WorldWideScience

Sample records for noninvasive mechanical ventilation

  1. 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.

  2. Technology for noninvasive mechanical ventilation: looking into the black box

    Directory of Open Access Journals (Sweden)

    Ramon Farré

    2016-03-01

    Full Text Available Current devices for providing noninvasive respiratory support contain sensors and built-in intelligence for automatically modifying ventilation according to the patient's needs. These devices, including automatic continuous positive airway pressure devices and noninvasive ventilators, are technologically complex and offer a considerable number of different modes of ventilation and setting options, the details of which are sometimes difficult to capture by the user. Therefore, better predicting and interpreting the actual performance of these ventilation devices in clinical application requires understanding their functioning principles and assessing their performance under well controlled bench test conditions with simulated patients. This concise review presents an updated perspective of the theoretical basis of intelligent continuous positive airway pressure and noninvasive ventilation devices, and of the tools available for assessing how these devices respond under specific ventilation phenotypes in patients requiring breathing support.

  3. 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

  4. 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.

  5. Non-Invasive Mechanic Ventilation Using in Flail Chest, Caused By Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Serdar Onat

    2008-01-01

    Full Text Available A 75-year-old woman admitted our faculty emergency room with shortness of breath, and chest pain after traffic accident’s second hour. She was diagnosed as bilateral multipl rib fractures, left clavicula fracture, and left flail chest by phsical and radiological examinations. She was transfered to Chest Surgery Depatment’s intensive care unit. The patient was undergone non-invasive mask mechanic ventilation support, because of the decreasing of blood oxygen saturation and increasing of arteriel blood partial carbondioxide pressure. The treatment of non-invasive mechanic ventilation was succesfull for ventilation support. With this report, we would like to attentioned that non-invasive mechanic ventilation for blunt chest trauma patients could be used succesfully and could be used instead of endotracheal invasive mechanic ventilation.

  6. Respiratory care year in review 2010: part 2. Invasive mechanical ventilation, noninvasive ventilation, pediatric mechanical ventilation, aerosol therapy.

    Science.gov (United States)

    Macintyre, Neil R; Nava, Stefano; Diblasi, Robert M; Restrepo, Ruben D; Hess, Dean R

    2011-05-01

    The purpose of this paper is to review the recent literature related to invasive mechanical ventilation, NIV, pediatric mechanical ventilation, and aerosol therapy. Topics covered related to invasive mechanical ventilation topics include the role of PEEP in providing lung protection during mechanical ventilation, unconventional modes for severe hypoxemia, and strategies to improve patient-ventilator interactions. Topics covered related to NIV include real-life NIV use, NIV and extubation failure, and NIV and pandemics. For pediatric mechanical ventilation, the topics addressed are NIV, invasive respiratory support, and inhaled nitric oxide. Topics covered related to aerosol therapy include short-acting β-adrenergic agents, long-acting β-adrenergic agents, long-acting antimuscarinic agents, inhaled corticosteroid therapy, phosphodiesterase type 4 (PDE4) inhibitors, long-acting β-adrenergic plus inhaled corticosteroid, long-acting antimuscarinic plus inhaled corticosteroid, nebulized hypertonic saline, inhaled mannitol, and inhaled antibiotic therapy. These topics were chosen and reviewed in a manner that is most likely to have interest to the readers of Respiratory Care.

  7. 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.

  8. 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.

  9. Online estimation of respiratory mechanics in non-invasive pressure support ventilation: a bench model study.

    Science.gov (United States)

    Mulqueeny, Qestra; Tassaux, Didier; Vignaux, Laurence; Jolliet, Philippe; Schindhelm, Klaus; Redmond, Stephen; Lovell, Nigel H

    2010-01-01

    An online algorithm for determining respiratory mechanics in patients using non-invasive ventilation (NIV) in pressure support mode was developed and embedded in a ventilator system. Based on multiple linear regression (MLR) of respiratory data, the algorithm was tested on a patient bench model under conditions with and without leak and simulating a variety of mechanics. Bland-Altman analysis indicates reliable measures of compliance across the clinical range of interest (± 11-18% limits of agreement). Resistance measures showed large quantitative errors (30-50%), however, it was still possible to qualitatively distinguish between normal and obstructive resistances. This outcome provides clinically significant information for ventilator titration and patient management.

  10. 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.

  11. 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.

  12. 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.

  13. Noninvasive mechanical ventilation in chronic obstructive pulmonary disease and in acute cardiogenic pulmonary edema.

    Science.gov (United States)

    Rialp Cervera, G; del Castillo Blanco, A; Pérez Aizcorreta, O; Parra Morais, L

    2014-03-01

    Noninvasive ventilation (NIV) with conventional therapy improves the outcome of patients with acute respiratory failure due to hypercapnic decompensation of chronic obstructive pulmonary disease (COPD) or acute cardiogenic pulmonary edema (ACPE). This review summarizes the main effects of NIV in these pathologies. In COPD, NIV improves gas exchange and symptoms, reducing the need for endotracheal intubation, hospital mortality and hospital stay compared with conventional oxygen therapy. NIV may also avoid reintubation and may decrease the length of invasive mechanical ventilation. In ACPE, NIV accelerates the remission of symptoms and the normalization of blood gas parameters, reduces the need for endotracheal intubation, and is associated with a trend towards lesser mortality, without increasing the incidence of myocardial infarction. The ventilation modality used in ACPE does not affect the patient prognosis.

  14. Non-invasive mechanical ventilation after the successful weaning: a comparison with the venturi mask

    Directory of Open Access Journals (Sweden)

    Esra Adıyeke

    Full Text Available Abstract Background and objectives: This study compared the rates of acute respiratory failure, reintubation, length of intensive care stay and mortality in patients in whom the non-invasive mechanical ventilation (NIMV was applied instead of the routine venturi face mask (VM application after a successful weaning. Methods: Following the approval of the hospital ethics committee, 62 patients who were under mechanical ventilation for at least 48 hours were scheduled for this study. 12 patients were excluded because of the weaning failure during T-tube trial. The patients who had optimum weaning criteria after the T-tube trial of 30 minutes were extubated. The patients were kept on VM for 1 hour to observe the hemodynamic and respiratory stability. The group of 50 patients who were successful to wean randomly allocated to have either VM (n = 25, or NIV (n = 25. Systolic arterial pressure (SAP, heart rate (HR, respiratory rate (RR, PaO2, PCO2, and pH values were recorded. Results: The number of patients who developed respiratory failure in the NIV group was significantly less than VM group of patients (3 reintubation vs. 14 NIV + 5 reintubation in the VM group. The length of stay in the ICU was also significantly shorter in NIV group (5.2 ± 4.9 vs. 16.7 ± 7.7 days. Conclusions: The ratio of the respiratory failure and the length of stay in the ICU were lower when non-invasive mechanical ventilation was used after extubation even if the patient is regarded as ‘successfully weaned’. We recommend the use of NIMV in such patients to avoid unexpected ventilator failure.

  15. Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy.

    Science.gov (United States)

    Yurtlu, Bülent Serhan; Köksal, Bengü; Hancı, Volkan; Turan, Işıl Özkoçak

    2016-01-01

    Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  16. [Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy].

    Science.gov (United States)

    Yurtlu, Bülent Serhan; Köksal, Bengü; Hancı, Volkan; Turan, Işıl Özkoçak

    2016-01-01

    Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  17. 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

  18. 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.

  19. 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

  20. Respiratory mechanics in COPD patients who failed non-invasive ventilation: role of intrinsic PEEP.

    Science.gov (United States)

    Antonaglia, Vittorio; Ferluga, Massimo; Capitanio, Guido; Lucangelo, Umberto; Piller, Fulvia; Roman-Pognuz, Erik; Biancardi, Bruno; Caggegi, Giuseppe Davide; Zin, Walter A

    2012-10-15

    Non-invasive positive pressure ventilation (NPPV) is the first choice to treat exacerbations in COPD patients. NPPV can fail owing to different causes related to gas exchange impairment (RF group) or intolerance (INT group). To assess if the respiratory mechanical properties and the ratio between the dynamic and static intrinsic positive end-expiratory pressure (PEEP(i),dyn/PEEP(i),stat), reflecting lung mechanical inequalities, were different between groups, 29 COPD patients who failed NPPV (15 RF and 14 INT) were studied, early after the application of invasive ventilation. Blood gas analysis, clinical status, and mechanical properties were measured. pH was higher in INT patients before intubation (p<0.001). PEEP(i),dyn/PEEP(i),stat was found higher in INT group with (p=0.021) and without PEEP (ZEEP, p<0.01). PEEP(i),dyn/PEEP(i),stat was exponentially associated with the duration of NPPV in INT group (p=0.011). INT and RF patients had similar impairment of respiratory system resistance and elastance.

  1. 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

  2. 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.

  3. Role of noninvasive ventilation in weaning from mechanical ventilation in patients of chronic obstructive pulmonary disease: An Indian experience

    Directory of Open Access Journals (Sweden)

    Prasad Shiva

    2009-01-01

    Full Text Available Background: Endotracheal intubation and mechanical ventilation (MV are often needed in patients of chronic obstructive pulmonary disease (COPD with acute hypercapnic respiratory failure. The rate of weaning failure is high and prolonged MV increases intubation associated complications. Objective: To evaluate the role of Noninvasive ventilation (NIV in weaning patients of chronic obstructive pulmonary disease (COPD from MV, after T piece trial failure. Design: A prospective, randomized, controlled study was conducted in a tertiary care centre. 30 patients of acute exacerbation of COPD with acute on chronic hypercapnic respiratory failure, who were mechanically ventilated, were included in the study A T-piece weaning trial was attempted once the patients achieved satisfactory clinical and biochemical parameters. After T-piece failure, defined as pH < 7.35, PaCO 2 > 50 mmHg, PaO 2 < 50 mmHg, HR> 100/min, RR> 35, patients were randomized to receive either NIV or PSV. Results: Demography, severity of disease and clinical profiles were similar in both groups. No significant difference between the two groups in duration of MV (6.20 ± 5.20 days vs. 7.47 ± 6.38 days, P > 0.05, duration of weaning (35.17 ± 16.98 and 47.05 ± 20.98 hours, P > 0.05 or duration of ICU stay (8.47 ± 4.79 and 10.80 ± 5.28 days, P > 0.05 in Gp I and Gp II, respectively. Five patients developed VAP in the PSV group, where as only one patient had pneumonia in the NIV group. Lesser number of deaths in the NIV group at discharge from ICU (3 vs. 5 patients, respectively and at 30 days (5 vs. 9 patients, respectively, it did not achieve statistical significance (P > 0.05. Conclusion: NIV is as useful as PSV in weaning and can be better in weaning failure especially in COPD for earlier weaning, decrease ICU stay, complications and mortality.

  4. Non-invasive ventilation for cystic fibrosis.

    Science.gov (United States)

    Moran, Fidelma; Bradley, Judy M; Piper, Amanda J

    2017-02-20

    Non-invasive ventilation may be a means to temporarily reverse or slow the progression of respiratory failure in cystic fibrosis by providing ventilatory support and avoiding tracheal intubation. Using non-invasive ventilation, in the appropriate situation or individuals, can improve lung mechanics through increasing airflow and gas exchange and decreasing the work of breathing. Non-invasive ventilation thus acts as an external respiratory muscle. This is an update of a previously published review. To compare the effect of non-invasive ventilation versus no non-invasive ventilation in people with cystic fibrosis for airway clearance, during sleep and during exercise. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. We searched the reference lists of each trial for additional publications possibly containing other trials.Most recent search: 08 August 2016. Randomised controlled trials comparing a form of pressure preset or volume preset non-invasive ventilation to no non-invasive ventilation used for airway clearance or during sleep or exercise in people with acute or chronic respiratory failure in cystic fibrosis. Three reviewers independently assessed trials for inclusion criteria and methodological quality, and extracted data. Ten trials met the inclusion criteria with a total of 191 participants. Seven trials evaluated single treatment sessions, one evaluated a two-week intervention, one evaluated a six-week intervention and one a three-month intervention. It is only possible to blind trials of airway clearance and overnight ventilatory support to the outcome assessors. In most of the trials we judged there was an unclear risk of bias with regards to blinding due to inadequate descriptions. The six-week trial was the only one judged to have a low risk of bias for all

  5. Non-invasive mechanical ventilation in patients with diffuse interstitial lung diseases

    OpenAIRE

    Aliberti, S.; Messinesi, G.; Gamberini, S; Maggiolini, S.; Visca, D.; Galavotti, V; Giuliani, F.; Cosentini, R; Brambilla, A M; Blasi, F; Scala, R; Carone, M.; Luisi, F; Harari, S.; Voza, A.

    2014-01-01

    Background To evaluate noninvasive ventilation (NIV) in diffuse interstitial lung diseases (DILD) patients with acute respiratory failure (ARF) according to baseline radiological patterns and the etiology of ARF. Methods In a multicenter, observational, retrospective study, consecutive DILD patients undergoing NIV because of an episode of ARF were evaluated in six Italian high dependency units. Three groups of patients were identified based on the etiology of ARF: those with pneumonia (Group ...

  6. Prevention and treatment of skin lesions associated with non-invasive mechanical ventilation. Recommendations of experts.

    Science.gov (United States)

    Raurell-Torredà, M; Romero-Collado, A; Rodríguez-Palma, M; Farrés-Tarafa, M; Martí, J D; Hurtado-Pardos, B; Peñarrubia-San Florencio, L; Saez-Paredes, P; Esquinas, A M

    In the last two decades, non-invasive mechanical ventilation (NIV) has been consolidated as an initial strategy for the management of respiratory failure in critical adult and paediatric patients. To identify risk factors and preventive strategies to reduce the incidence of skin lesions associated with clinical devices (LESADIC) related to NIV, as well as the most effective treatment for injuries that cannot be avoided. Review in the MEDLINE, CINAHL and Cochrane databases of studies published in the last 10years to reach consensus through an expert panel. Knowledge about how to measure correct mask size and protection of the skin with foam or hydrocolloids dressings are factors related to the incidence of LESADIC, as it conditions the degree of pressure-friction and shear that the interface exerts on the skin. The interface that causes fewer LESADIC and is better tolerated is the face mask. When there are injuries, the first thing is to remove the interface that causes pressure on damaged skin, recommending a Helmet(®) hood as an alternative, treating the infection, managing the exudate and stimulating perilesional skin. The mask of choice is the facial, always using foam or hydrocolloid dressings on the nasal bridge. Evaluate the condition of the skin under the interface and harness every 4hours (recommended) and 11hours (maximum). Evaluate the rotation strategy of the interface at 24hours if the NIV is still needed on an ongoing basis. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Obesity might be a good prognosis factor for COPD patients using domiciliary noninvasive mechanical ventilation

    Science.gov (United States)

    Altinoz, Hilal; Adiguzel, Nalan; Salturk, Cuneyt; Gungor, Gokay; Mocin, Ozlem; Berk Takir, Huriye; Kargin, Feyza; Balci, Merih; Dikensoy, Oner; Karakurt, Zuhal

    2016-01-01

    Cachexia is known to be a deteriorating factor for survival of patients with chronic obstructive pulmonary disease (COPD), but data related to obesity are limited. We observed that obese patients with COPD prescribed long-term noninvasive mechanical ventilation (NIMV) had better survival rate compared to nonobese patients. Therefore, we conducted a retrospective observational cohort study. Archives of Thoracic Diseases Training Hospital were sought between 2008 and 2013. All the subjects were prescribed domiciliary NIMV for chronic respiratory failure secondary to COPD. Subjects were grouped according to their body mass index (BMI). The first group consisted of subjects with BMI between 20 and 30 kg/m2, and the second group consisted of subjects with BMI >30 kg/m2. Data obtained at the first month’s visit for the following parameters were recorded: age, sex, comorbid diseases, smoking history, pulmonary function test, 6-minute walk test (6-MWT), and arterial blood gas analysis. Hospital admissions were recorded before and after the domiciliary NIMV usage. Mortality rate was searched from the electronic database. Overall, 118 subjects were enrolled. Thirty-eight subjects had BMI between 20 and 30 kg/m2, while 80 subjects had BMI >30 kg/m2. The mean age was 65.8±9.4 years, and 81% were male. The median follow-up time was 26 months and mortality rates were 32% and 34% for obese and nonobese subjects (P=0.67). Improvement in 6-MWT was protective against mortality. In conclusion, survival of obese patients with COPD using domiciliary NIMV was found to be better than those of nonobese patients, and the improvement in 6-MWT in such patients was found to be related to a better survival. PMID:27578969

  8. Obesity might be a good prognosis factor for COPD patients using domiciliary noninvasive mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Altinoz H

    2016-08-01

    Full Text Available Hilal Altinoz,1 Nalan Adiguzel,2 Cuneyt Salturk,2 Gokay Gungor,2 Ozlem Mocin,2 Huriye Berk Takir,2 Feyza Kargin,2 Merih Balci,2 Oner Dikensoy,1 Zuhal Karakurt2 1Pulmonary Division, Acibadem University School of Medicine, 2Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey Abstract: Cachexia is known to be a deteriorating factor for survival of patients with chronic obstructive pulmonary disease (COPD, but data related to obesity are limited. We observed that obese patients with COPD prescribed long-term noninvasive mechanical ventilation (NIMV had better survival rate compared to nonobese patients. Therefore, we conducted a retrospective observational cohort study. Archives of Thoracic Diseases Training Hospital were sought between 2008 and 2013. All the subjects were prescribed domiciliary NIMV for chronic respiratory failure secondary to COPD. Subjects were grouped according to their body mass index (BMI. The first group consisted of subjects with BMI between 20 and 30 kg/m2, and the second group consisted of subjects with BMI >30 kg/m2. Data obtained at the first month’s visit for the following parameters were recorded: age, sex, comorbid diseases, smoking history, pulmonary function test, 6-minute walk test (6-MWT, and arterial blood gas analysis. Hospital admissions were recorded before and after the domiciliary NIMV usage. Mortality rate was searched from the electronic database. Overall, 118 subjects were enrolled. Thirty-eight subjects had BMI between 20 and 30 kg/m2, while 80 subjects had BMI >30 kg/m2. The mean age was 65.8±9.4 years, and 81% were male. The median follow-up time was 26 months and mortality rates were 32% and 34% for obese and nonobese subjects (P=0.67. Improvement in 6-MWT was protective against mortality. In conclusion, survival of obese patients with COPD using domiciliary NIMV was found to be better than those of nonobese patients, and the improvement in 6-MWT in such

  9. Lights and shadows of non-invasive mechanical ventilation for chronic obstructive pulmonary disease (COPD exacerbations

    Directory of Open Access Journals (Sweden)

    Jose Luis Lopez-Campos

    2015-01-01

    Full Text Available Despite the overwhelming evidence justifying the use of non-invasive ventilation (NIV for providing ventilatory support in chronic obstructive pulmonary disease (COPD exacerbations, recent studies demonstrated that its application in real-life settings remains suboptimal. European clinical audits have shown that 1 NIV is not invariably available, 2 its availability depends on countries and hospital sizes, and 3 numerous centers declare their inability to provide NIV to all of the eligible patients presenting throughout the year. Even with an established indication, the use of NIV in acute respiratory failure due to COPD exacerbations faces important challenges. First, the location and personnel using NIV should be carefully selected. Second, the use of NIV is not straightforward despite the availability of technologically advanced ventilators. Third, NIV therapy of critically ill patients requires a thorough knowledge of both respiratory physiology and existing ventilatory devices. Accordingly, an optimal team-training experience, the careful selection of patients, and special attention to the selection of devices are critical for optimizing NIV outcomes. Additionally, when applied, NIV should be closely monitored, and endotracheal intubation should be promptly available in the case of failure. Another topic that merits careful consideration is the use of NIV in the elderly. This patient population is particularly fragile, with several physiological and social characteristics requiring specific attention in relation to NIV. Several other novel indications should also be critically examined, including the use of NIV during fiberoptic bronchoscopy or transesophageal echocardiography, as well as in interventional cardiology and pulmonology. The present narrative review aims to provide updated information on the use of NIV in acute settings to improve the clinical outcomes of patients hospitalized for COPD exacerbations.

  10. Successful management of acute respiratory failure with noninvasive mechanical ventilation after drowning, in an epileptic-patient.

    Science.gov (United States)

    Ruggeri, Paolo; Calcaterra, Salvatore; Bottari, Antonio; Girbino, Giuseppe; Fodale, Vincenzo

    2016-01-01

    Sea drowning is a common cause of accidental death worldwide. Respiratory complications such as acute pulmonary oedema, which is often complicated by acute respiratory distress syndrome, is often seen. Noninvasive ventilation is already widely used as a first approach to treat acute respiratory failure resulting from multiple diseases. We report a case of a 45 year old man with a history of epilepsy, motor and mental handicap who developed acute respiratory failure secondary to sea water drowning after an epileptic crisis. We illustrate successful and rapid management of this case with noninvasive ventilation. We emphasize the advantages and limitations of using noninvasive ventilation to treat acute respiratory failure due to sea water drowning syndrome.

  11. Successful management of acute respiratory failure with noninvasive mechanical ventilation after drowning, in an epileptic-patient

    Directory of Open Access Journals (Sweden)

    Paolo Ruggeri

    2016-01-01

    Full Text Available Sea drowning is a common cause of accidental death worldwide. Respiratory complications such as acute pulmonary oedema, which is often complicated by acute respiratory distress syndrome, is often seen. Noninvasive ventilation is already widely used as a first approach to treat acute respiratory failure resulting from multiple diseases. We report a case of a 45 year old man with a history of epilepsy, motor and mental handicap who developed acute respiratory failure secondary to sea water drowning after an epileptic crisis. We illustrate successful and rapid management of this case with noninvasive ventilation. We emphasize the advantages and limitations of using noninvasive ventilation to treat acute respiratory failure due to sea water drowning syndrome.

  12. Noninvasive ventilation in acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Mas A

    2014-08-01

    Full Text Available Arantxa Mas, Josep MasipCritical Care Department, Consorci Sanitari Integral (CSI, Hospital Sant Joan Despí Moisès Broggi and Hospital General de l’Hospitalet, University of Barcelona, Barcelona, SpainAbstract: After the institution of positive-pressure ventilation, the use of noninvasive ventilation (NIV through an interface substantially increased. The first technique was continuous positive airway pressure; but, after the introduction of pressure support ventilation at the end of the 20th century, this became the main modality. Both techniques, and some others that have been recently introduced and which integrate some technological innovations, have extensively demonstrated a faster improvement of acute respiratory failure in different patient populations, avoiding endotracheal intubation and facilitating the release of conventional invasive mechanical ventilation. In acute settings, NIV is currently the first-line treatment for moderate-to-severe chronic obstructive pulmonary disease exacerbation as well as for acute cardiogenic pulmonary edema and should be considered in immunocompromised patients with acute respiratory insufficiency, in difficult weaning, and in the prevention of postextubation failure. Alternatively, it can also be used in the postoperative period and in cases of pneumonia and asthma or as a palliative treatment. NIV is currently used in a wide range of acute settings, such as critical care and emergency departments, hospital wards, palliative or pediatric units, and in pre-hospital care. It is also used as a home care therapy in patients with chronic pulmonary or sleep disorders. The appropriate selection of patients and the adaptation to the technique are the keys to success. This review essentially analyzes the evidence of benefits of NIV in different populations with acute respiratory failure and describes the main modalities, new devices, and some practical aspects of the use of this technique. Keywords

  13. [Tension pneumocephalus secondary to non-invasive mechanical ventilation in a patient with severe traumatic brain injury].

    Science.gov (United States)

    Andreu-Ruiz, Antonio; Ros-Argente Del Castillo, Tomas; Moya-Sánchez, José; Garcia-Ortega, Ana Azahara

    2017-09-28

    The presence of air inside intracranial cavity is a rare entity known as pneumocephalus and in most cases doesńt present any clinical repercussion except in case of elevated intracranial pressure that can lead to a decreasing level of consciousness, coma and even death. We present a rare case of a young male, without medical precedents of interest, hospitalized in an intensive care unit for vigilance after a traffic accident with asymptomatic crane encephalic trauma and cranial computerized tomography without meaningful findings. During the intensive care unit stay positive pressure is applied in airway with non-invasive mechanical ventilation that produces air entrance in cranial cavity (pneumocephalus) causing neurological deterioration and necessity of urgent surgery. Copyright © 2017 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. The role of surfactant and non-invasive mechanical ventilation in early management of respiratory distress syndrome in premature infants

    Institute of Scientific and Technical Information of China (English)

    Narayan Prabhu Iyer; Maroun Jean Mhanna

    2014-01-01

    Background: Surfactant replacement therapy has been used for few decades for the treatment of respiratory distress syndrome (RDS) and has significantly improved morbidity and mortality in premature infants. Non-invasive respiratory support has recently emerged as a strategy in the early management of RDS. In this review, we discuss the different strategies of early management of RDS. Data sources: A literature search of PubMed database was conducted to review the subject. The quality of evidence of key clinical studies was graded according to a modified grading system of the international GRADE group. Results: Continuous positive airway pressure (CPAP) with selective surfactant is a safe alternative to routine intubation, surfactant and mechanical ventilation in preterm infants with spontaneous breathing, and such an approach has been associated with decreased risk of death and bronchopulmonary dysplasia. There is a risk of pneumothorax when using a high pressure of CPAP (≥8 cm of H2O), a high partial pressure of carbon dioxide (PCO2 >75 mm of Hg), and a high fraction of inspired oxygen (FiO2 >0.6) as a threshold for intubation while on CPAP. Conclusion: Not all preterm infants need surfactant treatment, and non-invasive respiratory support is a safe and effective approach.

  15. Noninvasive Monitoring of Oxygen and Ventilation.

    Science.gov (United States)

    Smallwood, Craig D; Walsh, Brian K

    2017-06-01

    Noninvasive monitoring of oxygenation and ventilation is an essential part of pediatric respiratory care. Carbon dioxide, gas exchange monitoring, transcutaneous monitoring, near-infrared spectroscopy, pulse oximetry, and electrical impedance tomography are examined. Although some of these technologies have been utilized for decades, incorporation into mechanical ventilators and recently developed methods may provide important clinical insights in a broader patient range. Less mature technologies (electrical impedance tomography and near-infrared spectroscopy) have been of particular interest, since they offer easy bedside application and potential for improved care of children with respiratory failure and other disorders. This article provides an overview of the principles of operation, a survey of recent and relevant literature, and important technological limitations and future research directions. Copyright © 2017 by Daedalus Enterprises.

  16. Noninvasive ventilation in hypoxemic respiratory failure

    Directory of Open Access Journals (Sweden)

    Raja Dhar

    2016-01-01

    Full Text Available Noninvasive ventilation (NIV refers to positive pressure ventilation delivered through a noninvasive interface (nasal mask, facemask, or nasal plugs etc. Over the past decade its use has become more common as its benefits are increasingly recognized. This review will focus on the evidence supporting the use of NIV in various conditions resulting in acute hypoxemic respiratory failure (AHRF, that is, non-hypercapnic patients having acute respiratory failure in the absence of a cardiac origin or underlying chronic pulmonary disease. Outcomes depend on the patient's diagnosis and clinical characteristics. Patients should be monitored closely for signs of noninvasive ventilation failure and promptly intubated before a crisis develops. The application of noninvasive ventilation by a trained and experienced team, with careful patient selection, should optimize patient outcomes.

  17. Long-Term Home Noninvasive Mechanical Ventilation Increases Systemic Inflammatory Response in Chronic Obstructive Pulmonary Disease: A Prospective Observational Study

    Directory of Open Access Journals (Sweden)

    Gregorino Paone

    2014-01-01

    Full Text Available Background. Long-term home noninvasive mechanical ventilation (NIV is beneficial in COPD but its impact on inflammation is unknown. We assessed the hypothesis that NIV modulates systemic and pulmonary inflammatory biomarkers in stable COPD. Methods. Among 610 patients referred for NIV, we shortlisted those undergoing NIV versus oxygen therapy alone, excluding subjects with comorbidities or non-COPD conditions. Sputum and blood samples were collected after 3 months of clinical stability and analyzed for levels of human neutrophil peptides (HNP, interleukin-6 (IL-6, interleukin-10 (IL-10, and tumor necrosis factor-alpha (TNF-alpha. Patients underwent a two-year follow-up. Unadjusted, propensity-matched, and pH-stratified analyses were performed. Results. Ninety-three patients were included (48 NIV, 45 oxygen, with analogous baseline features. Sputum analysis showed similar HNP, IL-6, IL-10, and TNF-alpha levels (P>0.5. Conversely, NIV group exhibited higher HNP and IL-6 systemic levels (P<0.001 and lower IL-10 concentrations (P<0.001. Subjects undergoing NIV had a significant reduction of rehospitalizations during follow-up compared to oxygen group (P=0.005. These findings were confirmed after propensity matching and pH stratification. Conclusions. These findings challenge prior paradigms based on the assumption that pulmonary inflammation is per se detrimental. NIV beneficial impact on lung mechanics may overcome the potential unfavorable effects of an increased inflammatory state.

  18. Noninvasive Mechanical Ventilation Knowledge Level of the Nurses: A Questionnaire Survey in a Tertiary Care Training and Research Hospital

    Directory of Open Access Journals (Sweden)

    Merve Tarhan

    2015-12-01

    Full Text Available Objective: The correct use of necessary equipment is the key for a successful noninvasive mechanical ventilation (NIMV practice. Trained health care personnel are important part of the practice. The current study was conducted to that end, with the aim of determining the level of knowledge about NIMV of nurses working in a training and research hospital as descriptive. Methods: The study was conducted with 147 nurses who are working at Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital in İstanbul. Questionnaire form of 36 questions prepared by investigators was used to collect data. For the analysis of the results, numerical, percentages, Mann-Whitney U and Kruskal Wallis tests were used.’ Results: 40.8% nurses had received training about NIMV. By contrast, 24.5% stated that they had learned NIMV practices on their own. The lowest rate (26.5% of correct answered question was “disadvantages of oronasal mask”. The most answered statement as true was “Face masks should be established to the patient’s face with no gaps for prevention of leaks and the mask should be worn not to pressure on nasal bridge” (78.9%. Female and postgraduate nurses‘ total scores obtained from NIMV questions were higher than others and were statistically significant (p<0.05. Conclusion: The effective NIMV practices requires trained personnel. Nurses who have active role in NIMV practices should receive basic training in this topic. How will be started treatment, indications, who will be responsible for follow-up and points to take into consideration are mentioned clearly in the training program. This training programme should include processing of clinical experience as well as theoretical information.

  19. Inhalation therapy in mechanical ventilation

    Science.gov (United States)

    Maccari, Juçara Gasparetto; Teixeira, Cassiano; Gazzana, Marcelo Basso; Savi, Augusto; Dexheimer-Neto, Felippe Leopoldo; Knorst, Marli Maria

    2015-01-01

    Patients with obstructive lung disease often require ventilatory support via invasive or noninvasive mechanical ventilation, depending on the severity of the exacerbation. The use of inhaled bronchodilators can significantly reduce airway resistance, contributing to the improvement of respiratory mechanics and patient-ventilator synchrony. Although various studies have been published on this topic, little is known about the effectiveness of the bronchodilators routinely prescribed for patients on mechanical ventilation or about the deposition of those drugs throughout the lungs. The inhaled bronchodilators most commonly used in ICUs are beta adrenergic agonists and anticholinergics. Various factors might influence the effect of bronchodilators, including ventilation mode, position of the spacer in the circuit, tube size, formulation, drug dose, severity of the disease, and patient-ventilator synchrony. Knowledge of the pharmacological properties of bronchodilators and the appropriate techniques for their administration is fundamental to optimizing the treatment of these patients. PMID:26578139

  20. Long-term survival in elderly patients with a do-not-intubate order treated with noninvasive mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Riario-Sforza GG

    2011-04-01

    Full Text Available Paolo Scarpazza1, Cristoforo Incorvaia2, Paolo Amboni3, Giuseppe di Franco1, Stefania Raschi1, Pierfranco Usai1, Monica Bernareggi1, Cristiano Bonacina1, Chiara Melacini1, Roberta Cattaneo1, Serena Bencini1, Chiara Pravettoni2, Gian Galeazzo Riario-Sforza2, Gianni Passalacqua4, Walter Casali11Divisione di Broncopneumotisiologia, Ospedale Civile, Vimercate, Italy; 2Pulmonary Rehabilitation, Istituti Clinici di Perfezionamento, Milan, Italy; 3Clinical Chemistry Laboratory, Ospedali Riuniti, Bergamo, Italy; 4Allergy and Respiratory Diseases, University Of Genoa, Genoa, ItalyBackground: Noninvasive mechanical ventilation (NIMV is an effective tool in treating patients with acute respiratory failure (ARF, since it reduces both the need for endotracheal intubation and the mortality in comparison with nonventilated patients. A particular issue is represented by the outcome of NIMV in patients referred to the emergency department for ARF and with a do-not-intubate (DNI status because of advanced age or excessively critical conditions. This study evaluated long-term survival in a group of elderly patients with acute hypercapnic ARF who had a DNI order and who were successfully treated by NIMV.Methods: The population consisted of 54 patients with a favorable outcome after NIMV for ARF. They were followed up for 3 years by regular control visits, with at least one visit every 4 months, or as needed according to the patient’s condition. Of these, 31 continued NIMV at home and 23 were on long-term oxygen therapy (LTOT alone.Results: A total of 16 of the 52 patients had not survived at the 1-year follow-up, and another eight patients died during the 3-year observation, with an overall mortality rate of 30.8% after 1 year and 46.2% after 3 years. Comparing patients who continued NIMV at home with those who were on LTOT alone, 9 of the 29 patients on home NIMV died (6 after 1 year and 3 after 3 years and 15 of the 23 patients on LTOT alone died (10 after 1

  1. Noninvasive positive pressure ventilation in unplanned extubation

    Directory of Open Access Journals (Sweden)

    Eryuksel Emel

    2009-01-01

    Full Text Available Background:Unplanned extubation is quite common in intensive care unit (ICU patients receiving mechanical ventilatory support. The present study aimed to investigate the effectiveness of noninvasive positive pressure ventilation (NPPV in patients with unplanned extubation. Materials and Methods: A total of 15 patients (12 male, age: 57 ± 24 years, APACHE II score: 19 ± 7 monitored at the medical ICU during the year 2004 who developed unplanned extubation were included in the study. NPPV was tried in all of them following unplanned extubation. Indications for admission to the ICU were as follows: nine patients with pneumonia, three with status epilepticus, one with gastrointestinal bleeding, one with cardiogenic pulmonary edema and one with diffuse alveolar bleeding. Results:Eleven of the patients (74% were at the weaning period at the time of unplanned extubation. Among these 11 patients, NPPV was successful in 10 (91% and only one (9% was reintubated due to the failure of NPPV. The remaining four patients (26% had pneumonia and none of them were at the weaning period at the time of extubation, but their requirement for mechanical ventilation was gradually decreasing. Unfortunately, an NPPV attempt for 6-8 h failed and these patients were reintubated. Conclusions:Patients with unplanned extubation before the weaning criteria are met should be intubated immediately. On the other hand, when extubation develops during the weaning period, NPPV may be an alternative. The present study was conducted with a small number of patients, and larger studies on the effectiveness of NPPV in unplanned extubation are warranted for firm conclusions.

  2. Mechanical ventilation of the premature neonate.

    Science.gov (United States)

    Brown, Melissa K; DiBlasi, Robert M

    2011-09-01

    Although the trend in the neonatal intensive care unit is to use noninvasive ventilation whenever possible, invasive ventilation is still often necessary for supporting pre-term neonates with lung disease. Many different ventilation modes and ventilation strategies are available to assist with the optimization of mechanical ventilation and prevention of ventilator-induced lung injury. Patient-triggered ventilation is favored over machine-triggered forms of invasive ventilation for improving gas exchange and patient-ventilator interaction. However, no studies have shown that patient-triggered ventilation improves mortality or morbidity in premature neonates. A promising new form of patient-triggered ventilation, neurally adjusted ventilatory assist (NAVA), was recently FDA approved for invasive and noninvasive ventilation. Clinical trials are underway to evaluate outcomes in neonates who receive NAVA. New evidence suggests that volume-targeted ventilation modes (ie, volume control or pressure control with adaptive targeting) may provide better lung protection than traditional pressure control modes. Several volume-targeted modes that provide accurate tidal volume delivery in the face of a large endotracheal tube leak were recently introduced to the clinical setting. There is ongoing debate about whether neonates should be managed invasively with high-frequency ventilation or conventional ventilation at birth. The majority of clinical trials performed to date have compared high-frequency ventilation to pressure control modes. Future trials with premature neonates should compare high-frequency ventilation to conventional ventilation with volume-targeted modes. Over the last decade many new promising approaches to lung-protective ventilation have evolved. The key to protecting the neonatal lung during mechanical ventilation is optimizing lung volume and limiting excessive lung expansion, by applying appropriate PEEP and using shorter inspiratory time, smaller tidal

  3. Use of non-invasive mechanical ventilation in the Emergency Department, clinical outcomes and correlates of failure

    Directory of Open Access Journals (Sweden)

    Paolo Groff

    2008-09-01

    Full Text Available

    Background: Despite several studies having been carried in this organizational context, there is an absence of information about the effectiveness of non-invasive mechanical ventilation (NIV in Emergency Departments (ED, based on a number of suitable patients with acute respiratory failure (ARF of different aetiology. In particular, it has not yet been defined as to whether the context of the ED suits the necessary requirement of quality for the correct application of the method and if the obtained results are different from those taken in other studies in general or respiratory intensive care unit. Finally there are few data related to the predictive factors to NIV failure (endotracheal intubation, in-hospital mortality when applied in the emergency setting.

    Methods: To answer these questions we have retrospectively studied a population of 210 patients (95 with COPD exsacerbation ; 92 with acute cardiogenic pulmonary oedema; 23 with severe community acquired pneumonia treated for ARF in the “critical area” of four Italian level II Emergency Departments. For all patients demographic data; some comorbidities (diabetes, dementia, sopraventricular arrhythmias, obesity; the physiological scores (Kelly, SAPS II, Apache II; the need for pharmacological sedation; vital and blood gas parameters (evaluated at entry, after one hour of treatment and before its suspension; the ventilatory modality applied (CPAP or PSV + PEEP and some parameters of in-hospital stay (duration of the hospitalization in the critical area, duration of ventilation, compliance to the treatment, patient's refusal to continue it, development of skin necrosis, need for endotracheal intubation, in-hospital mortality were considered. Finally demographic, event of death with Cox regression or to the need for ETI through linear regression analysis.

    Results: Globally, in-hospital mortality reached 13,3%, the percentage

  4. Complications of mechanical ventilation

    Directory of Open Access Journals (Sweden)

    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.

  5. Pulmonary mechanics during mechanical ventilation.

    Science.gov (United States)

    Henderson, William R; Sheel, A William

    2012-03-15

    The use of mechanical ventilation has become widespread in the management of hypoxic respiratory failure. Investigations of pulmonary mechanics in this clinical scenario have demonstrated that there are significant differences in compliance, resistance and gas flow when compared with normal subjects. This paper will review the mechanisms by which pulmonary mechanics are assessed in mechanically ventilated patients and will review how the data can be used for investigative research purposes as well as to inform rational ventilator management.

  6. Mechanical ventilation in children.

    Science.gov (United States)

    Kendirli, Tanil; Kavaz, Asli; Yalaki, Zahide; Oztürk Hişmi, Burcu; Derelli, Emel; Ince, Erdal

    2006-01-01

    Mechanical ventilation can be lifesaving, but > 50% of complications in conditions that require intensive care are related to ventilatory support, particularly if it is prolonged. We retrospectively evaluated the medical records of patients who had mechanical ventilation in the Pediatric Intensive Care Unit (PICU) during a follow-up period between January 2002-May 2005. Medical records of 407 patients were reviewed. Ninety-one patients (22.3%) were treated with mechanical ventilation. Ages of all patients were between 1-180 (median: 8) months. The mechanical ventilation time was 18.8 +/- 14.1 days. Indication of mechanical ventilation could be divided into four groups as respiratory failure (64.8%), cardiovascular failure (19.7%), central nervous system disease (9.8%) and safety airway (5.4%). Tracheostomy was performed in four patients. The complication ratio of mechanically ventilated children was 42.8%, and diversity of complications was as follows: 26.3% atelectasia, 17.5% ventilator-associated pneumonia, 13.1% pneumothorax, 5.4% bleeding, 4.3% tracheal edema, and 2.1% chronic lung disease. The mortality rate of mechanically ventilated patients was 58.3%, but the overall mortality rate in the PICU was 12.2%. In conclusion, there are few published epidemiological data on the follow-up results and mortality in infants and children who are mechanically ventilated.

  7. The application of noninvasive mechanical ventilation in the treatment of ARDS%无创机械通气在ARDS治疗中的应用探讨

    Institute of Scientific and Technical Information of China (English)

    陈根; 陈培铭

    2015-01-01

    Objective To investigate the clinical efficacy of noninvasive mechanical ventilation in the treatment of acute respiratory distress syndrome (ARDS).Methods 24 patients with ARDS were treated with noninvasive mechanical ventilation, and were divided into successful group and failure group according to the treatment effect. The heart rate (HR), respiratory rate (RR), respiratory rate (PaO2), oxygen index (PaO2), (FiO2), (PaCO2), and Sa (O2) were recorded in two groups of patients before and after treatment.Results there were 11 cases of ARDS patients in the successful group, and the / PaO2, FiO2, PaO2, SaO2, RR, HR,and h were significantly improved after treatment. The ARDS patients with severe respiratory distress were more severe in the failure group than in mechanical ventilation treatment, and no significant changes in / PaO2, HR, PaO2, SaO2, RR, PaCO2, FiO2, H.Conclusion noninvasive mechanical ventilation has good ventilation support for some patients with ARDS, especially in the early stage of ARDS.%目的:探讨无创机械通气治疗急性呼吸窘迫综合征(ARDS)患者的临床疗效。方法对24例ARDS患者采用无创机械通气,根据治疗效果分为成功组和失败组。记录两组病人治疗前后心率(HR)、呼吸频率(RR)、氧合指数(PaO2/FiO2)、氧分压(PaO2)、二氧化碳分压(PaCO2)、血氧饱和度(Sa O2)。结果无创机械通气成功组11例均为ARDS早期患者,治疗2 h后PaO2/FiO2、HR、PaO2、SaO2、RR都有明显好转。无创机械通气治疗失败组全为呼吸窘迫较严重的ARDS患者,治疗2 h后PaO2/FiO2、HR、PaO2、PaCO2、SaO2、RR无明显变化。结论无创机械通气对部分ARDS患者有良好的通气支持作用,尤其是ARDS的早期阶段。

  8. [The study of noninvasive ventilator impeller based on ANSYS].

    Science.gov (United States)

    Hu, Zhaoyan; Lu, Pan; Xie, Haiming; Zhou, Yaxu

    2011-06-01

    An impeller plays a significant role in the non-invasive ventilator. This paper shows a model of impeller for noninvasive ventilator established with the software Solidworks. The model was studied for feasibility based on ANSYS. Then stress and strain of the impeller were discussed under the external loads. The results of the analysis provided verification for the reliable design of impellers.

  9. Comparison of Noninvasive Positive Pressure Ventilation and Invasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure

    Institute of Scientific and Technical Information of China (English)

    Jian Li; De-hou Zhang; Xian-feng Huang; Ming Ding; Guo-rong Shu

    2005-01-01

    @@ The use of noninvasive positive pressure ventilation (NPPV)in the treatment of acute respiratory failure (ARF) has been supported by a number of randomised controlled trials. We conducted a controlled prospective randomised study to compare the efficacy of NPPV with the efficacy of invasive positive pressure ventilation (IPPV) in ARF patients whose conditions had not improved under aggressive medical therapy thus requiring mechanical ventilation (MV).

  10. [Intermediate care units and noninvasive ventilation].

    Science.gov (United States)

    Becker, Heinrich F; Schönhofer, Bernd; Vogelmeier, Claus

    2006-04-15

    Intermediate care units (IMC) have been introduced to provide optimal patient management according to disease severity and to bridge the gap between intensive care (ICU) and general wards. Most patients that are referred to an IMC need monitoring and intensive analgetic treatment. Over the past years noninvasive ventilation (NIV) and weaning have emerged as important new forms of active treatment in the IMC. Most studies that have been published so far demonstrate that an IMC improves patient outcome and lowers costs, although randomized controlled trials are missing. NIV reduces mortality, the need for intubation as well as ICU and hospital length of stay in patients with chronic obstructive pulmonary disease (COPD) and other disorders that cause respiratory failure. In many cases NIV can be performed in the IMC, a fact that reduces the number of ICU admissions, lowers costs and improves patient care. The high prevalence of pulmonary diseases and NIV emphasizes the importance of pneumologists as directors of both ICU and IMC.

  11. Conventional mechanical ventilation

    Directory of Open Access Journals (Sweden)

    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.

  12. Can patients with moderate to severe acute respiratory failure from COPD be treated safely with noninvasive mechanical ventilation on the ward?

    Directory of Open Access Journals (Sweden)

    Yalcinsoy M

    2016-05-01

    Full Text Available Murat Yalcinsoy,1 Cuneyt Salturk,2 Selahattin Oztas,2 Sinem Gungor,2 Ipek Ozmen,2 Feyyaz Kabadayi,2 Aysem Askim Oztim,2 Emine Aksoy,2 Nalan Adıguzel,2 Ozlem Oruc,2 Zuhal Karakurt2 1Department of Pulmonary Medicine, Inonu University Medical Faculty, Turgut Ozal Medical Center, Malatya, 2Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey Purpose: Noninvasive mechanical ventilation (NIMV usage outside of intensive care unit is not recommended in patients with COPD for severe acute respiratory failure (ARF. We assessed the factors associated with failure of NIMV in patients with ARF and severe acidosis admitted to the emergency department and followed on respiratory ward.Patients and methods: This is a retrospective observational cohort study conducted in a tertiary teaching hospital specialized in chest diseases and thoracic surgery between June 1, 2013 and May 31, 2014. COPD patients who were admitted to our emergency department due to ARF were included. Patients were grouped according to the severity of acidosis into two groups: group 1 (pH=7.20–7.25 and group 2 (pH=7.26–7.30.Results: Group 1 included 59 patients (mean age: 70±10 years, 30.5% female and group 2 included 171 patients (mean age: 67±11 years, 28.7% female. On multivariable analysis, partial arterial oxygen pressure to the inspired fractionated oxygen (PaO2/FiO2 ratio <200, delta pH value <0.30, and pH value <7.31 on control arterial blood gas after NIMV in the emergency room and peak C-reactive protein were found to be the risk factors for NIMV failure in COPD patients with ARF in the ward.Conclusion: NIMV is effective not only in mild respiratory failure but also with severe forms of COPD patients presenting with severe exacerbation. The determination of the failure criteria of NIMV and the expertise of the team is critical for treatment success. Keywords: noninvasive mechanical ventilation

  13. Where should noninvasive ventilation be delivered?

    Science.gov (United States)

    Hill, Nicholas S

    2009-01-01

    Noninvasive ventilation (NIV) has assumed an important role in the management of certain types of respiratory failure in acute-care hospitals. However, the optimal location for NIV has been a matter of debate. Some have argued that all patients begun on NIV in the acute-care setting should go to an intensive care unit (ICU), but this is impractical because ICU beds are often unavailable, and it may not be a sensible use of resources. Also, relatively few studies have examined the question of location for NIV. One problem is that various units' capabilities to deliver NIV differ substantially, even in the same hospital. Choosing the appropriate environment for NIV requires consideration of the patient's need for monitoring, the monitoring capabilities of the unit, including both technical and personnel resources (nursing and respiratory therapy), and the staff's skill and experience. In some hospitals NIV is begun most often in the emergency department, but is most often managed in an ICU. Step-down units are often good locations for NIV, but many institutions do not have step-down units. With ICU beds at a premium, many hospitals are forced to manage some NIV patients on general wards, which can be safely done with more stable patients if the ward is suitably monitored and experienced. When deciding where to locate the patient, clinicians must be familiar with the capabilities of the units in their facility and try to match the patient's need for monitoring and the unit's capabilities.

  14. Noninvasive ventilation in status asthmaticus in children: levels of evidence

    OpenAIRE

    Silva,Paula de Souza; Barreto,Sérgio Saldanha Menna

    2015-01-01

    Objective To evaluate the quality of available evidence to establish guidelines for the use of noninvasive ventilation for the management of status asthmaticus in children unresponsive to standard treatment. Methods Search, selection and analysis of all original articles on asthma and noninvasive ventilation in children, published until September 1, 2014 in all languages in the electronic databases PubMed, Web of Science, Cochrane Library, Scopus and SciELO, located using the search terms: "a...

  15. Interfaces and ventilator settings for long-term noninvasive ventilation in COPD patients

    Directory of Open Access Journals (Sweden)

    Callegari J

    2017-06-01

    Full Text Available Jens Callegari,1 Friederike Sophie Magnet,1 Steven Taubner,1 Melanie Berger,2 Sarah Bettina Schwarz,1 Wolfram Windisch,1 Jan Hendrik Storre3,4 1Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Koeln, Witten/Herdecke University Hospital, 2Department of Pneumology, Malteser Hospital St Hildegardis, Cologne, 3Department of Pneumology, University Medical Hospital, Freiburg, 4Department of Intensive Care, Sleep Medicine and Mechanical Ventilation, Asklepios Fachkliniken Munich-Gauting, Gauting, Germany Introduction: The establishment of high-intensity (HI noninvasive ventilation (NIV that targets elevated PaCO2 has led to an increase in the use of long-term NIV to treat patients with chronic hypercapnic COPD. However, the role of the ventilation interface, especially in more aggressive ventilation strategies, has not been systematically assessed.Methods: Ventilator settings and NIV compliance were assessed in this prospective cross-sectional monocentric cohort study of COPD patients with pre-existing NIV. Daytime ­arterialized blood gas analyses and lung function testing were also performed. The primary end point was the distribution among study patients of interfaces (full-face masks [FFMs] vs nasal masks [NMs] in a real-life setting.Results: The majority of the 123 patients studied used an FFM (77%, while 23% used an NM. Ventilation settings were as follows: mean ± standard deviation (SD inspiratory positive airway pressure (IPAP was 23.2±4.6 mbar and mean ± SD breathing rate was 16.7±2.4/minute. Pressure support ventilation (PSV mode was used in 52.8% of patients, while assisted pressure-controlled ventilation (aPCV was used in 47.2% of patients. Higher IPAP levels were associated with an increased use of FFMs (IPAP <21 mbar: 73% vs IPAP >25 mbar: 84%. Mean compliance was 6.5 hours/day, with no differences between FFM (6.4 hours/day and NM (6.7 hours/day users. PaCO2 assessment of ventilation quality revealed

  16. Noninvasive positive pressure ventilation in acute asthmatic attack

    Directory of Open Access Journals (Sweden)

    A. Soroksky

    2010-03-01

    Full Text Available Asthma is characterised by reversible airway obstruction. In most patients, control of disease activity is easily achieved. However, in a small minority, asthma may be fatal. Between the two extremes lie patients with severe asthmatic attacks, refractory to standard treatment. These patients are at an increased risk of recurrent severe attacks, with respiratory failure, and mechanical ventilation. Invasive mechanical ventilation of the asthmatic patient is associated with a higher risk of complications and, therefore, is a measure of last resort. Noninvasive positive pressure ventilation (NPPV is another treatment modality that may be beneficial in patients with severe asthmatic attack who are at an increased risk of developing respiratory failure. These patients have the potential to benefit from early respiratory support in the form of NPPV. However, reports of NPPV in asthmatic patients are scarce, and its usage in asthmatic attacks is, therefore, still controversial. Only a few reports of NPPV in asthma have been published over the last decade. These studies mostly involve small numbers of patients and those who have problematic methodology. In this article we review the available evidence for NPPV in asthma and try to formulate our recommendations for NPPV application in asthma based on the available evidence and reports.

  17. La ventilación mecánica no invasiva domiciliaria en el paciente EPOC Non-invasive home mechanical ventilation in the COPD patient

    Directory of Open Access Journals (Sweden)

    C. I. González Rodríguez

    2005-12-01

    whether non-invasive mechanical ventilation is beneficial to these patients. Methods. A cross sectional study was carried out evaluating the application of non-invasive home mechanical ventilation (BIPAP, during the nocturnal rest in 23 COPD patients, who presented hypercapnia in basal arterial gasometry during clinical stability. Clinical, gasometric and spirometric evaluations were carried out 3, 6 and 12 months after initiating this therapy. Similarly, an evaluation was made of the number of admissions due to worsening of the underlying respiratory pathology during one year. Results. The patients included in the study had an average age of 68.83 years. Sixty point nine percent (60.9% presented a severe degree of COPD. Sixty-nine point six percent (69.6% of the total sample had previously received continuous oxygenotherapy at home; 75% of them presented severe or very severe COPD. During the period of time of the study a fall was recorded in the number of hospital admissions due to worsening (0.61±0.15 annual admissions on average with respect to the period of time prior to the non-invasive mechanical ventilation (1.07±0.16 admissions on average, with greater benefits obtained by those who had previously shown a higher number of admissions and those with associated comorbidity. A reduction was also appreciated in the arterial pressure of carbon dioxide (PaCO2 in the majority of cases, principally those who at the start of the study presented a PaCO(263.32 mm of Hg; this improvement was appreciated from the first three months of treatment.

  18. Sleep-related breathing disorders and non-invasive ventilation

    Directory of Open Access Journals (Sweden)

    Agata Lax

    2015-05-01

    Full Text Available Non-invasive mechanical ventilation (NPPV was originally used in patients with acute respiratory impairment or exacerbations of chronic respiratory diseases, as an alternative to the endotracheal tube. Over the last thirty years NPPV has been also used at night in patients with stable chronic lung disease such as obstructive sleep apnea, the overlap syndrome (chronic obstructive pulmonary disease and obstructive sleep apnea, neuromuscular disorders, obesity-hypoventilation syndrome, and in other conditions such as sleep disorders associated with congestive heart failure (Cheyne-Stokes respiration. In this no-systematic review we discuss the different types of NPPV, the specific conditions in which they can be used and the indications, recommendations and evidence supporting the efficacy of NPPV. Optimizing patient acceptance and adherence to non-invasive ventilation treatment is challenging. The treatment of sleep-related disorders is a life-threatening condition. The optimal level of treatment should be determined in a sleep laboratory. Side effects directly affecting the patient’s adherence to treatment are known. The most common are nasopharyngeal symptoms including increased congestion and rhinorrhea; these effects are related to reduced humidity of inspired gas. Humidification of delivered gas may improve these symptoms.

  19. Noninvasive ventilation in patients with acute cardiogenic pulmonary edema

    Directory of Open Access Journals (Sweden)

    Andrea Bellone

    2013-07-01

    Full Text Available The term noninvasive ventilation (NIV encompasses two different modes of delivering positive airway pressure, namely continuous positive airway pressure (CPAP and bilevel positive airway pressure (bilevel-PAP. The two modes are different since CPAP does not actively assist inspiration whereas bilevel-PAP does. Bilevel-PAP is a type of noninvasive ventilation that helps keep the upper airways of the lungs open by providing a flow of air delivered through a face mask. The air is pressurized by a machine, which delivers it to the face mask through long, plastic hosing. With bilevel-PAP, the doctor prescribes specific alternating pressures: a higher pressure is used to breathe in (inspiratory positive airway pressure and a lower pressure is used to breath out (expiratory positive airway pressure. Noninvasive ventilation has been shown to reduce the rate of tracheal intubation. The main indications are exacerbation of chronic obstructive pulmonary disease and acute cardiogenic pulmonary edema (ACPE. This last is a common cause of respiratory failure with high incidence and high mortality rate. Clinical findings of ACPE are related to the increased extra-vascular water in the lungs and the resulting reduced lung compliance, increased airway resistance and elevated inspiratory muscle load which generates a depression in pleural pressure. These large pleural pressure swings are responsible for hemodynamic changes by increasing left ventricular afterload, myocardial transmural pressure, and venous return. These alterations can be detrimental to patients with left ventricular systolic dysfunction. Under these circumstances, NIV, either by CPAP or bilevel-PAP, improves vital signs, gas exchange, respiratory mechanics and hemodynamics by reducing left ventricular afterload and preload. In the first randomized study which compared the effectiveness of CPAP plus medical treatment vs medical treatment alone, the CPAP group showed a significant decrease in its

  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. Copyright © 2016 by Daedalus Enterprises.

  1. [Non-invasive mechanical ventilation with a facial interface during sedation for a percutaneous endoscopic gastrostomy in a patient with amyotrophic lateral sclerosis].

    Science.gov (United States)

    González-Frasquet, M C; García-Covisa, N; Vidagany-Espert, L; Herranz-Gordo, A; Llopis-Calatayud, J E

    2015-11-01

    Amyotrophic lateral sclerosis is a chronic neurodegenerative disease of the central nervous system which affects the motor neurons and produces a progressive muscle weakness, leading to atrophy and muscle paralysis, and ultimately death. Performing a percutaneous endoscopic gastrostomy with sedation in patients with amyotrophic lateral sclerosis can be a challenge for the anesthesiologist. The case is presented of a 76-year-old patient who suffered from advanced stage amyotrophic lateral sclerosis, ASA III, in which a percutaneous endoscopic gastrostomy was performed with deep sedation, for which non-invasive ventilation was used as a respiratory support to prevent hypoventilation and postoperative respiratory complications. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. 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.

  3. Ventilation and respiratory mechanics.

    Science.gov (United States)

    Sheel, Andrew William; Romer, Lee M

    2012-04-01

    During dynamic exercise, the healthy pulmonary system faces several major challenges, including decreases in mixed venous oxygen content and increases in mixed venous carbon dioxide. As such, the ventilatory demand is increased, while the rising cardiac output means that blood will have considerably less time in the pulmonary capillaries to accomplish gas exchange. Blood gas homeostasis must be accomplished by precise regulation of alveolar ventilation via medullary neural networks and sensory reflex mechanisms. It is equally important that cardiovascular and pulmonary system responses to exercise be precisely matched to the increase in metabolic requirements, and that the substantial gas transport needs of both respiratory and locomotor muscles be considered. Our article addresses each of these topics with emphasis on the healthy, young adult exercising in normoxia. We review recent evidence concerning how exercise hyperpnea influences sympathetic vasoconstrictor outflow and the effect this might have on the ability to perform muscular work. We also review sex-based differences in lung mechanics.

  4. The Clinical Application of Noninvasive Mechanical Ventilation in COPD with Respiratory Failure%无创机械通气用于 COPD 合并呼衰的临床观察

    Institute of Scientific and Technical Information of China (English)

    许莉; 徐淑晖; 颜浩

    2014-01-01

    Objective:To explore the clinical application value of noninvasive mechanical ventilation in patients with chronic obstructive pulmonary disease and respiratory failure .Methods:102 patients with chronic obstructive pulmonary disease and respiratory failure were treated with noninvasive mechanical ventilation .The results of the arterial blood gas before and after the treatment were compared each other .Results:The clinical symptoms were improved after treating with noninvasive mechanical ventilation .The analysis of arterial blood gas showed that pH , PaO2 , PaCO2 and SpO2 were significantly improved ( P<0.05) after treating.9 patients had adverse reactions in 102 patients of noninvasive mechanical ventilation , of which,4 patients had throat discomfort ,2 had abdominal distension ,2 had a sense of fear or tension and 1 had skin compression injury .The incidence of adverse reaction was 8.82%.Conclusion:The noninvasive mechanical ventilation in patients with chronic obstructive pulmonary disease and respiratory failure is effective .The early application can improve patients ’ respiratory function and oxygen deficit as well as relieve carbon dioxide retention ,may save more time for treating primary disease .Meanwhile ,the noninvasive mechanical ventilation can save patients from tracheal intubation for relieving the pain and enhancing the success rate .It is worthy of clinical popularization .%目的:观察无创机械通气用于慢性阻塞性肺疾病( COPD )合并呼吸衰竭患者的效果。方法:对102例COPD合并呼吸衰竭患者给予无创机械通气治疗,比较治疗前后动脉血气分析。结果:患者使用无创机械通气治疗后,临床症状明显缓解,治疗后血气分析中的pH值、PaO2、PaCO2、SpO2均较治疗前有明显改善( P<0.05)。102例进行无创机械通气治疗的患者中出现不良反应9例,其中4例为咽部不舒适,2例为腹胀,2例出现恐惧、紧张感,1例出现皮肤

  5. [Domiciliary noninvasive positive pressure ventilation in chronic alveolar hypoventilation].

    Science.gov (United States)

    Casas, J P; Robles, A M; Pereyra, M A; Abbona, H L; López, A M

    2000-01-01

    Effectiveness of treatment with domiciliary nocturnal noninvasive positive pressure ventilation is analyzed in a group of patients with chronic alveolar hypoventilation of different etiologies. It was applied with two levels of pressure (BiPAP) via nasal mask. Criteria for evaluation were symptomatology and improvement in gas exchange. Data were analyzed by Student t tests. A total of 13 patients were included, mean age 55.7 range 20 to 76 years (5 male 8 female). Main diagnosis was tuberculosis in 6, four of them having had surgical procedure (thoracoplasty 2, frenicectomy 1 and neumonectomy 1), myopathy 3 (myasthenia gravis 1, muscular dystrophy 1 and diaphragmatic paralysis 1), obesity-hypoventilation syndrome 1, escoliosis 1, bronchiectasis 1 and cystic fibrosis 1. These last two patients were on waiting list for lung transplantation. At the moment of consultation, the symptoms were: dysnea 13/13 (100%), astenia 13/13 (100%), hypersomnolency 10/13 (77%), cephalea 9/13 (69%), leg edema 6/13 (46%), loss of memory 6/13 (46%). Regarding gas exchange, they showed hypoxemia and hypercapnia. Mean follow up was of 2.2 years (range 6 months to 4 years). Within the year, all 13 patients became less dyspneic. Astenia, hypersomnolency, cephalea, leg edema and memory loss disappeared. Improvement in gas exchange was: PaO2/FiO2 from 269 +/- 65.4 (basal) to 336.7 +/- 75.3 post-treatment (p = 0.0018). PaCO2 from 70.77 +/- 25.48 mmHg (basal) to 46.77 +/- 8.14 mmHg (p = 0.0013). Ventilatory support was discontinued en 5 patients: three because of pneumonia requiring intubation and conventional mechanical ventilation, two of them died and one is still with tracheostomy; One patient with bronchiectasis and one with cystic fibrosis were transplanted. The remaining eight patients are stable. In conclusion, chronic alveolar hypoventilation can be effectively treated with domiciliary nocturnal noninvasive ventilation. Long term improvement in symptomatology and arterial blood gases

  6. 无创式机械通气与有创式机械通气治疗重症肌无力危象的比较研究%Comparative Study of Noninvasive Mechanical Ventilation and Invasive Mechanical Ventilation in Treatment of Myasthenic Crisis

    Institute of Scientific and Technical Information of China (English)

    赵世峰

    2011-01-01

    目的 比较无创式机械通气与有创式机械通气治疗重症肌无力危象的临床效果.方法 回顾性分析我院2005年1月-2010年11月就诊的23例重症肌无力危象患者的临床资料,采用有创式机械通气治疗的11例作为对照组,采用无创式机械通气治疗的12例作为观察组,比较两组的临床应用情况.结果 两组治疗后1、24 h患者的血气分析、呼吸频率以及心率均趋于正常(P0.05);观察组的并发症发生率及抗生素使用率均明显低于对照组,组间差异有统计学意义(P<0.05).结论 无创式机械通气治疗重症肌无力危象能够避免气管插管,且减少了并发症的发生和抗生素的使用,值得临床关注.%Objective To compare the clinical effect of noninvasive mechanical ventilation and invasive mechanical ventilation in the treatment of myasthenic crisis. Methods The clinical data of 23 patients with myasthenic crisis visited in our hospital from January, 2005 to November, 2010 were retrospectively analyzed. 11 patients who received invasive mechanical ventilation were served as control group, while 12. patients who received noninvasive mechanical ventilation were served as observation group. The clinical application condition of the two groups was compared. Results One and twenty -four hours after the treatment, the blood gas analysis, respiratory rate end heart rate of the two groups tended to be normal (P< 0.05), but no statistically significant difference was found between the two groups (P >0.05). The complication rate and antibiotic utilization rate of observation group were significantly lower than those of control group, there were statistically significant differences between the two groups (P< 0.05). Conclusions Noninvasive mechanical ventilation in the treatment of myasthenic crisis can avoid endotracheal intubation and reduce the incidence of complication and the use of antibiotics.It is worthy of attention in clinical practica.

  7. Noninvasive Mechanical Ventilation in COPD Patients with Type Ⅱ Respiratory Failure Failure Analysis%无创机械通气治疗COPD合并Ⅱ型呼吸衰竭失败原因分析

    Institute of Scientific and Technical Information of China (English)

    罗文恒

    2013-01-01

    Objective:To analyze the non-invasive mechanical ventilation in treatment of COPD(chronic obstructive pulmonary disease)to merge the reasons for the failure of Ⅱ -type respiratory failure,is safer,more effective use of non-invasive ventilation. Method:26 cases of hospital COPD(chronic obstructive pulmonary disease)Consolidated Ⅱ type respiratory failure requiring noninvasive mechanical ventilation retrospective analysis. Result:Hypoxemia and hypercapnia can not be corrected or aggravate 15 cases;five cases can not be tolerated;flatulence;to leak large two cases. Conclusion:Indications and contraindications,and establish good communication with patients and their families on the basis of the treatment process closely observed and dynamically adjust the parameter is the key to improve the non-invasive ventilation success rate.%  目的:分析无创机械通气治疗 COPD(慢性阻塞性肺疾病)合并Ⅱ型呼吸衰竭失败的原因,为更安全、更有效地使用无创通气。方法:对本院26例 COPD(慢性阻塞性肺疾病)合并Ⅱ型呼吸衰竭使用无创机械通气的原因进行回顾性分析。结果:低氧血症和高碳酸血症不能得到纠正或加重15例;不能耐受者5例;胃肠胀气4例;漏气量大2例。结论:掌握好适应证及禁忌证,在与患者及家属建立良好沟通的基础上,治疗过程严密观察和动态调节参数是提高无创通气成功率的关键。

  8. Home non-invasive mechanical ventilation for chronic obstructive pulmonary disease%慢性阻塞性肺疾病的家庭无创通气治疗

    Institute of Scientific and Technical Information of China (English)

    王金祥

    2013-01-01

    家庭无创通气(HMV)通常采用无创正压通气(NPPV),已经明确HMV治疗神经肌肉障碍性疾病,胸廓畸形和睡眠呼吸障碍性疾病导致的呼吸衰竭可以延长生命,缓解症状和改善生活质量。HMV治疗慢性阻塞性肺疾病(COPD)的结论不尽一致,HMV治疗重度COPD患者可缓解呼吸困难,多数研究表明HMV可改善生活质量,减少COPD急性加重。近期的研究表明,HMV时采用较高吸气压力支持水平治疗伴二氧化碳潴留的稳定期COPD患者,可以改善气体交换,肺功能和呼吸困难,减少COPD急性加重,而且具有较好的治疗依从性。%Home non-invasive mechanical ventilation (HMV) usually practiced via non-invasive positive pressure ventilation (NPPV). HMV can prolong life, ameliorate symptoms, and improve life quality in patients with respiratory failure secondary to neuromuscular disorder disease, thoracic deformity, and sleeping disordered breathing disease. The effect of HMV on chronic obstructive pulmonary disease (COPD) was not coincidence. It was confirmed that HMV can relieve dyspnea in severe COPD patients, and most study showed that HMV may improve life quality, reduce acute exacerbation of COPD. The lately research indicated High-intensity noninvasive positive pressure ventilation for stable hypercapnic COPD may improve gas exchange, lung function, relieve dyspnea, and reduce acute exacerbation of COPD.

  9. [Noninvasive positive pressure ventilation in postoperative period of tracheal surgery].

    Science.gov (United States)

    De La Torre, C A; Hernández, F; Sanabria, P; Vázquez, J; Miguel, M; Luis, A L; Barrena, S; Aguilar, R; Ramírez, M; Hernández, S; Borches, D; Lassaletta, L; Tovar, J A

    2011-04-01

    Reconstructive surgery of the airway often means prolonged periods of intubation during the post-operatory period, increasing the needs for drugs and favoring the appearance of infectious complications. We present an original system of ventilatory support with non-invasive positive pressure ventilation (NIPPV) using in patients subjected to reconstructive surgery of the airway. A retrospective study in patients undergoing reconstructive procedures of the airway in the year 2009 was carried out. We exclude those treated endoscopically and those who had vascular rings. The positive pressure mechanism used in the Surgery Critical Care Unit was a design made by the unit based on the circuit devised by Mapleson that provides optimum levels of ventilation without need for connection to a respiratory. We analyze the results, postoperatory intubation time, time dependent on NIPPV and medical treatment received. A total of 7 patients (1 Female and 6 Males) with median age of 1.6 (0.1-7.5) years were included. The diagnoses were: 4 subglottic stenosis, 2 had tracheal stenosis and 1 subcarinal stenosis with involvement of both principal bronchioles. The techniques used were: laryngotracheoplasty with costal cartilage graft (4), tracheoplasty with costal cartilage (1) and sliding tracheoplasty (2) with bilateral bronchoplasty in one of them. The mean time of nasotracheal intubation was 3 days, and mean time of NIPPV was 2.3. No patient required reintubation and none had infectious complications. Ventilatory support by VPPNI allows effective extubation in these patients, it being possible to maintain a safe airway. Infectious complications, frequent in prolonged intubations, were not observed in any of the cases.

  10. Predictors of noninvasive ventilation failure in patients with hematologic malignancy and acute respiratory failure.

    Science.gov (United States)

    Adda, Mélanie; Coquet, Isaline; Darmon, Michaël; Thiery, Guillaume; Schlemmer, Benoît; Azoulay, Elie

    2008-10-01

    The current trend to manage critically ill hematologic patients admitted with acute respiratory failure is to perform noninvasive ventilation to avoid endotracheal intubation. However, failure of noninvasive ventilation may lead to an increased mortality. Retrospective study to determine the frequency of noninvasive ventilation failure and identify its determinants. Medical intensive care unit in a University hospital. All consecutive patients with hematologic malignancies admitted to the intensive care unit over a 10-yr period who received noninvasive ventilation. A total of 99 patients were studied. Simplified Acute Physiology Score II at admission was 49 (median, interquartile range, 39-57). Fifty-three patients (54%) failed noninvasive ventilation and required endotracheal intubation. Their PaO2/FiO2 ratio was significantly lower (175 [101-236] vs. 248 [134-337]) and their respiratory rate under noninvasive ventilation was significantly higher (32 breaths/min [30-36] vs. 28 [27-30]). Forty-seven patients (89%) who failed noninvasive ventilation required vasopressors. Hospital mortality was 79% in those who failed noninvasive ventilation, and 41% in those who succeeded. Patients who failed noninvasive ventilation had a significantly longer intensive care unit stay (13 days [8-23] vs. 5 [2-8]) and a significantly higher rate of intensive care unit-acquired infections (32% compared with 7%). Factors independently associated with noninvasive ventilation failure by multivariate analysis were respiratory rate under noninvasive ventilation, longer delay between admission and noninvasive ventilation first use, need for vasopressors or renal replacement therapy, and acute respiratory distress syndrome. Failure of noninvasive ventilation occurs in half the critically ill hematologic patients and is associated with an increased mortality. Predictors of noninvasive ventilation failure might be used to guide decisions regarding intubation.

  11. Neonatal noninvasive ventilation techniques: do we really need to intubate?

    Science.gov (United States)

    DiBlasi, Robert M

    2011-09-01

    The current trend for supporting neonates with respiratory distress syndrome is nasal continuous positive airway pressure (CPAP). Nearly half of all neonates who are supported with CPAP will still develop respiratory failure that requires potentially injurious endotracheal intubation and invasive ventilation. Thus, the role of any neonatal clinician is to minimize invasive ventilation whenever possible, to avoid the multitude of complications that can arise when using this form of therapy. Noninvasive ventilation (NIV) is a form of respiratory assistance that provides greater respiratory support than does CPAP and may prevent intubation in a larger fraction of neonates who would otherwise fail CPAP. With the inception of nasal airway interfaces, clinicians have ushered in many different forms of NIV in neonates, often with very little experimental data to guide management. This review will explore in detail all of the different forms of neonatal NIV that are currently focused within an area of intense clinical investigation.

  12. Development of acute parotitis after non-invasive ventilation

    Science.gov (United States)

    Martinez, Eduardo

    2017-01-01

    A 90-year-old woman underwent laparoscopic exploratory laparotomy for evaluation of suspected mesenteric ischemia. She was promptly extubated postoperatively and transferred to the intensive care unit, where on the first postoperative day she developed hypoxemia necessitating initiation of noninvasive ventilation (NIV) with bilevel positive airway pressure (BiPAP). After 8 hours of BiPAP, she was noted to have swelling, erythema and tenderness in the right preauricular area. Ultrasound evaluation demonstrated an enlarged right parotid gland. With discontinuation of BiPAP and supportive measures, parotitis resolved within 6 days. The mechanism of NIV-induced acute parotitis likely involves transmission of positive pressure to the oral cavity, causing obstruction to salivary flow within the parotid (Stensen) duct. Conditions that increase salivary viscosity and promote salivary stasis, such as advanced age, dehydration, and absence of salivary gland stimulation due to restriction of oral intake, may render patients more susceptible to this complication. As NIV will continue to be a commonly-used modality for the treatment of acute respiratory failure, clinicians should be aware of this phenomenon. PMID:28840025

  13. Liberation From Mechanical Ventilation in Critically Ill Adults: An Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: Inspiratory Pressure Augmentation During Spontaneous Breathing Trials, Protocols Minimizing Sedation, and Noninvasive Ventilation Immediately After Extubation.

    Science.gov (United States)

    Ouellette, Daniel R; Patel, Sheena; Girard, Timothy D; Morris, Peter E; Schmidt, Gregory A; Truwit, Jonathon D; Alhazzani, Waleed; Burns, Suzanne M; Epstein, Scott K; Esteban, Andres; Fan, Eddy; Ferrer, Miguel; Fraser, Gilles L; Gong, Michelle Ng; Hough, Catherine L; Mehta, Sangeeta; Nanchal, Rahul; Pawlik, Amy J; Schweickert, William D; Sessler, Curtis N; Strøm, Thomas; Kress, John P

    2017-01-01

    An update of evidence-based guidelines concerning liberation from mechanical ventilation is needed as new evidence has become available. The American College of Chest Physicians (CHEST) and the American Thoracic Society (ATS) have collaborated to provide recommendations to clinicians concerning liberation from the ventilator. Comprehensive evidence syntheses, including meta-analyses, were performed to summarize all available evidence relevant to the guideline panel's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, and the results were summarized in evidence profiles. The evidence syntheses were discussed and recommendations developed and approved by a multidisciplinary committee of experts in mechanical ventilation. Recommendations for three population, intervention, comparator, outcome (PICO) questions concerning ventilator liberation are presented in this document. The guideline panel considered the balance of desirable (benefits) and undesirable (burdens, adverse effects, costs) consequences, quality of evidence, feasibility, and acceptability of various interventions with respect to the selected questions. Conditional (weak) recommendations were made to use inspiratory pressure augmentation in the initial spontaneous breathing trial (SBT) and to use protocols to minimize sedation for patients ventilated for more than 24 h. A strong recommendation was made to use preventive noninvasive ventilation (NIV) for high-risk patients ventilated for more than 24 h immediately after extubation to improve selected outcomes. The recommendations were limited by the quality of the available evidence. The guideline panel provided recommendations for inspiratory pressure augmentation during an initial SBT, protocols minimizing sedation, and preventative NIV, in relation to ventilator liberation. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights

  14. 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...

  15. 无创双水平正压呼吸机对长期气管切开 机械通气的肌萎缩侧索硬化症患者的效果%The clinical application of bilevel positive airway pressure noninvasive ventilator for home mechanical ventilation via tracheostomy in patients with amyotrophic lateral sclerosis

    Institute of Scientific and Technical Information of China (English)

    向平超; 孙佳; 杨慧; 郭伟安; 张硕; 宋丽萍; 鞠立新; 张鑫; 张二明; 杨珺楠

    2009-01-01

    Objective To study the feasibility of the bilevel positive airway pressure ( BiPAP) non- invasive ventilator used in home mechanical ventilation for long-term tracheostomy-mechanical ventilation (TMV) in patients with amyotrophic lateral sclerosis (ALS). Methods Sixteen patients(12 men and 4 women,mean age 59 years) with ALS were selected for this study at Respiratory Department of the Shougang Hospital, Peking University from January 2002 to March 2008. After the disease had been controlled by anti-infective therapy and comprehensive treatment,the patients received TMV,through the improved ( "Xiang's" connection) non-invasive BiPAP ventilator connected with tracheotomy tube,and on-going home mechanical ventilation ( HMV). The blood gas was evaluated during invasive ventilation and non-invasive ventilation before discharge . Family members of the patients were trained for the use of non-invasive ventilators. The use of ventilators and the patients' condition were regularly followed and the survival rate calculated. Statistical analysis was carried out by using one-way ANOVA. Results There was no statistical difference in the blood gas before the use of non-invasive ventilator,2 h and 1 d after the use of non-invasive ventilator, and before discharge, PaCO2[ (36 ± 10) ,(42 ± 11) , (41 ± 10) , (42 ± 11) mm Hg( 1 mm Hg =0.133 kPa) ] , PaO2 [(84 ±11), (81 ± 12), (87 ±14), (86 ±12) mm Hg], SaO2[(96.7 ± 1. 3 )% , (96. 5 ± 0. 8)% , (96.8±1.2)%,(96.5 ±1.0)%] respectively,( F = 1.21, 0.59, 0.97, 0. 41, respectively, all P> 0.05). All patients had no complaint of uncomfortable use, no intolerance to ventilators, and no ventilator breakdown. Fifteen patients were alive at the end of the follow-up ( July 31 ,2008). The mean time of using non-invasive ventilator was 39 months ( range 4 to 66 months). Conclusion For ALS patients who need long-term ventilation support, the use of BiPAP non-invasive ventilators is a safe and effective alternative for invasive

  16. 无创机械通气抢救急性心源性肺水肿40例分析%Analysis of noninvasive mechanical ventilation in acute cardiogenic pulmonary edema rescue of 40 cases

    Institute of Scientific and Technical Information of China (English)

    刘宏营

    2011-01-01

    目的 探讨无创机械通气在心源性肺水肿急救治疗中的临床作用,并观察其疗效.方法 对收治的40例心源性肺水肿,在常规治疗基础上加用无创机械通气,观察临床疗效及血气变化.结果 采用紧闭面罩双相气道正压通气前后患者心率、呼吸频率、平均动脉压、SpO、PaO均有明显变化,PaCO无明显变化.结论 在常规强心、利尿、扩张血管等基础治疗同时,加用无创双水平正压机械通气治疗急性肺水肿,可迅速纠正缺氧、改善病情、提高抢救成功率,减少气管插管及气管切开率,降低死亡率.%Objective To investigate and observe the effect of non - invasive mechanical ventilation in the treatment of pulmonary edema.Methods Totally 40 patients in our hospital with cardiogenic pulmonary edema, in the conventional treatment based on the use of noninvasive mechanical ventilation, observe clinical effect and blood gas changes.Results Before and after closed mask bilevel positive airway pressure ventilation in patients the heart rate, respiratory rate, mean arterial pressure,SpO2, PaO2 changed significantly, PaCO2 did not change.Conclusions In normal cardiac, diuretic,while expanding treatment and other infrastructure management, plus non- invasive bi -level positive pressure ventilation treatment of acut.

  17. Mechanical ventilation in rural ICUs.

    Science.gov (United States)

    Fieselmann; Bock; Hendryx; Wakefield; Helms; Bentler

    1999-01-01

    BACKGROUND: In recent years, rural hospitals have expanded their scope of specialized services, which has led to the development and staffing of rural intensive care units (ICUs). There is little information about the breadth, quality or outcomes of these services. This is particularly true for specialized ICU services such as mechanical ventilation, where little, if any, information exists specifically for rural hospitals. The long-term objectives of this project were to evaluate the quality of medical care provided to mechanically ventilated patients in rural ICUs and to improve patient care through an educational intervention. This paper reports baseline data on patient and hospital characteristics for both rural and rural referral hospitals. RESULTS: Twenty Iowa hospitals were evaluated. Data collected on 224 patients demonstrated a mean age of 70 years and a mean ICU admission Acute Physiology and Chronic Health Evaluation (APACHE) II score of 22, with an associated 36% mortality. Mean length of ICU stay was 10 days, with 7.7 ventilated days. Significant differences were found in both institutional and patient variables between rural referral hospitals and rural hospitals with more limited resources. A subgroup of patients with diagnoses associated with complex ventilation had higher mortality rates than patients without these conditions. Patients who developed nosocomial events had longer mean ventilator and ICU days than patients without nosocomial events. This study also found ICU practices that frequently fell outside the guidelines recommended by a task force describing minimum standards of care for critically ill patients with acute respiratory failure on mechanical ventilation. CONCLUSIONS: Despite distinct differences in the available resources between rural referral and rural hospitals, overall mortality rates of ventilated patients are similar. Considering the higher mortality rates observed in patients with complicated medical conditions requiring

  18. Noninvasive Ventilation Practice Patterns for Acute Respiratory Failure in Canadian Tertiary Care Centres: A Descriptive Analysis

    Directory of Open Access Journals (Sweden)

    Geneviève C Digby

    2015-01-01

    Full Text Available BACKGROUND: The extent of noninvasive ventilation (NIV use for patients with acute respiratory failure in Canadian hospitals, indications for use and associated outcomes are unknown.

  19. [Nasopharyngeal myiasis during mechanical ventilation].

    Science.gov (United States)

    Yoshitomi, A; Sato, A; Suda, T; Chida, K

    1997-12-01

    We report a case of myiasis caused by Phaenicia sericata during mechanical ventilation. An 86-year-old woman with bronchiectasis was admitted to our hospital with severe respiratory failure. Treatment with mechanical ventilation and sedatives was initiated. On the 10th day of hospitalization, about 20 white larvae were found in the patient's oral or nasal cavities. The larvae were removed and identified as Phaenicia sericata. No mucosal injury was found in the patient's oral or nasal cavity by endoscopic examination. The patient died of multiple organ failure caused by sepsis that had no association with myiasis. From the clinical course and the fly's life cycle, it is considered that the fly laid eggs in the patient's oral or nasal cavity while she was sedated during mechanical ventilation. Myiasis can occur even in a hospital.

  20. Noninvasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema Uso da ventilação não invasiva no tratamento de pacientes com edema agudo de pulmão cardiogênico

    Directory of Open Access Journals (Sweden)

    Marcelo Park

    2006-06-01

    Full Text Available Current literature was searched by using the MEDLINE database to find consistent evidence regarding the use of noninvasive mechanical ventilation in patients with acute cardiogenic pulmonary edema. 18 studies demonstrating that noninvasive ventilation applied by continuous positive airway pressure (CPAP or bilevel positive airway pressure (bilevel-PAP is safe, and that the two approaches have similar effects and are effective in preventing endotracheal intubation in patients with respiratory distress of cardiac origin, were found. The results support the concept that positive intrathoracic positive pressure must be seen as a nonpharmacological form of treatment of acute pulmonary edema rather than only a supportive measure.Pesquisamos a literatura atual usando a base de dados MEDLINE para encontrar evidências consistentes sobre o uso da ventilação não invasiva em pacientes com edema agudo de pulmão cardiogênico. Foram encontrados 18 estudos demonstrando que a ventilação não invasiva aplicada por CPAP ou bilevel-PAP é segura, tem efeitos similares e é efetiva em reduzir a necessidade de intubação traqueal em pacientes com desconforto respiratório de origem cardíaca. Os resultados reforçam o conceito que a pressão positiva intratorácica deve ser considerada um forma não farmacológica de tratamento do edema agudo de pulmão cardiogênico e não simplesmente uma medida de suporte.

  1. 无创机械通气在重症肺炎合并急性呼吸衰竭中的应用%Noninvasive mechanical ventilation in severe pneumonia an acute respiratory failure

    Institute of Scientific and Technical Information of China (English)

    王立芹

    2009-01-01

    目的 探讨无创机械通气(NIV)在救治重症肺炎合并急性呼吸衰竭中的价值.方法 收集24例重症肺炎合并急性呼吸衰竭患者进行NIV的临床资料,回顾性分析NIV前后缺氧的改善情况、并发症及转归等.结果 24例患者使用了机械通气,14例仅采用NIV,气体交换获得持久性改善,避免了气管插管,并最终存活出院.另10例先采用NIV,后改用有创机械通气.所有患者均能较好耐受.NIV使用1h后,PaO2和平均氧合指数较治疗前有明最提高(P<0.05).结论 NIV可用于重症肺炎合并急性呼吸衰竭的早期呼吸支持治疗,能有效改善缺氧,耐受性和安全性好.%Objective To evaluate the clinical value of noninvasive mechanical ventilation(NIV) in the patients with severe pneumonia and acute respiratory failure(ARF).Methods All clinical data(24cases)were analyzed retrospectively.The main analyzed parameters included improvement of hypoxemia before and after NIV,complications and prognosis.Results Mechanical ventilation was applied in 24 cases in which 14 cases received NIV only.Sustianed improvement in gas exchanges was observed in 14 patients who avoided endotracheal intuhation and survived and 10 cases received sequential invasive and noninvasive ventilation.The NIV was well tolerated by all patients,within first hour of NIV,the PaO2 and the ratio of the PaO2 to the fraction of inspired oxygen(FiO2) were improved in all patients(P<0.05).Conclusion As an early approach of respiratory support is effective in some cases with severe pneumonia and ARF with well tolerance and safety.

  2. Ventilação não invasiva em pediatria Noninvasive ventilation in pediatrics

    Directory of Open Access Journals (Sweden)

    Dafne Cardoso Bourguignon da Silva

    2003-11-01

    Full Text Available OBJETIVO: Apresentar a ventilação mecânica não invasiva em pediatria como uma alternativa à ventilação invasiva, mostrar suas vantagens e desvantagens, quando se encontra indicada e como instalá-la. FONTES DOS DADOS: Revisão bibliográfica através do PubMed/Medline, utilizando como fontes de pesquisa aqueles artigos de ventilação não invasiva na população pediátrica, além de artigos de consenso e meta-análise de ventilação não invasiva em adultos (por sua falta na população pediátrica. SÍNTESE DOS DADOS: A maior indicação da ventilação mecânica não invasiva é na insuficiência respiratória hipercápnica, estando contra-indicada na instabilidade hemodinâmica. Tem como vantagens: facilidade de instalação, não invasividade, diminuição do desconforto, redução da incidência das complicações associadas ao uso do tubo endotraqueal e menor custo. Desvantagens: distensão gástrica, hipoxemia transitória, necrose de pele facial. Sua instalação requer uma interface (máscara e um respirador. São revistos os tipos de ventiladores e modos ventilatórios, e orienta-se sua instalação, monitorização e parâmetros iniciais. A retirada da ventilação mecânica não invasiva é mais simples, mas pacientes crônicos podem necessitar assistência domiciliar. CONCLUSÕES: A ventilação mecânica não invasiva pode ser uma alternativa mais barata, eficaz e de simples execução nos casos de insuficiência respiratória sem descompensação hemodinâmica.OBJECTIVE: To introduce the notion of noninvasive mechanical ventilation as an alternative for invasive ventilation in children, describing advantages and disadvantages, indications, and the process of equipment installation. SOURCES OF DATA: Literature review through PubMed/Medline, using as source articles focusing on noninvasive ventilation in pediatric populations, as well as consensus statements and metanalyses concerning noninvasive ventilation in adults

  3. Involvement of patients' perspectives on treatment with noninvasive ventilation in patients with chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Christensen, Helle Marie; Huniche, Lotte; Titlestad, Ingrid L

    2017-01-01

    conduct their everyday lives with chronic obstructive pulmonary disease looking at chronic obstructive pulmonary disease as a basic life condition rather than an illness. This approach had a major impact on chronic obstructive pulmonary disease patients' attitudes to noninvasive ventilation treatment...... a nurse was assigned, was designated for chronic obstructive pulmonary disease patients treated with noninvasive ventilation....

  4. Ventilação mecânica não invasiva no pós-operatório imediato de cirurgia cardíaca Noninvasive mechanical ventilation in immediate postoperative cardiac surgery patients

    Directory of Open Access Journals (Sweden)

    João Batista Raposo Mazullo Filho

    2010-12-01

    use in cardiac surgery postoperative period. OBJECTIVE: To evaluate the effectiveness of preventive noninvasive ventilation in the immediate postoperative period of cardiac surgery, monitoring its impact until the sixth day of hospitalization. METHODS: This was a controlled study, where patients in immediate postoperative period of cardiac surgery were randomized into two groups: control (G1 and investigational (G2 which received noninvasive ventilation set on pressure support mode and positive end expiratory pressure, for 2 hours following extubation. Were evaluated ventilatory, hemodynamical and oxygenation variables both immediately after extubation and after noninvasive ventilation in G2. RESULTS: Thirty-two patients completed the study, 18 in G1 and 14 in G2. The mean age was 61±16.23 years for G1 and for G2 61.5 ± 9.4 years. Of the initial twenty-seven patients in G1, nine patients (33.3% were excluded due to invasive ventilation requirements, and three patients (11.11% had to go back to invasive mechanical ventilation. None of the 14 G2 patients was reintubated. Patients undergoing early ventilatory support showed better results in the assessments throughout the hospitalization time. CONCLUSION: Noninvasive post-cardiac surgery ventilation was proven effective, as demonstrated by increased vital capacity, decreased respiratory rate, prevention of post-extubation acute respiratory failure and reduced reintubation rates.

  5. Noninvasive ventilation: has Pandora’s box been opened?

    Directory of Open Access Journals (Sweden)

    Ari Manuel

    2010-02-01

    Full Text Available Ari Manuel1, Richard EK Russell2, Quentin Jones31Department of Respiratory Medicine, High Wycombe Hospital, Bucks, UK; 2Airway Disease Section, National Heart and Lung Institute, Imperial College, London, UK; 3Specialist Registrar, Department of Respiratory Medicine, Churchill Hospital, OxfordExacerbations of COPD are the largest single cause of hospital admission with respiratory disease, and are frequently associated with impaired gas exchange and mortality rates of up to 14%. Acute hypercapnic respiratory failure leads to admissions to intensive care units with a mortality rate of 59% at one year. Noninvasive ventilation (NIV is a well established and validated therapy for acidotic hypercapnia respiratory failure in COPD, a leading cause of global mortality and morbidity. The use of NIV in patients with acute type II or chronic respiratory failure has increased over the past 10 years.

  6. 无创通气改善心脏术后呼吸功能不全患者心功能的效果%Effect of noninvasive mechanical ventilation on cardiac function after the heart surgery

    Institute of Scientific and Technical Information of China (English)

    章淬; 穆心苇; 王翔; 施乾坤; 李静; 程子昊

    2011-01-01

    目的 观察无创通气对心脏术后患者血流动力学的影响.方法 对心脏术后在气管插管拔除后出现呼吸功能不全的患者48例实施无创通气治疗.记录无创通气前(T0)、无创通气30 min(T1)、1 h(T2)、2 h(T3)、4 h(T4)的脉搏氧饱和度(SpO2)、氧合指数(OI)、平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、心指数(CI)、右心射血分数(RVEF)、右室舒张末容积(RVEDV)、平均肺动脉压(MPAP)、肺血管阻力指数(PVRI).结果 与T0比较,HR、MAP、CVP、RVEDV在T1、T2、T3、T4时均无明显变化(P>0.05) ;MPAP在T4时明显降低(P<0.05);PVRI在T3、T4时明显降低(P<0.05);CI、RVEF在T3、T4时明显升高(P<0.05);SpO2和OI在T2、T3、T4时明显上升(P<0.05).结论 心脏术后出现呼吸功能不全时进行无创通气治疗可明显改善心功能.%Objective To investigate the effects of nomnvasive mechanical ventilation on hemodynamics after heart surgery. Methods Noninvasive mechanical ventilation was performed in 48 patients underwent cardiosurgery with respiratory insufficiency after extubation. The pulsed oxygen saturation(SpO2),oxygenation index(OI), mean arterial pressure(MAP), heart rate(HR), central venous pressure(CVP), cardiac index( CI), right ventricular ejection fraction(RVEF), right ventricular end-diastolic volume ( RVEDV), mean pulmonary artery pressure (MPAP) and pulmonary vascular resistance index(PVRI) were recorded after extubation (TO), at 30 min(Tl), 60 min(T2), 120 min (T3) and 240 min(T4) during noninvasive mechanical ventilatioa Results Compared with T0,there were no remarkable changes of HR,MAP,CVP and RVEDV at T1,T2,T3 and T4(P>0. 05),but CI and RVEF were highly increased at T3 and T4(P<0. 05),MPAP was decreased at T4(P<0. 05), PVRI was decreased at T3 and T4(P<0. 05),and SpO2. And OI were highly increased at T2,T3 and T4(P<0. 05). Conclusion The noninvasive mechanical ventilation can effectively improve cardiac function in the

  7. 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.

  8. Non-invasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema Application%无创机械通气在治疗急性心源性肺水肿中的应用研究

    Institute of Scientific and Technical Information of China (English)

    陈培莉

    2010-01-01

    目的 探讨无创机械通气(NMV)治疗急性心源性肺水肿(ACPE)的临床应用价值.方法 对80例各种原因所致的急性肺水肿患者随机分为NMV治疗组39例和对照组41例,对照组常规药物治疗加鼻导管高流量吸氧,NMV治疗组在常规药物治疗的基础上给予压力支持通气(PSV)加呼吸末正压(PEEP)通气模式,分别监测治疗前及治疗后的临床表现、动脉血气分析、血氧饱和度、呼吸频率、心率、血压等变化.结果 治疗组治疗后,39例患者均于30 min内症状缓解,除3例较重患者需辅助通气2 h才能撤机外,其他均于1 h内撤机.撤机后能平卧呼吸,面色恢复正常、大汗消失、口唇无青紫、泡沫样痰消失、双肺啰音明显减少甚至消失.两组临床各项指标比较差异均具有统计学意义(P<0.05).结论 在常规强心、利尿、扩管等基础治疗同时,加用无创双水平正压机械通气治疗急性肺水肿,可迅速纠正缺氧、改善病情、提高抢救成功率,减少气管插管及气管切开率,降低死亡率.%Objective To investigate the non-invasive mechanical ventilation (NMV) treatment of acute cardiogenic pulmonary edema (ACPE) for clinical application.Methods 80 patients with different causes of acute pulmonary edema were randomly divided into NMV treatment group and control group 39 cases,41 cases of conventional therapy control group,high-flow oxygen by nasal catheter,NMV in the conventional treatment group,drug treatment basis for pressure support ventilation (PSV) plus PEEP (PEEP) ventilation node,were monitored before treatment and after treatment of clinical manifestations,blood gas analysis,oxygen saturation,respiratory rate,heart rate,blood pressure changes.Results After treatment,39 patients were in remission within 30 min,in addition to three cases of heavy patients can be assisted ventilation weaning 2 h,the other are at weaning within 1 h.Supine position after weaning can breathe

  9. 序贯性机械通气策略治疗外科急性呼吸衰竭的效果%Sequential invasive-noninvasive mechanical ventilation for surgical acute respiratory failure

    Institute of Scientific and Technical Information of China (English)

    黄维雄; 钱巧慧; 樊海蓉; 姜维; 罗璧君; 张翔宇

    2012-01-01

    Objective To evaluate the clinical efficacy of sequential invasive-noninvasive mechanical ventilation ( SINMV) in treatment of surgical acute respiratory failure ( ARF). Methods One hundred and twenty six ARF patients due to surgery diseases were admitted in intensive care unit (ICU) and underwent tracheal intubation and invasive mechanical ventilation (MV) from October 2010 to November 2011; the patients were randomly divided into two groups with 63 cases in each. When the switch point was achieved, patients in sequential group accepted noninvasive MV and intubations were removed. Those in routine group continually accepted invasive MV and disconnect MV with routine mode. Results There were no significant differences in APACHE II scores, respiratory rate, heart rate, mean arterial blood pressure, pH of arterial blood and oxygenation index between the two groups (all P >0.05). The incidence of ventilation associated pneumonia (VAP) in sequential and routine groups was 15. 9% and 42. 9% , respectively (^2 = 17. 387 , P <0. 001). The duration of invasive MV was (8 ±3) d and (24 ± 12) d; the total duration of MV was (16 ±6) d and (24 ± 12) d, and duration of ICU stay was (17 ± 5) d and (26 ± 11) d, respectively (t = 9. 673, 8. 896 and 6. 879, respectively, all P < 0. 001). Conclusion Compared with routine MV, SNIMV may decrease the prevalence of VAP and shorten the duration of invasive MV, total MV and ICU stay in the patients with ARF due to surgery diseases.%目的 评价有创-无创序贯性机械通气治疗外科急性呼吸衰竭(acute respiratory failure,ARF)的临床效果.方法 以2010年10月至2011年11月收住我院ICU的126例外科ARF行气管插管和机械通气者为研究对象,前瞻性随机分为两组,每组63例.达到序贯切换点后,序贯组拔除气管插管,应用无创机械通气支持直至脱机;常规组则继续有创机械通气,以常规方式脱机.结果 两组患者在治疗前,APACHEⅡ评分、呼吸频率、心

  10. Use of noninvasive ventilation in severe acute respiratory distress syndrome due to accidental chlorine inhalation: a case report

    Science.gov (United States)

    Matos, Adriano Medina; de Oliveira, Rodrigo Ribeiro; Lippi, Mauro Martins; Takatani, Rodrigo Ryoji; de Oliveira Filho, Wilson

    2017-01-01

    Acute respiratory distress syndrome is characterized by diffuse inflammatory lung injury and is classified as mild, moderate, and severe. Clinically, hypoxemia, bilateral opacities in lung images, and decreased pulmonary compliance are observed. Sepsis is one of the most prevalent causes of this condition (30 - 50%). Among the direct causes of acute respiratory distress syndrome, chlorine inhalation is an uncommon cause, generating mucosal and airway irritation in most cases. We present a case of severe acute respiratory distress syndrome after accidental inhalation of chlorine in a swimming pool, with noninvasive ventilation used as a treatment with good response in this case. We classified severe acute respiratory distress syndrome based on an oxygen partial pressure/oxygen inspired fraction ratio <100, although the Berlin classification is limited in considering patients with severe hypoxemia managed exclusively with noninvasive ventilation. The failure rate of noninvasive ventilation in cases of acute respiratory distress syndrome is approximately 52% and is associated with higher mortality. The possible complications of using noninvasive positive-pressure mechanical ventilation in cases of acute respiratory distress syndrome include delays in orotracheal intubation, which is performed in cases of poor clinical condition and with high support pressure levels, and deep inspiratory efforts, generating high tidal volumes and excessive transpulmonary pressures, which contribute to ventilation-related lung injury. Despite these complications, some studies have shown a decrease in the rates of orotracheal intubation in patients with acute respiratory distress syndrome with low severity scores, hemodynamic stability, and the absence of other organ dysfunctions. PMID:28444079

  11. Observation of home non-invasive mechanical ventilation on AECOPD patients in MICU%MICU中AECOPD患者由医院转换为家庭无创机械通气的实施观察

    Institute of Scientific and Technical Information of China (English)

    姚翠玲; 徐喜媛; 尹东; 孙丽; 刘仙岭; 徐海燕; 杨敬平

    2014-01-01

    目的:观察慢性阻塞性肺病急性发作( AECOPD)患者由医院转换为家庭无创机械通气实施的效果。方法选取2011年1月至2013年12月期间住我科MICU采用无创机械通气( Non-Invasive Positive Pressure Ventilation,NIPPV)治疗的存在中度呼吸性酸中毒(7.2515 h。观察NIPPV治疗前、治疗后6个月的肺功能、呼吸困难评分( mMRC)、SGRQ量表及血气分析,酶联免疫吸附法检测外周血细胞因子IL-17、MMP-9、TNF-R75。结果 HMV治疗组6个月时与对照组比较PaO2、PaCO2、mMRC、SGRQ评分、FEV1%pro 及FEV1/FVC明显改善(P<0.05),同时,外周血细胞因子IL-17、MMP-9、TNF-R75亦较对照组有明显改善(P<0.05)。结论 HMV对MICU中存在中度呼吸性酸中毒的AECOPD患者可以安全实现从医院过渡到家庭NIPPV治疗,有效延长COPD的稳定期、提高患者生活质量。%Objective To observe the effect of home non-invasive mechanical ventilation ( HNIMV) on pa-tients with AECOPD in MICU. Methods 43 AECOPD patients with moderate respiratory acidosis ( 7. 25 non-invasive positive pressure ventilation (NIPPV) in MICU at first, and then they were di-vided into two groups:the HNIMV group (n=22) with home NIPPV therapy and the control group (n=21) without HMV therapy. Their lung function, dyspnea scores, SGRQ, arterial blood gas were observed, and their serum levels of IL-17, MMP-9 and TNF-R75 were measured by ELISA. Results Six months after the treatment, the improvement of mMRC and SGRQ scores, FEV1/FVC, arterial PaCO2 and PaO2 and the serum levels of IL-17, MMP-9 and TNF-R75 was more pronounced in the HNIMV group than in the control group (P<0. 05). Conclusion HNIMV therapy can effectively and safely achieve the transition of AECOPD patients with moderate respiratory acidosis from MICU to home NIPPV treatment, which can prolong the COPD stabilization and improve their life quality.

  12. Comparison of exercise capacity in COPD and other etiologies of chronic respiratory failure requiring non-invasive mechanical ventilation at home: retrospective analysis of 1-year follow-up

    Directory of Open Access Journals (Sweden)

    Salturk C

    2015-11-01

    Full Text Available Cuneyt Salturk,1 Zuhal Karakurt,1 Huriye Berk Takir,1 Merih Balci,2 Feyza Kargin,1 Ozlem Yazıcıoglu Mocin,1 Gokay Gungor,1 Ipek Ozmen,1 Selahattin Oztas,1 Murat Yalcinsoy,3 Ruya Evin,1 Murat Ozturk,1 Nalan Adiguzel1 1Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, 2Respiratory Intensive Care Unit, Kartal Kosuyolu Cardiovascular Disease and Surgery Teaching and Research Hospital, Istanbul, 3Respiratory Intensive Care Unit, Department of Chest Disease and Pulmonology, Inonu University Medical Faculty, Malatya, Turkey Introduction: The objective of this study was to compare the change in 6-minute walking distance (6MWD in 1 year as an indicator of exercise capacity among patients undergoing home non-invasive mechanical ventilation (NIMV due to chronic hypercapnic respiratory failure (CHRF caused by different etiologies.Methods: This retrospective cohort study was conducted in a tertiary pulmonary disease hospital in patients who had completed 1-year follow-up under home NIMV because of CHRF with different etiologies (ie, chronic obstructive pulmonary disease [COPD], obesity hypoventilation syndrome [OHS], kyphoscoliosis [KS], and diffuse parenchymal lung disease [DPLD], between January 2011 and January 2012. The results of arterial blood gas (ABG analyses and spirometry, and 6MWD measurements with 12-month interval were recorded from the patient files, in addition to demographics, comorbidities, and body mass indices. The groups were compared in terms of 6MWD via analysis of variance (ANOVA and multiple linear regression (MLR analysis (independent variables: analysis age, sex, baseline 6MWD, baseline forced expiratory volume in 1 second, and baseline partial carbon dioxide pressure, in reference to COPD group.Results: A total of 105 patients with a mean age (± standard deviation of 61±12 years of whom 37 had COPD, 34 had OHS, 20 had KS, and 14 had DPLD were included in statistical

  13. Use of Noninvasive Ventilation During Feeding Tube Placement.

    Science.gov (United States)

    Banfi, Paolo; Volpato, Eleonora; Valota, Chiara; D'Ascenzo, Salvatore; Alunno, Chiara Bani; Lax, Agata; Nicolini, Antonello; Ticozzi, Nicola; Silani, Vincenzo; Bach, John R

    2017-08-14

    Parenteral nutrition is indicated in amyotrophic lateral sclerosis (ALS) when dysphagia, loss of appetite, and difficulty protecting the airways cause malnutrition, severe weight loss, dehydration, and increased risk of aspiration pneumonia. The aim of this review is to compare percutaneous endoscopic gastrostomy (PEG), radiologically inserted G-tube (RIG), and percutaneous radiologic gastrostomy (PRG) in patients with ALS, performed with or without noninvasive ventilation (NIV). We searched PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the EBSCO Online Research Database, and Scopus up to December 2015. A priori selection included all randomized controlled trials (RCTs), quasi-randomized trials, and prospective and retrospective studies. The primary outcome was 30-d survival. We found no RCTs or quasi-RCTs. Seven studies about the implementation of the PEG/RIG procedure during the use of NIV and 5 studies without NIV were included. In another study of 59 subjects undergoing open gastrostomy, all with vital capacity < 30% of normal, 18 of whom were dependent on continuous NIV at full ventilatory support settings, there were no respiratory complications. Thus, the use of NIV during the implementation of these procedures, especially when used at full ventilatory support settings of pressure preset 18 -25 cm H2O, can support alveolar ventilation before, during, and after the procedures and prevent respiratory complications. The procedures investigated appear equivalent, but the methodological quality of the studies could be improved. Possible benefits with regard to nutrition parameters, quality of life, and psychological features need to be further investigated. Copyright © 2017 by Daedalus Enterprises.

  14. Iatrogenic pneumothorax related to mechanical ventilation

    OpenAIRE

    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...

  15. Effectiveness of Inspiratory Termination Synchrony with Automatic Cycling During Noninvasive Pressure Support Ventilation.

    Science.gov (United States)

    Chen, Yuqing; Cheng, Kewen; Zhou, Xin

    2016-05-20

    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.

  16. Immunoadjuvant Therapy and Noninvasive Ventilation for Acute Respiratory Failure in Lung Tuberculosis: A Case Study

    Science.gov (United States)

    Flores-Franco, René Agustín; Olivas-Medina, Dahyr Alberto; Pacheco-Tena, Cesar Francisco; Duque-Rodríguez, Jorge

    2015-01-01

    Acute respiratory failure caused by pulmonary tuberculosis is a rare event but with a high mortality even while receiving mechanical ventilatory support. We report the case of a young man with severe pulmonary tuberculosis refractory to conventional therapy who successfully overcame the critical period of his condition using noninvasive ventilation and immunoadjuvant therapy that included three doses of etanercept 25 mg subcutaneously. We conclude that the use of etanercept along with antituberculosis treatment appears to be safe and effective in patients with pulmonary tuberculosis presenting with acute respiratory failure. PMID:26273486

  17. Compliance with noninvasive home ventilation in children with obstructive sleep apnoea.

    Science.gov (United States)

    Nathan, Anna Maria; Tang, Jenny Poh Lin; Goh, Anne; Teoh, Oon Hoe; Chay, Oh Moh

    2013-12-01

    This study aimed to determine compliance with noninvasive home ventilation in children with obstructive sleep apnoea and the factors affecting this compliance. We retrospectively reviewed 51 children who were prescribed noninvasive home ventilation for the management of obstructive sleep apnoea from 1 January 2000 until 31 May 2008. Noninvasive ventilation was started based on positive polysomnogram, i.e. obstructive apnoea hypopnea index ≥ 1/hr. Compliance was defined as the use of noninvasive ventilation ≥ 4 days/week. Noninvasive home ventilation was started at a median age of 11.5 years. In all, 21 (41.2 %) children were reported to be compliant with treatment. Univariate analysis revealed that the female gender (p = 0.017), presence of asthma (p = 0.023), presence of genetic syndromes (p = 0.023), use of bi-level ventilation versus continuous positive airway pressure (p = 0.027), and funding from the social work department (p = 0.049) were associated with compliance with noninvasive home ventilation. Logistic regression revealed the presence of asthma (p = 0.008) and female gender (p = 0.047) to be significantly associated with compliance with treatment. However, factors such as counselling prior to initiation of treatment, severity of obstructive sleep apnoea before initiation of treatment, obesity, use of humidification, and polysomnogram indices were not found to be associated with treatment compliance. Only 41.2% of the children in this study were reported to be compliant with noninvasive home ventilation. The female gender and the presence of asthma were associated with treatment compliance. Future research focusing on effective methods to improve compliance with noninvasive home ventilation in children should be undertaken.

  18. Quality of life of ALS and LIS patients with and without invasive mechanical ventilation.

    Science.gov (United States)

    Rousseau, Marie-Christine; Pietra, Stéphane; Blaya, José; Catala, Anne

    2011-10-01

    There are very few studies where quality of life (QOL) is assessed in patients with complete physical and functional disability and dependence to invasive mechanical ventilation (IV). We compared QOL of amyotrophic lateral sclerosis (ALS) and locked-in-syndrome (LIS) patients with invasive mechanical ventilation to ALS and LIS patients without mechanical invasive ventilation. Thirty-four patients, 27 with ALS and seven with LIS (vascular or tumoral aetiology) were included in the study. Twelve had invasive ventilation, 22 had non-invasive ventilation, and in the non-invasive ventilation group, five of them had ventilation via mask. The following scales were used for patients: ALS Functional Rating Scale (ALSFRS), McGILL, Short-Form 36 (SF36), Beck Depression Inventory-II, the Toronto Alexithymia Scale and the anxiety inventory of Spielberger. Mean ALSFRS scores were significantly lower in the invasive ventilation group (IV) than in the non-invasive ventilation group. McGILL and SF36 were not significantly different between the IV group and the non-invasive ventilation group; there were no significant differences between the two groups for others scales either. Comparison between IV group and LIS without invasive mechanical ventilation revealed no significant difference for SF36 and McGILL QOL scores. QOL was not significantly different between the IV and not invasively ventilated patients, but ALSFRS was significantly lower in the IV group, and comparison of QOL scores between non-ventilated LIS patients who had the same score of dependence that invasively ventilated patients did not show any difference. Invasive mechanical ventilation for patients who accept tracheotomy allows life prolongation and their QOL is not affected; medical teams should be aware of that.

  19. Intraoperative mechanical ventilation for the pediatric patient.

    Science.gov (United States)

    Kneyber, Martin C J

    2015-09-01

    Invasive mechanical ventilation is required when children undergo general anesthesia for any procedure. It is remarkable that one of the most practiced interventions such as pediatric mechanical ventilation is hardly supported by any scientific evidence but rather based on personal experience and data from adults, especially as ventilation itself is increasingly recognized as a harmful intervention that causes ventilator-induced lung injury. The use of low tidal volume and higher levels of positive end-expiratory pressure became an integral part of lung-protective ventilation following the outcomes of clinical trials in critically ill adults. This approach has been readily adopted in pediatric ventilation. However, a clear association between tidal volume and mortality has not been ascertained in pediatrics. In fact, experimental studies have suggested that young children might be less susceptible to ventilator-induced lung injury. As such, no recommendations on optimal lung-protective ventilation strategy in children with or without lung injury can be made.

  20. 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 ob...... objective was to describe the professional group with responsibility for key ventilation and weaning decisions and to examine organizational characteristics associated with nurse involvement....

  1. Respiratory mechanics in mechanically ventilated patients.

    Science.gov (United States)

    Hess, Dean R

    2014-11-01

    Respiratory mechanics refers to the expression of lung function through measures of pressure and flow. From these measurements, a variety of derived indices can be determined, such as volume, compliance, resistance, and work of breathing. Plateau pressure is a measure of end-inspiratory distending pressure. It has become increasingly appreciated that end-inspiratory transpulmonary pressure (stress) might be a better indicator of the potential for lung injury than plateau pressure alone. This has resulted in a resurgence of interest in the use of esophageal manometry in mechanically ventilated patients. End-expiratory transpulmonary pressure might also be useful to guide the setting of PEEP to counterbalance the collapsing effects of the chest wall. The shape of the pressure-time curve might also be useful to guide the setting of PEEP (stress index). This has focused interest in the roles of stress and strain to assess the potential for lung injury during mechanical ventilation. This paper covers both basic and advanced respiratory mechanics during mechanical ventilation.

  2. 有创无创序贯机械通气在治疗急性重症心源性肺水肿中的应用价值分析%Sequential Invasive Noninvasive Mechanical Ventilation in the Treatment of Acute Severe Cardiogenic Pulmonary Edema Value

    Institute of Scientific and Technical Information of China (English)

    罗建宇; 王晓源; 蒋文芳

    2014-01-01

    目的探讨有创无创序贯机械通气在治疗急性重症心源性肺水肿中的应用效果及价值。方法将50例急性重症心源性肺水肿随机分为观察组和对照组,对照组采用有创机械通气,观察组采用有创-无创序贯机械通气,以SIMV+PSV方式进行机械通气,双水平气道正压支持并撤机。结果两组患者撤机时的HR、RR、PaO2、PaCO2、SaO2均较有创通气前有改善(<0.05)。观察组的机械通气时间、VAP、死亡率少于对照组,有统计学意义(<0.05)。结论有创无创序贯机械通气治疗急性重症心源性肺水肿疗效满意,能够减少并发症。%Objective To investigate and non-invasive sequential mechanical ventilation in the treatment of acute severe application effect and value of cardiac pulmonary edema. Methods 50 cases of acute severe cardiac pulmonary edema were randomly divided into observation group and control group, control group adopts invasive mechanical ventilation, observation group by invasive and non-invasive sequential mechanical ventilation, mechanical ventilation, on the basis of SIMV + PSV double level support and positive airway pressure ventilator. Results Two groups patients withdraw machine of HR, RR, PaO2, PaCO2, SaO2 were compared with invasive ventilation before improvement ( <0.05). Observation group of mechanical ventilation time, VAP, and mortality rate is less than the control group, with statistical significance ( <0.05). Conclusion Has a noninvasive sequential mechanical ventilation treatment of acute severe cardiac pulmonary edema curative effect is satisfied, can reduce the complications.

  3. Adaptation to different noninvasive ventilation masks in critically ill patients

    Directory of Open Access Journals (Sweden)

    Renata Matos da Silva

    2013-06-01

    Full Text Available OBJECTIVE: To identify which noninvasive ventilation (NIV masks are most commonly used and the problems related to the adaptation to such masks in critically ill patients admitted to a hospital in the city of São Paulo, Brazil. METHODS: An observational study involving patients ≥ 18 years of age admitted to intensive care units and submitted to NIV. The reason for NIV use, type of mask, NIV regimen, adaptation to the mask, and reasons for non-adaptation to the mask were investigated. RESULTS: We evaluated 245 patients, with a median age of 82 years. Acute respiratory failure was the most common reason for NIV use (in 71.3%. Total face masks were the most commonly used (in 74.7%, followed by full face masks and near-total face masks (in 24.5% and 0.8%, respectively. Intermittent NIV was used in 82.4% of the patients. Adequate adaptation to the mask was found in 76% of the patients. Masks had to be replaced by another type of mask in 24% of the patients. Adequate adaptation to total face masks and full face masks was found in 75.5% and 80.0% of the patients, respectively. Non-adaptation occurred in the 2 patients using near-total facial masks. The most common reason for non-adaptation was the shape of the face, in 30.5% of the patients. CONCLUSIONS: In our sample, acute respiratory failure was the most common reason for NIV use, and total face masks were the most commonly used. The most common reason for non-adaptation to the mask was the shape of the face, which was resolved by changing the type of mask employed.

  4. Noninvasive ventilation during the weaning process in chronically critically ill patients

    Science.gov (United States)

    Servera, Emilio; Barrot, Emilia; Sanchez-Oro-Gómez, Raquel; Gómez de Terreros, F. Javier; Martín-Vicente, M. Jesús; Utrabo, Isabel; Núñez, M. Belen; Binimelis, Alicia; Sala, Ernest; Zamora, Enrique; Segrelles, Gonzalo; Ortega-Gonzalez, Angel; Masa, Fernando

    2016-01-01

    Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV) during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process. We conducted a prospective study that included chronically critically ill patients admitted to Spanish respiratory care units. The weaning method used consisted of progressive periods of spontaneous breathing trials. Patients were transferred to NIV when it proved impossible to increase the duration of spontaneous breathing trials beyond 18 h. 231 chronically critically ill patients were included in the study. 198 (85.71%) patients achieved weaning success (mean weaning time 25.45±16.71 days), of whom 40 (21.4%) needed NIV during the weaning process. The variable which predicted the need for NIV was arterial carbon dioxide tension at respiratory care unit admission (OR 1.08 (95% CI 1.01–1.15), p=0.013), with a cut-off point of 45.5 mmHg (sensitivity 0.76, specificity 0.67, positive predictive value 0.76, negative predictive value 0.97). NIV is a useful tool during weaning in chronically critically ill patients. Hypercapnia despite mechanical ventilation at respiratory care unit admission is the main predictor of the need for NIV during weaning. PMID:28053973

  5. Noninvasive ventilation during the weaning process in chronically critically ill patients

    Directory of Open Access Journals (Sweden)

    Jesus Sancho

    2016-10-01

    Full Text Available Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process. We conducted a prospective study that included chronically critically ill patients admitted to Spanish respiratory care units. The weaning method used consisted of progressive periods of spontaneous breathing trials. Patients were transferred to NIV when it proved impossible to increase the duration of spontaneous breathing trials beyond 18 h. 231 chronically critically ill patients were included in the study. 198 (85.71% patients achieved weaning success (mean weaning time 25.45±16.71 days, of whom 40 (21.4% needed NIV during the weaning process. The variable which predicted the need for NIV was arterial carbon dioxide tension at respiratory care unit admission (OR 1.08 (95% CI 1.01–1.15, p=0.013, with a cut-off point of 45.5 mmHg (sensitivity 0.76, specificity 0.67, positive predictive value 0.76, negative predictive value 0.97. NIV is a useful tool during weaning in chronically critically ill patients. Hypercapnia despite mechanical ventilation at respiratory care unit admission is the main predictor of the need for NIV during weaning.

  6. Performance of ICU ventilators during noninvasive ventilation with large leaks in a total face mask: a bench study

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Miyuki Nakamura

    2014-06-01

    Full Text Available Objective: Discomfort and noncompliance with noninvasive ventilation (NIV interfaces are obstacles to NIV success. Total face masks (TFMs are considered to be a very comfortable NIV interface. However, due to their large internal volume and consequent increased CO2 rebreathing, their orifices allow proximal leaks to enhance CO2 elimination. The ventilators used in the ICU might not adequately compensate for such leakage. In this study, we attempted to determine whether ICU ventilators in NIV mode are suitable for use with a leaky TFM. Methods: This was a bench study carried out in a university research laboratory. Eight ICU ventilators equipped with NIV mode and one NIV ventilator were connected to a TFM with major leaks. All were tested at two positive end-expiratory pressure (PEEP levels and three pressure support levels. The variables analyzed were ventilation trigger, cycling off, total leak, and pressurization. Results: Of the eight ICU ventilators tested, four did not work (autotriggering or inappropriate turning off due to misdetection of disconnection; three worked with some problems (low PEEP or high cycling delay; and one worked properly. Conclusions: The majority of the ICU ventilators tested were not suitable for NIV with a leaky TFM.

  7. Outcomes Associated with Early Postoperative Noninvasive Ventilation in Bariatric Surgical Patients with Sleep Apnea

    Science.gov (United States)

    Stefan, Mihaela S.; Hill, Nicholas S.; Raghunathan, Karthik; Liu, Xiaoxia; Pekow, Penelope S.; Memtsoudis, Stavros G.; Ramachandran, Satya Krishna; Lindenauer, Peter K.

    2016-01-01

    Study Objectives: To examine the relationship of early initiation of noninvasive ventilation (NIV) with postoperative outcomes in patients with obstructive sleep apnea (OSA) undergoing bariatric surgery. Methods: We included 5,266 patients with OSA undergoing bariatric surgeries at 161 hospitals in the United States. We defined early postoperative NIV as NIV used on the day of or the day after surgery; this could include prophylactic NIV or NIV used for early signs of respiratory deterioration. We developed a hierarchical model to identify factors associated with early use of NIV. Then, in a propensity matched cohort, we assessed the association between NIV use and outcomes. Results: Overall, 996 patients (18.9%) were treated with early postoperative NIV. Predictors of NIV initiation were: male sex (odds ratio: 1.34, 95% confidence interval 1.14–1.59), older age, chronic obstructive pulmonary disease (COPD; odds ratio 1.39, confidence interval: 1.17–1.64), gastric bypass surgery, short-acting narcotics intravenous on the day of surgery and admission to a hospital with high rate of OSA diagnosis. In a propensity matched analysis, we found no significant association between early initiation of NIV and receipt of invasive mechanical ventilation (IMV) (early NIV 4.5% vs. no NIV 3.8% p = 0.46), cardiovascular complications or mortality. Results were consistent in several sensitivity analyses. Conclusions: In this large observational study of patients with OSA undergoing bariatric surgery, early postoperative NIV use was not associated with better outcomes including less intubation and mortality. Properly designed controlled trials will be necessary to provide more definitive answers to this important clinical question. Citation: Stefan MS, Hill NS, Raghunathan K, Liu X, Pekow PS, Memtsoudis SG, Ramachandran SK, Lindenauer PK. Outcomes associated with early postoperative noninvasive ventilation in bariatric surgical patients with sleep apnea. J Clin Sleep Med 2016

  8. January 2015 Phoenix pulmonary journal club: noninvasive ventilation in acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Mathew M

    2015-01-01

    Full Text Available No abstract available. Article truncated after 150 words. Noninvasive positive pressure ventilation has expanded its role in the treatment of both chronic and acute respiratory failure. Its initial use in conditions such as obstructive sleep apnea, neuromuscular disease and tracheobronchomalacia, have been shown to improve quality of life and reduce mortality. Over the past 20 years studies have looked at using noninvasive ventilation in the management of acute respiratory failure from pulmonary edema, asthma and COPD exacerbations. During this month's journal club we reviewed 3 articles evaluating the efficacy of noninvasive ventilation in acute respiratory failure. Gupta D, Nath A, Agarwal R, Behera D. A prospective randomized controlled trial on the efficacy of noninvasive ventilation in severe acute asthma. Respir Care. 2010;55(5:536-43. [PubMed] This was a small unblinded randomized controlled trial (RCT looking at the efficacy using noninvasive ventilation (NIV in acute asthma. A total of 53 patients were included and divided into 2 groups of 28 patients ...

  9. Severe bronchopulmonary dysplasia improved by noninvasive positive pressure ventilation: a case report

    Directory of Open Access Journals (Sweden)

    Mann Christian

    2011-09-01

    Full Text Available Abstract Introduction This is the first report to describe the feasibility and effectiveness of noninvasive positive pressure ventilation in the secondary treatment of bronchopulmonary dysplasia. Case presentation A former male preterm of Caucasian ethnicity delivered at 29 weeks gestation developed severe bronchopulmonary dysplasia. At the age of six months he was in permanent tachypnea and dyspnea and in need of 100% oxygen with a flow of 2.0 L/minute via a nasal cannula. Intermittent nocturnal noninvasive positive pressure ventilation was then administered for seven hours daily. The ventilator was set at a positive end-expiratory pressure of 6 cmH2O, with pressure support of 4 cmH2O, trigger at 1.4 mL/second, and a maximum inspiratory time of 0.7 seconds. Over the course of seven weeks, the patient's maximum daytime fraction of inspired oxygen via nasal cannula decreased from 1.0 to 0.75, his respiratory rate from 64 breaths/minute to 50 breaths/minute and carbon dioxide from 58 mmHg to 44 mmHg. Conclusion Noninvasive positive pressure ventilation may be a novel therapeutic option for established severe bronchopulmonary dysplasia. In the case presented, noninvasive positive pressure ventilation achieved sustained improvement in ventilation and thus prepared our patient for safe home oxygen therapy.

  10. Respiratory Variations in Pulse Pressure Reflect Central Hypovolemia during Noninvasive Positive Pressure Ventilation

    Directory of Open Access Journals (Sweden)

    Ingrid Elise Hoff

    2014-01-01

    Full Text Available Background. Correct volume management is essential in patients with respiratory failure. We investigated the ability of respiratory variations in noninvasive pulse pressure (ΔPP, photoplethysmographic waveform amplitude (ΔPOP, and pleth variability index (PVI to reflect hypovolemia during noninvasive positive pressure ventilation by inducing hypovolemia with progressive lower body negative pressure (LBNP. Methods. Fourteen volunteers underwent LBNP of 0, −20, −40, −60, and −80 mmHg for 4.5 min at each level or until presyncope. The procedure was repeated with noninvasive positive pressure ventilation. We measured stroke volume (suprasternal Doppler, ΔPP (Finapres, ΔPOP, and PVI and assessed their association with LBNP-level using linear mixed model regression analyses. Results. Stroke volume decreased with each pressure level (−11.2 mL, 95% CI −11.8, −9.6, P<0.001, with an additional effect of noninvasive positive pressure ventilation (−3.0 mL, 95% CI −8.5, −1.3, P=0.009. ΔPP increased for each LBNP-level (1.2%, 95% CI 0.5, 1.8, P<0.001 and almost doubled during noninvasive positive pressure ventilation (additional increase 1.0%, 95% CI 0.1, 1.9, P=0.003. Neither ΔPOP nor PVI was significantly associated with LBNP-level. Conclusions. During noninvasive positive pressure ventilation, preload changes were reflected by ΔPP but not by ΔPOP or PVI. This implies that ΔPP may be used to assess volume status during noninvasive positive pressure ventilation.

  11. A noninvasive high frequency oscillation ventilator: Achieved by utilizing a blower and a valve.

    Science.gov (United States)

    Yuan, YueYang; Sun, JianGuo; Wang, Baicun; Feng, Pei; Yang, ChongChang

    2016-02-01

    After the High Frequency Oscillatory Ventilation (HFOV) has been applied in the invasive ventilator, the new technique of noninvasive High Frequency Oscillatory Ventilation (nHFOV) which does not require opening the patient's airway has attracted much attention from the field. This paper proposes the design of an experimental positive pressure-controlled nHFOV ventilator which utilizes a blower and a special valve and has three ventilation modes: spontaneous controlled ventilation combining HFOV, time-cycled ventilation combining HFOV (T-HFOV), and continuous positive airway pressure ventilation combining HFOV. Experiments on respiratory model are conducted and demonstrated the feasibility of using nHFOV through the control of fan and valve. The experimental ventilator is able to produce an air flow with small tidal volume (VT) and a large minute ventilation volume (MV) using regular breath tubes and nasal mask (e.g., under T-HFOV mode, with a maximum tidal volume of 100 ml, the minute ventilation volume reached 14,400 ml). In the process of transmission, there is only a minor loss of oscillation pressure. (Under experimental condition and with an oscillation frequency of 2-10 Hz, peak pressure loss was around 0%-50% when it reaches the mask.).

  12. 无创机械通气治疗急性心源性肺水肿临床研究%Noninvasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    李强; 罗柳苏

    2010-01-01

    Objective To asses the efficacy of noninvasive nasal mask bi-level positive airway pressure (BiPAP) ventilation in acute cardiogenic pulmonary edema Methods 45patients with acute cardiogenic pulmonary edema hospitalized from October 2008 to May 2010 were randonly assigned to receive conventional medical treatment (21 patients,control group) or noninvasive nasal mask bi-level positive airway pressure (BiPAP) ventilation in addition to the conventional therapy (24 patients,study group). The symptoms,signs,and the findings of blood gas analysis were noted. Results One hour after therapy,HR,RR,SpO2.and PaO2 were improved significantly in the study group; SBP and PH were returned to normal; the symptoms and signs were improved,with significant differences as compared with the control group. (P<0.05). Conclusions Noninvasive ventilation is a safe,effective method in the treatment of acute cardiogenic pulmonary edema with acute respiratory failure. It improves cardiac function and is worth popularizing.%目的 评价BiPAP无创机械通气治疗急性心源性肺水肿病例的临床价值.方法 将兴宁市人民医院2008年10月-2010年5月收治的急性心源性肺水肿患者45例随机分为两组,对照组21例常规药物治疗,治疗组24例在常规药物治疗的基础上,应用BiPAP呼吸机面作者单位:514500 兴宁市人民医院心血管内科罩辅助通气,观察其前后症状、体征及动脉血气分析结果.结果 治疗组患者1h后呼吸、心率明显减慢SpO2、PaO2均明显改善,SBP和pH恢复正常,临床症状体征明显改善,与对照组比较差异有显著性(P<0.05).结论 无创机械通气治疗急性心源性肺水肿安全有效能迅速纠正缺氧、改善心功能,值得临床推广.

  13. 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...

  14. Predictors of failure of noninvasive ventilation in patients with severe community-acquired pneumonia.

    Science.gov (United States)

    Carron, Michele; Freo, Ulderico; Zorzi, Manuel; Ori, Carlo

    2010-09-01

    The study aimed to investigate cardiorespiratory parameters potentially predictive of failure of noninvasive ventilation (NIV) in severe community-acquired pneumonia (CAP). Sixty-four consecutive patients with severe CAP entered the study and underwent NIV with a helmet. Arterial blood gases, Pao(2)/FIo(2), and oxygenation index (OI; mean airway pressure × FIo(2) × 100/Pao(2)) were determined before and after a 1-hour trial of NIV. Noninvasive ventilation succeeded in 28 patients (43%) and failed in 36 patients (56%). Patients who avoided intubation had significantly (P intubation failed to improve or worsened arterial blood gases during NIV trial and, by the end of the trial, had lower (P predictors of NIV failure, with OI delta being significantly more accurate. Noninvasive ventilation failed in approximately half patients with severe CAP. Posttrial to pretrial deltas of Pao(2)/FiO(2) and OI may help to guide decision about endotracheal intubation. Copyright © 2010 Elsevier Inc. All rights reserved.

  15. [Design of a lung simulator for teaching lung mechanics in mechanical ventilation].

    Science.gov (United States)

    Heili-Frades, Sarah; Peces-Barba, Germán; Rodríguez-Nieto, María Jesús

    2007-12-01

    Over the last 10 years, noninvasive ventilation has become a treatment option for respiratory insufficiency in pulmonology services. The technique is currently included in pulmonology teaching programs. Physicians and nurses should understand the devices they use and the interaction between the patient and the ventilator in terms of respiratory mechanics, adaptation, and synchronization. We present a readily assembled lung simulator for teaching purposes that is reproducible and interactive. Based on a bag-in-box system, this model allows the concepts of respiratory mechanics in mechanical ventilation to be taught simply and graphically in that it reproduces the patterns of restriction, obstruction, and the presence of leaks. It is possible to demonstrate how each ventilation parameter acts and the mechanical response elicited. It can also readily simulate asynchrony and demonstrate how this problem can be corrected.

  16. 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

  17. Mechanical ventilation in neurological and neurosurgical patients.

    Science.gov (United States)

    Swain, Amlan; Bhagat, Hemant; Sahni, Neeru; Salunke, Pravin

    2016-01-01

    Approximately 20% of all patients requiring mechanical ventilation suffer from neurological dysfunction. It is imperative in the ventilatory management of such patients to have a thorough understanding of the disease pathology that may require institution of mechanical ventilation as well as in realizing its effects on the injured brain. These patients have unique challenges pertaining to the assessment and securing of the airway, maintenance of mechanical ventilation, as well as weaning and extubation readiness. This manuscript aims to present the current evidence in ventilatory management of the important subset of patients with neuronal injury. The indications for ventilatory management include both neurological and neurosurgical causes.

  18. Mechanisms of natural ventilation in livestock buildings

    DEFF Research Database (Denmark)

    Rong, Li; Bjerg, Bjarne Schmidt; Batzanas, Thomas;

    2016-01-01

    Studies on the mechanisms of natural ventilation in livestock buildings are reviewed and influences on discharge and pressure coefficients are discussed. Compared to studies conducted on buildings for human occupation and industrial buildings which focus on thermal comfort, ventilation systems......, indoor air quality, building physics and energy etc., our understanding of the mechanisms involved in natural ventilation of livestock buildings are still limited to the application of the orifice equation. It has been observed that the assumptions made for application of the orifice equation...... are not valid for wind-induced cross ventilation through large openings. This review identifies that the power balance model, the concept of stream tube and the local dynamic similarity model has helped in the fundamental understanding of wind-induced natural ventilation in buildings for human occupation...

  19. Ventilação mecânica não-invasiva em paciente com provável pneumonia por pneumocystis jirovecii: relato de caso Noninvasive mechanical ventilation in patient with pneumocystis jirovecii pneumonia: case report

    Directory of Open Access Journals (Sweden)

    Élida Mara Carneiro

    2008-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A pneumonia por Pneumocystis jirovecii tem sido uma das doenças mais comuns e uma complicação infecciosa fatal em pacientes com síndrome da imunodeficiência adquirida. O objetivo deste estudo foi apresentar uma paciente com provável diagnóstico de pneumonia por Pneumocystis jirovecii que recebeu ventilação não-invasiva com pressão positiva. RELATO DO CASO: Paciente do sexo feminino, 25 anos, com diagnóstico provável de pneumonia por Pneumocystis jirovecii grave, recebeu ventilação mecânica não-invasiva com pressão positiva. CONCLUSÕES: Todos os parâmetros melhoraram progressivamente nos primeiros cinco dias. Os resultados sugeriram a eficácia desta medida para otimizar a oxigenação, reverter a hipoxemia e prevenir a intubação traqueal.BACKGROUND AND OBJECTIVES: Pneumocystis jirovecii pneumonia has been one of the most common diseases and life-threatening infectious complications in acquired immunodeficiency syndrome patients. The objective of the case report was to present a patient with probable diagnosis of Pneumocystis jirovecii pneumonia who received noninvasive positive pressure ventilation. CASE REPORT: A female patient, 25 years old, with probable diagnosis of Pneumocystis jirovecii pneumonia received noninvasive positive pressure ventilation. CONCLUSIONS: All respiratory parameters progressively improved in the first five days. Results suggest the efficacy of this support to improve oxygenation, to revert hypoxemia and to prevent orotracheal intubation.

  20. Different characteristics of ventilator application between tracheostomy- and noninvasive positive pressure ventilation patients with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Park, Donghwi; Lee, Goo Joo; Kim, Ha Young; Ryu, Ju Seok

    2017-03-01

    The aim of the study was to investigate the appropriate home ventilator settings for patients with amyotrophic lateral sclerosis (ALS).In total, 71 patients with ALS, who had received either a noninvasive positive pressure ventilation (NIPPV) or tracheostomy positive pressure ventilation (TPPV), were included. Accordingly, patients were divided into 2 groups (the TPPV and NIPPV groups). We retrospectively evaluated the values used in home ventilators for patients with ALS, who had maintained a stable level of CO2 on both the arterial blood gas analysis (ABGA) and transcutaneous blood gas monitoring. To measure the main outcome, we also investigated the actual body weight (ABW) and predicted body weight (PBW) of patients, and the following setting values of ventilators were also recorded: the inspired tidal volume (VTi), minute ventilation (MV), peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP), and inspiratory time (Tins).VTi and MV showed a significantly positive correlation with both PBW and ABW of patients in the TPPV group. However, both VTi and MV had greater significant correlation with PBW than ABW in the TPPV group. In addition, VTi and MV did not show a significantly positive correlation with either PBW or ABW in the NIPPV group.In patients with ALS, PBW was more useful for predicting VTi and MV than ABW. Moreover, it will be helpful to know the differences of setting values between TPPV and NIPPV, especially because ALS patients are usually treated with TPPV due to the initial difficulties associated with NIPPV.

  1. New modes of assisted mechanical ventilation.

    Science.gov (United States)

    Suarez-Sipmann, F

    2014-05-01

    Recent major advances in mechanical ventilation have resulted in new exciting modes of assisted ventilation. Compared to traditional ventilation modes such as assisted-controlled ventilation or pressure support ventilation, these new modes offer a number of physiological advantages derived from the improved patient control over the ventilator. By implementing advanced closed-loop control systems and using information on lung mechanics, respiratory muscle function and respiratory drive, these modes are specifically designed to improve patient-ventilator synchrony and reduce the work of breathing. Depending on their specific operational characteristics, these modes can assist spontaneous breathing efforts synchronically in time and magnitude, adapt to changing patient demands, implement automated weaning protocols, and introduce a more physiological variability in the breathing pattern. Clinicians have now the possibility to individualize and optimize ventilatory assistance during the complex transition from fully controlled to spontaneous assisted ventilation. The growing evidence of the physiological and clinical benefits of these new modes is favoring their progressive introduction into clinical practice. Future clinical trials should improve our understanding of these modes and help determine whether the claimed benefits result in better outcomes.

  2. 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.

  3. 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...

  4. Humidification of inspired gases during mechanical ventilation.

    Science.gov (United States)

    Gross, J L; Park, G R

    2012-04-01

    Humidification of inspired gas is mandatory for all mechanically ventilated patients to prevent secretion retention, tracheal tube blockage and adverse changes occurring to the respiratory tract epithelium. However, the debate over "ideal" humidification continues. Several devices are available that include active and passive heat and moisture exchangers and hot water humidifiers Each have their advantages and disadvantages in mechanically ventilated patients. This review explores each device in turn and defines their role in clinical practice.

  5. Brazilian recommendations of mechanical ventilation 2013. Part 2

    Science.gov (United States)

    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; de Carvalho, Carlos Roberto Ribeiro; Toufen Júnior, Carlos; David, Cid Marcos Nascimento; Taniguchi, Corine; Mazza, Débora Dutra da Silveira; Dragosavac, Desanka; Toledo, Diogo Oliveira; Costa, Eduardo Leite; Caser, Eliana Bernadete; Silva, Eliezer; Amorim, Fabio Ferreira; Saddy, Felipe; Galas, Filomena Regina Barbosa Gomes; Silva, Gisele Sampaio; de Matos, Gustavo Faissol Janot; Emmerich, João Claudio; Valiatti, Jorge Luis dos Santos; Teles, José Mario Meira; Victorino, Josué Almeida; Ferreira, Juliana Carvalho; Prodomo, Luciana Passuello do Vale; Hajjar, Ludhmila Abrahão; Martins, Luiz Claudio; Malbouisson, Luis Marcelo Sá; Vargas, Mara Ambrosina de Oliveira; Reis, Marco Antonio Soares; Amato, Marcelo Brito Passos; Holanda, Marcelo Alcântara; Park, Marcelo; Jacomelli, Marcia; Tavares, Marcos; Damasceno, Marta Cristina Paulette; Assunção, Murillo Santucci César; Damasceno, Moyzes Pinto Coelho Duarte; Youssef, Nazah Cherif Mohamed; Teixeira, Paulo José Zimmermann; Caruso, Pedro; Duarte, Péricles Almeida Delfino; Messeder, Octavio; Eid, Raquel Caserta; Rodrigues, Ricardo Goulart; de Jesus, Rodrigo Francisco; Kairalla, Ronaldo Adib; Justino, Sandra; Nemer, Sergio Nogueira; Romero, Simone Barbosa; Amado, Verônica Moreira

    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 by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document. PMID:25295817

  6. Brazilian recommendations of mechanical ventilation 2013. Part I

    Science.gov (United States)

    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 by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document. PMID:25210957

  7. 有创与无创序贯机械通气治疗急性心源性肺水肿的疗效观察%Efficacy of invasive-noninvasive sequential mechanical ventilation in treatment of acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    梁勇

    2013-01-01

    目的 探讨有创与无创序贯机械通气在治疗急性重症心源性肺水肿中的应用价值.方法 将68例急性肺水肿患者随机分为观察组和对照组,对照组在常规治疗基础上采用有创机械通气治疗.治疗组在常规治疗基础上采用有创与无创序贯机械通气治疗.比较2组治疗前后各参数的差异.结果 给予治疗组有创与无创序贯通气治疗后,死亡比例、发生VAP比例、重新插管比例、有创通气时间均少于对照组(均P<0.05);治疗组血流动力学和氧动力学各项指标均优于对照组,2组差异均有统计学意义(P<0.05).结论 有创与无创序贯机械通气治疗急性心源性肺水肿患者疗效确切.%Objective To investigate the efficacy of invasive-noninvasive sequential mechanical ventilation in treatment of acute cardiogenic pulmonary edema.Methods Sixty-eight patients with acute pulmonary edema patients were randomly divided into observation group and control group.The control group received invasive mechanical ventilation based on the conventional treatment,and the treatment group received invasive-noninvasive sequential mechanical ventilation based on the conventional treatment.The parameters were compared before and after the treatment.Results Death rate,VAP,re-intubation and invasive ventilation time of the treatment group were less than the control group (P < 0.05).Hemodynamic science and oxygen dynamics indicators of the treatment group were better than the control group,the difference being statistically significant (P < 0.05).Conclusion Invasive-noninvasive sequential mechanical ventilation has better effect in the treatment of acute cardiogenic pulmonary edema.

  8. Mechanical ventilation and respiratory mechanics during equine anesthesia.

    Science.gov (United States)

    Moens, Yves

    2013-04-01

    The mechanical ventilation of horses during anesthesia remains a crucial option for optimal anesthetic management, if the possible negative cardiovascular side effects are managed, because this species is prone to hypercapnia and hypoxemia. The combined use of capnography and pitot-based spirometry provide complementary information on ventilation and respiratory mechanics, respectively. This facilitates management of mechanical ventilation in conditions of changing respiratory system compliance (ie, laparoscopy) and when investigating new ventilatory strategies including alveolar recruitment maneuvers and optimization of positive expiratory pressure.

  9. Long-term survival for COPD patients receiving noninvasive ventilation for acute respiratory failure

    DEFF Research Database (Denmark)

    Titlestad, Ingrid L; Lassen, Annmarie T; Vestbo, Jørgen

    2013-01-01

    Implementation of noninvasive ventilation (NIV) as an add-on treatment has been routinely used in a non-intensive care setting since 2004 for patients with chronic obstructive pulmonary disease (COPD) and acute hypercapnic respiratory failure at a university hospital in Denmark. Although randomiz...

  10. A meta-analysis of nocturnal noninvasive positive pressure ventilation in patients with stable COPD

    NARCIS (Netherlands)

    Wijkstra, PJ; Lacasse, Y; Guyatt, GH; Casanova, C; Gay, PC; Jones, JM; Goldstein, RS

    2003-01-01

    Study objectives: The potential benefits of noninvasive positive pressure ventilation (NIPPV) for patients with COPD remains inconclusive, as most studies have included only a small number of patients. We therefore undertook a meta-analysis of randomized controlled trials (RCTs) that compared noctur

  11. Utilization of noninvasive ventilation in acute care hospitals: a regional survey.

    Science.gov (United States)

    Maheshwari, Vinay; Paioli, Daniela; Rothaar, Robert; Hill, Nicholas S

    2006-05-01

    Little information is available on the utilization of noninvasive positive-pressure ventilation (NPPV) in the United States. Accordingly, we performed a survey on the use of NPPV at acute care hospitals in a region of the United States to determine variations in utilization and between hospitals, the reasons for lower rates of utilization, and the techniques used for application. Using survey methodology, we developed a questionnaire consisting of 19 questions and distributed it by mail to directors of respiratory care at all 82 acute care hospitals in Massachusetts and Rhode Island. Nonresponders were contacted by phone to complete the survey. Responses were analyzed using standard statistics, including t tests and Mann-Whitney U tests where appropriate. We obtained responses from 71 of the 82 hospitals (88%). The overall utilization rate for NPPV was 20% of ventilator starts, but we found enormous variation in the estimated utilization rates among different hospitals, from none to > 50%. The top two reasons given for lower utilization rates were a lack of physician knowledge and inadequate equipment. In the 19 hospitals that provided detailed information, COPD and congestive heart failure constituted 82% of the diagnoses of patients receiving NPPV, but NPPV was still used in only 33% of patients with these diagnoses receiving any form of mechanical ventilation. The utilization rates for NPPV vary enormously among different acute care hospitals within the same region. The perceived reasons for lower utilization rates include lack of physician knowledge, insufficient respiratory therapist training, and inadequate equipment. Educational programs directed at individual institutions may be useful to enhance utilization rates.

  12. Noninvasive positive-pressure ventilation in clinical practice at a large university-affiliated Brazilian hospital

    Directory of Open Access Journals (Sweden)

    Liria Yuri Yamauchi

    2012-07-01

    Full Text Available OBJECTIVES: To describe noninvasive positive-pressure ventilation use in intensive care unit clinical practice, factors associated with NPPV failure and the associated prognosis. METHODS: A prospective cohort study. RESULTS: Medical disorders (59% and elective surgery (21% were the main causes for admission to the intensive care unit. The main indications for the initiation of noninvasive positive-pressure ventilation were the following: post-extubation, acute respiratory failure and use as an adjunctive technique to chest physiotherapy. The noninvasive positive-pressure ventilation failure group was older and had a higher Simplified Acute Physiology Score II score. The noninvasive positive-pressure ventilation failure rate was 35%. The main reasons for intubation were acute respiratory failure (55% and a decreased level of consciousness (20%. The noninvasive positive-pressure ventilation failure group presented a shorter period of noninvasive positive-pressure ventilation use than the successful group [three (2-5 versus four (3-7 days]; they had lower levels of pH, HCO3 and base excess, and the FiO2 level was higher. These patients also presented lower PaO2:FiO2 ratios; on the last day of support, the inspiratory positive airway pressure and expiratory positive airway pressure were higher. The failure group also had a longer average duration of stay in the intensive care unit [17 (10-26 days vs. 8 (5-14 days], as well as a higher mortality rate (9 vs. 51%. There was an association between failure and mortality, which had an odds ratio (95% CI of 10.6 (5.93 -19.07. The multiple logistic regression analysis using noninvasive positive pressure ventilation failure as a dependent variable found that treatment tended to fail in patients with a Simplified Acute Physiology Score II$34, an inspiratory positive airway pressure level > 15 cmH2O and pH 34, pH<7.40 and higher inspiratory positive airway pressure levels were associated with failure.

  13. Early predictors of success of non-invasive positive pressure ventilation in hypercapnic respiratory failure.

    Science.gov (United States)

    Bhattacharyya, D; Prasad, Bnbm; Tampi, P S; Ramprasad, R

    2011-10-01

    Non-invasive positive pressure ventilation (NIPPV) has emerged as a significant advancement in the management of acute hypercapnic respiratory failure. Patients with hypercapnic respiratory failure requiring ventilation therapy (respiratory rate [RR] of > 30 breaths per minutes, PaCO2 > 55 mmHg and arterial pH intubation was evaluated. Of the 100 patients, 76 (76%) showed improvement in clinical parameters and ABG. There was improvement in HR and RR, pH, and PCO2 within the first hour in the success group and these parameters continued to improve even after four and 24 hours of NIPPV treatment. Out of 24 (24%) patients who failed to respond, 13 (54%) needed endotracheal intubation within one hour. The failure group had higher baseline HR than the success group. Improvement in HR, RR, pH, and PCO2 one hour after putting the patient on NIPPV predicts success of non-invasive positive pressure ventilation in hypercapnic respiratory failure.

  14. Early use of noninvasive techniques for clearing respiratory secretions during noninvasive positive-pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease and hypercapnic encephalopathy

    Science.gov (United States)

    Wang, Jinrong; Cui, Zhaobo; Liu, Shuhong; Gao, Xiuling; Gao, Pan; Shi, Yi; Guo, Shufen; Li, Peipei

    2017-01-01

    Abstract Noninvasive positive-pressure ventilation (NPPV) might be superior to conventional mechanical ventilation (CMV) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). Inefficient clearance of respiratory secretions provokes NPPV failure in patients with hypercapnic encephalopathy (HE). This study compared CMV and NPPV combined with a noninvasive strategy for clearing secretions in HE and AECOPD patients. The present study is a prospective cohort study of AECOPD and HE patients enrolled between October 2013 and August 2015 in a critical care unit of a major university teaching hospital in China. A total of 74 patients received NPPV and 90 patients received CMV. Inclusion criteria included the following: physician-diagnosed AECOPD, spontaneous airway clearance of excessive secretions, arterial blood gas analysis requiring intensive care, moderate-to-severe dyspnea, and a Kelly–Matthay scale score of 3 to 5. Exclusion criteria included the following: preexisting psychiatric/neurological disorders unrelated to HE, upper gastrointestinal bleeding, upper airway obstruction, acute coronary syndromes, preadmission tracheostomy or endotracheal intubation, and urgent endotracheal intubation for cardiovascular, psychomotor agitation, or severe hemodynamic conditions. Intensive care unit participants were managed by NPPV. Participants received standard treatment consisting of controlled oxygen therapy during NPPV-free periods; antibiotics, intravenous doxofylline, corticosteroids (e.g., salbutamol and ambroxol), and subcutaneous low-molecular-weight heparin; and therapy for comorbidities if necessary. Nasogastric tubes were inserted only in participants who developed gastric distension. No pharmacological sedation was administered. The primary and secondary outcome measures included comparative complication rates, durations of ventilation and hospitalization, number of invasive devices/patient, and in-hospital and 1-year mortality

  15. 有创-无创序贯机械通气治疗小儿重症肺炎合并呼吸衰竭45例%Invasive -Noninvasive Sequential mechanical ventilation treatment of children with severe pneumo-nia with respiratory failure of 45 cases

    Institute of Scientific and Technical Information of China (English)

    刘远林

    2016-01-01

    Objective To investigate the clinical results of invasive non-invasive sequential mechanical ventilation treat-ment of children with severe pneumonia with respiratory failure and. Methods 90 cases of children with severe pneumonia with respiratory failure patients admitted to our hospital between May 2012-August 2014 were selected,were randomly divid-ed into the observation group and the control group,45 cases in each group,children patients of the observation group were given invasive-Sequential non-invasive mechanical ventilation for treatment,the control group were given continuing invasive ventilation for treatment,heart rate,respiratory rate,blood gas analysis,ventilation,and extubation complications situation of two groups after treatment were compared. Results HR,RR,PaCO2 ,duration of mechanical ventilation,ICU stay of the ob-servation group were significantly lower than the control group,while PH,PaCO2 and oxygenation index was significantly high-er than the control group,the two groups were significantly different,(P<0. 01);and the incidence of complications,once a successful extubation rates of the observation group were 6. 7%,97. 8%,and the control group were 22. 2%,75. 6%,the difference was significant,(P<0. 05). Conclusion Invasive - Noninvasive Sequential mechanical ventilation can improve severe pneumonia with respiratory failure in children ventilation quality,shorten duration of mechanical ventilation,improve the success rate of 1 extubation and fewer complications,the clinical effect is significant,worthy of promotion in clinical.%目的:探讨有创-无创序贯机械通气治疗小儿重症肺炎合并呼吸衰竭的临床效果。方法选取我院2012年5月至2014年8月间收治的90例小儿重症肺炎合并呼吸衰竭患者,将其随机分为观察组和对照组,各45例,观察组患儿采取有创-无创序贯机械通气治疗,对照组采取持续性有创通气治疗,比较两组治疗后心率、呼吸频率、血气

  16. Utility of Transcutaneous Capnography for Optimization of Non-Invasive Ventilation Pressures.

    Science.gov (United States)

    Chhajed, Prashant N; Gehrer, Simone; Pandey, Kamlesh V; Vaidya, Preyas J; Leuppi, Joerg D; Tamm, Michael; Strobel, Werner

    2016-09-01

    Nocturnal Non-invasive Positive Pressure Ventilation (NPPV) is the treatment of choice in patients with chronic hypercapnic respiratory failure due to hypoventilation. Continuous oxygen saturation measured with a pulse oximeter provides a surrogate measure of arterial oxygen saturation but does not completely reflect ventilation. Currently, Partial Pressure of Arterial (PaCO2) measured by arterial blood analysis is used for estimating the adequacy of ventilatory support and serves as the gold standard. To examine the safety, feasibility and utility of cutaneous capnography to re-titrate the non-invasive positive pressure ventilation settings in patients with chronic hypercapnic respiratory failure due to hypoventilation. Twelve patients with chronic hypercapnic respiratory failure prospectively underwent complete polysomnography and cutaneous capnography measurement on the ear lobe. Non-invasive ventilation pressures were adjusted with the aim of normalizing cutaneous carbon dioxide or at least reducing it by 10 to 15 mmHg. Sensor drift for cutaneous carbon dioxide of 0.7 mmHg per hour was integrated in the analysis. Mean baseline cutaneous carbon dioxide was 45.4 ± 6.5 mmHg and drift corrected awake value was 45.1 ± 8.3 mmHg. The correlation of baseline cutaneous carbon dioxide and the corrected awake cutaneous carbon dioxide with arterial blood gas values were 0.91 and 0.85 respectively. Inspiratory positive airway pressures were changed in nine patients (75%) and expiratory positive airway pressures in eight patients (66%). Epworth sleepiness score before and after the study showed no change in five patients, improvement in six patients and deterioration in one patient. Cutaneous capnography is feasible and permits the optimization of non-invasive ventilation pressure settings in patients with chronic hypercapnic respiratory failure due to hypoventilation. Continuous cutaneous capnography might serve as an important additional tool to complement diurnal

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

    Directory of Open Access Journals (Sweden)

    Börger, Sandra

    2010-01-01

    . Mobile home ventilators are available for the implementation of the ventilation. Their technical performance however, differs regrettably. Studies comparing the economic aspects of ventilation in a hospital to outpatient ventilation, describe home ventilation as a more cost-effective alternative to in-patient care in an intensive care unit, however, more expensive in comparison to a noninvasive (via mask ventilation. Higher expenses arise due to the necessary equipment and the high expenditure of time for the partial 24-hour care of the affected patients through highly qualified personnel. However, none of the studies applies to the German provisionary conditions. The calculated costs strongly depend on national medical fees and wages of caregivers, which barely allows a transmission of the results. The results of quality-of-life studies are mostly qualitative. The patient’s quality of life using mechanical ventilation is predominantly considered well. Caregivers of ventilated patients report positive as well as negative ratings. Regarding the ethical questions, it was researched which aspects of ventilation implementation will have to be considered. From a legal point of view the financing of home ventilation, especially invasive mechanical ventilation, requiring specialised technical nursing is regulated in the code of social law (Sozialgesetzbuch V. The absorption of costs is distributed to different insurance carriers, who often, due to cost pressures within the health care system, insurance carriers, who consider others and not themselves as responsible. Therefore in practice, the necessity to enforce a claim of cost absorption often arises in order to exercise the basic right of free choice of location. Conclusion: Positive effects of the invasive mechanical ventilation (overall survival and symptomatic are highly probable based on the analysed literature, although with a low level of evidence. An establishment of a home ventilation registry and health care

  18. 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 .

  19. Timeframe for sequential non-invasive following short-term invasive mechanical ventilation in COPD induced hypercapnic respiratory failure%序贯性机械通气治疗COPD所致严重呼吸衰竭治疗切换点时间窗的研究

    Institute of Scientific and Technical Information of China (English)

    郑大伟; 王承志; 刘仁水; 高峰; 邓顺莲; 周鹏; 何炎

    2011-01-01

    目的 探索早期拔管改换无创机械通气策略的技术可行性并评价其治疗效果.方法 选择接受气管插管和机械通气的慢性阻塞性肺疾病(COPD)病例36例,随机分为治疗组20例和对照组16例,治疗组20例以同步间歇强制通气十压力支持通气(档SIMV+PSV)方式行机械通气,待"改良GCS评分达15分标准"稳定2h窗口期出现,此时拔除气管导管,改用经鼻面罩压力支持通气十呼气末正压(PSV+PEEP)通气,以后渐减PSV水平直至脱离呼吸机.对照组16例待肺部感染明显控制时判为"肺部感染控制窗"出现.此时拔除气管导管,改无创通气直至脱离呼吸机.动态观察两组病例机械通气前通气及氧合指标,两组接受有创机械通气时间、总机械通气时间、总住院时间、重新插管率、VAP发生例数.结果 治疗组与对照组的治疗前各指标相仿(P>0.05);两组有创通气时间分别为(3.2±1.1)和(5.4±2.3)d,P<0.05;呼吸机相关肺炎发生例数分别为0和3例,P<0.05;住院时间分别为(17±3)和(21±5)d,P<0.05.结论 对COPD合并呼吸衰竭插管上机病例,以"改良GCS评分达15分标准"窗口期为时机,早期拔管改用经鼻面罩无创通气可以显著改善治疗效果.%Objective To estimate the feasibility and the efficacy of early extubation and the improved sequential non-invasive mechanical ventilation ( MV ) in COPD with exacerbated hypereapnic respiratory failure. Methods Choose 36 eases to accept endotraeheal intubation and mechanical ventilation in chronic obstructive pulmonary disease(COPD) ,which were randomly divided into treatment group 20 eases and control group 16 cases. Treatment group,20 patients with synchronous intermittent mandatory ventilation + pressure support ventilation( SIMV + PSV )mede mechanical ventilation. To be" improved GCS score of 15 points standard" window peried appears at this time extubation,use of nasal mask pressure support + PEEP ventilation( PSV + PEEP

  20. Severe subcutaneous emphysema and pneumomediastinum secondary to noninvasive ventilation support in status asthmaticus

    Directory of Open Access Journals (Sweden)

    Lara González García

    2016-01-01

    Full Text Available A 12-year-old male with status asthmaticus developed subcutaneous emphysema and pneumomediastinum. He was transferred to our unit, where he received noninvasive ventilation (NIV. This respiratory support technique is not an absolute contraindication in these cases. After 2 h on NIV, he worsened sharply and the subcutaneous emphysema got bigger suddenly. He needed invasive ventilation for 5 days. Final outcome was satisfactory. This case illustrates that it is mandatory to keep a high level of vigilance when using NIV in patients with air leaks.

  1. 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.

  2. Recent innovations in mechanical ventilator support

    Directory of Open Access Journals (Sweden)

    Manu Chopra

    2014-01-01

    Full Text Available Mechanical ventilation as a means to provide basic lifesaving ventilatory support has grown leaps and bounds in the recent years. The basic modes of ventilation have seen a sea change and in addition other innovative techniques have been developed to prevent lung injury, ease of weaning and improve patient comfort. These modes and techniques though easily available are not adequately utilized for benefits of patient usually due to lack of knowledge about them. This article reviews some of these newer modes and innovations in mechanical ventilatory support.

  3. Early Mobilization of Mechanically Ventilated Patients.

    Science.gov (United States)

    Hruska, Pam

    2016-12-01

    Critically ill patients requiring mechanical ventilation are least likely to be mobilized and, as a result, are at-risk for prolonged complications from weakness. The use of bed rest and sedation when caring for mechanically ventilated patients is likely shaped by historical practice; however, this review demonstrates early mobilization, with little to no sedation, is possible and safe. Assessing readiness for mobilization in context of progressing patients from passive to active activities can lead to long-term benefits and has been achievable with resource-efficient implementations and team work.

  4. The Value of Noninvasive Mechanical Ventilation in the Treatment of Severe Respiratory Failure Patients With Disturbance of Consciousness%无创机械通气对伴有意识障碍的重症呼吸衰竭患者治疗价值

    Institute of Scientific and Technical Information of China (English)

    薛维亮; 张玲

    2016-01-01

    Objective To investigate the effect of noninvasive ventilation in the treatment of severe respiratory failure patients with disturbance of consciousness. Methods 45 cases of severe respiratory failure patients with conscious disturbance were treated with noninvasive mechanical ventilation. The clinical symptoms of patients were analyzed and compared. Results Appropriate treatment for patients,patient consciousness and respiratory muscle fatigue degree evaluation have been improved obviously,and has significant difference compared with those before the treatment. Conclusion Non invasive mechanical ventilation has good effect on the treatment of patients with severe respiratory failure associated with disturbance of consciousness,which can be applied in clinical practice.%目的:探讨无创机通气对伴有意识障碍的重症呼吸衰竭患者的治疗效果。方法将我院收治的45例伴有意识障碍的重症呼吸衰竭患者作为调查对象,以无创机械通气法对患者进行治疗,分析比较治疗后患者的临床症状改善情况。结果对患者进行相应的治疗后,患者神志及呼吸肌疲劳程度评价均得到了改善,与治疗前对比差异具有统计学意义。结论无创机械通气对伴有意识障碍的重症呼吸衰竭患者进行治疗具有较好的应用效果。

  5. Case Report of a Pressure Ulcer Occurring Over the Nasal Bridge Due to a Non-Invasive Ventilation Facial Mask

    Science.gov (United States)

    Ahmad, Faria; Zahoor, Muhammad Umar U

    2016-01-01

    Non-invasive ventilation (NIV) is used in patients with respiratory failure, sleep apnoea, and dyspnoea related to pulmonary oedema. NIV is provided through a facial mask. Many complications of NIV facial masks have been reported, including the breakdown of facial skin. We report a case of an elderly male admitted with multiple co-morbidities. The facial mask was applied continuously for NIV, without any relief or formal monitoring of the underlying skin. It resulted in a Grade II pressure ulcer. We discuss the possible mechanism and offer advice for prevention of such device-related pressure ulcers. PMID:27843731

  6. 有创—无创序贯机械通气在急性心源性肺水肿的临床疗效观察%Clinical study of sequential invasive-noninvasive mechanical ventilation in acute cardiogenic pulmonary edema patients

    Institute of Scientific and Technical Information of China (English)

    杨宏锋; 金兆辰; 吉木森; 张清艳; 李勇; 蔡燕

    2012-01-01

    目的 研究有创—无创序贯机械通气在急性心源性肺水肿中的疗效.方法 32例急性心源性肺水肿患者在常规治疗的基础上,采用有创—无创序贯机械通气治疗,即短期有创呼吸机辅助通气后,继续给予无创鼻面罩双水平气道正压通气,期间调整无创呼吸机以达到脉搏氧饱和度(SPO2)≥92%并最终达到撤机的目的.治疗期间监测患者治疗后的临床征象、动脉血气分析指标的变化、有创机械通气时间、住院期间、并发症的情况,以及患者治疗后无创血流动力学指标心排血量(CO)、心脏指数(CI)、每搏量(SV)的变化.结果 给予有创—无创序贯通气治疗后,患者总机械通气时间、呼吸机相关性肺炎发生率降低P<0.05);动脉血气分析指标中PaO2、SaO2明显改善(P<0.05),pH值及PaCO2变化不明显,血流动力学指标CO、CI、SV显著升高(P<0.05);在上述两组患者成功脱机后各项指标比较无统计学差异.结论 有创—无创序贯机械通气对急性心源性肺水肿患者有较好的疗效,能明显改善低氧血症和血流动力学指标,可以减少有创机械通气的并发症,是抢救急性心源性肺水肿的一种安全有效的方法.%Objective To study the application in acute cardiogenic pulmonary edema patients during sequential invasive-noninvasive mechanical ventilation. Methods Based on conventional treatment, 36 acute cardiogenic pulmonary edema patients were given sequential invasive and noninvasive mechanical ventilation, the short-term invasive mechanical ventilation , and were continued to provide non-invasive nasal mask bi-level positive airway pressure ventilation in order to a-chieve the purpose of weaning. During treatments we monitored the patients' clinical signs, arterial blood gas analysis indicators changes, invasive mechanical ventilation time, complications, and non-invasive treatment in patients and hemody-namic cardiac output (CO

  7. Noninvasive ventilation for acute respiratory failure: state of the art (I part

    Directory of Open Access Journals (Sweden)

    Federico Lari

    2013-04-01

    Full Text Available Background: In the last years Non-Invasive Ventilation (NIV has been playing an important role in the treatment of Acute Respiratory Failure (ARF. A lot of trials have shown improvements in clinical features (respiratory rate, neurological score, pH and arterial blood gases. Methods: In particular clinical conditions, such as Acute Cardiogenic Pulmonary Edema (ACPE and acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD, systematic reviews and meta-analysis show a reduction in the need for intubation and in-hospital mortality compared to standard medical treatment. In other clinical conditions, such as acute asthma, Acute Lung Injury (ALI/Acute Respiratory Distress Syndrome (ARDS and severe pneumonia, NIV does not show significant improvements in term of avoided intubations or mortality rate. Although the first important data on NIV comes from studies performed in Intensive Care Units (ICUs, subsequently these methodologies of ventilation have been used with increasing frequency in Emergency Departments (ED and medical wards. Results: Studies developed in ICU sometimes report slightly worse outcomes compared to studies performed in general wards due to the need to treat more severe patients in ICU. Aetiology remains one of the most important factor determining prognosis: different pathological mechanisms substain different clinical conditions and not in all cases the application of positive pressures to the airways is useful. NIV for ARF due to COPD and ACPE is feasible, safe and effective also in a general medical ward if selection of patients, staff training and monitoring are appropriate: its early application improves clinical parameters, arterial blood gases, prevents endotracheal intubation, decreases mortality and hospitalisation. This should encourage the diffusion of NIV in this specific setting.

  8. Striving for habitual well-being in non-invasive ventilation

    DEFF Research Database (Denmark)

    Sørensen, Dorthe; Frederiksen, Kirsten; Grøfte, Thorbjørn;

    2013-01-01

    . A constant comparative classic grounded theory study was performed. Methods. Data collection consisted of participant observation during the treatment of 21 patients undergoing non-invasive ventilation, followed by interviews with 11 of the patients after treatment completion. Data were collected from...... December 2009 to January 2012. Results. A substantive theory of striving for habitual well-being was developed. The theory included three phases: initiation, transition, and determination. Each phase contained a set of subcategories to indicate the dimensions of and variations in the participants......’ behaviour. Conclusions. The substantive theory revealed that the patients’ behaviour was related to their breathlessness, sensation of being restrained by the mask and head gear, and the side effects of non-invasive ventilation. Relevance to clinical practice. This inter-relationship should be addressed...

  9. Nocturnal noninvasive positive pressure ventilation in stable COPD : A systematic review and individual patient data meta-analysis

    NARCIS (Netherlands)

    Struik, F. M.; Lacasse, Y.; Goldstein, R. S.; Kerstjens, H. A. M.; Wijkstra, P. J.

    2014-01-01

    Introduction: The effects of nocturnal noninvasive positive pressure ventilation (NIPPV) in patients with stable chronic obstructive pulmonary disease (COPD) remain controversial. Methods: The Cochrane Airways group Register of Trials, MEDLINE, EMBASE and CINAHL were searched up to August 2012. Indi

  10. Indirect Calorimetry in Mechanically Ventilated Patients

    DEFF Research Database (Denmark)

    Allingstrup, Matilde Jo; Kondrup, Jens; Perner, Anders

    2017-01-01

    BACKGROUND AND AIMS: The 2 currently available indirect calorimeters, CCM Express Indirect Calorimeter (MedGraphics, St Paul, MN) and Quark RMR ICU Indirect Calorimeter (COSMED, Rome, Italy), have not been validated against a gold standard in mechanically ventilated patients. Our aim was to do so...

  11. Facial pressure zones of an oronasal interface for noninvasive ventilation: a computer model analysis

    Directory of Open Access Journals (Sweden)

    Luana Souto Barros

    2014-12-01

    Full Text Available OBJECTIVE: To study the effects of an oronasal interface (OI for noninvasive ventilation, using a three-dimensional (3D computational model with the ability to simulate and evaluate the main pressure zones (PZs of the OI on the human face. METHODS: We used a 3D digital model of the human face, based on a pre-established geometric model. The model simulated soft tissues, skull, and nasal cartilage. The geometric model was obtained by 3D laser scanning and post-processed for use in the model created, with the objective of separating the cushion from the frame. A computer simulation was performed to determine the pressure required in order to create the facial PZs. We obtained descriptive graphical images of the PZs and their intensity. RESULTS: For the graphical analyses of each face-OI model pair and their respective evaluations, we ran 21 simulations. The computer model identified several high-impact PZs in the nasal bridge and paranasal regions. The variation in soft tissue depth had a direct impact on the amount of pressure applied (438-724 cmH2O. CONCLUSIONS: The computer simulation results indicate that, in patients submitted to noninvasive ventilation with an OI, the probability of skin lesion is higher in the nasal bridge and paranasal regions. This methodology could increase the applicability of biomechanical research on noninvasive ventilation interfaces, providing the information needed in order to choose the interface that best minimizes the risk of skin lesion.

  12. 护理综合干预对双水平气道正压无创机械通气患者临床效果的影响%Influence of comprehensive nursing intervention on clinical effect of patients with non-invasive mechanical ventilation with BiPAP mode

    Institute of Scientific and Technical Information of China (English)

    卢艳; 吴彩军; 权京玉; 董亚娟; 张煜

    2008-01-01

    Objective To investigate the treatment effects of comprehensive nursing intervention on patients with chronic obstructive pulmonary disease(COPD) treated by non-invasive mechanical ventilation with BiPAP mode. Methods 96 patients with diagnosed COPD and using non-invasive mechanical ven- tilation with BiPAP mode were randomly divided into the control group (46 cases) which was treated with routine measures and the comprehensive nursing intervention group (50 cases) which adopted comprehen- sive nursing intervention according to experimental design. The frightening degree, incidence rate of com- plications and clinical treatment effect by ventilator were compared between the two groups. Results Pa- tients compliance with treatment and clinical treatment effect by ventilator in the comprehensive nursing in- tervention group was better than that of the control group. The frightening degree and incidence rate ofcomplications were lower than those of the control group (P < 0.01 ). Conclusions Comprehensive nurs-ing intervention with non-invasive mechanical ventilation with BiPAP mode can improve the treatmentcompliance of COPD patients,reduce complications followed by non-invasive mechanical ventilation andreach the prospective treatment effect.%目的 探讨护理综合干预双水平气道正压无创机械通气对慢性阻塞性肺疾病患者临床治疗效果的影响.方法 将符合纳入研究标准的使用双水平气道正压无创机械通气的96例慢性阻 塞性肺疾病患者随机分为对照组46例以及护理综合干预组50例.对照组采用常规护理,干预组按照实验设计予以综合护理干预,比较2组患者无创呼吸机治疗过程中的恐惧程度、并发症发生率以及呼吸机临床治疗效果.结果 护理综合干预组患者配合治疗的程度明显优于对照组,对无创呼吸机的恐惧及并发症发生率明显低于对照组(P<0.01);同时在临床呼吸机治疗效果的改善上也明显优于对照组(P<0

  13. Assessment of mechanical ventilation parameters on respiratory mechanics.

    Science.gov (United States)

    Pidaparti, Ramana M; Koombua, Kittisak; Ward, Kevin R

    2012-01-01

    Better understanding of airway mechanics is very important in order to avoid lung injuries for patients undergoing mechanical ventilation for treatment of respiratory problems in intensive-care medicine, as well as pulmonary medicine. Mechanical ventilation depends on several parameters, all of which affect the patient outcome. As there are no systematic numerical investigations of the role of mechanical ventilation parameters on airway mechanics, the objective of this study was to investigate the role of mechanical ventilation parameters on airway mechanics using coupled fluid-solid computational analysis. For the airway geometry of 3 to 5 generations considered, the simulation results showed that airflow velocity increased with increasing airflow rate. Airway pressure increased with increasing airflow rate, tidal volume and positive end-expiratory pressure (PEEP). Airway displacement and airway strains increased with increasing airflow rate, tidal volume and PEEP form mechanical ventilation. Among various waveforms considered, sine waveform provided the highest airflow velocity and airway pressure while descending waveform provided the lowest airway pressure, airway displacement and airway strains. These results combined with optimization suggest that it is possible to obtain a set of mechanical ventilation strategies to avoid lung injuries in patients.

  14. 无创呼吸机辅助通气治疗慢性阻塞性肺疾病合并呼吸衰竭临床体会%Clinical experience of non-invasive mechanical ventilation in chronic obstructive pulmonary disease with respiratory failure

    Institute of Scientific and Technical Information of China (English)

    施红伟; 姚炳荣; 徐爱明; 刘春峰; 徐朝晖

    2015-01-01

    目的 观察无创呼吸机辅助通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床效果. 方法选取2013年1月至2014年6月间入住我院的52例慢性阻塞性肺病( COPD)合并呼吸衰竭患者,随机分为两组,对照组给予吸痰、通畅气道、低流量持续吸氧、呼吸兴奋剂、抗感染、补液、营养支持等常规治疗,治疗组在常规治疗基础上,加用无创呼吸机辅助通气. 比较两组患者治疗前后有效率、血气分析及肺功能变化情况. 结果 治疗组的总有效率为92.00%,显著高于对照组(χ2 =6.166,P=0.02);治疗后治疗组在PaO2、PaCO2、血pH及肺功能方面均优于对照组. 结论 无创呼吸机辅助通气治疗可显著提高COPD合并呼吸衰竭患者氧分压,改善呼吸状况及肺功能.%Objective To observe clinical results of the non-invasive mechanical ventilation in chronic obstructive pulmonary disease with respiratory failure.Methods Between January 2013 and June 2014, 52 patients admitted to our hospital with chronic obstructive pulmonary disease ( COPD) and respiratory failure were randomly divided into two groups, a control group was given suction, unobstructed airway, low flow continued oxygen, respiratory stimulants, antibiotics, rehydration, nutritional support and other conventional treatment group on the basis of conventional therapy plus noninvasive mechanical ventilation.Two groups of patients before and after treatment efficiency, blood gas analysis and pulmonary function changes.Results The total effective rate of 92.00 percent effective, significantly higher (χ2 =6.166,P=0.02); the treatment group in PaO2, PaCO2 , blood pH and lung function than the control group.Conclusions Noninvasive mechanical ventilation therapy can significantly improve COPD patients with respiratory failure, oxygen partial pressure; improve the respiratory conditions and lung function.

  15. [Monitorization of respiratory mechanics in the ventilated patient].

    Science.gov (United States)

    García-Prieto, E; Amado-Rodríguez, L; Albaiceta, G M

    2014-01-01

    Monitoring during mechanical ventilation allows the measurement of different parameters of respiratory mechanics. Accurate interpretation of these data can be useful for characterizing the situation of the different components of the respiratory system, and for guiding ventilator settings. In this review, we describe the basic concepts of respiratory mechanics, their interpretation, and their potential use in fine-tuning mechanical ventilation.

  16. [Current status of non-invasive ventilation in German ICU's -- a postal survey].

    Science.gov (United States)

    Kumle, B; Haisch, G; Suttner, S W; Piper, S N; Maleck, W; Boldt, J

    2003-01-01

    The status of non-invasive ventilation (NIV) in intensive care units (ICU) in Germany was analysed by a national survey. Questionnaires consisting of multiple-choice and short-answer questions were sent to ICUs of university hospitals, hospitals with >1000 beds, with 500 - 1000 beds, and hospitals with pneumonia (64 %), pulmonary oedema (50 %), bronchial asthma (35 %) and ALI/ARDS (22 %). The use of NIV was considered when clinical signs of ventilation (93 %) and oxygenation [arterial blood gas analysis (92 %) and oxygen saturation (66 %)] were inadequate. Complications observed during NIV were panic reaction (83 %), ulceration of nose (38 %) and aspiration (14 %). The reasons to reject NIV were (total 13 %): lack of ventilators (64 %), expenditure of personnel (57 %) and risk of the procedure (11 %). 38 % of the ventilators used were older than 5 years. 56 % of the ICUs were content with the equipment for NIV. 76 % of the ICUs were interested to buy new equipment of NIV. 99 % of the survey have declined NIV as an alternative method of ventilation. In summary we found NIV as an accepted additional method of ventilatory support in respiratory failure in German ICUs. We found no significant increase in frequency of NIV in the last three years.

  17. 有创无创序贯机械通气抢救重症老年呼吸衰竭患者的有效性与安全性%The effectiveness and safety of noninvasive sequential mechanical ventilation in the treatment of severe respir-atory failure in elderly patients

    Institute of Scientific and Technical Information of China (English)

    李红建

    2016-01-01

    Objective To observe the effectiveness and safety of noninvasive mechanical ventilation in the treatment of severe respiratory failure in elderly patients.Methods Ninety patients with severe respiratory failure treated with mechanical ventilation were divided into the study group and the control group according to the different mechanical ventilation schemes.The study group was conducted with noninvasive sequential mechanical ventilation, while the control group received invasive mechanical ventilation.The blood gas, the clinical effect and the degree of stress reaction were compared between the two groups.Results The success rate of ventilator weaning, ventilator-as-sociated pneumonia, reintubation rate and mortality rate were significantly lower in the study group than those in the control group, with significant differences between the two groups ( P <0.05 ); The heart rate, respiration, pH, PaO2 , PaCO2 , SaO2 in the study group improved significantly better than those in the control group ( P <0.05 );There were significant differences in adrenaline( E) , norepinephrine( NE) , renin( R) , angiotensin( AT) and angio-tensin-Ⅱlevels between the study group and the control group(P<0.05).The total mechanical ventilation time, the hospitalization time, the duration of ventilation, the length of stay in ICU, the sternum sign disappeared time, and the time of PaO2/FiO2 were shorter in the study group than in the control group( P<0.05); The average hospitalization cost of the study group was significantly less than that of the control group( P<0.05) .Conclusion Noninvasive se-quential mechanical ventilation has a better clinical effect and a lower mortality rate in the treatment of severe respira-tory failure.%目的:观察有创无创序贯机械通气抢救重症老年呼吸衰竭患者的有效性与安全性。方法选取2008-01~2015-01该院接受机械通气治疗的重症呼吸衰竭老年患者90例,根据机械通气方案的不同分为

  18. Effect of noninvasive, positive pressure ventilation on patients with severe, stable chronic obstructive pulmonary disease: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    SHI Jia-xin; XU Jin; SUN Wen-kui; SU Xin; ZHANG Yan; SHI Yi

    2013-01-01

    Background This meta-analysis evaluated the effect of noninvasive,positive pressure ventilation on severe,stable chronic obstructive pulmonary disease (COPD).Methods PUBMED,CNKI,Wanfang,EMBASE and the Cochrane trials databases were searched.Randomized controlled trials of patients with severe,stable COPD and receiving noninvasive positive pressure ventilation,compared with sham ventilation or no ventilation,were reviewed.The mortality,physiological and health related parameters were pooled to yield odds ratio (OR),weighted mean differences or standardized mean differences (SMD),with 95% confidence interval (C/).Results Eight parallel and three crossover randomized controlled trials met the inclusion criteria.Pooled analysis for parallel,randomized controlled trials showed noninvasive positive pressure ventilation:(1) Did not affect the 12-or 24-month mortality (OR 0.82,95% C/:0.48 to 1.41); (2) Improved the arterial carbon dioxide tension (SMD-0.88,95%C/:-1.43 to-0.34); (3) Did not improve forced expiratory volume in one second (SMD 0.20,95% C/:-0.06 to 0.46),maximal inspiratory pressure (SMD 0.01,95% C/:-0.28 to 0.29) or 6-minute walk distance (SMD 0.17,95% C/:-0.16 to 0.50); (4) Subgroup analysis showed noninvasive positive pressure ventilation improved the arterial carbon dioxide tension in hypercapnic patients.Pooled analysis for crossover randomized controlled trials did not show improvement in arterial blood gas or forced expiratory volume in one second with noninvasive positive pressure ventilation.Conclusions Noninvasive positive pressure ventilation improves the arterial carbon dioxide tension but does not improve the mortality,pulmonary function,or exercise tolerance and should be cautiously used in severe stable chronic obstructive pulmonary disease.

  19. State of the evidence: mechanical ventilation with PEEP in patients with cardiogenic shock.

    Science.gov (United States)

    Wiesen, Jonathan; Ornstein, Moshe; Tonelli, Adriano R; Menon, Venu; Ashton, Rendell W

    2013-12-01

    The need to provide invasive mechanical ventilatory support to patients with myocardial infarction and acute left heart failure is common. Despite the large number of patients requiring mechanical ventilation in this setting, there are remarkably few data addressing the ideal mode of respiratory support in such patients. Although there is near universal acceptance regarding the use of non-invasive positive pressure ventilation in patients with acute pulmonary oedema, there is more concern with invasive positive pressure ventilation owing to its more significant haemodynamic impact. Positive end-expiratory pressure (PEEP) is almost universally applied in mechanically ventilated patients due to benefits in gas exchange, recruitment of alveolar units, counterbalance of hydrostatic forces leading to pulmonary oedema and maintenance of airway patency. The limited available clinical data suggest that a moderate level of PEEP is safe to use in severe left ventricular (LV) dysfunction and cardiogenic shock, and may provide haemodynamic benefits as well in LV failure which exhibits afterload-sensitive physiology.

  20. Severe exacerbations of chronic obstructive pulmonary disease: management with noninvasive ventilation on a general medicine ward

    Directory of Open Access Journals (Sweden)

    Sirio Fiorino

    2013-04-01

    Full Text Available Introduction: Recent evidence suggests that, with a well-trained staff, severe exacerbations of chronic obstructive pulmonary disease (COPD with moderate respiratory acidosis (pH > 7.3 can be successfully treated with noninvasive mechanical ventilation (NIMV on a general respiratory care ward. We conducted an open prospective study to evaluate the efficacy of this approach on a general medicine ward. Material and methods: This study population consisted in 27 patients admitted to a general medicine ward (median nurse:patient ratio 1:12 December 1, 2004 May 31, 2006 for acute COPD exacerbation with hypercapnic respiratory failure and acidosis (arterial pH < 7.34, PaC02 > 45 mmHg. All received assist-mode NIMV (average 12 h / day via oronasal masks (inspiratory pressure 10-25 cm H2O, expiratory pressure 4-6 cm H2O to maintain O2 saturation at 90-95%. Treatment was supervised by an experienced pulmonologist, who had also provided specific training in NIMV for medical and nursing staffs (90-day course followed by periodic refresher sessions. Arterial blood pressure, O2 saturation, and respiratory rate were continuously monitored during NIMV. Based on baseline arterial pH, the COPD was classified as moderate (7.25-7.34 or severe (< 7.25. Results: In patients with moderate and severe COPD, significant improvements were seen in arterial pH after 2 (p < 0.05 and 24 h (p< 0.05 of NIMV and in the PaC02 after 24 hours (p < 0.05. Four (15% of the 27 patients died during the study hospitalization (in-hospital mortality 15%, in 2 cases due to NIMV failure. For the other 23, mean long-term survival was 14.5 months (95% CI 10.2 to 18.8, and no significant differences were found between the moderate and severe groups. Over half (61% the patients were alive 1 year after admission. Conclusions: NIMV can be a cost-effective option for management of moderate or severe COPD on a general medicine ward. Its proper use requires: close monitoring of ventilated subjects

  1. Improved survival with an ambulatory model of non-invasive ventilation implementation in motor neuron disease.

    Science.gov (United States)

    Sheers, Nicole; Berlowitz, David J; Rautela, Linda; Batchelder, Ian; Hopkinson, Kim; Howard, Mark E

    2014-06-01

    Non-invasive ventilation (NIV) increases survival and quality of life in motor neuron disease (MND). NIV implementation historically occurred during a multi-day inpatient admission at this institution; however, increased demand led to prolonged waiting times. The aim of this study was to evaluate the introduction of an ambulatory model of NIV implementation. A prospective cohort study was performed. Inclusion criteria were referral for NIV implementation six months pre- or post-commencement of the Day Admission model. This model involved a 4-h stay to commence ventilation with follow-up in-laboratory polysomnography titration and outpatient attendance. Outcome measures included waiting time, hospital length of stay, adverse events and polysomnography data. Results indicated that after changing to the Day Admission model the median waiting time fell from 30 to 13.5 days (p Survival was also prolonged (median (IQR) 278 (51-512) days pre- vs 580 (306-1355) days post-introduction of the Day Admission model; hazard ratio 0.41, p = 0.04). Daytime PaCO2 was no different. In conclusion, reduced waiting time to commence ventilation and improved survival were observed following introduction of an ambulatory model of NIV implementation in people with MND, with no change in the effectiveness of ventilation.

  2. [Noninvasive ventilation: efficacy of a new ventilatory mode in patients with obesity-hypoventilation syndrome].

    Science.gov (United States)

    Couillard, A; Pepin, J-L; Rabec, C; Cuvelier, A; Portmann, A; Muir, J-F

    2015-03-01

    Noninvasive ventilation is recommended to correct the nocturnal hypoventilation and relieve the symptoms of patients with the obesity-hypoventilation syndrome (OHS). The benefits of fixed pressure ventilation (S/T technology) are recognized but limited on account of the variability of nocturnal ventilatory requirements. The new technique AVAPS-AE (automatic EPAP) allows adjustment of the pressure according to the volume currently targeted. Its efficacy has not yet been evaluated. Our objectives are to evaluate firstly, whether AVAPS-AE optimizes the benefits of S/T technology on sleep architecture and quality, secondly, whether these benefits are associated with an improvement in gas exchange, symptoms, exercise tolerance, level of physical activity and quality of life of patients with OHS. In this multicenter trial, 60 newly diagnosed patients with OHS will be randomized to the control (S/T) and trial (AVAPS-AE) groups. A standardized titration procedure will be followed for the calibration of the ventilators. Functional evaluations (polysomnography, blood gases, impedance measurements and walking tests), questionnaires (physical activity, quality of life, quality of sleep and daytime somnolence) visual scales (fatigue, headaches) and a recording of activity will be undertaken after two months of ventilation. Copyright © 2014 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  3. Prolonged propofol infusion for mechanically ventilated children.

    Science.gov (United States)

    Sasabuchi, Y; Yasunaga, H; Matsui, H; Lefor, A K; Fushimi, K

    2016-04-01

    We retrospectively analysed 30-day mortality and duration of intubation for 8016 children ventilated for three or more days, sedated with midazolam (n = 7716) or propofol (n = 300). We matched the propensity scores of 263 pairs of children. The propensity-matched 30-day mortality (95% CI) was similar: 17/263 (6.5%) with midazolam vs. 24/263 (9.1%) with propofol, p = 0.26. Weaning from mechanical ventilation of children sedated with midazolam was slower than weaning of children sedated with propofol, subhazard ratio (95% CI) 1.43 (1.18-1.73), p < 0.001. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

  4. 序贯性机械通气抢救多发伤者呼吸衰竭的临床研究%Application of improved Glasgow coma scale score (15 points) as switching point for sequential non-invasive following short-term invasive mechanical ventilation to treat respiration failure in polytrauma

    Institute of Scientific and Technical Information of China (English)

    曾祥彬; 郑大伟; 高峰; 邓顺莲

    2012-01-01

    目的 探讨改良格拉斯哥昏迷(GCS)评分15分为切换点行有创与无创序贯机械通气抢救多发伤者急性呼吸衰竭的临床治疗效果.方法 选择接受气管插管和机械通气的多发伤者急性呼吸衰竭患者,采用前瞻性对照研究方法,以2008年1月~2010年12月收治的20例为治疗组,采用同步间歇强制通气+压力支持方式(SIMV+PSV).待改良GCS评分达15分稳定2h的窗口期拔除气管导管,改用经鼻面罩PSV +呼气末正压(PEEP)通气,以后渐减压力支持(PS)水平直至脱离呼吸机.以2005年3月~2007年3月收治的23例患者作为对照组,按常规机械通气及传统的脱机方式脱离呼吸机.记录两组接受有创机械通气时间、总机械通气时间、总住院时间、重新插管例数,发生呼吸机相关性肺炎(VAP)的例数.结果 两组治疗前各指标相仿.治疗组和对照组有创通气时间分别为(3.2±1.0)d和(7.5±3.5) d(P0.05).结论 对多发伤急性呼吸衰竭患者,以改良GCS评分达15分标准稳定2h窗口期为时机早期拔管改用经鼻面罩无创通气,可以显著改善治疗效果.%Objective To investigate the effect of improved Glasgow coma scale (GCS) score as switching point for sequential non-invasive following short-term invasive mechanical ventilation to treat respiration failure in polytrauma. Methods Twenty patients with polytrauma and respiratory failure (treatment group) underwent endotracheal intubation and synchronized intermittent mandatory ventilation plus pressure support ventilation (SIMV + PSV). When the SIMV frequency and the pressure support (PS) level were decreased to 10~12 times/ minute and 10~12 cmH2O respectively, the patients were woken to undergo assessment by improved GCS scale, and when the score reached the standard of 15 points and was kept for 2 hours, the endotracheal tube could be withdrawn and nasal mask pressure support and positive end-expiratory pressure (PSV + PEEP) was given. Later the PSV

  5. Core competency in mechanical ventilation: development of educational objectives using the Delphi technique.

    Science.gov (United States)

    Goligher, Ewan C; Ferguson, Niall D; Kenny, Lisa P

    2012-10-01

    We sought to identify and standardize the core clinical knowledge and skills required to care for patients receiving mechanical ventilation. Prospective survey reaching consensus by the Delphi technique. North American survey conducted anonymously by electronic e-mail. International experts in mechanical ventilation, frontline resident educators, medical education experts, and community intensivists were recruited to participate Fourteen panelists participated (ten content experts, three resident educators, one medical education expert, zero community intensivists). Individual panelists generated a total of 200 educational objectives, of which 109 were duplicates. Of the remaining 91 items, 56 met predefined consensus criteria for inclusion in the final set of educational objectives. The educational objectives spanned a broad range of categories, including respiratory physiology, noninvasive ventilation, lung protective ventilation, weaning, and withholding and withdrawing mechanical ventilation. Agreement among panelists on the items included was high (median proportion supporting item inclusion was 88%, range 70%-100%). There is a consensus that general resident core competency in mechanical ventilation requires a broad range of knowledge application and skill. These educational objectives may help identify and standardize the educational outcomes related to mechanical ventilation that residents should achieve.

  6. Benefícios e complicações da ventilação mecânica não-invasiva na exacerbação aguda da doença pulmonar obstrutiva crônica Benefits and complications of noninvasive mechanical ventilation for acute exacerbation of chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Eduardo Rocha

    2008-06-01

    interface e experiência do fisioterapeuta.BACKGROUND AND OBJECTIVES: Chronic obstructive pulmonary disease (COPD is defined as a syndrome characterized by usually progressive chronic airflow limitation which is associated to a bronchial hyperresponsiveness and is partially reversible. Noninvasive mechanical ventilation is an alternative treatment for patients with COPD exacerbations. The objective of the literature reviews was to verify noninvasive mechanical ventilation benefits and complications in acute exacerbations of chronic obstructive pulmonary disease in patients. CONTENTS: This national and international's scientific literature review was developed according to criteria established for documentary research in the MedLine, LILACS, SciElo, PubMed and Cochrane, databases using the key words: chronic obstructive pulmonary disease and noninvasive mechanical ventilation. Inclusion criteria were articles published from 1995 to 2007; in English, Spanish and Portuguese; studies in the human model and with no gender restriction. CONCLUSIONS: Noninvasive mechanical ventilation can reduce partial pressure of carbon dioxide, improve gas exchange, alleviate symptoms as dyspnea caused by fatigue of the respiratory muscles, reduce duration of hospitalization, decrease need for invasive mechanical ventilation, reduce number of complications and also lessen hospital mortality. The main complications found were: facial skin erythema, claustrophobia, nasal congestion, face pain, eye irritation, aspiration pneumonia, hypotension, pneumothorax, aerophagia, hypercapnia, gastric insufflation, vomit, bronchoaspiration, morning headaches, face injuries, air embolism and, last but not least, discomfort of the patient. Noninvasive mechanical ventilation can be more effective in patients with moderate-severe exacerbations of COPD and these complications can be minimized by an adequate interface also by the contribution of the physiotherapist experience.

  7. 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.

  8. Noninvasive ventilation for acute respiratory failure: state of the art (II part

    Directory of Open Access Journals (Sweden)

    Federico Lari

    2013-04-01

    Full Text Available Background: In the last years Non-Invasive Ventilation (NIV has been playing an important role in the treatment of Acute Respiratory Failure (ARF. Prospective randomised controlled trials have shown improvements in clinical features (respiratory rate, neurological score, pH and arterial blood gases and in particular clinical conditions (Acute Cardiogenic Pulmonary Edema, ACPE, and acute exacerbation of Chronic Obstructive Pulmonary Disease, COPD systematic reviews and metha-analysis confirm a reduction in the need for intubation and in-hospital mortality compared to standard medical treatment. Methods: The most important techniques of ventilation in spontaneous breathing are: Continuous Positive Airway Pression (CPAP, usually performed with Venturi-like flow generators, and bi-level positive pressure ventilation (an high inspiratory pressure and a low expiratory pressure, performed with ventilators. Facial mask rather than nasal mask is used in ARF: the helmet is useful for prolonged treatments. Results: NIV’s success seems to be determined by early application, correct selection of patients and staff training. Controindications to NIV are: cardiac or respiratory arrest, a respiratory rate < 12 per minute, upper airway obstruction, hemodynamic instability or unstable cardiac arrhythmia, encephalopathy (Kelly score > 3, facial surgery trauma or deformity, inability to cooperate or protect the airway, high risk of aspiration and an inability to clear respiratory secretions. Conclusions: Bi-level ventilation for ARF due to COPD and CPAP or bi-level bentilation for ARF due to ACPE are feasible, safe and effective also in a General Medical ward if the selection of patients, the staff’s training and the monitoring are appropriate: they improve clinical parameters, arterial blood gases, prevent ETI, decrease mortality and hospitalisation. This should encourage the diffusion of NIV in this specific setting.

  9. Patient experiences during awake mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Danille Prime

    2016-02-01

    Full Text Available Background: Sedation practices in an ICU have shifted significantly in the past 20 years toward the use of minimizing sedation in mechanically ventilated patients. While minimizing sedation is clearly in the best interest of patients, data are lacking about how this approach affects patients’ experiences. Methods: We interviewed mechanically ventilated patients receiving minimal sedation, over a 6-month period in an ICU, in order to explore their emotional, comfort, and communication experiences. Their responses were compared with the responses of their available family members regarding their attitudes and perceptions of the patients’ experiences. Results: Seventy-five percent of the patients agreed or strongly agreed that they experienced pain, and 50% agreed or strongly agreed that they were comfortable. Half of the patients agreed or strongly agreed that they preferred to be kept awake. Five patients (31% indicated that they were frustrated while 17 relatives (89% agreed or strongly agreed that the patients were frustrated. When controlling for age and gender of respondents, family members perceived higher levels of patient pain (least square [LS] mean [95% CI]: 4.2 [3.7, 4.7] vs. 3.1 [2.5, 3.8]; p=0.022, frustration (LS mean [95% CI]: 4.2 [3.7, 4.6] vs. 3.2 [2.6, 3.9]; p=0.031, and adequate communication with nurses and doctors (LS mean [95% CI]: 3.9 [3.5, 4.4] vs. 3.1 [2.4, 3.7]; p=0.046 than the patients themselves. Conclusion: Patients tolerated minimal sedation without significant frustration while mechanically ventilated despite experiencing discomfort. Patient and family member perceptions of the patient experience may differ, especially in regards to pain and frustration. The use of a communication tool can facilitate understanding of patient experiences and preferences.

  10. 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. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Non-Invasive Ventilation in Patients with Heart Failure: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Bittencourt, Hugo Souza; dos Reis, Helena França Correia; Lima, Melissa Santos; Gomes Neto, Mansueto

    2017-01-01

    Non-invasive ventilation (NIV) may perfect respiratory and cardiac performance in patients with heart failure (HF). The objective of the study to establish, through systematic review and meta-analysis, NIV influence on functional capacity of HF patients. A systematic review with meta-analysis of randomized studies was carried out through research of databases of Cochrane Library, SciELO, Pubmed and PEDro, using the key-words: heart failure, non-invasive ventilation, exercise tolerance; and the free terms: bi-level positive airway pressure (BIPAP), continuous positive airway pressure (CPAP), and functional capacity (terms were searched for in English and Portuguese) using the Boolean operators AND and OR. Methodological quality was ensured through PEDro scale. Weighted averages and a 95% confidence interval (CI) were calculated. The meta-analysis was done thorugh the software Review Manager, version 5.3 (Cochrane Collaboration). Four randomized clinical trials were included. Individual studies suggest NIV improved functional capacity. NIV resulted in improvement in the distance of the six-minute walk test (6MWT) (68.7m 95%CI: 52.6 to 84.9) in comparison to the control group. We conclude that the NIV is an intervention that promotes important effects in the improvement of functional capacity of HF patients. However, there is a gap in literature on which are the most adequate parameters for the application of this technique. PMID:28099587

  12. Design Features of Modern Mechanical Ventilators.

    Science.gov (United States)

    MacIntyre, Neil

    2016-12-01

    A positive-pressure breath ideally should provide a VT that is adequate for gas exchange and appropriate muscle unloading while minimizing any risk for injury or discomfort. The latest generation of ventilators uses sophisticated feedback systems to sculpt positive-pressure breaths according to patient effort and respiratory system mechanics. Currently, however, these new control strategies are not totally closed-loop systems. This is because the automatic input variables remain limited, some clinician settings are still required, and the specific features of the perfect breath design still are not entirely clear. Despite these limitations, there are some rationale for many of these newer feedback features.

  13. Mechanical ventilation weaning protocol improves medical adherence and results.

    Science.gov (United States)

    Borges, Luís Guilherme Alegretti; Savi, Augusto; Teixeira, Cassiano; de Oliveira, Roselaine Pinheiro; De Camillis, Marcio Luiz Ferreira; Wickert, Ricardo; Brodt, Sérgio Fernando Monteiro; Tonietto, Túlio Frederico; Cremonese, Ricardo; da Silva, Leonardo Silveira; Gehm, Fernanda; Oliveira, Eubrando Silvestre; Barth, Jose Herve Diel; Macari, Juçara Gasparetto; de Barros, Cíntia Dias; Vieira, Sílvia Regina Rios

    2017-10-01

    Implementation of a weaning protocol is related to better patient prognosis. However, new approaches may take several years to become the standard of care in daily practice. We conducted a prospective cohort study to investigate the effectiveness of a multifaceted strategy to implement a protocol to wean patients from mechanical ventilation (MV) and to evaluate the weaning success rate as well as practitioner adherence to the protocol. We investigated all consecutive MV-dependent subjects admitted to a medical-surgical intensive care unit (ICU) for >24h over 7years. The multifaceted strategy consisted of continuing education of attending physicians and ICU staff and regular feedback regarding patient outcomes. The study was conducted in three phases: protocol development, protocol and multifaceted strategy implementation, and protocol monitoring. Data regarding weaning outcomes and physician adherence to the weaning protocol were collected during all phases. We enrolled 2469 subjects over 7years, with 1,943 subjects (78.7%) experiencing weaning success. Physician adherence to the protocol increased during the years of protocol and multifaceted strategy implementation (from 38% to 86%, p<0.01) and decreased in the protocol monitoring phase (from 73.9% to 50.0%, p<0.01). However, during the study years, the weaning success of all subjects increased (from 73.1% to 85.4%, p<0.001). When the weaning protocol was evaluated step-by-step, we found high adherence for noninvasive ventilation use (95%) and weaning predictor measurement (91%) and lower adherence for control of fluid balance (57%) and daily interruption of sedation (24%). Weaning success was higher in patients who had undergone the weaning protocol compared to those who had undergone weaning based in clinical practice (85.6% vs. 67.7%, p<0.001). A multifaceted strategy consisting of continuing education and regular feedback can increase physician adherence to a weaning protocol for mechanical ventilation

  14. Randomized cross-over trial of ventilator modes during non-invasive ventilation titration in amyotrophic lateral sclerosis.

    Science.gov (United States)

    Vrijsen, Bart; Buyse, Bertien; Belge, Catharina; Vanpee, Goele; Van Damme, Philip; Testelmans, Dries

    2017-08-01

    Non-invasive ventilation (NIV) improves survival, quality of life and sleep in patients with amyotrophic lateral sclerosis (ALS). Nevertheless, NIV titration is conducted in different ways. We aim to provide more insight into NIV titration by comparing the effects of a spontaneous (S) and spontaneous-timed (ST) modes on gas exchange, sleep architecture and patient-ventilator asynchronies (PVAs). After an initial night of NIV titration, patients were randomized to S or ST mode in a cross-over design. NIV was titrated using polysomnography, oximetry (oxygen saturation, SpO2 %) and transcutaneous carbon dioxide (PtcCO2 ) measurement. PVAs were analysed breath-by-breath. Thirteen patients were analysed after inclusion. ST mode showed better results in gas exchange (minimal SpO2 %: 83 (80-89)% vs 87 (84-89)%; oxygen desaturation index: 15 (5-28)/h sleep vs 7 (3-9)/h sleep; PtcCO2 >55 mm Hg: 20 (0-59)% vs 0 (0-27)% total sleep time for S and ST mode, respectively, all P < 0.05) and respiratory events (obstructive: 8.9 (1.2-18.3)/h sleep vs 1.8 (0.3-4.9)/h sleep and central: 2.6 (0.4-14.1)/h sleep vs 0.2 (0.0-1.1)/h sleep for S and ST mode, respectively, both P < 0.01). No differences in sleep architecture were found. Ineffective efforts and respiratory events were more frequently present in S mode. Nevertheless, four patients were discharged on S mode as these patients showed clinically better results for sleep architecture and PVA during the night on S mode. ST mode shows better results in gas exchange, respiratory events and PVA. Nevertheless, accurate NIV titration remains necessary as some patients show equal or better results when using the S mode. © 2017 Asian Pacific Society of Respirology.

  15. Hemodynamic Effects of Noninvasive Ventilation in Patients with Venocapillary Pulmonary Hypertension

    Directory of Open Access Journals (Sweden)

    André Moreira Bento

    2014-11-01

    Full Text Available Background: The hemodynamic effects of noninvasive ventilation with positive pressure in patients with pulmonary hypertension without left ventricular dysfunction are not clearly established. Objectives: Analyze the impact of increasing airway pressure with continuous positive airway pressure on hemodynamic parameters and, in particular, on cardiac output in patients with variable degrees of pulmonary hypertension. Methods: The study included 38 patients with pulmonary hypertension caused by mitral stenosis without left ventricular dysfunction or other significant valvulopathy. The hemodynamic state of these patients was analyzed in three conditions: baseline, after continuous positive pressure of 7 cmH2O and, finally, after pressure of 14 cmH2O. Results: The population was composed of predominantly young and female individuals with significant elevation in pulmonary arterial pressure (mean systolic pressure of 57 mmHg. Of all variables analyzed, only the right atrial pressure changed across the analyzed moments (from the baseline condition to the pressure of 14 cmH2O there was a change from 8 ± 4 mmHg to 11 ± 3 mmHg, respectively, p = 0.031. Even though there was no variation in mean cardiac output, increased values in pulmonary artery pressure were associated with increased cardiac output. There was no harmful effect or other clinical instability associated with use application of airway pressure. Conclusion: In patients with venocapillary pulmonary hypertension without left ventricular dysfunction, cardiac output response was directly associated with the degree of pulmonary hypertension. The application of noninvasive ventilation did not cause complications directly related to the ventilation systems.

  16. Hemodynamic Effects of Noninvasive Ventilation in Patients with Venocapillary Pulmonary Hypertension.

    Science.gov (United States)

    Bento, André Moreira; Cardoso, Luiz Francisco; Tarasoutchi, Flávio; Sampaio, Roney Orismar; Kajita, Luiz Junya; Lemos Neto, Pedro Alves

    2014-11-01

    Background: The hemodynamic effects of noninvasive ventilation with positive pressure in patients with pulmonary hypertension without left ventricular dysfunction are not clearly established. Objectives: Analyze the impact of increasing airway pressure with continuous positive airway pressure on hemodynamic parameters and, in particular, on cardiac output in patients with variable degrees of pulmonary hypertension. Methods: The study included 38 patients with pulmonary hypertension caused by mitral stenosis without left ventricular dysfunction or other significant valvulopathy. The hemodynamic state of these patients was analyzed in three conditions: baseline, after continuous positive pressure of 7 cmH2O and, finally, after pressure of 14 cmH2O. Results: The population was composed of predominantly young and female individuals with significant elevation in pulmonary arterial pressure (mean systolic pressure of 57 mmHg). Of all variables analyzed, only the right atrial pressure changed across the analyzed moments (from the baseline condition to the pressure of 14 cmH2O there was a change from 8 ± 4 mmHg to 11 ± 3 mmHg, respectively, p = 0.031). Even though there was no variation in mean cardiac output, increased values in pulmonary artery pressure were associated with increased cardiac output. There was no harmful effect or other clinical instability associated with use application of airway pressure. Conclusion: In patients with venocapillary pulmonary hypertension without left ventricular dysfunction, cardiac output response was directly associated with the degree of pulmonary hypertension. The application of noninvasive ventilation did not cause complications directly related to the ventilation systems.

  17. Application effect of targeted nursing in noninvasive mechanical ventila-tion in the treatment of acute cardiogenic pulmonary edema%针对性护理在无创机械通气治疗急性心源性肺水肿中的应用效果

    Institute of Scientific and Technical Information of China (English)

    王丽嫦

    2015-01-01

    Objective To investigate the application effect of targeted nursing in noninvasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema. Methods 80 cases with acute cardiogenic pulmonary edema from May 2010 to May 2013 in our hospital were selected and randomly divided into the treatment group and the control group,40 cases in each group.All patients were given the treatment of non-invasive mechanical ventilation,the treatment group was given targeted nursing measure,the control group was given conventional nursing.The level of heart rate, breathing,blood oxygen saturation,pH,PaO2,PaCO2 in two groups was compared respectively.The degree of nursing satis-faction and the incidence of complication in two groups was compared respectively. Results The level of heart rate, breathing,blood oxygen saturation,pH,PaO2,PaCO2 after noninvasive mechanical ventilation was better than before non-invasive mechanical ventilation,with significant difference(P0.05).The total satisfaction rate of the treatment group was 97.5%,which was higher than 85.0%of the control group, with significant difference(P<0.05).The incidence of complication in the treatment group was lower than that in the con-trol group,with significant difference(P<0.05). Conclusion The application effect of targeted nursing in noninvasive me-chanical ventilation in the treatment of acute cardiogenic pulmonary edema is significant,which can improve the degree of nursing c satisfaction,reduce the incidence of complication,it is worthy of clinical promotion and application.%目的:探讨针对性护理在无创机械通气治疗急性心源性肺水肿中的应用效果。方法选取本院2010年5月~2013年5月收治的80例急性心源性肺水肿患者作为研究对象,随机分为治疗组和对照组,各40例。所有患者入院后均给予无创机械通气治疗,其中治疗组采用针对性护理措施,对照组仅采用常规护理措施。比较两组的心率、呼吸、

  18. Exercise oscillatory ventilation:Mechanisms and prognostic significance

    Institute of Scientific and Technical Information of China (English)

    Bishnu P Dhakal; Gregory D Lewis

    2016-01-01

    Alteration in breathing patterns characterized by cyclic variation of ventilation during rest and during exercise has been recognized in patients with advanced heart failure(HF) for nearly two centuries. Periodic breathing(PB) during exercise is known as exercise oscillatory ventilation(EOV) and is characterized by the periods of hyperpnea and hypopnea without interposed apnea. EOV is a non-invasive parameter detected during submaximal cardiopulmonary exercise testing. Presence of EOV during exercise in HF patients indicates significant impairment in resting and exercise hemodynamic parameters. EOV is also an independent risk factor for poor prognosis in HF patients both with reduced and preserved ejection fraction irrespective of other gas exchange variables. Circulatory delay, increased chemosensitivity, pulmonary congestion and increased ergoreflex signaling have been proposed as the mechanisms underlying the generation of EOV in HF patients. There is no proven treatment of EOV but its reversal has been noted with phosphodiesterase inhibitors, exercise training and acetazolamide in relatively small studies. In this review, we discuss the mechanistic basis of PB during exercise and the clinical implications of recognizing PB patterns in patients with HF.

  19. Analysis of curative effect of noninvasive mechanical ventilation in the treatment of severe pneumonia patients with acute respiratory failure%无创机械通气在重症肺炎合并急性呼吸衰竭中的疗效分析

    Institute of Scientific and Technical Information of China (English)

    陈光宴

    2014-01-01

    Objective To study the clinical effect of noninvasive mechanical ventilation(NPPV) in the treatment of severe pneumonia complicated with acute respiratory failure(SP-ARF).Methods Divided 60 SP-ARF patients into observation group and control group under the consent of family, all patients received routine treatment. Observation group received NPPV, control group was treated with nasal catheter oxygen, blood gas analysis and clinical symptoms, signs and other indicators of two groups were observed before and after treatment.Results Blood gas indexes pH, PaO2, PaCO2 of two groups before treatment showed no significant difference(P0.05).Conclusion The clinical application effect of noninvasive positive pressure ventilation(NPPV) is satisfactory, the clinical effect is better than simple application of nasal catheter oxygen manner, it should be popularized and applied in conditional hospital, but invasive positive pressure ventilation(IPPV) treatment should be applied when it is difficult control the disease with noninvasive positive pressure ventilation.%目的:研究无创机械通气(NPPV)治疗重症肺炎合并急性呼吸衰竭(SP-ARF)的临床疗效。方法60例重症肺炎合并急性呼吸衰竭患者在征得患者家属同意的前提下随机分为两组,所有患者均在常规治疗的前提下,观察组应用NPPV治疗,对照组给予鼻导管吸氧,观察对比两组患者治疗前后血气分析和临床症状、体征等指标。结果两组患者治疗前血气分析指标pH、PaO2、PaCO2指标差异均无统计学意义(P>0.05);经过治疗之后,两组患者上述指标均显著下降,差异均有统计学意义(P0.05)。结论 NPPV在临床应用效果满意,临床效果优于单纯应用鼻导管吸氧的方式,在有条件的医院应推广应用,但在应用过程中,在发现无创正压通气控制病情困难时,应尽早行有创正压机械通气(IPPV)治疗。

  20. Acute respiratory failure and mechanical ventilation in pregnant patient: A narrative review of literature

    Directory of Open Access Journals (Sweden)

    Pradeep Kumar Bhatia

    2016-01-01

    Full Text Available Physiological changes of pregnancy imposes higher risk of acute respiratory failure (ARF with even a slight insult and remains an important cause of maternal and fetal morbidity and mortality. Although pregnant women have different respiratory physiology and different causes of ARF, guidelines specific to ventilatory settings, goals of oxygenation and weaning process could not be framed due to lack of large-scale randomized controlled trials. During the 2009 H1N1 pandemic, pregnant women had higher morbidity and mortality compared to nonpregnant women. During this period, alternative strategies of ventilation such as high-frequency oscillatory ventilation, inhalational of nitric oxide, prone positioning, and extra corporeal membrane oxygenation were increasingly used as a desperate measure to rescue pregnant patients with severe hypoxemia who were not improving with conventional mechanical ventilation. This article highlights the causes of ARF and recent advances in invasive, noninvasive and alternative strategies of ventilation used during pregnancy.

  1. Use of non-invasive ventilation in acute pulmonary edema and chronic obstructive pulmonary disease exacerbation in emergency medicine: predictors of failure.

    Science.gov (United States)

    Passarini, Juliana Nalin de Souza; Zambon, Lair; Morcillo, André Moreno; Kosour, Carolina; Saad, Ivete Alonso Bredda

    2012-09-01

    This study analyzed acute respiratory failure caused by acute pulmonary edema, as well as chronic obstructive pulmonary disease exacerbation, that was treated with non-invasive mechanical ventilation to identify the factors that are associated with the success or failure non-invasive mechanical ventilation in urgent and emergency service. This study was a prospective, descriptive and analytical study. We included patients of both genders aged >18 years who used non-invasive mechanical ventilation due to acute respiratory failure that was secondary to acute pulmonary edema or chronic obstructive pulmonary disease exacerbation. Patients with acute respiratory failure that was secondary to pathologies other than acute pulmonary edema and chronic obstructive pulmonary disease or who presented with contraindications for the technique were excluded. Expiratory pressures between 5 and 8 cmH2O and inspiratory pressures between 10 and 12 cmH2O were used. Supplemental oxygen maintained peripheral oxygen saturation at >90%. The primary outcome was endotracheal intubation. A total of 152 patients were included. The median non-invasive mechanical ventilation time was 6 hours (range 1 - 32 hours) for chronic obstructive pulmonary disease patients (n=60) and 5 hours (range 2 - 32 hours) for acute pulmonary edema patients (n=92). Most (75.7%) patients progressed successfully. However, reduced APACHE II scores and lower peripheral oxygen saturation were observed. These results were statistically significant in patients who progressed to intubation (pendotracheal intubation 2.3 times (p=0.032). Patients with acute pulmonary edema and elevated GCS scores also increased the probability of success. Respiratory frequency >25 rpm, higher APACHE II scores, BiPAP use and chronic obstructive pulmonary disease diagnosis were associated with endotracheal intubation. Higher GCS and SpO2 values were associated with NIV success. Non-invasive mechanical ventilation can be used in emergency

  2. Evaluation of Mechanical Ventilator Use with Liquid Oxygen Systems

    Science.gov (United States)

    2017-02-22

    AFRL-SA-WP-SR-2017-0006 Evaluation of Mechanical Ventilator Use with Liquid Oxygen Systems Thomas Blakeman, MSc, RRT; Dario...To) August 2014 – September 2016 4. TITLE AND SUBTITLE Evaluation of Mechanical Ventilator Use with Liquid Oxygen Systems 5a. CONTRACT NUMBER...Cleared, 88PA, Case # 2016-6491, 16 Dec 2016. 14. ABSTRACT Mechanical ventilators coupled with portable liquid oxygen (LOX) systems are critical

  3. Evaluation of self-perception of mechanical ventilation knowledge among Brazilian final-year medical students, residents and emergency physicians

    Science.gov (United States)

    Tallo, Fernando Sabia; de Campos Vieira Abib, Simone; de Andrade Negri, Alexandre Jorgi; Filho, Paulo Cesar; Lopes, Renato Delascio; Lopes, Antônio Carlos

    2017-01-01

    OBJECTIVE: To present self-assessments of knowledge about mechanical ventilation made by final-year medical students, residents, and physicians taking qualifying courses at the Brazilian Society of Internal Medicine who work in urgent and emergency settings. METHODS: A 34-item questionnaire comprising different areas of knowledge and training in mechanical ventilation was given to 806 medical students, residents, and participants in qualifying courses at 11 medical schools in Brazil. The questionnaire’s self-assessment items for knowledge were transformed into scores. RESULTS: The average score among all participants was 21% (0-100%). Of the total, 85% respondents felt they did not receive sufficient information about mechanical ventilation during medical training. Additionally, 77% of the group reported that they would not know when to start noninvasive ventilation in a patient, and 81%, 81%, and 89% would not know how to start volume control, pressure control and pressure support ventilation modes, respectively. Furthermore, 86.4% and 94% of the participants believed they would not identify the basic principles of mechanical ventilation in patients with obstructive pulmonary disease and acute respiratory distress syndrome, respectively, and would feel insecure beginning ventilation. Finally, 77% said they would fear for the safety of a patient requiring invasive mechanical ventilation under their care. CONCLUSION: Self-assessment of knowledge and self-perception of safety for managing mechanical ventilation were deficient among residents, students and emergency physicians from a sample in Brazil.

  4. Non-invasive positive pressure ventilation for acute asthma in children

    DEFF Research Database (Denmark)

    Korang, Steven Kwasi; Feinberg, Joshua; Wetterslev, Jørn

    2016-01-01

    BACKGROUND: Asthma is one of the most common reasons for hospital admission among children and constitutes a significant economic burden. Use of non-invasive positive pressure ventilation (NPPV) in the care of children with acute asthma has increased even though evidence supporting the intervention......: To assess the benefits and harms of NPPV as an add-on therapy to usual care (e.g. bronchodilators and corticosteroids) in children with acute asthma. SEARCH METHODS: We identified trials from the Cochrane Airways Group Specialised Register (CAGR). The Register contains trial reports identified through...... both studies as having high risk of bias; both trials assessed effects of bilateral positive airway pressure (BiPAP). Neither trial used continuous positive airway pressure (CPAP). Controls received standard care. Investigators reported no deaths and no serious adverse events (Grades of Recommendation...

  5. Experience of step-wise protocol using noninvasive positive pressure ventilation for treating cardiogenic pulmonary edema.

    Science.gov (United States)

    Momii, Hidetoshi; Tashima, Yuki; Kadokami, Toshiaki; Narita, Sumito; Yoshida, Masayoshi; Ando, Shin-ichi

    2012-08-01

    Initiating and weaning procedure of noninvasive positive pressure ventilation (NIPPV) on acute cardiogenic pulmonary edema (ACPE) has been determined empirically, and the total time of its use has been sometimes prolonged unnecessarily. A simple protocol for its use may facilitate initiation and avoids prolongation of the NIPPV treatment. We designed a step-wise protocol for NIPPV use and retrospectively examined the clinical outcome of our protocol for initiation and weaning of NIPPV in 45 patients with ACPE. Almost all patients recovered from respiratory distress successfully. There was no intubation nor complication related to NIPPV. In most of the cases, maximal-end expiratory pressure was less than 7-cm H2O. The mean duration of NIPPV was 19.5±28.0 h and the median duration was 8.0 h (interquartile range=14.0 h). This simple step-wise NIPPV protocol for ACPE can facilitate quick and safe initiation and termination of the treatment.

  6. Non-invasive ventilation for sleep-disordered breathing in Smith-Magenis syndrome.

    Science.gov (United States)

    Connor, Victoria; Zhao, Sizheng; Angus, Robert

    2016-08-05

    Smith-Magenis syndrome (SMS) is a rare genetic neurodevelopmental disorder characterised by behavioural disturbances, intellectual disability and early onset obesity. The physical features of this syndrome are well characterised; however, behavioural features, such as sleep disturbance, are less well understood and difficult to manage. Sleep issues in SMS are likely due to a combination of disturbed melatonin cycle, facial anatomy and obesity-related ventilatory problems. Sleep disorders can be very distressing to patients and their families, as exemplified by our patient's experience, and can worsen behavioural issues as well as general health. This case demonstrates the successful use of non-invasive ventilation in treating underlying obesity hypoventilation syndrome and obstructive sleep apnoea. As a consequence of addressing abnormalities in sleep patterns, some behavioural problems improved.

  7. Decision Making About Gastrostomy and Noninvasive Ventilation in Amyotrophic Lateral Sclerosis.

    Science.gov (United States)

    Martin, Naomi H; Lawrence, Vanessa; Murray, Joanna; Janssen, Anna; Higginson, Irene; Lyall, Rebecca; Burman, Rachel; Leigh, P Nigel; Al-Chalabi, Ammar; Goldstein, Laura H

    2016-08-01

    We used thematic analysis to investigate factors affecting decision making about gastrostomy and noninvasive ventilation (NIV) by people with Amyotrophic Lateral Sclerosis (ALS) from the viewpoint of the health care professionals (HCPs) supporting them. We conducted 20 in-depth interviews with 19 HCPs nominated by people with ALS who had made a decision to accept or decline NIV or gastrostomy. We found the main themes influencing decision making were patient-centric, caregiver-related or related to HCPs' own beliefs, perspectives, and actions. HCPs felt patients should be, and were, in control of decision making, although caregivers and HCPs played a role. The patient's evaluation of quality of life, the desirability of prolonging life, and acceptance of the disease and its progression by both patient and caregiver were the most important factors identified by HCPs. HCPs should be aware of the importance of multiprofessional discussions, and the potential influences (identified above) that might require discussion with patients and caregivers.

  8. Continuous positive airway pressure and noninvasive ventilation in prehospital treatment of patients with acute respiratory failure

    DEFF Research Database (Denmark)

    Bakke, Skule A; Bøtker, Morten Thingemann; Riddervold, Ingunn S;

    2014-01-01

    Continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are frequently used inhospital for treating respiratory failure, especially in treatment of acute cardiogenic pulmonary edema and exacerbation of chronic obstructive pulmonary disease. Early initiation of treatment...... is important for success and introduction already in the prehospital setting may be beneficial. Our goal was to assess the evidence for an effect of prehospital CPAP or NIV as a supplement to standard medical treatment alone on the following outcome measures; mortality, hospital length of stay, intensive care...... examine prehospital CPAP. Of these, only one small, randomized controlled trial shows a reduced mortality rate and a reduced intubation rate with supplemental CPAP. The other three studies have neutral findings, but in two of these a trend toward lower intubation rate is found. The effect of supplemental...

  9. No-sedation during mechanical ventilation

    DEFF Research Database (Denmark)

    Laerkner, Eva; Stroem, Thomas; Toft, Palle

    2016-01-01

    care unit (ICU), patients were Richmond Agitation and Sedation Scale (RASS) scored, nursing workload was measured with the Nursing Care Recording System (NCR11) and nurse's self-assessment of workload was reported on a Numeric Rating Scale from 1 (low) to 10 (high). RESULTS: Patients from the no......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......-sedation group had a median RASS score of -0·029 compared with -2 in the sedated group (P nurses self-reported workload was the same in both groups (P = 0·085). Because...

  10. Face Masks for Noninvasive Ventilation: Fit, Excess Skin Hydration, and Pressure Ulcers.

    Science.gov (United States)

    Visscher, Marty O; White, Cynthia C; Jones, Jennifer M; Cahill, Thomas; Jones, Donna C; Pan, Brian S

    2015-11-01

    Pressure ulcers (stages III and IV) are serious safety events (ie, never events). Healthcare institutions are no longer reimbursed for costs to care for affected patients. Medical devices are the leading cause of pediatric pressure ulcers. Face masks for noninvasive ventilation were associated with a high percentage of pressure ulcers at our institution. A prospective cohort study investigated factors contributing to pressure ulcer development in 50 subjects using face masks for noninvasive ventilation. Color imaging, 3-dimensional surface imaging, and skin hydration measurements were used to identify early skin compromise and evaluate 3 interventions to reduce trauma: (1) a silicone foam dressing, (2) a water/polyethylene oxide hydrogel dressing, and (3) a flexible cloth mask. A novel mask fit technique was used to examine the impact of fit on the potential for skin compromise. Fifty subjects age 10.4 ± 9.1 y participated with color images for 22, hydration for 34, and mask fit analysis for 16. Of these, 69% had diagnoses associated with craniofacial anomalies. Stage I pressure ulcers were the most common injury. Skin hydration difference was 317 ± 29 for sites with erythema versus 75 ± 28 for sites without erythema (P pressure ulcers. This fit method is currently being utilized to select best-fit masks from available options, to identify the potential areas of increased tissue pressure, and to prevent skin injuries and their complications. Improvement of mask fit is an important priority for improving respiratory outcomes. Strategies to maintain normal skin hydration are important for protecting tissue integrity. Copyright © 2015 by Daedalus Enterprises.

  11. Volume-Targeted Versus Pressure-Targeted Noninvasive Ventilation in Patients With Chest-Wall Deformity : A Pilot Study

    NARCIS (Netherlands)

    Struik, Fransien M.; Duiverman, Marieke L.; Meijer, Petra M.; Nieuwenhuis, Jellie A.; Kerstjens, Huib A. M.; Wijkstra, Peter J.

    2011-01-01

    BACKGROUND: Long-term noninvasive ventilation (NIV) is an effective treatment for patients with chronic respiratory failure due to chest-wall deformity, but it is unknown if the time required for the patient to adjust to long-term NIV depends on whether the NIV is volume-targeted or

  12. Oxygen therapy, continuous positive airway pressure, or noninvasive bilevel positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema

    Directory of Open Access Journals (Sweden)

    Park Marcelo

    2001-01-01

    Full Text Available OBJECTIVE: To compare the effects of 3 types of noninvasive respiratory support systems in the treatment of acute pulmonary edema: oxygen therapy (O2, continuous positive airway pressure, and bilevel positive pressure ventilation. METHODS: We studied prospectively 26 patients with acute pulmonary edema, who were randomized into 1 of 3 types of respiratory support groups. Age was 69±7 years. Ten patients were treated with oxygen, 9 with continuous positive airway pressure, and 7 with noninvasive bilevel positive pressure ventilation. All patients received medicamentous therapy according to the Advanced Cardiac Life Support protocol. Our primary aim was to assess the need for orotracheal intubation. We also assessed the following: heart and respiration rates, blood pressure, PaO2, PaCO2, and pH at begining, and at 10 and 60 minutes after starting the protocol. RESULTS: At 10 minutes, the patients in the bilevel positive pressure ventilation group had the highest PaO2 and the lowest respiration rates; the patients in the O2 group had the highest PaCO2 and the lowest pH (p<0.05. Four patients in the O2 group, 3 patients in the continuous positive pressure group, and none in the bilevel positive pressure ventilation group were intubated (p<0.05. CONCLUSION: Noninvasive bilevel positive pressure ventilation was effective in the treatment of acute cardiogenic pulmonary edema, accelerated the recovery of vital signs and blood gas data, and avoided intubation.

  13. High-frequency chest-wall oscillation in a noninvasive-ventilation-dependent patient with type 1 spinal muscular atrophy.

    Science.gov (United States)

    Keating, Joanna M; Collins, Nicola; Bush, Andrew; Chatwin, Michelle

    2011-11-01

    With the recent increased use of noninvasive ventilation, the prognoses of children with neuromuscular disease has improved significantly. However, children with muscle weakness remain at risk for recurrent respiratory infection and atelectasis. We report the case of a young girl with type 1 spinal muscular atrophy who was dependent on noninvasive ventilation, and in whom conventional secretion-clearance physiotherapy became insufficient to clear secretions. We initiated high-frequency chest-wall oscillation (HFCWO) as a rescue therapy, and she had improved self-ventilation time. This is the first case report of HFCWO for secretion clearance in a severely weak child with type 1 spinal muscular atrophy. In a patient with neuromuscular disease and severe respiratory infection and compromise, HFCWO can be used safely in combination with conventional secretion-clearance physiotherapy.

  14. Early non-invasive ventilation treatment for respiratory failure due to severe community-acquired pneumonia.

    Science.gov (United States)

    Nicolini, Antonello; Ferraioli, Gianluca; Ferrari-Bravo, Maura; Barlascini, Cornelius; Santo, Mario; Ferrera, Lorenzo

    2016-01-01

    Severe community-acquired pneumonia (sCAP) have been as defined pneumonia requiring admission to the intensive care unit or carrying a high risk of death. Currently, the treatment of sCAP consists of antibiotic therapy and ventilator support. The use of invasive ventilation causes several complications as does admission to ICU. For this reason, non-invasive ventilation (NIV) has been used for acute respiratory failure to avoid endotracheal intubation. However, few studies have currently assessed the usefulness of NIV in sCAP. We prospectively assessed 127 patients with sCAP and severe acute respiratory failure [oxygen arterial pressure/oxygen inspiratory fraction ratio (PaO2/FiO2) intubation and the achievement of PaO2/FiO2 >250 with spontaneous breathing. We assessed predictors of NIV failure and hospital mortality using univariate and multivariate analyses. NIV failed in 32 patients (25.1%). Higher chest X-ray score at admission, chest X-ray worsening, and a lower PaO2/FiO2 and higher alveolar-arteriolar gradient (A-aDO2) after 1 h of NIV all independently predicted NIV failure. Higher lactate dehydrogenase and confusion, elevated blood urea, respiratory rate, blood pressure plus age ≥65 years at admission, higher A-aDO2, respiratory rate and lower PaO2/FiO2 after 1 h of NIV and intubation rate were directly related to hospital mortality. Successful treatment is strongly related to less severe illness as well as to a good initial and sustained response to medical therapy and NIV treatment. Constant monitoring of these patients is mandatory. © 2014 John Wiley & Sons Ltd.

  15. Accuracy of gas exchange monitoring during noninvasive ventilation: an in vitro metabolic simulation.

    Science.gov (United States)

    Smallwood, Craig D; Mehta, Nilesh M

    2014-01-01

    Gas exchange monitoring by indirect calorimetry (IC) during noninvasive ventilation (NIV) is desirable but currently not available. Leaks around the mask preclude reliable measurements of carbon dioxide production (VCO2) and oxygen consumption (VO2) in this population. We aimed to examine the impact of system leaks and gas flows on the accuracy of gas exchange measurements during NIV using an in vitro metabolic simulation. We examined the agreement between VCO2 and VO2 measurements by IC (using a novel canopy device) and reference values generated during an in vitro metabolic simulation of NIV at room air. The flow rate of gas sampled by the IC device (VIC) was set relative to the output flow of the ventilator (VVENT) to obtain a range of sample factors (SF = VIC/VVENT). Linear regression was used to determine the effect of SF on the accuracy of the system. An acceptable agreement between measured and reference values was observed, with mean bias (limits of agreement) of -3.3% (-6.9% to 0.3%) and -10.6% (-14.9% to -6.4%) for VCO2 and VO2, respectively. An SF of 1.25 was associated with the highest accuracy of measurement. VO2 measurement accuracy deteriorated with system leak and at SF >1.25 and was linearly related to sample dilution by ambient air entrainment. A novel canopy device with titration of IC sample flow in relation to the ventilator flow allowed in vitro gas exchange measurements during simulated NIV with acceptable accuracy. This model needs to be tested in clinical settings.

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

    NARCIS (Netherlands)

    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 ven

  17. Mechanical ventilation in patients subjected to extracorporeal membrane oxygenation (ECMO).

    Science.gov (United States)

    Sánchez, M L

    2017-02-07

    Mechanical ventilation (MV) is a crucial element in the management of acute respiratory distress syndrome (ARDS), because there is high level evidence that a low tidal volume of 6ml/kg (protective ventilation) improves survival. In these patients with refractory respiratory insufficiency, venovenous extracorporeal membrane oxygenation (ECMO) can be used. This salvage technique improves oxygenation, promotes CO2 clearance, and facilitates protective and ultraprotective MV, potentially minimizing ventilation-induced lung injury. Although numerous trials have investigated different ventilation strategies in patients with ARDS, consensus is lacking on the optimal MV settings during venovenous ECMO. Although the concept of "lung rest" was introduced years ago, there are no evidence-based guidelines on its use in application to MV in patients supported by ECMO. How MV in ECMO patients can promote lung recovery and weaning from ventilation is not clear. The purpose of this review is to describe the ventilation strategies used during venovenous ECMO in clinical practice.

  18. 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

  19. 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…

  20. 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.

  1. Delirium during Weaning from Mechanical Ventilation

    Directory of Open Access Journals (Sweden)

    Marcela Aparecida Leite

    2014-01-01

    Full Text Available Background. We compare the incidence of delirium before and after extubation and identify the risk factors and possible predictors for the occurrence of delirium in this group of patients. Methods. Patients weaned from mechanical ventilation (MV and extubated were included. The assessment of delirium was conducted using the confusion assessment method for the ICU and completed twice per day until discharge from the intensive care unit. Results. Sixty-four patients were included in the study, 53.1% of whom presented with delirium. The risk factors of delirium were age (P=0.01, SOFA score (P=0.03, APACHE score (P=0.01, and a neurological cause of admission (P=0.01. The majority of the patients began with delirium before or on the day of extubation. Hypoactive delirium was the most common form. Conclusion. Acute (traumatic or medical neurological injuries were important risk factors in the development of delirium. During the weaning process, delirium developed predominantly before or on the same day of extubation and was generally hypoactive (more difficult to detect. Therefore, while planning early prevention strategies, attention must be focused on neurological patients who are receiving MV and possibly even on patients who are still under sedation.

  2. Palliative care and circumstances of dying in German ALS patients using non-invasive ventilation.

    Science.gov (United States)

    Kühnlein, Peter; Kübler, Andrea; Raubold, Sabine; Worrell, Marcia; Kurt, Anja; Gdynia, Hans-Jürgen; Sperfeld, Anne-Dorte; Ludolph, Albert Christian

    2008-04-01

    Non-invasive ventilation (NIV) is known to improve quality of life and to prolong survival in amyotrophic lateral sclerosis (ALS) patients. However, little is known about the circumstances of dying in ventilated ALS patients. In the light of the debate on legalizing euthanasia it is important to provide empirical data about the process of dying in these patients. In a structured interview, 29 family caregivers of deceased ALS patients were asked about their own and the patient's attitude toward physician-assisted suicide (PAS) and euthanasia, circumstances of dying, and the use of palliative medication. Quantitative and qualitative content analysis was performed on the data. Non-recurring suicidal thoughts were reported by five patients. Three patients and seven relatives had thought about PAS. Seventeen caregivers described the patients' death as "peaceful", while choking was reported in six bulbar patients. In final stages of dying, the general practitioner (GP) was involved in the treatment of 10 patients, with palliative medication including sedatives and opiates being administered in eight cases. In conclusion, in contrast to the Netherlands, where 20% of terminal ALS patients die from PAS or euthanasia, only a small minority of our patients seems to have thought about PAS. The legal situation in Germany (where euthanasia is illegal), a bias due to the selection of NIV patients as well as a high percentage of religious patients and those with good levels of social support from family and friends, might account for this. Most of our patients died peacefully at home from carbon dioxide narcosis, but choking was described in some bulbar patients. Thus, palliative care, especially the use of opiates, anxiolytics and sedatives should be optimized, and the involvement of GP should be strongly encouraged, especially in bulbar patients.

  3. Non-invasive ventilation improves respiratory distress in children with acute viral bronchiolitis: a systematic review.

    Science.gov (United States)

    Combret, Yann; Prieur, Guillaume; LE Roux, Pascal; Médrinal, Clément

    2017-06-01

    Non-invasive ventilation (NIV) is a common treatment for bronchiolitis. However, consensus concerning its efficacy is lacking. The aim of this systematic review was to assess NIV effectiveness to reduce respiratory distress. Secondary objectives were to summarize the effects of NIV, identify predictive factors for failure and describe settings and applications. Literature searches were conducted in MEDLINE/PubMed, PEDro, Cochrane, EMBASE, CINAHL, Web of Science, UpToDate, and SuDoc from 1990 to April 2015. Randomized controlled trials, controlled non-randomized trials and prospective studies of NIV (continuous positive airway pressure [CPAP], bi-level CPAP, or neurally-adjusted ventilator assist) for bronchiolitis in infants younger than 2 years were included. Fourteen studies were included, for a total of 379 children. Of these, 357 were treated with NIV as first intention. Respiratory distress, heart rate, respiratory rate and respiratory effort improved (P<0.05). Results were inconclusive regarding prevention of endotracheal intubation. Few adverse events were reported. NIV reduced carbon dioxide pressure (pCO2) in 10 studies. Two randomized controlled studies reported a decrease of 7 mmHg in pCO2 (P<0.05). Predictive factors of NIV failure were apneas, high pCO2, young age, low weight, elevated heart rate and high pediatric risk of mortality score. NIV is mostly administered through a nasal mask, nasal cannula or helmet, with an initial expiratory positive airway pressure of 7 cmH2O. NIV shows promising results for the reduction of respiratory distress in acute viral bronchiolitis, as shown in several recent studies. However, there is a lack of robust studies to confirm this.

  4. Análise das alterações ventilatórias e hemodinâmicas com utilização de ventilação mecânica não-invasiva com binível pressórico em pacientes com insuficiência cardíaca congestiva Analysis of ventilation and hemodynamic changes resulting from noninvasive bilevel pressure mechanical ventilation applied to patients with congestive heart failure

    Directory of Open Access Journals (Sweden)

    Ariadne Fernandes de Barros

    2007-01-01

    pressure (MAP, heart rate (HR, respiratory rate (RR, and peripheral oxygen saturation (SpO2, in patients with congestive heart failure (CHF. METHODS: Fourteen CHF patients (mean age 62.85 years were treated with noninvasive bilevel mechanical ventilation. Patients were consecutively treated with an expiratory positive airway pressure (EPAP of 5 cmH2O, 10 cmH2O, 15 cmH2O, 10 cmH2O, and 5 cmH2O, maintaining a variation in pressure (deltaP of 5 cmH2O between the inspiratory pressure (IPAP and the expiratory pressure (EPAP. Ventilation and hemodynamic data were collected at these time points, as well as 5 minutes before the beginning of the protocol and 5 minutes after its completion. RESULTS: A statistically significant difference was observed in the respiratory rate between the moment just before the beginning of the protocol and 5 minutes after positive pressure mask placement (p=0.022, and in oxygen saturation, between the final minute of EPAP at 5 cmH2O and after the removal of the mask (p=0.05. CONCLUSION: Noninvasive bilevel mechanical ventilation improves oxygenation and reduces respiratory work, thus being beneficial for patients with congestive heart failure. It was not possible to observe statistically significant changes in the hemodynamic data due to the small number of patients and to other associated heart diseases.

  5. Mechanical ventilation with heat recovery in cold climates

    DEFF Research Database (Denmark)

    Kragh, Jesper; Rose, Jørgen; Svendsen, Svend

    2005-01-01

    Building ventilation is necessary to achieve a healthy and comfortable indoor environment, but as energy prices continue to rise it is necessary to reduce the energy consumption. Using mechanical ventilation with heat recovery reduces the ventilation heat loss significantly, but in cold climates...... freezes to ice. The analysis of measurements from existing ventilation systems with heat recovery used in single-family houses in Denmark and a test of a standard heat recovery unit in the laboratory have clearly shown that this problem occurs when the outdoor temperature gets below approximately –5º......C. Due to the ice problem mechanical ventilation systems with heat recovery are often installed with an extra preheating system reducing the energy saving potential significantly. New designs of high efficient heat recovery units capable of continuously defrosting the ice without using extra energy...

  6. Mechanical ventilation and house-dust mites. Mekanisk ventilation og husstoevmider

    Energy Technology Data Exchange (ETDEWEB)

    Korsgaard, J. (Lungeklinikken, Aarhus Kommunehospital, Aarhus (DK))

    1991-01-01

    Nationally and internationally, it is recognised that the rational way to reduce inhabitant exposure to house-dust meters in a temperate climate is to reduce indoor absolute humidity to a level below 7.0 g/kg in the dry winter period. Consequently, it is medically recommended to install mechanical ventilation as environmental treatment of patients with chronic asthma caused by indoor exposure to house-dust mites. In this controlled investigation on the effect of mechanical ventilation on indoor climate conditions, it is documented that the establishment of a basic ventilation rate of 0.5 ach implies a significant reduction in the occurrence of house-dust mites in dwellings. Parallel with this effect, the rate of inside condensation on double-glazed windows was reduced, and the reported complaint rate of humid air, stuffy and dustry air and the indoor smelling sensation were reduced by a factor 2 to 7. No side effects relating to ventilation equipment were reported. It is conclued that the installation of mechanical ventilation in the treatment of mite allergy should be individualized with recommended air exchange rates adjusted to the actual size of dwelling and number of inhabitants. Furthermore care should be taken to avoid risk of condensation in the ventilation equipment. (author).

  7. Predictors of non-invasive ventilation failure in severe respiratory failure due to community acquired pneumonia.

    Science.gov (United States)

    Nicolini, Antonello; Piroddi, Ines Maria Grazia; Barlascini, Cornelius; Senarega, Renata

    2014-01-01

    Non-invasive ventilation (NIV) has been used for acute respiratory failure to avoid endotracheal intubation and intensive care admission. Few studies have assessed the usefulness of NIV in patients with severe community acquired pneumonia (CAP). The use of NIV in severe CAP is controversial because there is a greater variability in success compared to other pulmonary conditions. We retrospectively followed 130 patients with CAP and severe acute respiratory failure (PaO2/FiO2 predictors of NIV failure and hospital mortality using univariate and multivariate analyses. NIV failed in 26 patients (20.0%). Higher chest X-ray score at admission, higher heart rate after 1 hour of NIV, and a higher alveolar-arteriolar gradient (A-aDO2) after 24 hours of NIV each independently predicted NIV failure. Higher chest X ray score, higher LDH at admission, higher heart rate after 24 hours of NIV and higher A-aDO2 after 24 hours of NIV were directly related to hospital mortality. NIV treatment had high rate of success. Successful treatment is related to less lung involvement and to early good response to NIV and continuous improvement in clinical response.

  8. Noninvasive ventilation for acute hypercapnic respiratory failure: intubation rate in an experienced unit.

    Science.gov (United States)

    Contou, Damien; Fragnoli, Chiara; Córdoba-Izquierdo, Ana; Boissier, Florence; Brun-Buisson, Christian; Thille, Arnaud W

    2013-12-01

    Failure of noninvasive ventilation (NIV) is common in patients with COPD admitted to the ICU for acute hypercapnic respiratory failure (AHRF). We aimed to assess the rate of NIV failure and to identify early predictors of intubation under NIV in patients admitted for AHRF of all origins in an experienced unit. This was an observational cohort study using data prospectively collected over a 3-year period after the implementation of a nurse-driven NIV protocol in a 24-bed medical ICU of a French university hospital. Among 242 subjects receiving NIV for AHRF (P(aCO2) > 45 mm Hg), 67 had cardiogenic pulmonary edema (CPE), 146 had acute-on-chronic respiratory failure (AOCRF) (including 99 subjects with COPD and 47 with other chronic respiratory diseases), and 29 had non-AOCRF (mostly pneumonia). Overall, the rates of intubation and ICU mortality were respectively 15% and 5%. The intubation rates were 4% in CPE, 15% in AOCRF, and 38% in non-AOCRF (P intubation rate was reduced to 15% in patients receiving NIV for AHRF, with a mortality rate of only 5%. Whereas the risk of NIV failure is associated with hypoxemia and acidosis after initiation of NIV, it is also markedly influenced by the presence or absence of an underlying chronic respiratory disease.

  9. Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure.

    Directory of Open Access Journals (Sweden)

    Malcolm Lemyze

    Full Text Available PURPOSE: Acute respiratory failure (ARF is a common life-threatening complication in morbidly obese patients with obesity hypoventilation syndrome (OHS. We aimed to identify the determinants of noninvasive ventilation (NIV success or failure for this indication. METHODS: We prospectively included 76 consecutive patients with BMI>40 kg/m2 diagnosed with OHS and treated by NIV for ARF in a 15-bed ICU of a tertiary hospital. RESULTS: NIV failed to reverse ARF in only 13 patients. Factors associated with NIV failure included pneumonia (n = 12/13, 92% vs n = 9/63, 14%; p<0.0001, high SOFA (10 vs 5; p<0.0001 and SAPS2 score (63 vs 39; p<0.0001 at admission. These patients often experienced poor outcome despite early resort to endotracheal intubation (in-hospital mortality, 92.3% vs 17.5%; p<0.001. The only factor significantly associated with successful response to NIV was idiopathic decompensation of OHS (n = 30, 48% vs n = 0, 0%; p = 0.001. In the NIV success group (n = 63, 33 patients (53% experienced a delayed response to NIV (with persistent hypercapnic acidosis during the first 6 hours. CONCLUSIONS: Multiple organ failure and pneumonia were the main factors associated with NIV failure and death in morbidly obese patients in hypoxemic ARF. On the opposite, NIV was constantly successful and could be safely pushed further in case of severe hypercapnic acute respiratory decompensation of OHS.

  10. [Non-invasive ventilation improves comfort in pediatric palliative care patients].

    Science.gov (United States)

    Bosch-Alcaraz, A

    2014-01-01

    To analyze the appropriate use of non-invasive ventilation and its contribution to improving comfort in pediatric palliative care patients. This is a descriptive cross-sectional study comprising 55 palliative care patients from San Juan de Dios Hospital in Barcelona. The effectiveness was evaluated using a register of socio-demographic, clinical-ventilatory and oxymetric parameters, the comfort and dyspnea's grade using Silverman Anderson scale, and pain level using pediatric scales. The effectiveness of the technique was proved by a decreased heart rate (133.53±25.8 vs. 111.04±23.1; p<0.0001), respiratory rate (35.02±12.9 vs. 25.63±5.7; p<0.0001) and an increase of partial oxygen saturation (95.7±2.9 vs. 96.87±7.2; p<0.0001) and partial oxygen saturation/fraction of inspired oxygen ratio (297.12±113.4 vs. 336.97±100.7; p<0.0001). Dyspnea and pain levels improved in 100% of the patients. The therapy was effective and the comfort improved in 100% of the patients. Copyright © 2013 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  11. Experiences of noninvasive ventilation in adults with hypercapnic respiratory failure: a review of evidence

    Directory of Open Access Journals (Sweden)

    Hamadziripi Ngandu

    2016-12-01

    Full Text Available Noninvasive ventilation (NIV has been shown to be beneficial for patients with respiratory failure; however, many patients fail to tolerate it and require other interventions. The objective of this thematic synthesis was to describe the nature of NIV experiences in adults with hypercapnic respiratory failure. A systematic, computerised literature search of English-language databases was undertaken with no restriction on date of publication. A total of 99 papers was identified and screened for eligibility from databases including CINAHL, Medline and PsycINFO, and some were hand searched. 45 papers were critically appraised and 32 met our inclusion criteria. Thematic analysis identified six key themes: benefits of NIV; fear (of various categories, namely, fear of technology/mask, fear of death and dying, and fear of pain and suffering; adaptation to NIV machine; decision making; need for information; and relationship with healthcare professionals. For people using NIV treatment, the experience of being on the NIV machine is unexpected and can be stressful. Findings from this review offer healthcare professionals insights and understanding into the patient experience of NIV. Healthcare professionals may use these findings to implement new strategies in NIV provision and the exploration of the applicability of age-specific supportive care NIV guidelines.

  12. Inverse Modeling of Respiratory System during Noninvasive Ventilation by Maximum Likelihood Estimation

    Directory of Open Access Journals (Sweden)

    Esra Saatci

    2010-01-01

    Full Text Available We propose a procedure to estimate the model parameters of presented nonlinear Resistance-Capacitance (RC and the widely used linear Resistance-Inductance-Capacitance (RIC models of the respiratory system by Maximum Likelihood Estimator (MLE. The measurement noise is assumed to be Generalized Gaussian Distributed (GGD, and the variance and the shape factor of the measurement noise are estimated by MLE and Kurtosis method, respectively. The performance of the MLE algorithm is also demonstrated by the Cramer-Rao Lower Bound (CRLB with artificially produced respiratory signals. Airway flow, mask pressure, and lung volume are measured from patients with Chronic Obstructive Pulmonary Disease (COPD under the noninvasive ventilation and from healthy subjects. Simulations show that respiratory signals from healthy subjects are better represented by the RIC model compared to the nonlinear RC model. On the other hand, the Patient group respiratory signals are fitted to the nonlinear RC model with lower measurement noise variance, better converged measurement noise shape factor, and model parameter tracks. Also, it is observed that for the Patient group the shape factor of the measurement noise converges to values between 1 and 2 whereas for the Control group shape factor values are estimated in the super-Gaussian area.

  13. COPD: Mortality and Readmissions in Relation to Number of Admissions with Noninvasive Ventilation

    DEFF Research Database (Denmark)

    Ankjaergaard, Kasper Linde; Bech Rasmussen, Daniel; Schwaner, Signe Høyer

    2017-01-01

    with NIV predict new ones.We conducted a retrospective follow-up analysis of 201 patients two years after NIV treatment of AHRF. Comparison of time-to-event in patients previously treated with NIV versus patients with no previous NIV treatment. We found a one-year mortality of 33.8% and high risks of......: readmission (53.2%), any event (67.7%), and life-threatening events (49.8%). Patients with previous NIV treatments had an increased hazard ratio for life-threatening events: 1.60, p = 0.023 despite having lower in-hospital mortality than patients with no previous NIV treatment (18.9% vs. 33.1%, p = 0.043). We......In severe COPD, patients having survived acute hypercapnic respiratory failure (AHRF) treated with noninvasive ventilation (NIV) have a high mortality and risk of readmissions. The aim was to analyze the prognosis for patients with COPD having survived AHRF and to assess whether previous admissions...

  14. Noninvasive ventilation and exercise tolerance in heart failure: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Daiana C. Bündchen

    2014-10-01

    Full Text Available Background: Patients with heart failure (HF usually develop exercise intolerance. In this context, noninvasive ventilation (NIV can help to increase physical performance. Objective: To undertake a systematic review and meta-analysis of randomized controlled trials that evaluated the effects of NIV on exercise tolerance in patients with HF. Method: Search Strategy: Articles were searched in the following databases: Physiotherapy Evidence Database (PEDro, Scientific Electronic Library Online (SciELO, and MEDLINE. Selection Criteria: This review included only randomized controlled trials involving patients with HF undergoing NIV, with or without other therapies, that used exercise tolerance as an outcome, verified by the distance travelled in the six-minute walk test (6MWT, VO2peak in the cardiopulmonary test, time spent in testing, and dyspnea. Data Collection and Analysis: The methodological quality of the studies was rated according to the PEDro scale. Data were pooled in fixed-effect meta-analysis whenever possible. Results: Four studies were selected. A meta-analysis including 18 participants showed that the use of NIV prior to the 6MWT promoted increased distance, [mean difference 65.29 m (95% CI 38.80 to 91.78]. Conclusions: The use of NIV prior to the 6MWT in patients with HF may promote increased distance. However, the limited number of studies may have compromised a more definitive conclusion on the subject.

  15. Assessment of respiratory output in mechanically ventilated patients.

    Science.gov (United States)

    Laghi, Franco

    2005-06-01

    Mechanically ventilated patients are subject to few pathophysiologic disturbances that have such intuitive importance as abnormal function of the respiratory output. Abnormal function of the respiratory output plays a fundamental role in all aspects of mechanical ventilation: in determining which patients require mechanical ventilation, in determining the interaction between a patient and the ventilator, and in determining when a patient can tolerate discontinuation of mechanical ventilation. Monitoring indexes such as the rate of rise in electrical activity of the diaphragm, Po.1, (dP/dt)max, and Pmus, has provided insight into the performance of the respiratory centers in critically ill patients, but these methods require considerable refinement. A large body of research on measurements of energy expenditure of the respiratory muscles, such as pressure-time product, and measurements of inspiratory effort, such as the tension-time index, is currently accumulating. Several challenges, however, lay ahead regarding these indices. First, there is the need to identify the correct level of pressure generation and respiratory muscle effort that should be attained in the day-to-day management of mechanically ventilated patients. The correct titration of ventilator setting should not cause iatrogenic muscle damage because the support is excessive or insufficient. One of the challenges in reaching this goal is that for the same patient, different underlying pathologic conditions (eg, sepsis or ventilator-associated muscle injury) may require different levels of support. Second, many of the measurements of pressure generation and effort have been confined to the research laboratory. Modifications of the technology to achieve accurate measurements in the intensive care unit-outside of the research laboratory--are needed. To facilitate individual titration of ventilator settings, the new technologies must provide easier access to quantification of drive, pressure output, and

  16. 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.

  17. 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......Building ventilation is necessary to achieve a healthy and comfortable indoor environment, but as energy prices continue to rise it is necessary to reduce the energy consumption. Using mechanical ventilation with heat recovery reduces the ventilation heat loss significantly, but in cold climates...... freezes to ice. The analysis of measurements from existing ventilation systems with heat recovery used in single-family houses in Denmark and a test of a standard heat recovery unit in the laboratory have clearly shown that this problem occurs when the outdoor temperature gets below approximately –5º...

  18. Mechanical ventilation in pediatric intensive care units during the season for acute lower respiratory infection: a multicenter study.

    Science.gov (United States)

    Farias, Julio A; Fernández, Analía; Monteverde, Ezequiel; Flores, Juan C; Baltodano, Arístides; Menchaca, Amanda; Poterala, Rossana; Pánico, Flavia; Johnson, María; von Dessauer, Bettina; Donoso, Alejandro; Zavala, Inés; Zavala, Cesar; Troster, Eduardo; Peña, Yolanda; Flamenco, Carlos; Almeida, Helena; Nilda, Vidal; Esteban, Andrés

    2012-03-01

    To describe the characteristics and outcomes of mechanical ventilation in pediatric intensive care units during the season of acute lower respiratory infections. Prospective cohort of infants and children receiving mechanical ventilation for at least 12 hrs. Sixty medical-surgical pediatric intensive care units. All consecutive patients admitted to participating pediatric intensive care units during a 28-day period. Of 2,156 patients admitted to pediatric intensive care units, 1185 (55%) received mechanical ventilation for a median of 5 days (interquartile range 2-8). Median age was 7 months (interquartile range 2-25). Main indications for mechanical ventilation were acute respiratory failure in 78% of the patients, altered mental status in 15%, and acute on chronic pulmonary disease in 6%. Median length of stay in the pediatric intensive care units was 10 days (interquartile range 6-18). Overall mortality rate in pediatric intensive care units was 13% (95% confidence interval: 11-15) for the entire population, and 39% (95% confidence interval: 23 - 58) in patients with acute respiratory distress syndrome. Of 1150 attempts at liberation from mechanical ventilation, 62% (95% confidence interval: 60-65) used the spontaneous breathing trial, and 37% (95% confidence interval: 35-40) used gradual reduction of ventilatory support. Noninvasive mechanical ventilation was used initially in 173 patients (15%, 95% confidence interval: 13-17). In the season of acute lower respiratory infections, one of every two children admitted to pediatric intensive care units requires mechanical ventilation. Acute respiratory failure was the most common reason for mechanical ventilation. The spontaneous breathing trial was the most commonly used method for liberation from mechanical ventilation.

  19. 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.

  20. [Efficacy and safety of non-invasive positive pressure ventilation therapy in acute pulmonary edema].

    Science.gov (United States)

    Sarullo, Filippo Maria; D'Alfonso, Giovanni; Brusca, Ignazio; De Michele, Piero; Taormina, Andrea; Di Pasquale, Pietro; Castello, Antonio

    2004-03-01

    Non-invasive positive pressure ventilation (NIPPV) is an effective treatment for acute respiratory failure in patients with chronic obstructive pulmonary disease. We assessed the efficacy and safety of this therapy in acute cardiogenic pulmonary edema (ACPE). In addition to routine therapy consisting of oxygen, nitrates and diuretics, 60 patients (39 male, 21 female, mean age 72.5 +/- 15.8 years) were started on full mask NIPPV using a Sullivan VPAP II ventilator delivering pressure support 15 cm H2O, PEEP 5 cm H2O, FiO2 100%. Pressure support were titrated to achieve oxygen saturation (SaO2) > 95%. Physiological measurements were obtained in the first 2 h and at 3 h, 4 h, and 10 h. Outcome measures included arterial blood gas (ABG), Borg dyspnea score, vital signs, and need for endotracheal intubation (ETI). Initial mean values on FiO2 100% by non nonrebreather mask: pH 7.11 +/- 0.25, paCO2 67.7 +/- 17.5 mmHg, paO2 71.5 +/- 29.7 mmHg, SaO2 83 +/- 12%, lactate concentrations 4.7 +/- 2.3 mmol/L, Borg score 8.6 +/- 1.3, respiratory rate (RR) 41 +/- 7. At 60 minutes of NIPPV, improvement was statistically significant: pH 7.35 +/- 0.18 (difference 0.24; p < 0.0001), paCO2 43 +/- 13 mmHg (difference 24.7; p < 0.0001), paO2 102 +/- 10 mmHg (difference 30.5; p < 0.0001), SaO2 99 +/- 5% (difference 16; p < 0.0001), lactate concentrations 1.2 +/- 0.8 (difference 3.5; p < 0.0001) Borg score 3.6 +/- 0.9 (difference 5; p < 0.0001), RR 24.6 +/- 5 (difference 17.1; p < 0.0001). NIPPV duration ranged from 40 minutes to 24 hours (median 3 hours, 30 minutes). Fifty-six patients (93.4%) improved allowing cessation of NIPPV. ETI was required in four (6.6%) of 60 patients. There were non complications of NIPPV. In this study of acute cardiogenic pulmonary edema, NIPPV is an effective treatment and may help prevent ETI.

  1. 有创-无创序贯性机械通气治疗老年肺内源性急性呼吸窘迫综合征随机对照临床研究%Randomized control study of sequential non-invasive following short-term invasive mechanical ventilation in the treatment of acute respiratory distress syndrome as a result of existing pulmonary diseases in elderly patients

    Institute of Scientific and Technical Information of China (English)

    杜玲玲; 韩浩; 张晓军; 魏玲

    2009-01-01

    Objective To evaluate the feasibility and the efficacy of sequential non-invasive mechanical ventilation (MV) following short-term invasive MV in the treatment of acute respiratory distress syndrome (ARDS) consequent to pulmonary diseases in the elderly patients. Methods Thirty-two elderly patients of ARDS were enrolled and grouped into two groups (sequential therapy group and control group) randomly (16 cases in each group). Both groups with tracheal intubation received the following ventilation modality in the first 24 hours: control/assistant-control+positive end expiratory pressure (PEEP)+sustained inflation (SI), and when the patients' conditions were relieved, the ventilation modality was switched to synchronized intermittent mandatory ventilation (SIMV)+pressure support ventilation (PSV)+PEEP. When "ARDS-controlled window" appeared, the ventilation modility was switched to oronasal face continuous positive airway pressure (CPAP), followed by CPAP until weaning;the control group was weaned with SIMV+PSV+PEEP. The parameters including ventilation and oxygenation, ventilation duration, ventilation-associated pneumonia (VAP), duration of respiratory intensive care unit (RICU) stay were serially determined. Results Both groups had the similar baseline clinical characteristics (all P>0.05). The patients in the sequential therapy group showed shorter MV duration [(4.6±1.0) days], total duration of ventilation support [(12.7±4.0) days] and RICU stay duration [(16±7) days], and lower VAP incidence rate [6.25% (1/16)] and mortality rate [25.00% (4/16)] compared with control subjects [(21.9±9.0) days, (21.9±9.0) days, (29±13) days, 75.00% (12/16), 56.25% (9/16), respectively, P0.05);序贯组有创通气时间[(4.6±1.0)d]、总机械通气时间[(12.7±4.0)d]、住RICU时间[(16±7)d]较对照组[分别为(21.9±9.0)d、(21.9±9.0)d、(29±13)d]明显缩短,VAP发生率[6.25%(1/16)]和病死率[25.00%(4/16)]也较对照组[分别为75.00%(12/16)、56

  2. Non-Invasive Ventilation in Patients with Heart Failure: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Bittencourt, Hugo Souza; Reis, Helena França Correia Dos; Lima, Melissa Santos; Gomes, Mansueto

    2017-02-01

    Non-invasive ventilation (NIV) may perfect respiratory and cardiac performance in patients with heart failure (HF). The objective of the study to establish, through systematic review and meta-analysis, NIV influence on functional capacity of HF patients. A systematic review with meta-analysis of randomized studies was carried out through research of databases of Cochrane Library, SciELO, Pubmed and PEDro, using the key-words: heart failure, non-invasive ventilation, exercise tolerance; and the free terms: bi-level positive airway pressure (BIPAP), continuous positive airway pressure (CPAP), and functional capacity (terms were searched for in English and Portuguese) using the Boolean operators AND and OR. Methodological quality was ensured through PEDro scale. Weighted averages and a 95% confidence interval (CI) were calculated. The meta-analysis was done thorugh the software Review Manager, version 5.3 (Cochrane Collaboration). Four randomized clinical trials were included. Individual studies suggest NIV improved functional capacity. NIV resulted in improvement in the distance of the six-minute walk test (6MWT) (68.7m 95%CI: 52.6 to 84.9) in comparison to the control group. We conclude that the NIV is an intervention that promotes important effects in the improvement of functional capacity of HF patients. However, there is a gap in literature on which are the most adequate parameters for the application of this technique. Resumo A ventilação não invasiva (VNI) pode aperfeiçoar o desempenho cardíaco e respiratório dos pacientes com insuficiência cardíaca (IC). O objetivo do estudo é estabelecer, por meio de revisão sistemática e meta-análise, a influência da VNI na capacidade funcional (CF) de indivíduos com IC. Foi realizada uma revisão sistemática com meta-análise de estudos randomizados através da pesquisa nas bases de dados Biblioteca Cochrane, SciELO, Pubmed e PEDro, utilizando-se as palavras-chave: insuficiência cardíaca, ventilação n

  3. Noninvasive ventilation in amyotrophic lateral sclerosis: effects on sleep quality and quality of life.

    Science.gov (United States)

    Vandoorne, Eva; Vrijsen, Bart; Belge, Catharina; Testelmans, Dries; Buyse, Bertien

    2016-12-01

    Little is known about the effects of noninvasive ventilation (NIV) on sleep quality in amyotrophic lateral sclerosis (ALS). We aim to evaluate the long-term effects of NIV on sleep quality and quality of life in patients with ALS. In this prospective observational study, 13 ALS patients were followed for one year after initiating NIV. We evaluated sleep quality, quality of life and functional status with several questionnaires: Epworth sleepiness Scale (ESS), Pittsburg sleep quality index (PSQI), Short Form 36 Health Questionnaire (SF-36), McGill Quality of Life questionnaire (McGillQoL) and revised Amyotrophic Lateral Sclerosis Functional Rating Scale scores (ALSFRS-R). Median and interquartile range (IQR) at the start of NIV was 59 (53-65) years. The ALSFRS-R at start was 30 (24-37) (median, IQR), with three patients having severe bulbar impairment (ALSFRS-R-bulbar ≤ 9). The PaCO2 at start of NIV treatment was 48 (43-52) mmHg (median, IQR). During the one-year follow-up period, a significant decrease in the ALSFRS-R was observed. The impact of NIV in a short term (1 month) revealed a statistically significant decrease in ESS, decrease in total PSQI and of four PSQI subscales and improvement of almost all subscales of the McGill questionnaire. Long-term analyses (9 months to 1 year) revealed that amelioration in ESS and total PSQI was sustained. We conclude that accurately titrated NIV in ALS patients can stabilize sleep quality and quality of life for at least one year, despite significant disease progression.

  4. General ward and pneumonia size as predictors of noninvasive ventilation failure

    Directory of Open Access Journals (Sweden)

    Joveš-Sević Biljana

    2016-01-01

    Full Text Available Introduction. Shortage of intensive care beds has led to more frequent use of noninvasive ventilation (NIV outside respiratory units, and data on NIV efficacy and safety on general wards is lacking. Objective. The aim was to identify potential predictors for NIV failure. Methods. This was a retrospective analysis of patients treated with NIV at the Institute for Pulmonary Diseases of Vojvodina from 2009 to 2013. Demographics, blood gases, chest radiographs, setting, and outcomes were analyzed to identify predictors of NIV failure. Results. A total of 138 patients (65% men, mean age 66 ± 11 years were treated with NIV. Indications for NIV were acute exacerbation of chronic obstructive pulmonary disease (85% and cardiogenic pulmonary edema (7%, as well as respiratory insufficiency related to obesity and central hypoventilation (5% and neuromuscular disease (3%. Rate of NIV failure was 34.8%. In 86 patients NIV was applied in the High Dependency Unit (HDU, while 52 received NIV on the general ward. Baseline characteristics in terms of gender, arterial blood gases, and the extent of consolidation on chest radiographs were similar. Patients treated in HDU were younger (64.4 ± 1.2 vs. 69.4 ± 1.5 years, p < 0.001. NIV on the general ward compared to HDU had higher rates of NIV failure (28/52 vs. 20/86, p < 0.001. Presence of consolidation involving two or more quadrants on chest radiograph (55% vs. 29%, p < 0.001 was associated with NIV failure. When adjusted for age and the extent of consolidation on chest radiograph, NIV failure was still less likely in patients treated in HDU (OR 0.23, 95% CI 0.10-0.50. Conclusion. Patients with consolidation on chest X-ray and patients treated with NIV outside of dedicated respiratory units are at a higher risk for NIV failure.

  5. Unmasking of tracheomalacia following short-term mechanical ventilation in a patient of adult respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Harihar V Hegde

    2012-01-01

    Full Text Available Patients with chronic obstructive pulmonary disease (COPD are susceptible to airway malacia, which may be unmasked following mechanical ventilation or tracheostomy decannulation. Dynamic imaging of central airways, a non-invasive test as effective as bronchoscopy to diagnose airway malacia, has increased the recognition of this disorder. We describe a 70-year-old woman admitted with adult respiratory distress syndrome. She had cardiorespiratory arrest on admission, from which she was successfully resuscitated. She had obesity, hypertension, diabetes mellitus, recurrent ventricular tachycardia, sarcoidosis with interstitial lung disease and COPD. She received short-term (18 days mechanical ventilation with tracheostomy and developed respiratory distress following tracheostomy decannulation.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. [Hypercapnic respiratory failure. Pathophysiology, indications for mechanical ventilation and management].

    Science.gov (United States)

    Kreppein, U; Litterst, P; Westhoff, M

    2016-04-01

    Acute hypercapnic respiratory failure is mostly seen in patients with chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome (OHS). Depending on the underlying cause it may be associated with hypoxemic respiratory failure and places high demands on mechanical ventilation. Presentation of the current knowledge on indications and management of mechanical ventilation in patients with hypercapnic respiratory failure. Review of the literature. Important by the selection of mechanical ventilation procedures is recognition of the predominant pathophysiological component. In hypercapnic respiratory failure with a pH pathophysiological situation in patients with OHS or overlap syndrome. If severe respiratory acidosis and hypercapnia cannot be managed by mechanical ventilation therapy alone extracorporeal venous CO2 removal may be necessary. Reports on this approach in awake patients are available. The use of NIV is the predominant treatment in patients with hypercapnic respiratory failure but close monitoring is necessary in order not to miss the indications for intubation and invasive ventilation. Methods of extracorporeal CO2 removal especially in awake patients need further evaluation.

  11. 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

  12. Non-invasive mechanical ventilation in a child with central hypoventilation syndrome: one year follow-up%无创通气治疗中枢性低通气综合征一例随访观察及文献复习

    Institute of Scientific and Technical Information of China (English)

    许志飞; 贾鑫磊; 白萍; 申昆玲

    2014-01-01

    syndrome as the patient gained weight rapidly since 3 years of age and the brain magnetic resonance imaging (MRI) and genetic screening were unremarkable.Result The patient was treated with bi-level positive air pressure ventilation via nasal mask which showed good oxygen saturation and CO2 dropped down.The follow up study done one year later showed normal brain MRI,relief of pulmonary hypertension and better CO2 level in both awaken and sleeping status.Conclusion The late-onset congenital central hypoventilation syndrome in this case had onset of symptoms at 2 years of age,he had normal breathing while he was awake but had oxygen desaturation and CO2 retention during sleep,therefore,respiratory support is required in severe cases.Mechanical ventilation via tracheotomy and non-invasive ventilation via mask are the major choice.

  13. [The effect of noninvasive positive pressure ventilation in children with severe motor and intellectual disabilities with respiratory insufficiency].

    Science.gov (United States)

    Matsui, Shuji; Nakagawa, Gen; Takei, Satoko; Matsuda, Mitsunobu; Takechi, Nobuyuki; Wada, Keiko; Akahoshi, Keiko; Shiiki, Toshihide; Funahashi, Masuko; Suzuki, Yasuyuki

    2012-07-01

    We investigated the clinical course of 20 children (persons) with severe motor and intellectual disabilities (SMID) who were treated with noninvasive positive pressure ventilation (NPPV) for respiratory insufficiency. NPPV was effective in 10 of 11 patients treated for acute respiratory failure, and in 7 of 9 patients treated for chronic respiratory failure. Twelve patients were treated with NPPV for more than one year. There were no complications associated with NPPV in any of the patients. NPPV improved ventilation impairment soon after ventilation was started, and avoided the need for the endtracheal intubation by adjusting airway management and the choice of mask in all but one of the patients with acute respiratory failure. NPPV in combination with wearing a chin strap was highly effective in patients with open state or upper airway obstruction. Five patients were successfully weaned off the ventilator soon after recovery from acute respiratory failure using NPPV, whereas 5 patients who continued NPPV during the chronic phase after recovery did not experience recurrent episodes of acute respiratory failure. We conclude that NPPV may be an effective treatment for SMID with respiratory insufficiency.

  14. Pressure and volume controlled mechanical ventilation in anaesthetized pregnant sheep.

    Science.gov (United States)

    Davis, J; Musk, G C

    2014-10-01

    Optimal mechanical ventilation of the pregnant ewe during anaesthesia is of vital importance for maintaining fetal viability. This study aimed to compare peak inspiratory pressure (PIP), oxygenation and cardiovascular parameters with pressure-control (PCV) or volume-control (VCV) mechanical ventilation of anaesthetized pregnant sheep. Twenty ewes at 110 days gestation underwent general anaesthesia in dorsal recumbency for fetal surgery in a research setting. All the sheep were mechanically ventilated; one group with PCV (n = 10) and another with VCV (n = 10) to maintain normocapnia. PIP, direct arterial blood pressure, heart rate, arterial pH and arterial oxygen tension were recorded. PIP was lower in the PCV group (P sheep anaesthetized in dorsal recumbency, though PCV may provide superior oxygenation at a lower PIP.

  15. Risk factors for intubation as a guide for noninvasive ventilation in patients with severe acute cardiogenic pulmonary edema.

    Science.gov (United States)

    Masip, Josep; Páez, Joaquim; Merino, Montserrat; Parejo, Sandra; Vecilla, Francisco; Riera, Clara; Ríos, Araceli; Sabater, Joan; Ballús, Josep; Padró, J

    2003-11-01

    Noninvasive ventilation may reduce the endotracheal intubation rate in patients with acute cardiogenic pulmonary edema. However, criteria for selecting candidates for this technique are not well established. We analyzed a cohort of patients with severe acute cardiogenic pulmonary edema managed by conventional therapy to identify risk factors for intubation. These factors were used as guide for indications for noninvasive ventilation. Observational cohort registry in the ICU and emergency and cardiology departments in a community teaching hospital. . 110 consecutive patients with acute cardiogenic pulmonary edema, 80 of whom received conventional oxygen therapy. Physiological measurements and blood gas samples registered upon admission. Twenty-one patients (26%) treated with conventional oxygen therapy needed intubation. Acute myocardial infarction, pH below 7.25, low ejection fraction (predictors for intubation. Conversely, systolic blood pressure of 180 mmHg or higher showed to be a protective factor since only two patients with this blood pressure value required intubation (8%)], both presenting with a pH lower than 7.25. Considering systolic blood pressure lower than 180 mmHg, patients who showed hypercapnia presented a high intubation rate (13/21, 62%) whereas the rate of intubation in patients with normocapnia was intermediate (6/23, 26%). All normocapnic patients with pH less than 7.25 required intubation. No patient with hypocapnia was intubated regardless the level of blood pressure. Patients with pH less than 7.25 or systolic blood pressure less than 180 mmHg associated with hypercapnia should be promptly considered for noninvasive ventilation. With this strategy about 40% of the patients would be initially treated with this technique, which would involve nearly 90% of the patients that require intubation.

  16. Long-term survival for COPD patients receiving noninvasive ventilation for acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Titlestad IL

    2013-04-01

    Full Text Available Ingrid L Titlestad,1 Annmarie T Lassen,2 Jørgen Vestbo1,3 1Department of Respiratory Medicine, 2Department of Emergency Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark; 3Respiratory Research Group, Manchester Academic Health Sciences Centre, University Hospital South Manchester NHS Foundation Trust, University of Manchester, Manchester, UK Abstract: Implementation of noninvasive ventilation (NIV as an add-on treatment has been routinely used in a non-intensive care setting since 2004 for patients with chronic obstructive pulmonary disease (COPD and acute hypercapnic respiratory failure at a university hospital in Denmark. Although randomized controlled trials show lowered mortality rates in highly selected patients with acute exacerbation and respiratory failure, there are only few reports on long-term survival after receiving NIV. We present long-term all-cause mortality data from patients receiving NIV for the first time. Method: Data from medical records were retrospectively retrieved from all patients receiving NIV for the first time after being admitted acutely to an acute medical ward and further transfer to a respiratory ward with respiratory failure and a diagnosis of COPD in the period January 1, 2005 to December 31, 2007; patients were followed until January 2012. Demographic data collected included age, sex, diagnoses at discharge, and, when present, FEV1; a “not-to-intubate” order was also registered when listed. Results: In total, 253 patients (143 female, 110 male received NIV for the first time. The median age was 72 years (range 46–91 years. The 30-day mortality rate was 29.3%. The 5-year survival rate was 23.7%. Women showed a trend towards better survival than men (25.7% vs 19.2%, P = 0.25, and the trend was even more pronounced for patients with COPD. Conclusion: The mortality rate of patients receiving NIV is high, as expected in a real-life setting, but with a 5-year survival rate

  17. Validity of transcutaneous PCO2 in monitoring chronic hypoventilation treated with non-invasive ventilation.

    Science.gov (United States)

    Aarrestad, Sigurd; Tollefsen, Elin; Kleiven, Anne Louise; Qvarfort, Magnus; Janssens, Jean-Paul; Skjønsberg, Ole Henning

    2016-03-01

    Non-invasive ventilation (NIV) is an efficient treatment for patients with chronic hypercapnic respiratory failure (CRF), but requires regular monitoring to detect both diurnal and nocturnal residual hypercapnia. The present study was designed to determine 1) whether transcutaneous PCO2 (PtcCO2) is a valid tool for monitoring PaCO2 in this group of patients, and 2) if overnight instrumental drift of the PtcCO2 sensor is clinically significant. Sixty-seven patients with CRF on long term NIV were included. Arterial blood gases (ABG) were sampled from the radial artery during PtcCO2 measurement. PtcCO2 was recorded 2 min after ABG sampling. Instrumental drift was tested by measuring a gas of known CO2 concentration after auto-calibration of the sensor in the evening, and on the following morning. PaCO2 values ranged from 3.97 kPa to 9.0 kPa. Thirty-six (53%) patients were hypercapnic. Correlation between PaCO2 and PtcCO2 was highly significant (r(2) = 0.9, p < 0.0001), Bias (d) and SD of bias (s) were 0.23 kPa and 0.28 kPa respectively, with a minor underestimation of PaCO2. Limits of agreement (d ± 2s) were; -0.32; 0.79 kPa. None of the paired values of PaCO2/PtcCO2 had a difference exceeding 1 kPa. The mean drift of PtcCO2 was 0.14 ± 0.54 kPa/8 h (p = 0.04; 95% CI: 0.01-0.27). With the device tested, in stable patients under NIV-treatment for CRF, PtcCO2 accurately reflects PaCO2. PtcCO2 can be used to monitor CO2 overnight during NIV without any clinically significant drift. TRIAL REGISTRATION N°: NCT01845233. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Non-invasive ventilation in obesity hypoventilation syndrome without severe obstructive sleep apnoea

    Science.gov (United States)

    Masa, Juan F; Corral, Jaime; Caballero, Candela; Barrot, Emilia; Terán-Santos, Joaquin; Alonso-Álvarez, Maria L; Gomez-Garcia, Teresa; González, Mónica; López-Martín, Soledad; De Lucas, Pilar; Marin, José M; Marti, Sergi; Díaz-Cambriles, Trinidad; Chiner, Eusebi; Egea, Carlos; Miranda, Erika; Mokhlesi, Babak; García-Ledesma, Estefanía; Sánchez-Quiroga, M-Ángeles; Ordax, Estrella; González-Mangado, Nicolás; Troncoso, Maria F; Martinez-Martinez, Maria-Ángeles; Cantalejo, Olga; Ojeda, Elena; Carrizo, Santiago J; Gallego, Begoña; Pallero, Mercedes; Ramón, M Antonia; Díaz-de-Atauri, Josefa; Muñoz-Méndez, Jesús; Senent, Cristina; Sancho-Chust, Jose N; Ribas-Solís, Francisco J; Romero, Auxiliadora; Benítez, José M; Sanchez-Gómez, Jesús; Golpe, Rafael; Santiago-Recuerda, Ana; Gomez, Silvia; Bengoa, Mónica

    2016-01-01

    Background Non-invasive ventilation (NIV) is an effective form of treatment in patients with obesity hypoventilation syndrome (OHS) who have concomitant severe obstructive sleep apnoea (OSA). However, there is a paucity of evidence on the efficacy of NIV in patients with OHS without severe OSA. We performed a multicentre randomised clinical trial to determine the comparative efficacy of NIV versus lifestyle modification (control group) using daytime arterial carbon dioxide tension (PaCO2) as the main outcome measure. Methods Between May 2009 and December 2014 we sequentially screened patients with OHS without severe OSA. Participants were randomised to NIV versus lifestyle modification and were followed for 2 months. Arterial blood gas parameters, clinical symptoms, health-related quality of life assessments, polysomnography, spirometry, 6-min walk distance test, blood pressure measurements and healthcare resource utilisation were evaluated. Statistical analysis was performed using intention-to-treat analysis. Results A total of 365 patients were screened of whom 58 were excluded. Severe OSA was present in 221 and the remaining 86 patients without severe OSA were randomised. NIV led to a significantly larger improvement in PaCO2 of −6 (95% CI −7.7 to −4.2) mm Hg versus −2.8 (95% CI −4.3 to −1.3) mm Hg, (p<0.001) and serum bicarbonate of −3.4 (95% CI −4.5 to −2.3) versus −1 (95% CI −1.7 to −0.2 95% CI)  mmol/L (p<0.001). PaCO2 change adjusted for NIV compliance did not further improve the inter-group statistical significance. Sleepiness, some health-related quality of life assessments and polysomnographic parameters improved significantly more with NIV than with lifestyle modification. Additionally, there was a tendency towards lower healthcare resource utilisation in the NIV group. Conclusions NIV is more effective than lifestyle modification in improving daytime PaCO2, sleepiness and polysomnographic parameters. Long

  19. Links between the mechanics of ventilation and spine stability.

    Science.gov (United States)

    Wang, Simon; McGill, Stuart M

    2008-05-01

    Spine stability is ensured through isometric coactivation of the torso muscles; however, these same muscles are used cyclically to assist ventilation. Our objective was to investigate this apparent paradoxical role (isometric contraction for stability or rhythmic contraction for ventilation) of some selected torso muscles that are involved in both ventilation and support of the spine. Eight, asymptomatic, male subjects provided data on low back moments, motion, muscle activation, and hand force. These data were input to an anatomically detailed, biologically driven model from which spine load and a lumbar spine stability index was obtained. Results revealed that subjects entrained their torso stabilization muscles to breathe during demanding ventilation tasks. Increases in lung volume and back extensor muscle activation coincided with increases in spine stability, whereas declines in spine stability were observed during periods of low lung inflation volume and simultaneously low levels of torso muscle activation. As a case study, aberrant ventilation motor patterns (poor muscle entrainment), seen in one subject, compromised spine stability. Those interested in rehabilitation of patients with lung compromise and concomitant back troubles would be assisted with knowledge of the mechanical links between ventilation during tasks that impose spine loading.

  20. Mechanical ventilation: lessons from the ARDSNet trial

    Directory of Open Access Journals (Sweden)

    Marco Ranieri V

    2000-08-01

    Full Text Available Abstract The acute respiratory distress syndrome (ARDS is an inflammatory disease of the lungs characterized clinically by bilateral pulmonary infiltrates, decreased pulmonary compliance and hypoxemia. Although supportive care for ARDS seems to have improved over the past few decades, few studies have shown that any treatment can decrease mortality for this deadly syndrome. In the 4 May 2000 issue of New England Journal of Medicine, the results of an NIH-sponsored trial were presented; they demonstrated that the use of a ventilatory strategy that minimizes ventilator-induced lung injury leads to a 22% decrease in mortality. The implications of this study with respect to clinical practice, further ARDS studies and clinical research in the critical care setting are discussed.

  1. Adequacy of oxygenation parameters in elderly patients undergoing mechanical ventilation

    OpenAIRE

    Guedes, Luana Petruccio Cabral Monteiro; Delfino,Fabrício Costa; de Faria, Flavia Perassa; de Melo, Gislane Ferreira; Carvalho, Gustavo Azevedo

    2013-01-01

    ABSTRACT Objective: To compare ideal PaO2 with PaO2 found, ideal PaO2/FiO2 of room air with the one found, and ideal FiO2 with FiO2 found in mechanically ventilated elderly patients. Methods: Cross-sectional study that evaluated elderly mechanically ventilated patients for at least 72 hours and who underwent three subsequent blood gas analyses. Results: The sample consisted of 48 elderly with mean age of 74.77±9.36 years. There was a significant difference between the ideal PaO2 and the one f...

  2. O uso da ventilação mecânica não-invasiva nos cuidados paliativos de paciente com sarcoma torácico metastático: relato de caso The use of noninvasive mechanical ventilation in the palliative care of a patient with metastatic thoracic sarcoma: case report

    Directory of Open Access Journals (Sweden)

    Mariana Almada Bassani

    2008-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Os cuidados paliativos se baseiam na prevenção e alívio do sofrimento, identificando, avaliando e tratando a dor e outros problemas físicos, psicossociais e espirituais. Quadros súbitos de dispnéia são freqüentes em pacientes oncológicos em fase terminal. Nestes casos, a ventilação mecânica não-invasiva pode ser uma boa opção no manuseio da dispnéia, promovendo conforto e permitindo o contato do paciente com seus familiares. O objetivo deste estudo foi apresentar os benefícios obtidos com a ventilação mecânica não-invasiva no paciente sob cuidados paliativos. RELATO DO CASO: Paciente com 29 anos, em pós-operatório imediato de cesariana, admitida na unidade de terapia intensiva (UTI para tratamento de insuficiência respiratória aguda. À radiografia de tórax visualizava-se massa pulmonar a direita. Após investigação clínica e de imagem foi diagnosticado sarcoma torácico metastático em fase avançada, sendo indicadas pela equipe de Oncologia medidas e cuidados paliativos. Para alivio da dispnéia, a equipe multidisciplinar da UTI optou pelo uso de ventilação mecânica não-invasiva (modalidade CPAP + PSV, permitindo a interação da mãe com o bebê e familiares. CONCLUSÕES: No contexto de cuidados paliativos, a VMNI mostrou-se ser um método capaz de contribuir para o controle da dispnéia provendo conforto e alívio ao paciente.BACKGROUND AND OBJECTIVES: Palliative care is based on prevention and relief of suffering, identifying, assessing and treating pain and other physical, psychological, social and spiritual problems. Sudden dyspnea is frequently observed in terminal oncologic patients. In these cases, noninvasive ventilation can be an adequate option to control dyspnea promoting comfort and allowing patient interaction with their relatives. The aim of this article was to present the benefits of noninvasive ventilation in the palliative care setting. CASE REPORT: The case of a 29

  3. Lung mechanics in the TIMP3 null mouse and its response to mechanical ventilation.

    Science.gov (United States)

    Martin, Erica L; Truscott, Emily A; Bailey, Timothy C; Leco, Kevin J; McCaig, Lynda A; Lewis, James F; Veldhuizen, Ruud A W

    2007-03-01

    Tissue inhibitor of metalloproteinase-3 (TIMP3) null mice develop emphysema-like airspace enlargement due to an enzymatic imbalance. This study investigates how these abnormalities alter lung mechanics and the response to 2 different mechanical ventilation strategies. Phenotypically, TIMP3 null mice had increased compliance, and decreased resistance, tissue damping, and tissue elastance over wild-type controls. Decreased compliance and increased resistance were observed following the injurious ventilation strategy; however, the TIMP3 null response to both ventilation strategies was similar to wild-type mice. In conclusion, TIMP3 null mice have significant alterations in lung mechanics; however, this does not affect their response to ventilation.

  4. 有创-无创序贯性机械通气对高龄重症社区获得性肺炎患者预后的影响%An investigation of the efficacy of invasive-noninvasive sequential mechanical ventilation in senile patients with severe community-acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    郭凤英; 徐思成; 刘光明; 王秀岩

    2015-01-01

    ObjectiveTo investigate the efficacy of invasive-noninvasive sequential mechanical ventilation (MV) in senile patients with severe community-acquired pneumonia (CAP).Methods A prospective study was conducted. The patients with severe CAP aged≥ 75 years admitted to Department of Respiratory Intensive Care Unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from November 2012 to July 2014, with refusal to have tracheostomy, were enrolled. All patients meeting the diagnostic criteria of CAP and severe CAP were first admitted into the Department of Emergency, and they were found to need MV without absolute contraindication for noninvasive ventilation (NIV) in RICU. The patients were mechanically ventilated via endotracheal intubation (ETI), and they were randomly divided into invasive-noninvasive sequential MV group (sequential MV group) and conventional MV group. NIV was initiated immediately when patients matched the conditions for early extubation in the sequential MV group. Oxygen therapy (5 L/min) via a Venturi mask was provided when the indications of conventional extubation were met. The baseline data and clinical characteristics were recorded, the risk factors of death were analyzed by logistic regression analysis, and 60-day survival rate was analyzed by Kaplan-Meier curve. Results Ninety-one senile patients with severe CAP were enrolled, among them 28 patients died within 60 days, with a mortality rate of 30.77%. No significant difference in 60-day mortality was found between sequential MV group (n = 44) and conventional MV group [n = 47, 25.0% (11/44) vs. 36.2% (17/47),χ2 = 1.331,P = 0.249]. In the sequential MV group, the incidence of ventilator-associated pneumonia (VAP) was significantly decreased [27.3%(12/44) vs. 55.3% (26/47),χ2 = 7.350,P = 0.007], and the rate of ETI≥2 times was increased [59.1% (26/44) vs. 29.8% (14/47),χ2 = 5.095,P = 0.024] as compared with conventional MV group. Compared with survival group, the

  5. 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.

  6. ICU Occupancy and mechanical ventilator use in the United States

    Science.gov (United States)

    Wunsch, Hannah; Wagner, Jason; Herlim, Maximilian; Chong, David; Kramer, Andrew; Halpern, Scott D.

    2013-01-01

    Objectives Detailed data on occupancy and use of mechanical ventilators in United States intensive care units (ICU) over time and across unit types, are lacking. We sought to describe the hourly bed occupancy and use of ventilators in US ICUs to improve future planning of both the routine and disaster provision of intensive care. Design Retrospective cohort study. We calculated mean hourly bed occupancy in each ICU and hourly bed occupancy for patients on mechanical ventilators. We assessed trends in overall occupancy over the three years. We also assessed occupancy and mechanical ventilation rates across different types and sizes of ICUs. Setting 97 US ICUs participating in Project IMPACT from 2005–07. Patients 226,942 consecutive admissions to ICUs. Interventions None. Measurements and Main Results Over the three years studied, total ICU occupancy ranged from 57.4% to 82.1% and the number of beds filled with mechanically ventilated patients ranged from 20.7% to 38.9%. There was no change in occupancy across years and no increase in occupancy during influenza seasons. Mean hourly occupancy across ICUs was 68.2% SD ± 21.3, and was substantially higher in ICUs with fewer beds (mean 75.8% (± 16.5) for 5–14 beds versus 60.9% (± 22.1) for 20+ beds, P = 0.001), and in academic hospitals (78.7% (± 15.9) versus 65.3% (± 21.3) for community not-for profit hospitals, P beds available more than half the time. The mean percentage of ICU patients receiving mechanical ventilation in any given hour was 39.5% (± 15.2), and a mean of 29.0% (± 15.9) of ICU beds were filled with a patient on a ventilator. Conclusions Occupancy of US ICUs was stable over time, but there is uneven distribution across different types and sizes of units. Only three out of ten beds were filled at any time with mechanically ventilated patients, suggesting substantial surge capacity throughout the system to care for acutely critically ill patients. PMID:23963122

  7. 针对性护理对无创机械通气治疗急性心源性肺水肿患者的效果%Effect of specific nursing on the acute cardiogenic pulmonary edema of noninvasive mechanical ventilation patients

    Institute of Scientific and Technical Information of China (English)

    齐慧

    2014-01-01

    Objective To explore the effective nursing measures of noninvasive mechanical ventilation in the treatment of patients with acute cardiogenic pulmonary edema .Methods Sixty patients with acute pulmonary edema were randomly divided into observation group and control group , with 30 cases each .The observation group was treated with targeted nursing intervention , while the control group received routine nursing care.Clinical monitoring indicators of 60 patients, as well as the occurrence of complications of the two groups of patients were observed and compared .Results After treatment, clinical indicators of HR, R, pH, SpO2, PaCO2, PaO2 were (84.25 ±3.87)beat/min, (23.62 ±6.24)beat/min, (7.38 ±0.15), (0.94 ±0.01)%, (30.48 ±4.73 ) mmHg, ( 94.04 ±3.38 ) mmHg, respectively, which were significantly improved than (119.25 ±9.68)beat/min, (30.83 ±7.08) beat/min, (7.27 ±0.14), (0.83 ±0.04)%, (38.44 ± 2.86)mmHg, (65.03 ±5.79)mmHg before treatment (t =2.215,2.326,2.567,2.413,2.985,3.258, respectively;P<0 .05 ) .3 cases in the observation group had complications ( 2 cases of sputum obstruction asphyxia and 1 cases of flatulence ) .18 cases in the control group had complications ( 8 cases of sputum obstruction asphyxia and 10 cases of flatulence ).The difference was statistically significant (χ2 =3.495, 6.689, respectively;P <0.05).Conclusions The noninvasive mechanical ventilation in the treatment of patients with acute cardiogenic pulmonary edema had remarkable curative effect .During the treatment , careful nursing measures could effectively reduce the incidence of complications .%目的:探讨无创机械通气法治疗急性心源性肺水肿患者的有效护理措施。方法将采用无创机械通气法治疗的60例急性心源性肺水肿患者按照随机数字表法分为观察组30例和对照组30例,观察组采用针对性护理措施,对照组采用常规护理。观察两组患者治疗后的临床监测指标,以及两组患者的

  8. Influence of Adrenal Cortex Function of Respiratory Failure Patients on Noninvasive Mechanical Ventilation Treatment ;Outcome%呼吸衰竭患者肾上腺皮质功能对无创机械通气治疗效果的影响研究

    Institute of Scientific and Technical Information of China (English)

    廖卫平; 朱丽阳; 周立新; 傅艳妮

    2016-01-01

    Objective To investigate the influence of adrenal cortex function of respiratory failure patients on noninvasive mechanical ventilation treatment outcome. Methods From February 2010 to August 2015,120 respiratory failure patients in intensive care units( ICU)of the 4th People's Hospital of Foshan City were selected in this study. The selected patients were divided into the normal adrenal cortex function group〔plasma cortisol( COR) ﹥3. 0 μg/dl,n =80〕and the adrenocortical insufficiency group(plasma COR≤3. 0 μg/dl,n=40)according to functional status of adrenal cortex of them at admission. 14 days after treatment,patients' rehabilitation condition,and plasma COR level,pulmonary function test index, heart rate and mean arterial pressure pre and posttreatment were also compared. Results There was no significant difference in gender,average age,BMI,acute physiology and chronic health evaluation Ⅱ score( APACHEⅡ),and protopathy between the two groups(P﹥0. 05). The standard time of weaning for the first time,duration of mechanical ventilation and time of ICU stay of the adrenocortical insufficiency group were significantly longer than those in normal group(P﹤0. 05). The plasma COR level of the adrenocortical insufficiency group pre and posttreatment was significantly lower than that of normal group(P﹤0. 05);the plasma COR level of the two groups posttreatment was significantly higher than that of pretreatment(P﹤0. 05). The forced vital capacity( FVC)and the ratio of forced expiratory volume to FVC( FEV1/FVC)between two groups pretreatment showed no significant differences ( P ﹥ 0. 05 );FVC and FEV1/FVC of the adrenocortical insufficiency group posttreatment were significantly lower than those of normal group ( P ﹤ 0. 05 );FVC and FEV1/FVC between two groups posttreatment were significantly higher than those of pretreatment(P﹤0. 05). The heart rate and average arterial pressure of the two groups pre and posttreatment showed no significant

  9. Efficacy and safety of noninvasive positive pressure ventilation in the treatment of acute respiratory failure after cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    ZHU Guang-fa; WANG Di-jia; LIU Shuang; JIA Ming; JIA Shi-jie

    2013-01-01

    Background Although noninvasive positive pressure ventilation (NPPV) has been successfully used for various kinds of acute respiratory failure,the data are limited regarding its application in postoperative respiratory failure after cardiac surgery.Therefore,we conducted a prospective randomized control study in a university surgical intensive care unit to evaluate the efficacy and safety of NPPV in the treatment of acute respiratory failure after cardiac surgery,and explore the predicting factors of NPPV failure.Methods From September 2011 to November 2012 patients with acute respiratory failure after cardiac surgery who had indication for the use of NPPV were randomly divided into a NPPV treatment group (NPPV group) and the conventional treatment group (control group).The between-group differences in the patients' baseline characteristics,re-intubation rate,tracheotomy rate,ventilator associated pneumonia (VAP) incidence,in-hospital mortality,mechanical ventilation time after enrollment (MV time),intensive care unit (ICU) and postoperative hospital stays were compared.The factors that predict NPPV failure were analyzed.Results During the study period,a total of 139 patients who had acute respiratory failure after cardiac surgery were recorded,and 95 of them met the inclusion criteria,which included 59 males and 36 females with a mean age of (61.5±11.2) years.Forty-three patients underwent coronary artery bypass grafting (CABG),23 underwent valve surgery,13 underwent CABG+valve surgery,13 underwent major vascular surgery,and three underwent other surgeries.The NPPV group had 48 patients and the control group had 47 patients.In the NPPV group,the re-intubation rate was 18.8%,tracheotomy rate was 12.5%,VAP incidence was 0,and the in-hospital mortality was 18.8%,significantly lower than in the control group 80.9%,29.8%,17.0% and 38.3% respectively,P <0.05 or P <0.01.The MV time and ICU stay (expressed as the median (P25,P75)) were 18.0 (9

  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. Determinants of skin contact pressure formation during non-invasive ventilation.

    Science.gov (United States)

    Dellweg, Dominic; Hochrainer, Dieter; Klauke, Matthias; Kerl, Jens; Eiger, Glenn; Kohler, Dieter

    2010-03-01

    There is no published data about mask features that impact skin contact pressure during mask ventilation. To investigate the physical factors of skin contact pressure formation. We measured masks with original and reduced air cushion size and recorded contact pressure. We determined cushion contact and mask areas by planimetric measurements. Contact pressures necessary to prevent air leakage during inspiration exceed inspiratory pressure by 1.01+/-0.41 hPa independent of cushion size. Contact area, ventilator pressure and mask area during inspiration and expiration impact contact pressure. Mask contact pressures are higher during expiration. The contact pressure increases with increase in inspiratory pressures independent of the ventilator cycle. During expiration, the contact pressure will increase in proportion to the expiratory pressure reduction of the ventilator. The mask with reduced air cushion size developed higher contact pressures. Contact pressure can be reduced by selecting masks with a small mask area in combination with a large mask cushion.

  12. Heliox and noninvasive positive-pressure ventilation: a role for heliox in exacerbations of chronic obstructive pulmonary disease?

    Science.gov (United States)

    Hess, Dean R

    2006-06-01

    Evidence-based respiratory therapy for exacerbations of chronic obstructive pulmonary disease (COPD) includes oxygen, inhaled bronchodilators, and noninvasive positive-pressure ventilation. Examining the physics of gas flow, a case can be made either for or against the use of helium-oxygen mixture (heliox) in the care of patients with COPD. The evidence for the use of heliox in patients with COPD exacerbation is not strong at present. Most of the peer-reviewed literature consists of case reports, case series, and physiologic studies in small samples of carefully selected patients. Some patients with COPD exacerbation have a favorable physiologic response to heliox therapy, but predicting who will be a responder is difficult. Moreover, the use of heliox is hampered by the lack of widespread availability of an approved heliox delivery system. Appropriately designed randomized controlled trials with patient-important outcomes, such as avoidance of intubation, decreased intensive-care-unit and hospital days, and decreased cost of therapy, are sorely needed to establish the role of heliox in patients with COPD exacerbation, including those receiving noninvasive positive-pressure ventilation. Lacking such evidence, the use of heliox in patients with COPD exacerbation cannot be considered standard therapy.

  13. 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

  14. Liberation From Mechanical Ventilation in Critically Ill Adults

    DEFF Research Database (Denmark)

    Ouellette, Daniel R; Patel, Sheena; Girard, Timothy D

    2017-01-01

    BACKGROUND: An update of evidence-based guidelines concerning liberation from mechanical ventilation is needed as new evidence has become available. The American College of Chest Physicians (CHEST) and the American Thoracic Society (ATS) have collaborated to provide recommendations to clinicians ...

  15. 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...

  16. 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

  17. Liberation From Mechanical Ventilation in Critically Ill Adults

    DEFF Research Database (Denmark)

    Schmidt, Gregory A; Girard, Timothy D; Kress, John P

    2017-01-01

    BACKGROUND: This clinical practice guideline addresses six questions related to liberation from mechanical ventilation in critically ill adults. It is the result of a collaborative effort between the American Thoracic Society (ATS) and the American College of Chest Physicians (CHEST). METHODS...

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

    DEFF Research Database (Denmark)

    Baumgarten, Mette; Poulsen, Ingrid

    2015-01-01

    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......, consisting of anxiety, fear and loneliness. IMPLICATIONS FOR PRACTICE: In future practice, it is expected that patients will be more awake during mechanical ventilation. It is therefore important that health professionals have the knowledge that their presence and their support of the relationship between...

  19. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review

    Directory of Open Access Journals (Sweden)

    Mark Elkins

    2015-07-01

    Full Text Available Question: Does inspiratory muscle training improve inspiratory muscle strength in adults receiving mechanical ventilation? Does it improve the duration or success of weaning? Does it affect length of stay, reintubation, tracheostomy, survival, or the need for post-extubation non-invasive ventilation? Is it tolerable and does it cause adverse events? Design: Systematic review of randomised trials. Participants: Adults receiving mechanical ventilation. Intervention: Inspiratory muscle training versus sham or no inspiratory muscle training. Outcome measures: Data were extracted regarding: inspiratory muscle strength and endurance; the rapid shallow breathing index; weaning success and duration; duration of mechanical ventilation; reintubation; tracheostomy; length of stay; use of non-invasive ventilation after extubation; survival; readmission; tolerability and adverse events. Results: Ten studies involving 394 participants were included. Heterogeneity within some meta-analyses was high. Random-effects meta-analyses showed that the training significantly improved maximal inspiratory pressure (MD 7 cmH2O, 95% CI 5 to 9, the rapid shallow breathing index (MD 15 breaths/min/l, 95% CI 8 to 23 and weaning success (RR 1.34, 95% CI 1.02 to 1.76. Although only assessed in individual studies, significant benefits were also reported for the time spent on non-invasive ventilation after weaning (MD 16 hours, 95% CI 13 to 18, length of stay in the intensive care unit (MD 4.5 days, 95% CI 3.6 to 5.4 and length of stay in hospital (MD 4.4 days, 95% CI 3.4 to 5.5. Weaning duration decreased in the subgroup of patients with known weaning difficulty. The other outcomes weren’t significantly affected or weren’t measured. Conclusion: Inspiratory muscle training for selected patients in the intensive care unit facilitates weaning, with potential reductions in length of stay and the duration of non-invasive ventilatory support after extubation. The heterogeneity

  20. [Sleep-apnea syndrome, mechanical ventilation and critical care in Archivos de Bronconeumología (December 2009-December 2010)].

    Science.gov (United States)

    Abad Fernández, Araceli; Pumarega, Irene Cano; Hernández, Concepción; Sampol, Gabriel; Terán-Santos, Joaquín

    2011-01-01

    The present study aims to review all the major articles on respiratory sleep disorders, mechanical ventilation, and respiratory critical care published in the last year in Archivos de bronconeumología. Between December 2009 and November 2010, 15 studies on these topics were published in Archivos de bronconeumología. Ten of these studies dealt with respiratory sleep disorders, consisting of six original articles, one special article, one review article, one letter to the editor and one supplement on chronic obstructive pulmonary disease and its association with sleep apneas. Five articles were published on non-invasive mechanical ventilation: one editorial, one special article, one article in a supplement and two original articles. As in previous years, there was a marked difference in the number of articles published on non-invasive mechanical ventilation and sleep-apnea syndrome, with a greater number of articles being published on the latter. Although some articles highlight the importance of the place where ventilation is commenced, no study specifically dealing with intermediate care units was published in Archivos de bronconeumología in 2010. This absence could be interpreted as a result of the low implantation of this type of unit in Spain, contrasting with the high activity undertaken in this field by pneumology services.

  1. 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...... decisions higher than physician directors: median of 7 (IQR 5-8) (nurses) versus 5 (3-6) (physicians), (p collaborated in assessment of patient response to ventilator changes and titrating...... 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...

  2. 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 ...... an experimental study of the cooling of wall surfaces in a test room by mechanical night-time ventilation. Significant improvement of indoor thermal environment is presented resulting from the enhanced internal convection heat transfer.......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...

  3. Non-invasive positive pressure ventilation for acute asthma in children.

    Science.gov (United States)

    Korang, Steven Kwasi; Feinberg, Joshua; Wetterslev, Jørn; Jakobsen, Janus C

    2016-09-30

    Asthma is one of the most common reasons for hospital admission among children and constitutes a significant economic burden. Use of non-invasive positive pressure ventilation (NPPV) in the care of children with acute asthma has increased even though evidence supporting the intervention has been considered weak and clinical guidelines do not recommend the intervention. NPPV might be an effective intervention for acute asthma, but no systematic review has been conducted to assess the effects of NPPV as an add-on therapy to usual care in children with acute asthma. To assess the benefits and harms of NPPV as an add-on therapy to usual care (e.g. bronchodilators and corticosteroids) in children with acute asthma. We identified trials from the Cochrane Airways Group Specialised Register (CAGR). The Register contains trial reports identified through systematic searches of bibliographic databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, AMED and PsycINFO, and by handsearching of respiratory journals and meeting abstracts. We also conducted a search of ClinicalTrials.gov (www.ClinicalTrials.gov) and the WHO trials portal (www.who.int/ictrp/en/). We searched all databases from their inception to February 2016, with no restriction on language of publication. We included randomised clinical trials (RCTs) assessing NPPV as add-on therapy to usual care versus usual care for children (age process in sufficient detail to complete a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) flow diagram and 'Characteristics of excluded studies' table. We identified the risk of bias of included studies to reduce the risk of systematic error. We contacted relevant study authors when data were missing. We included two RCTs that randomised 20 participants to NPPV and 20 participants to control. We assessed both studies as having high risk of bias; both trials assessed effects of bilateral positive airway

  4. Effectiveness and predictors of success of noninvasive ventilation during H1N1 pandemics: a multicenter study.

    Science.gov (United States)

    Nicolini, A; Tonveronachi, E; Navalesi, P; Antonelli, M; Valentini, I; Melotti, R M; Pigna, A; Carrassi, A; Righini, P; Ferrari Bravo, M; Pelosi, P; Nicoli, F; Cosentini, R; Vaschetto, R; Faenza, S; Nava, S

    2012-12-01

    The use of non-invasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF) due to H1N1 virus infection is controversial. In this multicenter study we aimed to assess the efficacy of NIV in avoiding endotracheal intubation (ETI) and to identify predictors of success or failure. In this prospective multicenter study, 98 patients with new pulmonary infiltrate(s) sustained by H1N1 virus and a PaO(2)/FiO2intubated after 5.8+5.5 hours from enrolment. The remaining 47/60 patients were successfully ventilated with NIV. Hospital mortality was significantly higher in those patients who failed NIV vs. those who succeeded (53.8% vs. 2.1%; OR=0.52, P29 and a PaO(2)/FIO(2)≤127 at admission and PaO2/FIO(2)≤149 after 1 hr of NIV were independently associated with the need for ETI. The early application of NIV, with the aim to avoid invasive ventilation, during the H1N1 pandemics was associated with an overall success rate of 47/98 (48%). Patients presenting at admission with an high SAPS II score and a low PaO(2)/FiO(2) ratio and/or unable to promptly correct gas exchange are at high risk of intubation and mortality.

  5. Effect of Naloxone combined with noninvasive positive pressure ventilation therapy on blood gas indexes and serum indexes of COPD complicated with respiratory failure patients

    Institute of Scientific and Technical Information of China (English)

    Zhi-Xin Huang

    2015-01-01

    Objective: To analyze effect of Naloxone combined with noninvasive positive pressure ventilation therapy on blood gas indexes and serum indexes of COPD complicated with respiratory failure patients. Methods: 116 cases of COPD complicated with respiratory failure patients treated in our hospital from June 2012 to June 2014 were enrolled and randomly divided into observation group (58 cases) who received Naloxone combined with noninvasive positive pressure ventilation therapy, and control group (58 cases) who received plain noninvasive positive pressure ventilation therapy. Then differences of blood gas indexes, serum inflammatory factor levels and serum prognosis-related factor levels of both groups were compared. Results: 1) after treatment, artery blood PaO2 and PH level of observation group were higher than those of control group; PaCO2 level was lower than that of control group (P<0.05); 2) after treatment, serum factor levels of IL-13, IL-18, sICAM-1, PGE2 and hs-CRP, etc of observation group were all significantly lower than those of control group (P<0.05); 3) after treatment, serum α1-AT, D-Dimer and BNP levels of observation group were lower than those of control group; FT3 level was higher than that of control group (P<0.05). Conclusion:Naloxone combined with noninvasive positive pressure ventilation therapy helps to improve ventilation and oxygenation levels of COPD complicated with respiratory failure patients, reduce systemic inflammatory response and optimize prognosis-related indexes.

  6. Unilateral pulmonary oedema due to lung re-expansion following pleurocentesis for spontaneous pneumothorax. The role of non-invasive continuous positive airway pressure ventilation.

    Science.gov (United States)

    Papakonstantinou, Dimitrios K; Gatzioufas, Zisis I; Tzegas, Georgios I; Stergiopoulos, Panagiotis I; Tsokantaridis, Christos G; Chalikias, Georgios K; Tziakas, Dimitrios N

    2007-01-18

    Re-expansion pulmonary oedema represents a rare complication of treatment of spontaneous pneumothorax with only a few cases documented in the current literature. We present the case of a 47-year-old male who presented a right-sided spontaneous pneumothorax and developed respiratory failure after chest tube drainage. The diagnosis of re-expansion pulmonary oedema was made and he was successfully treated with non-invasive continuous positive airway pressure ventilation. Since pathogenesis of re-expansion unilateral pulmonary oedema differs significantly from that of cardiogenic pulmonary oedema, the role of non-invasive continuous positive airway pressure ventilation is discussed as an additional therapeutic option.

  7. 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. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  8. Microbial profiling of dental plaque from mechanically ventilated patients.

    Science.gov (United States)

    Sands, Kirsty M; Twigg, Joshua A; Lewis, Michael A O; Wise, Matt P; Marchesi, Julian R; Smith, Ann; Wilson, Melanie J; Williams, David W

    2016-02-01

    Micro-organisms isolated from the oral cavity may translocate to the lower airways during mechanical ventilation (MV) leading to ventilator-associated pneumonia (VAP). Changes within the dental plaque microbiome during MV have been documented previously, primarily using culture-based techniques. The aim of this study was to use community profiling by high throughput sequencing to comprehensively analyse suggested microbial changes within dental plaque during MV. Bacterial 16S rDNA gene sequences were obtained from 38 samples of dental plaque sampled from 13 mechanically ventilated patients and sequenced using the Illumina platform. Sequences were processed using Mothur, applying a 97% gene similarity cut-off for bacterial species level identifications. A significant 'microbial shift' occurred in the microbial community of dental plaque during MV for nine out of 13 patients. Following extubation, or removal of the endotracheal tube that facilitates ventilation, sampling revealed a decrease in the relative abundance of potential respiratory pathogens and a compositional change towards a more predominantly (in terms of abundance) oral microbiota including Prevotella spp., and streptococci. The results highlight the need to better understand microbial shifts in the oral microbiome in the development of strategies to reduce VAP, and may have implications for the development of other forms of pneumonia such as community-acquired infection.

  9. Consenso Argentino De Ventilacion No Invasiva Argentine consensus of non-invasive ventilation

    Directory of Open Access Journals (Sweden)

    Ana R. Diez

    2005-10-01

    tracheal intubation related complications makes it particularly attractive in patients with moderately acute respiratory failure (ARF who still have some degree of respiratory autonomy. It has also been used to support patients with chronic respiratory failure. However, final outcomes are variable according to the conditions which determined its application. This Consensus was performed in order to review the evidence supporting the use of positive pressure NIV. The patho-physiological background of NIV and the equipment required technology are described. Available evidence clearly suggests benefits of NIV in acute exacerbation of chronic obstructive pulmonary disease (COPD and in cardiogenic pulmonary edema (Recommendation A. When considering ARF in the setting of acute respiratory distress syndromeresults are uncertain, unless dealing with immunosupressed patients (Recommendation B. Positive results are also shown in weaning of mechanical ventilation (MV, particularly regarding acute exacerbation of COPD patients (Recommendation A. An improved quality of life in chronic respiratory failure and a longer survival in restrictive disorders has also been shown (Recommendation B while its benefit in stable COPD patients is still controversial (Recommendation C. NIV should be performed according to pre-established standards. A revision of NIV related complications is performed and the cost-benefit comparison with invasive MV is also considered.

  10. [Lung-brain interaction in the mechanically ventilated patient].

    Science.gov (United States)

    López-Aguilar, J; Fernández-Gonzalo, M S; Turon, M; Quílez, M E; Gómez-Simón, V; Jódar, M M; Blanch, L

    2013-10-01

    Patients with acute lung injury or acute respiratory distress syndrome (ARDS) admitted to the ICU present neuropsychological alterations, which in most cases extend beyond the acute phase and have an important adverse effect upon quality of life. The aim of this review is to deepen in the analysis of the complex interaction between lung and brain in critically ill patients subjected to mechanical ventilation. This update first describes the neuropsychological alterations occurring both during the acute phase of ICU stay and at discharge, followed by an analysis of lung-brain interactions during mechanical ventilation, and finally explores the etiology and mechanisms leading to the neurological disorders observed in these patients. The management of critical patients requires an integral approach focused on minimizing the deleterious effects over the short, middle or long term. Copyright © 2012 Elsevier España, S.L. y SEMICYUC. All rights reserved.

  11. Ventilation distribution and chest wall mechanics in microgravity

    Science.gov (United States)

    Paiva, M.; Wantier, M.; Verbanck, S.; Engel, L. A.; Prisk, G. K.; Guy, H. J. B.; West, J. B.

    1997-01-01

    The effect of gravity on lung ventilation distribution and the mechanisms of the chest wall were investigated. The following tests were performed with the respiratory monitoring system of the Anthorack, flown onboard Spacelab D2 mission: single breath washout (SBW), multiple breath washout (MBW) and argon rebreathing (ARB). In order to study chest wall mechanisms in microgravity, a respiratory inductive plethysmograph was used. The SBW tests did not reach statistical significance, while the ARB tests showed that gravity independent inhomogeneity of specific ventilation is larger than gravity dependent inhomogeneity. In which concerns the chest wall mechanisms, the analysis on the four astronauts during the normal respirations of the relaxation maneuver showed a 40 percent increase on the abdominal contribution to respiration.

  12. 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

  13. Pulmonary levels of high-mobility group box 1 during mechanical ventilation and ventilator-associated pneumonia

    NARCIS (Netherlands)

    van Zoelen, Marieke A D; Ishizaka, Akitoshi; Wolthuls, Esther K; Choi, Goda; van der Poll, Tom; Schultz, Marcus J

    2008-01-01

    High-mobility group box (HMGB) 1 is a recently discovered proinflammatory mediator that contributes to acute lung injury. We determined HMGB-1 levels in bronchoalveolar lavage fluid of patients during mechanical ventilation (MV) and ventilator-associated pneumonia (VAP). Bronchoalveolar lavage fluid

  14. 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.

  15. Effective sample size estimation for a mechanical ventilation trial through Monte-Carlo simulation: Length of mechanical ventilation and Ventilator Free Days.

    Science.gov (United States)

    Morton, S E; Chiew, Y S; Pretty, C; Moltchanova, E; Scarrott, C; Redmond, D; Shaw, G M; Chase, J G

    2017-02-01

    Randomised control trials have sought to seek to improve mechanical ventilation treatment. However, few trials to date have shown clinical significance. It is hypothesised that aside from effective treatment, the outcome metrics and sample sizes of the trial also affect the significance, and thus impact trial design. In this study, a Monte-Carlo simulation method was developed and used to investigate several outcome metrics of ventilation treatment, including 1) length of mechanical ventilation (LoMV); 2) Ventilator Free Days (VFD); and 3) LoMV-28, a combination of the other metrics. As these metrics have highly skewed distributions, it also investigated the impact of imposing clinically relevant exclusion criteria on study power to enable better design for significance. Data from invasively ventilated patients from a single intensive care unit were used in this analysis to demonstrate the method. Use of LoMV as an outcome metric required 160 patients/arm to reach 80% power with a clinically expected intervention difference of 25% LoMV if clinically relevant exclusion criteria were applied to the cohort, but 400 patients/arm if they were not. However, only 130 patients/arm would be required for the same statistical significance at the same intervention difference if VFD was used. A Monte-Carlo simulation approach using local cohort data combined with objective patient selection criteria can yield better design of ventilation studies to desired power and significance, with fewer patients per arm than traditional trial design methods, which in turn reduces patient risk. Outcome metrics, such as VFD, should be used when a difference in mortality is also expected between the two cohorts. Finally, the non-parametric approach taken is readily generalisable to a range of trial types where outcome data is similarly skewed.

  16. 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

  17. Postoperative Pulmonary Dysfunction and Mechanical Ventilation in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Rafael Badenes

    2015-01-01

    Full Text Available Postoperative pulmonary dysfunction (PPD is a frequent and significant complication after cardiac surgery. It contributes to morbidity and mortality and increases hospitalization stay and its associated costs. Its pathogenesis is not clear but it seems to be related to the development of a systemic inflammatory response with a subsequent pulmonary inflammation. Many factors have been described to contribute to this inflammatory response, including surgical procedure with sternotomy incision, effects of general anesthesia, topical cooling, and extracorporeal circulation (ECC and mechanical ventilation (VM. Protective ventilation strategies can reduce the incidence of atelectasis (which still remains one of the principal causes of PDD and pulmonary infections in surgical patients. In this way, the open lung approach (OLA, a protective ventilation strategy, has demonstrated attenuating the inflammatory response and improving gas exchange parameters and postoperative pulmonary functions with a better residual functional capacity (FRC when compared with a conventional ventilatory strategy. Additionally, maintaining low frequency ventilation during ECC was shown to decrease the incidence of PDD after cardiac surgery, preserving lung function.

  18. Influence of the ventilatory mode on acute adverse effects and facial thermography after noninvasive ventilation.

    Science.gov (United States)

    Pontes, Suzy Maria Montenegro; Melo, Luiz Henrique de Paula; Maia, Nathalia Parente de Sousa; Nogueira, Andrea da Nóbrega Cirino; Vasconcelos, Thiago Brasileiro; Pereira, Eanes Delgado Barros; Bastos, Vasco Pinheiro Diógenes; Holanda, Marcelo Alcantara

    2017-01-01

    To compare the incidence and intensity of acute adverse effects and the variation in the temperature of facial skin by thermography after the use of noninvasive ventilation (NIV). We included 20 healthy volunteers receiving NIV via oronasal mask for 1 h. The volunteers were randomly divided into two groups according to the ventilatory mode: bilevel positive airway pressure (BiPAP) or continuous positive airway pressure (CPAP). Facial thermography was performed in order to determine the temperature of the face where it was in contact with the mask and of the nasal dorsum at various time points. After removal of the mask, the volunteers completed a questionnaire about adverse effects of NIV. The incidence and intensity of acute adverse effects were higher in the individuals receiving BiPAP than in those receiving CPAP (16.1% vs. 5.6%). Thermographic analysis showed a significant cooling of the facial skin in the two regions of interest immediately after removal of the mask. The more intense acute adverse effects occurred predominantly among the participants in whom the decrease in the mean temperature of the nasal dorsum was lower (14.4% vs. 7.2%). The thermographic visual analysis of the zones of cooling and heating on the face identified areas of hypoperfusion or reactive hyperemia. The use of BiPAP mode was associated with a higher incidence and intensity of NIV-related acute adverse effects. There was an association between acute adverse effects and less cooling of the nasal dorsum immediately after removal of the mask. Cutaneous thermography can be an additional tool to detect adverse effects that the use of NIV has on facial skin. Comparar a incidência e a intensidade de efeitos adversos agudos e a variação da temperatura da pele da face através da termografia após a aplicação de ventilação não invasiva (VNI). Foram incluídos 20 voluntários sadios, de ambos os gêneros, submetidos à VNI com máscara oronasal por 1 h e divididos aleatoriamente em

  19. 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...... 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......') oscillations were absent in 9% and 22% of the patients, respectively. In patients in whom spontaneous blood pressure oscillations were preserved, the MF' oscillations occurred at 0.021 Hz (median, interquartile range 0.013-0.030), whereas the LF' oscillations occurred at 0.009 Hz (median, interquartile range 0...

  20. The application of improved Glasgow coma scale score of 15 as switching point for invasive-noninvasive mechanical ventilation in treatment of severe respiratory failure in chronic obstructive pulmonary disease%以改良格拉斯哥昏迷评分15分为切换点在有创-无创机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭中的应用

    Institute of Scientific and Technical Information of China (English)

    郑大伟; 王承志; 刘仁水; 高峰; 邓顺莲; 周鹏; 何炎

    2011-01-01

    Objective To estimate the feasibility and the efficacy of early extubation and the sequential non-invasive mechanical ventilation (MV) in severe respiratory failure of chronic obstructive pulmonary disease (COPD) with the improved Glasgow coma scale (GCS) score of 15 as the switching point. Methods By a prospective control study, 20 patients with COPD and respiratory failure who had undergone endotracheal intubation and MV from March 2007 to November 2009 were enrolled as treatment group.Invasive MV with synchronous intermittent mandatory ventilation and pressure support ventilation (SIMV+PSV) pattern were given to these patients. When the period of "improved GCS score of 15 standard" window period appeared and being kept for 2 hours, endotracheal tube was extubated, and nasal mask with PSV±positive end-expiratory pressure (PEEP) was used, followed by gradual decrease of the level of pressure support till weaning of MV. Nineteen patients who were treated with MV with ordinary way of weaning from March 2005 to March 2007 served as the control group. Prior to the MV, the ventilation and oxygenation index, the length of invasive MV, total MV time, total hospital stay, re-intubation and ventilator-associated pneumonia (VAP) occurred in the number of cases were observed and compared between two groups. Results There was no significant difference in the ventilation and oxygenation index prior to the MV. Compared with control group, in treatment group, the length of invasive ventilation (days: 3. 2±1.1 vs. 10. 5± 3. 2),the total duration of MV (days: 4. 8±2. 5 vs. 10. 5±3. 2), the length of hospital stay (days:17±3 vs. 22±7) were significantly shorter (all P<0.01), and the incidence of VAP was significantly lower (cases: 0 vs.5, P< 0. 01), while the number of re-intubation was slightly higher but without statistical significance (cases:3 vs. 1, P>0. 05). Conclusion The application of improved GCS score of 15 as the switching point with 2 hours as window

  1. A rapid decrease in pulmonary arterial pressure by noninvasive positive pressure ventilation in a patient with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Dursunoglu Nese

    2007-01-01

    Full Text Available The natural history of chronic obstructive pulmonary disease (COPD is characterized by progressive decrements in expiratory airflow, increments in end-expired pulmonary volume, hypoxaemia, hypercapnia and the progression of pulmonary arterial hypertension (PAH. Noninvasive positive pressure ventilation (NPPV treatment is increasingly used for the treatment of acute and chronic respiratory failure in patients with COPD. NPPV can increase PaO2 and decrease PaCO2 by correcting the gas exchange in such patients. The acute effect of NPPV on decreasing PAP is seen in patients with respiratory failure, probably due to the effect on cardiac output. Here, a case with COPD whose respiratory acidosis and PAH rapidly improved by NPPV was presented and therefore we suggested to perform an echocardiographic assessment to reveal an improvement of PAH as well as respiratory acidosis, hypercapnia and hypoxemia with that treatment.

  2. The Significance of Sedation Control in Patients Receiving Mechanical Ventilation

    OpenAIRE

    2012-01-01

    Background Adequate assessment and control of sedation play crucial roles in the proper performance of mechanical ventilation. Methods A total of 30 patients with various pulmonary diseases were prospectively enrolled. The study population was randomized into two groups. The sedation assessment group (SAG) received active protocol-based control of sedation, and in the empiric control group (ECG), the sedation levels were empirically adjusted. Subsequently, daily interruption of sedation (DIS)...

  3. Factors leading to poor outcome of noninvasive positive pressure ventilation in acute exacerbation of chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    Ashok Kumar; Anoop Kumar; Kelash Rai; Shaista Ghazal; Nadeem Rizvi; Sunil Kumar; Sadhna Notani

    2015-01-01

    Objective:To determine frequency of factors leading to poor outcome of non-invasive positive pressure ventilation in acute exacerbation of chronic obstructive pulmonary disease. Methods:This cross sectional study was conducted at our center between May 2012 and November 2012. A total of 195 diagnosed patients of acute exacerbation of chronic obstructive pulmonary disease meeting the inclusion criteria were selected from the ER department. At the time of admission age was inquired BP, respiratory rate and oxygen saturation will be noted and pedal edema was assessed and investigations were sent for pH assessment. Noninvasive positive pressure ventilation (NIPPV) using BiPAP was applied in spontaneous mode by the help of oronasal mask. Presence of respiratory rate (less than 12/min), systolic blood pressure140 bpm was taken as poor outcome. Results:The average age of the cases was 61.9±9.3 years with male to female ratio being 1.5:1. NIPPV was successful in 151 (77.4%) cases and 44 (22.6%) cases were underwent endotracheal intubation. About 38 (44.7%) of patients with oxygen saturation (82%-86%) had poor prognosis. A total of 40 (55.6%) of patients with pH range 7.20-7.26, required endotracheal intubation, 43 (66.2%) with pedal edema underwent endotracheal intubation. While 29 (24.16%) patients of age>60 years needed endotracheal intubation. Conclusions:In this study, NIPPV was successful in 77.4%cases and 22.6%cases were underwent endotracheal intubation. Pedal edema was the most common factor leading to poor outcomes while age>60 years was the least common factor, 66.2%and 24.2%respectively.

  4. Hot Topics in Noninvasive Ventilation : Report of a Working Group at the International Symposium on Sleep-Disordered Breathing in Leuven, Belgium

    NARCIS (Netherlands)

    Vrijsen, Bart; Chatwin, Michelle; Contal, Oliver; Derom, Eric; Janssens, Jean-Paul; Kampelmacher, Mike J.; Muir, Jean-Francois; Pinto, Susana; Rabec, Claudio; Ramsay, Michelle; Randerath, Winfried J.; Storre, Jan H.; Wijkstra, Peter J.; Windisch, Wolfram; Testelmans, Dries

    2015-01-01

    During the last few decades, attention has increasingly focused on noninvasive ventilation (NIV) in the treatment of chronic respiratory failure. The University of Leuven and the University Hospitals Leuven therefore chose this topic for a 2-day working group session during their International Sympo

  5. Hot Topics in Noninvasive Ventilation : Report of a Working Group at the International Symposium on Sleep-Disordered Breathing in Leuven, Belgium

    NARCIS (Netherlands)

    Vrijsen, Bart; Chatwin, Michelle; Contal, Oliver; Derom, Eric; Janssens, Jean-Paul; Kampelmacher, Mike J.; Muir, Jean-Francois; Pinto, Susana; Rabec, Claudio; Ramsay, Michelle; Randerath, Winfried J.; Storre, Jan H.; Wijkstra, Peter J.; Windisch, Wolfram; Testelmans, Dries

    During the last few decades, attention has increasingly focused on noninvasive ventilation (NIV) in the treatment of chronic respiratory failure. The University of Leuven and the University Hospitals Leuven therefore chose this topic for a 2-day working group session during their International

  6. Two-year home-based nocturnal noninvasive ventilation added to rehabilitation in chronic obstructive pulmonary disease patients : A randomized controlled trial

    NARCIS (Netherlands)

    Duiverman, Marieke L.; Wempe, Johan B.; Bladder, Gerrie; Vonk, Judith M.; Zijlstra, Jan G.; Kerstjens, Huib A. M.; Wijkstra, Peter J.

    2011-01-01

    Background: The use of noninvasive intermittent positive pressure ventilation (NIPPV) in chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure remains controversial as long-term data are almost lacking. The aim was to compare the outcome of 2-year home-ba

  7. Management and outcome of mechanically ventilated patients after cardiac arrest.

    Science.gov (United States)

    Sutherasan, Yuda; Peñuelas, Oscar; Muriel, Alfonso; Vargas, Maria; Frutos-Vivar, Fernando; Brunetti, Iole; Raymondos, Konstantinos; D'Antini, Davide; Nielsen, Niklas; Ferguson, Niall D; Böttiger, Bernd W; Thille, Arnaud W; Davies, Andrew R; Hurtado, Javier; Rios, Fernando; Apezteguía, Carlos; Violi, Damian A; Cakar, Nahit; González, Marco; Du, Bin; Kuiper, Michael A; Soares, Marco Antonio; Koh, Younsuck; Moreno, Rui P; Amin, Pravin; Tomicic, Vinko; Soto, Luis; Bülow, Hans-Henrik; Anzueto, Antonio; Esteban, Andrés; Pelosi, Paolo

    2015-05-08

    The aim of this study was to describe and compare the changes in ventilator management and complications over time, as well as variables associated with 28-day hospital mortality in patients receiving mechanical ventilation (MV) after cardiac arrest. We performed a secondary analysis of three prospective, observational multicenter studies conducted in 1998, 2004 and 2010 in 927 ICUs from 40 countries. We screened 18,302 patients receiving MV for more than 12 hours during a one-month-period. We included 812 patients receiving MV after cardiac arrest. We collected data on demographics, daily ventilator settings, complications during ventilation and outcomes. Multivariate logistic regression analysis was performed to calculate odds ratios, determining which variables within 24 hours of hospital admission were associated with 28-day hospital mortality and occurrence of acute respiratory distress syndrome (ARDS) and pneumonia acquired during ICU stay at 48 hours after admission. Among 812 patients, 100 were included from 1998, 239 from 2004 and 473 from 2010. Ventilatory management changed over time, with decreased tidal volumes (VT) (1998: mean 8.9 (standard deviation (SD) 2) ml/kg actual body weight (ABW), 2010: 6.7 (SD 2) ml/kg ABW; 2004: 9 (SD 2.3) ml/kg predicted body weight (PBW), 2010: 7.95 (SD 1.7) ml/kg PBW) and increased positive end-expiratory pressure (PEEP) (1998: mean 3.5 (SD 3), 2010: 6.5 (SD 3); P <0.001). Patients included from 2010 had more sepsis, cardiovascular dysfunction and neurological failure, but 28-day hospital mortality was similar over time (52% in 1998, 57% in 2004 and 52% in 2010). Variables independently associated with 28-day hospital mortality were: older age, PaO2 <60 mmHg, cardiovascular dysfunction and less use of sedative agents. Higher VT, and plateau pressure with lower PEEP were associated with occurrence of ARDS and pneumonia acquired during ICU stay. Protective mechanical ventilation with lower VT and higher PEEP is more

  8. 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

  9. A new horizon for the use of non-invasive ventilation in patients with acute respiratory distress syndrome

    Science.gov (United States)

    2016-01-01

    Non-invasive ventilation (NIV) has assumed an important role in the management of acute respiratory failure (ARF). NIV, compared with standard medical therapy, improves survival and reduces complications in selected patients with ARF. NIV represents the first-line intervention for some forms of ARF, such as chronic obstructive pulmonary disease (COPD) exacerbations and acute cardiogenic pulmonary edema. The use of NIV is also well supported for immunocompromised patients who are at high risk for infectious complications from endotracheal intubation. Selection of appropriate patients is crucial for optimizing NIV success rates. Appropriate ventilator settings, a well-fitting and comfortable interface, and a team skilled and experienced in managing NIV are key components to its success. In a recent issue of the Journal of the American Medical Association, Patel et al. reported the results of their single-center trial of 83 patients with acute respiratory distress syndrome (ARDS) who were randomly assigned to NIV delivered via a helmet or face mask. Patients assigned to the helmet group exhibited a significantly lower intubation rate and were more likely to survive through 90 days. This perspective reviews the findings of this trial in the context of current clinical practice and in light of data from the literature focused on the potential reasons for success of NIV delivered through a helmet compared to face mask. The implications for early management of patients with ARDS are likewise discussed.

  10. Hypervirulent Klebsiella pneumoniae induced ventilator-associated pneumonia in mechanically ventilated patients in China.

    Science.gov (United States)

    Yan, Q; Zhou, M; Zou, M; Liu, W-e

    2016-03-01

    The purpose of this study was to investigate the clinical characteristics of hypervirulent K. pneumoniae (hvKP) induced ventilator-associated pneumonia (VAP) and the microbiological characteristics and epidemiology of the hvKP strains. A retrospective study of 49 mechanically ventilated patients with K. pneumoniae induced VAP was conducted at a university hospital in China from January 2014 to December 2014. Clinical characteristics and K. pneumoniae antimicrobial susceptibility and biofilm formation were analyzed. Genes of capsular serotypes K1, K2, K5, K20, K54 and K57 and virulence factors plasmid rmpA(p-rmpA), iroB, iucA, mrkD, entB, iutA, ybtS, kfu and allS were also evaluated. Multilocus sequence typing (MLST) and random amplified polymorphic DNA (RAPD) analyses were used to study the clonal relationship of the K. pneumoniae strains. Strains possessed p-rmpA and iroB and iucA were defined as hvKP. Of 49 patients, 14 patients (28.6 %) were infected by hvKP. Antimicrobial resistant rate was significantly higher in cKP than that in hvKP. One ST29 K54 extended-spectrum-beta-lactamase (ESBL) producing hvKP strain was detected. The prevalence of K1 and K2 in hvKP was 42.9 % and 21.4 %, respectively. The incidences of K1, K2, K20, p-rmpA, iroB, iucA, iutA, Kfu and alls were significantly higher in hvKP than those in cKP. ST23 was dominant among hvKP strains, and all the ST23 strains had identical RAPD pattern. hvKP has become a common pathogen of VAP in mechanically ventilated patients in China. Clinicians should increase awareness of hvKP induced VAP and enhance epidemiologic surveillance.

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

    DEFF Research Database (Denmark)

    Bertelsen, Mads F.; Buchanan, Rasmus; Jensen, Heidi M.

    2015-01-01

    , randomized trial. ANIMALS: Twenty one fasted adult South American rattlesnakes (Crotalus durissus terrificus). METHODS: Snakes were anesthetized with propofol (15 mg kg(-1) ) intravenously, endotracheally intubated and assigned to one of four ventilation regimens: Spontaneous ventilation, or mechanical...

  12. End-tidal arterial CO2 partial pressure gradient in patients with severe hypercapnia undergoing noninvasive ventilation

    Directory of Open Access Journals (Sweden)

    Defilippis V

    2013-06-01

    Full Text Available Vito Defilippis,1 Davide D’Antini,2 Gilda Cinnella,2 Michele Dambrosio,2 Fernando Schiraldi,3 Vito Procacci1 1Emergency Department, Riuniti Hospital, 2Department of Anaesthesiology and Intensive Care, University of Foggia, Foggia, 3Emergency Department, San Paolo Hospital, Naples, Italy Background: Patients with severe hypercapnia represent a particularly serious condition in an emergency department (ED, requiring immediate attention. Noninvasive ventilation (NIV is an integral part of the treatment for acute respiratory failure. The present study aimed to validate the measurement of end-tidal CO2 (EtCO2 as a noninvasive technique to evaluate the effectiveness of NIV in acute hypercapnic respiratory failure. Methods: Twenty consecutive patients admitted to the ED with severe dyspnea were enrolled in the study. NIV by means of bilevel positive airway pressure, was applied to the patients simultaneously with standard medical therapy and continued for 12 hours; the arterial blood gases and side-stream nasal/oral EtCO2 were measured at subsequent times: T0 (admission to the ED, T1h (after 1 hour, T6h (after 6 hours, and T12h (after 12 hours during NIV treatment. Results: The arterial CO2 partial pressure (PaCO2–EtCO2 gradient decreased progressively, reaching at T6h and T12h values lower than baseline (P < 0.001, while arterial pH increased during the observation period (P < 0.001. A positive correlation was found between EtCO2 and PaCO2 values (r = 0.89, P < 0.001 at the end of the observation period. Conclusion: In our hypercapnic patients, the effectiveness of the NIV was evidenced by the progressive reduction of the PaCO2–EtCO2 gradient. The measurement of the CO2 gradient could be a reliable method in monitoring the effectiveness of NIV in acute hypercapnic respiratory failure in the ED. Keywords: arterial end-tidal CO2 gradient, noninvasive ventilation, bilevel positive airway pressure, acute respiratory failure

  13. 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

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

    Science.gov (United States)

    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 experiments were performed in each to determine the reproducibility of the method. A solution of technetium-99m labelled human serum albumin (99mTc HSA (50 micrograms); activity in experiment 1, 74 MBq; in experiment 2, 185 MBq) in 3 ml saline was administered with a Siemens Servo 945 nebuliser system (high setting) and a System 22 Acorn nebuliser unit. Pulmonary deposition was quantified by means of a gamma camera and corrections derived from lung phantom studies. RESULTS: Pulmonary aerosol deposition was completed in 22 (SD 4) minutes. Total pulmonary deposition (% nebuliser dose (SD)) was 2.2 (0.8)% with 1.5% and 0.7% depositing in the right and left lungs respectively; 0.9% of the nebuliser activity was detected in the endotracheal tube or trachea and 51% was retained within the nebuliser unit. Considerable variability between subjects was found for total deposition (coefficient of variation (CV) 46%), but within subject reproducibility was good (CV 15%). CONCLUSIONS: Administration of aerosol in this way is inefficient and further research is needed to find more effective alternatives in patients who require mechanical respiratory support. This method of measurement seems suitable for the assessment of new methods of aerosol delivery in these patients. Images PMID:8493630

  15. Communication of mechanically ventilated patients in intensive care units

    Science.gov (United States)

    Martinho, Carina Isabel Ferreira; Rodrigues, Inês Tello Rato Milheiras

    2016-01-01

    Objective The aim of this study was to translate and culturally and linguistically adapt the Ease of Communication Scale and to assess the level of communication difficulties for patients undergoing mechanical ventilation with orotracheal intubation, relating these difficulties to clinical and sociodemographic variables. Methods This study had three stages: (1) cultural and linguistic adaptation of the Ease of Communication Scale; (2) preliminary assessment of its psychometric properties; and (3) observational, descriptive-correlational and cross-sectional study, conducted from March to August 2015, based on the Ease of Communication Scale - after extubation answers and clinical and sociodemographic variables of 31 adult patients who were extubated, clinically stable and admitted to five Portuguese intensive care units. Results Expert analysis showed high agreement on content (100%) and relevance (75%). The pretest scores showed a high acceptability regarding the completion of the instrument and its usefulness. The Ease of Communication Scale showed excellent internal consistency (0.951 Cronbach's alpha). The factor analysis explained approximately 81% of the total variance with two scale components. On average, the patients considered the communication experiences during intubation to be "quite hard" (2.99). No significant correlation was observed between the communication difficulties reported and the studied sociodemographic and clinical variables, except for the clinical variable "number of hours after extubation" (p < 0.05). Conclusion This study translated and adapted the first assessment instrument of communication difficulties for mechanically ventilated patients in intensive care units into European Portuguese. The preliminary scale validation suggested high reliability. Patients undergoing mechanical ventilation reported that communication during intubation was "quite hard", and these communication difficulties apparently existed regardless of the

  16. 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

  17. Inhibition of Janus kinase signaling during controlled mechanical ventilation prevents ventilation-induced diaphragm dysfunction.

    Science.gov (United States)

    Smith, Ira J; Godinez, Guillermo L; Singh, Baljit K; McCaughey, Kelly M; Alcantara, Raniel R; Gururaja, Tarikere; Ho, Melissa S; Nguyen, Henry N; Friera, Annabelle M; White, Kathy A; McLaughlin, John R; Hansen, Derek; Romero, Jason M; Baltgalvis, Kristen A; Claypool, Mark D; Li, Wei; Lang, Wayne; Yam, George C; Gelman, Marina S; Ding, Rongxian; Yung, Stephanie L; Creger, Daniel P; Chen, Yan; Singh, Rajinder; Smuder, Ashley J; Wiggs, Michael P; Kwon, Oh-Sung; Sollanek, Kurt J; Powers, Scott K; Masuda, Esteban S; Taylor, Vanessa C; Payan, Donald G; Kinoshita, Taisei; Kinsella, Todd M

    2014-07-01

    Controlled mechanical ventilation (CMV) is associated with the development of diaphragm atrophy and contractile dysfunction, and respiratory muscle weakness is thought to contribute significantly to delayed weaning of patients. Therefore, therapeutic strategies for preventing these processes may have clinical benefit. The aim of the current study was to investigate the role of the Janus kinase (JAK)/signal transducer and activator of transcription 3 (STAT3) signaling pathway in CMV-mediated diaphragm wasting and weakness in rats. CMV-induced diaphragm atrophy and contractile dysfunction coincided with marked increases in STAT3 phosphorylation on both tyrosine 705 (Tyr705) and serine 727 (Ser727). STAT3 activation was accompanied by its translocation into mitochondria within diaphragm muscle and mitochondrial dysfunction. Inhibition of JAK signaling during CMV prevented phosphorylation of both target sites on STAT3, eliminated the accumulation of phosphorylated STAT3 within the mitochondria, and reversed the pathologic alterations in mitochondrial function, reduced oxidative stress in the diaphragm, and maintained normal diaphragm contractility. In addition, JAK inhibition during CMV blunted the activation of key proteolytic pathways in the diaphragm, as well as diaphragm atrophy. These findings implicate JAK/STAT3 signaling in the development of diaphragm muscle atrophy and dysfunction during CMV and suggest that the delayed extubation times associated with CMV can be prevented by inhibition of Janus kinase signaling.-Smith, I. J., Godinez, G. L., Singh, B. K., McCaughey, K. M., Alcantara, R. R., Gururaja, T., Ho, M. S., Nguyen, H. N., Friera, A. M., White, K. A., McLaughlin, J. R., Hansen, D., Romero, J. M., Baltgalvis, K. A., Claypool, M. D., Li, W., Lang, W., Yam, G. C., Gelman, M. S., Ding, R., Yung, S. L., Creger, D. P., Chen, Y., Singh, R., Smuder, A. J., Wiggs, M. P., Kwon, O.-S., Sollanek, K. J., Powers, S. K., Masuda, E. S., Taylor, V. C., Payan, D. G

  18. The effects of long-term noninvasive ventilation in hypercapnic COPD patients: a randomized controlled pilot study

    Directory of Open Access Journals (Sweden)

    De Backer L

    2011-11-01

    Full Text Available L De Backer¹, W Vos², B Dieriks¹, D Daems¹, S Verhulst¹, S Vinchurkar², K Ides¹, J De Backer², P Germonpre¹, W De Backer¹1Antwerp University Hospital, Department of Respiratory Medicine, 2FluidDa, Antwerp, BelgiumIntroduction: Noninvasive ventilation (NIV is a well-established treatment for acute-on-chronic respiratory failure in hypercapnic COPD patients. Less is known about the effects of a long-term treatment with NIV in hypercapnic COPD patients and about the factors that may predict response in terms of improved oxygenation and lowered CO2 retention.Methods: In this study, we randomized 15 patients to a routine pharmacological treatment (n = 5, age 66 [standard deviation ± 6] years, FEV1 30.5 [±5.1] %pred, PaO2 65 [±6] mmHg, PaCO2 52.4 [±6.0] mmHg or to a routine treatment and NIV (using the Synchrony BiPAP device [Respironics, Inc, Murrsville, PA] (n = 10, age 65 [±7] years, FEV1 29.5 [±9.0] %pred, PaO2 59 [±13] mmHg, PaCO2 55.4 [±7.7] mmHg for 6 months. We looked at arterial blood gasses, lung function parameters and performed a low-dose computed tomography of the thorax, which was later used for segmentation (providing lobe and airway volumes, iVlobe and iVaw and post-processing with computer methods (providing airway resistance, iRaw giving overall a functional image of the separate airways and lobes.Results: In both groups there was a nonsignificant change in FEV1 (NIV group 29.5 [9.0] to 38.5 [14.6] %pred, control group 30.5 [5.1] to 36.8 [8.7] mmHg. PaCO2 dropped significantly only in the NIV group (NIV: 55.4 [7.7] → 44.5 [4.70], P = 0.0076; control: 52.4 [6.0] → 47.6 [8.2], NS. Patients actively treated with NIV developed a more inhomogeneous redistribution of mass flow than control patients. Subsequent analysis indicated that in NIV-treated patients that improve their blood gases, mass flow was also redistributed towards areas with higher vessel density and less emphysema, indicating that flow was

  19. Mixed acid-base disorders, hydroelectrolyte imbalance and lactate production in hypercapnic respiratory failure: the role of noninvasive ventilation.

    Directory of Open Access Journals (Sweden)

    Claudio Terzano

    Full Text Available BACKGROUND: Hypercapnic Chronic Obstructive Pulmonary Disease (COPD exacerbation in patients with comorbidities and multidrug therapy is complicated by mixed acid-base, hydro-electrolyte and lactate disorders. Aim of this study was to determine the relationships of these disorders with the requirement for and duration of noninvasive ventilation (NIV when treating hypercapnic respiratory failure. METHODS: Sixty-seven consecutive patients who were hospitalized for hypercapnic COPD exacerbation had their clinical condition, respiratory function, blood chemistry, arterial blood gases, blood lactate and volemic state assessed. Heart and respiratory rates, pH, PaO(2 and PaCO(2 and blood lactate were checked at the 1st, 2nd, 6th and 24th hours after starting NIV. RESULTS: Nine patients were transferred to the intensive care unit. NIV was performed in 11/17 (64.7% mixed respiratory acidosis-metabolic alkalosis, 10/36 (27.8% respiratory acidosis and 3/5 (60% mixed respiratory-metabolic acidosis patients (p = 0.026, with durations of 45.1 ± 9.8, 36.2 ± 8.9 and 53.3 ± 4.1 hours, respectively (p = 0.016. The duration of ventilation was associated with higher blood lactate (p<0.001, lower pH (p = 0.016, lower serum sodium (p = 0.014 and lower chloride (p = 0.038. Hyponatremia without hypervolemic hypochloremia occurred in 11 respiratory acidosis patients. Hypovolemic hyponatremia with hypochloremia and hypokalemia occurred in 10 mixed respiratory acidosis-metabolic alkalosis patients, and euvolemic hypochloremia occurred in the other 7 patients with this mixed acid-base disorder. CONCLUSIONS: Mixed acid-base and lactate disorders during hypercapnic COPD exacerbations predict the need for and longer duration of NIV. The combination of mixed acid-base disorders and hydro-electrolyte disturbances should be further investigated.

  20. Mixed acid-base disorders, hydroelectrolyte imbalance and lactate production in hypercapnic respiratory failure: the role of noninvasive ventilation.

    Science.gov (United States)

    Terzano, Claudio; Di Stefano, Fabio; Conti, Vittoria; Di Nicola, Marta; Paone, Gregorino; Petroianni, Angelo; Ricci, Alberto

    2012-01-01

    Hypercapnic Chronic Obstructive Pulmonary Disease (COPD) exacerbation in patients with comorbidities and multidrug therapy is complicated by mixed acid-base, hydro-electrolyte and lactate disorders. Aim of this study was to determine the relationships of these disorders with the requirement for and duration of noninvasive ventilation (NIV) when treating hypercapnic respiratory failure. Sixty-seven consecutive patients who were hospitalized for hypercapnic COPD exacerbation had their clinical condition, respiratory function, blood chemistry, arterial blood gases, blood lactate and volemic state assessed. Heart and respiratory rates, pH, PaO(2) and PaCO(2) and blood lactate were checked at the 1st, 2nd, 6th and 24th hours after starting NIV. Nine patients were transferred to the intensive care unit. NIV was performed in 11/17 (64.7%) mixed respiratory acidosis-metabolic alkalosis, 10/36 (27.8%) respiratory acidosis and 3/5 (60%) mixed respiratory-metabolic acidosis patients (p = 0.026), with durations of 45.1 ± 9.8, 36.2 ± 8.9 and 53.3 ± 4.1 hours, respectively (p = 0.016). The duration of ventilation was associated with higher blood lactate (prespiratory acidosis patients. Hypovolemic hyponatremia with hypochloremia and hypokalemia occurred in 10 mixed respiratory acidosis-metabolic alkalosis patients, and euvolemic hypochloremia occurred in the other 7 patients with this mixed acid-base disorder. Mixed acid-base and lactate disorders during hypercapnic COPD exacerbations predict the need for and longer duration of NIV. The combination of mixed acid-base disorders and hydro-electrolyte disturbances should be further investigated.

  1. Cisapride decreases gastric content aspiration in mechanically ventilated patients

    Science.gov (United States)

    Pneumatikos, John; Koulouras, Basil; Frangides, Christ; Goe, Dian; Nakos, George

    1999-01-01

    Objective: To determine the effect of the prokinetic agent cisapride in the prevention of aspiration of gastric contents. Design: A prospective randomized two-period crossover study. Setting: Fourteen-bed polyvalent intensive care unit in a University Hospital. Patients: Eighteen intubated, mechanically ventilated patients who were seated in a semirecumbent position were studied. Method: Tc-99 m sulfur colloid (80 megabecquerels) was administered via nasogastric tube on 2 consecutive days. Patients randomly received cisapride (10 mg, via nasogastric tube) one day and a placebo the other. Bronchial secretions were obtained before and for 5 consecutive h after Tc-99 m administration. The radioactivity was measured in a standard amount (1ml) of bronchial fluid using a gamma counter and expressed as counts per min (cpm) after correction for decay. Results: Sixteen out of 18 (88%) patients had increased radioactivity in bronchial secretions. The radioactivity increased over time both with and without cisapride, although it was lower in patients receiving cisapride than in those receiving a placebo. The cumulative bronchial secretion radioactivity obtained when patients received cisapride was significantly lower than when patients received a placebo: 7540 ± 5330 and 21965 ± 16080 cpm, respectively (P <0.05). Conclusion: Our results suggest that aspiration of gastric contents exists even in patients who are kept in a semirecumbent position. Moreover, cisapride decreases the amount of gastric contents aspiration in intubated and mechanically ventilated patients and may play a role in the prevention of ventilator associated pneumonia. Cisapride, even with the patient in the semirecumbent position, did not completely prevent gastric content aspiration. PMID:11056722

  2. Carbon dioxide elimination and oxygen consumption in mechanically ventilated children.

    Science.gov (United States)

    Smallwood, Craig D; Walsh, Brian K; Bechard, Lori J; Mehta, Nilesh M

    2015-05-01

    Accurate measurement of carbon dioxide elimination (V̇CO2 ) and oxygen consumption (V̇O2 ) at the bedside may help titrate nutritional and respiratory support in mechanically ventilated patients. Continuous V̇CO2 monitoring is now available with many ventilators. However, because normative data are sparsely available in the literature, we aimed to describe the range of V̇CO2 and V̇O2 values observed in mechanically ventilated children. We also aimed to examine the characteristics of V̇CO2 values that are associated with standard steady state (5-min period when V̇CO2 and V̇O2 variability are 8 y, the mean V̇CO2 values were 7.6, 5.8, and 3.5 mL/kg/min. Normalized V̇CO2 and V̇O2 values were inversely related to subject height and age. The relationships between normalized gas exchange values and height were demonstrated by the models: V̇CO2 = 115 × (height in cm)(-0.71) (R = 0.61, P < .001) and V̇O2 = 130 × (height in cm)(-0.72) (R = 0.61, P < .001). Steady-state V̇CO2 predicted standard steady state (sensitivity of 0.84, specificity of 1.0, P < .01). V̇CO2 and V̇O2 measurements correlated with subject height and age. Smaller and younger subjects produced larger amounts of CO2 and consumed more O2 per unit of body weight. The use of a 5-min period when V̇CO2 varied by < 5% predicted standard steady state. Our observations may facilitate greater utility of V̇CO2 at the bedside in the pediatric ICU and thereby extend the benefits of metabolic monitoring to a larger group of patients. Copyright © 2015 by Daedalus Enterprises.

  3. Long term continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) in children: Initiation criteria in real life.

    Science.gov (United States)

    Amaddeo, A; Moreau, J; Frapin, A; Khirani, S; Felix, O; Fernandez-Bolanos, M; Ramirez, A; Fauroux, B

    2016-09-01

    Long term noninvasive continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are increasingly used in children but limited information is available on the criteria and conditions leading to the initiation of these treatments. The aim of the study is to describe the objective overnight respiratory parameters and clinical situations that led to the initiation of CPAP/NIV in a pediatric NIV unit. Retrospective analysis of the data of all the children discharged on home CPAP/NIV over a 1 year period. Seventy-six patients were started on CPAP (n = 64) or NIV (n = 12). CPAP/NIV was initiated because of CPAP/NIV weaning failure (Acute group) in 15 patients. None of these patients had an overnight gas exchange or sleep study before CPAP/NIV initiation. In 18 patients, CPAP/NIV was initiated on abnormal nocturnal gas exchange alone (Subacute group). These patients had a median of three of the following five overnight gas exchange abnormalities: minimal pulse oximetry (SpO2 ) transcutaneous carbon dioxide (PtcCO2 ) >50 mmHg, time spent with SpO2 50 mmHg ≥2% of recording time, oxygen desaturation index >1.4/hr. In the last 43 patients, CPAP/NIV was initiated after an abnormal sleep study (Chronic group) on a mean of four of the aforementioned criteria and an apnea-hypopnea index >10/hr. In clinical practice, CPAP/NIV was initiated in an acute, subacute and chronic setting with most patients having an association of several abnormal gas exchange or sleep study parameters. Future studies should evaluate the effectiveness and benefits of CPAP/NIV according to the clinical situation and initiation criteria. Pediatr Pulmonol. 2016; 51:968-974. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  4. Increasing inspiratory time exacerbates ventilator-induced lung injury during high-pressure/high-volume mechanical ventilation.

    Science.gov (United States)

    Casetti, Alfredo V; Bartlett, Robert H; Hirschl, Ronald B

    2002-10-01

    Ventilator-induced lung injury may be caused by overdistension of alveoli during high-pressure ventilation. In this study, we examined the effects of increasing inspiratory time on ventilator-induced lung injury. Sprague-Dawley rats were divided into four different groups with ten animals per group. Each group was then ventilated for 30 mins with one of four ventilator strategies. All groups were ventilated with an Fio2 of 1.0 and a positive end-expiratory pressure of 0 cm H2O. Group LoP was the negative control group and was ventilated with low pressures (peak inspiratory pressure = 12 cm H2O, rate = 30, and inspiratory time = 0.5 secs). Groups iT = 0.5, iT = 1.0, and iT = 1.5 were the experimental groups and were ventilated with high pressures (peak inspiratory pressure = 45 cm H2O, rate = 10, and inspiratory times = 0.5 secs, iT = 1.0 sec, and iT = 1.5 secs, respectively). Outcome measures included lung compliance, Pao /Fio ratio, wet/dry lung weight, and dry lung/body weight. Final static lung compliance (p =.0002) and Pao2/Fio2 (p =.001) decreased as inspiratory time increased. Wet/dry lung weights (p <.0001) and dry lung/body weights (p <.0001) increased as inspiratory time increased. Light microscopy revealed evidence of intra-alveolar edema and hemorrhage in the iT = 1.0 and iT = 1.5 animals but not the LoP and iT = 0.5 animals. Increasing inspiratory time during high-pressure/high-volume mechanical ventilation is associated with an increase in variables of lung injury.

  5. Prolonged mechanical ventilation induces cell cycle arrest in newborn rat lung

    NARCIS (Netherlands)

    Kroon, A.A.; Wang, J.; Kavanagh, B.; Huang, Z.; Kuliszewski, M.; van Goudoever, J.B.; Post, M.

    2011-01-01

    The molecular mechanism(s) by which mechanical ventilation disrupts alveolar development, a hallmark of bronchopulmonary dysplasia, is unknown. To determine the effect of 24 h of mechanical ventilation on lung cell cycle regulators, cell proliferation and alveolar formation in newborn rats.

  6. Prolonged mechanical ventilation induces cell cycle arrest in newborn rat lung

    NARCIS (Netherlands)

    A.A. Kroon (Abraham); J. Wang (Jinxia); B. Kavanagh (Brian); Z. Huang (Zhen); M. Kuliszewski (Maciej); J.B. van Goudoever (Hans); M.R. Post (Martin)

    2011-01-01

    textabstractRationale: The molecular mechanism(s) by which mechanical ventilation disrupts alveolar development, a hallmark of bronchopulmonary dysplasia, is unknown. Objective: To determine the effect of 24 h of mechanical ventilation on lung cell cycle regulators, cell proliferation and alveolar f

  7. 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.

  8. 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.

  9. 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.

  10. Noninvasive Measurement of Carbon Dioxide during One-Lung Ventilation with Low Tidal Volume for Two Hours: End-Tidal versus Transcutaneous Techniques.

    Directory of Open Access Journals (Sweden)

    Hong Zhang

    Full Text Available There may be significant difference between measurement of end-tidal carbon dioxide partial pressure (PetCO2 and arterial carbon dioxide partial pressure (PaCO2 during one-lung ventilation with low tidal volume for thoracic surgeries. Transcutaneous carbon dioxide partial pressure (PtcCO2 monitoring can be used continuously to evaluate PaCO2 in a noninvasive fashion. In this study, we compared the accuracy between PetCO2 and PtcCO2 in predicting PaCO2 during prolonged one-lung ventilation with low tidal volume for thoracic surgeries.Eighteen adult patients who underwent thoracic surgeries with one-lung ventilation longer than two hours were included in this study. Their PetCO2, PtcCO2, and PaCO2 values were collected at five time points before and during one-lung ventilation. Agreement among measures was evaluated by Bland-Altman analysis.Ninety sample sets were obtained. The bias and precision when PtcCO2 and PaCO2 were compared were 4.1 ± 6.5 mmHg during two-lung ventilation and 2.9 ± 6.1 mmHg during one-lung ventilation. Those when PetCO2 and PaCO2 were compared were -11.8 ± 6.4 mmHg during two-lung ventilation and -11.8 ± 4.9 mmHg during one-lung ventilation. The differences between PtcCO2 and PaCO2 were significantly lower than those between PetCO2 and PaCO2 at all five time-points (p < 0.05.PtcCO2 monitoring was more accurate for predicting PaCO2 levels during prolonged one-lung ventilation with low tidal volume for patients undergoing thoracic surgeries.

  11. 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.

  12. Cost-effectiveness of noninvasive ventilation for chronic obstructive pulmonary disease-related respiratory failure in Indian hospitals without ICU facilities

    Directory of Open Access Journals (Sweden)

    Shraddha P Patel

    2015-01-01

    Full Text Available Introduction: The majority of Indian hospitals do not provide intensive care unit (ICU care or ward-based noninvasive positive pressure ventilation (NIV. Because no mechanical ventilation or NIV is available in these hospitals, the majority of patients suffering from respiratory failure die. Objective: To perform a cost-effective analysis of two strategies (ward-based NIV with concurrent standard treatment vs standard treatment alone in chronic obstructive pulmonary disease (COPD respiratory failure patients treated in Indian hospitals without ICU care. Materials and Methods: A decision-analytical model was created to compare the cost-effectiveness for the two strategies. Estimates from the literature were used for parameters in the model. Future costs were discounted at 3%. All costs were reported in USD (2012. One-way, two-way, and probabilistic sensitivity analysis were performed. The time horizon was lifetime and perspective was societal. Results: The NIV strategy resulted in 17.7% more survival and was slightly more costly (increased cost of $101 (USD 2012 but resulted in increased quality-adjusted life-years (QALYs (1.67 QALY. The cost-effectiveness (2012 USD/QALY in the standard and NIV groups was $78/QALY ($535.02/6.82 and $75/QALY ($636.33/8.49, respectively. Incremental cost-effectiveness ratio (ICER was only $61 USD/QALY. This was substantially lower than the gross domestic product (GDP per capita for India (1489 USD, suggesting the NIV strategy was very cost effective. Using a 5% discount rate resulted in only minimally different results. Probabilistic analysis suggests that NIV strategy was preferred 100% of the time when willingness to pay was >$250 2012 USD. Conclusion: Ward-based NIV treatment is cost-effective in India, and may increase survival of patients with COPD respiratory failure when ICU is not available.

  13. Regional tidal lung strain in mechanically ventilated normal lungs.

    Science.gov (United States)

    Paula, Luis Felipe; Wellman, Tyler J; Winkler, Tilo; Spieth, Peter M; Güldner, Andreas; Venegas, Jose G; Gama de Abreu, Marcelo; Carvalho, Alysson R; Vidal Melo, Marcos F

    2016-12-01

    Parenchymal strain is a key determinant of lung injury produced by mechanical ventilation. However, imaging estimates of volumetric tidal strain (ε = regional tidal volume/reference volume) present substantial conceptual differences in reference volume computation and consideration of tidally recruited lung. We compared current and new methods to estimate tidal volumetric strains with computed tomography, and quantified the effect of tidal volume (VT) and positive end-expiratory pressure (PEEP) on strain estimates. Eight supine pigs were ventilated with VT = 6 and 12 ml/kg and PEEP = 0, 6, and 12 cmH2O. End-expiratory and end-inspiratory scans were analyzed in eight regions of interest along the ventral-dorsal axis. Regional reference volumes were computed at end-expiration (with/without correction of regional VT for intratidal recruitment) and at resting lung volume (PEEP = 0) corrected for intratidal and PEEP-derived recruitment. All strain estimates demonstrated vertical heterogeneity with the largest tidal strains in middependent regions (P < 0.01). Maximal strains for distinct estimates occurred at different lung regions and were differently affected by VT-PEEP conditions. Values consistent with lung injury and inflammation were reached regionally, even when global measurements were below critical levels. Strains increased with VT and were larger in middependent than in nondependent lung regions. PEEP reduced tidal-strain estimates referenced to end-expiratory lung volumes, although it did not affect strains referenced to resting lung volume. These estimates of tidal strains in normal lungs point to middependent lung regions as those at risk for ventilator-induced lung injury. The different conditions and topography at which maximal strain estimates occur allow for testing the importance of each estimate for lung injury.

  14. Morgagni hernia with respiratory failure aggravated by noninvasive positive pressure ventilation: a case report and overview of the literature.

    Science.gov (United States)

    Tone, Kazuya; Kiryu, Ikumi; Yoshida, Masahiro; Tsuboi, Kazuto; Takagi, Masamichi; Kuwano, Kazuyoshi

    2014-05-01

    An elderly woman diagnosed with multiple myeloma (MM) in 2007 had improved with chemotherapy. She had severe kyphosis and a diaphragmatic hernia (DH), but no respiratory symptoms. In 2011, because of thoracic deformity and emaciation, we advised her to continue the previously prescribed domiciliary noninvasive positive pressure ventilation (NPPV) therapy for chronic type II respiratory failure. However, she refused to continue NPPV. She was later admitted for deterioration in respiratory status and carbon dioxide (CO2) narcosis. We believed her low adherence to domiciliary NPPV caused CO2 narcosis; hence, we advised her to continue domiciliary NPPV and she complied. In May 2012, the now 79-year-old patient was admitted for acute exacerbation of chronic respiratory failure and CO2 narcosis. Chest imaging suggested that DH had caused a deterioration of her status. She underwent laparoscopic diaphragmatic hernia repair. Operative findings revealed a retrosternal hernia sac, and she was diagnosed as having a Morgagni hernia (MH). Her respiratory status subsequently improved. We hypothesize that NPPV increased intra-abdominal pressure, thereby worsening the MH and exacerbating respiratory failure. We believe that clinicians should be cautious when prescribing NPPV for MH patients.

  15. Home Non-Invasive Ventilation Fails to Improve Quality of Life in the Elderly: Results from a Multicenter Cohort Study.

    Directory of Open Access Journals (Sweden)

    Adrien Tissot

    Full Text Available Home non-invasive ventilation (NIV is a widely used treatment for chronic hypoventilation but little is known on its impact in the elderly. In a multicenter prospective cohort study, we studied tolerance and efficacy of domiciliary NIV in patients aged 75 or more compared to younger ones.264 patients with at least a six-month follow-up were analyzed. Among them, 82 were elderly. In the elderly and the younger, we found an improvement of arterial blood gas, the Epworth sleepiness scale and the Pittsburgh sleep quality index at 6 months. Mean daily use of NIV at 6 months was 7 hours and the rate of non-adherent patients was similar in both group. Health-related quality of life (HRQL assessed by SF-36 questionnaires did not change significantly after NIV initiation in the elderly whereas HRQL improved in the less than 75. On univariate analysis, we found that diabetes was a predictive factor for non-adherence in the elderly (Odds ratio: 3.95% confidence interval: 1.06-8.52.NIV was efficient in the elderly while evaluation at 6 months showed a good adherence but failed to improve HRQL.

  16. Outcomes of percutaneous endoscopic gastrostomy tube insertion in respiratory impaired amyotrophic lateral sclerosis patients under noninvasive ventilation.

    Science.gov (United States)

    Czell, David; Bauer, Matthias; Binek, Janek; Schoch, Otto D; Weber, Markus

    2013-05-01

    Percutaneous endoscopic gastrostomy (PEG) tube placement in amyotrophic lateral sclerosis (ALS) patients with impaired respiratory function is associated with an increased risk of peri-procedural and post-interventional complications. It was the aim of the study to analyze peri- and post-interventional complications and survival after PEG tube placement under noninvasive ventilation (NIV) in ALS patients with various degrees of respiratory impairment. Twenty-six subjects were included in this retrospective case study. Prior to PEG tube placement, training with ventilatory support via an oronasal mask was performed with ALS subjects on the pneumology ward. PEG placement was then performed under continuous NIV. FVC, sniff nasal inspiratory pressure, and demographic data were assessed. Complication rates and 1-month and overall survival rates were analyzed. There were no deaths within 24 hours after PEG placement. One subject died within the first month. The mean survival rate after PEG was 12 ± 10 months (range 0.6-42 months). There was no difference in post-PEG survival between subjects with moderately (> 50%) and severely (< 50%) impaired FVC. In this case series, PEG tube insertion was associated with minimal peri- and post-procedural complications. The low complication rate might be due to the systematic use of procedural NIV in ALS subjects.

  17. Effect of adjuvant treatment of noninvasive positive pressure ventilation in patients with acute cardiogenic pulmonary edema%无创正压机械通气辅助治疗急性心源性肺水肿的效果

    Institute of Scientific and Technical Information of China (English)

    方凯; 王晓玲; 柳月珍; 皮铎波; 吴峰; 王贞

    2012-01-01

    Objectives To evaluate the effect of adjuvant treatment of noninvasive positive pressure ventilation in patients with acute cardiogenic pulmonary edema. Methods Twenty seven patients with acute cardiogenic pulmonary edema were given noninvasive positive pressure ventilation via face mask after hypoxia cannot be corrected by high-flow oxygen and conventional drug treatment. Clinical symptom, heart rate, breathing, arterial oxygen saturation and changes of arterial blood gas analysis were observed before and after the use of noninvasive positive pressure ventilation. Results Clinical symptoms and signs were obviously improved, oxygen partial pressure significantly increased [(90.08±15.39) mm Hgvs. (53.12±17.65) mm Hg, P<0.05], partial pressure of carbon dioxide significantly declined [(14.52±20.52) mm Hg vs. (55.47±23.82) mm Hg, P<0.05] in 20 cases (74.07%) out of the 27 patients with acute cardiogenic pulmonary edema after application of noninvasive positive pressure ventilation via face mask. Seven (25.93%) cases treated by orotracheal intubation and mechanical ventilation when noninvasive positive pressure ventilation failed. There were 2 dead cases. Conclusions Application of noninvasive positive pressure ventilation can significantly improve symptoms, signs and blood gas analysis results in patients with acute cardiogenic pulmonary edema. It can be used as one of the safe, rapid and effective adjuvant means of treatment on acute cardiogenic pulmonary edema.%目的 评价无创正压机械通气辅助治疗急性心源性肺水肿的疗效.方法 选择27例急性心源性肺水肿患者,在高流量吸氧及常规药物治疗不能纠正缺氧时,经面罩给予无创正压通气,观察使用无创正压机械通气治疗前、治疗后其临床症状、心率、呼吸、血氧饱和度和动脉血气分析的变化.结果 经面罩无创正压通气治疗后,27例患者中20例(74.07%)临床症状、体征明显改善,血气分析中氧气分压明显升

  18. Effects of Noninvasive Positive-Pressure Ventilation with Different Interfaces in Patients with Hypoxemia after Surgery for Stanford Type A Aortic Dissection

    OpenAIRE

    Yang, Yi; Sun, Lizhong; Liu, Nan; Hou, Xiaotong; Wang, Hong; Jia, Ming

    2015-01-01

    Background Hypoxemia is a severe perioperative complication that can substantially increase intensive care unit and hospital stay and mortality. The aim of this study was to determine the effects of non-invasive positive-pressure ventilation (NIPPV) in patients with hypoxemia after surgery for Stanford type A aortic dissection, and to compare the effects of helmet and mask NIPPV. Material/Methods We recruited 40 patients who developed hypoxemia within 24 h after extubation after surgery for S...

  19. 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.

  20. 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.

  1. Noninvasive ventilation in hypercapnic acute respiratory failure due to chronic obstructive pulmonary disease vs. other conditions: effectiveness and predictors of failure.

    Science.gov (United States)

    Phua, Jason; Kong, Kien; Lee, Kang Hoe; Shen, Liang; Lim, T K

    2005-04-01

    This study compared the effectiveness of noninvasive ventilation (NIV) and the risk factors for NIV failure in hypercapnic acute respiratory failure (ARF) due to chronic obstructive pulmonary disease (COPD) vs. non-COPD conditions. Prospective cohort study in the medical intensive care unit of a university hospital. 111 patients with hypercapnic ARF, 43 of whom had COPD exacerbations and 68 other conditions. Baseline characteristics of the two groups were similar. The risk of NIV failure, defined as the need for endotracheal intubation, was significantly lower in COPD than in other conditions (19% vs. 47%). High APACHE II score was an independent predictor of NIV failure in COPD (OR 5.38 per 5 points). The presence of pneumonia (OR 5.63), high APACHE II score (OR 2.59 per 5 points), rapid heart rate (OR 1.22 per 5 beats/min), and high PaCO(2) 1 h after NIV (OR 1.22 per 5 mmHg) were independent predictors of NIV failure in the non-COPD group. Failure of NIV independently predicted mortality (OR 10.53). Noninvasive ventilation was more effective in preventing endotracheal intubation in hypercapnic ARF due to COPD than non-COPD conditions. High APACHE II score predicted NIV failure in both groups. Noninvasive ventilation was least effective in patients with hypercapnic ARF due to pneumonia.

  2. [Evaluation of preoperative non-invasive ventilation in thoracic surgery for lung cancer: the preOVNI study GFPC 12-01].

    Science.gov (United States)

    Paleiron, N; André, M; Grassin, F; Chouaïd, C; Venissac, N; Margery, J; Couturaud, F; Noël-Savina, E; Tromeur, C; Vinsonneau, U; Vedrine, L; Leroyer, C; Nowak, E; Berard, H; Thomas, P; Brouchet, L; Bagan, P; Fournel, P; Mottier, D; Robinet, G

    2013-03-01

    Surgical resection is the best treatment for stage I and II non-small cell lung cancer. Despite an improvement in the perioperative management of cancer patients and specialization of surgical teams, morbidity and mortality remains significant. Non-invasive ventilation (NIV) is an effective therapeutic option in hypercapnic respiratory failure. It also improves functional and gasometric parameters when undertaken before surgery. The objective of the preOVNI study is to demonstrate that preoperative non-invasive ventilation for 7 days, at home, reduces the postoperative respiratory and cardiovascular complications of lung resection surgery, in a high-risk population. A prospective, randomized, controlled open-labelled multicentric French study, under the supervision of the Groupe Français de Pneumocancérologie (GFPC), comparing 7 days of preoperative non-invasive ventilation with standard treatment. Inclusion criteria are: patients suitable for lobectomy or segmentectomy for primary bronchial carcinoma and presenting with obstructive or restrictive lung disease, obesity or chronic cardiac insufficiency. The primary criterion is a composite one, including all respiratory and cardiac complications. The number of patients is 150 in each treatment arm, 300 in total. We think that preoperative NIV will be able to reduce the rate of postoperative complications. If this objective is achieved, the management of these patients could be changed. Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.

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

    DEFF Research Database (Denmark)

    Terkildsen, Søren

    the performance of mechanical ventilation systems. The power consumption of mechanical ventilation depends on the flow rate, fan efficiency and pressure loss in the system. This thesis examines the options and develops a concept and components for the design of low-pressure mechanical ventilation. The hypothesis....... Paper I introduces the concept and its performance is evaluated through simulations of a system designed for a test-case building. All the components were designed to minimize pressure losses and therefore the fan power needed to operate the system. The total pressure loss was 30-75 Pa depending......, including ventilation, therefore now represent a larger part of the total energy consumption. Mechanical ventilation has been the most widely used principle of ventilation over the last 50 years, but the conventional system design needs revising to meet future energy requirements. The increase in the use...

  4. Low mechanical ventilation times and reintubation rates associated with a specific weaning protocol in an intensive care unit setting: a retrospective study

    Directory of Open Access Journals (Sweden)

    Cilene Saghabi de Medeiros Silva

    2012-09-01

    Full Text Available OBJECTIVES: A number of complications exist with invasive mechanical ventilation and with the use of and withdrawal from prolonged ventilator support. The use of protocols that enable the systematic identification of patients eligible for an interruption in mechanical ventilation can significantly reduce the number of complications. This study describes the application of a weaning protocol and its results. METHODS: Patients who required invasive mechanical ventilation for more than 24 hours were included and assessed daily to identify individuals who were ready to begin the weaning process. RESULTS: We studied 252 patients with a median mechanical ventilation time of 3.7 days (interquartile range of 1 to 23 days, a rapid shallow breathing index value of 48 (median, a maximum inspiratory pressure of 40 cmH(20, and a maximum expiratory pressure of 40 cm H(20 (median. Of these 252 patients, 32 (12.7% had to be reintubated, which represented weaning failure. Noninvasive ventilation was used postextubation in 170 (73% patients, and 15% of these patients were reintubated, which also represented weaning failure. The mortality rate of the 252 patients studied was 8.73% (22, and there was no significant difference in the age, gender, mechanical ventilation time, and maximum inspiratory pressure between the survivors and nonsurvivors. CONCLUSIONS: The use of a specific weaning protocol resulted in a lower mechanical ventilation time and an acceptable reintubation rate. This protocol can be used as a comparative index in hospitals to improve the weaning system, its monitoring and the informative reporting of patient outcomes and may represent a future tool and source of quality markers for patient care.

  5. Mechanical ventilation with heat recovery in arctic climate

    DEFF Research Database (Denmark)

    Kragh, Jesper; Svendsen, Svend

    2005-01-01

    Mechanical ventilations systems with highly effective heat recovery units in arctic climate have problems with condensing water from the extracted humid indoor air. If the condensing water freezes to ice in the heat recovery unit, the airflow rate will quickly diminish due to the increasing...... pressure drop. Preheating the inlet air (outdoor air) to a temperature just above 0ºC is typically used to solve the problem. To minimize the energy cost, a more efficient solution to the problem is therefore desirable. In this project a new design of a heat recovery unit has been developed to the low......-energy house in Sisimiut, which is capable of continuously defrosting itself. The disadvantage of the unit is that it is quite big compared with other units. In this paper the new heat recovery unit is described and laboratory measurements are presented showing that the unit is capable of continuously...

  6. 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.

  7. Evaluation of the user interface simplicity in the modern generation of mechanical ventilators.

    Science.gov (United States)

    Uzawa, Yoshihiro; Yamada, Yoshitsugu; Suzukawa, Masayuki

    2008-03-01

    We designed this study to evaluate the simplicity of the user interface in modern-generation mechanical ventilators. We hypothesized that different designs in the user interface could result in different rates of operational failures. A laboratory in a tertiary teaching hospital. Crossover design. Twenty-one medical resident physicians who did not possess operating experience with any of the selected ventilators. Four modern mechanical ventilators were selected: Dräger Evita XL, Maquet Servo-i, Newport e500, and Puritan Bennett 840. Each subject was requested to perform 8 tasks on each ventilator. Two objective variables (the number of successfully completed tasks without operational failures and the operational time) and the overall subjective rating of the ease of use, measured with a 100-mm visual analog scale were recorded. The total percentage of operational failures made for all subjects, for all tasks, was 23%. There were significant differences in the rates of operational failures and operational time among the 4 ventilators. Subjects made more operational failures in setting up the ventilators and in making ventilator-setting changes than in reacting to alarms. The subjective feeling of the ease of use was also significantly different among the ventilators. The design of the user interface is relevant to the occurrence of operational failures. Our data indicate that ventilator designers could optimize the user-interface design to reduce the operational failures; therefore, basic user interface should be standardized among the clinically used mechanical ventilators.

  8. Acidemia in severe acute cardiogenic pulmonary edema treated with noninvasive pressure support ventilation: a single-center experience.

    Science.gov (United States)

    Lazzeri, Chiara; Gensini, Gian F; Picariello, Claudio; Attanà, Paola; Mattesini, Alessio; Chiostri, Marco; Valente, Serafina

    2015-09-01

    In clinical practice, acidotic patients with acute cardiogenic pulmonary edema (ACPE) are commonly considered more severe in comparison with nonacidotic patients, and data on the outcome of these patients treated with noninvasive pressure support ventilation (NIV) are lacking.The present investigation was aimed at assessing whether acidosis on admission (pH < 7.35) was associated with adverse outcome in 65 consecutive patients with ACPE treated with NIV and admitted to our Intensive Cardiac Care Unit (ICCU).In our population, 28 patients were acidotic (28 of 65, 43.1%), whereas 41 patients were not (37 of 65, 56.9%). According to the Repeated Measures General Linear Model, pCO2 values significantly changed throughout the 2-h NIV treatment (P = 0.019) in both groups (P = 0001). In acidotic patients, pCO2 significantly decreased (51.9 ± 15.3 → 47.0 ± 12.8 → 44.8 ± 12.7), whereas they increased in the nonacidotic subgroup (36.8 ± 6.5 → 36.9 ± 7.2 → 37.6 ± 6.4). No difference was observed in intubation rate between acidotic (eight patients, 28.6%) and nonacidotic patients (12 patients, 32.4%) (P = 0.738). In-ICCU mortality rate did not differ between (13 patients, 35.1%) and nonacidotic patients (nine patients, 32.1%) (P = 0.801).Our data strongly suggest that in patients with severe ACPE treated with NIV, the presence of acidosis is not associated with adverse outcomes (early mortality and intubation rates) in these patients.

  9. Use and performance of non-invasive ventilation in Internal Medicine ward: a real-life study

    Directory of Open Access Journals (Sweden)

    Francesco Ventrella

    2015-01-01

    Full Text Available Controlled trials demonstrated efficacy and safety of non-invasive ventilation (NIV in treatment of acute respiratory failure, initially in Intensive Care Units, then in other care settings (semi-intensive care units, emergency departments, and also in the wards, more often pneumological ones. Few studies have been published about NIV in Italian wards of Internal Medicine with full self-management of NIV by internists in a normal ward setting. We performed a prospective real-life study about the use of NIV in Internal Medicine ward devoid of a critical area of semi-intensive therapy, with the aim of confirming, in this setting, the effectiveness of NIV. During a period of 13 months, 42 patients with hypercapnic respiratory failure of different etiology and acidosis (pH<7.25were treated by NIV. NIV was successful in 81% of patients. In-hospital mortality was 9.5%. Safety of NIV is demonstrated by the absence of serious complications: only 7 patients showed poor compliance and 2 patients had facial pressure ulcer due to the mask. There were not statistical differences in success rate of NIV according to severity of acidosis at admission (pH<7.25 vs pH>7.25, neither according to the acute physiology and chronic health evaluation II score and the national early warning score, but the modified early warning score only showed statistically significant difference with lower values in the success group: 2.82±1.57 vs 4.13±1.46 (P<0.05. NIV has proven to be effective and safe in Internal Medicine ward.

  10. Predictive factors for reintubation following noninvasive ventilation in patients with respiratory complications after living donor liver transplantation.

    Directory of Open Access Journals (Sweden)

    Yuichi Chihara

    Full Text Available BACKGROUND: Postoperative respiratory complications are a major cause of mortality following liver transplantation (LT. Noninvasive ventilation (NIV appears to be effective for respiratory complications in patients undergoing solid organ transplantation; however, mortality has been high in patients who experienced reintubation in spite of NIV therapy. The predictors of reintubation following NIV therapy after LT are not exactly known. METHODS: Of 511 adult patients who received living-donor LT, data on the 179 who were treated by NIV were retrospectively examined. RESULTS: Forty-three (24% of the 179 patients who received NIV treatment required reintubation. Independent factors associated with reintubation by multivariate logistic regression analysis were controlled preoperative infections (odds ratio [OR] 8.88; 95% confidence interval (CI 1.64 to 48.11; p = 0.01, ABO-incompatibility (OR 4.49; 95% CI, 1.50 to 13.38; p = 0.007, and presence of postoperative pneumonia at the time of starting NIV (OR 3.28; 95% CI, 1.02 to 11.01; p = 0.04. The reintubated patients had a significant higher rate of postoperative infectious complications and a significantly longer intensive care unit stay than those in whom NIV was successful (p<0.0001. Of the 43 reintubated patients, 22 (51.2% died during hospitalization following LT vs. 8 (5.9% of the 136 patients in whom NIV was successful (p<0.0001. CONCLUSIONS: Because controlled preoperative infection, ABO-incompatibility or pneumonia prior to the start of NIV were independent risk factors for reintubation following NIV, caution should be used in applying NIV in patients with these conditions considering the high rate of mortality in patients requiring reintubation following NIV.

  11. Agreement between mathematically arterialised venous versus arterial blood gas values in patients undergoing non-invasive ventilation: a cohort study.

    Science.gov (United States)

    Kelly, Anne-Maree; Klim, Sharon; Rees, Stephen E

    2014-10-01

    Blood gas analysis is important for assessment of ventilatory function. Traditionally, arterial analysis has been used. A method for mathematically arterialising venous blood gas values has been developed. Our aim was to validate this method in patients undergoing non-invasive ventilation (NIV) in an emergency department (ED). This post hoc substudy of a prospective cohort study included adult patients undergoing NIV for acute respiratory compromise. When arterial blood gas analysis was required for clinical purposes, a venous sample was also drawn. Mathematically arterialised values were calculated independent of arterial values. Primary outcome of interest was agreement between mathematically arterialised venous and arterial values for pH and pCO2. Bland-Altman agreement plot analysis was used. Eighty sample-pairs (58 patients) were studied. Mean difference for arterial pH (actual-calculated) was 0.01 pH units (95% limits of agreement: -0.04, 0.06). Mean difference for pCO2 (actual-calculated) was -0.06 kPa (95% limits of agreement: -1.34, 1.22). For patients undergoing NIV in an ED, agreement between mathematically arterialised venous values and arterial values was close for pH but only moderate for pCO2. Depending on clinician tolerance for agreement, this method may be a clinically useful alternative to arterial blood gas analysis in the ED. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. Long-term non-invasive positive pressure ventilation in severe stable chronic obstructive pulmonary disease: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    CHEN Hong; LIANG Bin-miao; XU Zhi-bo; TANG Yong-jiang; WANG Ke; XIAO Jun; YI Qun; SUN Jian; FENG Yu-lin

    2011-01-01

    Background The evidence for non-invasive positive pressure ventilation (NIPPV) used in patients with severe stable chronic obstructive pulmonary disease (COPD) is insufficient.The aim of the meta-analysis was to assess the treatment effects of long-term NIPPV on gas change,lung function,health-related quality of life (HRQL),survival and mortality in severe stable COPD patients.Methods Randomized controlled trials (RCTs) and crossover studies comparing the treatment effects of NIPPV with conventional therapy were identified from electronic databases and reference lists from January 1995 to August 2010.Two reviewers independently assessed study quality.Data were combined using Review Manager 5.0.Both pooled effects and 95% confidence intervals were calculated.Results Five RCTs and one randomized crossover study with a total of 383 severe stable COPD patients were included.NIPPV improved gas change significantly when using a higher inspiratory positive airway pressures.The weighted mean difference (WMD) for the partial pressure of carbon dioxide in artery (PaCO2) was -3.52 (-5.26,-1.77) mmHg and for the partial pressure of oxygen in artery (PaO2) 2.84 (0.23,5.44) mmHg.There were significant improvements in dyspnea and sleep quality,but gained no benefits on lung function.The standardized mean difference (SMD) for the forced expiratory volume in 1 second (FEV1)was 0.00 (0.29,0.29).And the benefits for exercise tolerance,mood,survival and mortality remained unclear.Conclusions Patients with severe stable COPD can gain some substantial treatment benefits when using NIPPV,especially improvements in gas change,dyspnea and sleep quality.Studies of high methodological quality with large population,especially those based on a higher inspiratory positive airway pressures are required to provide more evidences.

  13. Randomized crossover trial of a pressure sensing visual feedback system to improve mask fitting in noninvasive ventilation.

    Science.gov (United States)

    Brill, Anne-Kathrin; Moghal, Mohammad; Morrell, Mary J; Simonds, Anita K

    2017-10-01

    A good mask fit, avoiding air leaks and pressure effects on the skin are key elements for a successful noninvasive ventilation (NIV). However, delivering practical training for NIV is challenging, and it takes time to build experience and competency. This study investigated whether a pressure sensing system with real-time visual feedback improved mask fitting. During an NIV training session, 30 healthcare professionals (14 trained in mask fitting and 16 untrained) performed two mask fittings on the same healthy volunteer in a randomized order: one using standard mask-fitting procedures and one with additional visual feedback on mask pressure on the nasal bridge. Participants were required to achieve a mask fit with low mask pressure and minimal air leak (mask fit and staff- confidence were measured. Compared with standard mask fitting, a lower pressure was exerted on the nasal bridge using the feedback system (71.1 ± 17.6 mm Hg vs 63.2 ± 14.6 mm Hg, P trained healthcare professionals were able to reduce the pressure on the nasal bridge (74.5 ± 21.2 mm Hg vs 66.1 ± 17.4 mm Hg, P = 0.023 and 67 ± 12.1 mm Hg vs 60 ± 10.6 mm Hg, P = 0.002, respectively) using the feedback system and self-rated confidence increased in the untrained group. Real-time visual feedback using pressure sensing technology supported healthcare professionals during mask-fitting training, resulted in a lower pressure on the skin and better mask fit for the volunteer, with increased staff confidence. © 2017 Asian Pacific Society of Respirology.

  14. Amyotrophic lateral sclerosis: impact of pulmonary follow-up and mechanical ventilation on survival. A study of 114 cases.

    Science.gov (United States)

    Sanjuán-López, Pilar; Valiño-López, Paz; Ricoy-Gabaldón, Jorge; Verea-Hernando, Héctor

    2014-12-01

    To study the impact of ventilatory management and treatment on the survival of patients with amyotrophic lateral sclerosis (ALS). Retrospective analysis of 114 consecutive patients admitted to a general hospital, evaluating demographic data, type of presentation, clinical management, treatment with mechanical ventilation and survival. descriptive and Kaplan-Meier estimator. Sixty four patients presented initial bulbar involvement. Overall mean survival after diagnosis was 28.0 months (95%CI, 21.1-34.8). Seventy patients were referred to the pulmonary specialist (61.4%) and 43 received non-invasive ventilation (NIV) at 12.7 months (median) after diagnosis. Thirty seven patients continued to receive NIV with no subsequent invasive ventilation. The mean survival of these patients was 23.3 months (95%CI, 16.7-28.8), higher in those without bulbar involvement, although below the range of significance. Survival in the 26 patients receiving programmed NIV was higher than in the 11 patients in whom this was indicated without prior pulmonary assessment (considered following diagnosis, P<.012, and in accordance with the start of ventilation, P<.004). A total of 7 patients were treated invasively; mean survival in this group was 72 months (95%CI, 14.36-129.6), median 49.6±17.5 (95%CI, 15.3-83.8), and despite the difficulties involved in home care, acceptance and tolerance was acceptable. Long-term mechanical ventilation prolongs survival in ALS. Programmed pulmonary assessment has a positive impact on survival of ALS patients and is key to the multidisciplinary management of this disease. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  15. 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

  16. Model-based advice for mechanical ventilation: From research (INVENT) to product (Beacon Caresystem).

    Science.gov (United States)

    Rees, Stephen E; Karbing, Dan S

    2015-01-01

    This paper describes the structure and functionality of a physiological model-based system for providing advice on the settings of mechanical ventilation. Use of the system is presented with examples of patients on support and control modes of mechanical ventilation.

  17. The comparison of manual and LabVIEW-based fuzzy control on mechanical ventilation.

    Science.gov (United States)

    Guler, Hasan; Ata, Fikret

    2014-09-01

    The aim of this article is to develop a knowledge-based therapy for management of rats with respiratory distress. A mechanical ventilator was designed to achieve this aim. The designed ventilator is called an intelligent mechanical ventilator since fuzzy logic was used to control the pneumatic equipment according to the rat's status. LabVIEW software was used to control all equipments in the ventilator prototype and to monitor respiratory variables in the experiment. The designed ventilator can be controlled both manually and by fuzzy logic. Eight female Wistar-Albino rats were used to test the designed ventilator and to show the effectiveness of fuzzy control over manual control on pressure control ventilation mode. The anesthetized rats were first ventilated for 20 min manually. After that time, they were ventilated for 20 min by fuzzy logic. Student's t-test for p < 0.05 was applied to the measured minimum, maximum and mean peak inspiration pressures to analyze the obtained results. The results show that there is no statistical difference in the rat's lung parameters before and after the experiments. It can be said that the designed ventilator and developed knowledge-based therapy support artificial respiration of living things successfully.

  18. Performance of low pressure mechanical ventilation concept with diffuse ceiling inlet for renovation of school classrooms

    DEFF Research Database (Denmark)

    Terkildsen, Søren; Svendsen, Svend

    In a great portion of Danish primary schools the mechanical ventilation systems is outdated or simply rely on opening of windows to ventilate the classrooms. This leads to high energy consumption for fans and/or ventilation heat losses and poor indoor environment, as the ventilation systems cannot...... provide a sufficient ventilation rate. A recent study with 750 Danish classrooms show that 56 % had CO2-concentrations over a 1000 ppm, which is the recommended limit by the Danish working environment authority and this adversely affects the performance and well being of the pupils. This paper describes...... a mechanical ventilation concept to lower energy consumption and improve the indoor environment, developed for refurbishment of school classrooms. The performance of the concept is investigated through computer simulations and measurements of energy consumption and indoor environment. The measurements are made...

  19. Lung Injury After One-Lung Ventilation: A Review of the Pathophysiologic Mechanisms Affecting the Ventilated and the Collapsed Lung.

    Science.gov (United States)

    Lohser, Jens; Slinger, Peter

    2015-08-01

    Lung injury is the leading cause of death after thoracic surgery. Initially recognized after pneumonectomy, it has since been described after any period of 1-lung ventilation (OLV), even in the absence of lung resection. Overhydration and high tidal volumes were thought to be responsible at various points; however, it is now recognized that the pathophysiology is more complex and multifactorial. All causative mechanisms known to trigger ventilator-induced lung injury have been described in the OLV setting. The ventilated lung is exposed to high strain secondary to large, nonphysiologic tidal volumes and loss of the normal functional residual capacity. In addition, the ventilated lung experiences oxidative stress, as well as capillary shear stress because of hyperperfusion. Surgical manipulation and/or resection of the collapsed lung may induce lung injury. Re-expansion of the collapsed lung at the conclusion of OLV invariably induces duration-dependent, ischemia-reperfusion injury. Inflammatory cytokines are released in response to localized injury and may promote local and contralateral lung injury. Protective ventilation and volatile anesthesia lessen the degree of injury; however, increases in biochemical and histologic markers of lung injury appear unavoidable. The endothelial glycocalyx may represent a common pathway for lung injury creation during OLV, because it is damaged by most of the recognized lung injurious mechanisms. Experimental therapies to stabilize the endothelial glycocalyx may afford the ability to reduce lung injury in the future. In the interim, protective ventilation with tidal volumes of 4 to 5 mL/kg predicted body weight, positive end-expiratory pressure of 5 to 10 cm H2O, and routine lung recruitment should be used during OLV in an attempt to minimize harmful lung stress and strain. Additional strategies to reduce lung injury include routine volatile anesthesia and efforts to minimize OLV duration and hyperoxia.

  20. TLR2 deficiency aggravates lung injury caused by mechanical ventilation

    NARCIS (Netherlands)

    Kuipers, Maria Theresa; Jongsma, Geartsje; Hegeman, Maria A; Tuip-de Boer, Anita M; Wolthuis, Esther K; Choi, Goda; Bresser, Paul; van der Poll, Tom; Schultz, Marcus J; Wieland, Catharina W

    2014-01-01

    Innate immunity pathways are found to play an important role in ventilator-induced lung injury. We analyzed pulmonary expression of Toll-like receptor 2 (TLR2) in humans and mice and determined the role of TLR2 in the pathogenesis of ventilator-induced lung injury in mice. Toll-like receptor 2 gene

  1. The clinical value of dexmedetomidine during mechanical ventilation in ICU patients of different ages

    Directory of Open Access Journals (Sweden)

    Yan ZHU

    2015-10-01

    Full Text Available Objectives To provide basis for the safe use of indigenous dexmedetomidine hydrochloride by observing its sedative effect and safety when it was given to mechanically ventilated patients of different ages. Methods Three hundred and fourteen mechanically ventilated patients were admitted to our ICU. According to the age, patients were divided into two subgroups: group A (25-50 years old and group B (51-80 years old, with 157 patients in each group. Dexmedetomidine was given to achieve the target sedation level (Ramsay score 3. The changes in noninvasive blood pressure (SBP, DBP, MAP, heart rate, SpO2, respiratory rate and FiO2 were continuously monitored and recorded before treatment (T1, and 10min (T2, 30min (T3 and 120min (T4 after drug administration, on the instant moment of extubation (T5, and 30min after extubation (T6. The adverse reactions such as hypertension, hypotension, bradycardia, tachycardia, delirium were also observed and recorded after treatment. Results Patients of both A and B groups showed a lowering of SBP, DBP, MAP and HR after treatment with dexmedetomidine, especially in group B(P80mmHg, HR>60 times/min. Respiratory rate was reduced (P0.05. SpO2 was not reduced, and it even rose 30min after administration of dexmedetomidine (P0.05, and the heart rate was slightly slower in group B (P<0.05. The probability of occurrence of adverse reactions, such as hypertension, hypotension, tachycardia, bradycardia and delirium was significantly higher in group B than in group A. Conclusions Dexmedetomidine does not depress respiration, and a stable hemodynamics was maintained after extubation in ICU patients undergoing mechanical ventilation, thus it is an ideal sedative drug. But when it is used in elderly patients, proper monitoring should be maintained, especially when a loading dose is used, in order to prevent adverse reactions such as hypotension and bradycardia, and should be corrected in time. DOI: 10.11855/j.issn.0577-7402.2015.09.15

  2. Early treatment with noninvasive positive pressure ventilation prolongs survival in Amyotrophic Lateral Sclerosis patients with nocturnal respiratory insufficiency

    Directory of Open Access Journals (Sweden)

    Scoditti Cristina

    2009-03-01

    Full Text Available Abstract Background Amyotrophic lateral sclerosis (ALS is a neurodegenerative disease, which rapidly leads to chronic respiratory failure requiring mechanical ventilation. Currently, forced vital capacity (FVC 75%, independently by any treatment. Aim To assess the role of NPPV in improving outcome of ALS, a retrospective analysis was performed to investigate 1 year survival of ALS patients with FVC Methods We investigated seventy-two consecutive ALS patients who underwent pulmonary function test. Forty-four presented a FVC > 75% and served as control group. Twenty-eight patients presented a FVC Results Increased survival rate at 1 year in patients with FVC Conclusion This report demonstrates that early treatment with NPPV prolongs survival and reduces decline of FVC% in ALS.

  3. Use of non-invasive ventilation is increasing in patients admitted with a chronic obstructive pulmonary disease exacerbation

    DEFF Research Database (Denmark)

    Tøttenborg, Sandra Søgaard; Johnsen, Søren Paaske; Thomsen, Reimar Wernich;

    2013-01-01

    .8% to 7.0% (adjusted for age, sex and co-morbidity, relative risk (RR): 1.21, 95% confidence interval (CI): 1.05-1.38). Concurrently, a statistically significant increase from 1.3% to 1.8% (RR: 1.36; 95% CI: 1.03-1.80) in NIV given together with invasive mechanical ventilation was observed. During...... the launch of a national COPD quality programme in 2008. However, regional variation remains and no substantial improvements in mortality have been observed. Continued efforts are warranted to ensure appropriate implementation of NIV. FUNDING: The study was supported financially by University of Copenhagen...... and the Danish Lung Association. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency (record no. 2012-41-0438), the Danish National Indicator Project, Danish Regions and the Danish Ministry of Health....

  4. 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...... removal effectiveness (CRE) and local air change index was measured in order to characterize ventilation effectiveness in the occupied zone. Acceptable thermal comfort was found in most experiments; however, air temperature differences higher than 3 °C occurred when floor cooling was combined...... with unconditioned outdoor air supply, i.e. at the supply air temperatures higher than the room air temperature. Moreover, low floor temperatures were needed to maintain the desired reference temperature in the stratified thermal environment. Mainly in cooling conditions the ventilation effectiveness depended...

  5. Non lineal respiratory systems mechanics simulation of acute respiratory distress syndrome during mechanical ventilation.

    Science.gov (United States)

    Madorno, Matias; Rodriguez, Pablo O

    2010-01-01

    Model and simulation of biological systems help to better understand these systems. In ICUs patients often reach a complex situation where supportive maneuvers require special expertise. Among them, mechanical ventilation in patients suffering from acuter respiratory distress syndrome (ARDS) is specially challenging. This work presents a model which can be simulated and use to help in training of physicians and respiratory therapists to analyze the respiratory mechanics in this kind of patients. We validated the model in 2 ARDS patients.

  6. Non-invasive ventilation with intelligent volume-assured pressure support versus pressure-controlled ventilation: effects on the respiratory event rate and sleep quality in COPD with chronic hypercapnia.

    Science.gov (United States)

    Nilius, Georg; Katamadze, Nato; Domanski, Ulrike; Schroeder, Maik; Franke, Karl-Josef

    2017-01-01

    COPD patients who develop chronic hypercapnic respiratory failure have a poor prognosis. Treatment of choice, especially the best form of ventilation, is not well known. This study compared the effects of pressure-controlled (spontaneous timed [ST]) non-invasive ventilation (NIV) and NIV with intelligent volume-assured pressure support (IVAPS) in chronic hypercapnic COPD patients regarding the effects on alveolar ventilation, adverse patient/ventilator interactions and sleep quality. This prospective, single-center, crossover study randomized patients to one night of NIV using ST then one night with the IVAPS function activated, or vice versa. Patients were monitored using polysomnography (PSG) and transcutaneous carbon dioxide pressure (PtcCO2) measurement. Patients rated their subjective experience (total score, 0-45; lower scores indicate better acceptability). Fourteen patients were included (4 females, age 59.4±8.9 years). The total number of respiratory events was low, and similar under pressure-controlled (5.4±6.7) and IVAPS (8.3±10.2) conditions (P=0.064). There were also no clinically relevant differences in PtcCO2 between pressure-controlled and IVAPS NIV (52.9±6.2 versus 49.1±6.4 mmHg). Respiratory rate was lower under IVAPS overall; between-group differences reached statistical significance during wakefulness and non-rapid eye movement sleep. Ventilation pressures were 2.6 cmH2O higher under IVAPS versus pressure-controlled ventilation, resulting in a 20.1 mL increase in breathing volume. Sleep efficiency was slightly higher under pressure-controlled ventilation versus IVAPS. Respiratory arousals were uncommon (24.4/h [pressure-controlled] versus 25.4/h [IVAPS]). Overall patient assessment scores were similar, although there was a trend toward less discomfort during IVAPS. Our results show that IVAPS NIV allows application of higher nocturnal ventilation pressures versus ST without affecting sleep quality or inducing ventilation- associated events.

  7. Non-invasive ventilation with intelligent volume-assured pressure support versus pressure-controlled ventilation: effects on the respiratory event rate and sleep quality in COPD with chronic hypercapnia

    Directory of Open Access Journals (Sweden)

    Nilius G

    2017-03-01

    Full Text Available Georg Nilius,1,2 Nato Katamadze,1,2 Ulrike Domanski,1 Maik Schroeder,1 Karl-Josef Franke1,2 1HELIOS Klinik Hagen-Ambrock, 2Internal Medicine I, Witten/Herdecke University, Witten, Germany Background: COPD patients who develop chronic hypercapnic respiratory failure have a poor prognosis. Treatment of choice, especially the best form of ventilation, is not well known. Objectives: This study compared the effects of pressure-controlled (spontaneous timed [ST] non-invasive ventilation (NIV and NIV with intelligent volume-assured pressure support (IVAPS in chronic hypercapnic COPD patients regarding the effects on alveolar ventilation, adverse patient/ventilator interactions and sleep quality. Methods: This prospective, single-center, crossover study randomized patients to one night of NIV using ST then one night with the IVAPS function activated, or vice versa. Patients were monitored using polysomnography (PSG and transcutaneous carbon dioxide pressure (PtcCO2 measurement. Patients rated their subjective experience (total score, 0–45; lower scores indicate better acceptability. Results: Fourteen patients were included (4 females, age 59.4±8.9 years. The total number of respiratory events was low, and similar under pressure-controlled (5.4±6.7 and IVAPS (8.3±10.2 conditions (P=0.064. There were also no clinically relevant differences in PtcCO2 between pressure-controlled and IVAPS NIV (52.9±6.2 versus 49.1±6.4 mmHg. Respiratory rate was lower under IVAPS overall; between-group differences reached statistical significance during wakefulness and non-rapid eye movement sleep. Ventilation pressures were 2.6 cmH2O higher under IVAPS versus pressure-controlled ventilation, resulting in a 20.1 mL increase in breathing volume. Sleep efficiency was slightly higher under pressure-controlled ventilation versus IVAPS. Respiratory arousals were uncommon (24.4/h [pressure-controlled] versus 25.4/h [IVAPS]. Overall patient assessment scores were similar

  8. Predicting survival after acute exacerbation chronic obstructive pulmonary disease (ACOPD: is long-term application of noninvasive ventilation the last life guard?

    Directory of Open Access Journals (Sweden)

    Esquinas AM

    2013-08-01

    Full Text Available Antonio M Esquinas,1 Yoshinori Matsuoka,2 Sven Stieglitz3 1Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain; 2Saga Medical School Hospital, Department of Anesthesiology and Intensive Care Medicine, Saga, Japan; 3Clinic for Pneumology and Allergology, Centre for Sleep and Ventilation Medicine, Solingen, Germany Patients with acute chronic obstructive pulmonary disease (ACOPD admitted to an intensive care unit (ICU still show substantial high hospital mortality (24%.1 After ICU discharge, long-term application noninvasive ventilation (NIV may be a reasonable and effective indication.2 However, hospital mortality shows higher mortality rates for patients with COPD surviving their first episode after 2 and 5 years.2,3 View original paper by Titlestad and colleagues.

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

    NARCIS (Netherlands)

    E.J.O. Kompanje (Erwin); B. van der Hoven (Ben); J. 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-extu

  10. 应用无创呼吸机患者腹胀的临床观察及处理体会%Application of noninvasive ventilator clinical observation and treatment experience of patients with abdominal distension

    Institute of Scientific and Technical Information of China (English)

    魏方义

    2015-01-01

    summarizes the application especial y in ventilator patients complicated with abdominal distension of clinical observation and treatment experience.Application of noninva-sive ventilator patients complicated with abdominal distension of the main reasons for the patients with poor,intestinal peristalsis abate,hypoxemia,infection,and use of antibiotics,hypokale-mia.After actively symptomatic care,43 cases of abdominal distension obviously al eviate,4 cases of abdominal distension,no relief,because dangerous warbler.Line of tracheal intubation and mechanical ventilation.%总结应用尤创呼吸机患者并发腹胀的临床观察及处理体会。应用无创呼吸机患者并发腹胀的主要原因为患者配合不佳、肠蠕动减弱、低氧血症、感染及应用抗生素、低血钾。经积极对症护理后,43例腹胀明显缓解,4例腹胀无缓解,因病情危莺。行气管插管机械通气。

  11. Transcutaneous versus blood carbon dioxide monitoring during acute noninvasive ventilation in the emergency department - a retrospective analysis.

    Science.gov (United States)

    Horvath, Christian Michael; Brutsche, Martin Hugo; Baty, Florent; Rüdiger, Jochen Julius

    2016-01-01

    Transcutaneous measurement of carbon dioxide (PtCO2) has been suggested as an alternative to invasively obtained PaCO2 for the monitoring of patients with hypercapnic respiratory failure during noninvasive ventilation (NIV). Current data on monitoring in hypoxaemic respiratory failure are scarce and show conflicting results in hypercapnic patients in the emergency department. We performed a retrospective comparison of real-time PtCO2 (SenTec Digital Monitor) and arterial/venous carbon dioxide tension (PaCO2/PvCO2) measurements in patients with severe hypoxaemic and/or hypercapnic respiratory failure during NIV. Agreement between PtCO2 and PaCO2/PvCO2 was the primary endpoint. Bland-Altman analysis and linear regression were used. 102 patients had at least one matched measurement of PtCO2 and PaCO2/PvCO2. For patients with arterial blood gas analysis, the mean difference was 0.46 kPa at baseline (95% confidence interval [CI] 0.23 to 0.60, limits of agreement 95% CI -0.54 to 1.45) and 0.12 kPa after NIV (95% CI -0.04 to 0.29, limits of agreement 95% CI: -0.61 to 0.86). The linear regression analysis found a correlation R2 of 0.88 (p 8 kPa was associated with a lesser degree of agreement between the levels of PtCO2 and PaCO2/PvCO2 (p Transcutaneous PCO2 monitoring shows a good concordance with PaCO2 and is a reliable, feasible, patient-friendly and safe alternative to repeated blood gas analysis for patients with severe hypoxaemic and/or hypercapnic respiratory failure receiving emergency NIV in the emergency department. An initial blood gas analysis to evaluate the respiratory and metabolic state and to rule out a significant discrepancy compared with the transcutaneous measurement is recommended.

  12. Asistencia ventilatoria no invasiva domiciliaria nocturna en Pediatría PEDIATRIC NOCTURNAL NONINVASIVE VENTILATION ASSISTANCE AT HOME

    Directory of Open Access Journals (Sweden)

    FRANCISO PRADO A.

    2003-01-01

    Full Text Available La asistencia ventilatoria no invasiva domiciliaria nocturna (AVNIDN se indica en insuficiencia respiratoria crónica (IRC, síndrome de apnea obstructiva del sueño (SAOS y ocasionalmente por hipoventilación central y fibrosis quística. Se hace una revisión retrospectiva de 10 pacientes sometidos a esta técnica de soporte ventilatorio no invasivo durante un periodo de 6 años (1996-2002, describiendo las indicaciones, tipo de AVNIDN y el seguimiento. Sus edades fluctuaron entre 1 a 13 años; 6 mujeres y 4 hombres. Seis pacientes tenían enfermedad neuromuscular; 3 parálisis cerebral y uno Arnold Chiari tipo II. Nueve presentaban xifoescoliosis. Las indicaciones fueron: IRC estable 3 pacientes; posterior a IRC descompensada 1; luego de insuficiencia respiratoria aguda en enfermos neuromusculares sin diagnóstico claro de IRC, 2 pacientes. SAOS secundaria a faringomalacia en 3 y por hipoventilación central uno. Dos presentaban restricción pulmonar moderada a severa y presiones máximas de vía aérea subnormales. Seis pacientes recibieron CPAP y 4 Bipap. El tiempo de hospitalización previo al alta fue de 3 a 90 días y la duración promedio del seguimiento fue 2 años. Tres recibieron entrenamiento muscular respiratorio. No hubo mortalidad; un paciente fue traqueostomizado. Nueve mejoraron, 5 no tuvieron rehospitalizaciones y 4 las disminuyeron. Cinco pacientes asisten al colegio. Un paciente con miopatía congénita y artrodesis mejoró sus pruebas funcionales respiratorias y la distancia recorrida en 6 minutos. Dos usaron irregularmente la AVNIDN y dos suspendieron tratamiento luego de un año. En nuestra experiencia, la AVNID minimizó las hospitalizaciones y promovió la reinserción social y escolar. La modalidad Bipap fue útil en patologías restrictivas y el CPAP en obstrucción de vía aérea superior/SAOSThe nocturnal noninvasive ventilation (NNIV at home is often used in chronic respiratory failure (CRF and obstructive sleep

  13. Cough augmentation techniques for extubation or weaning critically ill patients from mechanical ventilation.

    Science.gov (United States)

    Rose, Louise; Adhikari, Neill Kj; Leasa, David; Fergusson, Dean A; McKim, Douglas

    2017-01-11

    There are various reasons why weaning and extubation failure occur, but ineffective cough and secretion retention can play a significant role. Cough augmentation techniques, such as lung volume recruitment or manually- and mechanically-assisted cough, are used to prevent and manage respiratory complications associated with chronic conditions, particularly neuromuscular disease, and may improve short- and long-term outcomes for people with acute respiratory failure. However, the role of cough augmentation to facilitate extubation and prevent post-extubation respiratory failure is unclear. Our primary objective was to determine extubation success using cough augmentation techniques compared to no cough augmentation for critically-ill adults and children with acute respiratory failure admitted to a high-intensity care setting capable of managing mechanically-ventilated people (such as an intensive care unit, specialized weaning centre, respiratory intermediate care unit, or high-dependency unit).Secondary objectives were to determine the effect of cough augmentation techniques on reintubation, weaning success, mechanical ventilation and weaning duration, length of stay (high-intensity care setting and hospital), pneumonia, tracheostomy placement and tracheostomy decannulation, and mortality (high-intensity care setting, hospital, and after hospital discharge). We evaluated harms associated with use of cough augmentation techniques when applied via an artificial airway (or non-invasive mask once extubated/decannulated), including haemodynamic compromise, arrhythmias, pneumothorax, haemoptysis, and mucus plugging requiring airway change and the type of person (such as those with neuromuscular disorders or weakness and spinal cord injury) for whom these techniques may be efficacious. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 4, 2016), MEDLINE (OvidSP) (1946 to April 2016), Embase (OvidSP) (1980 to April 2016), CINAHL (EBSCOhost) (1982

  14. Incidence of Ventilator-Associated Pneumonia in Critically Ill Children Undergoing Mechanical Ventilation in Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Ali Amanati

    2017-07-01

    Full Text Available Background: Among hospital-acquired infections (HAIs in children, ventilator-associated pneumonia (VAP is the most common after blood stream infection (BSI. VAP can prolong length of ventilation and hospitalization, increase mortality rate, and directly change a patient’s outcome in Pediatric Intensive Care Units (PICU. Objectives: The research on VAP in children is limited, especially in Iran; therefore, the identification of VAP incidence and mortality rate will be important for both clinical and epidemiological implications. Materials and Methods: Mechanically ventilated pediatric patients were assessed for development of VAP during hospital course on the basis of clinical, laboratory and imaging criteria. We matched VAP group with control group for assessment of VAP related mortality in the critically ill ventilated children. Results: VAP developed in 22.9% of critically ill children undergoing mechanical ventilation. Early VAP and late VAP were found in 19.3% and 8.4% of VAP cases, respectively. Among the known VAP risk factors that were investigated, immunodeficiency was significantly greater in the VAP group (p = 0.014. No significant differences were found between the two groups regarding use of corticosteroids, antibiotics, PH (potential of hydrogen modifying agents (such as ranitidine or pantoprazole, presence of nasogastric tube and total or partial parenteral nutrition administration. A substantial number of patients in the VAP group had more than four risk factors for development of VAP, compared to those without VAP (p = 0.087. Mortality rate was not statistically different between the VAP and control groups (p = 0.477. Conclusion: VAP is still one of the major causes of mortality in PICUs. It is found that altered immune status is a significant risk factor for acquiring VAP. Also, occurrence of VAP was high in the first week after admission in PICU.

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

    DEFF Research Database (Denmark)

    Terkildsen, Søren; Svendsen, Svend

    2013-01-01

    ventilation systems with minimal pressure loss and minimal energy use. This can provide comfort ventilation and avoid overheating through increased ventilation and night cooling. Based on this concept, a test system was designed for a fictive office building and its performance was documented using building...... simulations that quantify fan power consumption, heating demand and indoor environmental conditions. The system was designed with minimal pressure loss in the duct system and heat exchanger. Also, it uses state-of-the-art components such as electrostatic precipitators, diffuse ceiling inlets and demand......-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...

  16. What is the role of the physiotherapist in paediatric intensive care units? A systematic review of the evidence for respiratory and rehabilitation interventions for mechanically ventilated patients.

    Science.gov (United States)

    Hawkins, Ellie; Jones, Anne

    2015-12-01

    Physiotherapy in intensive care units (ICU) has traditionally focussed on the respiratory management of mechanically ventilated patients. Gradually, focus has shifted to include rehabilitation in adult ICUs, though evidence of a similar shift in the paediatric ICU (PICU) is limited. Review the evidence to determine the role of physiotherapists in the management of mechanically ventilated patients in PICU. A search was conducted of: PEDro, CINAHL, Medline, PubMed and the Cochrane Library. Studies involving PICU patients who received physiotherapy while invasively ventilated were included in this review. Those involving neonatal or adult ICU patients, or patients on non-invasive or long-term ventilation, were not included in the study. All articles were critically appraised by two reviewers and results were analysed descriptively. Six studies on chest physiotherapy (CPT) met the selection criteria. Results support the use of the expiratory flow increase technique and CPT, especially manual hyperinflation and vibrations, for secretion clearance. Evidence does not support the routine use of either CPT or suction alone. No studies investigating rehabilitation in PICU met selection criteria. A lack of high level evidence was available to inform this review. Evidence indicates that CPT is still the focus of physiotherapy intervention in PICU for mechanically ventilated patients, and supports its use for secretion clearance in this setting. PROSPERO register for systematic reviews (registration no. CRD42014009582). Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  17. Noninvasive monitoring of PaCO2 during one-lung ventilation and minimal access surgery in adults: End-tidal versus transcutaneous techniques

    OpenAIRE

    Cox, Paul; Tobias, Joseph D.

    2007-01-01

    Background: Previous studies have suggested that end-tidal CO2 (ET-CO2) may be inaccurate during one-lung ventilation (OLV). This study was performed to compare the accuracy of the noninvasive monitoring of PCO2 using transcutaneous CO2 (TC-CO2) with ET-CO2 in patients undergoing video-assisted thoracoscopic surgery (VATS) during OLV. Materials and Methods: In adult patients undergoing thoracoscopic surgical procedures, PCO2 was simultaneously measured with TC-CO2 and ET-CO2 devices and compa...

  18. Non-invasive ventilation used as an adjunct to airway clearance treatments improves lung function during an acute exacerbation of cystic fibrosis: a randomised trial

    Directory of Open Access Journals (Sweden)

    Tiffany J Dwyer

    2015-07-01

    Full Text Available Question: During an acute exacerbation of cystic fibrosis, is non-invasive ventilation beneficial as an adjunct to the airway clearance regimen? Design: Randomised controlled trial with concealed allocation and intention-to-treat analysis. Participants: Forty adults with moderate to severe cystic fibrosis lung disease and who were admitted to hospital for an acute exacerbation. Intervention: Comprehensive inpatient care (control group compared to the same care with the addition of non-invasive ventilation during airway clearance treatments from Day 2 of admission until discharge (experimental group. Outcome measures: Lung function and subjective symptom severity were measured daily. Fatigue was measured at admission and discharge on the Schwartz Fatigue Scale from 7 (no fatigue to 63 (worst fatigue points. Quality of life and exercise capacity were also measured at admission and discharge. Length of admission and time to next hospital admission were recorded. Results: Analysed as the primary outcome, the experimental group had a greater rate of improvement in forced expiratory volume in 1 second (FEV1 than the control group, but this was not statistically significant (MD 0.13% predicted per day, 95% CI –0.03 to 0.28. However, the experimental group had a significantly higher FEV1 at discharge than the control group (MD 4.2% predicted, 95% CI 0.1 to 8.3. The experimental group reported significantly lower levels of fatigue on the Schwartz fatigue scale at discharge than the control group (MD 6 points, 95% CI 1 to 11. There was no significant difference between the experimental and control groups in subjective symptom severity, quality of life, exercise capacity, length of hospital admission or time to next hospital admission. Conclusion: Among people hospitalised for an acute exacerbation of cystic fibrosis, the use of non-invasive ventilation as an adjunct to the airway clearance regimen significantly improves FEV1 and fatigue. Trial

  19. [Sleep respiratory disorders, non-invasive ventilation and critical care in Archivos de Bronconeumología (June 2008-November 2009)].

    Science.gov (United States)

    Terán-Santos, Joaquín; Luz Alonso Alvarez, M; Carbajo, Estrella Ordax; Guevara, José Cordero; Jiménez, Fernando Masa

    2010-03-01

    The present study analyses the works published in Archivos de Bronconeumología from June 2008 to November 2009 that mention sleep disorders, non-invasive ventilation and critical care. The methodology used was to analyse the objectives of the works submitted, with their main results and the conclusions suggested by the authors, often putting forward the possibility of conducting new research studies. The review no only includes original articles but is also a reflection on the editorials, special articles and review works.

  20. 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.

  1. Short term non-invasive ventilation post-surgery improves arterial blood-gases in obese subjects compared to supplemental oxygen delivery - a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Zoremba Norbert

    2011-05-01

    Full Text Available Abstract Background In the immediate postoperative period, obese patients are more likely to exhibit hypoxaemia due to atelectasis and impaired respiratory mechanics, changes which can be attenuated by non-invasive ventilation (NIV. The aim of the study was to evaluate the duration of any effects of early initiation of short term pressure support NIV vs. traditional oxygen delivery via venturi mask in obese patients during their stay in the PACU. Methods After ethics committee approval and informed consent, we prospectively studied 60 obese patients (BMI 30-45 undergoing minor peripheral surgery. Half were randomly assigned to receive short term NIV during their PACU stay, while the others received routine treatment (supplemental oxygen via venturi mask. Premedication, general anaesthesia and respiratory settings were standardized. We measured arterial oxygen saturation by pulse oximetry and blood gas analysis on air breathing. Inspiratory and expiratory lung function was measured preoperatively (baseline and at 10 min, 1 h, 2 h, 6 h and 24 h after extubation, with the patient supine, in a 30 degrees head-up position. The two groups were compared using repeated-measure analysis of variance (ANOVA and t-test analysis. Statistical significance was considered to be P Results There were no differences at the first assessment. During the PACU stay, pulmonary function in the NIV group was significantly better than in the controls (p Conclusion Early initiation of short term NIV during in the PACU promotes more rapid recovery of postoperative lung function and oxygenation in the obese. The effect lasted 24 hours after discontinuation of NIV. Patient selection is necessary in order to establish clinically relevant improvements. Trial Registration# DRKS00000751; http://www.germanctr.de

  2. Acid-base balance, serum electrolytes and need for non-invasive ventilation in patients with hypercapnic acute exacerbation of chronic obstructive pulmonary disease admitted to an internal medicine ward.

    Science.gov (United States)

    Schiavo, Alfonso; Renis, Maurizio; Polverino, Mario; Iannuzzi, Arcangelo; Polverino, Francesca

    2016-01-01

    Hypoventilation produces or worsens respiratory acidosis in patients with hypercapnia due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). In these patients acid-base and hydroelectrolite balance are closely related. Aim of the present study was to evaluate acid-base and hydroelectrolite alterations in these subjects and the effect of non-invasive ventilation and pharmacological treatment. We retrospectively analysed 110 patients consecutively admitted to the Internal Medicine ward of Cava de' Tirreni Hospital for acute exacerbation of hypercapnic chronic obstructive pulmonary disease. On admission all patients received oxygen with a Venturi mask to maintain arterial oxygen saturation at least >90 %, and received appropriate pharmacological treatment. Non-Invasive Ventilation (NIV) was started when, despite optimal therapy, patients had severe dyspnea, increased work of breathing and respiratory acidosis. Based on Arterial Blood Gas (ABG) data, we divided the 110 patients in 3 groups: A = 51 patients with compensated respiratory acidosis; B = 36 patients with respiratory acidosis + metabolic alkalosis; and C = 23 patients with respiratory acidosis + metabolic acidosis. 55 patients received only conventional therapy and 55 had conventional therapy plus NIV. The use of NIV support was lower in the patients belonging to group B than in those belonging to group A and C (25 %, vs 47 % and 96 % respectively; p respiratory acidosis due to AECOPD, differently from previous studies, the metabolic alkalosis is not a negative prognostic factor neither determines greater NIV support need, whereas the metabolic acidosis in addition to respiratory acidosis is an unfavourable element, since it determines an increased need of NIV and invasive mechanical ventilation support.

  3. Comparison of Airway Pressure Release Ventilation to Conventional Mechanical Ventilation in the Early Management of Smoke Inhalation Injury in Swine

    Science.gov (United States)

    2011-01-01

    acute respiratory distress syndrome developed ( PaO2 /FIO2 ratio ), plateau pressures were limited to ន cm H2O. Six uninjured pigs received...conventional mechanical ventilation for 48 hrs and served as time controls. Changes in PaO2 /FIO2 ratio, tidal volume, respiratory rate, mean airway pressure...plateau pressure, and hemody- namic variables were recorded. Survival was assessed using Kaplan- Meier analysis. PaO2 /FIO2 ratio was lower in airway

  4. Evaluation of an Incremental Ventilation Energy Model for Estimating Impacts of Air Sealing and Mechanical Ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Logue, Jennifer M. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Turner, Willliam JN [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Walker, Iain S. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Singer, Brett C. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2012-07-01

    Changing the rate of airflow through a home affects the annual thermal conditioning energy. Large-scale changes to airflow rates of the housing stock can significantly alter the energy consumption of the residential energy sector. However, the complexity of existing residential energy models hampers the ability to estimate the impact of policy changes on a state or nationwide level. The Incremental Ventilation Energy (IVE) model developed in this study was designed to combine the output of simple airflow models and a limited set of home characteristics to estimate the associated change in energy demand of homes. The IVE model was designed specifically to enable modelers to use existing databases of home characteristics to determine the impact of policy on ventilation at a population scale. In this report, we describe the IVE model and demonstrate that its estimates of energy change are comparable to the estimates of a wellvalidated, complex residential energy model when applied to homes with limited parameterization. Homes with extensive parameterization would be more accurately characterized by complex residential energy models. The demonstration included a range of home types, climates, and ventilation systems that cover a large fraction of the residential housing sector.

  5. Development of an Outdoor Temperature-Based Control Algorithm for Residential Mechanical Ventilation Control

    Energy Technology Data Exchange (ETDEWEB)

    Less, Brennan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Walker, Iain [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Tang, Yihuan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2014-06-01

    Smart ventilation systems use controls to ventilate more during those periods that provide either an energy or IAQ advantage (or both) and less during periods that provide a dis advantage. Using detailed building simulations, this study addresses one of the simplest and lowest cost types of smart controllers —outdoor temperature- based control. If the outdoor temperature falls below a certain cut- off, the fan is simply turned off. T he main principle of smart ventilation used in this study is to shift ventilation from time periods with large indoor -outdoor temperature differences, to periods where these differences are smaller, and their energy impacts are expected to be less. Energy and IAQ performance are assessed relative to a base case of a continuously operated ventilation fan sized to comply with ASHRAE 62.2-2013 whole house ventilation requirements. In order to satisfy 62.2-2013, annual pollutant exposure must be equivalent between the temperature controlled and continuous fan cases. This requires ventilation to be greater than 62.2 requirements when the ventilation system operates. This is achieved by increasing the mechanical ventilation system air flow rates.

  6. 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.

  7. Transpulmonary pressure monitoring during mechanical ventilation: a bench-to-bedside review.

    Science.gov (United States)

    Mietto, Cristina; Malbrain, Manu L N G; Chiumello, Davide

    2015-01-01

    Different ventilation strategies have been suggested in the past in patients with acute respiratory distress syndrome (ARDS). Airway pressure monitoring alone is inadequate to assure optimal ventilatory support in ARDS patients. The assessment of transpulmonary pressure (PTP) can help clinicians to tailor mechanical ventilation to the individual patient needs. Transpulmonary pressure monitoring, defined as airway pressure (Paw) minus intrathoracic pressure (ITP), provides essential information about chest wall mechanics and its effects on the respiratory system and lung mechanics. The positioning of an esophageal catheter is required to measure the esophageal pressure (Peso), which is clinically used as a surrogate for ITP or pleural pressure (Ppl), and calculates the transpulmonary pressure. The benefits of such a ventilation approach are avoiding excessive lung stress and individualizing the positive end-expiratory pressure (PEEP) setting. The aim is to prevent over-distention of alveoli and the cyclic recruitment/derecruitment or shear stress of lung parenchyma, mechanisms associated with ventilator-induced lung injury (VILI). Knowledge of the real lung distending pressure, i.e. the transpulmonary pressure, has shown to be useful in both controlled and assisted mechanical ventilation. In the latter ventilator modes, Peso measurement allows one to assess a patient's respiratory effort, patient-ventilator asynchrony, intrinsic PEEP and the calculation of work of breathing. Conditions that have an impact on Peso, such as abdominal hypertension, will also be discussed briefly.

  8. 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.

  9. Gas exchange measurement during pediatric mechanical ventilation--agreement between gas sampling at the airway and the ventilator exhaust.

    Science.gov (United States)

    Smallwood, Craig D; Mehta, Nilesh M

    2013-12-01

    A variety of indirect calorimetry (IC) devices are used for gas exchange measurement and calculation of resting energy expenditure (REE) in the pediatric intensive care unit. The aim of this investigation was to compare oxygen consumption (VO2), carbon dioxide elimination (VCO2), REE and respiratory quotient (RQ) in mechanically ventilated children, obtained by 2 devices using distinct gas sampling methods. Mechanically ventilated children were targeted for IC and gas exchange measurements were recorded for a 30 min period, simultaneously using the E-COVX(®) (gas sampling at the airway) and the Vmax(®) (gas sampling at the humidifier and ventilator exhaust). Steady state gas exchange measurements by the 2 devices were tested for agreement using Spearman correlation and Bland-Altman analysis. Steady state data from both devices were available in 19 tests and were included in the analysis. The correlations coefficients for measurements by the 2 devices were r = 0.903(P < 0.001), 0.955(P < 0.001), 0.944(P < 0.001) and 0.484(P < 0.05) for VO2, VCO2, REE and RQ, respectively. The mean percentage bias (limits of agreement) for VO2, VCO2, REE and RQ values between the two methods (Vmax-E-COVX) was 0.2 (-41.8-42.3), -0.8 (-21.8-20.1), -2.2 (-33.9-29.6) and 1.9 (-21-24.9) respectively. Despite strong correlations and small mean biases for VO2, VCO2 and REE obtained by the Vmax(®) and E-COVX(®), the limits of agreement were beyond the clinically acceptable range. These devices should not be used interchangeably for gas exchange measurements in mechanically ventilated children. Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  10. Relationship between airway narrowing, patchy ventilation and lung mechanics in asthmatics.

    Science.gov (United States)

    Tgavalekos, N T; Musch, G; Harris, R S; Vidal Melo, M F; Winkler, T; Schroeder, T; Callahan, R; Lutchen, K R; Venegas, J G

    2007-06-01

    Bronchoconstriction in asthma results in patchy ventilation forming ventilation defects (VDefs). Patchy ventilation is clinically important because it affects obstructive symptoms and impairs both gas exchange and the distribution of inhaled medications. The current study combined functional imaging, oscillatory mechanics and theoretical modelling to test whether the degrees of constriction of airways feeding those units outside VDefs were related to the extent of VDefs in bronchoconstricted asthmatic subjects. Positron emission tomography was used to quantify the regional distribution of ventilation and oscillatory mechanics were measured in asthmatic subjects before and after bronchoconstriction. For each subject, ventilation data was mapped into an anatomically based lung model that was used to evaluate whether airway constriction patterns, consistent with the imaging data, were capable of matching the measured changes in airflow obstruction. The degree and heterogeneity of constriction of the airways feeding alveolar units outside VDefs was similar among the subjects studied despite large inter-subject variability in airflow obstruction and the extent of the ventilation defects. Analysis of the data amongst the subjects showed an inverse relationship between the reduction in mean airway conductance, measured in the breathing frequency range during bronchoconstriction, and the fraction of lung involved in ventilation defects. The current data supports the concept that patchy ventilation is an expression of the integrated system and not just the sum of independent responses of individual airways.

  11. Prolonged mechanical ventilation induces cell cycle arrest in newborn rat lung.

    Directory of Open Access Journals (Sweden)

    Andreas A Kroon

    Full Text Available RATIONALE: The molecular mechanism(s by which mechanical ventilation disrupts alveolar development, a hallmark of bronchopulmonary dysplasia, is unknown. OBJECTIVE: To determine the effect of 24 h of mechanical ventilation on lung cell cycle regulators, cell proliferation and alveolar formation in newborn rats. METHODS: Seven-day old rats were ventilated with room air for 8, 12 and 24 h using relatively moderate tidal volumes (8.5 mL.kg⁻¹. MEASUREMENT AND MAIN RESULTS: Ventilation for 24 h (h decreased the number of elastin-positive secondary crests and increased the mean linear intercept, indicating arrest of alveolar development. Proliferation (assessed by BrdU incorporation was halved after 12 h of ventilation and completely arrested after 24 h. Cyclin D1 and E1 mRNA and protein levels were decreased after 8-24 h of ventilation, while that of p27(Kip1 was significantly increased. Mechanical ventilation for 24 h also increased levels of p57(Kip2, decreased that of p16(INK4a, while the levels of p21(Waf/Cip1 and p15(INK4b were unchanged. Increased p27(Kip1 expression coincided with reduced phosphorylation of p27(Kip1 at Thr¹⁵⁷, Thr¹⁸⁷ and Thr¹⁹⁸ (p<0.05, thereby promoting its nuclear localization. Similar -but more rapid- changes in cell cycle regulators were noted when 7-day rats were ventilated with high tidal volume (40 mL.kg⁻¹ and when fetal lung epithelial cells were subjected to a continuous (17% elongation cyclic stretch. CONCLUSION: This is the first demonstration that prolonged (24 h of mechanical ventilation causes cell cycle arrest in newborn rat lungs; the arrest occurs in G₁ and is caused by increased expression and nuclear localization of Cdk inhibitor proteins (p27(Kip1, p57(Kip2 from the Kip family.

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

    Science.gov (United States)

    Scholz, Alexander-Wigbert; Weiler, Norbert; David, Matthias; Markstaller, Klaus

    2011-05-01

    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 cmH(2)O s l(-1) and the compliance from 12 to 32 ml cmH(2)O(-1). A Bland-Altman analysis of the resistance resulted in a sufficient agreement (bias -0.4 cmH(2)O s l(-1); standard deviation of differences 1.4 cmH(2)O 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 cmH(2)O(-1), standard deviation of differences 7 ml cmH(2)O(-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.

  13. 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 ...

  14. Mechanical ventilation-induced intrathoracic pressure distribution and heart-lung interactions

    NARCIS (Netherlands)

    Lansdorp, Benno; Hofhuizen, C.; van Lavieren, M.A.; van Swieten, H.; Lemson, J.; van Putten, Michel Johannes Antonius Maria; van der Hoeven, J.G.; Pickkers, P.

    2014-01-01

    OBJECTIVE: Mechanical ventilation causes cyclic changes in the heart's preload and afterload, thereby influencing the circulation. However, our understanding of the exact physiology of this cardiopulmonary interaction is limited. We aimed to thoroughly determine airway pressure distribution, how

  15. Mechanical ventilation-induced intrathoracic pressure distribution and heart-lung interactions*

    NARCIS (Netherlands)

    Lansdorp, B.; Hofhuizen, C.M.; Lavieren, M. van; Swieten, H.A. van; Lemson, J.; Putten, M.J.A.M. van; Hoeven, J.G. van der; Pickkers, P.

    2014-01-01

    OBJECTIVE: Mechanical ventilation causes cyclic changes in the heart's preload and afterload, thereby influencing the circulation. However, our understanding of the exact physiology of this cardiopulmonary interaction is limited. We aimed to thoroughly determine airway pressure distribution, how thi

  16. 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. ...

  17. High-flow nasal cannula therapy versus non-invasive ventilation in children with severe acute asthma exacerbation: An observational cohort study.

    Science.gov (United States)

    Pilar, J; Modesto I Alapont, V; Lopez-Fernandez, Y M; Lopez-Macias, O; Garcia-Urabayen, D; Amores-Hernandez, I

    2017-10-01

    The present study describes our experience with the high-flow humidified nasal cannula (HFNC) versus non-invasive ventilation (NIV) in children with severe acute asthma exacerbation (SA). An observational study of a retrospective cohort of 42 children with SA admitted to a Pediatric Intensive Care Unit (PICU) for non-invasive respiratory support was made. The primary outcome measure was failure of initial respiratory support (need to escalate from HFNC to NIV or from NIV to invasive ventilation). Secondary outcome measures were the duration of respiratory support and PICU length of stay (LOS). Forty-two children met the inclusion criteria. Twenty (47.6%) received HFNC and 22 (52.3%) NIV as initial respiratory support. There were no treatment failures in the NIV group. However, 8 children (40%) in the HFNC group required escalation to NIV. The PICU LOS was similar in both the NIV and HFNC groups. However, on considering the HFNC failure subgroup, the median length of respiratory support was 3-fold longer (63h) and the PICU LOS was also longer compared with the rest of subjects exhibiting treatment success. Despite its obvious limitations, this observational study could suggest that HFNC in some subjects with SA may delay NIV support and potentially cause longer respiratory support, and longer PICU LOS. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  18. Limitations of split-night polysomnography for the diagnosis of nocturnal hypoventilation and titration of non-invasive positive pressure ventilation in amyotrophic lateral sclerosis.

    Science.gov (United States)

    Loewen, Andrea H S; Korngut, Lawrence; Rimmer, Karen; Damji, Omar; Turin, Tanvir C; Hanly, Patrick J

    2014-12-01

    Split-night polysomnography is performed at our centre in all patients with ALS who require assessment for nocturnal hypoventilation and their response to non-invasive ventilation. The purpose of this study was to determine how successful this practice has been, reflected by whether a complete assessment was achieved by a single split-night polysomnogram. We undertook a systematic, retrospective review of all consecutive split-night polysomnograms in ALS patients between 2005 and 2012. A total of 47 cases were reviewed. Forty-three percent of patients had an incomplete test, resulting in a recommendation to repeat the polysomnogram. Poor sleep efficiency and absence of REM sleep in the diagnostic portion of the study were strongly associated with incomplete studies. Clinical variables that reflect severity of ALS (FVC, PaCO2, ALSFRS-R) and use of REM-suppressing antidepressants or sedative-hypnotics were not associated with incomplete split-night polysomnogram. In conclusion, a single, split-night polysomnogram is frequently inconclusive for the assessment of nocturnal hypoventilation and complete titration of non-invasive positive pressure ventilation in patients with ALS. Poor sleep efficiency and absence of REM sleep are the main limitations of split-night polysomnography in this patient population.

  19. 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

  20. Assessment of Sedation and Analgesia in Mechanically Ventilated Patients in Intensive Care Unit

    OpenAIRE

    2008-01-01

    Post traumatic stress resulting from an intensive care unit(ICU) stay may be prevented by adequate level of sedation and analgesia. Aims of the study were reviewing the current practices of sedation and analgesia in our ICU setup and to assess level of sedation and analgesia to know the requirement of sedative and analgesics in mechani-cally ventilated ICU patients. This prospective observational study was conducted on 50 consecutive mechanically ventilated patients in ICU over a period of 6 ...

  1. 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.

  2. Effect of methacholine on peripheral lung mechanics and ventilation heterogeneity in asthma.

    Science.gov (United States)

    Downie, Sue R; Salome, Cheryl M; Verbanck, Sylvia; Thompson, Bruce R; Berend, Norbert; King, Gregory G

    2013-03-15

    The forced oscillation technique (FOT) and multiple-breath nitrogen washout (MBNW) are noninvasive tests that are potentially sensitive to peripheral airways, with MBNW indexes being especially sensitive to heterogeneous changes in ventilation. The objective was to study methacholine-induced changes in the lung periphery of asthmatic patients and determine how changes in FOT variables of respiratory system reactance (Xrs) and resistance (Rrs) and frequency dependence of resistance (Rrs5-Rrs19) can be linked to changes in ventilation heterogeneity. The contributions of air trapping and airway closure, as extreme forms of heterogeneity, were also investigated. Xrs5, Rrs5, Rrs19, Rrs5-Rrs19, and inspiratory capacity (IC) were calculated from the FOT. Ventilation heterogeneity in acinar and conducting airways, and trapped gas (percent volume of trapped gas at functional residual capacity/vital capacity), were calculated from the MBNW. Measurements were repeated following methacholine. Methacholine-induced airway closure (percent change in forced vital capacity) and hyperinflation (change in IC) were also recorded. In 40 mild to moderate asthmatic patients, increase in Xrs5 after methacholine was predicted by increases in ventilation heterogeneity in acinar airways and forced vital capacity (r(2) = 0.37, P ventilation heterogeneity in conducting airway increase or IC decrease. Increases in Rrs5 and Rrs5-Rrs19 after methacholine were not correlated with increases in ventilation heterogeneity, trapped gas, hyperinflation, or airway closure. Increased reactance in asthmatic patients after methacholine was indicative of heterogeneous changes in the lung periphery and airway closure. By contrast, increases in resistance and frequency dependence of resistance were not related to ventilation heterogeneity or airway closure and were more indicative of changes in central airway caliber than of heterogeneity.

  3. 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.

  4. 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.

  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. 46 CFR 154.1205 - Mechanical ventilation system: Standards.

    Science.gov (United States)

    2010-10-01

    ...-ferrous material. (3) The impeller and housing made of austenitic stainless steel. (4) The impeller and housing made of ferrous material with at least 13mm (0.512 in.) tip clearance. (j) No ventilation fan may have any combination of fixed or rotating components made of an aluminum or magnesium alloy and ferrous...

  7. Nutritional Risk Screening 2002 as a Predictor of Outcome During General Ward-Based Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease with Respiratory Failure.

    Science.gov (United States)

    Cui, Jinbo; Wan, Qunfang; Wu, Xiaoling; Zeng, Yihua; Jiang, Li; Ao, Dongmei; Wang, Feng; Chen, Ting; Li, Yanli

    2015-09-18

    BACKGROUND Noninvasive ventilation (NIV) may reduce the need for intubation and mortality associated with chronic obstructive pulmonary disease (COPD) with type II respiratory failure. Early and simple predictors of NIV outcome could improve clinical management. This study aimed to assess whether nutritional risk screening 2002 (NRS2002) is a useful outcome predictor in COPD patients with type II respiratory failure treated by noninvasive positive pressure ventilation (NIPPV). MATERIAL AND METHODS This prospective observational study enrolled COPD patients with type II respiratory failure who accepted NIPPV. Patients were submitted to NRS2002 evaluation upon admission. Biochemical tests were performed the next day and blood gas analysis was carried out prior to NIPPV treatment and 4 hours thereafter. Patients were divided into NRS2002 score ≥3 and NRS2002 score <3 groups and NIV failure rates were compared between both groups. RESULTS Of the 233 patients, 71 (30.5%) were not successfully treated by NIPPV. The failure rate was significantly higher in the NRS2002 score ≥3 group (35.23%) in comparison with patients with NRS2002 score <3 (15.79%) (p<0.05). Multivariate analysis indicated that PaCO2 (OR 1.25, 95%CI 1.172-1.671, p<0.05) prior to NIPPV treatment and NRS2002 score ≥3 (OR 1.76, 95%CI 1.303-2.374, p<0.05) were independent predictive factors for NIPPV treatment failure. CONCLUSIONS NRS2002 score ≥3 and PaCO2 values at admission may predict unsuccessful NIPPV treatment of COPD patients with type II respiratory failure and help to adjust therapeutic strategies. NRS2002 is a noninvasive and simple method for predicting NIPPV treatment outcome.

  8. Nursing of Mechanical Ventilation Patients with Withdrawal of Ventilator%机械通气患者撤离呼吸机的护理

    Institute of Scientific and Technical Information of China (English)

    陈静静; 程宝霞; 王鑫; 刘兰芬

    2011-01-01

    Objective To explore the nursing measures during the withdrawal of ventilator in patients with mechanical ventilation. Methods The nursing plan during the withdrawal of ventilator in patients with mechanical ventilation was summarized based on the clinical nursing science and combined with clinical practice. Results Safety and suitable nursing care is key to elevate the success rate of the withdrawal of ventilator in patients with mechanical ventilation up to 95%. Conclusion Strengthening the clinical nursing during the withdrawal of ventilator in patients with mechanical ventilation can contribute to the recovery of respiratory function for improving life quality of patients.%目的 探讨机械通气患者撤离呼吸机过程中的护理措施.方法 以临床护理学为基础,结合临床工作实践经验,总结机械通气患者撤离呼吸机过程的护理措施.结果 通过正确及安全的护理措施,机械通气患者撤离呼吸机的成功率提高至95%.结论 加强机械通气患者撤离呼吸机过程的护理,可帮助患者恢复正常自主呼吸功能,从而提高患者生活质量.

  9. Effect of a musical intervention on tolerance and efficacy of non-invasive ventilation in the ICU: study protocol for a randomized controlled trial (MUSique pour l’Insuffisance Respiratoire Aigue - Mus-IRA)

    OpenAIRE

    Messika, Jonathan; Hajage, David; Panneckoucke, Nataly; Villard, Serge; Martin, Yolaine; Renard, Emilie; Blivet, Annie; Reignier, Jean; Maquigneau, Natacha; Stoclin, Annabelle; Puechberty, Christelle; Guétin, Stéphane; Dechanet, Aline; Fauquembergue, Amandine; Gaudry, Stéphane

    2016-01-01

    Background Non-invasive ventilation (NIV) tolerance is a key factor of NIV success. Hence, numerous sedative pharmacological or non-pharmacological strategies have been assessed to improve NIV tolerance. Music therapy in various health care settings has shown beneficial effects. In invasively ventilated critical care patients, encouraging results of music therapy on physiological parameters, anxiety, and agitation have been reported. We hypothesize that a musical intervention improves NIV tol...

  10. Total liquid ventilation provides superior respiratory support to conventional mechanical ventilation in a large animal model of severe respiratory failure.

    Science.gov (United States)

    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 the pulmonary circulation until PaO2:FiO2 ≤ 60 mm Hg, followed by transition to a protective CMV protocol (n = 5) or TLV (n = 5) for 24 hours. Pathophysiology was recorded, and the lungs were harvested for histological analysis. Animals treated with CMV became progressively hypoxic and hypercarbic despite maximum ventilatory support. Sheep treated with TLV maintained normal blood gases with statistically greater PO2 (p < 10(-9)) and lower PCO2 (p < 10(-3)) than the CMV group. Survival at 24 hours in the TLV and CMV groups were 100% and 40%, respectively (p < 0.05). Thus, TLV provided gas exchange superior to CMV in this laboratory model of severe ARDS.

  11. 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.

  12. Linking Ventilation Heterogeneity Quantified via Hyperpolarized 3He MRI to Dynamic Lung Mechanics and Airway Hyperresponsiveness.

    Science.gov (United States)

    Lui, Justin K; Parameswaran, Harikrishnan; Albert, Mitchell S; Lutchen, Kenneth R

    2015-01-01

    Advancements in hyperpolarized helium-3 MRI (HP 3He-MRI) have introduced the ability to render and quantify ventilation patterns throughout the anatomic regions of the lung. The goal of this study was to establish how ventilation heterogeneity relates to the dynamic changes in mechanical lung function and airway hyperresponsiveness in asthmatic subjects. In four healthy and nine mild-to-moderate asthmatic subjects, we measured dynamic lung resistance and lung elastance from 0.1 to 8 Hz via a broadband ventilation waveform technique. We quantified ventilation heterogeneity using a recently developed coefficient of variation method from HP 3He-MRI imaging. Dynamic lung mechanics and imaging were performed at baseline, post-challenge, and after a series of five deep inspirations. AHR was measured via the concentration of agonist that elicits a 20% decrease in the subject's forced expiratory volume in one second compared to baseline (PC20) dose. The ventilation coefficient of variation was correlated to low-frequency lung resistance (R = 0.647, P ventilation heterogeneity. Also, the degree of AHR appears to be dependent on the degree to which baseline airway constriction creates baseline ventilation heterogeneity. HP 3He-MRI imaging may be a powerful predictor of the degree of AHR and in tracking the efficacy of therapy.

  13. Arterial to end-tidal carbon dioxide difference in children undergoing mechanical ventilation of the lungs during general anaesthesia.

    Science.gov (United States)

    Onodi, C; Bühler, P K; Thomas, J; Schmitz, A; Weiss, M

    2017-07-11

    Capnography (ETCO2 ) is routinely used as a non-invasive estimate of arterial carbon dioxide (PaCO2 ) levels in order to modify ventilatory settings, whereby it is assumed that there is a positive gap between PaCO2 and ETCO2 of approximately 0.5 kPa. However, negative values (ETCO2 > PaCO2 ) can be observed. We retrospectively analysed arterial to end-tidal carbon dioxide differences in 799 children undergoing general anaesthesia with mechanical ventilation of the lungs in order to elucidate predictors for a negative gap. A total of 2452 blood gas analysis readings with complete vital sign monitoring, anaesthesia gas analysis and spirometry data were analysed. Mean arterial to end-tidal carbon dioxide difference was -0.18 kPa (limits of 95% agreement -1.10 to 0.74) and 71.2% of samples demonstrated negative values. The intercept model revealed PaCO2 to be the strongest predictor for a negative PaCO2 -ETCO2 difference. A decrease in PaCO2 by 1 kPa resulted in a decrease in the PaCO2 -ETCO2 difference by 0.23 kPa. This study demonstrates that ETCO2 monitoring in children whose lungs are mechanically ventilated may paradoxically lead to overestimation of ETCO2 (ETCO2 > PaCO2 ) with a subsequent risk of unrecognised hypocarbia. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  14. 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.

  15. Incidence and risk factors of upper gastrointestinal bleeding in mechanically ventilated children.

    Science.gov (United States)

    Deerojanawong, Jitladda; Peongsujarit, Danayawan; Vivatvakin, Boosba; Prapphal, Nuanchan

    2009-01-01

    To identify the incidence and factors related to upper gastrointestinal (UGI) bleeding in children requiring mechanical ventilation for longer than 48 hrs. Prospective analytic study. Ten-bed-pediatric intensive care unit of a tertiary care University Hospital. A total of 110 patients requiring mechanical ventilation for longer than 48 hrs from January 1, 2005 to December 31, 2005. UGI bleeding was defined by evidence of blood in nasogastric aspirates, hematemesis, or melena within 5 days of pediatric intensive care unit admission. We prospectively collected data on patient demographics, admission diagnosis, operative status, and pediatric risk of mortality score. UGI bleeding and the potential risk factors including organ failure, coagulopathy, maximum ventilator setting, enteral feeding, stress ulcer prophylaxis as well as sedation were daily monitored. Of the 110 patients who required mechanical ventilation for >48 hrs, the incidence of UGI bleeding was 51.8%, in which 3.6% of the cases presented with clinically significant bleeding (shock, requiring blood transfusion and/or surgery). Significant risk factors were thrombocytopenia, prolonged partial thromboplastin time, organ failure, high pressure ventilator setting >/=25 cm H2O, and pediatric risk of mortality score >/= 10 using univariate analysis. However, the independent factors of UGI bleeding in the multivariate analysis were organ failure (relative risk = 2.85, 95% confidence interval 1.18-6.92) and high pressure ventilator setting >/=25 cm H2O (relative risk = 3.73, 95% confidence interval 1.59-8.72). The incidence of UGI bleeding is high in children requiring mechanical ventilation. Organ failure and high pressure ventilator setting are significant risk factors for UGI bleeding.

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

    OpenAIRE

    Kompanje, Erwin; van der 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...

  17. 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.

  18. 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.

  19. Efficiency and outcome of non-invasive versus invasive positive pressure ventilation therapy in respiratory failure due to chronic obstructive pulmonary disease.

    Science.gov (United States)

    Amri Maleh, Valiollah; Monadi, Mahmood; Heidari, Behzad; Maleh, Parviz Amri; Bijani, Ali

    2016-01-01

    Background: Application noninvasive ventilation in the patients with exacerbation of chronic obstructive pulmonary disease (COPD) reduced mortality. This case-control study was designed to compare efficiency and outcome of non-invasive (NIV) versus invasive positive pressure ventilation (IPPV) in respiratory failure due to COPD. Methods: The patients were assigned to NIV or IPPV intermittantly.The clinical parameters, including RR (respiratory rate), BP (blood pressure), HR (heart rate) and PH, PaCO2, PaO2 before and 1, 4 and 24 h after treatment were measured. Demographic information such as age, sex, severity of disease based on APACHE score, length of stay and outcome were recorded. Results: Fifty patients were enrolled in the NIV group and 50 patients in IPPV. The mean age was 70.5 in NIV and 63.9 in invasive ventilation group (p>0.05). In IPPV group, the average values of PH: PCO2: and PO2, were 7.22±0.11, 69.64 + 24.25: and 68.86±24.41 .In NIV, the respective values were 7.30±0.07, 83.94±18.95, and 60.60±19.88. In NIV group, after 1, 4 and 24 h treatment, the clinical and ventilation parameters were stable. The mean APACHE score in was IPPV, 26.46±5.45 and in NIV was 12.26±5.54 (p<0.05). The average length of hospital stay in IPPV was 15.90±10 and in NIV 8.12±6.49 days (p<0.05). The total mortality in the NIV was 4 (8%) and in IPPV, 27 patients (54%) (p<0.05). Conclusion: This study indicates that using NIPPV is a useful therapeutic mode of treatment for respiratory failure with acceptable success rate and lower mortality. The application of NIPPV reduces hospital stay, intubation and its consequent complications. PMID:27386061

  20. 住院哮喘患者行机械通气治疗情况分析%Analysis of inpatients with asthma received mechanical ventilation

    Institute of Scientific and Technical Information of China (English)

    谢华; 张志远; 张俊丽; 刘美岑; 宋迪; 赵海涛; 马壮; 陈萍

    2015-01-01

    them were given mechanical ventilation, including 3. 4% of non-invasive mechanical ventilation and 3. 2% of invasive mechanical ventilation. Those patients received mechanical ventilation were tend to be senior citizens, staying in ICU and complicating with typeⅡrespira-tory failure. The incidence of pneumonia, diabetes, cerebrovascular disease and renal failure was higher in the venti-lation group than in the control group. The non-invasive mechanical ventilation group had the characteristics of more male and bronchiectasis. Further analysis of the risk factors found that the risk factors of non-invasive mechanical ventilation only included older than 65 years, male, stay in ICU, type Ⅱ respiratory failure and bronchiectasis, but the risk factors of invasive mechanical ventilation included older than 65 years, stay in ICU, typeⅡrespiratory fail-ure, pneumonia, coronary heart disease, diabetes, cerebrovascular disease, and liver and kidney dysfunction. The average hospitalization cost was 11,667 yuan for non-ventilation patients, and 42,460 yuan for ventilation patients (P<0. 05). The mortality of the non-ventilation group was 0. 2%, 2. 2% of the non-invasive ventilation group, and 27. 9% of the invasive ventilation group (P<0. 05). Conclusion The main risk factors causing asthma inpatients received mechanical ventilation are old age and complications.

  1. Early use of non-invasive positive pressure ventilation for acute exacerbations of chronic obstructive pulmonary disease: a multicentre randomized controlled trial

    Institute of Scientific and Technical Information of China (English)

    Collaborative Research Group of Noninvasive Mechan

    2005-01-01

    Background Respiratory muscle fatigue plays an important role in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). In previous clinical studies, non-invasive positive pressure ventilation (NPPV) was proved to be successful only for AECOPD patients with severe respiratory failure. We hypothesized that, the outcomes of AECOPD would be improved if NPPV is early (within 24 to 48 hours of admission) administered in those patients with respiratory muscle fatigue and mild respiratory insufficiency, especially in patients without fulfilling the conventional criteria of mechanical ventilatory support. Methods A prospective multicentre randomized controlled trial was conducted in 19 hospitals in China over 16 months. Three hundred and forty-two AECOPD patients with pH≥7.25 and PaCO2>45 mmHg were recruited on general ward and randomly assigned to standard medical treatment (control group) or early administration of additional NPPV (NPPV group).Results The characteristics of two groups on admission were similar. The number of AECOPD patients requiring intubations in NPPV group was much fewer than that of the control group (8/171 vs 26/71, P=0.002). Subgroup analysis showed the needs for intubation in mildly (pH≥7.35) and severe (pH<7.30) acidotic patients in NPPV group were both decreased (9/80 vs 2/71, P=0.047 and 8/30 vs 3/43, P=0.048, respectively). The mortality in hospital was reduced slightly by NPPV but with no significant difference (7/171 vs 12/171, P=0.345). Respiratory rate (RR),scale for accessory muscle use and arterial pH improved rapidly at the first 2 hours only in patients of NPPV group. After 24 hours, the differences of pH, PaO2, scale for accessory muscle use and RR in NPPV group [(7.36±0.06) mmHg, (72±22) mmHg, (2.5±0.9)/min, (22±4)/min] were statistically significant compared with control group (7.37±0.05) mmHg, (85±34) mmHg, (2.3±1.1)/min, (21±4)/min, P<0.01 for all comparisons].Conclusions The early use of NPPV on

  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. The use of 2% chlorhexidine gel and toothbrushing for oral hygiene of patients receiving mechanical ventilation: effects on ventilator-associated pneumonia

    Science.gov (United States)

    Meinberg, Maria Cristina de Avila; Cheade, Maria de Fátima Meinberg; Miranda, Amanda Lucia Dias; Fachini, Marcela Mascaro; Lobo, Suzana Margareth

    2012-01-01

    Objective To evaluate the effects of oral chlorhexidine hygiene with toothbrushing on the rate of ventilator-associated pneumonia in a mixed population of critically ill patients under prolonged mechanical ventilation. Methods Prospective, randomized, and placebo-controlled pilot study. Patients who were receiving mechanical ventilation, had been admitted less than 24 hours prior, and were anticipated to require mechanical ventilation for more than 72 hours were included in the study. The patients were randomly divided into one of the following groups: chlorhexidine hygiene with toothbrushing or a placebo group (gel with the same color and consistency and toothbrushing). Results The planned interim analysis was conducted using 52 patients, and the study was terminated prematurely. In total, 28 patients were included in the chlorhexidine / toothbrushing group, and 24 patients were included in the placebo group. Ventilator-associated pneumonia occurred in 45.8% of the placebo group and in 64.3% of the chlorhexidine hygiene with toothbrushing group (RR=1.4; 95% CI=0.83-2.34; p=0.29). Conclusion Because the study was terminated due to futility, it was not possible to evaluate the impact of oral hygiene using 2% chlorhexidine and toothbrushing on the incidence of ventilator-associated pneumonia in this heterogeneous population of critical patients receiving long-term mechanical ventilation, and no beneficial effect was observed for this intervention. PMID:23917935

  4. The influence of mechanical ventilation on physiological parameters in ball pythons (Python regius).

    Science.gov (United States)

    Jakobsen, Sashia L; Williams, Catherine J A; Wang, Tobias; Bertelsen, Mads F

    2017-05-01

    Mechanical ventilation is widely recommended for reptiles during anesthesia, and while it is well-known that their low ectothermic metabolism requires much lower ventilation than in mammals, very little is known about the influence of ventilation protocol on the recovery from anesthesia. Here, 15 ball pythons (Python regius) were induced and maintained with isoflurane for 60min at one of three ventilation protocols (30, 125, or 250mlmin(-1)kg(-1) body mass) while an arterial catheter was inserted, and ventilation was then continued on 100% oxygen at the specified rate until voluntary extubation. Mean arterial blood pressure and heart rate (HR) were measured, and arterial blood samples collected at 60, 80, 180min and 12 and 24h after intubation. In all three groups, there was evidence of a metabolic acidosis, and snakes maintained at 30mlmin(-1)kg(-1) experienced an additional respiratory acidosis, while the two other ventilation protocols resulted in normal or low arterial PCO2. In general, normal acid-base status was restored within 12h in all three protocols. HR increased by 143±64% during anesthesia with high mechanical ventilation (250mlmin(-1)kg(-1)) in comparison with recovered values. Recovery times after mechanical ventilation at 30, 125, or 250mlmin(-1)kg(-1) were 289±70, 126±16, and 68±7min, respectively. Mild overventilation may result in a faster recovery, and the associated lowering of arterial PCO2 normalised arterial pH in the face of metabolic acidosis. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. The use of dexmedetomidine combined with propofol in mechanically ventilated patients

    Directory of Open Access Journals (Sweden)

    Zi-long HU

    2015-07-01

    Full Text Available Objective To estimate and compare the efficacy and safety of midazolam, propofol and dexmedetomidine combined with propofol in sedation for mechanically ventilated patients. Methods Seventy-six patients with mechanical ventilation time >24h in ICU of Navy General Hospital of PLA from Mar. 2012 to Sep. 2014 were randomly divided into midazolam group (n=23, propofol group (n=27 and dexmedetomidine combined with propofol group (n=26, and they were given corresponding drugs for sedation. The proportions in each group which reached the target score of Richmond agitation-sedation scale (RASS and the nonverbal pain assessment scale (Critical-Care Pain Observation Tool, CPOT were accounted and recorded, and the positive rate of delirium was assessed with the confusion assessment method in the intensive care unit (CAM-ICU. The mechanical ventilation time and the effectiveness of sedation among the 3 groups were compared, the frequency of adverse cardiovascular events was recorded, and the frequency of controlled ventilation, daily mean arterial pressure as well as the heart rate range were analyzed. Results The proportion of reaching the target score of RASS was higher in dexmedetomidine combined with propofol group (86.54% than that in midazolam group (69.32%, P0.05. The proportion of reaching the target score of CPOT was higher in dexmedetomidine combined with propofol group (63.1% than in midazolam group (51.2% and propofol group (49.5%, P0.05. The positive rate of delirium and the proportion of controlled ventilation were lower, and the time of mechanical ventilation is shorter in dexmedetomidine combined with propofol group than in the other two groups (P0.05. Conclusion The efficacy and safety of dexmedetomidine combined with propofol is higher than the individual use of midazolam or propofol in producing sedation for mechanically ventilated patients. DOI: 10.11855/j.issn.0577-7402.2015.06.12

  6. Outcome of mechanically ventilated patients initially denied admission to an intensive care unit and subsequently admitted.

    Science.gov (United States)

    Naser, Wasim; Schwartz, Naama; Finkelstein, Richard; Bisharat, Naiel

    2016-11-01

    The outcome of mechanically ventilated patients initially denied admission to an intensive care unit (ICU) and subsequently admitted is unclear. We compared outcomes of patients denied ICU admission and subsequently admitted, to those of patients admitted to the ICU and to patients refused ICU admission. The medical records of all the patients who were subjected to mechanical ventilation for at least 24h over a 4year period (2010-2014) were reviewed. Of 707 patients (757 admissions), 124 (18%) were initially denied ICU admission and subsequently admitted. Multivariate stepwise logistic regression analysis showed significant association with death of: age, length of stay, nursing home residency, duration of mechanical ventilation, previous admission with mechanical ventilation, cause for mechanical ventilation, rate of failed extubations, associated morbidity (previous cerebrovascular accident, dementia, chronic renal failure), and occurrence of nosocomial bacteremia. The odds for death among patients denied ICU admission and subsequently transferred to the ICU compared to patients admitted directly to the ICU was 3.6 (95% CI: 1.9-6.7) (Padmission compared to those who were initially denied and subsequently admitted were not statistically significant (OR=1.7, 95% CI: 0.8-3.8). In conclusion, patients denied ICU admission and subsequently admitted face a considerable risk of morbidity and mortality. Their odds of death are nearly three times those admitted directly to the ICU. Late admission to the ICU does not appear to provide benefit compared to patients who remain in general medicine wards.

  7. 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.

  8. The Influence of Fluid Overload on the Length of Mechanical Ventilation in Pediatric Congenital Heart Surgery.

    Science.gov (United States)

    Sampaio, Tatiana Z A L; O'Hearn, Katie; Reddy, Deepti; Menon, Kusum

    2015-12-01

    Fluid overload and prolonged mechanical ventilation lead to worse outcomes in critically ill children. However, the association between these variables in children following congenital heart surgery is unknown. The objectives of this study were to describe the association between fluid overload and duration of mechanical ventilation, oxygen requirement and radiologic findings of pulmonary and chest wall edema. This study is a retrospective chart review of patients who underwent congenital heart surgery between June 2010 and December 2013. Univariate and multivariate associations between maximum cumulative fluid balance and length of mechanical ventilation and OI were tested using the Spearman correlation test and multiple linear regression models, respectively. There were 85 eligible patients. Maximum cumulative fluid balance was associated with duration of mechanical ventilation (adjusted analysis beta coefficient = 0.53, CI 0.38-0.66, P Fluid overload is associated with prolonged duration of mechanical ventilation and PICU length of stay after congenital heart surgery. Fluid overload was also associated with physiological markers of respiratory restriction. A randomized controlled trial of a restrictive versus liberal fluid replacement strategy is necessary in this patient population, but in the meantime, accumulating observational evidence suggests that cautious use of fluid in the postoperative care may be warranted.

  9. A new system for continuous and remote monitoring of patients receiving home mechanical ventilation

    Science.gov (United States)

    Battista, L.

    2016-09-01

    Home mechanical ventilation is the treatment of patients with respiratory failure or insufficiency by means of a mechanical ventilator at a patient's home. In order to allow remote patient monitoring, several tele-monitoring systems have been introduced in the last few years. However, most of them usually do not allow real-time services, as they have their own proprietary communication protocol implemented and some ventilation parameters are not always measured. Moreover, they monitor only some breaths during the whole day, despite the fact that a patient's respiratory state may change continuously during the day. In order to reduce the above drawbacks, this work reports the development of a novel remote monitoring system for long-term, home-based ventilation therapy; the proposed system allows for continuous monitoring of the main physical quantities involved during home-care ventilation (e.g., differential pressure, volume, and air flow rate) and is developed in order to allow observations of different remote therapy units located in different places of a city, region, or country. The developed remote patient monitoring system is able to detect various clinical events (e.g., events of tube disconnection and sleep apnea events) and has been successfully tested by means of experimental tests carried out with pulmonary ventilators typically used to support sick patients.

  10. Pulmonary Drug Delivery System for inhalation therapy in mechanically ventilated patients.

    Science.gov (United States)

    Dhand, Rajiv; Sohal, Harjyot

    2008-01-01

    The Pulmonary Drug Delivery System (PDDS) Clinical represents a newer generation of electronic nebulizers that employ a vibrating mesh or aperture plate to generate an aerosol. The PDDS Clinical is designed for aerosol therapy in patients receiving mechanical ventilation. The components of the device include a control module that is connected to the nebulizer/reservoir unit by a cable. The nebulizer contains Aerogen's OnQ aerosol generator. A pressure sensor monitors the pressure in the inspiratory limb of the ventilator circuit and provides feedback to the control module. Based on the feedback from the pressure sensor, aerosol generation occurs only during a specific part of the respiratory cycle. In bench models, the PDDS Clinical has high efficiency for aerosol delivery both on and off the ventilator, with a lower respiratory tract delivery of 50-70% of the nominal dose. Currently, the PDDS Clinical is being evaluated for the treatment of ventilator-associated pneumonia with aerosolized amikacin, an aminoglycoside antibiotic. Preliminary studies in patients with ventilator-associated pneumonia found that the administration of amikacin via PDDS reduced the need for concomitant intravenous antibiotics; however, more definitive clinical studies are needed. The PDDS Clinical delivers a high percentage of the nominal dose to the lower respiratory tract, and is well suited for inhalation therapy in mechanically ventilated patients.

  11. 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

  12. 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.

  13. Respiratory severity score on day of life 30 is predictive of mortality and the length of mechanical ventilation in premature infants with protracted ventilation.

    Science.gov (United States)

    Malkar, Manish B; Gardner, William P; Mandy, George T; Stenger, Michael R; Nelin, Leif D; Shepherd, Edward G; Welty, Stephen E

    2015-04-01

    We tested the hypothesis that Respiratory Severity Score (RSS) on day of life 30 is predictive of mortality and length of mechanical ventilation in premature infants on prolonged mechanical ventilation. A retrospective chart review was performed using the Nationwide Children's Hospital medical record and Vermont-Oxford Network databases. The primary outcome variable was survival to hospital discharge and the secondary outcome was length of mechanical ventilation after day of life 30. We identified 199 neonates admitted to Nationwide Children's Hospital between 2004 and 2007 with birth weight less than 1,500 g that received prolonged mechanical ventilation in the first 30 days of their life. A total of 184 infants were included in the analysis, excluding 14 patients with congenital anomalies and one infant with incomplete data. RSS on day of life 30 was significantly greater in the group of infants that died compared to those that survived (P = 0.003, 95% CI = [0.08, 0.40]). Further analysis demonstrated that the maximum difference in mortality was obtained with a threshold RSS of 6. Of the 109 patients who had RSS less than 6 on day of life 30, mortality rate was 4.6% (5/109) while those greater than or equal to 6 had a mortality rate of 21.3% (16/75). Both Kaplan-Meier survival curves comparing mortality and length of mechanical ventilation in infants with RSS < 6 versus those with RSS ≥ 6 demonstrated strong associations between RSS on day of life 30 and survival (P = 0.002) and length of ventilation after day of life 30 (P < 0.001). RSS ≥ 6 on day of life 30 is associated with higher mortality and longer period of mechanical ventilation in premature infants requiring mechanical ventilation through 30 days of life. © 2014 Wiley Periodicals, Inc.

  14. Non-Invasive Positive Pressure Ventilation in Acute Hypercapnic Respiratory Failure: Ten-Year’s Clinical Experience of a Respiratory Semi-Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Raffaele Scala, M.D., esp.

    2007-12-01

    Full Text Available BackgroundAlthough several prospective controlled randomizedtrials demonstrated the success of non-invasive positive pressure ventilation (NIPPV in selected cases of acute hypercapnic respiratory failure (ARF in setting with different care levels, clinical practice data about the use of VNI in the “real world” are limited.AimTo report the results of our clinical experiencein NIPPV applied for ARF in the Respiratory Semi-Intensive Care Unit (UTSIR allocated within the Respiratory Division of Arezzo betweenthe years 1996-2006 in terms of: patient tolerance, effects upon arterial blood gases, successrate and predictors of failure. Methods: Three hundred and filthy out of the 1484 patients (23.6% consecutively admittedfor ARF to our Respiratory Division during the study period received NIPPV in addition to standard therapy, according to the predeterminedroutinely used criteria. Results: Eight patients (2.3% did not tolerateNIPPV because of mask discomfort, while the remaining 342 (M: 240, F: 102; median (interquartilesage: 74.0 (68.0-79.3 yrs; COPD: 69.3% were ventilated for >1 hour. Arterial blood gases significantly improved after two hours of NIPPV (mean (standard deviation pH: 7.33 (0.07 versus 7.28 (7.25-7.31, p 48 hrs of ventilation after an initial positive response. Conclusions: As results of ten years of clinicalexperience at our UTSIR, NIPPV was shown to be well tolerated, effective in improving arterialblood gases and useful in avoiding intubationin most ARF episodes non-responsive to standard therapy.

  15. Effects of noninvasive ventilation on treadmill 6-min walk distance and regional chest wall volumes in cystic fibrosis: randomized controlled trial.

    Science.gov (United States)

    Lima, Cibelle Andrade; Andrade, Armèle de Fátima Dornelas de; Campos, Shirley Lima; Brandão, Daniella Cunha; Fregonezi, Guilherme; Mourato, Ianny Pereira; Aliverti, Andrea; Britto, Murilo Carlos Amorim de

    2014-10-01

    Dyspnea and exercise intolerance are the symptoms that most affect the quality of life of children and adolescents with respiratory disorders resulting from cystic fibrosis (CF). To evaluate the effect of noninvasive ventilation (NIV) on treadmill 6-min walk distance and regional chest wall volumes in cystic fibrosis patients. Crossover clinical trial, randomized, controlled and open with 13 children and adolescents with CF, aged 7-16 years, with pulmonary impairment (NTC01987271). The patients performed a treadmill walking test (TWT) during 6 min, with and without NIV on a BiLEVEL mode, an interval of 24-48 h between tests. Before and after each test, patients were assessed by spirometry and optoelectronic plethysmography. Walking distance in TWT with NIV was significantly higher that without ventilatory support (mean ± sd: 0.41 ± 0.08 vs. 0.39 ± 0.85 km, p = 0.039). TWT with NIV increase forced expiratory volume on 1 s (FEV1; p = 0.036), tidal volume (Vt; p = 0.005), minute ventilation (MV; p = 0.013), pulmonary rib cage volume (Vrcp; p = 0.011), and decrease the abdominal volume (Vab; p = 0.013) after test. There was a significant reduction in oxygen saturation (p = 0.018) and permanent increase in respiratory rate after 5 min (p = 0.021) after the end test without NIV. During the walking test on the treadmill, the NIV change thoracoabdominal kinematics and lung function in order to optimized ventilation and tissue oxygenation, with improvement of walk distance. Consequently, NIV is an effective tool to increase functional capacity in children and adolescents with cystic fibrosis. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    National Research Council Canada - National Science Library

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

    2010-01-01

    .... 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...

  17. 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.

  18. 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.)

  19. 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.

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

    Science.gov (United States)

    Coisel, Yannael; Bousbia, Sabri; Forel, Jean-Marie; Hraiech, Sami; Lascola, Bernard; Roch, Antoine; Zandotti, Christine; Million, Matthieu; Jaber, Samir; Raoult, Didier; Papazian, Laurent

    2012-01-01

    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. Prospective epidemiological study. Medical intensive care unit of a tertiary medical center. Ninety-three patients with suspected pneumonia. 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. 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. 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.

  1. 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/

  2. Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: a quality improvement project.

    Science.gov (United States)

    McWilliams, David; Weblin, Jonathan; Atkins, Gemma; Bion, Julian; Williams, Jenny; Elliott, Catherine; Whitehouse, Tony; Snelson, Catherine

    2015-02-01

    Prolonged periods of mechanical ventilation are associated with significant physical and psychosocial adverse effects. Despite increasing evidence supporting early rehabilitation strategies, uptake and delivery of such interventions in Europe have been variable. The objective of this study was to evaluate the impact of an early and enhanced rehabilitation program for mechanically ventilated patients in a large tertiary referral, mixed-population intensive care unit (ICU). A new supportive rehabilitation team was created within the ICU in April 2012, with a focus on promoting early and enhanced rehabilitation for patients at high risk for prolonged ICU and hospital stays. Baseline data on all patients invasively ventilated for at least 5 days in the previous 12 months (n = 290) were compared with all patients ventilated for at least 5 days in the 12 months after the introduction of the rehabilitation team (n = 292). The main outcome measures were mobility level at ICU discharge (assessed via the Manchester Mobility Score), mean ICU, and post-ICU length of stay (LOS), ventilator days, and in-hospital mortality. The introduction of the ICU rehabilitation team was associated with a significant increase in mobility at ICU discharge, and this was associated with a significant reduction in ICU LOS (16.9 vs 14.4 days, P = .007), ventilator days (11.7 vs 9.3 days, P rehabilitation within this European ICU improved levels of mobility at critical care discharge, and this was associated with reduced ICU and hospital LOS and reduced days of mechanical ventilation. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  3. Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Zhongheng Zhang

    2017-01-01

    Full Text Available Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed. Next, we discussed the timing of ECMO initiation based on the risks and benefits of ECMO. During the running of ECMO, the protective ventilation strategy can be employed without worrying about catastrophic hypoxemia and carbon dioxide retention. There is a large body of evidence showing that protective ventilation with low tidal volume, high positive end-expiratory pressure, and prone positioning can provide benefits on mortality outcome. More recently, there is an increasing popularity on the use of awake and spontaneous breathing for patients undergoing ECMO, which is thought to be beneficial in terms of rehabilitation.

  4. Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

    Science.gov (United States)

    Gu, Wan-Jie; Chen, Kun; Ni, Hongying

    2017-01-01

    Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV) to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO) provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed. Next, we discussed the timing of ECMO initiation based on the risks and benefits of ECMO. During the running of ECMO, the protective ventilation strategy can be employed without worrying about catastrophic hypoxemia and carbon dioxide retention. There is a large body of evidence showing that protective ventilation with low tidal volume, high positive end-expiratory pressure, and prone positioning can provide benefits on mortality outcome. More recently, there is an increasing popularity on the use of awake and spontaneous breathing for patients undergoing ECMO, which is thought to be beneficial in terms of rehabilitation. PMID:28127231

  5. 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

  6. Manual ventilation and open suction procedures contribute to negative pressures in a mechanical lung model

    Science.gov (United States)

    Nakstad, Espen Rostrup; Opdahl, Helge; Heyerdahl, Fridtjof; Borchsenius, Fredrik; Skjønsberg, Ole Henning

    2017-01-01

    Introduction Removal of pulmonary secretions in mechanically ventilated patients usually requires suction with closed catheter systems or flexible bronchoscopes. Manual ventilation is occasionally performed during such procedures if clinicians suspect inadequate ventilation. Suctioning can also be performed with the ventilator entirely disconnected from the endotracheal tube (ETT). The aim of this study was to investigate if these two procedures generate negative airway pressures, which may contribute to atelectasis. Methods The effects of device insertion and suctioning in ETTs were examined in a mechanical lung model with a pressure transducer inserted distal to ETTs of 9 mm, 8 mm and 7 mm internal diameter (ID). A 16 Fr bronchoscope and 12, 14 and 16 Fr suction catheters were used at two different vacuum levels during manual ventilation and with the ETTs disconnected. Results During manual ventilation with ETTs of 9 mm, 8 mm and 7 mm ID, and bronchoscopic suctioning at moderate suction level, peak pressure (PPEAK) dropped from 23, 22 and 24.5 cm H2O to 16, 16 and 15 cm H2O, respectively. Maximum suction reduced PPEAK to 20, 17 and 11 cm H2O, respectively, and the end-expiratory pressure fell from 5, 5.5 and 4.5 cm H2O to –2, –6 and –17 cm H2O. Suctioning through disconnected ETTs (open suction procedure) gave negative model airway pressures throughout the duration of the procedures. Conclusions Manual ventilation and open suction procedures induce negative end-expiratory pressure during endotracheal suctioning, which may have clinical implications in patients who need high PEEP (positive end-expiratory pressure). PMID:28725445

  7. A Survey of Mechanical Ventilator Practices Across Burn Centers in North America

    Science.gov (United States)

    Rhie, Ryan Y.; Lundy, Jonathan B.; Cartotto, Robert; Henderson, Elizabeth; Pressman, Melissa A.; Joe, Victor C.; Aden, James K.; Driscoll, Ian R.; Faucher, Lee D.; McDermid, Robert C.; Mlcak, Ronald P.; Hickerson, William L.; Jeng, James C.

    2016-01-01

    Burn injury introduces unique clinical challenges that make it difficult to extrapolate mechanical ventilator (MV) practices designed for the management of general critical care patients to the burn population. We hypothesize that no consensus exists among North American burn centers with regard to optimal ventilator practices. The purpose of this study is to examine various MV practice patterns in the burn population and to identify potential opportunities for future research. A researcher designed, 24-item survey was sent electronically to 129 burn centers. The χ2, Fisher’s exact, and Cochran–Mantel–Haenszel tests were used to determine if there were significant differences in practice patterns. We analyzed 46 questionnaires for a 36% response rate. More than 95% of the burn centers reported greater than 100 annual admissions. Pressure support and volume assist control were the most common initial MV modes used with or without inhalation injury. In the setting of Berlin defined mild acute respiratory distress syndrome (ARDS), ARDSNet protocol and optimal positive end-expiratory pressure were the top ventilator choices, along with fluid restriction/diuresis as a nonventilator adjunct. For severe ARDS, airway pressure release ventilation and neuromuscular blockade were the most popular. The most frequently reported time frame for mechanical ventilation before tracheostomy was 2 weeks (25 of 45, 55%); however, all respondents reported in the affirmative that there are certain clinical situations where early tracheostomy is warranted. Wide variations in clinical practice exist among North American burn centers. No single ventilator mode or adjunct prevails in the management of burn patients regardless of pulmonary insult. Movement toward American Burn Association–supported, multicenter studies to determine best practices and guidelines for ventilator management in burn patients is prudent in light of these findings. PMID:26135527

  8. Advances in the clinical application of non-invasive positive pressure ventilation%无创正压通气临床应用进展

    Institute of Scientific and Technical Information of China (English)

    宫帅; 刘跃建

    2013-01-01

    20世纪初首次运用负压机械通气治疗神经肌肉疾病,从此开创了呼吸疾病治疗史上的新纪元.如今无创正压通气有了迅猛发展,在观念和机器设备上都发生了革命性变化.为顺应医学事业发展,国内外相继发表了无创通气治疗指南,这些指南以循证医学为依据并具有较高科学价值与临床实用性,很大程度上促进了无创呼吸机的应用与推广.现就无创正压通气应用现状及进展综述如下.%In the beginning of the twentith century,negative pressure mechanical ventilation was used in the treatment of neuromuscular diseases for the first time,and began a new era in the history of respiratory disease treatment.Today,non invasive positive pressure ventilation has been the dramatic development of a revolutionary change in terms of concepts and machinery and equipment.In order to conform to the medical career development,non invasive ventilation treatment guidelines have been published at home and abroad,these guidelines have been based on the evidence-based medicine and have a high scientific value and clinical utility,also contributed to the application and promotion of non invasive ventilation.This review aims to summarize the current situation and progression for non invasive positive pressure ventilation.

  9. Efficacy of non-invasive positive pressure ventilation in the treatment of respiratory failure in patients with COPD at the acute exacerbation stage

    Institute of Scientific and Technical Information of China (English)

    De-Peng Li

    2016-01-01

    Objective:To observe the efficacy of non-invasive positive pressure ventilation (NIPPV) in the treatment of respiratory failure in patients with COPD at the acute exacerbation stage. Methods:A total of 38 COPD patients at the acute exacerbation stage with respiratory failure who were admitted in our hospital from January, 2012 to January, 2013 with complete medical materials were included in the study and divided into the observation group and the control group according to different treatment methods. On admission, the patients in the two groups were given oxygen inhalation, positive infection control, and drugs that could improve the respiratory function. On the basis, the patients in the observation group were given additional NIPPV. The improvement of blood gas indicators 4, 24, 72 d after admission, and 5, 30 d after discharge in the two groups was compared. The hospitalization time and the number of second hospitalization within 3 months in the two groups were compared.Results: In the observation group, pH value after 4 h ventilation was significantly elevated, and maintained at a stable state after 24 h ventilation, while in the control group, the change of pH value was not statistically significant, and after 5 d treatment, pH value was yet low. In the observation group, PaCO2 was significantly reduced in a short ventilation time, while in the control group, the descending range was small. The comparison of pH and PaCO2 4 h, 24 h, 72 h, and 5 d after treatment between the two groups was statistically significant, but PaCO2 in the two groups could not reduce to the normal level. PaO2 after treatment in the two groups was improved, but the improved degree in the observation degree was significantly superior to that in the control group. The comparison of blood gas indicators 30 d after discharge between the two groups was not statistically significant. The hospitalization time in the observation group was shortened, and the number of second hospitalization

  10. 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.

  11. Neonatal total liquid ventilation: is low-frequency forced oscillation technique suitable for respiratory mechanics assessment?

    Science.gov (United States)

    Bossé, Dominick; Beaulieu, Alexandre; Avoine, Olivier; Micheau, Philippe; Praud, Jean-Paul; Walti, Hervé

    2010-08-01

    This study aimed to implement low-frequency forced oscillation technique (LFFOT) in neonatal total liquid ventilation (TLV) and to provide the first insight into respiratory impedance under this new modality of ventilation. Thirteen newborn lambs, weighing 2.5 + or - 0.4 kg (mean + or - SD), were premedicated, intubated, anesthetized, and then placed under TLV using a specially design liquid ventilator and a perfluorocarbon. The respiratory mechanics measurements protocol was started immediately after TLV initiation. Three blocks of measurements were first performed: one during initial respiratory system adaptation to TLV, followed by two other series during steady-state conditions. Lambs were then divided into two groups before undergoing another three blocks of measurements: the first group received a 10-min intravenous infusion of salbutamol (1.5 microg x kg(-1) x min(-1)) after continuous infusion of methacholine (9 microg x kg(-1) x min(-1)), while the second group of lambs was chest strapped. Respiratory impedance was measured using serial single-frequency tests at frequencies ranging between 0.05 and 2 Hz and then fitted with a constant-phase model. Harmonic test signals of 0.2 Hz were also launched every 10 min throughout the measurement protocol. Airway resistance and inertance were starkly increased in TLV compared with gas ventilation, with a resonant frequency ventilation. We show that LFFOT is an effective tool to track respiratory mechanics under TLV.

  12. 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.

  13. Indicators of fatigue and of prolonged weaning from mechanical ventilation in surgical patients.

    Science.gov (United States)

    O'Keefe, G E; Hawkins, K; Boynton, J; Burns, D

    2001-01-01

    Indicators of weaning success have been tested primarily in patients who have been ventilated for short periods of time, and they may not be as accurate in cases where support has been required for longer than a few days. In patients requiring longer periods of support it is difficult to estimate the likelihood of successful liberation. Therefore we evaluated established weaning indices for their accuracy in surgical patients who required > or = 72 hours of mechanical ventilation. Surgical patients who required mechanical ventilation for > or = 72 hours were prospectively followed (over 6 months). We obtained standard indices of ventilatory function daily once patients were ready to wean. These indices included the respiratory rate/tidal volume ratio (RSBI), the maximal inspiratory pressure, and the minute ventilation. The duration of weaning and explicitly defined episodes of fatigue were the outcomes of interest. Statistical analyses evaluated the multiple factors that might influence the duration of weaning. Ninety-five patients (66% trauma; 34% surgery) survived to begin weaning, and 93% were liberated. The median duration of mechanical ventilation prior to weaning was 4 days (range 3-16 days), and the median duration of weaning was 3 days (range 0-56 days). Fatigue occurred in 36 patients and was not reliably predicted by any of the weaning measurements. However, a RSBI of > 105 on the first day of weaning was associated with prolonged weaning. By multivariate analysis, an RSBI of > 105 on the first day of weaning predicted prolonged weaning (hazard ratio 1.9; p = 0.03). After 72 hours of mechanical ventilation, clinical fatigue and successful liberation are not reliably predicted by standard indices of respiratory muscle strength and reserve. However, an RSBI of >105 observed once the patient is ready to wean is associated with prolonged weaning.

  14. Inspiratory muscle training is ineffective in mechanically ventilated critically ill patients

    Directory of Open Access Journals (Sweden)

    Caruso Pedro

    2005-01-01

    Full Text Available PURPOSE: Invasive mechanical ventilation is associated with complications, and its abbreviation is desirable. The imbalance between increased workload, decreased inspiratory muscle strength and endurance is an important determinant of ventilator dependence. Low endurance may be present due to respiratory muscle atrophy, critical illness, or steroid use. Specific inspiratory muscle training may increase or preserve endurance. The objective of the study was to test the hypothesis that inspiratory muscle training from the beginning of mechanical ventilation would abbreviate the weaning duration and decrease reintubation rate. As a secondary objective, we described the evolution of inspiratory muscle strength with and without inspiratory muscle training. METHODS: Prospective, randomized clinical trial in an adult clinical-surgical intensive care unit. Twelve patients trained the inspiratory muscles twice a day, and 13 patients did not (control. Training was performed adjusting the sensitivity of the ventilator based on the maximal inspiratory pressure. Patients underwent daily surveillance of the maximal inspiratory pressure. RESULTS: The weaning duration (31 ± 22 hr, control and 23 ± 11 hr, training group; P = .24 and reintubation rate (5 control and 3 training group; P = .39 were not statistically different. The maximal inspiratory pressure of the control group showed a trend toward a modest increase. In contrast, the training group showed a small decrease (P = .34. CONCLUSIONS: In acute critically ill patients, inspiratory muscle training from the beginning of mechanical ventilation neither abbreviated the weaning duration, nor decreased the reintubation rate. Inspiratory muscle strength tended to stay constant, along the mechanical ventilation, with or without this specific inspiratory muscle training.

  15. Promoting effective communication for patients receiving mechanical ventilation.

    Science.gov (United States)

    Grossbach, Irene; Stranberg, Sarah; Chlan, Linda

    2011-06-01

    Communicating effectively with ventilator-dependent patients is essential so that various basic physiological and psychological needs can be conveyed and decisions, wishes, and desires about the plan of care and end-of-life decision making can be expressed. Numerous methods can be used to communicate, including gestures, head nods, mouthing of words, writing, use of letter/picture boards and common words or phrases tailored to meet individualized patients' needs. High-tech alternative communication devices are available for more complex cases. Various options for patients with a tracheostomy tube include partial or total cuff deflation and use of a speaking valve. It is important for nurses to assess communication needs; identify appropriate alternative communication strategies; create a customized care plan with the patient, the patient's family, and other team members; ensure that the care plan is visible and accessible to all staff interacting with the patient; and continue to collaborate with colleagues from all disciplines to promote effective communication with nonvocal patients.

  16. 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.

  17. Monitoring of total positive end-expiratory pressure during mechanical ventilation by artificial neural networks.

    Science.gov (United States)

    Perchiazzi, Gaetano; Rylander, Christian; Pellegrini, Mariangela; Larsson, Anders; Hedenstierna, Göran

    2016-04-11

    Ventilation treatment of acute lung injury (ALI) requires the application of positive airway pressure at the end of expiration (PEEPapp) to avoid lung collapse. However, the total pressure exerted on the alveolar walls (PEEPtot) is the sum of PEEPapp and intrinsic PEEP (PEEPi), a hidden component. To measure PEEPtot, ventilation must be discontinued with an end-expiratory hold maneuver (EEHM). We hypothesized that artificial neural networks (ANN) could estimate the PEEPtot from flow and pressure tracings during ongoing mechanical ventilation. Ten pigs were mechanically ventilated, and the time constant of their respiratory system (τRS) was measured. We shortened their expiratory time (TE) according to multiples of τRS, obtaining different respiratory patterns (Rpat). Pressure (PAW) and flow (V'AW) at the airway opening during ongoing mechanical ventilation were simultaneously recorded, with and without the addition of external resistance. The last breath of each Rpat included an EEHM, which was used to compute the reference PEEPtot. The entire protocol was repeated after the induction of ALI with i.v. injection of oleic acid, and 382 tracings were obtained. The ANN had to extract the PEEPtot, from the tracings without an EEHM. ANN agreement with reference PEEPtot was assessed with the Bland-Altman method. Bland Altman analysis of estimation error by ANN showed -0.40 ± 2.84 (expressed as bias ± precision) and ±5.58 as limits of agreement (data expressed as cmH2O). The ANNs estimated the PEEPtot well at different levels of PEEPapp under dynamic conditions, opening up new possibilities in monitoring PEEPi in critically ill patients who require ventilator treatment.

  18. Parameter estimation of an artificial respiratory system under mechanical ventilation following a noisy regime

    Directory of Open Access Journals (Sweden)

    Marcus Henrique Victor Júnior

    Full Text Available Abstract Introduction: This work concerns the assessment of a novel system for mechanical ventilation and a parameter estimation method in a bench test. The tested system was based on a commercial mechanical ventilator and a personal computer. A computational routine was developed do drive the mechanical ventilator and a parameter estimation method was utilized to estimate positive end-expiratory pressure, resistance and compliance of the artificial respiratory system. Methods The computational routine was responsible for establishing connections between devices and controlling them. Parameters such as tidal volume, respiratory rate and others can be set for standard and noisy ventilation regimes. Ventilation tests were performed directly varying parameters in the system. Readings from a calibrated measuring device were the basis for analysis. Adopting a first-order linear model, the parameters could be estimated and the outcomes statistically analysed. Results Data acquisition was effective in terms of sample frequency and low noise content. After filtering, cycle detection and estimation took place. Statistics of median, mean and standard deviation were calculated, showing consistent matching with adjusted values. Changes in positive end-expiratory pressure statistically imply changes in compliance, but not the opposite. Conclusion The developed system was satisfactory in terms of clinical parameters. Statistics exhibited consistent relations between adjusted and estimated values, besides precision of the measurements. The system is expected to be used in animals, with a view to better understand the benefits of noisy ventilation, by evaluating the estimated parameters and performing cross relations among blood gas, ultrasonography and electrical impedance tomography.

  19. 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 ...

  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 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 ...

  2. A protocol of no sedation for critically ill patients receiving mechanical ventilation

    DEFF Research Database (Denmark)

    Strøm, Thomas; Martinussen, Torben; Toft, Palle

    2