MacIntyre, Neil R

    2016-06-01

    High-frequency oscillatory ventilation (HFOV) can improve ventilation-perfusion matching without excessive alveolar tidal stretching or collapse-reopening phenomenon. This is an attractive feature in the ventilation of patients with ARDS. However, two recent large multi-center trials of HFOV failed to show benefits in this patient population. The following review addresses whether, in view of these trails, HFOV should be abandoned in the adult population? PMID:27235314

  17. Nonpharmacological interventions to manage common symptoms in patients receiving mechanical ventilation.

    Science.gov (United States)

    Tracy, Mary Fran; Chlan, Linda

    2011-06-01

    Patients receiving mechanical ventilation can experience symptoms such as pain, anxiety, agitation, and lack of sleep while in the intensive care unit, all of which can affect healing. Nonpharmacological complementary therapies can be used as adjuncts to sedatives and analgesics. By incorporating appropriate use of complementary therapies in conjunction with mainstream medical therapies, nurses can decrease patients' anxiety, promote sleep, and promote a healing environment to improve outcomes. Minimizing noise and providing access to natural light help promote a healing environment. Methods to promote sleep include relaxation techniques such as progressive muscle relaxation and massage and communication with patients' and their families to determine the patients' normal sleep patterns. Complementary therapies to relieve anxiety and agitation include music intervention, imagery, presence, and animal-assisted therapy. PMID:21632591

  18. A case of pneumothorax due to non-invasive mechanical ventilation

    Directory of Open Access Journals (Sweden)

    İbrahim Koç

    2014-09-01

    Full Text Available Emphysema is enlargement of alveolus, alveolary ducts and destruction of alveolary wall. One of complications of non-invasive mechanical ventilation (NIMV is barotrauma of damaged lung. Here we present a 75 years old male who had Chronic Obstructive Pulmonary Disease (COPD, emphysema for 5 years and suffered from pneumothorax after NIMV. During treatment with NIMV his general condition deteriorated and oxygen saturation decreased immediately. Chest X-ray and tomography revealed pneumothorax. Chest tube inserted under local anesthesia. Although NIMV might seem like innocent, in patients whose general condition immediately worsens, oxygen saturation decreases, has emphysema and bullous lesions pneumothorax must be excluded. J Clin Exp Invest 2014; 5 (3: 469-471

  19. [Postural therapy during mechanical pulmonary ventilation with PEEP in patients with unilateral lung damage].

    Science.gov (United States)

    Neverin, V K; Vlasenko, A V; Mitrokhin, A A; Galushka, S V; Ostapchenko, D V; Shishkina, E V

    2000-01-01

    Mechanical ventilation of the lungs (MVL) with positive end expiratory pressure (PEEP) is difficult in patients with unilateral lung damage because of uneven distribution of volumes and pressures in the involved and intact lungs. Harmful effects are easier manifested under such conditions. Selective MVL with selective PEEP is widely used abroad for optimizing MVL, but this method is rather expensive and is not devoid of shortcomings. Our study carried out in 32 patients with unilateral lung involvement showed that traditional MVL with general PEEP can effectively (in 75% cases) regulate gaseous exchange and decrease its untoward effects if MVL is performed with the patient lying on the healthy side and not supine. MVL in patients with unilateral lung injury lying on the healthy side can be a simpler and cheaper alternative to selective MVL with selective PEEP. PMID:10833838

  20. A novel fuzzy logic inference system for decision support in weaning from mechanical ventilation.

    Science.gov (United States)

    Kilic, Yusuf Alper; Kilic, Ilke

    2010-12-01

    Weaning from mechanical ventilation represents one of the most challenging issues in management of critically ill patients. Currently used weaning predictors ignore many important dimensions of weaning outcome and have not been uniformly successful. A fuzzy logic inference system that uses nine variables, and five rule blocks within two layers, has been designed and implemented over mathematical simulations and random clinical scenarios, to compare its behavior and performance in predicting expert opinion with those for rapid shallow breathing index (RSBI), pressure time index and Jabour' weaning index. RSBI has failed to predict expert opinion in 52% of scenarios. Fuzzy logic inference system has shown the best discriminative power (ROC: 0.9288), and RSBI the worst (ROC: 0.6556) in predicting expert opinion. Fuzzy logic provides an approach which can handle multi-attribute decision making, and is a very powerful tool to overcome the weaknesses of currently used weaning predictors.

  1. Perceived effort of funtional activities after a period of mechanical ventilation

    Directory of Open Access Journals (Sweden)

    R. Roos

    2002-02-01

    Full Text Available A case report to assess exercise testing post-mechanical ventilation, using functional activities while monitoring changes in the physiological parameters and subjective rating of perceived exertion.  The case report subject was able to use the Modified Borg Scale to report  her perception of perceived exertion during functional exercise testing.  An increase in heart rate, respiratory rate and Modified Borg Scale rating was noted on progression through the exercise test.  Difficulty was experienced with subject follow-up due to discharged from hospital as soon as the patient was considered to be medically stable.  The subject was unable to complete the functional exercise test before discharge.

  2. Comparison of mechanical and manual ventilation during transport of patients to the intensive care unit after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Atilla Canbulat

    2012-12-01

    Full Text Available Objectives: We compared effects of mechanical andmanual ventilation during transport to the intensive careunit(ICU in cardiac surgeries.Materials and methods: After ethical approval, 66 patients(ASAgrade II and III, 20-80years were assignedrandomly. Ventilation during transport to ICU was performedmanual (Group EV; n=36 or mechanical ventilation(Group MV; n=30. Measurements were recorded:operation room (A, during transport (T and in ICU (YB.Systolic, diastolic pressures (SAP, DAP, pulmonary arterialpressure (PAP, pulmonary capillary wedge pressure(PCWP, central venous pressure (CVP, heart rate (HR,cardiac output (CO, blood gases (pH, PCO2, PO2, BEand peripheral oxygen saturation (SpO2 were recorded.Stroke volume index (SVI, systemic and pulmonary vascularresistance indices (SVRI, PVRI and mean arterialpressures(MAP were calculated.Results: Patients were similar. Duration of transportwas shorter in Group MV (p< 0.01. The alterations inHR, MAP, DAP, CVP, PAP, PCWP, PVRI, SVRI, SVI, CO,SpO2 were similar, the increase in SAP during T periodwas higher in Group MV (p<0.05. Pulmonary arterial pHin Group MV was lower (p< 0.05. Arterial and pulmonaryarterial pO2, pCO2 decreased in Group MV, there was increasein Group EV during ICU (p< 0.001, p< 0.01, p<0.01, p< 0.05. During T period hypotension and tachycardiain Group EV, and hypertension in Group MV wereobserved.Conclusions: Mechanical ventilation had short transporttime, less alterations in hemodynamic and respiration valuesand less complication rates. We concluded that theuse of mechanical ventilation is a safer method for theintrahospital transport of critical patients. J Clin Exp Invest2012; 3(4: 521-528Key words: Cardiac surgery, patient transport, mechanicalventilator, manual ventilator, hemodynamia

  3. Absence of TNF-α enhances inflammatory response in the newborn lung undergoing mechanical ventilation.

    Science.gov (United States)

    Ehrhardt, Harald; Pritzke, Tina; Oak, Prajakta; Kossert, Melina; Biebach, Luisa; Förster, Kai; Koschlig, Markus; Alvira, Cristina M; Hilgendorff, Anne

    2016-05-15

    Bronchopulmonary dysplasia (BPD), characterized by impaired alveolarization and vascularization in association with lung inflammation and apoptosis, often occurs after mechanical ventilation with oxygen-rich gas (MV-O2). As heightened expression of the proinflammatory cytokine TNF-α has been described in infants with BPD, we hypothesized that absence of TNF-α would reduce pulmonary inflammation, and attenuate structural changes in newborn mice undergoing MV-O2 Neonatal TNF-α null (TNF-α(-/-)) and wild type (TNF-α(+/+)) mice received MV-O2 for 8 h; controls spontaneously breathed 40% O2 Histologic, mRNA, and protein analysis in vivo were complemented by in vitro studies subjecting primary pulmonary myofibroblasts to mechanical stretch. Finally, TNF-α level in tracheal aspirates from preterm infants were determined by ELISA. Although MV-O2 induced larger and fewer alveoli in both, TNF-α(-/-) and TNF-α(+/+) mice, it caused enhanced lung apoptosis (TUNEL, caspase-3/-6/-8), infiltration of macrophages and neutrophils, and proinflammatory mediator expression (IL-1β, CXCL-1, MCP-1) in TNF-α(-/-) mice. These differences were associated with increased pulmonary transforming growth factor-β (TGF-β) signaling, decreased TGF-β inhibitor SMAD-7 expression, and reduced pulmonary NF-κB activity in ventilated TNF-α(-/-) mice. Preterm infants who went on to develop BPD showed significantly lower TNF-α levels at birth. Our results suggest a critical balance between TNF-α and TGF-β signaling in the developing lung, and underscore the critical importance of these key pathways in the pathogenesis of BPD. Future treatment strategies need to weigh the potential benefits of inhibiting pathologic cytokine expression against the potential of altering key developmental pathways. PMID:27016588

  4. ARDS患者中APACHEⅡ评分及CRP值对呼吸机应用的指导意义%The guide significance of the APACHE Ⅱ score and CRP in acute respiratory distress syndrome to ventilator applications

    Institute of Scientific and Technical Information of China (English)

    杨晓帆; 王君一; 田六九; 黄彩凤; 荣清源; 葛良

    2011-01-01

    Objective: To investigate the guide significance of APACHE Ⅱ score and CRP in acute respiratory distress syndrome to vertilator applications.Methods: Reviewed the 54 ARDS patients from October 2009 to October 2010 that had been freed from ARDS in the ICU of the First People's Hospital of Anqing City, compared the APACHE Ⅱ score and CRP in 55 ARDS before mechanical ventilation with when freed from ventilators, compared the APACHE Ⅱ score and CRP in male ARDS with in the female, and the APACHE Ⅱ score and CRP in ARDS patients with different etiology; at the same time studied the relations between APACHE Ⅱ score and CRP in ARDS patients.Results: The APACHE Ⅱ score and CRP when freed from ventilator were obviously lower than before mechanical ventilation; there was no statistical meaning in the differenee of APACHE Ⅱ score and CRP between male and female; the APACHE Ⅱ acore and CRP in trauma ARDS patients was lower than in pulmonary infection and aspiration ARDS patients without statistical mearung (P>0.05).There was a positive relation between APACHE Ⅱ score and CRP in ARDS patients (r=0 52).Conclusion: There i8 a great guide significance in the applications of mechanical ventilation through studying the change of APACHE Ⅱ score and CRP in ARDS patients.%目的:探讨APACHEⅡ评分及CRP值对ARDS患者呼吸机应用的指导意义.方法:回顾性分析安庆市第一人民医院ICU 2009年10月~2010年10月以来成功救治的55例ARDS患者,比较机械通气前及脱机时APACHEⅡ评分及CRP值,比较不同性别间ARDS患者APACHEⅡ评分及CRP值,比较不同病因间ARDS患者APACHEⅡ评分及CRP值并分析APACHEⅡ评分和CRP值的关联性.结果:脱机时APACHE评分及CRP值较机械通气前显著降低,不同性别间ARDS患者APACHEⅡ评分及CRP值无差异,外伤性ARDS患者机械通气前APACHEⅡ评分及CRP值均较肺部感染及误吸性ARDS高,但差异无统计学意义(P>0.05).ARDS患者APACHEⅡ评分

  5. Mortality risk factors in premature infants with respiratory distress syndrome treated by mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Fidanovski Duško

    2005-01-01

    Full Text Available Respiratory distress syndrome (RDS is the most common cause of respiratory failure and requirement for mechanical ventilation (MV of newborns. RDS is also common cause of mortality and severe morbidity in premature infants. In developing countries, despite facilities for respiratory care of newborn infants, RDS mortality rate and percentage of complications still remain high in comparison to the developed countries. Survival rates of RDS infants requiring MV ranged from 25% in those newborns with birth weight <1000 grams up to 53% in those with birth weight >2500 grams. There have been limited data about causes of high mortality rate in infants with RDS from developing countries. AIM The objectives of the study were to determine (I the incidence of severe RDS at Pediatric Intensive Care Unit (PICU, University Children's Hospital Skopje (UCHS and main characteristics of infants with RDS, as well as (II the survival rate and mortality risk factors of these infants. MATERIAL AND METHODS The study included 126 premature infants with clinical and radiological signs of RDS requiring mechanical ventilation who were admitted to PICU, UCHS between January 1996 and December 2003. The mean gestational age (GA of the infants was 31.5+2.5 weeks, and the mean birth weight (BW was 1663+489 grams. The management of newborns with RDS at PICU, UCHS, follows the standard protocol, with emphasis on minimal manipulation, maintenance of thermo neutral environment, administration of humidified oxygen and non-invasive cardio respiratory monitoring. Pressure-limited time-cycled mechanical ventilation with pediatric/neonatal ventilators was performed in all infants. In those newborn infants with clinical and radiological signs of RDS and need for MV with FiO2>0.4, synthetic (Exosurf or natural (Survanta surfactants were administered. Out of all newborns, 43 infants (34% were not treated with surfactant, because it was not available at that time. RESULTS In the period

  6. Non-sedation versus sedation with a daily wake-up trial in critically ill patients receiving mechanical ventilation-effects on physical function

    DEFF Research Database (Denmark)

    Nedergaard, Helene Korvenius; Jensen, Hanne Irene; Lauridsen, Jørgen T;

    2015-01-01

    will be intubated, mechanically ventilated patients with expected duration of mechanical ventilation >24 h. Exclusion criteria will be patients with severe head trauma, coma at admission or status epilepticus, patients treated with therapeutic hypothermia, patients with PaO2/FiO2

  7. Factors Influencing Continuous Breath Signal in Intubated and Mechanically-Ventilated Intensive Care Unit Patients Measured by an Electronic Nose

    Science.gov (United States)

    Leopold, Jan Hendrik; Abu-Hanna, Ameen; Colombo, Camilla; Sterk, Peter J.; Schultz, Marcus J.; Bos, Lieuwe D. J.

    2016-01-01

    Introduction: Continuous breath analysis by electronic nose (eNose) technology in the intensive care unit (ICU) may be useful in monitoring (patho) physiological changes. However, the application of breath monitoring in a non-controlled clinical setting introduces noise into the data. We hypothesized that the sensor signal is influenced by: (1) humidity in the side-stream; (2) patient-ventilator disconnections and the nebulization of medication; and (3) changes in ventilator settings and the amount of exhaled CO2. We aimed to explore whether the aforementioned factors introduce noise into the signal, and discuss several approaches to reduce this noise. Methods: Study in mechanically-ventilated ICU patients. Exhaled breath was monitored using a continuous eNose with metal oxide sensors. Linear (mixed) models were used to study hypothesized associations. Results: In total, 1251 h of eNose data were collected. First, the initial 15 min of the signal was discarded. There was a negative association between humidity and Sensor 1 (Fixed-effect β: −0.05 ± 0.002) and a positive association with Sensors 2–4 (Fixed-effect β: 0.12 ± 0.001); the signal was corrected for this noise. Outliers were most likely due to noise and therefore removed. Sensor values were positively associated with end-tidal CO2, tidal volume and the pressure variables. The signal was corrected for changes in these ventilator variables after which the associations disappeared. Conclusion: Variations in humidity, ventilator disconnections, nebulization of medication and changes of ventilator settings indeed influenced exhaled breath signals measured in ventilated patients by continuous eNose analysis. We discussed several approaches to reduce the effects of these noise inducing variables. PMID:27556467

  8. Factors Influencing Continuous Breath Signal in Intubated and Mechanically-Ventilated Intensive Care Unit Patients Measured by an Electronic Nose

    Directory of Open Access Journals (Sweden)

    Jan Hendrik Leopold

    2016-08-01

    Full Text Available Introduction: Continuous breath analysis by electronic nose (eNose technology in the intensive care unit (ICU may be useful in monitoring (patho physiological changes. However, the application of breath monitoring in a non-controlled clinical setting introduces noise into the data. We hypothesized that the sensor signal is influenced by: (1 humidity in the side-stream; (2 patient-ventilator disconnections and the nebulization of medication; and (3 changes in ventilator settings and the amount of exhaled CO2. We aimed to explore whether the aforementioned factors introduce noise into the signal, and discuss several approaches to reduce this noise. Methods: Study in mechanically-ventilated ICU patients. Exhaled breath was monitored using a continuous eNose with metal oxide sensors. Linear (mixed models were used to study hypothesized associations. Results: In total, 1251 h of eNose data were collected. First, the initial 15 min of the signal was discarded. There was a negative association between humidity and Sensor 1 (Fixed-effect β: −0.05 ± 0.002 and a positive association with Sensors 2–4 (Fixed-effect β: 0.12 ± 0.001; the signal was corrected for this noise. Outliers were most likely due to noise and therefore removed. Sensor values were positively associated with end-tidal CO2, tidal volume and the pressure variables. The signal was corrected for changes in these ventilator variables after which the associations disappeared. Conclusion: Variations in humidity, ventilator disconnections, nebulization of medication and changes of ventilator settings indeed influenced exhaled breath signals measured in ventilated patients by continuous eNose analysis. We discussed several approaches to reduce the effects of these noise inducing variables.

  9. Effect of alveolar recruitment maneuvers combined with lung protection mechanical ventilation on lung injury in a rabbit model of acute respiratory distress syndrome%反复肺复张联合肺保护性通气对急性呼吸窘迫综合征家兔肺损伤的影响

    Institute of Scientific and Technical Information of China (English)

    赵小龙; 李家琼; 史载祥; 许继元; 莫逊; 李茂琴

    2011-01-01

    目的 评价反复肺复张联合肺保护性通气对急性呼吸窘迫综合征(ARDS)家兔肺损伤的影响.方法 家兔24只,雌雄各半,体重2.5~3.5 kg,采用随机数字表法,将兔随机分为4组(n=6):正常对照组(Ⅰ组)、ARDS模型组(Ⅱ组)、肺保护性通气组(Ⅲ组)和反复肺复张联合肺保护性通气组(Ⅳ组).麻醉下进行机械通气,Ⅱ组、Ⅲ组和Ⅳ组采用静脉输注油酸0.1 ml/kg(经15 min输注)的方法 制备ARDS模型,模型制备成功后经3 min确定静态压力.容积曲线低位转折点.Ⅰ组和Ⅱ组的通气参数为:VT12 ml/kg,通气频率30次/min,呼气末正压(PEEP)0,FiO2 1.0,氧流量1 L/min,吸气时间0.6 s,吸呼比1.0∶2.3;Ⅲ和Ⅳ组通气参数为:VT6 ml/kg,PEEP为静态压力-容积曲线低位转折点对应气道力+2 cm H2O,其他通气参数同Ⅰ组和Ⅱ组,Ⅳ组分别在确定静态压力-容积曲线低位转折点后即刻、1、2和3 h时实施肺复张.肺复张的方法:吸气压力为30 cm H2O,吸气时间为30 s.分别于每次肺复张后采集动脉血样,测定PaO2,计算氧合指数.最后一次肺复张后1 h处死动物,取肺组织,测定TNF-α和IL-10的含量、髓过氧化物酶(MPO)活性、丙二醛(MDA)含量和湿/干重比(W/D比),计算TNF-α与IL-10的比值(TNF-α/IL-10),光镜下观察肺组织病理学结果.结果 与Ⅰ组比较,Ⅱ组氧合指数降低,肺组织TNF-α/IL-10、MPO、MDA和W/D比升高(P<0.05);与Ⅱ组比较,Ⅲ组氧合指数升高,肺组织TNF-α/IL-10、MPO、MDA和W/D比降低(P<0.05);与Ⅲ组比较,Ⅳ组氧合指数升高,肺组织TNF-α/IL-10、MPO、MDA和W/D比降低(P<0.05).Ⅳ组肺组织损伤程度轻于Ⅲ组.结论 与肺保护性通气比较,肺保护性通气期间反复肺复张可进一步减轻ARDS家兔肺损伤,其机制与抑制肺组织炎性反应有关.%Objective To evaluate the effect of alveolar recruitment maneuvers (ARM) combined with lung protection mechanical ventilation on lung injury in a

  10. Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

    NARCIS (Netherlands)

    Halbertsma, F.J.; Hoeven, J.G. van der

    2005-01-01

    A literature review was conducted to assess the evidence for recruitment manoeuvres used in conventional mechanical positive pressure ventilation. A total of 61 studies on recruitment manoeuvres were identified: 13 experimental, 31 ICU, 6 PICU and 12 anaesthesia studies. Recruitment appears to be a

  11. Influence of mechanical abrasion of carbon adsorbents on aerodynamic resistance of filters of system of ventilation of NPS

    International Nuclear Information System (INIS)

    Influence of mechanical abrasion of granules on aerodynamic resistance of different carbon adsorbents at conditions similar to work of filters AU-1500 is studied. The change of fractional composition of the probed adsorbents by abrasion is determined. The obtained experimental data allow making conclusion about practicability using mixture of adsorbent Norit with different fractional composition for renewal of adsorbers of ventilation system of NPS.

  12. Independent risk of mechanical ventilation for AIDS-related Pneumocystis carinii pneumonia associated with bronchoalveolar lavage neutrophilia

    DEFF Research Database (Denmark)

    Bang, D; Emborg, J; Elkjaer, J;

    2001-01-01

    The use of mechanical ventilation (MV) for AIDS-related Pneumocystis carinii pneumonia (PCP) has varied over time. The introduction of adjunctive corticosteroid therapy has changed the pathophysiology of PCP. In the present study, we attempted to identify factors predictive of severe respiratory...

  13. Mechanisms of improvement of respiratory failure in patients with restrictive thoracic disease treated with non-invasive ventilation

    OpenAIRE

    Nickol, A; Hart, N.; Hopkinson, N; Moxham, J.; Simonds, A; Polkey, M.

    2005-01-01

    Background: Nocturnal non-invasive ventilation (NIV) is an effective treatment for hypercapnic respiratory failure in patients with restrictive thoracic disease. We hypothesised that NIV may reverse respiratory failure by increasing the ventilatory response to carbon dioxide, reducing inspiratory muscle fatigue, or enhancing pulmonary mechanics.

  14. Independent risk of mechanical ventilation for AIDS-related Pneumocystis carinii pneumonia associated with bronchoalveolar lavage neutrophilia

    DEFF Research Database (Denmark)

    Bang, D.; Emborg, J.; Elkjaer, J.;

    2001-01-01

    %). In a logistic regression analysis, higher age, increased bronchoalveolar lavage (BAL) neutrophilia and a positive BAL cytomegalovirus CMV culture were associated with the need of MV. In multivariate analyses, only BAL neutrophilia remained independently predictive of mechanical ventilation. In conclusion, short...

  15. Midline submental orotracheal intubation in maxillofacial injuries: A substitute to tracheostomy where postoperative mechanical ventilation is not required

    Directory of Open Access Journals (Sweden)

    Malti Agrawal

    2010-01-01

    Conclusion: There were no significant operative or postoperative complications. Postoperative submental scarring was acceptable [6] . We conclude that midline submental intubation is a simple and useful technique with low morbidity. It can be chosen in selected cases of maxillofacial trauma and is an excellent substitute to tracheostomy where postoperative mechanical ventilation is not required.

  16. INCIDENCE OF BRONCHOPULMONARY DYSPLASIA IN PRETERM NEWBORNS SUBMITTED TO MECHANICAL VENTILATION: A RETROSPECTIVE STUDY OF 1250 PRETERM NEWBORNS

    Directory of Open Access Journals (Sweden)

    Leilianna de Souza Vieira

    2014-03-01

    Full Text Available Objective: To determine the incidence of preterm newborn infants in mechanical ventilation who developed bronchopulmonary dysplasia in a public hospital at Fortaleza/CE. Method: Descriptive, retrospective and longitudinal quantitative analysis with 1250 preterm infants admitted to the Intensive Care Unit, Dr. César Cals General Hospital, at Fortaleza, from July 2006 to June 2007. Data collection occurred during two months, with visits to units twice a week, where the medical records were done. Were included in these sample newborns that were in mechanical ventilation and developed bronchopulmonary dysplasia. Then the gestational average was 28.6 weeks; the mean weight of infants was 1125.33 grams, born vaginally or cesarean section, of both sexes and with various primary diseases such as respiratory distress syndrome, jaundice and neonatal infection. Results: In the sample from the total admissions, 34.48% were for mechanical ventilation and 3.48% developed bronchopulmonary dysplasia. Conclusion: Despite the low prevalence, bronchopulmonary dysplasia is a important complication of prematurity, directly related to the duration of mechanical ventilation, thus the team must be committed on weaning and extubation of those as soon as possible, preferably within the first week of life.

  17. Researches Regarding the Efficiency of Water to Air Heat Exchanger with Heat Pipes for the Mechanical Ventilation System

    Directory of Open Access Journals (Sweden)

    Andrei Burlacu

    2007-01-01

    Full Text Available The present paper proposes the analysis of the efficiency of water to air heat exchanger with heat pipes for the mechanical ventilation system. The performed study is based on the necessity of the unconventional energy forms capitalization, increasing of the energy efficiency and the energy consumption decrease in concordance with the sustainable development concept.

  18. Researches Regarding the Efficiency of Water to Air Heat Exchanger with Heat Pipes for the Mechanical Ventilation System

    OpenAIRE

    Andrei Burlacu; Theodor Mateescu

    2007-01-01

    The present paper proposes the analysis of the efficiency of water to air heat exchanger with heat pipes for the mechanical ventilation system. The performed study is based on the necessity of the unconventional energy forms capitalization, increasing of the energy efficiency and the energy consumption decrease in concordance with the sustainable development concept.

  19. Heterogeneity of cerebral vasoreactivity in preterm infants supported by mechanical ventilation

    International Nuclear Information System (INIS)

    The reaction of cerebral blood flow to acute changes in arterial carbon dioxide pressure (PaCO2) and mean arterial blood pressure was determined in 57 preterm infants supported by mechanical ventilation (mean gestational age 30.1 weeks) during the first 48 hours of life. All infants had normal brain sonograms at the time of the investigation. In each infant, global cerebral blood flow was determined by xenon-133 clearance two to five times within a few hours at different levels of PaCO2. Changes in PaCO2 followed adjustments of the ventilator settings. Arterial oxygen pressure was intended to be kept constant, and mean arterial blood pressure fluctuated spontaneously between measurements. The data were analyzed by stepwise multiple regression, with changes in global cerebral blood flow, PaCO2, mean arterial blood pressure, and postnatal age or intracranial hemorrhage used as variables. In infants with persistently normal brain sonograms, the global cerebral blood flow-carbon dioxide reactivity was markedly lower during the first day of life (mean 11.2% to 11.8%/kPa PaCO2) compared with the second day of life (mean 32.6/kPa PaCO2), and pressure-flow autoregulation was preserved. Similarly, global cerebral blood flow-carbon dioxide reactivity and pressure-flow autoregulation were present in infants in whom mild intracranial hemorrhage developed after the study. In contrast, global cerebral blood flow reactivity to changes in PaCO2 and mean arterial blood pressure was absent in infants in whom ultrasonographic signs of severe intracranial hemorrhage subsequently developed. These infants also had about 20% lower global cerebral blood flow before hemorrhage, in comparison with infants whose sonograms were normal, a finding that suggests functional disturbances of cerebral blood flow regulation

  20. Flexible bronchoscopy during non-invasive positive pressure mechanical ventilation: are two better than one?

    Science.gov (United States)

    Scala, Raffaele

    2016-09-01

    Flexible bronchoscopy (FBO) and non-invasive positive pressure ventilation (NIPPV) are largely applied in respiratory and general intensive care units. FBO plays a crucial role for the diagnosis of lung infiltrates of unknown origin and for the treatment of airways obstruction due to bronchial mucous plugging and hemoptysis in critical patients. NIPPV is the first-choice ventilatory strategy for acute respiratory failure (ARF) of different causes as it could be used as prevention or as alternative to the conventional mechanical ventilation (CMV) via endotracheal intubation (ETI). Some clinical scenarios represent contraindications for these techniques such as severe ARF in spontaneous breathing patients for FBO and accumulated tracheo-bronchial secretions in patients with depressed cough for NIPPV. In these contexts, the decision of performing ETI should carefully consider the risk of CMV-correlated complications. An increasing amount of published data suggested the use of FBO during NIPPV in ARF in order to avoid/reduce the need of ETI. Despite a strong rationale for the combined use of the two techniques, there is not still enough evidence for a large-scale application of this strategy in all different clinical scenarios. The majority of the available data are in favor of the "help" given by NIPPV to diagnostic FBO in high-risk spontaneously breathing patients with severe hypoxemia. Preliminary findings report the successful "help" given by early FBO to NIPPV in patients with hypoxemic-hypercapnic ARF who are likely to fail because of hypersecretion. Synergy of FBO and NIPPV application is emerging also to perform ETI in challenging situations, such as predicted difficult laringoscopy and NPPV failure in severely hypoxemic patients. This combined approach should be performed only in centers showing a wide experience with both NIPPV and FBO, where close monitoring and ETI facilities are promptly available. PMID:27012292