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Sample records for pulmonary ventilation

  1. Pulmonary ventilation/perfusion scan

    Science.gov (United States)

    V/Q scan; Ventilation/perfusion scan; Lung ventilation/perfusion scan ... A pulmonary ventilation/perfusion scan is actually two tests. They may be done separately or together. During the perfusion scan, a health care provider injects ...

  2. 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.

  3. 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.

  4. 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....

  5. Unusual ventilation perfusion scintigram in a case of immunologic pulmonary edema clinically simulating pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Campeau, R.J.; Faust, J.M.; Ahmad, S.

    1987-11-01

    A case of immunologic pulmonary edema secondary to hydrochlorothiazide allergy developed in a 55-year-old woman that clinically simulated pulmonary embolism. The patient had abnormal washin images with normal washout images on an Xe-133 ventilation study. On the perfusion study, large bilateral central and posterior perfusion defects were present that showed an unusual mirror image pattern on the lateral and posterior oblique views. Resolution of radiographic and scintigraphic abnormalities occurred over a 3-day period in conjunction with corticosteroid therapy.

  6. 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

  7. Assessing the utility of the ventilation phase in ventilation-perfusion imaging for acute pulmonary embolism.

    Science.gov (United States)

    Grimm, Lars J; Coleman, Ralph E

    2013-01-01

    This study aims to identify patient characteristics that allow the exclusion of the ventilation phase in ventilation-perfusion imaging for the evaluation of acute pulmonary embolism (PE). A total of 500 consecutive ventilation-perfusion reports with an indication for possible acute PE were retrospectively reviewed. Information on ventilation abnormalities, perfusion defects, PIOPED classification, age, sex, chest radiograph results, and presence of respiratory disease was recorded. Patients with moderate and large perfusion defects were analyzed to assess the utility of the ventilation phase on the final PIOPED classification. Moderate (n=39) or large (n=26) perfusion defects were seen in 65 (13%) studies. Of these, 46 studies (70.8%) had defects unmatched on ventilation and three (4.6%) had triple-match defects, resulting in 49 reports (75.4%) classified as intermediate (n=28) or high (n=21) probability for PE. There was a statistically significant association between unmatched defects and a clear chest radiograph (P=0.03) and an association approaching statistical significance with younger age (P=0.05). There was a strong association with respiratory disease (P=0.12) and no association with patient sex (P=0.82). The percentage of studies with unmatched defects increased from 70.8 to 76.7% (33/43, P=0.39) if patients with respiratory disease were excluded, to 82.4% (28/34, P=0.14) if abnormal chest radiographs were excluded, and to 95.7% (22/23, P=0.01) if both were excluded. There may be a subset of patients - younger patients with clear chest radiographs and no respiratory disease - for whom the ventilation phase can be excluded and the determination of a PE is based solely on perfusion abnormalities.

  8. 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.

  9. Modified PISAPED Criteria in Combination with Ventilation Scintigraphic Finding for Predicting Acute Pulmonary Embolism

    OpenAIRE

    Watanabe, Naoyuki; Fettich, Jure; Küçük, Nurie Özlem; Kraft, Otakar; Mut, Fernando; Choudhury, Partha; Sharma, Surendra K.; Endo, Keigo; Dondi, Maurizio

    2015-01-01

    This prospective clinical study aimed at assessing three pulmonary scintigraphic algorithms to detect acute pulmonary embolism (PE): Lung ventilation/perfusion (V/Q) scintigraphy along with modified prospective investigation of pulmonary embolism diagnosis (PIOPED) criteria; lung perfusion scintigraphy along with prospective investigative study of acute pulmonary embolism diagnosis (PISAPED) criteria; and lung perfusion scan in combination with ventilation scan, along with modified PISAPED cr...

  10. Low cost of pulmonary ventilation in American alligators (Alligator mississippiensis) stimulated with doxapram.

    Science.gov (United States)

    Skovgaard, Nini; Crossley, Dane A; Wang, Tobias

    2016-04-01

    To determine the costs of pulmonary ventilation without imposing severe oxygen limitations or acidosis that normally accompany exposures to hypoxia or hypercapnia, we opted to pharmacologically stimulate ventilation with doxapram (5 and 10 mg kg(-1)) in alligators. Doxapram is used clinically to alleviate ventilatory depression in response to anaesthesia and acts primarily on the peripheral oxygen-sensitive chemoreceptors. Using this approach, we investigated the hypothesis that pulmonary ventilation is relatively modest in comparison to resting metabolic rate in crocodilians and equipped seven juvenile alligators with masks for concurrent determination of ventilation and oxygen uptake. Doxapram elicited a dose-dependent and up to fourfold rise in ventilation, primarily by increasing ventilatory frequency. The accompanying rise in oxygen uptake was very small; ventilation in resting animals constitutes no more than 5% of resting metabolic rate. The conclusion that pulmonary ventilation is energetically cheap is consistent with earlier studies on alligators where ventilation was stimulated by hypoxia or hypercapnia.

  11. Interstitial pulmonary emphysema in ventilated neonates. Long-term observations

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, K.; Fendel, H.

    1986-06-01

    106 (15.7%) of 675 artificially ventilated newborn developed interstitial pulmonary emphysema (PIE). Basic lung diseases were: IRDS, neonatal pneumonia, shock lung, meconium aspiration, hypoplasia of the lungs and other miscellaneous disorders of the chest. PIE developed in 68% of patients within 8 hours following artificial respiration. At the beginning of PIE both lungs were concerned in 41.5% of patients, one lobe of both lungs was affected in 32.1%. PIE was located in one lung in 8.5% and in only one lobe in 17.9%. Maximum of PIE was seen within 5 days after initiating respiration in 76.7% of the patients. Persistent PIE developed in 28.7% of the patients. Persistent PIE of both lungs was seen in 11 cases, PIE of one lung in 8 cases and persistent lobar emphysema in another 8. Pulmonary pseudocysts developed in 22 (20.8%) of the patients.

  12. Pulmonary Ventilation Imaging Based on 4-Dimensional Computed Tomography: Comparison With Pulmonary Function Tests and SPECT Ventilation Images

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Tokihiro, E-mail: toyamamoto@ucdavis.edu [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California (United States); Kabus, Sven; Lorenz, Cristian [Department of Digital Imaging, Philips Research Europe, Hamburg (Germany); Mittra, Erik [Departments of Radiology, Stanford University School of Medicine, Stanford, California (United States); Hong, Julian C.; Chung, Melody; Eclov, Neville; To, Jacqueline; Diehn, Maximilian; Loo, Billy W. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Keall, Paul J. [Radiation Physics Laboratory, Sydney Medical School, University of Sydney, Sydney, New South Wales (Australia)

    2014-10-01

    Purpose: 4-dimensional computed tomography (4D-CT)-based pulmonary ventilation imaging is an emerging functional imaging modality. The purpose of this study was to investigate the physiological significance of 4D-CT ventilation imaging by comparison with pulmonary function test (PFT) measurements and single-photon emission CT (SPECT) ventilation images, which are the clinical references for global and regional lung function, respectively. Methods and Materials: In an institutional review board–approved prospective clinical trial, 4D-CT imaging and PFT and/or SPECT ventilation imaging were performed in thoracic cancer patients. Regional ventilation (V{sub 4DCT}) was calculated by deformable image registration of 4D-CT images and quantitative analysis for regional volume change. V{sub 4DCT} defect parameters were compared with the PFT measurements (forced expiratory volume in 1 second (FEV{sub 1}; % predicted) and FEV{sub 1}/forced vital capacity (FVC; %). V{sub 4DCT} was also compared with SPECT ventilation (V{sub SPECT}) to (1) test whether V{sub 4DCT} in V{sub SPECT} defect regions is significantly lower than in nondefect regions by using the 2-tailed t test; (2) to quantify the spatial overlap between V{sub 4DCT} and V{sub SPECT} defect regions with Dice similarity coefficient (DSC); and (3) to test ventral-to-dorsal gradients by using the 2-tailed t test. Results: Of 21 patients enrolled in the study, 18 patients for whom 4D-CT and either PFT or SPECT were acquired were included in the analysis. V{sub 4DCT} defect parameters were found to have significant, moderate correlations with PFT measurements. For example, V{sub 4DCT}{sup HU} defect volume increased significantly with decreasing FEV{sub 1}/FVC (R=−0.65, P<.01). V{sub 4DCT} in V{sub SPECT} defect regions was significantly lower than in nondefect regions (mean V{sub 4DCT}{sup HU} 0.049 vs 0.076, P<.01). The average DSCs for the spatial overlap with SPECT ventilation defect regions were only moderate (V

  13. Xenon-enhanced CT imaging of local pulmonary ventilation

    Science.gov (United States)

    Tajik, Jehangir K.; Tran, Binh Q.; Hoffman, Eric A.

    1996-04-01

    We are using the unique features of electron beam CT (EBCT) in conjunction with respiratory and cardiac gating to explore the use of non-radioactive xenon gas as a pulmonary ventilation contrast agent. The goal is to construct accurate and quantitative high-resolution maps of local pulmonary ventilation in humans. We are evaluating xenon-enhanced computed tomography in the pig model with dynamic tracer washout/dilution and single breath inhalation imaging protocols. Scanning is done via an EBCT scanner which offers 50 msec scan aperture speeds. CT attenuation coefficients (image gray scale value) show a linear increase with xenon concentration (r equals 0.99). We measure a 1.55 Hounsfield Unit (HU) enhancement (kV equals 130, mA equals 623) per percentage increase in xenon gas concentration giving an approximately 155 HU enhancement with 100% xenon gas concentration as measured in a plexiglass super-syringe. Early results indicate that a single breath (from functional residual capacity to total lung capacity) of 100% xenon gas provides an average 32 +/- 1.85 (SE) HU enhancement in the lung parenchyma (maximum 50 HU) and should not encounter unwanted xenon side effects. However, changes in lung density occurring during even short breath holds (as short as 10 seconds) may limit using a single breath technique to synchronous volumetric scanning, currently possible only with EBCT. Preliminary results indicate close agreement between measured regional xenon concentration-time curves and theoretical predictions for the same sample. More than 10 breaths with inspirations to as high as 25 cmH2O airway pressure were needed to clear tracer from all lung regions and some regions had nearly linear rather than mono-exponential clearance curves. When regional parenchymal xenon concentration-time curves were analyzed, vertical gradients in ventilation and redistribution of ventilation at higher inspiratory flow rates were consistent with known pulmonary physiology. We present

  14. Ventilation-perfusion relationships following experimental pulmonary contusion.

    Science.gov (United States)

    Batchinsky, Andriy I; Weiss, William B; Jordan, Bryan S; Dick, Edward J; Cancelada, David A; Cancio, Leopoldo C

    2007-09-01

    Ventilation-perfusion changes after right-sided pulmonary contusion (PC) in swine were investigated by means of the multiple inert gas elimination technique (MIGET). Anesthetized swine (injury, n = 8; control, n = 6) sustained a right-chest PC by a captive-bolt apparatus. This was followed by a 12-ml/kg hemorrhage, resuscitation, and reinfusion of shed blood. MIGET and thoracic computed tomography (CT) were performed before and 6 h after injury. Three-dimensional CT scan reconstruction enabled determination of the combined fractional volume of poorly aerated and non-aerated lung tissue (VOL), and the mean gray-scale density (MGSD). Six hours after PC in injured animals, Pa(O(2)) decreased from 234.9 +/- 5.1 to 113.9 +/- 13.0 mmHg. Shunt (Q(S)) increased (2.7 +/- 0.4 to 12.3 +/- 2.2%) at the expense of blood flow to normal ventilation/perfusion compartments (97.1 +/- 0.4 to 87.4 +/- 2.2%). Dead space ventilation (V(D)/V(T)) increased (58.7 +/- 1.7% to 67.2 +/- 1.2%). MGSD increased (-696.7 +/- 6.1 to -565.0 +/- 24.3 Hounsfield units), as did VOL (4.3 +/- 0.5 to 33.5 +/- 3.2%). Multivariate linear regression of MGSD, VOL, V(D)/V(T), and Q(S) vs. Pa(O(2)) retained VOL and Q(S) (r(2) = .835) as independent covariates of Pa(O(2)). An increase in Q(S) characterizes lung failure 6 h after pulmonary contusion; Q(S) and VOL correlate independently with Pa(O(2)).

  15. The role of invasive ventilation in exacerbations of chronic obstructive pulmonary disease causing respiratory failure.

    Science.gov (United States)

    Kosky, Christopher; Turton, Charles

    2006-01-01

    Acute hypercapnic respiratory failure in chronic obstructive pulmonary disease can usually be managed initially with medical treatment and non- invasive ventilation. In circumstances where non- invasive ventilation cannot be used or has failed, intubation and invasive ventilation may be lifesaving. The outcome of patients with an exacerbation of COPD requiring invasive ventilation is better than often thought, with a hospital survival of 70-89%. Decisions regarding invasive ventilation made by physicians and patients with COPD are unpredictable and vary with the individual. This article reviews the role of invasive ventilation in exacerbations of COPD to assist decision making.

  16. 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.

  17. Analysis of the dynamic states of pulmonary ventilation and perfusion in bronchial asthmatics using (133)Xe gas ventilation scintigraphy and (99m)Tc-MAA lung perfusion scintigraphy

    OpenAIRE

    石濱,英暢

    1994-01-01

    To clarify the organic changes and pathophysiology of the lungs in intractable asthmatics, the dynamic states of pulmonary ventilation and perfusion were analyzed in 15 bronchial asthmatic in the stable state using (133)Xe gas ventilation scintigraphy and (99m)Tc-MAA lung perfusion scintigraphy, respectively. Dysfunction of pulmonary ventilation and impairment of pulmonary perfusin were significantly severer in intractable asthmatics than in non-intractable asthmatics (p

  18. 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

  19. Changes in pulmonary blood flow do not affect gas exchange during intermittent ventilation in resting turtles

    DEFF Research Database (Denmark)

    Wang, Tobias; Hicks, James W.

    2008-01-01

    with characteristic increases in pulmonary blood flow and tachycardia. In animals with central vascular shunts, the rise in pulmonary blood flow during ventilation is associated with the development of left-to-right (L-R) cardiac shunt (pulmonary recirculation of oxygenated blood returning from the lungs......The breathing pattern of many different air-breathing vertebrates, including lungfish, anuran amphibians, turtles, crocodiles and snakes, is characterized by brief periods of lung ventilation interspersed among apnoeas of variable duration. These intermittent ventilatory cycles are associated...... experimentally. The present study measured pulmonary gas exchange in fully recovered, freely diving turtles, where changes in pulmonary blood flow were prevented by partial occlusion of the pulmonary artery. Prevention of L-R shunt during ventilation did not impair CO2 excretion and overall, oxygen uptake and CO...

  20. sup 133 Xe ventilation study in pulmonary infiltration with eosinophilia and hypersensitivity pneumonitis

    Energy Technology Data Exchange (ETDEWEB)

    Akaki, Shiro; Kohno, Yoshihiro; Yasui, Kotaro (Okayama Univ. (Japan). School of Medicine) (and others)

    1990-09-01

    Ventilation study using {sup 133}Xe were performed to measure regional ventilation in four normal volunteers, four patients with pulmonary infiltration with eosinophilia (PIE) and five patients with hypersensitivity pneumonitis (HP). In both PIE and HP, regional abnormality of ventilation was seen and two indexes of ventilation T{sub 1/2}, T{sub A/H} were in a tendency to be longer in PIE and HP than in normal volunteers. It was suggested that {sup 133}Xe ventilation study might be useful for PIE and HP. (author).

  1. Effect of high-frequency positive-pressure ventilation on halothane ablation of hypoxic pulmonary vasoconstriction.

    Science.gov (United States)

    Hall, S M; Chapleau, M; Cairo, J; Levitzky, M G

    1985-08-01

    High-frequency positive-pressure ventilation (HFPPV) was compared to intermittent positive-pressure ventilation (IPPV) during unilateral atelectasis with and without halothane anesthesia. Dogs with electromagnetic flow probes chronically implanted on their main (Qt) and left (Ql) pulmonary arteries were ventilated via Carlen's dual-lumen endotracheal tubes. In eight closed-chest dogs, about 43% of the cardiac output perfused the left lung during bilateral ventilation by either a Harvard animal respirator (IPPV) or a Health-dyne model 300 high-frequency ventilator (HFPPV). Unilateral atelectasis decreased blood flow (Ql/Qt) to that lung. Ql/Qt was 19 +/- 1% with HFPPV during left-lung atelectasis and right-lung ventilation, compared to 32 +/- 1% with unilateral IPPV. This suggests that HFPPV permits stronger hypoxic pulmonary vasoconstriction. Addition of 1% halothane increased blood flow to the atelectatic left lung during unilateral ventilation with IPPV but not with HFPPV. This suggests that halothane decreases the effects of hypoxic pulmonary vasoconstriction during conventional ventilation but not during HFPPV.

  2. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery

    Science.gov (United States)

    2016-01-01

    The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery, can reduce postoperative pulmonary complications. Facilitating perioperative bundle care by combining prophylactic and postoperative positive-pressure ventilation with intraoperative lung-protective ventilation may be helpful to reduce postoperative pulmonary complications. PMID:26885294

  3. Pulmonary hemodynamic responses to in utero ventilation in very immature fetal sheep

    Directory of Open Access Journals (Sweden)

    Allison Beth J

    2010-08-01

    Full Text Available Abstract Background The onset of ventilation at birth decreases pulmonary vascular resistance (PVR resulting in a large increase in pulmonary blood flow (PBF. As the large cross sectional area of the pulmonary vascular bed develops late in gestation, we have investigated whether the ventilation-induced increase in PBF is reduced in immature lungs. Methods Surgery was performed in fetal sheep at 105 d GA (n = 7; term ~147 d to insert an endotracheal tube, which was connected to a neonatal ventilation circuit, and a transonic flow probe was placed around the left pulmonary artery. At 110 d GA, fetuses (n = 7 were ventilated in utero (IUV for 12 hrs while continuous measurements of PBF were made, fetuses were allowed to develop in utero for a further 7 days following ventilation. Results PBF changes were highly variable between animals, increasing from 12.2 ± 6.6 mL/min to a maximum of 78.1 ± 23.1 mL/min in four fetuses after 10 minutes of ventilation. In the remaining three fetuses, little change in PBF was measured in response to IUV. The increases in PBF measured in responding fetuses were not sustained throughout the ventilation period and by 2 hrs of IUV had returned to pre-IUV control values. Discussion and conclusion Ventilation of very immature fetal sheep in utero increased PBF in 57% of fetuses but this increase was not sustained for more than 2 hrs, despite continuing ventilation. Immature lungs can increase PBF during ventilation, however, the present studies show these changes are transient and highly variable.

  4. Critical evaluation of pulmonary contusion in the early post-traumatic period: risk of assisted ventilation.

    Science.gov (United States)

    Hamrick, Miller C; Duhn, Ryan D; Ochsner, M Gage

    2009-11-01

    This study attempts to accurately quantify pulmonary contusion and predict those patients most likely to require assisted ventilation early in their hospital course. Patients admitted to a Level I trauma center were evaluated for pulmonary contusion by helical CT scan. Scans were reviewed by a single radiologist who attempted to accurately quantify contusion as a percentage of total lung volume. These patients were then followed for 48 hours in an attempt to use CT measurements of contusion to predict those that would require assisted ventilation early in their hospital course. After using numerous exclusion criteria, 152 patients were included in the study. Of these, 31 patients (20%) required assisted ventilation within 48 hours of hospital admission. Twenty per cent pulmonary contusion proved to be a highly predictive variable leading to need for assisted ventilation. Of patients sustaining contusion, only 7 of 92 (8%) required assisted ventilation versus 24 of 60 (40%) sustaining >20 per cent contusion. Pulmonary contusion is a significant injury especially when contusion volume exceeds 20 per cent of total lung volume. With accurate measurement of contusion, we can identify those patients at high risk of requiring assisted ventilation early in their hospital course.

  5. A randomized comparison of different ventilator strategies during thoracotomy for pulmonary resection.

    Science.gov (United States)

    Maslow, Andrew D; Stafford, Todd S; Davignon, Kristopher R; Ng, Thomas

    2013-07-01

    Protective lung ventilation is reported to benefit patients with acute respiratory distress syndrome. It is not known whether protective lung ventilation is also beneficial to patients undergoing single-lung ventilation for elective pulmonary resection. In an institutional review board-approved prospective randomized trial, 34 patients undergoing elective pulmonary resection requiring single-lung ventilation were enrolled. Informed consent was obtained. Patients were randomized to 1 of 2 groups: (1) high tidal volume (Hi-TV) of 10 mL/kg, rate of 7 breaths/min, and zero positive end-expiratory pressure or (2) low tidal volume (Lo-TV) of 5 mL/kg, rate of 14 breaths/min, and 5 cmH2O positive end-expiratory pressure. Ventilator settings were continued during both double- and single-lung ventilation. Pulmonary functions, hemodynamics, and postoperative outcomes were recorded. Patient demographics, operative characteristics, intraoperative hemodynamics, and postoperative pain and sedation scores were similar between the 2 groups. During most time periods, airway pressures (peak and plateau) were significantly higher in the Hi-TV group; however, plateau pressures remained less than 30 cmH2O at all times for all patients. The Hi-TV group had significantly lower arterial carbon dioxide tension, less arterial carbon dioxide tension-end-tidal carbon dioxide gradient, lower alveolar dead space ratio, and higher dynamic pulmonary compliance. There were no differences in postoperative morbidity and hospital days between the 2 groups, but atelectasis scores on postoperative days 1 and 2 were lower in the Hi-TV group. The use of Hi-TV during single-lung ventilation for pulmonary resection resulted in no increase in morbidity and was associated with less hypercarbia, less dead space ventilation, better dynamic compliance, and less postoperative atelectasis. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  6. Clinical Validation of 4-Dimensional Computed Tomography Ventilation With Pulmonary Function Test Data

    Energy Technology Data Exchange (ETDEWEB)

    Brennan, Douglas [University of Colorado School of Medicine, Aurora, Colorado (United States); Schubert, Leah; Diot, Quentin [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States); Castillo, Richard [Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, Texas (United States); Castillo, Edward; Guerrero, Thomas [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Martel, Mary K. [Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Linderman, Derek; Gaspar, Laurie E.; Miften, Moyed; Kavanagh, Brian D. [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States); Vinogradskiy, Yevgeniy, E-mail: yevgeniy.vinogradskiy@ucdenver.edu [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States)

    2015-06-01

    Purpose: A new form of functional imaging has been proposed in the form of 4-dimensional computed tomography (4DCT) ventilation. Because 4DCTs are acquired as part of routine care for lung cancer patients, calculating ventilation maps from 4DCTs provides spatial lung function information without added dosimetric or monetary cost to the patient. Before 4DCT-ventilation is implemented it needs to be clinically validated. Pulmonary function tests (PFTs) provide a clinically established way of evaluating lung function. The purpose of our work was to perform a clinical validation by comparing 4DCT-ventilation metrics with PFT data. Methods and Materials: Ninety-eight lung cancer patients with pretreatment 4DCT and PFT data were included in the study. Pulmonary function test metrics used to diagnose obstructive lung disease were recorded: forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity. Four-dimensional CT data sets and spatial registration were used to compute 4DCT-ventilation images using a density change–based and a Jacobian-based model. The ventilation maps were reduced to single metrics intended to reflect the degree of ventilation obstruction. Specifically, we computed the coefficient of variation (SD/mean), ventilation V20 (volume of lung ≤20% ventilation), and correlated the ventilation metrics with PFT data. Regression analysis was used to determine whether 4DCT ventilation data could predict for normal versus abnormal lung function using PFT thresholds. Results: Correlation coefficients comparing 4DCT-ventilation with PFT data ranged from 0.63 to 0.72, with the best agreement between FEV1 and coefficient of variation. Four-dimensional CT ventilation metrics were able to significantly delineate between clinically normal versus abnormal PFT results. Conclusions: Validation of 4DCT ventilation with clinically relevant metrics is essential. We demonstrate good global agreement between PFTs and 4DCT-ventilation, indicating that 4DCT-ventilation

  7. 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.)

  8. Adult patient with pulmonary agenesis: focusing on one-lung ventilation during general anesthesia.

    Science.gov (United States)

    Yu, Yuetian; Zhu, Cheng; Qian, Xiaozhe; Gao, Yuan; Zhang, Zhongheng

    2016-01-01

    Congenital pulmonary agenesis is a rare condition with high mortality. Mechanical ventilation in these patients is challenging and there has no such case been reported in the literature. We reported a 61-year-old female with lung agenesis who presented to our hospital with pneumonia and pelvic mass. In the past, she had undergone repairing of atrial septal defect and mitral valve forming surgery at 6-year-old. Thereafter she had remained asymptomatic until this time of hospital admission. The patient underwent operation for the pelvic mass with one-lung ventilation (OLV) under general anesthesia. We highlighted the use of protective ventilation (PV) strategy during OLV.

  9. 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.

  10. 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.

  11. The use of intratracheal pulmonary ventilation and partial liquid ventilation in newborn piglets with meconium aspiration syndrome.

    Science.gov (United States)

    Onasanya, Babatunde I.; Rais-Bahrami, Khodayar; Rivera, Oswaldo; Seale, Winslow R.; Short, Billie L.

    2001-01-01

    OBJECTIVE: To determine whether intratracheal pulmonary ventilation (ITPV) combined with partial liquid ventilation (PLV) improves oxygenation and ventilation at lower mean airway and peak inspiratory pressures when compared with conventional mechanical ventilation in a piglet model of meconium aspiration syndrome. DESIGN: Prospective, randomized, interventional study. SETTING: Animal Research Laboratory at the Children's National Medical Center, Washington, DC. SUBJECTS: Twenty newborn piglets, 1 to 2 wks of age, 1.8-2.8 kg in weight. INTERVENTION: The animals were anesthetized, paralyzed, and intubated with a 4.0 mm (internal diameter) endotracheal tube via a tracheostomy and were ventilated. Catheters were placed in the femoral artery and vein. Seven milliliters per kilogram of 20% human meconium was insufflated into the lungs over 30 mins. Dynamic pulmonary compliance was measured before and after instillation of meconium. Animals were ventilated to maintain arterial blood gases in a normal range, that is, pH = 7.35-7.45, Paco(2) = 40-45 torr (5.3-6.0 kPa), and Pao(2) = 70-90 torr (9.3-12.0 kPa). Ventilator settings were increased as needed to a maximum setting of Fio(2) = 1.0, peak inspiratory pressure (PIP) = 40 cm H(2)O, positive end-expiratory pressure = 5 cm H(2)O, and intermittent mandatory ventilation = 60 bpm. After a period of stabilization, 30 mL/kg of perflubron (Liquivent; Alliance Pharmaceutical Corp., San Diego, CA) was given intratracheally over 30 mins and the animals were randomized to either ITPV or control group. Measurements and RESULTS: Arterial blood gases were taken every 30 mins, and ventilatory settings were adjusted to achieve the targeted blood gas parameters. The animals' temperature, arterial blood pressure, heart rate, and oxygen saturation were monitored continuously. There was a significant decrease in the dynamic pulmonary compliance measurements in both groups immediately after meconium instillation. Compliance measurements

  12. Pulmonary functional MRI:an animal model study of oxygen-enhanced ventilation combined with Gd-DTPA-enhanced perfusion

    Institute of Scientific and Technical Information of China (English)

    杨健; 万明习; 郭佑民

    2004-01-01

    Background The assessment of regional pulmonary ventilation and perfusion is essential for the evaluation of a variety of lung disorders. Pulmonary ventilation MRI using inhaled oxygen as a contrast medium can be obtained with a clinical MR scanner, without additional equipment, and has been demonstrated to be a feasible means of assessing ventilation in animal models and some clinical patients. However, few studies have reported on MR ventilation-perfusion imaging. In this study, we evaluated the usefulness of oxygen-enhanced ventilation in combination with first-pass Gd-DTPA-enhanced perfusion MRI in a canine model of pulmonary embolism and airway obstruction.Methods Peripheral pulmonary embolisms were produced in eight dogs by intravenous injection of gelfoam strips at the pulmonary segmental arterial level, and airway obstructions were created in five of the dogs by inserting a self-designed balloon catheter into a secondary bronchus. Oxygen-enhanced MR ventilation images were produced by subtracting images from before and after inhalation of pure oxygen. Pulmonary perfusion MR images were acquired with a dynamic three-dimensional fast gradient-echo sequence. MR ventilation and perfusion images were read and contrasted with results from general examinations of pathological anatomy, ventilation-perfusion scintigraphy, and pulmonary angiography. Results Regions identified as having airway obstructions matched using both MR ventilation and perfusion imaging, but regions of pulmonary embolisms were mismatched. The area of airway obstruction defects was smaller using MR ventilation imagery than that using ventilation scintigraphy. Abnormal perfusion regions due to pulmonary embolisms were divided into defective regions and reduced regions based on the time course of signal intensity changes. In the diagnosis of pulmonary embolisms with the technique of ventilation and perfusion MRI, sensitivity and specificity were 75.0% and 98.1%, respectively, and the diagnostic

  13. Pressure-regulated volume controlled ventilation in acute respiratory failure of pulmonary diseases

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    M.E. Abou Shehata

    2012-07-01

    Conclusion: PRVC ventilation improves oxygenation parameters in ARF of different etiologies and is equally effective in management of ARF of different pulmonary disorders. The most important predictors for mortality were development of MODS and prolonged duration of MV as detected by logistic regression analysis.

  14. Modified PISAPED Criteria in Combination with Ventilation Scintigraphic Finding for Predicting Acute Pulmonary Embolism.

    Science.gov (United States)

    Watanabe, Naoyuki; Fettich, Jure; Küçük, Nurie Özlem; Kraft, Otakar; Mut, Fernando; Choudhury, Partha; Sharma, Surendra K; Endo, Keigo; Dondi, Maurizio

    2015-01-01

    This prospective clinical study aimed at assessing three pulmonary scintigraphic algorithms to detect acute pulmonary embolism (PE): Lung ventilation/perfusion (V/Q) scintigraphy along with modified prospective investigation of pulmonary embolism diagnosis (PIOPED) criteria; lung perfusion scintigraphy along with prospective investigative study of acute pulmonary embolism diagnosis (PISAPED) criteria; and lung perfusion scan in combination with ventilation scan, along with modified PISAPED criteria, which were newly developed. Patients with suspicion of PE were eligible for this study if they had no abnormal chest x-ray. Their diagnostic workup included a clinical assessment, a pulmonary V/Q scintigraphy, and CT pulmonary angiography (CTPA), as well as a clinical outcome assessment over a period of 24 weeks. Referred to the final clinical diagnosis of patients, the sensitivity and specificity of each algorithm were evaluated. The diagnostic performance of each algorithm by the area under the maximum likelihood fitted receiver operating characteristic (ROC) curve was determined. With respect to the PISAPED criteria, the sensitivity was 60.8% and specificity was 87.3%. No patient was classified into nondiagnostic category. The PIOPED criteria showed that the sensitivity was 95.0% and specificity was 88.2%, while 57.4% of the patients were in nondiagnostic category. The areas under the ROC curve constructed from the PISAPED criteria results and the modified PIOPED criteria results were 0.734 and 0.859 (P < 0.01), respectively. The modified PISAPED criteria demonstrated that the sensitivity was 83.8% and specificity was 89.1%. No patient was classified into nondiagnostic category. The area under the ROC curve constructed from modified PISAPED criteria was 0.864 (P < 0.01). Perfusion scans used with ventilation scans and modified PISAPED criteria may increase the diagnostic accuracy of pulmonary scintigraphy for acute PE, compared with the two major algorithms.

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

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    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. 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.

  18. Pulmonary infection control window as a switching point for consequential ventilation: an encouraging finding in treatment of acute respiratory failure of chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xi-long

    2005-01-01

    @@ I read with great interest the article by Collaborating Research Group for Noninvasive Mechanical Ventilation of Chinese Respiratory Society.1 Based on the concept mentioned in this paper, I have found that it is really an encouraging new finding in the field of clinical application of mechanical ventilation and treatment of acute respiratory failure (ARF) of chronic obstructive pulmonary disease (COPD).

  19. 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.

  20. Assessment of right ventricular ejection fraction during intravenous /sup 133/Xe pulmonary ventilation study

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, S.M.; Spencer, R.P.; Herrera, N.E.

    1985-01-01

    Intravenous /sup 133/Xe in saline was used to estimate right-ventricular ejection fraction (RVEF). In three healthy volunteers, the first pass RVEF with /sup 133/Xe was followed by RVEF estimation by intravenous /sup 99m/Tc-pertechnetate. There was agreement between the /sup 133/Xe and 99mTc determined values. Subjects rebreathed the liberated /sup 133/Xe gas, allowing an estimation of regional pulmonary ventilation. Intravenous /sup 133/Xe in saline may have potential use in measuring RVEF, as well as in evaluating pulmonary function in cor pulmonale.

  1. Adult patient with pulmonary agenesis: focusing on one-lung ventilation during general anesthesia

    OpenAIRE

    Yu, Yuetian; ZHU, CHENG; QIAN, XIAOZHE; Gao, Yuan; Zhang, Zhongheng

    2016-01-01

    Congenital pulmonary agenesis is a rare condition with high mortality. Mechanical ventilation in these patients is challenging and there has no such case been reported in the literature. We reported a 61-year-old female with lung agenesis who presented to our hospital with pneumonia and pelvic mass. In the past, she had undergone repairing of atrial septal defect and mitral valve forming surgery at 6-year-old. Thereafter she had remained asymptomatic until this time of hospital admission. The...

  2. Lack of additional effect of adjunct of assisted ventilation to pulmonary rehabilitation in mild COPD patients.

    Science.gov (United States)

    Bianchi, L; Foglio, K; Porta, R; Baiardi, R; Vitacca, M; Ambrosino, N

    2002-05-01

    Different modalities of assisted ventilation improve breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the effects of the addition of assisted ventilation during exercise training on the outcome of a structured pulmonary rehabilitation programme (PRP) in COPD patients. Thirty-three male patients with stable COPD (mean (SD) forced expiratory volume in 1 s (FEV1) 44 (16) % pred), without chronic ventilatory failure, undergoing a 6-week multidisciplinary outpatient PRP including exercise training, were randomised to training during either mask proportional assist ventilation (PAV: 18 patients) or spontaneous breathing (SB: 15 patients). Assessment included exercise tolerance, dyspnoea, leg fatigue, and health-related quality of life (HRQL). Five out of 18 patients (28%) in the PAV group dropped out due to lack of compliance with the equipment. Both groups showed significant post-PRP improvements in exercise tolerance (peak work rate difference: 20 (95% Cl 2.4-37.6) and 14 (3.8% CI to 24.2) W in PAV and SB group, respectively), dyspnoea and leg fatigue, but not in HRQL, without any significant difference between groups. It is concluded that with the modality and in the patients assessed in this study assisted ventilation during training sessions included in a multidisciplinary PRP was not well tolerated by all patients and gave no additional physiological benefit in comparison with exercise training alone.

  3. Can CT pulmonary angiography replace ventilation-perfusion scans as a first line investigation for pulmonary emboli?

    Science.gov (United States)

    McEwan, L; Gandhi, M; Andersen, J; Manthey, K

    1999-08-01

    A prospective study was performed to determine efficacy of diagnosis of pulmonary emboli by computed tomographic pulmonary angiography (CTPA) in patients who underwent both CTPA and ventilation-perfusion (V/Q) scanning. The results were compared with the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study in which conventional pulmonary angiography had been performed instead of CTPA. Forty-two of 161 (26%) patients had a positive CTPA compared with a 27% prevalence in the PIOPED population. Fourteen of 16 patients (87.5%) with high-probability V/Q scans also had a positive CTPA compared with 87% in PIOPED. Twelve of 40 patients (30%) with intermediate probability V/Q scans also had a positive CTPA compared with 34.7% in PIOPED, while 12 of 80 patients (15%) who had low-probability V/Q scans had positive CTPA compared with 14.5% in PIOPED. Four of 25 patients (16%) with normal V/Q scans had positive CTPA compared with 0% in PIOPED. While the present study size was relatively small, the results compared favourably with PIOPED, suggesting that equivalent prevalence of clot was being detected using CTPA. This result, together with the cost considerations, has led us to replace V/Q scanning with CTPA for investigation of the majority of cases of suspected, acute pulmonary emboli.

  4. Can CT pulmonary angiography replace ventilation-perfusion scans as a first line investigation for pulmonary emboli?

    Energy Technology Data Exchange (ETDEWEB)

    McEwan, L.; Gandhi, M.; Andersen, J.; Manthey, K. [The Princess Alexandra Hospital, Woolloongabba, QLD (Australia). Division of Radiology

    1999-08-01

    A prospective study was performed to determine efficacy of diagnosis of pulmonary emboli by computed tomographic pulmonary angiography (CTPA) in patients who underwent both CTPA and ventilation-perfusion (V/Q) scanning. The results were compared with the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study in which conventional pulmonary angiography had been performed instead of CTPA. Forty-two of 161 (26%) patients had a positive CTPA compared with a 27% prevalence in the PIOPED population. Fourteen of 16 patients (87.5%) with high-probability V/Q scans also had a positive CTPA compared with 87% in PIOPED. Twelve of 40 patients (30%) with intermediate probability V/Q scans also had a positive CTPA compared with 34.7% in PIOPED, while 12 of 80 patients (15%) who had low-probability V/Q scans had positive CTPA compared with 14.5% in PIOPED. Four of 25 patients (16%) with normal V/Q scans had positive CTPA compared with 0% in PIOPED. While the present study size was relatively small, the results compared favourably with PIOPED, suggesting that equivalent prevalence of clot was being detected using CTPA. This result, together with the cost considerations, has led us to replace V/Q scanning with CTPA for investigation of the majority of cases of suspected, acute pulmonary emboli. Copyright (1999) Blackwell Science Pty Ltd 6 refs., 5 tabs., 2 figs.

  5. Value of the ventilation/perfusion scan in acute pulmonary embolism: Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED)

    Energy Technology Data Exchange (ETDEWEB)

    1990-05-23

    To determine the sensitivities and specificities of ventilation/perfusion lung scans for acute pulmonary embolism, a random sample of 933 of 1,493 patients was studied prospectively. Nine hundred thirty-one underwent scintigraphy and 755 underwent pulmonary angiography; 251 (33%) of 755 demonstrated pulmonary embolism. Almost all patients with pulmonary embolism had abnormal scans of high, intermediate, or low probability, but so did most without pulmonary embolism. Of 116 patients with high-probability scans and definitive angiograms, 102 (88%) had pulmonary embolism, but only a minority with pulmonary embolism had high-probability scans. Of 322 with intermediate-probability scans and definitive angiograms, 105 (33%) had pulmonary embolism. Follow-up and angiography together suggest pulmonary embolism occurred among 12% of patients with low-probability scans. Clinical assessment combined with the ventilation/perfusion scan established the diagnosis or exclusion of pulmonary embolism only for a minority of patients--those with clear and concordant clinical and ventilation/perfusion scan findings.

  6. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED).

    Science.gov (United States)

    To determine the sensitivities and specificities of ventilation/perfusion lung scans for acute pulmonary embolism, a random sample of 933 of 1493 patients was studied prospectively. Nine hundred thirty-one underwent scintigraphy and 755 underwent pulmonary angiography; 251 (33%) of 755 demonstrated pulmonary embolism. Almost all patients with pulmonary embolism had abnormal scans of high, intermediate, or low probability, but so did most without pulmonary embolism (sensitivity, 98%; specificity, 10%). Of 116 patients with high-probability scans and definitive angiograms, 102 (88%) had pulmonary embolism, but only a minority with pulmonary embolism had high-probability scans (sensitivity, 41%; specificity, 97%). Of 322 with intermediate-probability scans and definitive angiograms, 105 (33%) had pulmonary embolism. Follow-up and angiography together suggest pulmonary embolism occurred among 12% of patients with low-probability scans. Clinical assessment combined with the ventilation/perfusion scan established the diagnosis or exclusion of pulmonary embolism only for a minority of patients--those with clear and concordant clinical and ventilation/perfusion scan findings.

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

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    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

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

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    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. Evaluation of revised criteria for ventilation-perfusion scintigraphy in patients with suspected pulmonary embolism.

    Science.gov (United States)

    Sostman, H D; Coleman, R E; DeLong, D M; Newman, G E; Paine, S

    1994-10-01

    To evaluate the accuracy of the revised PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) criteria for categorization of ventilation-perfusion lung scans and to compare the diagnostic accuracy of the revised criteria with that of the original PIOPED criteria and subjective probability estimates. The ventilation-perfusion scans of 104 consecutive patients with suspected pulmonary embolism were reviewed. All patients had also undergone pulmonary angiography. The scans were categorized according to the original and revised PIOPED criteria, and a "gestalt" percent probability estimate was made. In addition, the official clinical interpretation (made with the original PIOPED criteria) was recorded. The gestalt percent probability estimate was the most accurate for assessing the likelihood of pulmonary embolism (area under the receiver operating characteristic [ROC] curve = 0.836). The revised PIOPED criteria (area under the ROC curve = 0.753) were more accurate than the original PIOPED criteria. The revised PIOPED criteria are more accurate than the original PIOPED criteria. Experienced readers of lung scans can achieve higher accuracy after applying formal criteria by using their experience and subjective judgment.

  10. [Evaluation of lung perfusion scintigraphy without ventilation scintigraphy in the diagnosis of pulmonary thromboembolism].

    Science.gov (United States)

    Jurkiene, Nemira

    2002-01-01

    The role of perfusion lung scintigraphy in the diagnosis of pulmonary embolism (PE) is reviewed. During the study 227 perfusion lung scans were obtained. The scans were grouped according to the PIOPED criteria into 5 groups: normal scans, very low, low, intermediate and high PE probability. The perfusion scans were analyzed according to the original PIOPED criteria, without ventilation scans. Evidence is provided that a normal perfusion scan excludes pulmonary embolism, and that a high probability lung scan, defined as a segmental perfusion defect with locally normal chest X-ray or findings in X-ray are smaller, sufficiently confirms the presence of pulmonary embolism in the majority of these patients (92.2%).

  11. 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.

  12. MRI methods for pulmonary ventilation and perfusion imaging; Methoden der MRT zur Ventilations- und Perfusionsbildgebung der Lunge

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    Sommer, G. [Universitaetsspital Basel, Klinik fuer Radiologie und Nuklearmedizin, Basel (Switzerland); Bauman, G. [Universitaetsspital Basel, Klinik fuer Radiologie und Nuklearmedizin - Radiologische Physik, Basel (Switzerland)

    2016-02-15

    Separate assessment of respiratory mechanics, gas exchange and pulmonary circulation is essential for the diagnosis and therapy of pulmonary diseases. Due to the global character of the information obtained clinical lung function tests are often not sufficiently specific in the differential diagnosis or have a limited sensitivity in the detection of early pathological changes. The standard procedures of pulmonary imaging are computed tomography (CT) for depiction of the morphology as well as perfusion/ventilation scintigraphy and single photon emission computed tomography (SPECT) for functional assessment. Magnetic resonance imaging (MRI) with hyperpolarized gases, O{sub 2}-enhanced MRI, MRI with fluorinated gases and Fourier decomposition MRI (FD-MRI) are available for assessment of pulmonary ventilation. For assessment of pulmonary perfusion dynamic contrast-enhanced MRI (DCE-MRI), arterial spin labeling (ASL) and FD-MRI can be used. Imaging provides a more precise insight into the pathophysiology of pulmonary function on a regional level. The advantages of MRI are a lack of ionizing radiation, which allows a protective acquisition of dynamic data as well as the high number of available contrasts and therefore accessible lung function parameters. Sufficient clinical data exist only for certain applications of DCE-MRI. For the other techniques, only feasibility studies and case series of different sizes are available. The clinical applicability of hyperpolarized gases is limited for technical reasons. The clinical application of the techniques described, except for DCE-MRI, should be restricted to scientific studies. (orig.) [German] Die separate Beurteilung von Atemmechanik, Gasaustauschprozessen und Lungenzirkulation ist wesentlich fuer die Diagnose und Therapie von Lungenerkrankungen. Klinische Lungenfunktionstests sind aufgrund ihrer zumeist nur globalen Aussage oft nicht hinreichend spezifisch in der Differenzialdiagnostik oder eingeschraenkt sensitiv bei der

  13. Effect of endobronchial valve therapy on pulmonary perfusion and ventilation distribution.

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    Carmen Pizarro

    Full Text Available Endoscopic lung volume reduction (ELVR is an emerging therapy for emphysematous COPD. However, any resulting changes in lung perfusion and ventilation remain undetermined. Here, we report ELVR-mediated adaptations in lung perfusion and ventilation, as investigated by means of pulmonary scintigraphy.In this observational study, we enrolled 26 patients (64.9 ± 9.4 yrs, 57.7% male with COPD heterogeneous emphysema undergoing ELVR with endobronchial valves (Zephyr, Pulmonx, Inc.. Mean baseline FEV1 and RV were 32.9% and 253.8% predicted, respectively. Lung scintigraphy was conducted prior to ELVR and eight weeks thereafter. Analyses of perfusion and ventilation shifts were performed and complemented by correlation analyses between paired zones.After ELVR, target zone perfusion showed a mean relative reduction of 43.32% (p<0.001, which was associated with a significant decrease in target zone ventilation (p<0.001. Perfusion of the contralateral untreated zone and of the contralateral total lung exhibited significant increases post-ELVR (p = 0.002 and p = 0.005, respectively; both correlated significantly with the corresponding target zone perfusion adaptations. Likewise, changes in target zone ventilation correlated significantly with ventilatory changes in the contralateral untreated zone and the total contralateral lung (Pearson's r: -0.42, p = 0.04 and Pearson's r: -0.42, p = 0.03, respectively. These effects were observed in case of clinical responsiveness to ELVR, as assessed by changes in the six-minute walk test distance.ELVR induces a relevant decrease in perfusion and ventilation of the treated zone with compensatory perfusional and ventilatory redistribution to the contralateral lung, primarily to the non-concordant, contralateral zone.

  14. Development of Localized Pulmonary Interstitial Emphysema in a Late Preterm Infant without Mechanical Ventilation

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    Pritish Bawa

    2014-01-01

    Full Text Available Pulmonary interstitial emphysema (PIE is not an uncommon finding in premature infants with respiratory distress who need respiratory support by mechanical ventilation. PIE has been reported in a few cases of neonates in whom either no treatment other than room air was given or they were given continuous positive end-expiratory pressure (CPAP support. We present a case of a premature neonate who presented with respiratory distress, in whom PIE and spontaneous pneumothorax (PTX developed while on CPAP therapy only. The patient was treated conservatively with subsequent resolution of the radiological findings and clinical improvement. No surgical intervention was required. It is important to know that PIE may develop independently of mechanical ventilation. We would like to add this case to the literature and describe the pertinent plain film and computed tomography (CT findings of this entity, the possible mechanism of development, and the differential diagnosis. A review of the literature is also provided.

  15. Development of Localized Pulmonary Interstitial Emphysema in a Late Preterm Infant without Mechanical Ventilation

    Science.gov (United States)

    Soontarapornchai, Kultida; Perenyi, Agnes; Amodio, John

    2014-01-01

    Pulmonary interstitial emphysema (PIE) is not an uncommon finding in premature infants with respiratory distress who need respiratory support by mechanical ventilation. PIE has been reported in a few cases of neonates in whom either no treatment other than room air was given or they were given continuous positive end-expiratory pressure (CPAP) support. We present a case of a premature neonate who presented with respiratory distress, in whom PIE and spontaneous pneumothorax (PTX) developed while on CPAP therapy only. The patient was treated conservatively with subsequent resolution of the radiological findings and clinical improvement. No surgical intervention was required. It is important to know that PIE may develop independently of mechanical ventilation. We would like to add this case to the literature and describe the pertinent plain film and computed tomography (CT) findings of this entity, the possible mechanism of development, and the differential diagnosis. A review of the literature is also provided. PMID:24744939

  16. DTPA aerosol in ventilation/perfusion scintigraphy for diagnosing pulmonary embolism.

    Science.gov (United States)

    Trujillo, N P; Pratt, J P; Talusani, S; Quaife, R A; Kumpe, D; Lear, J L

    1997-11-01

    The use of lung scintigraphy in evaluating suspected pulmonary embolism (PE) is controversial. Several diagnostic methods have been described for lung scans, of which the most widely applied uses 99mTc-MAA for perfusion, 133Xe for ventilation and PIOPED diagnostic criteria. This study evaluates the accuracy of lung scintigraphy using an alternative ventilation agent, 99mTc-diethylenetriamine pentacetic acid (DTPA) aerosol, and specific criteria. Diagnostic criteria for DTPA aerosol ventilation were prospectively applied to 5017 patients over a 9-yr period. Lung scan interpretations were analyzed for frequency of occurrence, and results were compared to those of angiography in 455 patients. Scans were interpreted as normal, low or high probability in 79% of patients and as either indeterminate or medium probability in 21% of patients. Three patients had normal scans and negative angiography. In patients with low-probability scans, 111 angiograms were performed: 103 (93%) were negative, and 8 (7%) were positive. In patients with indeterminate scans, 114 angiograms were performed: 85 (75%) were negative, and 29 (25%) were positive. In patients with medium-probability scans, 149 angiograms were performed: 86 (58%) were negative, and 63 (42%) were positive. In patients with high-probability scans, 78 angiograms were performed: 6 (8%) were negative, and 72 (92%) were positive. These results indicate that lung scintigraphy using DTPA aerosol and our criteria is accurate in diagnosing and stratifying risk of pulmonary embolic disease. Compared with 133Xe and PIOPED criteria, DTPA ventilation and our criteria reduced the false-negative rate in low-probability scans (7% versus 16%, p < 0.005) and decreased the fraction of intermediate-probability scans (21 % versus 39%, p < 0.01).

  17. Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review

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    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.

  18. A novel fiber-optic measurement system for the evaluation of performances of neonatal pulmonary ventilators

    Science.gov (United States)

    Battista, L.; Scorza, A.; Botta, F.; Sciuto, S. A.

    2016-02-01

    Published standards for the performance evaluation of pulmonary ventilators are mainly directed to manufacturers rather than to end-users and often considered inadequate or not comprehensive. In order to contribute to overcome the problems above, a novel measurement system was proposed and tested with waveforms of mechanical ventilation by means of experimental trials carried out with infant ventilators typically used in neonatal intensive care units: the main quantities of mechanical ventilation in newborns are monitored, i.e. air flow rate, differential pressure and volume from infant ventilator are measured by means of two novel fiber-optic sensors (OFSs) developed and characterized by the authors, while temperature and relative humidity of air mass are obtained by two commercial transducers. The proposed fiber-optic sensors (flow sensor Q-OFS, pressure sensor P-OFS) showed measurement ranges of air flow and pressure typically encountered in neonatal mechanical ventilation, i.e. the air flow rate Q ranged from 3 l min-1 to 18 l min-1 (inspiratory) and from  -3 l min-1 to  -18 l min-1 (expiratory), the differential pressure ΔP ranged from  -15 cmH2O to 15 cmH2O. In each experimental trial carried out with different settings of the ventilator, outputs of the OFSs are compared with data from two reference sensors (reference flow sensor RF, reference pressure sensor RP) and results are found consistent: flow rate Q showed a maximum error between Q-OFS and RF up to 13 percent, with an output ratio Q RF/Q OFS of not more than 1.06  ±  0.09 (least square estimation, 95 percent confidence level, R 2 between 0.9822 and 0.9931). On the other hand the maximum error between P-OFS and RP on differential pressure ΔP was lower than 10 percent, with an output ratio ΔP RP/ΔP OFS between 0.977  ±  0.022 and 1.0  ±  0.8 (least square estimation, 95 percent confidence level, R 2 between 0.9864 and 0.9876). Despite the possible improvements

  19. Distribution of ventilation/perfusion ratios in pulmonary embolism: an adjunct to the interpretation of ventilation/perfusion lung scans.

    Science.gov (United States)

    Itti, Emmanuel; Nguyen, Séverine; Robin, Fabrice; Desarnaud, Serge; Rosso, Jean; Harf, Alain; Meignan, Michel

    2002-12-01

    Diagnosis of pulmonary embolism (PE) by visual interpretation of ventilation/perfusion (V/Q) scans is limited by the high percentages of patients classified in the intermediate- and low-probability categories. This study proposes a quantitative analysis of the distribution of V/Q ratios to better identify patients with PE. We studied 99 consecutive patients who underwent dual-isotope (81m)Kr/(99m)Tc-macroaggregate V/Q scanning and arterial blood gas analysis within 48 h. The 8-view V/Q scans were visually analyzed by 2 observers according to the revised criteria of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) (normal scan or low, intermediate, or high probability of PE). Quantitative analysis of the posterior-view distribution histogram of V/Q ratios was performed using dedicated software. Briefly, regions of interest were drawn around the lungs on the matched V/Q images, smooth filtering was applied, normalized regional V/Q ratios were calculated within each pixel, and a distribution histogram was built. Patients with normal scans (n = 16) had a predominance of V/Q ratios (63.3% +/- 13.0%) between 0.8 and 1.2. They had only 9.8% +/- 5.8% of ratios > 1.2, and the remaining 26.9% +/- 7.5% of ratios were 1.2) and a significant increase (34.5% +/- 8.2%, P = 0.003) in low V/Q ratios (PIOPED probability of PE, 21.3% +/- 11.0% and 37.5% +/- 9.2%, respectively. Within the nondiagnostic group (intermediate- + low-probability scans, n = 58), 17 patients were finally diagnosed with PE. Analysis of the distribution histogram in this group allowed the identification of 5 patients with PE (specificity, 78%). A quantitative approach to lung scan interpretation, based on the distribution histogram of V/Q ratios, may be helpful for categorizing patients with suspected PE.

  20. Control study of pulmonary surfactant combined with CPAP and BIPAP ventilation modes respectively in treatment of neonatal NRDS

    Institute of Scientific and Technical Information of China (English)

    Yao Liu

    2016-01-01

    Objective:To analyze the differences in effect of pulmonary surfactant combined with CPAP and BIPAP ventilation modes respectively in treatment of neonatal NRDS.Methods:A total of 50 cases of children with neonatal respiratory distress syndrome (NRDS) born and receiving treatment in our hospital from August 2012 to January 2015 were selected as research subjects and randomly divided into observation group and control group, each with 25 cases. Control group received pulmonary surfactant combined with CPAP ventilation mode treatment, observation group received pulmonary surfactant combined with BIPAP ventilation mode treatment, and then differences in blood gas indicators and mechanical ventilation parameters, pulmonary artery pressure, endothelin and nitric oxide levels, blood coagulation and anticoagulation indicators and protein expression levels of CD24, TNF-α, IL-6 and IL-17A of two groups after treatment were compared.Results:PaO2, PH value and oxygenation index of observation group after treatment were higher than those of control group, and PaCO2, positive end-expiratory pressure, peak inspiratory pressure and inspired oxygen concentration were lower than those of control group; pulmonary artery pressure and EF-1 level of observation group after treatment were lower than those of control group, and NO level was higher than that of control group; PC, TPS and AT-Ⅲ levels of observation group after treatment were higher than those of control group, and D-D and vWF levels were lower than those of control group; protein expression of CD24 and IL-6 of observation group after treatment were lower than those of control group, and protein expression of TNF-α and IL-17A were higher than those of control group.Conclusion:Pulmonary surfactant combined with BIPAP ventilation mode treatment of children with NRDS can effectively optimize ventilation function and realize homeostasis, and it has active clinical significance.

  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. A novel preterm respiratory mechanics active simulator to test the performances of neonatal pulmonary ventilators

    Science.gov (United States)

    Cappa, Paolo; Sciuto, Salvatore Andrea; Silvestri, Sergio

    2002-06-01

    A patient active simulator is proposed which is capable of reproducing values of the parameters of pulmonary mechanics of healthy newborns and preterm pathological infants. The implemented prototype is able to: (a) let the operator choose the respiratory pattern, times of apnea, episodes of cough, sobs, etc., (b) continuously regulate and control the parameters characterizing the pulmonary system; and, finally, (c) reproduce the attempt of breathing of a preterm infant. Taking into account both the limitation due to the chosen application field and the preliminary autocalibration phase automatically carried out by the proposed device, accuracy and reliability on the order of 1% is estimated. The previously indicated value has to be considered satisfactory in light of the field of application and the small values of the simulated parameters. Finally, the achieved metrological characteristics allow the described neonatal simulator to be adopted as a reference device to test performances of neonatal ventilators and, more specifically, to measure the time elapsed between the occurrence of a potentially dangerous condition to the patient and the activation of the corresponding alarm of the tested ventilator.

  3. [Open loop gain of the CO2-ventilation feedback control system in chronic obstructive pulmonary disease].

    Science.gov (United States)

    Kimura, H; Kunitomo, F; Okita, S; Tojima, H; Tatsumi, K; Kuriyama, T; Hashizume, I; Honda, Y

    1989-07-01

    To evaluate the stability of the CO2-ventilation feedback system, we measured its open loop gain (G) in 12 patients with chronic obstructive pulmonary disease (COPD) and 15 control subjects. Then, we compared G to the conventional slope of the CO2-ventilation response line (S) and that of the metabolic hyperbola (SL). G was determined as the ratio of S to SL by applying external dead space of 250 and 500 ml. G, S and 1/SL in the control and the COPD were +17.1 +/- 7.2 (Mean +/- SD), 1.70 +/- 0.75 L.min-1.Torr-1 and -10.4 +/- 2.0 L-1.min.Torr, and -7.2 +/- 3.3, 0.48 +/- 0.27 L.min-1.Torr-1 and -16.1 +/- 6.4 L-1.min.Torr, respectively. G was significantly correlated with S in both groups, but that was not the case in 1/SL. The magnitude of G and S in COPD was about 42% and 28% of the control, indicating that G was maintained more stable than S. These data suggest that the decreased G in the COPD resulted from insufficient compensation of ventilatory drive, whereas 1/SL increased higher than the control. We conclude that G can be used to indicate the stability of the CO2-ventilation feedback system better than S.

  4. Impact of ventilator associated pneumonia on outcome in patients with chronic obstructive pulmonary disease exacerbation

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    Vijay Hadda

    2014-01-01

    Full Text Available Background and Objective: There are sparse data regarding the impact of ventilator-associated pneumonia (VAP on outcome among patients with chronic obstructive pulmonary disease (COPD exacerbation. Materials and Methods: This retrospective study included patients with COPD exacerbation requiring endotracheal intubation for more than 48 h admitted in a single respiratory unit from January 2008 to December 2009. Records of these patients were checked for the occurrence of VAP. Results: One hundred and fifty-three patients required endotracheal intubation for COPD exacerbation during this period. The mean age of this cohort was 61.46 ± 11.3 years. The median duration of COPD was 6 years (range: 1-40. A total of 35 (22.8% patients developed VAP (early: 9 and late: 26. The risk of mortality was comparable between two groups, that is, patients with and without VAP [odd′s ratio (OR−1.125; 95% confidence interval (CI, 0.622-2.035]. The duration of mechanical ventilation and hospital stay (median ± standard error, 95% CI was 32 ± 10 (95% CI, 13-51 versus 10 ± 2 (95% CI, 6-14 days; P ≤ 0.001 and 53 ± 26 (95% CI, 3-103 versus 18 ± 7 (95% CI, 5-31 days; P = 0.031, respectively was higher among patients with VAP. Conclusions: Our study has shown that VAP leads to increased duration of mechanical ventilation and hospital stay; however, the mortality is not affected.

  5. Combination of constant-flow and continuous positive-pressure ventilation in canine pulmonary edema.

    Science.gov (United States)

    Sznajder, J I; Becker, C J; Crawford, G P; Wood, L D

    1989-08-01

    Constant-flow ventilation (CFV) maintains alveolar ventilation without tidal excursion in dogs with normal lungs, but this ventilatory mode requires high CFV and bronchoscopic guidance for effective subcarinal placement of two inflow catheters. We designed a circuit that combines CFV with continuous positive-pressure ventilation (CPPV; CFV-CPPV), which negates the need for bronchoscopic positioning of CFV cannula, and tested this system in seven dogs having oleic acid-induced pulmonary edema. Addition of positive end-expiratory pressure (PEEP, 10 cmH2O) reduced venous admixture from 44 +/- 17 to 10.4 +/- 5.4% and kept arterial CO2 tension (PaCO2) normal. With the innovative CFV-CPPV circuit at the same PEEP and respiratory rate (RR), we were able to reduce tidal volume (VT) from 437 +/- 28 to 184 +/- 18 ml (P less than 0.001) and elastic end-inspiratory pressures (PEI) from 25.6 +/- 4.6 to 17.7 +/- 2.8 cmH2O (P less than 0.001) without adverse effects on cardiac output or pulmonary exchange of O2 or CO2; indeed, PaCO2 remained at 35 +/- 4 Torr even though CFV was delivered above the carina and at lower (1.6 l.kg-1.min-1) flows than usually required to maintain eucapnia during CFV alone. At the same PEEP and RR, reduction of VT in the CPPV mode without CFV resulted in CO2 retention (PaCO2 59 +/- 8 Torr). We conclude that CFV-CPPV allows CFV to effectively mix alveolar and dead spaces by a small bulk flow bypassing the zone of increased resistance to gas mixing, thereby allowing reduction of the CFV rate, VT, and PEI for adequate gas exchange.

  6. Haemodynamic stability and pulmonary shunt during spontaneous breathing and mechanical ventilation in porcine lung collapse.

    Science.gov (United States)

    Vimláti, L; Larsson, A; Hedenstierna, G; Lichtwarck-Aschoff, M

    2012-07-01

    We investigated the haemodynamic stability of a novel porcine model of lung collapse induced by negative pressure application (NPA). A secondary aim was to study whether pulmonary shunt correlates with cardiac output (CO). In 12 anaesthetized and relaxed supine piglets, lung collapse was induced by NPA (-50 kPa). Six animals resumed spontaneous breathing (SB) after 15 min; the other six animals were kept on mechanical ventilation (MV) at respiratory rate and tidal volume (V(T) ) that corresponded to SB. All animals were followed for 135 min with blood gas analysis and detailed haemodynamic monitoring. Haemodynamics and gas exchange were stable in both groups during the experiment with arterial oxygen tension (PaO(2) )/inspired fraction of oxygen (FiO(2) ) and pulmonary artery occlusion pressure being higher, venous admixture (Q(va) /Q(t) ) and pulmonary perfusion pressure being lower in the SB group. CO was similar in both groups, showing slight decrease over time in the SB group. During MV, Q(va) /Q(t) increased with CO (slope: 4.3 %min/l; P slope: 0.55 %min/l; P = 0.16). This porcine lung collapse model is reasonably stable in terms of haemodynamics for at least 2 h irrespective of the mode of ventilation. SB achieves higher PaO(2) /FiO(2) and lower Q(va) /Q(t) compared with MV. During SB, Q(va) /Q(t) seems to be less, if at all, affected by CO compared with MV. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

  7. 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.

  8. 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.

  9. Susceptibility To High Altitude Pulmonary Edema Is Associated With A More Uniform Distribution Of Regional Specific Ventilation.

    Science.gov (United States)

    Patz, Michael D; Sá, Rui Carlos; Darquenne, Chantal; Elliott, Ann R; Assadi, Amran K; Theilmann, Rebecca J; Dubowitz, David J; Swenson, Erik Richard; Prisk, Gordon Kim; Hopkins, Susan Roberta

    2017-01-05

    High altitude pulmonary edema (HAPE) is a potentially fatal condition affecting high altitude sojourners. The biggest predictor of HAPE development is a history of prior HAPE. Magnetic resonance imaging (MRI) shows HAPE-susceptible, with a history of HAPE, but not HAPE-resistant (a history of repeated ascents without illness) individuals develop greater heterogeneity of regional pulmonary perfusion breathing hypoxic gas (O2=12.5%), consistent with uneven hypoxic pulmonary vasoconstriction (HPV). Why HPV is uneven in HAPE-susceptibles is unknown, but may arise from regionally heterogeneous ventilation resulting in an uneven stimulus to HPV. We tested the hypothesis that ventilation is more heterogeneous in HAPE-susceptible subjects (n=6) compared to HAPE-resistant controls (n=7). MRI Specific Ventilation Imaging (SVI), was used to measure regional specific ventilation and the relative dispersion (SD/mean) of SVI used to quantify baseline heterogeneity. Ventilation heterogeneity from conductive and respiratory airways was measured in normoxia and hypoxia (O2=12.5%) using multiple breath washout and heterogeneity quantified from the indices Scond and Sacin, respectively. Contrary to our hypothesis, HAPE-susceptibles had significantly lower relative dispersion of specific ventilation than the HAPE-resistant controls (Susceptible=1.33±0.67, Resistant=2.36±0.98, p=0.05) and Sacin tended to be more uniform (Susceptible=0.085±0.009, Resistant=0.113±0.030, p=0.07). Scond was not significantly different between groups (Susceptible=0.019±0.007, Resistant=0.020±0.004, p=0.67). Sacin and Scond did not change significantly in hypoxia (p=0.56, 0.19, respectively). In conclusion, ventilation heterogeneity does not change with short-term hypoxia irrespective of HAPE susceptibility and lesser rather than greater ventilation heterogeneity is observed in HAPE-susceptible subjects. This suggests the basis for uneven HPV in HAPE involves vascular phenomena.

  10. [A comparison of ventilation/perfusion single photon emission CT and CT pulmonary angiography for diagnosis of pulmonary embolism].

    Science.gov (United States)

    Meng, Jing-jing; Zhang, Li-jun; Wang, Qian; Fang, Wei; Dai, Hao-jie; Yan, Jue; Wang, Tie; Yao, Zhi-ming; He, Jia; Li, Mei; Mi, Hong-zhi; Jiao, Jian; Zheng, Yu-min

    2013-03-01

    To assess the diagnostic accuracy of ventilation/perfusion (V/Q) single photon emission CT (SPECT) as compared to computed tomographic pulmonary angiography (CTPA) for pulmonary embolism (PE). In this prospective multicenter study, 111 patients in whom acute or sub-acute PE was clinically confirmed or suspected were enrolled. The patients underwent one-day method V/Q lung scan (including SPECT and planar imaging) within 3 days before and after completion of CTPA. The European Association of Nuclear Medicine (EANM) guidelines for ventilation/perfusion scintigraphy (2009) reference was used as the evaluation criteria of V/Q SPECT imaging. The refined modified prospective investigation of pulmonary embolism diagnosis (RM-PIOPED) criteria was used for evaluation of planar imaging. According to the direct and indirect signs of PE, the imaging of CTPA was evaluated. All patients were followed for at least 6 months. A diagnosis was finally made by consensus of respiratory physicians, radiologists and nuclear medicine physicians based on the clinical data, laboratory tests, imaging features and follow-up results. The difference among diagnostic methods was evaluated for significance using chi-square test. The receiver operator characteristic (ROC) curve was drawn according to the results of the 3 diagnostic tests. The area under ROC curve (AUC) was calculated and compared. P < 0.05 was considered statistically significant. Among the 111 patients, PE was confirmed in 80, and excluded in 31. The diagnostic sensitivity/specificity/accuracy of V/Q SPECT, planar imaging, and CTPA were 85.9%/93.5%/88.1%, 75.7%/92.9%/81.4%, and 85.5%/90.0%/86.8%, respectively. By ROC curve analysis, the AUC values of V/Q SPECT, planar imaging and CTPA were 0.898, 0.838, and 0.877, respectively; with 95% confidence intervals [CI] 0.831 to 0.966, 0.759 to 0.917, and 0.801 to 0.954, respectively. The area of the fitted smooth ROC curve was statistically significant (P < 0.05) as compared with the

  11. Low yield of ventilation and perfusion imaging for the evaluation of pulmonary embolism after indeterminate CT pulmonary angiography.

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    Curtis, Brian R; Cox, Mougnyan; Poplawski, Michael; Lyshchik, Andrej

    2017-04-12

    Ventilation and perfusion (VQ) imaging is common following suboptimal CT pulmonary angiogram (CTPA) for pulmonary embolism (PE) evaluation; however, the results of this diagnostic pathway are unclear. The purpose of our study is to determine the incidence of PE diagnosed on VQ scans performed in patients with suboptimal CTPAs. One hundred twenty-two suboptimal CTPAs with subsequent VQ scans within 1 week were retrospectively identified. VQ reports utilizing modified ​prospective investigation of pulmonary embolism diagnosis (PIOPED) and prospective investigative study of acute pulmonary embolism diagnosis (PISAPED) criteria were evaluated for presence of PE; intermediate probability, high probability, and PE present were considered PE positive. Three hundred consecutive reports of each diagnostic CTPA and diagnostic VQ studies were reviewed to estimate baseline PE positive rates at our institution. These were compared to the positive VQ scan rate after suboptimal CTPA by Fisher's exact test. Reported reason for suboptimal CTPA was noted. When contrast bolus timing was suboptimal, we measured main pulmonary artery (mPA) Hounsfield units (HU). Potential alternative diagnoses in CTPA reports were noted. 97.5% (119/122) of VQ scans following suboptimal CTPA were negative for PE, and 2.5% (3/122) were positive for PE. This was significantly lower than baseline PE positive rate of 10.7% (32/300, p < 0.01) for VQ imaging, and 10.3% (31/300, p < 0.01) for CTPA at our institution. Most (79.5%) CTPAs were suboptimal due to contrast timing. Average mPA density in these cases was 164 ± 61 HU. Most of these studies ruled out central PE. Potential alternative diagnosis was reported in 34/122 (28%) of suboptimal CTPAs, for which pneumonia accounted 59%. There is very low incidence of PE diagnosed on VQ imaging performed after suboptimal CTPA. This may be attributed to the ability of most suboptimal CTPAs to rule out central PE.

  12. Acute pulmonary embolism: sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II study.

    Science.gov (United States)

    Sostman, H Dirk; Stein, Paul D; Gottschalk, Alexander; Matta, Fadi; Hull, Russell; Goodman, Larry

    2008-03-01

    To use Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II data to retrospectively determine sensitivity and specificity of ventilation-perfusion (V/Q) scintigraphic studies categorized as pulmonary embolism (PE) present or PE absent and the proportion of patients for whom these categories applied. The PIOPED II study had institutional review board approval at all participating centers. Patient informed consent was obtained; the study was HIPAA compliant. Approval and consent included those for future retrospective research. Patients in the PIOPED II database of clinical and imaging results were included if they had diagnosis at computed tomographic (CT) angiography, Wells score, and diagnosis at V/Q scanning. V/Q scan central readings were recategorized as PE present (PIOPED II reading = high probability of PE), PE absent (PIOPED II reading = very low probability of PE or normal), or nondiagnostic (PIOPED II reading = low or intermediate probability of PE). A composite reference standard was used: the PIOPED II digital subtraction angiographic (DSA) result, or if there was no definitive DSA result, CT angiographic results that were concordant with the Wells score (ie, positive CT angiographic result and Wells score > 2 or negative CT angiographic result and Wells score PIOPED II, results of V/Q scintigraphy can be diagnostically definitive in a majority of patients; thus, it can be considered an appropriate pulmonary imaging procedure in patients for whom CT angiography may be disadvantageous. (c) RSNA, 2008.

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

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    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.

  14. A sigmoidal fit for pressure-volume curves of idiopathic pulmonary fibrosis patients on mechanical ventilation: clinical implications

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    Juliana C. Ferreira

    2011-01-01

    Full Text Available OBJECTIVE: Respiratory pressure-volume curves fitted to exponential equations have been used to assess disease severity and prognosis in spontaneously breathing patients with idiopathic pulmonary fibrosis. Sigmoidal equations have been used to fit pressure-volume curves for mechanically ventilated patients but not for idiopathic pulmonary fibrosis patients. We compared a sigmoidal model and an exponential model to fit pressure-volume curves from mechanically ventilated patients with idiopathic pulmonary fibrosis. METHODS: Six idiopathic pulmonary fibrosis patients and five controls underwent inflation pressure-volume curves using the constant-flow technique during general anesthesia prior to open lung biopsy or thymectomy. We identified the lower and upper inflection points and fit the curves with an exponential equation, V = A-B.e-k.P, and a sigmoid equation, V = a+b/(1+e-(P-c/d. RESULTS: The mean lower inflection point for idiopathic pulmonary fibrosis patients was significantly higher (10.5 ± 5.7 cm H2O than that of controls (3.6 ± 2.4 cm H2O. The sigmoidal equation fit the pressure-volume curves of the fibrotic and control patients well, but the exponential equation fit the data well only when points below 50% of the inspiratory capacity were excluded. CONCLUSION: The elevated lower inflection point and the sigmoidal shape of the pressure-volume curves suggest that respiratory system compliance is decreased close to end-expiratory lung volume in idiopathic pulmonary fibrosis patients under general anesthesia and mechanical ventilation. The sigmoidal fit was superior to the exponential fit for inflation pressure-volume curves of anesthetized patients with idiopathic pulmonary fibrosis and could be useful for guiding mechanical ventilation during general anesthesia in this condition.

  15. Registration pipeline for pulmonary free-breathing 1H MRI ventilation measurements

    Science.gov (United States)

    Guo, Fumin; Capaldi, Dante P. I.; Di Cesare, Robert; Fenster, Aaron; Parraga, Grace

    2017-03-01

    Objectives: Our aim was to develop a clinically-practical and physiologically-relevant approach for regional structure-function measurements of the lung using Fourier decomposition of free-breathing pulmonary magnetic resonance imaging (FDMRI). Methods: Ten patients with chronic obstructive pulmonary disease provided written informed consent to a study protocol approved by Health Canada and completed pulmonary function tests, 1H/hyperpolarized noble gas and free-breathing pulmonary magnetic resonance imaging (MRI) during a single 2-hour visit. Free-breathing 1H MRI was simultaneously segmented using a multi-region coupled continuous max-flow approach by exploring primal/dual analysis and convex optimization techniques. The segmented free-breathing 1H MRI lung was registered using deformable registration approach that was developed using dual and convex optimization methods to compensate for respiratory/cardiac motion. Fourier decomposition of the co-registered lung was used to generate pulmonary functional information that was quantified as ventilation-defect-percent (VDP). The pipeline was implemented on a GPU for speed-up. Lung segmentation accuracy was measured by comparing algorithm and manual lung masks using Dice-similarity-coefficient (DSC). FD-VDP was compared to 3He-VDP using Pearson correlation coefficient and Bland-Altman analysis. The reproducibility of our algorithm was measured using coefficient of variation (CoV) and intraclass correlation coefficient (ICC) for DSC and FD-VDP. Results: The pipeline yielded a whole lung DSC of 95.7+/-1.7% and FD-VDP that were correlated with 3He-VDP (r = 0.81, p = 0.004). CoV (ICC) were 0.4% (0.98) and 4.1% (0.98) for whole lung DSC and FD-VDP, respectively. The proposed approach requires 45 min for parallel implementation with minimal user interaction. Conclusion: The proposed approach provides a clinically-practical pipeline to generate regional pulmonary structure-function measurements using free

  16. Electrical impedance tomography for assessing ventilation/perfusion mismatch for pulmonary embolism detection without interruptions in respiration.

    Science.gov (United States)

    Nguyen, Doan Trang; Thiagalingam, Aravinda; Bhaskaran, Abhishek; Barry, Michael A; Pouliopoulos, Jim; Jin, Craig; McEwan, Alistair L

    2014-01-01

    Recent studies have shown high correlation between pulmonary perfusion mapping with impedance contrast enhanced Electrical Impedance Tomography (EIT) and standard perfusion imaging methods such as Computed Tomography (CT) and Single Photon Emission Computerized Tomography (SPECT). EIT has many advantages over standard imaging methods as it is highly portable and non-invasive. Contrast enhanced EIT uses hypertonic saline bolus instead of nephrotoxic contrast medium that are utilized by CT and nuclear Ventilation/Perfusion (V/Q) scans. However, current implementation of contrast enhanced EIT requires induction of an apnea period for perfusion measurement, rendering it disadvantageous compared with current gold standard imaging modalities. In the present paper, we propose the use of a wavelet denoising algorithm to separate perfusion signal from ventilation signal such that no interruption in patient's ventilation would be required. Furthermore, right lung to left lung perfusion ratio and ventilation ratio are proposed to assess the mismatch between ventilation and perfusion for detection of Pulmonary Embolism (PE). The proposed methodology was validated on an ovine model (n=3, 83.7±7.7 kg) with artificially induced PE in the right lung. The results showed a difference in right lung to left lung perfusion ratio between baseline and diseased states in all cases with all paired t-tests between baseline and PE yielding p <; 0.01, while the right lung to left lung ventilation ratio remained unchanged in two out of three experiments. Statistics were pooled from multiple repetitions of measurements per experiment.

  17. 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.

  18. Persistent pulmonary consolidation treated with intrapulmonary percussive ventilation: a preliminary report.

    Science.gov (United States)

    Birnkrant, D J; Pope, J F; Lewarski, J; Stegmaier, J; Besunder, J B

    1996-04-01

    Intrapulmonary percussive ventilation (IPV) is a novel form of chest physiotherapy delivered by a percussive pneumatic device (IPV, Percussionaire, Sand Point, ID). There are few published reports about the use of IPV for diseases other than cystic fibrosis. We report our experience with three pediatric patients and one adult patient with persistent pulmonary consolidation refractory to conventional therapies. Three of the four patients had neuromuscular disease; one patient had segmental atelectasis due to aspiration. Three of the four patients showed clinical and radiographic improvement within 48 hours of starting IPV. The fourth patient experienced brief episodes of third-degree atrioventricular block, hypoxemia, and bradycardia during two IPV treatments. IPV was safely restarted and he slowly improved. We conclude that while IPV requires further clinical evaluation, it appears to be a safe and effective therapy for selected patients. However, close observation is essential during and after IPV treatments, especially in patients who have difficulty mobilizing or expectorating sputum.

  19. Influence of changes in the pulmonary artery pressure on ventilation requirements in patients undergoing mitral valve replacement.

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    Muralidhar K

    2004-01-01

    Full Text Available The study was designed to evaluate the influence of changes in pulmonary artery pressure on the ventilation requirements in patients undergoing mitral valve surgery. Thirty patients with mitral valve disease with significant pulmonary arterial hypertension undergoing mitral valve replacement under cardiopulmonary bypass were included in this prospective study. All patients had a pulmonary artery catheter placed after the anaesthetic induction. The minute ventilation was adjusted to achieve an arterial carbon dioxide tension (PaCO2 of 35-40 mm Hg. After a stabilisation period of 15 minutes, the pulmonary artery pressure and the minute volume needed for maintaining a PaCO2 of 35-40 mm Hg in the precardiopulmonary bypass, post-cardiopulmonary bypass and six hours postoperatively were measured after ensuring stable haemodynamics and normothermia. There was a significant decrease in the mean pulmonary artery pressure from pre-cardiopulmonary bypass value of 41.3+/-15 mm Hg to 29.3+/-8 mm Hg in the postcardiopulmonary bypass period and subsequently to 25.5+/-7 mm Hg in the intensive care unit. There was a corresponding increase in the minute volume requirements from a pre-cardiopulmonary bypass value of 6.8+/-1 L/min to 8.0+/-1 L/min in the post cardiopulmonary bypass period and then to 9.4+/-1.2 L/min in the postoperative period. We conclude that there is a significant decrease in the pulmonary blood volume and a subsequent decrease in the pulmonary artery pressure after a successful mitral valve replacement in patients with pulmonary arterial hypertension. This is associated with a significant increase in the requirement of minute ventilation to maintain normocarbia.

  20. 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

  1. [First diagnostic choice in patients with high clinical suspicion of pulmonary thromboembolism: helical CT or ventilation/perfusion pulmonary scintigraphy?].

    Science.gov (United States)

    Ferrán, N; Martín-Comín, J; Bajén, M; Carrera, D; Mora, J; Ricart, Y; Sánchez, F; Mast, R

    2005-01-01

    Comparative analysis about helical CT (ThC) vs ventilation-perfusion pulmonary scintigraphy (V/P Sc) diagnosis effectiveness, as a first diagnosis technique in patients with high clinical suspicion of pulmonary thromboembolism (PT). Prospective study of 30 patients with high clinical suspicion and high Dimer-D levels (> 250 microg/l). The diagnosis was defined as anticoagulant therapeutic prescription and posterior clinical evolution. V/P Sc were performed to each patient within the next 48 h (an average of 14.8 h) after TCh, without anticoagulant treatment. We classified the scintigrams according to the PIOPED criteria and hTC images as positive, negative and indeterminated. In sixteen patients final diagnosis was PT: in 9 both techniques were positive; in 5 scintigraphy was positive with normal hTC and in 1, hTC was normal with negative scintigraphy. The last case was an indeterminated hTC with negative scintigraphy. In fourteen patients, final diagnosis was non-PT: in 6 both techniques were negative; in 7 scintigraphy was negative with positive hTC and in 1, both results were indeterminated. The sensitivity, specificity, positive predictive value, negative predictive value and efficiency were respectively 87.5, 100, 100, 87.5 and 93 % for V/P Sc and 62, 50, 58.8, 53.8 and 53 % for TCh. V/P Sc has better PT diagnosis reliability. It is recommended to do V/P Sc in all patients with high clinical suspicion of PT.

  2. 99mTc technegas ventilation and perfusion lung scintigraphy for the diagnosis of pulmonary embolus.

    Science.gov (United States)

    Howarth, D M; Lan, L; Thomas, P A; Allen, L W

    1999-04-01

    Lung scintigraphy is used widely for diagnosis of pulmonary embolus (PE). Technegas ventilation imaging has many advantages over other methods, but little outcome data exists on this technique. The aims of this study were to better define the role of lung scintigraphy in the management of patients with suspected PE and to evaluate technegas ventilation imaging by following patient outcomes. A group of 717 out of 834 consecutive patients, referred to a university teaching hospital for lung scintigraphy to confirm or refute the diagnosis of PE, was followed for 18-30 mo to determine clinical outcome. The follow-up endpoints were death as a result of PE, death as a result of hemorrhage after treatment for PE, uncomplicated survival, survival with subsequent PE, nonfatal hemorrhage after treatment for PE and recurrence of PE in treated patients. Ventilation imaging was performed using technegas, and perfusion imaging was performed using intravenous 99mTc macroaggregated albumin. The modified PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) diagnostic criterion was used for interpretation of lung scintigraphy. Diagnostic results included 3.5% normal studies, 67.4% assessed as low probability for PE, 10% as moderate probability for PE and 19.1% as high probability for PE. A total of 231 patents received therapy with heparin, followed by warfarin, including those receiving anticoagulation therapy for other conditions. Ninety-six percent of patients with normal and low probability studies (n = 508) had good outcomes, 6 patients died as a result of PE and 12 subsequently developed PE. The odds ratio for death by PE in this group was 0.2. Of the 72 moderate probability studies, 39 patients were untreated. In this group there was 1 death due to PE, and PE subsequently developed in 2 patients. None of the remaining 33 treated patients died, but 4 patients experienced bleeding complications. The odds ratio for death by PE in the moderate probability group was

  3. Prevalence of acute pulmonary embolism in central and subsegmental pulmonary arteries and relation to probability interpretation of ventilation/perfusion lung scans.

    Science.gov (United States)

    Stein, P D; Henry, J W

    1997-05-01

    The purpose of this investigation is to determine the prevalence of acute pulmonary embolism (PE) limited to subsegmental pulmonary arteries. Contrast-enhanced helical (spiral) and electron-beam CT, in the hands of experienced radiologists who are skillful with this modality, are sensitive for the detection of acute PE in central pulmonary arteries, but have a low sensitivity for the detection of PE limited to subsegmental pulmonary arteries. The potential for CT to diagnose PE, therefore, is partially dependent on the prevalence of PE limited to subsegmental pulmonary arteries. Data are from the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). The largest pulmonary arteries that showed PE, as interpreted by the PIOPED angiographic readers, were identified in 375 patients in PIOPED with angiographically diagnosed PE. Among all patients with PE, 6% (95% confidence interval [CI], 4 to 9%) had PE limited to subsegmental branches of the pulmonary artery. Patients with high-probability ventilation/ perfusion (V/Q) scans had PE limited to subsegmental branches in only 1% (95% CI, 0 to 4%). Among patients with low-probability V/Q lung scans, 17% (95% CI, 8 to 29%) had PE limited to the subsegmental branches. Patients with low-probability V/Q scans and no prior cardiopulmonary disease had PE limited to the subsegmental pulmonary arteries in 30% (95% CI, 13 to 53%), whereas patients with low-probability V/Q scans who had prior cardiopulmonary disease had PE limited to subsegmental pulmonary arteries in 8% (95% CI, 2 to 22%) (p PIOPED, the prevalence of PE limited to subsegmental pulmonary arteries is low, 6%. PE limited to subsegmental pulmonary arteries was most prevalent among patients with low-probability V/Q scans, particularly if they had no prior cardiopulmonary disease.

  4. [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.

  5. Pulmonary embolism among patients with a nearly normal ventilation/perfusion lung scan.

    Science.gov (United States)

    Henry, J W; Stein, P D; Gottschalk, A; Raskob, G E

    1996-08-01

    Among patients with nearly normal ventilation/perfusion (V/Q) lung scans in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED), pulmonary embolism (PE) was diagnosed more frequently in those who underwent pulmonary angiography than in those in whom PE was diagnosed on the basis of an adverse outcome while receiving no anticoagulant therapy. This may suggest that an adverse outcome is not apparent in patients with PE of such mild severity that the V/Q scan is nearly normal. If this were the case, patients with mild PE might not require treatment. The purpose of this investigation was to evaluate patients in PIOPED with nearly normal-V/Q lung scans. The V/Q scans and clinical characteristics of those in whom PE was diagnosed or excluded by pulmonary angiography (angiography group) were compared with those in whom PE was diagnosed or excluded by the presence or absence of an adverse outcome while not receiving anticoagulant therapy (outcome group). If the characteristics were the same, it would suggest that some patients with mild PE do well without treatment. If the characteristics were different, it would indicate that there is no evidence from these data that mild PE need not be treated. Data from PIOPED were evaluated from patients with suspected acute PE who had V/Q scans interpreted as nearly normal. There were 75 patients in the angiography group and 90 patients in the outcome group. Patients with entirely normal V/Q scans were excluded. PE was more frequent in the angiography group than in the outcome group, 8 of 75 (11%) vs 0 of 90 (0%) (p < 0.01). In patients with nearly normal V/Q scans who were in the outcome group in comparison to the angiography group, the V/Q scan showed fewer mismatched segmental perfusion defects, a lower percentage of low-probability V/Q interpretations by one of the two V/Q readers (compared with very low or normal probability), and a generally lower clinical assessment. The observed lower frequency of PE in the

  6. Invasive and Noninvasive Mechanical Ventilation For Acute Exacerbations Of Chronic Obstructive Pulmonary Disease

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    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

  7. Investigation of four-dimensional computed tomography-based pulmonary ventilation imaging in patients with emphysematous lung regions.

    Science.gov (United States)

    Yamamoto, Tokihiro; Kabus, Sven; Klinder, Tobias; Lorenz, Cristian; von Berg, Jens; Blaffert, Thomas; Loo, Billy W; Keall, Paul J

    2011-04-07

    A pulmonary ventilation imaging technique based on four-dimensional (4D) computed tomography (CT) has advantages over existing techniques. However, physiologically accurate 4D-CT ventilation imaging has not been achieved in patients. The purpose of this study was to evaluate 4D-CT ventilation imaging by correlating ventilation with emphysema. Emphysematous lung regions are less ventilated and can be used as surrogates for low ventilation. We tested the hypothesis: 4D-CT ventilation in emphysematous lung regions is significantly lower than in non-emphysematous regions. Four-dimensional CT ventilation images were created for 12 patients with emphysematous lung regions as observed on CT, using a total of four combinations of two deformable image registration (DIR) algorithms: surface-based (DIR(sur)) and volumetric (DIR(vol)), and two metrics: Hounsfield unit (HU) change (V(HU)) and Jacobian determinant of deformation (V(Jac)), yielding four ventilation image sets per patient. Emphysematous lung regions were detected by density masking. We tested our hypothesis using the one-tailed t-test. Visually, different DIR algorithms and metrics yielded spatially variant 4D-CT ventilation images. The mean ventilation values in emphysematous lung regions were consistently lower than in non-emphysematous regions for all the combinations of DIR algorithms and metrics. V(HU) resulted in statistically significant differences for both DIR(sur) (0.14 ± 0.14 versus 0.29 ± 0.16, p = 0.01) and DIR(vol) (0.13 ± 0.13 versus 0.27 ± 0.15, p Jac) resulted in non-significant differences for both DIR(sur) (0.15 ± 0.07 versus 0.17 ± 0.08, p = 0.20) and DIR(vol) (0.17 ± 0.08 versus 0.19 ± 0.09, p = 0.30). This study demonstrated the strong correlation between the HU-based 4D-CT ventilation and emphysema, which indicates the potential for HU-based 4D-CT ventilation imaging to achieve high physiologic accuracy. A further study is needed to confirm these results.

  8. 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.

  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. 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.

  11. High intensity positive pressure ventilation and long term pulmonary function responses in severe stable COPD. A delicate and difficult balance.

    Science.gov (United States)

    Esquinas, Antonio M; Petroianni, Angelo

    2014-06-01

    Method to improve minute ventilation (MV) during spontaneous breathing (SB) in stable severe chronic obstructive pulmonary disease (COPD) have a great clinical relevant in long term outcome. In this scenario, recommendations of early use of high-Intensity non-invasive Positive pressure Ventilation (HI-NPPV) or intelligent Volume Assured Pressure (iVAP) Support in Hypercapnic COPD have been proposed by safe therapeutics options. We analyze in this letter, Ekkernkamp et al. study that described the effect of HI-NPPV compared with SB on MV in patients receiving long-term treatment. We consider that interpretation of relationships between ABG, functional parameters, and respiratory mechanics reported need clarifications. Further prospective large clinical trials identifying the best mode of ventilation according to the characteristics in severe stable COPD are necessary to balance an effective approach and response on clinical symptoms and long-term effects.

  12. Pulmonary Perfusion and Ventilation During Cardiopulmonary Bypass Are Not Associated with Improved Postoperative Outcomes After Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Yiliam F Rodriguez-Blanco

    2016-11-01

    Full Text Available ObjectivesClinical trials of either pulmonary perfusion or ventilation during cardiopulmonary bypass are equivocal. We hypothesized that to achieve significant improvement in outcomes both interventions had to be concurrent.DesignRetrospective case-control studySettingsMajor academic tertiary referral medical centerParticipants274 consecutive patients who underwent open heart surgery with cardiopulmonary bypass 2009 - 2013.InterventionsThe outcomes of 86 patients who received pulmonary perfusion and ventilation during cardiopulmonary bypass were retrospectively compared to the control group of 188 patients.Measurements and Main ResultsRespiratory complications rates were similar in both groups (33.7% vs. 33.5%, as were the rates of postoperative pneumonia (4.7% vs. 4.3%, pleural effusions (13.9% vs. 12.2% and re-intubations (9.3% vs. 9.1%. Rates of adverse postoperative cardiac events including ventricular tachycardia (9.3% vs. 8.5% and atrial fibrillation (33.7% vs. 28.2% were equivalent in both groups. Incidence of sepsis (8.1% vs. 5.3%, postoperative stroke (2.3% vs. 2.1%, acute kidney injury (2.3% vs. 3.7% and renal failure (5.8% vs. 3.7% were likewise comparable. Despite similar transfusion requirements, coagulopathy (12.8% vs. 5.3%, p=0.031 and the need for mediastinal re-exploration (17.4% vs. 9.6%, p=0.0633 were observed more frequently in the pulmonary perfusion and ventilation group, but the difference did not reach the statistical significance. ICU and hospital stays, and the ICU readmission rates (7.0% vs. 8.0% were similar in both groups.ConclusionsSimultaneous pulmonary perfusion and ventilation during cardiopulmonary bypass were not associated with improved clinical outcomes.

  13. Safety of ventilation/perfusion single photon emission computed tomography for pulmonary embolism diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Le Roux, Pierre-Yves; Palard, Xavier; Robin, Philippe; Abgral, Ronan; Querellou, Solene; Salaun, Pierre-Yves [Universite Europeenne de Bretagne, Brest (France); Universite de Brest, Brest (France); CHRU de la Cavale Blanche, Service de medecine nucleaire, Brest (France); Delluc, Aurelien; Couturaud, Francis [Universite Europeenne de Bretagne, Brest (France); Universite de Brest, Brest (France); CHRU de la Cavale Blanche, Departement de medecine interne et de pneumologie, Brest (France); Le Gal, Gregoire [Universite Europeenne de Bretagne, Brest (France); University of Ottawa, Ottawa Hospital Research Institute, Ottawa (Canada); CHRU de la Cavale Blanche, Departement de medecine interne et de pneumologie, Brest (France); Universite de Brest, Brest (France)

    2014-10-15

    The aim of this management outcome study was to assess the safety of ventilation/perfusion single photon emission computed tomography (V/Q SPECT) for the diagnosis of pulmonary embolism (PE) using for interpretation the criteria proposed in the European Association of Nuclear Medicine (EANM) guidelines for V/Q scintigraphy. A total of 393 patients with clinically suspected PE referred to the Nuclear Medicine Department of Brest University Hospital from April 2011 to March 2013, with either a high clinical probability or a low or intermediate clinical probability but positive D-dimer, were retrospectively analysed. V/Q SPECT were interpreted by the attending nuclear medicine physician using a diagnostic cut-off of one segmental or two subsegmental mismatches. The final diagnostic conclusion was established by the physician responsible for patient care, based on clinical symptoms, laboratory test, V/Q SPECT and other imaging procedures performed. Patients in whom PE was deemed absent were not treated with anticoagulants and were followed up for 3 months. Of the 393 patients, the prevalence of PE was 28 %. V/Q SPECT was positive for PE in 110 patients (28 %) and negative in 283 patients (72 %). Of the 110 patients with a positive V/Q SPECT, 78 (71 %) had at least one additional imaging test (computed tomography pulmonary angiography or ultrasound) and the diagnosis of PE was eventually excluded in one patient. Of the 283 patients with a negative V/Q SPECT, 74 (26 %) patients had another test. The diagnosis of PE was finally retained in one patient and excluded in 282 patients. The 3-month thromboembolic risk in the patients not treated with anticoagulants was 1/262: 0.38 % (95 % confidence interval 0.07-2.13). A diagnostic management including V/Q SPECT interpreted with a diagnostic cut-off of ''one segmental or two subsegmental mismatches'' appears safe to exclude PE. (orig.)

  14. Excess ventilation and ventilatory constraints during exercise in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Teopompi, Elisabetta; Tzani, Panagiota; Aiello, Marina; Gioia, Maria Rosaria; Marangio, Emilio; Chetta, Alfredo

    2014-06-15

    We assessed the relationship between minute ventilation/carbon dioxide output (VE/VCO2) and ventilatory constraints during an incremental cardiopulmonary exercise testing (CPET) in patients with chronic obstructive pulmonary disease (COPD). Slope and intercept of the VE/VCO2 linear relationship, the ratios of inspiratory capacity/total lung capacity (IC/TLC) and of tidal volume (VT) over vital capacity (VTpeak/VC) and IC (VTpeak/IC) and over forced expiratory volume at 1st second (VTpeak/FEV1) at peak of exercise were measured in 52 COPD patients during a CPET. The difference peak-rest in end-tidal pressure of CO2 (PETCO2) was also measured. VE/VCO2 intercept showed a negative correlation with IC/TLC peak (pCOPD, VE/VCO2 slope and intercept provide complementary information on the ventilatory limitation to exercise, as assessed by changes in the end-expiratory lung volume and in tidal volume excursion.

  15. Hypercapnic acidosis attenuates the pulmonary innate immune response in ventilated healthy mice.

    NARCIS (Netherlands)

    Halbertsma, F.J.; Vaneker, M.; Pickkers, P.; Snijdelaar, D.G.; Egmond, J. van; Scheffer, G.J.; Hoeven, J.G. van der

    2008-01-01

    BACKGROUND: Mechanical ventilation with small tidal volumes reduces the development of ventilator-induced lung injury and mortality, but may increase PaCO2. It is not clear whether the beneficial effect of a lung-protective strategy results from reduced ventilation pressures/tidal volumes or is medi

  16. Spatial and temporal heterogeneity of regional lung ventilation determined by electrical impedance tomography during pulmonary function testing.

    Science.gov (United States)

    Vogt, Barbara; Pulletz, Sven; Elke, Gunnar; Zhao, Zhanqi; Zabel, Peter; Weiler, Norbert; Frerichs, Inéz

    2012-10-01

    Electrical impedance tomography (EIT) is a functional imaging modality capable of tracing continuously regional pulmonary gas volume changes. The aim of our study was to determine if EIT was able to assess spatial and temporal heterogeneity of ventilation during pulmonary function testing in 14 young (37 ± 10 yr, mean age ± SD) and 12 elderly (71 ± 9 yr) subjects without lung disease and in 33 patients with chronic obstructive pulmonary disease (71 ± 9 yr). EIT and spirometry examinations were performed during tidal breathing and a forced vital capacity (FVC) maneuver preceded by full inspiration to total lung capacity. Regional inspiratory vital capacity (IVC); FVC; forced expiratory volume in 1 s (FEV(1)); FEV(1)/FVC; times required to expire 25%, 50%, 75%, and 90% of FVC (t(25), t(50), t(75), t(90)); and tidal volume (V(T)) were determined in 912 EIT image pixels in the chest cross section. Coefficients of variation (CV) were calculated from all pixel values of IVC, FVC, FEV(1), and V(T) to characterize the ventilation heterogeneity. The highest values were found in patients, and no differences existed between the healthy young and elderly subjects. Receiver-operating characteristics curves showed that CV of regional IVC, FVC, FEV(1), and V(T) discriminated the young and elderly subjects from the patients. Frequency distributions of pixel FEV(1)/FVC, t(25), t(50), t(75), and t(90) identified the highest ventilation heterogeneity in patients but distinguished also the healthy young from the elderly subjects. These results indicate that EIT may provide additional information during pulmonary function testing and identify pathologic and age-related spatial and temporal heterogeneity of regional lung function.

  17. 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

  18. Plasma-derived human C1-esterase inhibitor does not prevent mechanical ventilation-induced pulmonary complement activation in a rat model of Streptococcus pneumoniae pneumonia.

    Science.gov (United States)

    de Beer, F M; Aslami, H; Hoeksma, J; van Mierlo, G; Wouters, D; Zeerleder, S; Roelofs, J J T H; Juffermans, N P; Schultz, M J; Lagrand, W K

    2014-11-01

    Mechanical ventilation has the potential to cause lung injury, and the role of complement activation herein is uncertain. We hypothesized that inhibition of the complement cascade by administration of plasma-derived human C1-esterase inhibitor (C1-INH) prevents ventilation-induced pulmonary complement activation, and as such attenuates lung inflammation and lung injury in a rat model of Streptococcus pneumoniae pneumonia. Forty hours after intratracheal challenge with S. pneumoniae causing pneumonia rats were subjected to ventilation with lower tidal volumes and positive end-expiratory pressure (PEEP) or high tidal volumes without PEEP, after an intravenous bolus of C1-INH (200 U/kg) or placebo (saline). After 4 h of ventilation blood, broncho-alveolar lavage fluid and lung tissue were collected. Non-ventilated rats with S. pneumoniae pneumonia served as controls. While ventilation with lower tidal volumes and PEEP slightly amplified pneumonia-induced complement activation in the lungs, ventilation with higher tidal volumes without PEEP augmented local complement activation more strongly. Systemic pre-treatment with C1-INH, however, failed to alter ventilation-induced complement activation with both ventilation strategies. In accordance, lung inflammation and lung injury were not affected by pre-treatment with C1-INH, neither in rats ventilated with lower tidal volumes and PEEP, nor rats ventilated with high tidal volumes without PEEP. Ventilation augments pulmonary complement activation in a rat model of S. pneumoniae pneumonia. Systemic administration of C1-INH, however, does not attenuate ventilation-induced complement activation, lung inflammation, and lung injury.

  19. Spatial correspondence of 4D CT ventilation and SPECT pulmonary perfusion defects in patients with malignant airway stenosis

    Science.gov (United States)

    Castillo, Richard; Castillo, Edward; McCurdy, Matthew; Gomez, Daniel R.; Block, Alec M.; Bergsma, Derek; Joy, Sarah; Guerrero, Thomas

    2012-04-01

    To determine the spatial overlap agreement between four-dimensional computed tomography (4D CT) ventilation and single photon emission computed tomography (SPECT) perfusion hypo-functioning pulmonary defect regions in a patient population with malignant airway stenosis. Treatment planning 4D CT images were obtained retrospectively for ten lung cancer patients with radiographically demonstrated airway obstruction due to gross tumor volume. Each patient also received a SPECT perfusion study within one week of the planning 4D CT, and prior to the initiation of treatment. Deformable image registration was used to map corresponding lung tissue elements between the extreme component phase images, from which quantitative three-dimensional (3D) images representing the local pulmonary specific ventilation were constructed. Semi-automated segmentation of the percentile perfusion distribution was performed to identify regional defects distal to the known obstructing lesion. Semi-automated segmentation was similarly performed by multiple observers to delineate corresponding defect regions depicted on 4D CT ventilation. Normalized Dice similarity coefficient (NDSC) indices were determined for each observer between SPECT perfusion and 4D CT ventilation defect regions to assess spatial overlap agreement. Tidal volumes determined from 4D CT ventilation were evaluated versus measurements obtained from lung parenchyma segmentation. Linear regression resulted in a linear fit with slope = 1.01 (R2 = 0.99). Respective values for the average DSC, NDSC1 mm and NDSC2 mm for all cases and multiple observers were 0.78, 0.88 and 0.99, indicating that, on average, spatial overlap agreement between ventilation and perfusion defect regions was comparable to the threshold for agreement within 1-2 mm uncertainty. Corresponding coefficients of variation for all metrics were similarly in the range: 0.10%-19%. This study is the first to quantitatively assess 3D spatial overlap agreement between

  20. Pulmonary rehabilitation coupled with negative pressure ventilation decreases decline in lung function, hospitalizations, and medical cost in COPD

    Science.gov (United States)

    Huang, Hung-Yu; Chou, Pai-Chien; Joa, Wen-Ching; Chen, Li-Fei; Sheng, Te-Fang; Lin, Horng-Chyuan; Yang, Lan-Yan; Pan, Yu-Bin; Chung, Fu-Tsai; Wang, Chun-Hua; Kuo, Han-Pin

    2016-01-01

    Abstract Pulmonary rehabilitation (PR) brings benefits to patients with chronic obstructive pulmonary disease (COPD). Negative pressure ventilation (NPV) increases ventilation and decreases hyperinflation as well as breathing work in COPD. We evaluated the long-term effects of a hospital-based PR program coupled with NPV support in patients with COPD on clinical outcomes. One hundred twenty-nine patients with COPD were followed up for more than 5 years, with the NPV group (n = 63) receiving the support of NPV (20–30 cm H2O delivery pressure for 60 min) and unsupervised home exercise program of 20 to 30 min daily walk, while the control group (n = 6) only received unsupervised home exercise program. Pulmonary function tests and 6 min walk tests (6MWT) were performed every 3 to 6 months. Emergency room (ER) visits and hospitalization with medical costs were recorded. A significant time-by-group interaction in the yearly decline of forced expiratory volume in 1 s in the control group analyzed by mixed-model repeated-measure analysis was found (P = 0.048). The 6MWT distance of the NPV group was significantly increased during the first 4 years, with the interaction of time and group (P = 0.003), the time alone (P = 0.014), and the quadratic time (P lung function, exacerbations, and hospitalization rates, and improved walking distance and medical costs in patients with COPD during a 5-year observation PMID:27741132

  1. Fluctuation in measurements of pulmonary nodule under tidal volume ventilation on four-dimensional computed tomography: preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Tateishi, Ukihide [National Cancer Center Hospital, Division of Diagnostic Radiology, Chuo-ku, Tokyo (Japan); Tsukagoshi, Shinsuke; Inokawa, Hiroyasu; Okumura, Miwa [Toshiba Medical Systems Corporation, CT Systems Development, Otawara (Japan); Moriyama, Noriyuki [National Cancer Center, Division of Cancer Screening, Research Center for Cancer Prevention and Screening, Tokyo (Japan)

    2008-10-15

    The present study aimed to assess the feasibility of four-dimensional (4D) chest computed tomography (CT) under tidal volume ventilation and the impact of respiratory motion on quantitative analysis of CT measurements. Forty-four pulmonary nodules in patients with metastatic disease were evaluated. CT examinations were performed using a 256 multidetector-row CT (MDCT) unit. Volume data were obtained from the lower lung fields (128 mm) above the diaphragm during dynamic CT acquisition. The CT parameters used were 120 kV, 100 or 150 mA, 0.5 s{sup -1}, and 0.5 mm collimation. Image data were reconstructed every 0.1 s during one respiratory cycle by a 180 reconstruction algorithm for four independent fractions of the respiratory cycle. Pulmonary nodules were measured along their longest and shortest axes using electronic calipers. Automated volumetry was assessed using commercially available software. The diameters of long and short axes in each frame were 9.0-9.6 mm and 7.1-7.5 mm, respectively. There was fluctuation of the long axis diameters in the third fraction. The mean volume in each fraction ranged from 365 to 394 mm{sup 3}. Statistically significant fluctuation was also found in the third fraction. 4D-CT under tidal volume ventilation is feasible to determine diameter or volume of the pulmonary nodule. (orig.)

  2. Compute raided classification of ventilation patterns inpatients with chronic obstructive pulmonary diseases at two-phase xenon-enhanced CT

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Son Ho; Goo, Jin Mo; Lee, Chang Hyun; Lee, You Kyung; Jin, Kwang Nam; Choo, Ji Yung; Lee, Nyoung Keun [Seoul National University College of Medicine, Seoul (Korea, Republic of); Jung, Julip; Hong, Helen [Dept. of Multimedia Engineering, Seoul Women' s University, Seoul (Korea, Republic of)

    2014-06-15

    To evaluate the technical feasibility, performance, and interobserver agreement of a computer-aided classification (CAC) system for regional ventilation at two-phase xenon-enhanced CT in patients with chronic obstructive pulmonary disease (COPD). Thirty-eight patients with COPD underwent two-phase xenon ventilation CT with resulting wash-in (WI) and wash-out (WO) xenon images. The regional ventilation in structural abnormalities was visually categorized into four patterns by consensus of two experienced radiologists who compared the xenon attenuation of structural abnormalities with that of adjacent normal parenchyma in the WI and WO images, and it served as the reference. Two series of image datasets of structural abnormalities were randomly extracted for optimization and validation. The proportion of agreement on a per-lesion basis and receiver operating characteristics on a per-pixel basis between CAC and reference were analyzed for optimization. Thereafter, six readers independently categorized the regional ventilation in structural abnormalities in the validation set without and with a CAC map. Interobserver agreement was also compared between assessments without and with CAC maps using multirater κ statistics. Computer-aided classification maps were successfully generated in 31 patients (81.5%). The proportion of agreement and the average area under the curve of optimized CAC maps were 94% (75/80) and 0.994, respectively. Multirater k value was improved from moderate (k=0.59: 95% confidence interval [CI], 0.56-0.62) at the initial assessment to excellent with the CAC map.

  3. Positive outcome of average volume-assured pressure support mode of a Respironics V60 Ventilator in acute exacerbation of chronic obstructive pulmonary disease: a case report

    Directory of Open Access Journals (Sweden)

    Okuda Miyuki

    2012-09-01

    Full Text Available Abstract Introduction We were able to treat a patient with acute exacerbation of chronic obstructive pulmonary disease who also suffered from sleep-disordered breathing by using the average volume-assured pressure support mode of a Respironics V60 Ventilator (Philips Respironics: United States. This allows a target tidal volume to be set based on automatic changes in inspiratory positive airway pressure. This removed the need to change the noninvasive positive pressure ventilation settings during the day and during sleep. The Respironics V60 Ventilator, in the average volume-assured pressure support mode, was attached to our patient and improved and stabilized his sleep-related hypoventilation by automatically adjusting force to within an acceptable range. Case presentation Our patient was a 74-year-old Japanese man who was hospitalized for treatment due to worsening of dyspnea and hypoxemia. He was diagnosed with acute exacerbation of chronic obstructive pulmonary disease and full-time biphasic positive airway pressure support ventilation was initiated. Our patient was temporarily provided with portable noninvasive positive pressure ventilation at night-time following an improvement in his condition, but his chronic obstructive pulmonary disease again worsened due to the recurrence of a respiratory infection. During the initial exacerbation, his tidal volume was significantly lower during sleep (378.9 ± 72.9mL than while awake (446.5 ± 63.3mL. A ventilator that allows ventilation to be maintained by automatically adjusting the inspiratory force to within an acceptable range was attached in average volume-assured pressure support mode, improving his sleep-related hypoventilation, which is often associated with the use of the Respironics V60 Ventilator. Polysomnography performed while our patient was on noninvasive positive pressure ventilation revealed obstructive sleep apnea syndrome (apnea-hypopnea index = 14, suggesting that his chronic

  4. 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.

  5. EXPERIENCE WITH NON - INVASIVE VENTILATION IN TYPE II RESPIRATORY FAILURE AT DEPARTMENT OF PULMONARY MEDICINE, KURNOOL MEDICAL COLLEGE, KURNOOL

    Directory of Open Access Journals (Sweden)

    Sailaja

    2015-07-01

    Full Text Available BACKGROUND : Non - invasive ventilation (NIV is the delivery of positive pressure ventilation through an interface to upper airways without using the invasive airway. Use of NIV is becoming common with the increasing recognition of its benefits. OBJECTIVES: This study was done to evaluate the feasibility and outcome of NIV (BiPAP in Type II Respiratory Failu re in Department of Pulmonary Medicine, Kurnool Medical College. Materials and Methods: An observational study conducted over a period of 18 months in Department of pulmonary medicine, Kurnool Medical C ollege in 40 patients who were treated by NIV (BiPaP. Patients were stratified on basis of set of exclusion and inclusion criteria. NIV was given in accordance with the arterial blood gas (ABG parameters defining Type II respiratory failure. RESULTS: In the present study NIPPV was successful in 34(85% and failed in 6(15% patients . The most common indication of NIV in our hospital was acute exacerbation of chronic obstructive pulmonary disease (AE - COPD 90% and 88% of AE - COPD patients were improved by NIV. Application of NIV resulted in significant improvem ent of pH and blood gases in COPD patients. Kyphoscoliosis, Obstructive Sleep Apnea (OSA patients with Type II Respirato r y failure also showed significant improvement in partial pressure of oxygen and carbon dioxide. CONCLUSION: This study demonstrates and encourages the use of NIV as the first - line ventilator treatment in AE - COPD patients with Type II respiratory failure. It also supports NIV usage in other causes of type II Respiratory failure as a promising step toward prevention of mechanical ventila tion.

  6. Effects of continuous tracheal gas insufflation during pressure limited ventilation on pulmonary surfactant in rabbits with acute lung injury

    Institute of Scientific and Technical Information of China (English)

    ZHU Guang-fa; ZHANG Wei; ZONG Hua; LIANG Ying

    2006-01-01

    Background Pulmonary surfactant dysfunction may contribute to the development of ventilator induced lung injury (VILI). Tracheal gas insufflation (TGI) is a technique in which fresh gas is introduced into the trachea and augment ventilation by reducing the dead space of ventilatory system, reducing ventilatory pressures and tidal volume (VT) while maintaining constant partial arterial CO2 pressure (PaCO2). We hypothesised that TGI limited peak inspiratory pressure (PIP) and VT and would minimize conventional mechanical ventilation (CMV) induced pulmonary surfactant dysfunction and thereby attenuate VILI in rabbits with acute lung injury (ALI).Methods ALI was induced by intratracheal administration of lipopolysaccharide in anaesthetized, ventilated healthy adult rabbits randomly assigned to continuous TGI at 0.5 L/min (TGI group) or CMV group (n=8 for each group), and subsequently ventilated with limited PIP and VT to maintain PaCO2 within 35 to 45 mmHg for 4 hours. Physiological dead space to VT ratio (VD/VT), dynamic respiratory compliance (Cdyn) and partial arterial O2 pressure (PaO2) were monitored. After ventilation, lungs were analysed for total phospholipids (TPL), total proteins (TP), pulmonary surfactant small to large aggregates ratio (SA/LA) in bronchoalveolar lavage fluid (BALF) and for determination of alveolar volume density (Vv), myeloperoxidase and interleukin (IL)-8.Results TGI resulted in significant (P<0.05 or P<0.01) decrease in PIP [(22.4±1.8) cmH2O vs (29.5±1.1) cmH2O], VT [(6.9±1.3) ml/kg vs (9.8±1.11) ml/kg], VD/VT [(32±5)% vs (46±2)%], TP [(109±22) mg/kg vs (187±25) mg/kg], SA/LA (2.5±0.4 vs 5.4±0.7), myeloperoxidase [(6.2±0.5) U/g tissue vs (12.3±0.8) U/g tissue] and IL-8 [(987±106) ng/g tissue vs (24±3) mN/m] of BALF, and significant (P<0.05) increase in Cdyn [(0.47±0.02) ml ·cmH2O-1 ·kg-1 vs (0.31±0.02) ml ·cmH2O-1 ·kg-1], PaO2 [(175±24) mmHg vs (135±26) mmHg],TPL/TP (52±8 vs 33±11) and Vv (0.65±0.05 vs 0

  7. Ventilation-perfusion scintigraphy is more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension.

    Science.gov (United States)

    Tunariu, Nina; Gibbs, Simon J R; Win, Zarni; Gin-Sing, Wendy; Graham, Alison; Gishen, Philip; Al-Nahhas, Adil

    2007-05-01

    Pulmonary hypertension (PH) is a progressive disease with a poor prognosis. Identifying chronic thromboembolic pulmonary disease as a cause of PH has major clinical implications as these patients could be potentially offered a surgical cure. Ventilation-perfusion (V/Q) scintigraphy has a high sensitivity to detect embolic disease but its value has been challenged with the emergence of multidetector CT pulmonary angiography (CTPA). We compared the value of V/Q scintigraphy with CTPA in detecting chronic thromboembolic pulmonary disease. We retrospectively reviewed the results of V/Q scintigraphy and CTPA performed on patients who had been referred to the Pulmonary Hypertension Service at Hammersmith Hospital between 2000 and 2005. A total of 227 patients (85 males, 142 females; age range, 18-81 y; mean age, 42 y) had all tests done at Hammersmith Hospital and were included in the study. Interpretation of scans was according to the modified PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) criteria. CTPA was considered as suggestive of chronic thromboembolic pulmonary disease if it showed visualization of the thrombus or webs, recanalization, perfusion abnormalities, stenosis, or strictures. Standard pulmonary angiography was performed via femoral approach. In 90% of the cases, CTPA and V/Q scintigraphy were performed within 10 d. Seventy-eight patients (group A) had a final diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) and 149 (group B) had non-CTEPH etiology. Among group A, V/Q scintigraphy was reported as high probability in 75 patients, intermediate probability in 1 patient, and low probability in 2 patients. CTPA was positive in 40 patients and negative in 38 patients. Among group B, V/Q scintigraphy was reported as low probability in 134, intermediate probability in 7, and high probability in 8 patients. CTPA was negative in 148 patients and false-positive in 1 patient. Statistical analysis showed V/Q scintigraphy to have a

  8. Combined nutritional support in patients with chronic obstructive pulmonary disease (COPD), under mechanical ventilation (MV).

    Science.gov (United States)

    Grigorakos, Leonidas; Sotiriou, Evangelia; Markou, Nikolaos; Stratouli, Stamatina; Boutzouka, Eleni; Philntisis, George; Baltopoulos, George

    2009-01-01

    The importance of nutrition is clearly established in the management of the critically ill patient: malnutrition contributes to immune incompetence, poor wound healing, increased postoperative complication and prolonged hospital stay. The interaction between nutritional status, nutritional supply and respiratory function is important in the management of the Chronic Obstructive pulmonary Disease (COPD) patients under mechanical ventilation (MV). In the present study was analyzed the benefits of combined nutritional support in patients with COPD under MV. One hundred ninety two (192) patients with COPD were admitted to our Intensive Care Unit (ICU), due to severe respiratory failure of whom 163 (84.9%) patients were under MV. In 18 (11.04%) patients after the 10th day under MV and due to severe malnutrition (serum albumin nutrition (EN) of 1800 Kcals and parenteral nutrition (PN) of 2000 Kcals, at high concentration in lipids from central venous catheter. Seven (38.89%) patients on the 4th day, after combined nutrition, had a positive balance of nitrogen and normal level of the nutritional indices, 4 (22.22%) were on normal level on the 5th day, 3 (16.67%) on the 6th day, 1 (5.56%) on the 7th day after combined nutrition. We had no complications from the combination of EN and PN. Conclusively, of these 18 patients that were given both EN and PN, 15 (83.33%) were weaned from MV and continued the combined nutritional support for 3 days, while 3 (16.67%) died during the combination of EN and PN, without having achieved a normal level of the indices of nutrition and without a positive balance of nitrogen. In this study was found that: 1. patients with COPD under MV rapidly developed malnutrition, 2. the combination EN and PN without complications contribute to the weaning from MV, 3. positive nitrogen balance and normal increases of nutrition are achieved after the 4th day of combined nutrition and 4. Early addition of EN and PN in patients with COPD under MV, probably

  9. Review of criteria appropriate for a very low probability of pulmonary embolism on ventilation-perfusion lung scans: a position paper.

    Science.gov (United States)

    Stein, P D; Gottschalk, A

    2000-01-01

    The "low-probability" interpretation of ventilation-perfusion lung scans has been characterized as misleading or even dangerous because of the high prevalence of pulmonary embolism associated with such an interpretation. Since the completion of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study, analyses of the PIOPED database have allowed identification of several abnormalities seen on ventilation-perfusion scans that have a positive predictive value (PPV) for pulmonary embolism of less than 10%. These include nonsegmental perfusion abnormalities (PPV = 8%), perfusion defects smaller than the corresponding areas of increased opacity at chest radiography (PPV = 8%), matched ventilation-perfusion abnormalities in two or three zones of a single lung (PPV = 3%), one to three small segmental perfusion defects (PPV = 1%), triple matched defects in the upper or middle lung zone (PPV = 4%), and the stripe sign (PPV = 7%). Use of these abnormalities as interpretative criteria constitutes "very low probability" interpretation and will reduce the number of low-probability interpretations of ventilation-perfusion lung scans, which may be considered nondiagnostic because of the unacceptably high rate of false-negative results. This will enhance the utility of the ventilation-perfusion lung scan for screening patients with suspected pulmonary embolism.

  10. Integrative understanding of hypoxic pulmonary vasoconstriction using in vitro models: from ventilated/perfused lung to single arterial myocyte

    Directory of Open Access Journals (Sweden)

    Hae Young Yoo

    2014-12-01

    Full Text Available Contractile response of a pulmonary artery (PA to hypoxia (hypoxic pulmonary vasoconstriction; HPV is a unique physiological reaction. HPV is beneficial for the optimal distribution of blood flow to differentially ventilated alveolar regions in the lung, thereby preventing systemic hypoxemia. Numerous in vitro studies have been conducted to elucidate the mechanisms underlying HPV. These studies indicate that PA smooth muscle cells (PASMCs sense lowers the oxygen partial pressure (PO2 and contract under hypoxia. As for the PO2-sensing molecules, a variety of ion channels in PASMCs had been suggested. Nonetheless, the modulator(s of the ion channels alone cannot mimic HPV in the experiments using PA segments and/or isolated organs. We compared the hypoxic responses of PASMCs, PAs, lung slices, and total lungs using a variety of methods (e.g., patch-clamp technique, isometric contraction measurement, video analysis of precision-cut lung slices, and PA pressure measurement in ventilated/perfused lungs. In this review, the relevant results are compared to provide a comprehensive understanding of HPV. Integration of the influences from surrounding tissues including blood cells as well as the hypoxic regulation of ion channels in PASMCs are indispensable for insights into HPV and other related clinical conditions.

  11. Effect of Electrode Belt and Body Positions on Regional Pulmonary Ventilation- and Perfusion-Related Impedance Changes Measured by Electric Impedance Tomography

    Science.gov (United States)

    Ericsson, Elin; Tesselaar, Erik; Sjöberg, Folke

    2016-01-01

    Ventilator-induced or ventilator-associated lung injury (VILI/VALI) is common and there is an increasing demand for a tool that can optimize ventilator settings. Electrical impedance tomography (EIT) can detect changes in impedance caused by pulmonary ventilation and perfusion, but the effect of changes in the position of the body and in the placing of the electrode belt on the impedance signal have not to our knowledge been thoroughly evaluated. We therefore studied ventilation-related and perfusion-related changes in impedance during spontaneous breathing in 10 healthy subjects in five different body positions and with the electrode belt placed at three different thoracic positions using a 32-electrode EIT system. We found differences between regions of interest that could be attributed to changes in the position of the body, and differences in impedance amplitudes when the position of the electrode belt was changed. Ventilation-related changes in impedance could therefore be related to changes in the position of both the body and the electrode belt. Perfusion-related changes in impedance were probably related to the interference of major vessels. While these findings give us some insight into the sources of variation in impedance signals as a result of changes in the positions of both the body and the electrode belt, further studies on the origin of the perfusion-related impedance signal are needed to improve EIT further as a tool for the monitoring of pulmonary ventilation and perfusion. PMID:27253433

  12. Effect of Electrode Belt and Body Positions on Regional Pulmonary Ventilation- and Perfusion-Related Impedance Changes Measured by Electric Impedance Tomography.

    Directory of Open Access Journals (Sweden)

    Elin Ericsson

    Full Text Available Ventilator-induced or ventilator-associated lung injury (VILI/VALI is common and there is an increasing demand for a tool that can optimize ventilator settings. Electrical impedance tomography (EIT can detect changes in impedance caused by pulmonary ventilation and perfusion, but the effect of changes in the position of the body and in the placing of the electrode belt on the impedance signal have not to our knowledge been thoroughly evaluated. We therefore studied ventilation-related and perfusion-related changes in impedance during spontaneous breathing in 10 healthy subjects in five different body positions and with the electrode belt placed at three different thoracic positions using a 32-electrode EIT system. We found differences between regions of interest that could be attributed to changes in the position of the body, and differences in impedance amplitudes when the position of the electrode belt was changed. Ventilation-related changes in impedance could therefore be related to changes in the position of both the body and the electrode belt. Perfusion-related changes in impedance were probably related to the interference of major vessels. While these findings give us some insight into the sources of variation in impedance signals as a result of changes in the positions of both the body and the electrode belt, further studies on the origin of the perfusion-related impedance signal are needed to improve EIT further as a tool for the monitoring of pulmonary ventilation and perfusion.

  13. Ventilation-perfusion-chest radiography match is less likely to represent pulmonary embolism if perfusion is decreased rather than absent.

    Science.gov (United States)

    Kim, C K; Worsley, D F; Alavi, A

    2000-09-01

    The authors' goal was to determine whether the prevalence of pulmonary embolism in patients with matching ventilation-perfusion (V-Q) defects and chest radiographic opacities differs depending on the degree of perfusion deficit (absent versus decreased). The authors performed a retrospective analysis of the data obtained from the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study. In 233 patients, angiograms were of diagnostic quality for 275 lung zones that showed matching V-Q defects and chest radiographic opacities (triple matches). Of these, V-Q scans and chest radiographs from 217 patients with triple matches in 255 lung zones were retrieved and reviewed. Areas corresponding to chest radiographic opacities were scored as having either decreased perfusion or absent perfusion by consensus. Information regarding the presence or absence of pulmonary embolism in corresponding lung zones was obtained from the PIOPED database. The overall prevalence of pulmonary embolism in all lung zones with triple matches was 27% (69 of 255). Of the 255 areas of triple matches, the perfusion was decreased in 153 (60%) and absent in 102 (40%). The prevalence of pulmonary embolism in areas of triple matches with decreased perfusion and triple matches with absent perfusion was 13% (20 of 153) and 48% (49 of 102), respectively (P = 0.0001 by the chi-square test). When these were divided further by lung zones, triple matches with decreased perfusion and triple matches with absent perfusion in the upper-middle lung zone were associated with a prevalence of 0% (O of 44), and 25% (9 of 36), respectively. The prevalence of pulmonary embolism in areas of triple matches with decreased perfusion and triple matches with absent perfusion in the lower lung zone was 18% (20 of 109), and 61% (40 of 66), respectively. A V-Q/chest radiographic match is less likely to represent pulmonary embolism if perfusion is decreased rather than absent. The overall prevalence of pulmonary

  14. Non-invasive ventilation during exercise training for people with chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    Menadue, C.; Piper, A.J.; Hul, A.J. van 't; Wong, K.K.

    2014-01-01

    BACKGROUND: Exercise training as a component of pulmonary rehabilitation improves health-related quality of life (HRQL) and exercise capacity in people with chronic obstructive pulmonary disease (COPD). However, some individuals may have difficulty performing exercise at an adequate intensity. Non-i

  15. Time-course of ventilation, arterial and pulmonary CO(2) tension during CO (2) increase in humans.

    Science.gov (United States)

    Satoh, Toru; Okada, Yasumasa; Hara, Yasushi; Sakamaki, Fumio; Kyotani, Shingo; Tomita, Takeshi; Nagaya, Noritoshi; Nakanishi, Norifumi

    2012-01-01

    A change of ventilation (VE), PaCO( 2 ) (arterial CO( 2 ) tension) and PvCO( 2 ) (pulmonary arterial CO( 2 ) tension) with time was not evaluated precisely during exercise or CO( 2 ) rebreathing in humans. In this study, changes of these variables with time were fitted to exponential curves {y = Exp ( x/ T + A ) + k} and compared. When exercise pulmonary hemodynamics was examined in 15 cardiac patients to decide therapies, we asked the patients to undergo CO( 2 ) rebreathing using air with supplementation of consumed O( 2 ). Arterial and pulmonary blood was drawn every minute. During exercise, T was 28.2 ± 8.4 and 26.8 ± 12.4, and A was 0.80 ± 0.50 and 0.50 ± 0.90 in VE and PvCO( 2 ), respectively, with no statistical differences. During CO( 2 ) rebreathing, T was 18.6 ± 5.8, 41.8 ± 38.0 and 21.6 ± 9.7 and A was 0.39 ± 0.67, 1.64 ± 1.35 and 0.17 ± 0.83 in VE, PaCO( 2 ) and PvCO( 2 ), respectively, with statistical difference of PaCO( 2 ) from other variables, suggesting that VE and PvCO( 2 ) showed same mode of change according to time but PaCO( 2 ) did not.

  16. Adapted ECMO criteria for newborns with persistent pulmonary hypertension after inhaled nitric oxide and/or high-frequency oscillatory ventilation.

    NARCIS (Netherlands)

    Berkel, S. van; Binkhorst, M.; Heijst, A.F.J. van; Wijnen, M.H.W.A.; Liem, K.D.

    2013-01-01

    PURPOSE: Early prediction of extracorporeal membrane oxygenation (ECMO) requirement in term newborns with persistent pulmonary hypertension (PPHN), partially responding to inhaled nitric oxide (iNO) and/or high-frequency oscillatory ventilation (HFOV), based on oxygenation parameters. METHODS: This

  17. 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

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

    Institute of Scientific and Technical Information of China (English)

    Kris C.Sekar

    2010-01-01

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

  19. Detection of pulmonary embolism with combined ventilation-perfusion SPECT and low-dose CT: head-to-head comparison with multidetector CT angiography

    DEFF Research Database (Denmark)

    Gutte, Henrik; Mortensen, Jann; Jensen, Claus Verner

    2009-01-01

    The diagnosis of pulmonary embolism (PE) is usually established by a combination of clinical assessment, D-dimer testing, and imaging with either pulmonary ventilation-perfusion (V/Q) scintigraphy or pulmonary multidetector CT (MDCT) angiography. Both V/Q SPECT and MDCT angiography seem to have...... high diagnostic accuracy. However, only limited data directly comparing these 2 modalities are available. Hybrid gamma-camera/MDCT systems have been introduced and allow simultaneous 3-dimensional lung V/Q SPECT and MDCT angiography, suitable for diagnosing PE. The aim of our study was to compare...

  20. Diagnosis of pulmonary embolus using ventilation/perfusion lung scintigraphy: more than 0.5 segment of ventilation/perfusion mismatch is sufficient.

    Science.gov (United States)

    Howarth, D M; Booker, J A; Voutnis, D D

    2006-05-01

    To determine the optimal diagnostic cut-off point using a simplified criterion for the detection of pulmonary embolus (PE) and to evaluate the criterion's utility and reporter reproducibility. Lung scintigraphy was carried out in 924 patients for the diagnosis of PE. This group consisted of 316 men and 608 women with median age of 63 years (range 18-94 years). Ventilation imaging was carried out with Tc-99m Technegas followed by perfusion imaging using 190 MBq Tc-99m macroaggregated albumin. Studies were classified using a 6-category probability criterion of incremental ventilation/perfusion (V/Q) mismatch: A, normal; B, low (minor matched V/Q defects or segmental matched V/Q defects without opacity on chest X-ray); C, low-moderate (a partial segment of V/Q mismatch); D, moderate (1 segment of mismatch); E, moderate-high (1-2 segments of V/Q mismatch) and F, high probability (=2 segments of V/Q mismatch). Clinical end-points at 3 and 6 months were death by PE or PE treated with anticoagulation therapy. Three-reporter reproducibility was determined by kappa statistic on a subgroup of patients (53/924). A total of 122 patients (13%) had a confirmed diagnosis of PE at 3 months and no additional cases were registered at 6 months. The lung scintigraphy probability classification showed: normal 152 (16%), low 620 (67%), low-moderate 20 (2%), moderate 28 (3%), moderate-high 24 (3%) and high 80 (9%). The respective sensitivities and specificities, where the diagnostic cut-offs were established at F, high; E, moderate-high; D, moderate and C, low-moderate probability, were F, 64 and 100%; E, 82 and 99%; D, 95 and 98% and C, 98 and 96%. The respective false-negative cases for F, E, D and C cut-offs were 44, 22, 7 and 3. Using the revised Prospective Investigation of Pulmonary Embolism Diagnosis reporting classification reporter agreement showed kappa values of 0.31-0.48. Using a simplified 2-category (>0.5 segment of V/Q mismatch positive, all others negative) criterion

  1. 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.

  2. 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.

  3. Role of caveolin-1 expression in the pathogenesis of pulmonary edema in ventilator-induced lung injury

    Science.gov (United States)

    Maniatis, Nikolaos A.; Kardara, Matina; Hecimovich, Dan; Letsiou, Eleftheria; Castellon, Maricela; Roussos, Charalambos; Shinin, Vasily; Votta-Vellis, E. Gina; Schwartz, David E.; Minshall, Richard D.

    2012-01-01

    Caveolin-1 is a key regulator of pulmonary endothelial barrier function. Here, we tested the hypothesis that caveolin-1 expression is required for ventilator-induced lung injury (VILI). Caveolin-1 gene-disrupted (Cav-1-/-) and age-, sex-, and strain-matched wild-type (WT) control mice were ventilated using two protocols: volume-controlled with protective (8 mL/kg) versus injurious (21 mL/Kg) tidal volume for up to 6 hours; and pressure-controlled with protective (airway pressure = 12 cm H2O) versus injurious (30 cm H2O) ventilation to induce lung injury. Lung microvascular permeability (whole-lung 125I-albumin accumulation, lung capillary filtration coefficient [Kf, c]) and inflammatory markers (bronchoalveolar lavage [BAL] cytokine levels and neutrophil counts) were measured. We also evaluated histologic sections from lungs, and the time course of Src kinase activation and caveolin-1 phosphorylation. VILI induced a 1.7-fold increase in lung 125I-albumin accumulation, fourfold increase in Kf, c, significantly increased levels of cytokines CXCL1 and interleukin-6, and promoted BAL neutrophilia in WT mice. Lung injury by these criteria was significantly reduced in Cav-1-/- mice but fully restored by i.v. injection of liposome/Cav-1 cDNA complexes that rescued expression of Cav-1 in lung microvessels. As thrombin is known to play a significant role in mediating stretch-induced vascular injury, we observed in cultured mouse lung microvascular endothelial cells (MLECs) thrombin-induced albumin hyperpermeability and phosphorylation of p44/42 MAP kinase in WT but not in Cav-1-/- MLECs. Thus, caveolin-1 expression is required for mechanical stretch-induced lung inflammation and endothelial hyperpermeability in vitro and in vivo. PMID:23372929

  4. Analysis of risk factors for hospital mortality in patients with chronic obstructive pulmonary diseases requiring invasive mechanical ventilation

    Institute of Scientific and Technical Information of China (English)

    LIU Hui; ZHANG Tian-tuo; YE Jin

    2007-01-01

    Background Accurate prediction for prognosis is important for hospitalized patients with chronic obstructive pulmonary disease (COPD) requiring invasive mechanic ventilation (IMV) and for their family members to make end-of-life decisions. The response to therapy in such a patient population has rarely been investigated. The aim of the study was to evaluate the risk factors in these patients and investigate their response to IMV and the relationship between their responses and prognosis.Methods A cohort of 138 patients with COPD requiring IMV≥12 hours for acute respiratory failure of diverse etiological factors during a 4-year period were retrospectively studied using prospectively gathered data. All variables potentially related to hospital mortality were evaluated by univariate and multiple stepwise logistic regression analysis.Results The mean age of all patients investigated was (65.7±11.6) years and the hospital mortality was 39.9%(31.1% with COPD exacerbation). Correction of acidosis (pH≥7.30) was seen in 58 patients (69.9%) in survivors but only 12 patients (21.8%) in nonsurvivors (P<0.05) after ventilation. Using multivariate logistic analysis, the variables independently associated with hospital mortality were a higher acute physiology score before intubation, lower pH value measured 24 hours after the onset of ventilation and development of multiorgan dysfunction syndrome (MODS).Conclusions In COPD patients requiring IMV, the postintubation pH value can not only reflect patients' response to treatment, but also serve as an independent determinant of hospital mortality apart from other risk factors such as a higher preintubation APACHE II score and development of MODS. A close correlation between the response to IMV and prognosis was proved in these patients.

  5. Ventilation/perfusion lung scan to diagnose pulmonary embolism: new insights (for the year 2000); Scintigraphie de ventilation/perfusion dans l'embolie pulmonaire donnees pour l'an 2000

    Energy Technology Data Exchange (ETDEWEB)

    Baillet, G.; Thomassin, M.; Planchon, C.A.; Foult, J.M. [Hopital Americain de Neuilly, 92 (France)

    2000-06-01

    We present the changes that have taken place since the results of 'Prospective Investigation of Pulmonary Embolism Diagnosis' (PIOPED) in the diagnostic approach of pulmonary embolism (PE). In 1990 PIOPED documented the value of ventilation/perfusion lung scanning, but pulmonary angiography was often unavoidable. PIOPED had some drawbacks. During the last decade, three significant improvements have appeared: new ventilation tracers such as Technegas and 81m krypton yield high quality and dependable images; PIOPED reading criteria have been revised and improved; the diagnostic approach has benefited from lower extremity ultrasonography and D-dimer assay. New strategic approaches have therefore been devised and have become accurate enough to avoid the use of pulmonary angiography in a vast majority of cases. In pulmonary scintigram reading, the presence of an abnormal chest X-ray or of an underlying cardiopulmonary disease deserves special attention. Helical CT is of limited value in presence of PE restricted to sub-segmental arteries. Already published multicenter trials seem to indicate a lesser diagnostic value than initially anticipated with this semi-invasive method. CT cannot yet be recommended as a first line screening test for PE. (authors)

  6. Liquid Ventilation

    Directory of Open Access Journals (Sweden)

    Qutaiba A. Tawfic

    2011-01-01

    Full Text Available Mammals have lungs to breathe air and they have no gills to breath liquids. When the surface tension at the air-liquid interface of the lung increases, as in acute lung injury, scientists started to think about filling the lung with fluid instead of air to reduce the surface tension and facilitate ventilation. Liquid ventilation (LV is a technique of mechanical ventilation in which the lungs are insufflated with an oxygenated perfluorochemical liquid rather than an oxygen-containing gas mixture. The use of perfluorochemicals, rather than nitrogen, as the inert carrier of oxygen and carbon dioxide offers a number of theoretical advantages for the treatment of acute lung injury. In addition, there are non-respiratory applications with expanding potential including pulmonary drug delivery and radiographic imaging. The potential for multiple clinical applications for liquid-assisted ventilation will be clarified and optimized in future. Keywords: Liquid ventilation; perfluorochemicals; perfluorocarbon; respiratory distress; surfactant.

  7. SU-E-J-86: Functional Conformal Planning for Stereotactic Body Radiation Therapy with CT-Pulmonary Ventilation Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kurosawa, T; Moriya, S; Sato, M [Komazawa University, Setagaya, Tokyo (Japan); Tachibana, H [National Cancer Center Hospital East, Kashiwa, Chiba (Japan)

    2015-06-15

    Purpose: To evaluate the functional planning using CT-pulmonary ventilation imaging for conformal SBRT. Methods: The CT-pulmonary ventilation image was generated using the Jacobian metric in the in-house program with the NiftyReg software package. Using the ventilation image, the normal lung was split into three lung regions for functionality (high, moderate and low). The anatomical plan (AP) and functional plan (FP) were made for ten lung SBRT patients. For the AP, the beam angles were optimized with the dose-volume constraints for the normal lung sparing and the PTV coverage. For the FP, the gantry angles were also optimized with the additional constraint for high functional lung. The MLC aperture shapes were adjusted to the PTV with the additional 5 mm margin. The dosimetric parameters for PTV, the functional volumes, spinal cord and so on were compared in both plans. Results: Compared to the AP, the FP showed better dose sparing for high- and moderate-functional lungs with similar PTV coverage while not taking care of the low functional lung (High:−12.9±9.26% Moderate: −2.0±7.09%, Low: +4.1±12.2%). For the other normal organs, the FP and AP showed similar dose sparing in the eight patients. However, the FP showed that the maximum doses for spinal cord were increased with the significant increment of 16.4Gy and 21.0Gy in other two patients, respectively. Because the beam direction optimizer chose the unexpected directions passing through the spinal cord. Conclusion: Even the functional conformal SBRT can selectively reduce high- and moderatefunctional lung while keeping the PTV coverage. However, it would be careful that the optimizer would choose unexpected beam angles and the dose sparing for the other normal organs can be worse. Therefore, the planner needs to control the dose-volume constraints and also limit the beam angles in order to achieve the expected dose sparing and coverage.

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

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    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.

  9. [Intrathoracic drainage of a compressive pulmonary bulla in a patient receiving mechanical ventilation].

    Science.gov (United States)

    Sleth, J C; Aldebert, S; Safont, L; Knoerr, M F

    1998-01-01

    A lung suppuration may result in a lung bulla with its own course. We report such a case following a Pseudomonas aeruginosa pneumonia of the upper right lobe, after aspiration of gastric contents, in a 21-year-old tracheotomized patient in chronic post-traumatic coma. Mechanical ventilation (IPPV) was indicated because of respiratory insufficiency. The pneumonia was followed by an abscess and later a lung bulla, increasing in size under the effect of mechanical ventilation with progressive mediastinal compression. Surgery was contraindicated because of poor physical status. An acute episode of cardiac tamponade was controlled with an emergency transthoracic drain insertion into the bulla. The course was favourable after a drainage for 23 days and a persisting small cavity in the lung apex. All weaning attempts being unsuccessful, the patient was discharged under home mechanical ventilation. A CT-scan control 6 months later showed a normal lung parenchyma. The various alternative techniques to surgery for treatment of a lung bulla are discussed.

  10. [Scintigraphy of pulmonary ventilation with 99mTc-DTPA radio-aerosol. I. Semiotics of the static images].

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    Maini, C L; Bonetti, M G; Giordano, A; Pistelli, R; Antonelli Incalzi, R; Vecchioli, A; Galli, G

    1986-04-01

    Papers on deposition pattern analyses of radio-aerosol lung scans are few and not easy to interpret as there is a general lack of technical standardization and the number of patients studied is not large. Moreover these reports have been generally obtained with non-hydrosoluble radioaerosols. In the present study 43 patients underwent conventional pulmonary function testing and lung scanning using small droplet (equal or less than 2 microns) polydisperse 99mTc-DTPA radioaerosol produced with the "Settling Bag System"--Medi 400 (Sorin). The scans were analysed by two methods: a semiquantitative method proposed by Taplin (SQT); an original simpler semiquantitative method (SQM). Correlations of SQT and SQM with FEV1 and MEF75 resulted highly significant (p less than 0,001). SQM proved to be superior to SQT as far as reproducibility is concerned. The following conclusions can be drawn: small particle 99mTc-DTPA aerosol can be easily and cheaply produced by a commercial device; such a radioaerosol is well suited for the evaluation of small and large airways patency, as reflected by MEF75 and FEV1 respectively, with a diagnostic yield comparable to non-hydrosoluble radioaerosols; the original semiquantitative description of the deposition patterns proposed and validated in this study is quite easy to implement and it yields a high correlation with pulmonary function tests; moreover such an approach does not require digital data processing; the sensitivity of 99mTc-DTPA for the diagnosis of bronchial obstruction is very high and superior to routine pulmonary function tests; in addition the ventilation scan allows the topographical localization of the obstructions themselves.

  11. [Effect of artificial ventilation on pulmonary capillary pressure in acute respiratory insufficiency].

    Science.gov (United States)

    Labrousse, J; Tenaillon, A; Massabie, P; Simonneau, G; Lissac, J

    1977-05-07

    To determine the influence of intermittent positive pressure breathing (IPPB), the level of pulmonary capillary wedge pressure (PCWP) was compared during IPPB and after a short period off the respirator in 68 occasions on 42 patients with an acute respiratory failure (ARF) of various etiologies. During IPPB, the average PCWP was in the normal range in patients with toxic or neurologic comas and in cases of increased pulmonary capillary permeability edema (IPCPE), PCWP slightly increased within chronic obstructive pulmonary disease (COPD) complicated with ARF and in hemodynamic acute pulmonary edema (HAPE). During the weaning stage, PCWP decreased in the groups of coma, COPD, and IPCPE, but increased in HAPE. The weaning test demonstrates that IPPB influenced PCWP in all patients. Therefore, PCWP cannot be assumed to represent the left ventricle filling pressure. The weaning test allows differentiation of IPCPE from HAPE. In the event of over-infusion or hypovolemia, PCWP measured under IPPB can lead to misinterpretation if not followed up by a second measurement off the respirator.

  12. Effect of a spacer on pulmonary aerosol deposition from a jet nebuliser during mechanical ventilation.

    Science.gov (United States)

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

    1995-01-01

    BACKGROUND--Several factors have been identified which improve nebulised aerosol delivery in vitro. One of these is the addition of a spacer to the ventilator circuit which improves aerosol delivery from a jet nebuliser to a model lung by approximately 30%. The current study was designed to demonstrate whether similar improvements could be demonstrated in vivo. METHODS--Ten patients (seven men) were studied during mechanical ventilation (Siemens Servo 900C) after open heart surgery. Aerosol was delivered using a Siemens Servo 945 nebuliser system (high setting) driving a System 22 Acorn jet nebuliser (Medic-Aid) containing 3 ml technetium-99m labelled human serum albumin (99mTc-HSA (50 micrograms); activity in the first nebulisation, 90 MBq; in the second nebulisation, 185 MBq). Central and peripheral lung aerosol deposition and the time to complete deposition were measured using a gamma camera and compared when the nebuliser was connected to the inspiratory limb using a simple T-piece or a 600 ml spacer. RESULTS--The addition of the spacer increased total lung deposition (mean (SD) percentage initial nebuliser activity) from 2.2 (0.7)% to 3 (0.8)%. There was no difference in the time required to complete nebulisation (18.2 min v 18.3 min respectively for T-piece and spacer) or in the retention of activity in the nebuliser (46.2% v 47.1% respectively). CONCLUSIONS--The combination of a spacer with a jet nebuliser increased lung deposition by 36% in mechanically ventilated patients and is a simple way of increasing drug deposition or reducing the amount of an expensive drug required for nebulisation. Images PMID:7886649

  13. Development and application of methods to quantify spatial and temporal hyperpolarized 3He MRI ventilation dynamics: preliminary results in chronic obstructive pulmonary disease

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    Kirby, Miranda; Wheatley, Andrew; McCormack, David G.; Parraga, Grace

    2010-03-01

    Hyperpolarized helium-3 (3He) magnetic resonance imaging (MRI) has emerged as a non-invasive research method for quantifying lung structural and functional changes, enabling direct visualization in vivo at high spatial and temporal resolution. Here we described the development of methods for quantifying ventilation dynamics in response to salbutamol in Chronic Obstructive Pulmonary Disease (COPD). Whole body 3.0 Tesla Excite 12.0 MRI system was used to obtain multi-slice coronal images acquired immediately after subjects inhaled hyperpolarized 3He gas. Ventilated volume (VV), ventilation defect volume (VDV) and thoracic cavity volume (TCV) were recorded following segmentation of 3He and 1H images respectively, and used to calculate percent ventilated volume (PVV) and ventilation defect percent (VDP). Manual segmentation and Otsu thresholding were significantly correlated for VV (r=.82, p=.001), VDV (r=.87 p=.0002), PVV (r=.85, p=.0005), and VDP (r=.85, p=.0005). The level of agreement between these segmentation methods was also evaluated using Bland-Altman analysis and this showed that manual segmentation was consistently higher for VV (Mean=.22 L, SD=.05) and consistently lower for VDV (Mean=-.13, SD=.05) measurements than Otsu thresholding. To automate the quantification of newly ventilated pixels (NVp) post-bronchodilator, we used translation, rotation, and scaling transformations to register pre-and post-salbutamol images. There was a significant correlation between NVp and VDV (r=-.94 p=.005) and between percent newly ventilated pixels (PNVp) and VDP (r=- .89, p=.02), but not for VV or PVV. Evaluation of 3He MRI ventilation dynamics using Otsu thresholding and landmark-based image registration provides a way to regionally quantify functional changes in COPD subjects after treatment with beta-agonist bronchodilators, a common COPD and asthma therapy.

  14. Is pulmonary resistance constant, within the range of tidal volume ventilation, in patients with ARDS?

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    Mols, G; Kessler, V; Benzing, A; Lichtwarck-Aschoff, M; Geiger, K; Guttmann, J

    2001-02-01

    When managing patients with acute respiratory distress syndrome (ARDS), respiratory system compliance is usually considered first and changes in resistance, although recognized, are neglected. Resistance can change considerably between minimum and maximum lung volume, but is generally assumed to be constant in the tidal volume range (V(T)). We measured resistance during tidal ventilation in 16 patients with ARDS or acute lung injury by the slice method and multiple linear regression analysis. Resistance was constant within V(T) in only six of 16 patients. In the remaining patients, resistance decreased, increased or showed complex changes. We conclude that resistance within V(T) varies considerably from patient to patient and that constant resistance within V(T) is not always likely.

  15. Predicting maximal exercise ventilation in patients with chronic obstructive pulmonary disease.

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    Carter, R; Peavler, M; Zinkgraf, S; Williams, J; Fields, S

    1987-08-01

    Shortness of breath is a chief complaint of many individuals with cardiopulmonary diseases. Exercise testing is often used to help differentiate cardiac from pulmonary involvement. In assessing pulmonary dysfunction during exercise it is essential to know the point at which ventilatory limitation will occur. Numerous authors have presented regression equations based on the FEV1 for predicting either MVV or VEmax. Resting pulmonary function studies were obtained from 53 patients with COPD. Symptom-limited maximal exercise testing was completed on a cycle ergometer using increments of 10 watts/min. Each regression equation for predicting MVV or VEmax was then applied to the data set. Results showed that the FEV1 correlated with the measured VEmax (r = .81) as did PEF (r = .81), MVV (r = .78), IC (r = .78), DCO (r = .68), VA (r = .67), VE (r = .65) and FVC (r = .64). Single post-bronchodilator FEV1 measurements ranged from 0.56 to 1.64 L (mean 1.0 L) while VEmax ranged from 16 to 78 L/min (mean 37.69 L/min). The equation VEmax = 37.5 X FEV1 was the most robust equation found in the literature for predicting VEmax in this sample. This equation was not statistically different from the line of identity when predicted VEmax was plotted against the measured VEmax. The intercept was 0.91 with a slope of 0.98. In addition, this equation had a smaller mean square error in predicting VEmax than those of the other equations investigated.

  16. [Pulmonary blood flow measurement using magnetic resonance imaging (MRI) without contrast medium;comparison of phase contrast MRI and perfusion-ventilation scintigraphy].

    Science.gov (United States)

    Yatsuyanagi, Eiji; Sato, Kazuhiro; Kikuchi, Keisuke; Saito, Hirotsugu

    2014-02-01

    To define the accuracy of pulmonary arterial blood flow (PA-flow) measured by phase contrast magnetic resonance imaging (PC-MRI), we compared the PA-flow data of PC-MRI with the data of perfusion-ventilation lung scintigraphy. Eighteen patients who preoperatively underwent PA-flow measurement using PC-MRI and perfusion-ventilation lung scintigraphy were evaluated. The PA-flow (cm3/sec) of MRI was calculated by multiplying maximum velocity (cm/sec) by region of interest (ROI) area (cm2) of measured main pulmonary artery using phase contrast method. The left to right ratio (R/L ratio) of PA-flow measured by PC-MRI was compared with the R/L ratios of the date of perfusion-ventilation lung scintigraphy. The R/L ratios of PC-MRI and perfusion lung scintigraphy were 1.43 ± 1.07 and 1.35 ± 0.82, respectively. Both ratios showed excellent correlation( y=-0.50+1.30x, r=0.99,pperfusion lung scintigraphy in the patients with a past history of lung resection, even if their R/L ratios of perfusion lung scintigraphy differed from those of ventilation lung scintigraphy. These results revealed that the PA-flow could be accurately measured by PC-MRI without contrast medium and nuclear medicine instruments.

  17. The current and continuing important role of ventilation-perfusion scintigraphy in evaluating patients with suspected pulmonary embolism.

    Science.gov (United States)

    Freeman, Leonard M; Stein, Evan G; Sprayregen, Seymour; Chamarthy, Murthy; Haramati, Linda B

    2008-11-01

    After the publication of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study in 1990, there was considerable controversy concerning the ventilation-perfusion (V/Q) study in regard to its low sensitivity and high number of nondiagnostic examinations when used in patients with suspected pulmonary embolism (PE). Many lessons have been learned from the PIOPED database that have greatly improved our interpretive skills in the 2 decades since the study was performed. One of the key problems negatively impacting interpretation was the predominantly inpatient population that was studied. Inpatients generally are sicker patients with abnormal chest x-rays. This factor significantly degrades V/Q interpretation. A normal chest x-ray greatly facilitates accurate interpretation of the lung scan. The emergence of computed tomography angiography (CTA) in the early to mid-1990s provided a superb new means of imaging patients with suspected PE. As this technology became more sophisticated with multidetector units, it became the procedure of choice in the great majority of medical centers. CT scanners located in or proximal to many emergency departments as well as its 24/7 availability supported this preference. Within the past 2 to 3 years, the publication of the PIOPED II study as well as some other prospective and retrospective studies have confirmed similar diagnostic accuracy for CTA and V/Q studies. Additionally, there have been several recent publications cautioning physicians about the large radiation dose associated with CTA, particularly to the female breast. Considering the great benefits of both techniques as well as their limitations, it is prudent for both clinicians and imaging physicians to develop an appropriate approach to studying patients with suspected PE. Considerations such as objective clinical assessment, D-dimer assay and the chest x-ray appearance all play significant roles in this decision-making process.

  18. Relation of tricuspid annular displacement and tissue Doppler imaging velocities with duration of weaning in mechanically ventilated patients with acute pulmonary edema

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    Dragoumanis Christos K

    2010-05-01

    Full Text Available Abstract Background Liberation from the ventilator is a difficult task, whereas early echocardiographic indices of weaning readiness are still lacking. The aim of this study was to test whether tricuspid annular plane systolic excursion (TAPSE and right ventricular (RV systolic (Sm and diastolic (Em & Am tissue Doppler imaging (TDI velocities are related with duration of weaning in mechanically ventilated patients with acute respiratory failure due to acute pulmonary edema (APE. Methods Detailed quantification of left and right ventricular systolic and diastolic function was performed at admission to the Intensive Care Unit by Doppler echocardiography, in a cohort of 32 mechanically ventilated patients with APE. TAPSE and RV TDI velocities were compared between patients with and without prolonged weaning (≥ or Results Patients with prolonged weaning (n = 12 had decreased TAPSE (14.59 ± 1.56 vs 19.13 ± 2.59 mm, Sm (8.68 ± 0.94 vs 11.62 ± 1.77 cm/sec and Em/Am ratio (0.98 ± 0.80 vs 2.62 ± 0.67, p 2 = 0.53, beta slope = 0.76, p 2 = 0.52, beta = 0.75, p 2 = 0.57, beta = 0.32, p Conclusions We suggest that in mechanically ventilated patients with APE, low TAPSE and RV TDI velocities upon admission are associated with delayed liberation from mechanical ventilation, probably due to more severe LV heart failure.

  19. The characteristic of Indonesia's pre-eclampsia: From obstetric intensive care with ventilator until epidemiologic and its molecular biology profile of pulmonary edema in severe pre-eclampsia.

    Science.gov (United States)

    Hermanto; Adityawarman; Sulistyono; Ardian, M; Dachlan, E G

    2014-07-01

    Pulmonary edema is among the least frequently diagnosed criteria for severe pre-eclampsia. A higher incidence of pulmonary edema was noted in older patients, multigravidas, and patients with underlying chronic hypertension that developed prior to delivery. The development of pulmonary edema was also associated with the administration of excess colloid or crystaloid infusion. Two hundreds and thirty millions people occupying Indonesia as tropical and coastal country gave rise the problem of highly maternal mortality rate of 225/100,000 deliveries where pre-eclampsia and eclampsia as most possible cause. Over 5years from the year 2005 through 2009 our 160 eclampsia study observed about significantly correlation between typical estafet referred case and maternal mortality (Odds ratio 19.1 and P=0.065). Specifically those referred eclampsia cases arriving lately to our tertiary hospital, complication of pulmonary edema also apparently became determinant factor to uphold the increased maternal mortality (Odds ratio 6.1 and P=0.083) We found at our teaching hospital Dr. Soetomo Surabaya as referral center along the year 2012, 477 pre-eclampsia-eclampsia cases which complicated by 27 cases of pulmonary from which we apply obstetric intensive care unit for tightly monitoring treatment. The majority use of ventilator were applied on 22 cases (81.4%), that most approximately 16 cases (72%) need 48h under ventilator use and the remaining 6 cases was not untill 5days of extubation. The etiology of pulmonary edema in preeclamptic patients involves multi-factors; abnormal COP-PWCP gradient, increased pulmonary capillary permeability, and left ventricular failure were identified causes. It has been well known that the pathogenesis of pulmonary edema in severe pre-eclampsia-eclampsia initiated by capillary alveolar leakage that leading increased capillary permeability and extravascular fluid oncotic as well as decreased plasma oncotic pressure. In severe pre-eclampsia appear that

  20. Lung function and incidence of chronic obstructive pulmonary disease after improved cooking fuels and kitchen ventilation: a 9-year prospective cohort study.

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    Yumin Zhou

    2014-03-01

    Full Text Available BACKGROUND: Biomass smoke is associated with the risk of chronic obstructive pulmonary disease (COPD, but few studies have elaborated approaches to reduce the risk of COPD from biomass burning. The purpose of this study was to determine whether improved cooking fuels and ventilation have effects on pulmonary function and the incidence of COPD. METHODS AND FINDINGS: A 9-y prospective cohort study was conducted among 996 eligible participants aged at least 40 y from November 1, 2002, through November 30, 2011, in 12 villages in southern China. Interventions were implemented starting in 2002 to improve kitchen ventilation (by providing support and instruction for improving biomass stoves or installing exhaust fans and to promote the use of clean fuels (i.e., biogas instead of biomass for cooking (by providing support and instruction for installing household biogas digesters; questionnaire interviews and spirometry tests were performed in 2005, 2008, and 2011. That the interventions improved air quality was confirmed via measurements of indoor air pollutants (i.e., SO₂, CO, CO₂, NO₂, and particulate matter with an aerodynamic diameter of 10 µm or less in a randomly selected subset of the participants' homes. Annual declines in lung function and COPD incidence were compared between those who took up one, both, or neither of the interventions. Use of clean fuels and improved ventilation were associated with a reduced decline in forced expiratory volume in 1 s (FEV₁: decline in FEV₁ was reduced by 12 ml/y (95% CI, 4 to 20 ml/y and 13 ml/y (95% CI, 4 to 23 ml/y in those who used clean fuels and improved ventilation, respectively, compared to those who took up neither intervention, after adjustment for confounders. The combined improvements of use of clean fuels and improved ventilation had the greatest favorable effects on the decline in FEV₁, with a slowing of 16 ml/y (95% CI, 9 to 23 ml/y. The longer the duration of improved fuel use and

  1. 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.

  2. 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.

  3. Predictors of requirement of mechanical ventilation in patients with chronic obstructive pulmonary disease with acute respiratory failure

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    S Kumar

    2013-01-01

    Full Text Available Background and Objective: Acute exacerbation of chronic obstructive pulmonary disease (COPD leads to increased morbidity, mortality and requirement of invasive mechanical ventilation (MV. The aim of this study was to identify predictors of need of MV in these patients. Materials and Methods: Clinical symptomatology, demographic profile, biochemical parameters including renal functions, liver functions and acid base parameters, and acute physiology and chronic health evaluation II (APACHE II score at the time of admission were recorded in 100 patients of COPD exacerbation. Various parameters were compared between patients in whom MV was required with those managed with medical therapy. Results: MV was required in 73% of the patients. Parameters found to be independent predictors of need of MV were: Admission APACHE-II score ≥ 11.5 {adjusted odds ratio (OR [95% confidence interval (CI]: 1.42 [1.08-1.86]; P = 0.012}, first day pH ≤ 7.28 (adjusted OR [95% CI]: 1.09 [1.02-1.15]; P = 0.008, first day PaCO 2 ≥ 68.6 mmHg (adjusted OR [95% CI]: 1.09 [1.02-1.15]; P = 0.004 and worse premorbid functional status (adjusted OR [95% CI]: 17.01 [1.95-148.68]; P = 0.01. Conclusions: Underlying disease severity as assessed by premorbid functional status and APACHE-II score, and the acuity of respiratory system decompensation as assessed by the admitting arterial pH and PaCO 2 , are independent predictors of need of MV in patients with exacerbation of COPD.

  4. Goal-Directed Fluid Therapy Using Stroke Volume Variation Does Not Result in Pulmonary Fluid Overload in Thoracic Surgery Requiring One-Lung Ventilation

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    Sebastian Haas

    2012-01-01

    Full Text Available Background. Goal-directed fluid therapy (GDT guided by functional parameters of preload, such as stroke volume variation (SVV, seems to optimize hemodynamics and possibly improves clinical outcome. However, this strategy is believed to be rather fluid aggressive, and, furthermore, during surgery requiring thoracotomy, the ability of SVV to predict volume responsiveness has raised some controversy. So far it is not known whether GDT is associated with pulmonary fluid overload and a deleterious reduction in pulmonary function in thoracic surgery requiring one-lung-ventilation (OLV. Therefore, we assessed the perioperative course of extravascular lung water index (EVLWI and paO2/FiO2-ratio during and after thoracic surgery requiring lateral thoracotomy and OLV to evaluate the hypothesis that fluid therapy guided by SVV results in pulmonary fluid overload. Methods. A total of 27 patients (group T were enrolled in this prospective study with 11 patients undergoing lung surgery (group L and 16 patients undergoing esophagectomy (group E. Goal-directed fluid management was guided by SVV (SVV 0.05 in EVLWI during the observation period (BL: 7.8 ± 2.5, 24postop: 8.1 ± 2.4 mL/kg. A subgroup analysis for group L and group E also did not reveal significant changes of EVLWI. The paO2/FiO2-ratio decreased significantly during the observation period (group L: BL: 462 ± 140, OLVterm15: 338 ± 112 mmHg; group E: BL: 389 ± 101, 24postop: 303 ± 74 mmHg but remained >300 mmHg except during OLV. Conclusions. SVV-guided fluid management in thoracic surgery requiring lateral thoracotomy and one-lung ventilation does not result in pulmonary fluid overload. Although oxygenation was reduced, pulmonary function remained within a clinically acceptable range.

  5. Pulmonary rehabilitation coupled with negative pressure ventilation decreases decline in lung function, hospitalizations, and medical cost in COPD: A 5-year study.

    Science.gov (United States)

    Huang, Hung-Yu; Chou, Pai-Chien; Joa, Wen-Ching; Chen, Li-Fei; Sheng, Te-Fang; Lin, Horng-Chyuan; Yang, Lan-Yan; Pan, Yu-Bin; Chung, Fu-Tsai; Wang, Chun-Hua; Kuo, Han-Pin

    2016-10-01

    Pulmonary rehabilitation (PR) brings benefits to patients with chronic obstructive pulmonary disease (COPD). Negative pressure ventilation (NPV) increases ventilation and decreases hyperinflation as well as breathing work in COPD. We evaluated the long-term effects of a hospital-based PR program coupled with NPV support in patients with COPD on clinical outcomes.One hundred twenty-nine patients with COPD were followed up for more than 5 years, with the NPV group (n = 63) receiving the support of NPV (20-30 cm H2O delivery pressure for 60 min) and unsupervised home exercise program of 20 to 30 min daily walk, while the control group (n = 6) only received unsupervised home exercise program. Pulmonary function tests and 6 min walk tests (6MWT) were performed every 3 to 6 months. Emergency room (ER) visits and hospitalization with medical costs were recorded.A significant time-by-group interaction in the yearly decline of forced expiratory volume in 1 s in the control group analyzed by mixed-model repeated-measure analysis was found (P = 0.048). The 6MWT distance of the NPV group was significantly increased during the first 4 years, with the interaction of time and group (P = 0.003), the time alone (P = 0.014), and the quadratic time (P function, exacerbations, and hospitalization rates, and improved walking distance and medical costs in patients with COPD during a 5-year observation.

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

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    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.

  7. 急性心源性肺水肿应用呼吸机的抢救效果%Rescue effect of ventilator on acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    马爱华

    2016-01-01

    Objective To investigate the effect of ventilator on acute cardiogenic pulmonary edema.Methods From December 2012 to June 2014, 64 patients with cardiogenic pulmonary edema were selected, ventilator was used in its rescue, combined with psychological nursing, postural care and respiratory management, observed the illness closely, prevented to dealing with complications.Results Breathing machine for 2 to 5 days, the condition of 60 patients were improved, 2 cases were replaced by the use of the face mask for tracheal intubation, while 2 cases of elderly patients with pulmonary infection due to poor drainage.Conclusions The rescue process in mind when hypoxemia in patients with pulmonary edema, early ventilator significantly improved therapeutic effect, but a series of patient care is to ensure the key to ventilator therapy.%目的 探讨急性心源性肺水肿应用呼吸机的抢救效果.方法 选取2012年12月至2014年6月心源性肺水肿患者64例,在其抢救过程中使用呼吸机,配合心理护理、体位护理以及呼吸道管理等,密切观察病情,预防和处理并发症.结果 呼吸机治疗2~5d,病情好转60例.2例因不配合使用面罩改为气管插管,2例高龄患者因排痰较差肺部感染改为气管插管辅助通气.结论 在心源性肺水肿患者抢救过程中出现低氧血症时,尽早使用呼吸机可提高治疗效果,而对患者的一系列护理则是保证呼吸机治疗的关键.

  8. Intravenous Infusion of Dexmedetomidine Combined Isoflurane Inhalation Reduces Oxidative Stress and Potentiates Hypoxia Pulmonary Vasoconstriction during One-Lung Ventilation in Patients

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    Rui Xia

    2015-01-01

    Full Text Available Inhalation anesthetic isoflurane inhibits hypoxia pulmonary vasoconstriction (HPV, while dexmedetomidine (Dex could reduce the dose of isoflurane inhalation and potentiate HPV, but the mechanism is unclear. Inhibition of reactive oxygen species (ROS production can favor HPV during one-lung ventilation (OLV. Similarly, nitric oxide (NO, an important endothelium-derived vasodilator in lung circulation, can decrease the regional pulmonary vascular resistance of ventilated lung and reduce intrapulmonary shunting. We hypothesized that Dex may augment HPV and improve oxygenation during OLV through inhibiting oxidative stress and increasing NO release. Patients undergoing OLV during elective thoracic surgery were randomly allocated to either isoflurane + saline (NISO, n=24 or isoflurane + dexmedetomidine (DISO, n=25 group. Anesthesia was maintained with intravenous remifentanil and inhalational isoflurane (1.0–2.0%, with concomitant infusion of dexmedetomidine 0.7 μgkg−1h−1 in DISO and saline 0.25 mL kg−1h−1 in NISO group. Hemodynamic variables or depth of anesthesia did not significantly differ between groups. Administration of Dex significantly reduced Qs/Qt and increased PaO2 after OLV, accompanied with reduced lipid peroxidation product malondialdehyde and higher levels of SOD activity as well as serum NO (all P<0.05 DISO versus NISO. In conclusion, reducing oxidative stress and increasing NO release during OLV may represent a mechanism whereby Dex potentiates HPV.

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

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    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.

  10. Breathing exercises to improve pulmonary ventilation were observed slow resistance pulmonary function%呼吸操训练提高慢阻肺患者肺通气功能的观察

    Institute of Scientific and Technical Information of China (English)

    杨玉平; 周向东

    2013-01-01

    目的:探讨慢性阻塞性肺病患者(COPD)进行呼吸操训练对肺通气功能的影响。方法:选取2011年1月至2012年6月我院住院的COPD患者120例,采用自身对照的方法,对入院患者进行初始评估及肺通气功能检测,并练习呼吸操,告知其锻炼的具体要求,随访观察患者锻炼呼吸操3个月后的肺通气功能各项指标及气短症状的改善情况。所有数据均使用t检验方法进行比较。结果:患者经呼吸操锻炼后,肺通气功能检测指标(VC、FVC、FEV1、FEV1/FVC%)以及气短症状均有所改善,差别具有显著性(p<0.05)。结论:COPD患者进行呼吸操锻炼有助于改善肺通气功能、缓解气短症状。%Objective:To investigate the breathing exercises to improve in patients with chronic obstructive pulmonary disease (COPD) effect of pulmonary ventilation function. Methods:From 2011 January to 2012 June in COPD 120 cases in our hospital, using self control ed method, initial assessment of patients, the church breath exercise method, tel the specific requirements for their training, improve the exercise of patients were observed after 3 months of pulmonary ventilation function and shortness of breath, were compared with t test al data. Results:After breathing exercises, index (VC, FVC, FEV1, FEV1/FVC%) of pulmonary function in patients with dyspnea symptoms were significantly improved , there was significant difference (p<0.05). Conclusions:Respiratory exercises can improve the pulmonary ventilation function of the patients with COPD symptoms, al eviate the effect of shortness of breath.

  11. 两种通气模式对严重肺挫伤的应用比较%Comparison of two ventilations in treating severe pulmonary contusion

    Institute of Scientific and Technical Information of China (English)

    陈亮; 易云峰; 陈检明

    2012-01-01

    目的 探讨不同模式下机械通气对严重肺挫伤患者的早期治疗效果.方法 选择35例诊断严重肺挫伤需要机械通气的患者,给予低潮气量+呼气末正压通气(PEEP)或同步间歇指令通气(SIMV)+压力支持(PSV)通气.结果 低潮气量+ PEEP组18例,SIMV+ PSV组17例.低潮气量+PEEP模式在改善低氧血症和降低吸气末峰压方面优于SIMV+ PSV模式(P <0.05).结论 低潮气量+ PEEP模式是减少呼吸机相关并发症的理想模式.%Objective To assess the early treatment of severe pulmonary contusion by using different modes of mechanical ventilation. Methods From January of 2008 to January of 2011, consecutive patients with severe pulmonary contusion were enrolled in this trial by using mechanical ventilation. All the patients were treated with lower tidal volumes + PEEP or SIMV + PSV. Results Thirty-five patients were enrolled in this trial. The samples of lower tidal volumes + PEEP and SIMV + PSV were 18 and 17, respectively. The lower tidal volumes + PEEP was more effective than SIMV + PSV, which was not only in improving hypoxemia but also in decreasing peak inspirato-ry pressure. Conclusion The lower tidal volumes + PEEP is a perfect mode for preventing the related complications in mechanical ventilation.

  12. Can pulmonary angiography be limited to the most suspicious side if the contralateral side appears normal on the ventilation/perfusion lung scan? Data from PIOPED. Prospective Investigation of Pulmonary Embolism Diagnosis.

    Science.gov (United States)

    Gottschalk, A; Stein, P D; Henry, J W; Relyea, B

    1996-08-01

    The purpose of this investigation was to determine the frequency of pulmonary embolism (PE) in a single lung that showed a normal ventilation/perfusion (V/Q) lung scan when the V/Q scan on the contralateral side was interpreted as non-high-probability for PE. Data are from the national collaborative study Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). PE was diagnosed or excluded in all lungs by pulmonary angiography. Single lungs with no V/Q abnormalities, when the V/Q scan on the contralateral side was interpreted as non-high-probability for PE, showed PE in 2 of 19 (11%) (95% confidence interval [CI], 1 to 33%). If PE was excluded by angiography on the side of the abnormal V/Q scan, then PE on the side of the normal V/Q scan was shown in only 1 of 19 (5%) (95% CI, 0 to 26%). A normal V/Q scan in a single lung, when the contralateral lung was interpreted as non-high-probability for PE, did not completely exclude PE on the apparently normal side. In such lungs, the probability of PE was in the range of low-probability interpretations. If the pulmonary angiogram showed no PE on the side of the abnormal V/Q scan, the probability of PE on the side of the normal V/Q scan satisfied the definition of very low probability for PE. This observation in patients undergoing pulmonary angiography may assist in determining whether the pulmonary angiogram should be bilateral.

  13. Activation of the Wnt/β-catenin signaling pathway by mechanical ventilation is associated with ventilator-induced pulmonary fibrosis in healthy lungs.

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    Jesús Villar

    Full Text Available BACKGROUND: Mechanical ventilation (MV with high tidal volumes (V(T can cause or aggravate lung damage, so-called ventilator induced lung injury (VILI. The relationship between specific mechanical events in the lung and the cellular responses that result in VILI remains incomplete. Since activation of Wnt/β-catenin signaling has been suggested to be central to mechanisms of lung healing and fibrosis, we hypothesized that the Wnt/β-catenin signaling plays a role during VILI. METHODOLOGY/PRINCIPAL FINDINGS: Prospective, randomized, controlled animal study using adult, healthy, male Sprague-Dawley rats. Animals (n = 6/group were randomized to spontaneous breathing or two strategies of MV for 4 hours: low tidal volume (V(T (6 mL/kg or high V(T (20 mL/kg. Histological evaluation of lung tissue, measurements of WNT5A, total β-catenin, non-phospho (Ser33/37/Thr41 β-catenin, matrix metalloproteinase-7 (MMP-7, cyclin D1, vascular endothelial growth factor (VEGF, and axis inhibition protein 2 (AXIN2 protein levels by Western blot, and WNT5A, non-phospho (Ser33/37/Thr41 β-catenin, MMP-7, and AXIN2 immunohistochemical localization in the lungs were analyzed. High-V(T MV caused lung inflammation and perivascular edema with cellular infiltrates and collagen deposition. Protein levels of WNT5A, non-phospho (Ser33/37/Thr41 β-catenin, MMP-7, cyclin D1, VEGF, and AXIN2 in the lungs were increased in all ventilated animals although high-V(T MV was associated with significantly higher levels of WNT5A, non-phospho (Ser33/37/Thr41 β-catenin, MMP-7, cyclin D1, VEGF, and AXIN2 levels. CONCLUSIONS/SIGNIFICANCE: Our findings demonstrate that the Wnt/β-catenin signaling pathway is modulated very early by MV in lungs without preexistent lung disease, suggesting that activation of this pathway could play an important role in both VILI and lung repair. Modulation of this pathway might represent a therapeutic option for prevention and/or management of VILI.

  14. Efficiency of Continuous Positive Airway Pressure or High-Frequency Jet Ventilation by Means a Nasooral Mask in the Treatment of Pulmonary Edema

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    J. Salantay

    2008-01-01

    Full Text Available Objective: to compare the efficiency of continuous positive airway pressure (CPAP and high-frequency jet ventilation by means of a mask (HFJV-M in the treatment of cardiogenic edema of the lung. Design: a retrospective study. Setting: Department of Anesthesiology and Intensive Medicine, Hospital NsP, Vranov, Slovakia. Subjects and methods. A hundred and ninety-six patients with varying cardiogenic edema of the lung were divided into 3 groups according to the severity of pulmonary edema (PE. By taking into account comparable pharmacotherapy, mean airway pressure, and FiO2, the authors compared the efficiency of CPAP (n=64 and HFJV-M (n=101 from the rate of changes in respiration rate, blood oxygenation, acid-base balance, and the duration of ventilation support and the length of stay in the intensive care unit (ICU. The results were assessed by the unpaired Student’s test. The procedure of artificial ventilation via HFJV-M was approved by the Professional and Ethics Committee, Ministry of Health in the Republic of Slovakia, in 1989 for clinical application. Results. Comparison of CPAP or HFJV-M used in mild PE that was called Phase 1 of PE revealed no statistically significant differences in the parameters being assessed. In severer forms of PE characterized as Phases 2 and 3, the use of HFJV-M in the first 3 hours of ventilation maintenance caused a rapider reduction in spontaneous respiration rate from 25—33 per min to 18—22 per min (p>0.01. The application of HFJV-M also showed a statistically significant difference in the correction rate of PaO2, pH, and oxygenation index (PaO2/FIO2 (p>0.01 predominantly within the first 2 hours of therapy. Comparison of the mean duration of necessary ventilation maintenance (CPAP versus HFJV-M: 10.9 versus 6.8 hours and the mean length of stay in the ICU (CPAP versus HFJV-N: 2.7 versus 2 days revealed a statistically significant difference (p>0.01 and p>0.05, respectively. Only 6.6% of the HFJV-M group

  15. 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

  16. Sleep apnea syndrome: central sleep apnea and pulmonary hypertension worsened during treatment with auto-CPAP, but improved by adaptive servo-ventilation.

    Science.gov (United States)

    Ono, Hiroshi; Fujimoto, Hiroyuki; Kobayashi, Yoshinori; Kudoh, Shoji; Gemma, Akihiko

    2010-01-01

    In this 71-year-old man diagnosed as obstructive sleep apnea syndrome initially, the apnea-hypopnea index in polysomnography was 31.3/hour. He started auto-adjusted continuous positive airway pressure (auto-CPAP) treatment in July 2005 but developed congestive heart failure in December 2007. Pulmonary arterial pressure (PAP), estimated by echocardiography, was 71 mmHg. In January 2008, during simplified sleep examination with a breath-movement sensor under auto-CPAP, many central-type apneas were recognized. After replacing auto-CPAP with adaptive servo-ventilation (ASV), the apnea-hypopnea index was 5.3/hour and PAP became 36 mmHg after 3 months. It was thought that the increase of PAP was due to long-term inadequate use of auto-CPAP.

  17. Maintained inspiratory activity during proportional assist ventilation in surfactant-depleted cats early after surfactant instillation: phrenic nerve and pulmonary stretch receptor activity

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    Schaller Peter

    2006-03-01

    Full Text Available Abstract Background Inspiratory activity is a prerequisite for successful application of patient triggered ventilation such as proportional assist ventilation (PAV. It has recently been reported that surfactant instillation increases the activity of slowly adapting pulmonary stretch receptors (PSRs followed by a shorter inspiratory time (Sindelar et al, J Appl Physiol, 2005 [Epub ahead of print]. Changes in lung mechanics, as observed in preterm infants with respiratory distress syndrome and after surfactant treatment, might therefore influence the inspiratory activity when applying PAV early after surfactant treatment. Objective To investigate the regulation of breathing and ventilatory response in surfactant-depleted young cats during PAV and during continuous positive airway pressure (CPAP early after surfactant instillation in relation to phrenic nerve activity (PNA and the activity of PSRs. Methods Seven anesthetized, endotracheally intubated young cats were exposed to periods of CPAP and PAV with the same end-expiratory pressure (0.2–0.5 kPa before and after lung lavage and after surfactant instillation. PAV was set to compensate for 75% of the lung elastic recoil. Results Tidal volume and respiratory rate were higher with lower PaCO2 and higher PaO2 during PAV than during CPAP both before and after surfactant instillation (p Conclusion PSR activity and the control of breathing are maintained during PAV in surfactant-depleted cats early after surfactant instillation, with a higher ventilatory response and a lower breathing effort than during CPAP.

  18. Disease severity at the first hospitalization as a predictor for mechanical ventilation dependency in elderly patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Liao, Kuang-Ming; Lin, Wei-Chieh; Lin, Tzu-Chieh; Li, Chung-Yi; Yang, Yea-Huei Kao

    2014-12-01

    Patients with chronic obstructive pulmonary disease (COPD) are predisposed to respiratory failure with ventilator dependency. This study aims to determine the risk of prolonged mechanical ventilation (PMV), defined as 22 days or more of mechanical ventilation dependency after the first day of hospital admission (index date) in patients diagnosed with COPD. A retrospective cohort was conducted using medical claim data of Taiwan's National Health Insurance Research Database. Eligible study subjects were those who had a diagnosis of COPD made between January 1, 2005 and December 31, 2009. Patients were then followed until being registered as a PMV case, death, or the end of the study. The comorbidities were measured from January 1, 1997 to the index date by the ICD-9 code. The study sample consisted of 6,341 patients with COPD with a mean age of 73.89 (± 12.01) years. Over a maximum of 6 years of follow-up, 654 patients developed PMV dependency, with an incidence density of 41.56 per 1,000 person-years. Patients aged 70 years and older were at significantly increased risk for PMV dependency, compared to those aged 40-49 years after adjusting for confounders. Expenses per visit and hospital visits per year, representing the severity of the COPD, were also associated with an elevated risk of PMV. Most patients developed PMV dependency within the first two years after the index date. Physicians should be aware that elderly patients with COPD have a high risk of PMV after first hospitalization, and these patients need to be closely monitored.

  19. Comparison of ventilation/perfusion scintigraphy and multi-detector computerized tomography in diagnosis of asymptomatic pulmonary embolism after deep vein thrombosis

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    Eflatun Yücedağ

    2014-03-01

    Full Text Available Objective: Pulmonary thromboembolism (PTE named due to migration of clots formed in systemic venous system to pulmonary vascular bed is a serious clinical table. After acute DVT, asymptomatic PTE is seen about 40-60% and this situation can not be discovered because of silent clinical course. In this study, we aimed to compare sensivity and spesifity of multi detector computerized tomography (MDCT, which is used extensively in recent years, with ventilation-perfusion (V/P scintigraphy which is used formerly for diagnosis of asymptomatic PTE developed after acute lower extremity DVT. Methods: The study was carried out 25 patients who were admitted to our clinic and treated for lower extremity acute DVT. Pregnants, and cases with recurrent DVT, presence of symptomatic PTE during admission, thrombosis extending to vena cava, and history of passed PTE were excluded from the study. DVTs in patients were diagnosed by color doppler, and confirmed by D-dimer test. After patients’s admission, V/P scintigraphy and MDCT were used to detects asymptomatic PTE at 1st and 8 th day of the admission. Results: D-dimer was measured as higher in 24 of 25 patients with asemptomatic PTE. Ten patients were diagnosed by MDCT. Development of asymptomatic PTE related to acute DVT was determined as 40%. Conclusion: In terms of diagnostic value, MDCT was found more useful than V/P scintigraphy.

  20. An evaluation of preoperative and postoperative ventilation and perfusion lung scintigraphy in the screening for pulmonary embolism after elective orthopedic surgery

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    Keenan, A.M.; Palevsky, H.I.; Steinberg, M.E.; Hartman, K.M.; Alavi, A.; Lotke, P.A. (Univ. of Pennsylvania, Philadelphia (USA))

    1991-01-01

    One hundred two patients undergoing elective knee or hip arthroplasty were studied with radionuclide ventilation scans (V) and perfusion scans (Q) preoperatively (preop) and postoperatively (postop) to assess their relative value in the diagnosis of asymptomatic pulmonary embolism (PE) after orthopedic surgery. Postop Q were read in combination with preop V and Q and postop V using prospective investigation of pulmonary embolism diagnosis (PIOPED) criteria. Of 25 postop Q interpreted as either high or intermediate probability for PE, preop Q were judged useful in 96%; the postop V were useful in 78%; and the preop V were not helpful in any of the cases. Of 63 postop Q interpreted as low probability, preop Q were useful in 74%; the postop V were useful in only 33%; and the preop V were useful in only one case. When postop Q were read as normal (14 cases), none of the three auxiliary studies were found to be useful. Overall, postop V were more helpful than preop Q in only 2%, and preop V contributed significantly in only 1%. This experience suggests that preop Q alone is the most useful adjunct to the postop Q in the postoperative evaluation for PE. The authors conclude that to screen for asymptomatic PE after elective orthopedic surgery, preop Q should be performed in all cases, preop V are not necessary, and postop V need be performed only if a baseline preop Q is not available.

  1. 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

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

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    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.

  3. 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.

  4. Clinical observation on mechanical ventilation in treatment of neonatal pulmonary hemorrhage%机械通气治疗新生儿肺出血的临床观察

    Institute of Scientific and Technical Information of China (English)

    谢彦奇

    2012-01-01

    Objective: To study the clinical curative effect of mechanical ventilation in treatment of neonatal pulmonary hemorrhage. Methods; Twenty-three neonates with pulmonary hemorrhage were divided into conventional mechanical ventilation (CMV) group and high frequency oscillatory ventilation ( HFOV) group, thirteen neonates in CMV group were treated with CMV therapy, while ten neonates in HFOV group were treated with HFOV therapy. Blood gas analysis, monitoring indexes of pulmonary oxygenation, and prognosis of the disease at 1, 4, 8, 24, and 48 hours after mechanical ventilation in the two groups were compared. Results: The total fatality rate of neonates with pulmonary hemorrhage treated with mechanical ventilation was 39.1%. The fataiity rate and the incidence of complications in HFOV group were significantly lower than those in CMV group ( P < 0. 05 ) . At 1, 4, 8 , and 24 hours after mechanical ventilation; the correction of hypoxemia and hypercapnia, the improvement of pulmonary oxygenation in HFOV group were significantly quicker that those in CMV group (P<0.05) . The mean stopping time of pulmonary hemorrhage, the main application time of mechanical ventilation, and the mean hospilalization time in HFOV group were significantly shorter than those in CMV group (P < 0.05 ) . Conclusion: The curative effect of mechanical ventilation is good in treatment of pulmonary hemorrhage. HFOV can correct hypoxemia and hypercapnia more quickly, improve pulmonary oxygenation, shorten the course of the disease, and reduce the occurrence of complications and neonatal mortality.%目的:研究机械通气治疗新生儿肺出血的临床疗效.方法:将23例肺出血新生儿分组采用常频机械通气(CMV)、高频震荡通气(HFOV)呼吸机模式治疗,CMV组(n=13例)采用常频机械通气治疗,HFOV组(n=10例)采用高频震荡通气治疗,比较两组患儿上机后1、4、8、24、48 h的血气和肺氧合功能监测指标以及病情转归.结果:采用机械通气

  5. 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.

  6. Edema pulmonar de reexpansão tratado com ventilação não invasiva: relato de caso Reexpansion pulmonary edema treated with non-invasive ventilation: case report

    Directory of Open Access Journals (Sweden)

    Amarilio Vieira de Macedo Neto

    2001-02-01

    Full Text Available The authors report a case of Reexpansion Pulmonary Edema (RPE seen at Hospital de Pronto Socorro de Porto Alegre 3 hours after drainage of spontaneous pneumothorax. The patient presented a unilateral pneumothorax with one-week duration. After pleural drainage respiratory failure occured being managed at the Intensive Care Unit with non-invasive positive pressure ventilation through facial mask. The patient had favorable outcome and was discharged asymtomatic after 72 hours.

  7. High-resolution imaging of pulmonary ventilation and perfusion with {sup 68}Ga-VQ respiratory gated (4-D) PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Callahan, Jason [Centre for Molecular Imaging, Peter MacCallum Cancer Centre, East Melbourne, VIC (Australia); Hofman, Michael S. [The University of Melbourne, Department of Medicine, Peter MacCallum Cancer Centre, Centre for Molecular Imaging, East Melbourne, VIC (Australia); Siva, Shankar [The University of Melbourne, Peter MacCallum Cancer Centre, Department of Radiation Oncology, East Melbourne, VIC (Australia); The University of Melbourne, Sir Peter MacCallum Department of Oncology, East Melbourne, VIC (Australia); Kron, Tomas [The University of Melbourne, Sir Peter MacCallum Department of Oncology, East Melbourne, VIC (Australia); The University of Melbourne, Peter MacCallum Cancer Centre, Department of Physical Sciences, East Melbourne, VIC (Australia); Schneider, Michal E. [Monash University, Department of Medical Imaging and Radiation Science, Clayton, VIC (Australia); Binns, David; Eu, Peter [Peter MacCallum Cancer Centre, Centre for Cancer Imaging, East Melbourne, VIC (Australia); Hicks, Rodney J. [The University of Melbourne, Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, Centre for Molecular Imaging, East Melbourne, VIC (Australia)

    2014-02-15

    Our group has previously reported on the use of {sup 68}Ga-ventilation/perfusion (VQ) PET/CT scanning for the diagnosis of pulmonary embolism. We describe here the acquisition methodology for {sup 68}Ga-VQ respiratory gated (4-D) PET/CT and the effects of respiratory motion on image coregistration in VQ scanning. A prospective study was performed in 15 patients with non-small-cell lung cancer. 4-D PET and 4-D CT images were acquired using an infrared marker on the patient's abdomen as a surrogate for breathing motion following inhalation of Galligas and intravenous administration of {sup 68}Ga-macroaggregated albumin. Images were reconstructed with phase-matched attenuation correction. The lungs were contoured on CT and PET VQ images during free-breathing (FB) and at maximum inspiration (Insp) and expiration (Exp). The similarity between PET and CT volumes was measured using the Dice coefficient (DC) comparing the following groups; (1) FB-PET/CT, (2) InspPET/InspCT, (3) ExpPET/Exp CT, and (4) FB-PET/AveCT. A repeated measures one-way ANOVA with multiple comparison Tukey tests were performed to evaluate any difference between the groups. Diaphragmatic motion in the superior-inferior direction on the 4-D CT scan was also measured. 4-D VQ scanning was successful in all patients without additional acquisition time compared to the nongated technique. The highest volume overlap was between ExpPET and ExpCT and between FB-PET and AveCT with a DC of 0.82 and 0.80 for ventilation and perfusion, respectively. This was significantly better than the DC comparing the other groups (0.78-0.79, p < 0.05). These values agreed with a visual inspection of the images with improved image coregistration around the lung bases. The diaphragmatic motion during the 4-D CT scan was highly variable with a range of 0.4-3.4 cm (SD 0.81 cm) in the right lung and 0-2.8 cm (SD 0.83 cm) in the left lung. Right-sided diaphragmatic nerve palsy was observed in 3 of 15 patients. {sup 68}Ga-VQ 4-D

  8. 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....

  9. [Outcome of patients with suspected pulmonary thromboembolism and low probability ventilation/perfusion lung scan who receive no long-term anticoagulation].

    Science.gov (United States)

    Calvo Romero, J M; Arévalo Lorido, J C; Carretero Gómez, J

    2005-08-01

    To know in our area the security of no long-term anticoagulation in patients with suspected pulmonary thromboembolism (PTE) and a low probability ventilation/perfusion (V/Q) lung scan. Retrospective review of a series of consecutive outpatients with suspected PTE and a low probability V/Q lung scan, according to the modified PIOPED criteria, who receive no long-term anticoagulation. Among 38 patients with a low probability V/Q lung scan, 31 (81.6%) did not receive long-term anticoagulation. The median age was 69.1 years (range 26-88 years), and 19 (61.3%) were female. The clinical probability of PTE was moderate in 27 patients (87.1%). Twenty-two patients (71%) had a venous lower extremities echography-doppler negative for deep vein thrombosis (DVT). The median follow-up was 6.3 months (range 3-12 months). There was one case (3.2%; 95% confidence interval, 0.1-16.7%) with demonstrated PTE and DVT, and there was no death. No long-term anticoagulation in outpatients with a moderate clinical probability of PTE, a low probability V/Q lung scan and a venous lower extremities echography-doppler negative for DVT may be secure in our area.

  10. 肺通气灌注扫描在孕妇肺栓塞诊断中的研究进展%Research advance of lung ventilation perfusion scanning for diagnosis of pulmonary embolism in pregnant women

    Institute of Scientific and Technical Information of China (English)

    张泽明; 刘丽君; 杨泽西

    2014-01-01

    Pulmonary embolism is the primary cause of maternal death in western countries.If the pulmonary embolism of the pregnant women can not get timely diagnosis and treatment,the life safety of the pregnant women and fetus will be seriously threatened.At present,the lung ventilation perfusion scanning examination is recognized as the most sensitive and noninvasive diagnosis method of pulmonary embolism in the world.But this check is partially limited,considering the influence on the pregnant women and fetus.This article reviews the application progress of lung ventilation perfusion scanning in the pregnant women with pulmonary embolism.%在西方国家,肺栓塞是孕产妇死亡的首要原因,如肺栓塞的孕妇得不到及时的诊断和治疗,将严重威胁孕妇及胎儿的生命安全.肺通气灌注扫描显像检查是目前国际上公认的诊断肺栓塞的最敏感而无创的检查方法,但考虑到对孕妇及胎儿的影响,此检查受到了一定的限制.本文就肺通气灌注扫描显像检查在孕妇可疑肺栓塞中的应用进展作一综述.

  11. Ventilación no invasiva y rehabilitación respiratoria en pacientes con enfermedad pulmonar obstructiva crónica Noninvasive ventilation and pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    FRANCISCO ARANCIBIA H

    2011-06-01

    Full Text Available Se ha demostrado que la rehabilitación respiratoria en pacientes con enfermedad pulmonar obstructiva crónica (EPOC aumenta la capacidad de ejercicio y reduce la disnea. En la mayoría de los pacientes con discapacidad, la intensidad del ejercicio durante las sesiones de entrenamiento se ve limitada por la capacidad de la bomba ventilatoria. La ventilación no invasiva (VNI ha sido utilizada con mucho éxito en pacientes con EPOC que presentan una exacerbación de su enfermedad. No obstante, su beneficio en pacientes con EPOC estable o en rehabilitación respiratoria está en discusión. En este capitulo se evaluó la evidencia científica que existe en cuanto al beneficio de la ventilación no invasiva (VNI en la rehabilitación respiratoria. Se revisó la modalidad y las características de la VNI en cuanto a cuando realizarla -si durante el entrenamiento o nocturna-. Se recomendó la utilización de la ventilación no invasiva en rehabilitación respiratoria en pacientes seleccionados, con EPOC en etapa grave o avanzada, y en aquellos con respuestas subóptimas al entrenamiento. La utilización de la ventilación no invasiva debe ser preferentemente nocturna, y utilizando presión de soporte inspiratorio, la cual puede permitir alcanzar una mejor tolerancia al ejercicio, una mejoría del intercambio gaseoso y una disminución de la sobrecarga de los músculos respiratorios y la disnea. (calidad de la evidencia B, fuerza de la recomendación: moderada.In patients with chronic obstructive pulmonary disease (COPD, pulmonary rehabilitation has been demonstrated to increase exercise capacity and reduce dyspnea. In the most disabled patients, the intensity of exercise during the training sessions is limited by ventilatory pump capacity. Non-invasive ventilation (NIV support has been used successfully in patients with exacerbation of COPD. However, its benefit in patients with stable COPD or in a pulmonary rehabilitation program is under discussion

  12. Xenon ventilation CT using dual-source and dual-energy technique in children with bronchiolitis obliterans: correlation of xenon and CT density values with pulmonary function test results

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo; Yang, Dong Hyun; Seo, Joon Beom; Chae, Eun Jin; Lee, Jeongjin [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul (Korea); Hong, Soo-Jong; Yu, Jinho; Kim, Byoung-Ju [University of Ulsan College of Medicine, Department of Pediatrics, Asan Medical Center, Seoul (Korea); Krauss, Bernhard [Siemens Medical Solutions AG-Computed Tomography, Forchheim (Germany)

    2010-09-15

    Xenon ventilation CT using dual-source and dual-energy technique is a recently introduced, promising functional lung imaging method. To expand its clinical applications evidence of additional diagnostic value of xenon ventilation CT over conventional chest CT is required. To evaluate the usefulness of xenon ventilation CT using dual-source and dual-energy technique in children with bronchiolitis obliterans (BO). Seventeen children (age 7-18 years; 11 boys) with BO underwent xenon ventilation CT using dual-source and dual-energy technique. Xenon and CT density values were measured in normal and hyperlucent lung regions on CT and were compared between the two regions. Volumes of hyperlucent regions and ventilation defects were calculated with thresholds determined by visual and histogram-based analysis. Indexed volumes of hyperlucent lung regions and ventilation defects were correlated with pulmonary function test results. Effective doses of xenon CT were calculated. Xenon (14.6 {+-} 6.4 HU vs 26.1 {+-} 6.5 HU; P < 0.001) and CT density (-892.8 {+-} 25.4 HU vs -812.3 {+-} 38.7 HU; P < 0.001) values were significantly lower in hyperlucent regions than in normal lung regions. Xenon and CT density values showed significant positive correlation for the entire lung in 16 children ({gamma} = 0.55 {+-} 0.17, P < 0.001 or =0.017) and for hyperlucent regions in 13 children ({gamma} = 0.44 {+-} 0.16, P < 0.001 or =0.001-0.019). Indexed volumes and volume percentages of hyperlucent lung regions and ventilation defects showed strong negative correlations with forced expiratory volume [FEV1, ({gamma} = -0.64-0.85, P {<=} 0.006)], FEV1/forced vital capacity [FVC, ({gamma} = -0.63-0.84, P {<=} 0.008)], and forced midexpiratory flow rate [FEF{sub 25-75}, ({gamma} = -0.68-0.88, P {<=} 0.002). Volume percentages of xenon ventilation defects (35.0 {+-} 16.4%)] were not significantly different from those of hyperlucent lung regions (38.2 {+-} 18.6%). However, mismatches between the

  13. The effects of breathing a helium-oxygen gas mixture on maximal pulmonary ventilation and maximal oxygen consumption during exercise in acute moderate hypobaric hypoxia.

    Science.gov (United States)

    Ogawa, Takeshi; Calbet, Jose A L; Honda, Yasushi; Fujii, Naoto; Nishiyasu, Takeshi

    2010-11-01

    To test the hypothesis that maximal exercise pulmonary ventilation (VE max) is a limiting factor affecting maximal oxygen uptake (VO2 max) in moderate hypobaric hypoxia (H), we examined the effect of breathing a helium-oxygen gas mixture (He-O(2); 20.9% O(2)), which would reduce air density and would be expected to increase VE max. Fourteen healthy young male subjects performed incremental treadmill running tests to exhaustion in normobaric normoxia (N; sea level) and in H (atmospheric pressure equivalent to 2,500 m above sea level). These exercise tests were carried out under three conditions [H with He-O(2), H with normal air and N] in random order. VO2 max and arterial oxy-hemoglobin saturation (SaO(2)) were, respectively, 15.2, 7.5 and 4.0% higher (all p max, 171.9 ± 16.1 vs. 150.1 ± 16.9 L/min; VO2 max, 52.50 ± 9.13 vs. 48.72 ± 5.35 mL/kg/min; arterial oxyhemoglobin saturation (SaO(2)), 79 ± 3 vs. 76 ± 3%). There was a linear relationship between the increment in VE max and the increment in VO2 max in H (r = 0.77; p VO2 max, both groups showed increased VE max and SaO(2) in H with He-O(2), but VO2 max was increased only in the high VO2 max group. These findings suggest that in acute moderate hypobaric hypoxia, air-flow resistance can be a limiting factor affecting VE max; consequently, VO2 max is limited in part by VE max especially in subjects with high VO2 max.

  14. Noninvasive positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema%无创正压通气治疗急性心源性肺水肿疗效观察

    Institute of Scientific and Technical Information of China (English)

    关晶; 李建民

    2012-01-01

    目的:观察无创正压通气(noninvasive positive pressure ventilation,NPPV)治疗急性心源性肺水肿的疗效.方法:对急性心源性肺水肿引起的急性呼吸衰竭患者行NPPV,2小时后观察心率和动脉血气分析的指标变化情况.结果:急性心源性肺水肿患者使用无创正压通气后,心率及动脉血气分析指标均较使用前有显著改善.结论:对急性心源性肺水肿引起的急性呼吸衰竭行NPPV疗效显著.%Objective To observe the curative effect of noninvasive positive pressure ventilation (NPPV) in treatment of acute cardiogenic pulmonary edema. Methods patients with acute respiratory failure due to acute cardiogenic pulmonary edema were treated by NPPV. The variation of heart rate and the blood gas analysis were observed. Compared before treatment and 2 hours after treatment. Results The symptoms of the patients were significantly alleviated including heart rate and the blood gas analysis. Conclusion NPPV has therapeutic advantages and significant effect in treatment of acute respiratory failure due to acute cardiogenic pulmonary edema.

  15. 单肺通气中右美托咪定辅助麻醉对肺通气/血流的影响%Single Lung Ventilation of Dexmedetomidine Assisted Anesthesia on Pulmonary Ventilation/Blood Flow

    Institute of Scientific and Technical Information of China (English)

    康忠奎

    2016-01-01

    Objective Observed in single lung ventilation,right the microphones on auxiliary anesthesia hemodynamic, whether to help to improve the single lung ventilation lung ventilation/blood flow abnormalities.Methods 60 cases of esophageal cancer radical under one-lung ventilation were divided into control group and experimental group.Control group 0.9% saline injec-tion 10 mL after anesthesia induction,the experimental group after anesthesia induction right set beauty holds the mi 0.6 mu g/kg (input) 10 minutes.Observe two groups of related indicators: single lung ventilation time,operation time,airway pressure,oxygen partial pressure;Observe preoperative,15 minutes before intubation and after intubation and after intubation,cut skin,into the chest,single lung ventilation when 60 minutes,90 minutes of single lung ventilation,double lung ventilation 15 minutes time point of the mean arterial pressure (MAP),heart rate (HR);Observe preoperatively,single lung ventilation 60 minutes,90 minutes of one-lung ventilation and oxygen index.Results This study results show that the oxygen and index in preoperative point in time,the ex-perimental group there was no statistically significant difference compared with control group (P>0.05);Oxygen index and one-lung ventilation 60 minutes,single lung ventilation in 90 minutes,the experimental group compared with control group difference was sta-tistically significant(P0.05);氧和指数在单肺通气60 min、单肺通气90 min时间点,实验组与对照组比较差异有统计学意义(P<0.05),其机制可能就是减轻了单肺通气引起急性肺损伤。 HR、MAP在插管前、插管后、插管后15 min、切皮时、进胸、单肺通气60 min、单肺通气90 min、双肺通气15 min时间点,实验组与对照组比较差异有统计学意义(P<0.05)。结论在单肺通气中,右美托咪定辅助麻醉血流动力学更平稳,氧和指数增加,有助于改善单肺通气时的肺通气/血流异常。

  16. 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

  17. 无创正压通气在急性心源性肺水肿中的应用进展%Application progress of nonivasive positive pressure ventilation in acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    竺文静; 朱蕾

    2010-01-01

    急性心源性肺水肿的发病率和病死率皆较高.对严重持续低氧血症或呼吸窘迫进行性加重的患者及早进行无创正压通气治疗有独到的优势,较单纯药物治疗更快地缓解症状、改善氧合、降低气管插管率,并且可能改善患者的预后.%Acute cardiogenie pulmonary edema is a disease with high morbidity and mortality. Noninvasive positive pressure ventilation has been proved specific advantage for patients suffering severe continuous hypoxemia or progressive respiratory failure. Compared with single medication, noninvasive positive pressure ventilation can relieve symptom,improve oxygenation, decrease tracheal intubation more quickly,and probably improve patients' prognosis.

  18. 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.

  19. Evaluation of the Effect of early mechanical ventilation in the treatment of severe pulmonary contusion%严重肺挫伤行早期呼吸机治疗临床观察

    Institute of Scientific and Technical Information of China (English)

    周秋根; 鄢永安

    2015-01-01

    目的:评价严重肺挫伤行早期呼吸机治疗的效果。方法回顾2009年10月-2014年12月严重肺挫伤患者87例,行呼吸机治疗24 h后分析血气指标的变化。结果行呼吸机治疗24 h后动脉血氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、氧合指数(PaO2/FiO2)、呼吸和心率均较前有明显改善(P<0.05)。部分患者避免了手术内固定治疗。本组治愈76例,治愈率87.4%。结论尽早对严重肺挫伤患者行呼吸机治疗能明显改善病情。%Objective To evaluate the effect of early mechanical ventilation on the treatment of severe pulmonary contusion.Methods 87 cases of severe pulmonary contusion from October 2009 to December 2014 were retrospectively analyzed-the changes of all kinds of parameters after 24 h mechanical ventilation treatment were analysed. Results PaO2,PaCO2,PaO2/FiO2,R and HR were obviously improved after the treatment,and there was statistical significance (P<0.05);Part of the patients avoided internal fixation operation.76 cases were cured. The cure rate was 87.4%. Conclusion Early mechanical ventilation could obviously improve patientg conditions in treating severe pulmonary contusion.

  20. Effects of selective lobar ventilation on intrapulmonary shunt and inflammatory response in patients with pulmonary dysfunction during thoracotomy%选择性肺叶通气对肺功能不全患者开胸术中肺内分流及炎性反应的影响

    Institute of Scientific and Technical Information of China (English)

    周清河; 肖旺频; 安尔丹

    2014-01-01

    Objective To investigate the effects of selective lobar ventilation on intrapulmonary shunt and inflammatory response in patients with pulmonary dysfunction during thoracotomy.Methods Thirty-four ASA Ⅱ or Ⅲ patients,aged 64-79 years,weighing 50-85 kg,with moderate or severe impaired pulmonary function,scheduled for esophageal cancer radical correction,were randomly divided into two groups (n =17 each):one-lung ventilation group (group A) and selective lobar ventilation group (group B).In group A,an endobronchial blocker tube was used to obstruct the bronchus principalis and practice one-lung ventilation.In group B,an endobronchial blocker tube was used to obstruct the bronchi Iobares and practice selective lobar ventilation.Blood samples were taken from the arteria radialis and the internal jugular vein for blood gas analysis and determination of plasma concentrations of tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6) and IL-8 by enzyme linked immunosorbent assay (ELISA) before anesthesia induction (T0),30 minutes following two-lung ventilation at the lateral position (T1),60 minutes following one-lung ventilation or selective lobar ventilation (T2) and at the end of surgery (T3).Peak airway pressure (Ppeak) and plateau airway pressure (Pplat) were recorded at the same time.Results The incidence of hypoxemia was significantly lower in group B (0) than in group A (18%,P < 0.05).Compared with group A,Pliat and Ppeak at T1-3,the intrapulmonary shunt rate (Qs/Qt) at T2,TNF-α,IL-6 and IL-8 concentrations at T2-3 were significantly decreased in group B (P < 0.05).Conclusion Selective lobar ventilation can reduce intrapulmonary shunt and inhibit inflammatory responses to help lessen mechanical ventilation-related lung injuryduring thoracotomy in patients with pulmonary dysfunction.

  1. 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.

  2. Ventilation/perfusion SPECT in chronic obstructive pulmonary disease: an evaluation by reference to symptoms, spirometric lung function and emphysema, as assessed with HRCT

    Energy Technology Data Exchange (ETDEWEB)

    Joegi, Jonas; Bajc, Marika [Lund University, Skaane University Hospital, Department of Clinical Physiology, Institution of Clinical Sciences, Lund (Sweden); Ekberg, Marie [Lund University, Skaane University Hospital, Department of Respiratory Medicine and Allergology, Institution of Clinical Sciences, Lund (Sweden); Jonson, Bjoern [Lund University, Department of Clinical Physiology, Institution of Clinical Sciences, Lund (Sweden); Bozovic, Gracijela [Lund University, Skaane University Hospital, Department of Radiology, Institution of Clinical Sciences, Lund (Sweden)

    2011-07-15

    Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation which is not fully reversible. Despite the heterogeneity of COPD, its diagnosis and staging is currently based solely on forced expiratory volume in 1 s (FEV{sub 1}). FEV{sub 1} does not explain the underlying pathophysiology of airflow limitation. The relationship between FEV{sub 1}, symptoms and emphysema extent is weak. Better diagnostic tools are needed to define COPD. Tomographic lung scintigraphy [ventilation/perfusion single photon emission tomography (V/P SPECT)] visualizes regional V and P. In COPD, relations between V/P SPECT, spirometry, high-resolution computed tomography (HRCT) and symptoms have been insufficiently studied. The aim of this study was to investigate how lung function imaging and obstructive disease grading undertaken using V/P SPECT correlate with symptoms, spirometric lung function and degree of emphysema assessed with HRCT in patients with COPD. Thirty patients with stable COPD were evaluated with the Medical Research Council dyspnoea questionnaire (MRC) and the clinical COPD questionnaire (CCQ). Spirometry was performed. The extent of emphysema was assessed using HRCT. V/P SPECT was used to assess V/P patterns, total reduction in lung function and degree of obstructive disease. The total reduction in lung function and degree of obstructive disease, assessed with V/P SPECT, significantly correlated with emphysema extent (r = 0.66-0.69, p < 0.0001) and spirometric lung function (r = 0.62-0.74, p < 0.0005). The correlation between emphysema extent and spirometric lung function was weaker. No correlation between MRC, CCQ and objective measurements was found. V/P SPECT is sensitive to early changes in COPD. V/P SPECT also has the possibility to identify comorbid disease. V/P SPECT findings show a significant correlation with emphysema extent and spirometric lung function. We therefore recommend that scintigraphic signs of COPD, whenever found, should be

  3. 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

  4. The study of protective ventilation strategy on severe pulmonary contusion%保护性机械通气治疗严重肺挫伤的疗效评价

    Institute of Scientific and Technical Information of China (English)

    严四军; 刘燕; 曹祥; 乔德成; 邓波荣

    2010-01-01

    目的 研究保护性机械通气治疗严重肺挫伤的临床效果.方法 将53例严重肺挫伤患者按住院日期单双数随机分为两组:保护性通气组25例,潮气量6-8 ml/kg,传统通气组28例,潮气量12-15 ml/kg,其他呼吸机参数按同一策略调整.观察机械通气治疗前后血气参数的变化,比较两组呼吸机使用时间、病死率及并发症的发生率.结果 两组患者机械通气后动脉血氧分压、氧合指数均明显改善,两组比较差异无统计学意义.保护性通气组呼吸机使用时间(149.8±77.3)h,死亡7例(28.0%),传统通气组呼吸机使用时间(203.3±85.2)h,死亡11例(39.3%),两组呼吸机使用时间和病死率比较差异有统计学意义(P<0.01).且保护性通气组并发肺部感染、气胸,纵隔气肿的发生率均低于传统通气组(P<0.05),急性呼吸窘迫综合征的发生率虽低于传统通气组,但差异无统计学意义(P>0.05).结论 保护性机械通气可有效改善严重肺挫伤患者的肺氧合功能,提高动脉血氧分压,显著缩短呼吸机使用时间,降低病死率和呼吸机相关并发症的发生率,改善预后,值得临床推广.%Objective To investigate the effect of protective ventilation strategy on severe plumonary contusion. Methods Fifty-three patients suffered from severe pulmonary contusion were randomly divided into the protective ventilation group (25 cases,the tidal volume was 6-8 ml/kg) and the traditional ventilation group (28 cases,the tidal volume was 12-15 ml/kg). The blood gases were examined before and after ventilation. Moreover,the time for ventilation therapy,mortality rate and morbidity of complications were compared between the two groups. Results After ventilation,arterial oxygen content and oxygenation index were improved obviously in two groups,and there was no significant difference between the two groups. Average time for ventilation therapy and mortality rate in the protective ventilation group were

  5. 高频振荡通气治疗新生儿肺出血的临床研究%Effect of high-frequency oscillatory ventilation on pulmonary hemorrhage in newborn infants

    Institute of Scientific and Technical Information of China (English)

    陈丹; 黄西林; 李小萍; 李明玉; 沈剑峰

    2011-01-01

    目的 探讨高频振荡通气(HFOV)治疗新生儿肺出血的有效性及安全性.方法 回顾性分析高频和常频通气(CMV)治疗肺出血患儿62例的临床效果,比较两组患儿的肺氧合功能、肺出血时间、住院时间、上机时间、氧疗时间、合并症及转归.结果 HFOV组治疗后1、6、12、24、48、72 h 氧合指数(OI)明显低于CMV组,动脉/肺泡氧分压(a/APO2)明显高于CMV组,差异有统计学意义(P < 0.05).HFOV组呼吸机相关性肺炎(VAP)发生率明显低于CMV组(P < 0.05),治愈率增高(P < 0.05).HFOV组气胸、颅内出血、消化道出血、血糖异常、败血症、肾功能损害的发生率与CMV组比较差异无统计学意义(P > 0.05).存活患儿中,HFOV组在肺出血时间、住院时间、上机时间、氧疗时间较CMV组明显缩短(P < 0.05).结论 HFOV能更好地改善肺出血患儿氧合功能,降低VAP的发生率,缩短病程,提高治愈率,与CMV组比较并不增加不良反应的发生率.%Objectives To investigate the efficacy and safety of high-frequency oscillatory ventilation (HFOV)for the treatment of pulmonary hemorrhage in newborn infants. Methods The clinical effect for the treatment of pulmonary hemorrhage was retrospectively evaluated in 30 newborn infants with HFOV and 32 newborn infants with conventional mechanical ventilation (CMV) by comparing the oxygenate function, the duration of pulmonary hemorrhage, the length of hospital stay, the duration of mechanical ventilation, the duration of oxygen therapy,complications and prognosis. Results The oxygen index (OI) was lower obviously and the arterial/alveolar oxygen tension ratio (a/APO2) was higher markedly at 1, 6, 12, 24, 48 and 72 h after treatment in the HFOV group compared to those in the CMV group, respectively (P <0.05 for all). There were significantly the lower incidence of ventilator-associated pneumonia (VAP) and the higher recovery rate in the HFOV group compared to those in the CMV

  6. 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.

  7. 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.

  8. Methodology for ventilation/perfusion SPECT

    DEFF Research Database (Denmark)

    Bajc, Marika; Neilly, Brian; Miniati, Massimo

    2010-01-01

    Ventilation/perfusion single-photon emission computed tomography (V/Q SPECT) is the scintigraphic technique of choice for the diagnosis of pulmonary embolism and many other disorders that affect lung function. Data from recent ventilation studies show that the theoretic advantages of Technegas ov...

  9. Ventilation-induced Alterations in Lung Development

    NARCIS (Netherlands)

    A.A. Kroon (André)

    2011-01-01

    textabstractMechanical ventilation is a lifesaving treatment in critically ill neonates. However, mechanical ventilation is also one of the most important risk factors (Table 1) of Bronchopulmonary dysplasia (BPD), the most common chronic lung disease in infancy with long-term pulmonary and neurolog

  10. Effects of drugs during anesthesia with one lung ventilation on pulmonary shunt fraction%单肺通气期间麻醉期用药对肺内分流的影响

    Institute of Scientific and Technical Information of China (English)

    纪凡层; 牟爱珍

    2016-01-01

    Background Hypoxemia is one of the most common complications during one lung ventilation(OLV).Hypoxemia pulmonary vasoconstriction (HPV) is a reflex contraction of vascular smooth muscle in the pulmonary circulation in response to low regional partial pressure of oxygen.It can decrease pulmonary shunt fraction (Qs/Qt) and improve oxygenation.Objective To discuss the effects of drugs during anesthesia with OLV on Qs/Qt.Content Many drugs during anesthesia have an effect on HPV, Qs/Qt and oxygenation.Trend Drugs during anesthesia with OLV can inhibit or enhance the response of HPV, increase or decrease the Qs/Qt.We should avoid of drugs that inhibit the response of HPV and increase Qs/Qt.It can help patients to avoid of hypoxia.%背景 低氧血症是单肺通气(one lung ventilation,OLV)期间最常见的并发症.缺氧性肺血管收缩(hypoxic pulmonary vasoconstriction,HPV)是肺血管对局部低氧分压的反射性收缩,可以减少肺内分流(pulmonary shunt fraction,Qs/Qt)、维持动脉血氧分压(partial pressure of arterial oxygen,PaO2)、防止低氧血症的发生.目的 探讨OLV期间麻醉期用药对Qs/Qt的影响,指导临床应用.内容 综述OLV期间麻醉期用药对机体HPV、Qs/Qt和PaO2的影响.趋向 OLV期间麻醉期用药可以对HPV产生抑制或增强作用,从而影响Qs/Qt和PaO2.临床上要避免使用抑制HPV作用、增加Qs/Qt的药物,防止患者出现低氧血症.

  11. Ventilation effectiveness

    CERN Document Server

    Mathisen, Hans Martin; Nielsen, Peter V; Moser, Alfred

    2004-01-01

    Improving the ventilation effectiveness allows the indoor air quality to be significantly enhanced without the need for higher air changes in the building, thereby avoiding the higher costs and energy consumption associated with increasing the ventilation rates. This Guidebook provides easy-to-understand descriptions of the indices used to mesure the performance of a ventilation system and which indices to use in different cases.

  12. 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

  13. 两种有创机械通气模式在肺挫伤患者的比较研究%Comparison of the Effect of Two Kinds of Invasive Mechanical Ventilations in the Treatment of Pulmonary Contusion

    Institute of Scientific and Technical Information of China (English)

    周文来; 郑祥德; 李充沛; 刘小毅; 张丽; 刘成

    2016-01-01

    目的 比较两种有创机械通气治疗肺挫伤患者的效果. 方法 回顾分析2011年8月—2015年4月肺挫伤患者60例,所有患者均采取经口气管插管机械通气,分为治疗组(n=30),通气模式为适应性支持通气+呼气末正压;对照组(n=30),通气模式为同步间歇指令通气+压力支持通气+呼气末正压.观察两组机械通气情况和血气分析指标. 结果 治疗组的机械通气时间、住ICU时间和VAP发生率少于对照组(P<0.05). 治疗后两组的血气指标均优于治疗前(P<0.05),治疗组效果优于对照组[PaO2 (64.8±3.0) mmHg vs (62.2±2.3) mmHg;PaCO2 (39.8±2.9) mmHg vs (42.3±1.5) mmHg; SaO2 (94.7±2.2)% vs (92.9±1.7)%; PaO2/FiO2 (162.2±6.5) vs (154.7±5.8), 均P<0.05]. 结论 肺挫伤患者采用ASV模式机械通气疗法可提高通气效果,改善血气指标,具有潜在的临床推广价值.%Objective To compare the effect of two kinds of invasive mechanical ventilations in the treatment of pulmonary contusion. Methods An analysis was conducted on 60 cases with pulmonary contusion enrolled from August 2011 to April 2015. All the subjects were treated by mechanical ventilation with orotracheal intubation. The patients were divided into the treatment group (n=30) and the control group (n=30) according with different treatments. The treatment group received ASV and PEEP, while the control group received SIMV, PSV and PEEP. Mechanical ventilation and blood gas analysis indexes were observed in both groups. Results Compared with the control group, the treatment group had shorter duration of me-chanical ventilation, less length of stay in the ICU and lower incidence rate of VAP, the differences were statistically signif-icant, P<0.05. After treatment, the values of blood gas indexes in both groups were better than those before treatment, P<0.05. Furthermore, the treatment group had better treatment effect than the control group after treatment in PaO2 [(64.8±3.0) mmHg vs (62.2±2.3)mm

  14. Demand Controlled Ventilation and Classroom Ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Fisk, William J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Mendell, Mark J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Davies, Molly [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Eliseeva, Ekaterina [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Faulkner, David [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Hong, Tienzen [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sullivan, Douglas P. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2012-05-01

    This document summarizes a research effort on demand controlled ventilation and classroom ventilation. The research on demand controlled ventilation included field studies and building energy modeling.

  15. Displacement Ventilation

    DEFF Research Database (Denmark)

    Nielsen, Peter Vilhelm

    Displacement ventilation is an interesting new type of air distribution principle which should be considered in connection with design of comfort ventilation in both smal1 and large spaces. Research activities on displacement ventilation are large all over the world and new knowledge of design...... methods appears continuously. This book gives an easy introduction to the basis of displacement ventilation and the chapters are written in the order which is used in a design procedure. The main text is extended by five appendices which show some of the new research activities taking place at Aalborg...

  16. 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.

  17. 机械通气治疗重症心源性肺水肿40例临床分析%Clinical Analysis of 40 Patients with Severe Acute Cardiogenic Pulmonary Edema Treated by Mechanical Ventilation

    Institute of Scientific and Technical Information of China (English)

    陆逢时; 骆斯敏; 金同新

    2015-01-01

    Objective:To summarize the clinical efficacy of patients with severe acute cardiogenic pulmonary edema treated by mechanical ventilation. Methods:The clinical data of 40 patients with severe acute cardiogenic pulmonary edema treated by mechanical ventilation were retrospectively analyzed from Jan 2010 to Dec 2014. Results:The condition improved rate of the patients was 87.5% (35/40), with an average recovery time of (7.5 ±0.9) h. 4 cases died, the cause of death were all a large area of myocardial infarction complicated with cardiogenic shock. The pH,PaO2,SaO2 of patients were significantly increased after treatment (P<0.05). While PaCO2, heart rate, respiratory rate, systolic pressure, diastolic pressure were decreased significantly,all P<0.05. Conclusion:Mechanical ventilation contributes to the improvement of hypoxia symptoms of patients with severe acute cardiogenic pulmonary edema and improve their cardiac function.%目的:总结机械通气治疗重症心源性肺水肿的临床疗效。方法:回顾性分析2010年1月至2014年12月我科收治的机械通气治疗的重症心源性肺水肿患者40例的临床资料。结果:患者病情好转率87.5%(35/40),平均好转时间(7.5±0.9)h;死亡4例,死于大面积心梗合并心源性休克;治疗后患者pH、PaO2、SaO2均有明显上升,PaCO2、心率、呼吸频率、收缩压、舒张压均明显下降,P均<0.05。结论:机械通气治疗有助于改善重症心源性肺水肿患者低氧症状、改善其心功能。

  18. Noninvasive Ventilation in the Treatment of Toxic Chemical Gas Efficacy of Pulmonary Edema%无创通气治疗化学气体中毒性肺水肿的疗效观察

    Institute of Scientific and Technical Information of China (English)

    占凌峰

    2011-01-01

    [Objective]To explore the effect of noninvasive nasal (facial) mask bi-level positive airway pressure ventilation (BiPAP) treatment of toxic chemical gases pulmonary edema. [Methods] 48 chemical gas poisoning causes pulmonary edema patients were randomly divided into treatment groups(n= 23 )and the control group(n= 25). Patients in treatment groups had non-invasive nasal (facial) mask bi-level positive airway pressure ventilation (BiPAP) combined with methylprednisolone treatment, patients in control groups were given routine face mask combined with methylprednisolone treatment. Respiratory rate observed before and after respiratory rate (RR), heart rate (HR), arterial oxygen tension (PaO2) and arterial carbon dioxide tension (PaCO2), chest CT changes and improvements in clinical symptoms. [Results] The treatment group respiratory rate (RR), heart rate (HR), arterial oxygen tension (PaO2), chest CT changes and clinical symptoms improved significantly better than the control group (P<0.05). [Conclusion] Noninvasive nasal (facial) mask bi-level positive airway pressure ventilation (BiPAP) treatment of toxic pulmonary edema of chemical gas results were satisfactory.%[目的]探讨元创性鼻(面)罩双水平气道正压通气(BiPAP)治疗化学气体中毒性肺水肿的疗效.[方法]对48例化学气体中毒导致肺水肿的患者随机分为两组,治疗组(23例)予以无创性鼻(面)罩双水平气道正压通气(BiPAP)联合甲强龙治疗,对照组(25例)予以常规面罩吸氧联合甲强龙治疗.观察通气前后呼吸频率(RR)、心率(HR)、氧分压(PaO2)及二氧化碳(PaCO2)、胸部CT变化及临床症状的改善情况.[结果]治疗组呼吸频率(RR)、心率(HR)、氧分压(PaO2)胸部CT变化及临床症状的改善明显优于对照组(P<0.05)[结论]无创性鼻(面)罩双水平气道正压通气(BiPAP)治疗化学气体中毒性肺水肿疗效满意.

  19. 机械通气治疗113例ICU重症肺心病呼吸衰竭的分析%Analysis of Mechanical Ventilation Therapy of 113 Cases of ICU Severe Pulmonary Heart Disease Patients with Respiratory Failure

    Institute of Scientific and Technical Information of China (English)

    陈光梅

    2016-01-01

    目的:探讨机械通气法治疗重症肺心病呼吸衰竭的临床效果。方法选取收治的113例重症肺心病呼吸衰竭患者使用机械通气法对患者进行治疗,比较患者治疗前后呼吸频率和血气分析指标:动脉血氧分压(PaO2)和动脉血二氧化碳分压(PaCO2)变化。结果患者治疗前后的呼吸频率和PaO2、PaCO2均有明显变化,差异具有统计学意义(P<0.05)。结论使用机械通气法治疗重症肺心病呼吸衰竭可以有效改善患者呼吸衰竭的症状,提高患者的成活率,值得在临床应用中进行推广。%Objective To explore the effect of mechanical ventilation therapy of severe pulmonary heart disease with respiratory failure.Methods 113 cases of severe pulmonary heart disease with respiratory failure were selected retrospectively for the study, who were treated with mechanical ventilation method. Respiratory rate and blood gas analysis indicators including changes of arterial oxygen tension (PaO2) and arterial carbon dioxide tension (PaCO2) of patients before and after treatment were compared.Results The respiratory rate, PaO2, and PaCO2 of patients before and after treatment changed signiifcantly, the differences were statistically signiifcant (P<0.05).Conclusion The use of mechanical ventilation method of severe pulmonary heart disease with respiratory failure can improve respiratory failure symptoms and survival rate of patients, which is worth promoting in clinical applications.

  20. Ventilation Effectiveness

    DEFF Research Database (Denmark)

    Mundt, M.; Mathisen, H. M.; Moser, M.;

    Improving the ventilation effectiveness allows the indoor air quality to be significantly enhanced without the need for higher air changes in the building, thereby avoiding the higher costs and energy consumption associated with increasing the ventilation rates. This Guidebook provides easy...

  1. Hypoxic pulmonary vasodilation: a paradigm shift with a hydrogen sulfide mechanism

    National Research Council Canada - National Science Library

    Kenneth R. Olson; Nathan L. Whitfield; Shawn E. Bearden; Judy St. Leger; Erika Nilson; Yan Gao; Jane A. Madden

    2010-01-01

    Hypoxic pulmonary vasoconstriction (HVC), an intrinsic and assumed ubiquitous response of mammalian pulmonary blood vessels, matches regional ventilation to perfusion via an unknown O2-sensing mechanism...

  2. 体外循环中肺动脉灌注和间断肺通气的肺保护作用%Protective effects of pulmonary artery perfusion and intermittent ventilation on lung during cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    任王胜; 吴延虎; 王晓伟; 刘翔; 梁永年; 朱锦富

    2011-01-01

    Objective:To explore the protective effects of comprehensive measures,including pulmonary artery perfusion with 4℃ oxygenated blood and intermittent ventilation on lung during CPB. Methods:Thirty patients with rheumatic heart disease (RHD) or congenital heart defect (CHD) were divided into two groups with random dumber table: protective group (n =15), given simultaneously intermittent ventilation and pulmonary artery perfusion with 4℃ oxygenated blood on lung during CPB; control group (n =15) , performed using routine approaches. Mechanical ventilation time was recorded, the lung oxygenate index (OI), respiratory index (RI), airway resistance(Raw) and lung static compliance (Cstat) were detected at the beginning, ending, 1 h and 6 h after CPB termination, respectively. Results:The time of mechanical ventilation was significantly shorter in protective group than in the control group. The OI and Cstat of protective group at 1 h and 6 h after CPB termination was significantly better than that of the control group (P<0.05, P<0.01, respectively); the Raw and RI of protective group was significantly lower than that of control group at 1 h and 6 h (P<0.05, P<0.01, respectively). Conclusion Comprehensive measures, pulmonary artery perfusion with 4℃ oxygenated blood and intermittent ventilation, has protective effects on lung injury during CPB.%目的:探讨肺动脉灌注4℃含氧冷血和间断肺通气对体外循环(cardiopulmonary bypass,CPB)肺损伤的保护作用.方法:将30例符合条件的心脏手术患者采用随机数字表法分为两组:肺保护组(n=15):CPB期间经肺动脉间断灌注4℃含氧冷血,并在灌注期间给予间断肺通气;对照组(n=15):常规行心脏手术.记录呼吸机支持时间;分别在CPB前和CPB结束及结束后1、6 h测算氧合指数(0I)、呼吸指数(RI)、肺气道阻力(Raw)和肺静态顺应性(Cstat).结果:术后肺保护组呼吸机支持时间明显短于对照组(P<0.05),

  3. 氦-氧混合气降低气道阻力和提高肺有效通气的实验研究%The experimental studies of Heliox decreasing air way resistance and improving pulmonary effective ventilation

    Institute of Scientific and Technical Information of China (English)

    解立新; 刘又宁; 马迎民

    2003-01-01

    AIM: The study evaluated the effects of breathing helium-oxygen(79% helioxand 21% oxygen) on respiratory insufficiency by way of experimental andclinical observations. METHODS: Six mongrel dogs were randomly inspiredair or heiox after dripping 2% methacholine in tracheas controlled by 900Cventilator. During the experimental course, respiratory mechanical limits,hemodynamic index and blood gas values were observed. Six ventilated pa-tients with COPD in the respiratory intensive care unit inspired heliox, and thedata of respiratory mechanics were recorded. RESULTS: The results demon-strate that heliox can reduce airway resistance, airway pressure, and work ofbreathing, improve lung effective compliance, but heliox has no side effects onpulmonary circulation and systemic circulation. Heliox improves oxygen dif-fusion and CO2 climinating. CONCLUSION: Breathing heliox is one of theeffective ways for patients with severe obstructive pulmonary diseases.

  4. Plasma-derived human antithrombin attenuates ventilator-induced coagulopathy but not inflammation in a Streptococcus pneumoniae pneumonia model in rats.

    NARCIS (Netherlands)

    Aslami, H.; Haitsma, J.J.; Hofstra, J.J.; Florquin, S.; Santos, C. dos; Streutker, C.; Zhang, H.; Levi, M.; Slutsky, A.S.; Schultz, M.J.

    2012-01-01

    BACKGROUND: Mechanical ventilation exaggerates pneumonia-associated pulmonary coagulopathy and inflammation. We hypothesized that the administration of plasma-derived human antithrombin (AT), one of the natural inhibitors of coagulation, prevents ventilator-induced pulmonary coagulopathy,

  5. Plasma-derived human antithrombin attenuates ventilator-induced coagulopathy but not inflammation in a Streptococcus pneumoniae pneumonia model in rats.

    NARCIS (Netherlands)

    Aslami, H.; Haitsma, J.J.; Hofstra, J.J.; Florquin, S.; Santos, C. dos; Streutker, C.; Zhang, H.; Levi, M.; Slutsky, A.S.; Schultz, M.J.

    2012-01-01

    BACKGROUND: Mechanical ventilation exaggerates pneumonia-associated pulmonary coagulopathy and inflammation. We hypothesized that the administration of plasma-derived human antithrombin (AT), one of the natural inhibitors of coagulation, prevents ventilator-induced pulmonary coagulopathy, inflammati

  6. 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.

  7. Handbook of pulmonary emergencies

    Energy Technology Data Exchange (ETDEWEB)

    Spaquolo, S.V.; Medinger, A

    1986-01-01

    This book presents information on the following topics: clinical assessment of the patient with pulmonary disease; interpretation of arterial blood gases in the emergency patient; life-threatening pneumonia; extrapulmonic ventilatory failure; acute inhalation lung disease; pulmonary edema; near drowning; chest trauma; upper airway emergencies; chronic lung disease with acute respiratory decompensation; acute respiratory failure in the patient with chronic airflow obstruction; asthma; hemoptysis; embolic pulmonary disease; superior vena cava syndrome; catastrophic pleural disease; ventilatory assistance and its complications; and ventilator emergencies.

  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. Ventilative Cooling

    DEFF Research Database (Denmark)

    Heiselberg, Per Kvols; Kolokotroni, Maria

    This report, by venticool, summarises the outcome of the work of the initial working phase of IEA ECB Annex 62 Ventilative Cooling and is based on the findings in the participating countries. It presents a summary of the first official Annex 62 report that describes the state-of-the-art of ventil......This report, by venticool, summarises the outcome of the work of the initial working phase of IEA ECB Annex 62 Ventilative Cooling and is based on the findings in the participating countries. It presents a summary of the first official Annex 62 report that describes the state...

  10. Efficacy of intermittent ventilation performed in lungs on operated side for prevention of reexpansion pulmonary edema after pulmonary resection%术侧肺间断机械通气对肺切除术后病人复张性肺水肿的预防效果

    Institute of Scientific and Technical Information of China (English)

    张伟; 张加强; 孟凡民

    2015-01-01

    目的 评价术侧肺间断机械通气对肺切除术后病人复张性肺水肿的预防效果.方法 择期胸腔镜辅助下行肺切除术病人40例,性别不限,年龄16~32岁,体重指数18~ 25 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为2组(n=20):对照组(C组)和术侧肺间断机械通气组(Ⅴ组).麻醉诱导后行气管插管,机械通气,采用纤维支气管镜定位准确后即改为单肺通气.C组术中常规单肺通气;Ⅴ组单肺通气期间对术侧肺行间断机械通气,潮气量2 ml/kg,通气频率20次/min,通气30 s后停止,支气管导管开口于大气中,10 min后重复上述操作,直至病变组织切除完毕.于病变组织取出后取其周边正常肺组织,检测肺组织水通道蛋白1(AQP-1)和AQP-5的表达水平;记录术后24 h内肺不张、低氧血症和复张性肺水肿的发生情况.结果 与C组比较,Ⅴ组肺组织AQP-1和AQP-5表达上调,术后24 h内肺不张和复张性肺水肿的发生率降低(P<0.05),低氧血症发生率差异无统计学意义(P>0.05).结论 肺切除术病人单肺通气期间,术侧肺行间断机械通气可有效地预防术后复张性肺水肿的发生.%Objective To evaluate the efficacy of intermittent ventilation performed in lungs on the operated side for prevention of reexpansion pulmonary edema after pulmonary resection.Methods Forty patients of both sexes,aged 16-32 yr,with body mass index of 18-25 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective thoracoscope-assisted pulmonary resection,were randomly divided into 2 groups (n =20 each) using a random number table:control group (group C) and intermittent ventilation performed in lungs on the operated side group (group Ⅴ).After induction of anesthesia,the patients were tracheally intubated and mechanically ventilated.After correct positioning was confirmed by fiberoptic bronchoscopy,one-lung ventilation was performed instead.One-lung ventilation was performed routinely in

  11. Ventilation Model

    Energy Technology Data Exchange (ETDEWEB)

    V. Chipman

    2002-10-05

    The purpose of the Ventilation Model is to simulate the heat transfer processes in and around waste emplacement drifts during periods of forced ventilation. The model evaluates the effects of emplacement drift ventilation on the thermal conditions in the emplacement drifts and surrounding rock mass, and calculates the heat removal by ventilation as a measure of the viability of ventilation to delay the onset of peak repository temperature and reduce its magnitude. The heat removal by ventilation is temporally and spatially dependent, and is expressed as the fraction of heat carried away by the ventilation air compared to the fraction of heat produced by radionuclide decay. One minus the heat removal is called the wall heat fraction, or the remaining amount of heat that is transferred via conduction to the surrounding rock mass. Downstream models, such as the ''Multiscale Thermohydrologic Model'' (BSC 2001), use the wall heat fractions as outputted from the Ventilation Model to initialize their post-closure analyses. The Ventilation Model report was initially developed to analyze the effects of preclosure continuous ventilation in the Engineered Barrier System (EBS) emplacement drifts, and to provide heat removal data to support EBS design. Revision 00 of the Ventilation Model included documentation of the modeling results from the ANSYS-based heat transfer model. The purposes of Revision 01 of the Ventilation Model are: (1) To validate the conceptual model for preclosure ventilation of emplacement drifts and verify its numerical application in accordance with new procedural requirements as outlined in AP-SIII-10Q, Models (Section 7.0). (2) To satisfy technical issues posed in KTI agreement RDTME 3.14 (Reamer and Williams 2001a). Specifically to demonstrate, with respect to the ANSYS ventilation model, the adequacy of the discretization (Section 6.2.3.1), and the downstream applicability of the model results (i.e. wall heat fractions) to

  12. VEGF Production by Ly6C+high Monocytes Contributes to Ventilator-Induced Lung Injury

    National Research Council Canada - National Science Library

    Shi, Chung-Sheng; Huang, Tzu-Hsiung; Lin, Chin-Kuo; Li, Jhy-Ming; Chen, Mei-Hsin; Tsai, Mei-Ling; Chang, Chih-Ching

    2016-01-01

      Background Mechanical ventilation is a life-saving procedure for patients with acute respiratory failure, although it may cause pulmonary vascular inflammation and leakage, leading to ventilator-induced lung injury (VILI). Ly6C...

  13. Clinical efficacy observation of noninvasive positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema%无创正压通气治疗急性心源性肺水肿的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    陈占伟

    2014-01-01

    目的:观察无创正压通气( NPPV)治疗急性心源性肺水肿的临床疗效。方法对48例急性心源性肺水肿引起的急性呼吸衰竭患者行NPPV,观察治疗期间心率和经皮血氧饱和度的变化,比较治疗前及治疗后2 h血气情况。结果急性心源性肺水肿患者治疗后2h缺氧症状得到明显改善,心悸、呼吸困难及紫绀明显好转,心功能评级明显降低(P﹤0.01)。结论对急性心源性肺水肿引起的急性呼吸衰竭行NPPV疗效显著,具有良好的临床实用价值,值得推广。%Objective To observe the clinical effect of noninvasive positive pressure ventilation( NPPV)on acute cardiogenic pulmonary edema. Methods Forty-eight patients with acute respiratory failure due to acute cardiogenic pulmonary edema were treated by NPPV. The variation of heart rate and percutaneous oxygen saturation were observed. The blood gas analysis was com-pared before treatment and 2 hours after treatment. Results The symptoms of the patients were significantly alleviated including hypoxia,heart palpitations,breathing difficulties and cyanosis,and the NYHA decreased significantly( P﹤0. 01 ). Conclusion NPPV has therapeutic advantages and significant effect in the treatment of acute respiratory failure due to acute cardiogenic pul-monary edema. It is of certain clinical value and is worth popularizing.

  14. Ventilação mecânica na doença pulmonar obstrutiva crônica Mechanical ventilation in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Sérgio Jezler

    2007-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Em 2000, foi publicado o II Consenso Brasileiro de Ventilação Mecânica. Desde então, o conhecimento na área da ventilação mecânica avançou rapidamente, com a publicação de numerosos estudos clínicos que acrescentaram informações importantes para o manejo de pacientes críticos em ventilação artificial. Além disso, a expansão do conceito de Medicina Baseada em Evidências determinou a hierarquização das recomendações clínicas, segundo o rigor metodológico dos estudos que as embasaram. Essa abordagem explícita vem ampliando a compreensão e a aplicação das recomendações clínicas. Por esses motivos, a AMIB - Associação de Medicina Intensiva Brasileira - e a SBPT - Sociedade Brasileira de Pneumologia e Tisiologia - julgaram conveniente a atualização das recomendações descritas no Consenso anterior. Dentre os tópicos selecionados a Ventilação Mecânica na Agudização da DPOC foi um dos temas propostos. O objetivo deste estudo foi descrever os pontos mais importantes relacionados à ventilação mecânica durante a agudização da doença pulmonar obstrutiva crônica (DPOC e sugerir as principais abordagens terapêuticas. MÉTODO: Objetivou-se chegar a um documento suficientemente sintético, que refletisse a melhor evidência disponível na literatura. A revisão bibliográfica baseou-se na busca de estudos através de palavras-chave e em sua gradação conforme níveis de evidência. As palavras-chave utilizadas para a busca foram: ventilação mecânica na DPOC: COPD and mechanical ventilation. RESULTADOS: São apresentadas recomendações quanto aos modos ventilatórios e aos parâmetros a serem aplicados quando do ajuste do ventilador, além da monitoração recomendada. Apresentam-se ainda, técnicas alternativas que possam ser utilizadas. CONCLUSÕES: Estratégias protetoras de ventilação mecânica são recomendadas durante a ventilação mecânica de um paciente DPOC

  15. Severe but not mild hypercapnia affects the outcome in patients with severe cardiogenic pulmonary edema treated by non-invasive ventilation

    OpenAIRE

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

    2015-01-01

    Background Patients with severe cardiogenic pulmonary edema (CPE) are frequently hypercapnic, possibly because of associated underlying chronic lung disease (CLD). Since hypercapnia has been associated with outcome, we aimed to identify factors associated to hypercapnia and its role on outcome of patients with CPE and no underlying CLD. Methods Observational cohort study using data prospectively collected over a 3-year period. After excluding patients with any CLD or obstructive sleep apneas,...

  16. 综合肺部物理治疗在成人机械通气中对预后的影响%Effect of comprehensive pulmonary physical therapy on the prognosis in adult mechanical ventilation

    Institute of Scientific and Technical Information of China (English)

    齐心

    2012-01-01

    Objective To analyze the method of bedside pulmonary physical therapy in mechanically ventilated patients to reduce ventilator-associated complications, and improve the prognosis. Methods 58 patients were randomly divided into two groups, an experiment group and a control group. The experiment group was given a comprehensive chest physical therapy while the control group was only given ordinary chest physical therapy. A comparison was made between the two groups on ventilation associated pneumonia (VAP) incidence, as well as the prognostic difference. Results There is no significant difference between the two groups in general clinical data. It reflected 22.22% (6 cases) VAP incidence in the experiment group and 48.39% (15cases) in the control group with duration of mechanical ventilation of 9.7+8.3 days, and 16.51 + 14.4 days, respectively, with a statistical difference between the two groups. There was also a statistical difference on mortality between the two groups (P0.05). Conclusion Bedside pulmonary physical therapy may effectively reduce VAP incidence and mortality and improve the prognosis, on the other hand.%目的 总结床边行肺部物理治疗对长时间机械通气患者的分泌物排出,增加肺廓清功能,从而减少呼吸机相关并发症,改善预后的作用.方法 将入选的58例患者随机分为试验组,对照组两组,试验组患者在机械通气期间给予综合胸部物理治疗,对照组则仅给予ICU常规胸部物理治疗即翻身、扣背、吸痰.比较两组之间呼吸机相关肺炎发生率,以及预后的差异.结果 两组之间一般临床资料无显著性差异.治疗组VAP发生率22.22%(6例),对照组VAP发生率48.39%(15例).机械通气时间分别为(9.7±8.3)d和(16.51±14.4)d.两组间差异有统计学意义.两组之间死亡率差异有统计学意义(P0.05).结论 保证质量的床边肺部理疗,能够有效降低VAP发生率和死亡率,改善预后.

  17. Comparison of the pulmonary dead-space fraction derived from ventilator volumetric capnography and a validated equation in the survival prediction of patients with acute respiratory distress syndrome

    Institute of Scientific and Technical Information of China (English)

    Yu-Jiao Zhang; Xin-Jing Gao; Zhi-Bo Li; Zhi-Yong Wang; Quan-Sheng Feng; Cheng-Fen Yin; Xing Lu

    2016-01-01

    Purpose:This prospective observational study aims to evaluate the accuracy of dead-space fraction derived from the ventilator volumetric capnography (volumetric CO2) or a prediction equation to predict the survival of mechanically ventilated patients with acute respiratory distress syndrome (ARDS).Methods:Consecutive VD/VT measurements were obtained based upon a prediction equation validated by Frankenfield et al for dead-space ventilation fraction:VD/VT 0.320 + 0.0106 (PaCO2-ETCO2) + 0.003 (RR) + 0.0015 (age) in adult patients who had infection-related severe pneumonia and were confirmed as having ARDS.Here PaCO2 is the arterial partial pressure of carbon dioxide in mmHg;ETCO2,the endtidal carbon dioxide measurement in mmHg;RR,respiratory rate per minute;and age in years.Once the patient had intubation,positive end expiratory pressure was adjusted and after Phigh reached a steady state,VD/VT was measured and recorded as the data for the first day.VD/VT measurement was repeated on days 2,3,4,5 and 6.Meanwhile we collected dead-space fraction directly from the ventilator volumetric CO2 and recorded it as Vd/Vt.We analyzed the changes in VD/VT and Vd/Vt over the 6-day period to determine their accuracy in predicting the survival of ARDS patients.Results:Overall,46 patients with ARDS met the inclusion criteria and 24 of them died.During the first 6 days of intubation,VD/VT was significantly higher in nonsurvivors on day 4 (0.70 ± 0.01 vs 0.57 ± 0.01),day 5 (0.73 ± 0.01 vs.0.54 ± 0.01).and day 6 (0.73 ± 0.02 vs.0.54 ± 0.01) (all p =0.000).Vd/Vt showed no significant difference on days 1-4 but it was much higher in nonsurvivors on day 5 (0.45 ± 0.04 vs.0.41 ± 0.06) and day 6 (0.47 ± 0.05 vs.0.40 ± 0.03) (both p =0.008).VD/VT on the fourth day was more accurate to predict survival than Vd/Vt.The area under the receiver-operating characteristic curve for VD/VT and Vd/Vt in evaluating ARDS patients survival was day 4 (0.974 ± 0.093 vs.0.701 ± 0.023,p 0

  18. Effect of penehyclidine hydrochloride pretreatment on pulmonary function during mechanical ventilation in patients with chronic obstructive pulmonary disease undergoing non-thoracotomy%盐酸戊乙奎醚预先给药对COPD患者非开胸手术机械通气期间肺功能的影响

    Institute of Scientific and Technical Information of China (English)

    陈志远; 吴健华; 许小婷; 王玉珍; 李岩

    2014-01-01

    Objective To evaluate the effect of penehyclidine hydrochloride pretreatment on pulmonary function during mechanical ventilation in the patients with chronic obstructive pulmonary disease (COPD) undergoing non-thoracotomy.Methods Sixty patients with COPD,aged 58-82 yr,weighing 45-76 kg,of ASA physical status Ⅱ or Ⅲ,scheduled for elective non-thoracotomy under general anesthesia,were randomly divided into Ⅰ,Ⅱ and Ⅲ groups (n =20 each) using a random number table.Anesthesia was induced with iv midazolam,sufentanil,cisatracurium and propofol.The patients were endotracheally intubated and mechanically ventilated.At 30 min before endotracheal intubation,normal saline 5 ml (group Ⅰ),penehyclidine hydrochloride 0.01 mg/kg (group Ⅱ) or penehyclidine hydrochloride 0.02 mg/kg (group Ⅲ) was injected intravenously.At 30,60 and 120 min of ventilation,airway peak pressure (Ppeak),airway plateau pressure (Pplat),airway resistance (Raw) and dynamic lung compliance (Cdyn) were recorded.At 120 min of ventilation,arterial blood samples were obtained for blood gas analysis and oxygenation index (OI),respiratory index (RI),physiologic dead space fraction (VD/VT) and alveolar-arterial oxygen gradient (A-aDO2) were calculated.At 30 min before ventilation and 120 min of ventilation,blood samples were drawn from the radial artery for determination of the serum concentrations of TNF-α,IL-8 and IL-10 by ELISA.The extubation time and pulmonary complications within 72 h after operation were recorded.Results Compared with group Ⅰ,Ppeak,Pplat,Raw,RI,VD/VT and A-aDO2 were significantly decreased,Cdyn and OI were increased,the serum TNF-α,IL-8 and IL-10 concentrations and incidence of pulmonary complications were decreased,and no significant change was found in the extubation time in Ⅱ and Ⅲ groups.There were no significant differences in the parameters mentioned above between group Ⅱ and group Ⅲ.Conclusion Penehyclidine hydrochloride pretreatment can reduce the

  19. The treatment application of acute cardiogenic pulmonary edema with BiPAP noninvasive positive air pressure ventilation%BiPAP无创通气在急性心源性肺水肿救治中的应用

    Institute of Scientific and Technical Information of China (English)

    黄玉蓉; 王晓园; 张海涛; 李玮; 白会云

    2012-01-01

    目的 探讨双水平正压无创机械通气在救治急性心源性肺水肿患者中的疗效.方法 将我科收治的59例急性心源性肺水肿患者随机分为两组:在常规利尿、扩血管、强心和镇静治疗的基础上,治疗组26例经BiPAP无创通气治疗;而对照组33例则给予高浓度面罩吸氧,观察两组治疗前后心率、呼吸频率、血气分析指标及临床征象的变化,评价治疗效果.结果 治疗组无创正压通气2 h后患者心率(HR)、呼吸频率(RR)明显减慢(P<0.05),收缩压(ABP)及舒张压(DBP)明显下降(P<0.01),血氧饱和度(SaO2)明显升高(P<0.01).结论 BiPAP无创通气治疗急性心源性肺水肿起效快,能明显改善低氧血症,是抢救急性心源性肺水肿的重要方法之一,值得临床推广.%Objective To evaluate the effects of BiPAP noninvasive positive ah- pressure ventilation on acute cardiogenic pulmo nary edema. Methods Fifty-nine patients with acute cardiogenic pulmonary edema were randomly divided into two groups: 26 patients in treatment group received BiPAP, while 33 patients in control groups had high concentration oxygen mask. All the patients received conven tional treatments including diuresis, cardiac stimulant, and sedation. Results Two hours after BiPAP, the patients' heart rate and breathing rate slowed down obviously ( P<0.05 ), and their systolic pressure and diastolic pressure declined dearly ( P <0. 01 ). Be sides , the oxygen saturation of blood rose obviously ( P < 0. 01 ). Conclusion BiPAP noninvasive positive air pressure ventilation can im prove meionectic blood better and take into effect quickly. Therefore it is an important means to rescue acute pulmonary edema and wouth to popularize.

  20. In the Absence of the Effect of Nursing Intervention on Invasive Ventilation in the Treatment of Acute Cardiogenic Pulmonary Edema%急性心源性肺水肿在无创呼吸机治疗中的护理干预及效果

    Institute of Scientific and Technical Information of China (English)

    努日古力·阿布都瓦依提; 余世勤

    2014-01-01

    Objective:To investigate the nursing methods and curative effect of noninvasive ventilation in the treatment of acute cardiogenic pulmonary edema.Method:60 cases of patients with acute cardiogenic pulmonary edema were treated in author’s hospital,early application of noninvasive ventilator,and nursing intervention measures professional,observation and nursing effect of patients.Result:This group of 60 cases of patients wereimproved,no complications, satisfactory effect.Conclusion:Early application of noninvasive ventilator in the treatment of patients with acute cardiogenic pulmonary edema ventilation,can effectively improve the hypoxemia;at the same time,effective intervention measures to become an important guarantee for noninvasive ventilator therapy.%目的:探讨无创呼吸机治疗急性心源性肺水肿的护理干预方法及疗效。方法:选取笔者所在医院收治的60例急性心源性肺水肿患者,早期均应用无创呼吸机治疗,并配合专业的护理干预措施,观察患者护理效果。结果:本组60例患者病情均好转,无并发症发生,取得满意疗效。结论:早期应用无创呼吸机对急性心源性肺水肿患者通气治疗,能够有效改善患者的低氧血症;同时有效的护理干预措施成为无创呼吸机治疗的重要保证。

  1. 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.

  2. Clinical analysis of mechanical ventilation of tracheotomy treatment of multiple trauma combined pulmonary contusion%气管切开机械通气治疗多发伤合并肺挫伤临床分析

    Institute of Scientific and Technical Information of China (English)

    刘杉; 陈勇; 胡宝森

    2015-01-01

    Objective To analyze the clinical effect of mechanical ventilation of tracheotomy treatment of multiple trauma with pulmonary contusion.Methods 68 patients with multiple trauma combined pulmonary contusion in 500 patients with multiple trauma,who were selected as the research objects in our hospital from December 1995 to December 2010,were divided into tracheotomy group and non-tracheotomied group,with 34 cases in each group.To monitor the dynamic change of the patients regained consciousness,the subjective symptom,the vital signs of heart rate,rhythm,hematoid saturation,and blood pressure,the blood gas analysis,the oxygen index,and the X-ray appeara. To record all the research objects of the damage location,the injury severity score(ISS) which was the square sum of Indian physic AIS score as the evaluation standard of Abbreviated Injury Scale(AIS-90),the average using time of ventilator,the ICU monitoring time,the mortality within 1 month postoperative. Results The difference of damage location before operation in tracheotomy group compared with which in non-tracheotomied group was no statistical significance(P>0.05).The average using time of ventilator,the ICU monitoring time in tracheotomy group were shorter than which in non-tracheotomied group,the mortality within 1 month in tracheotomy group was less than which in non-tracheotomied group,the differences were statistical significance(P<0.05).ConclusionMultiple trauma combined pulmonary contusion has the complexity of treatment,has less attention to pulmonary contusion to delay the disease,should be treated with tracheotomy early,has significant effect to prevent ARDS,could improve ventilation,prevent atelectasis,eliminate secretion of small airway,prevent pulmonary infection.%目的:分析气管切开机械通气治疗多发伤合并肺挫伤临床疗效。方法1995年12月~2010年12月我院共收治多发伤500余例,选取68例合并肺挫伤病例作为研究对象,分为气管切开组(34

  3. 随即法V/Q 显像诊断肺动脉栓塞的临床价值%The clinical value of lung ventilation/perfusion imaging successively in diagnosis of pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    张国旭; 郝珊瑚; 王治国; 郭佳; 张彤; 张文文; 陈兰兰

    2011-01-01

    Objective To investigate the clinical value of lung ventilation /perfusion(V/Q) imaging successively in diagnosis of pulmonary embolism (PE). Methods 103 and 107 patients random selected with suspected PE underwent V/Q imaging in successive (the perfusion imaging was performed after the ventilation imaging immediately ) and distance ( the ventilation and perfusion imaging was performed independently in the morning and afternoon or during tow days immediately ) method respectively. The differences in sensitivity and specificity were compared in the diagnosis of PE . Results The sensitivity and specificity were 96. 70% , 94. 79% ( P > 0. 05 ) with successive method and 75. 00% ,72. 72% ( P > 0. 05 ) with distance method. Conclusions There's no obvious difference in diagnosis of PE using successive and distance V/Q imaging. Advantage: The successive V/Q imaging could decurtate the visit time obviously , which is much more important for the diagnosis of acute PE. Shortage: The successive method requested major drug consumption.%目的 探讨随即法V/Q 显像诊断肺动脉栓塞的临床价值.方法 分别随机选择103 例和107 例可疑肺动脉栓塞患者,分别行随即法V/Q 显像(通气显像结束后立即行血流灌注显像)和间隔法V/Q 显像(上下午分别行通气和灌注显像或隔日行通气和灌注显像),比较两种方法的诊断肺动脉栓塞灵敏度和特异性的差异.结果 随即法V/Q 显像和间隔法V/Q 显像诊断肺动脉栓塞灵敏度和特异性分别为96.70%、94.79%(P >0.05)和75.00%、72.72%(P >0.05).结论 随即法V/Q 显像和间隔法V/Q 显像诊断肺动脉栓塞的临床价值无统计学差异,随即法V/Q 显像可明显缩短就诊时间,对急性肺动脉栓塞的诊断具有重要意义,但用药量偏大.

  4. Clinical efficacy of preferred use of high-frequency oscillatory ventilation in treatment of neonatal pulmonary hemorrhage%首选使用高频振荡通气治疗新生儿肺出血的临床效果分析

    Institute of Scientific and Technical Information of China (English)

    王华; 杜立中; 唐军; 伍金林; 母得志

    2015-01-01

    ObjectiveTo investigate the clinical efifcacy and safety of preferred use of high-frequency oscillatory ventilation (HFOV) in the treatment of neonatal pulmonary hemorrhage.MethodsThe clinical efifcacy of preferred use of HFOV (preferred use group) and rescue use of HFOV after conventional mechanical ventilation proved ineffective (rescue use group) in the treatment of 26 cases of neonatal pulmonary hemorrhage was retrospectively analyzed. The oxygenation index (OI), pulmonary hemorrhage time, hospitalization time, ventilation time, oxygen therapy time, complications, and outcome of the two groups were compared.ResultsCompared with the rescue use group, the preferred use group had signiifcantly lower IO values at 1, 6, 12, 24, 48, and 72 hours after treatment (P0.05). Compared with those in the rescue use group, children who survived in the preferred use group had signiifcantly shorter pulmonary hemorrhage time, hospitalization time, ventilation time, and oxygen therapy time (P0.05)。存活患儿中,首选组在肺出血时间、住院时间、上机时间、氧疗时间上较解救组明显缩短(P<0.05)。结论与解救组相比,首选HFOV较解救性使用HFOV能更好地改善肺出血患儿氧合功能,降低VAP的发生率,缩短病程,提高治愈率,且未增加不良反应的发生率。

  5. 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...

  6. Personalized ventilation

    DEFF Research Database (Denmark)

    Melikov, Arsen Krikor

    2004-01-01

    existing knowledge on performance of personalized ventilation (PV) and on human response to it. The airflow interaction in the vicinity of the human body is analyzed and its impact on thermal comfort and inhaled air quality is discussed together with control strategies and the application of PV in practice...

  7. Displacement Ventilation

    DEFF Research Database (Denmark)

    Bjørn, Erik; Mattsson, Magnus; Sandberg, Mats

    Full-scale experiments were made in a displacement ventilated room with two breathing thermal manikins to study the effect of movements and breathing on the vertical contaminant distribution, and on the personal exposure of occupants. Concentrations were measured with tracer gas equipment...

  8. Mixing Ventilation

    DEFF Research Database (Denmark)

    Kandzia, Claudia; Kosonen, Risto; Melikov, Arsen Krikor;

    In this guidebook most of the known and used in practice methods for achieving mixing air distribution are discussed. Mixing ventilation has been applied to many different spaces providing fresh air and thermal comfort to the occupants. Today, a design engineer can choose from large selection of ...

  9. MR pulmonary ventilation information of canines inhaling aerosolized gadolinium-DTPA%应用雾化Gd DTPA获得犬肺通气信息

    Institute of Scientific and Technical Information of China (English)

    郭佑民; 吴晓明; 杨健; 王建国; 雷晓燕

    2003-01-01

    AIM:To investigate the effect of inhaling aerosolized gadolinium DTPA (Gd-DTPA) on pulmonary MR imaging in canines. METHODS:Six healthy northern dogs were performed MR scanning by using single shot turbo spin echo sequence.The changes of signal intensity (SI) in pulmonary parenchyma were respectively measured after inhaling air gas,aerosolized sodium chloride and Gd-DTPA as contrast agents.The differences of SI were compared between them. RESULTS:The SI of pulmonary parenchyma increased by 11.5%- 25.8% after inhalation of aerosolized sodium chloride solution, with no statistic difference compared to inhalation of air(t=2.798,P >0.05). Whereas the SI after inhalation of aerosolized Gd DTPA increased much higher by 42.7%- 76.8% than that after inhalation of air and aerosolized sodium chloride solution(t=4.660, P0.05);吸入 Gd-DTPA雾化颗粒后肺实质信号强度明显增加,增强幅度 42.7~ 76.8%,平均 59.2%,与吸入空气时的信号强度相比有统计学差异 (t=4.660,P< 0.05). 结论 :雾化的 Gd-DTPA可以作为一种有效的肺部 MRI增强对比剂,应用雾化 Gd DTPA来获得大型实验动物的有关肺通气信息是可行的.

  10. 早期机械通气治疗连枷胸并发急性肺挫伤的疗效评价%Evaluation of the effect of early mechanical ventilation in the treatment of flail chest complicated with acute pulmonary contusion

    Institute of Scientific and Technical Information of China (English)

    严四军; 邓波荣; 刘燕; 曹祥; 黄洁健; 乔德成

    2011-01-01

    Objective:To investigate the therapeutic efficacy of mechanical ventilation in the treatment of ilail chest complicated with acute pulmonary contusion. Method:The data of 51 cases suffered of flail chest complicated with acute pulmonary contusion in our hospital from March 2001 to February 2010 were retrospectively analyzed.According to the starting time of mechanical ventilation, the patients were divided into two groups: the early mechanical ventilation group (n = 32) and the later mechanical ventilation group (n = 19). The parameters of blood gas,time of mechanical ventilation, time in intensive care unit(ICU),incidence of complications,and the mortality were compared between the two groups. Result: The degree of respiratory failure of the early mechanical ventilation group was serious than that of the later mechanical ventilation group on admission. However, the degree of respiratory failure of the former was more lightly than that of the latter 24 hours after ventilation(P<0.01). The time of mechanical ventilation and in ICU of the former were obviously shorter than that of the latter,and the incidence of acute respiratory distress syndrome(ARDS) of the former was obviously lower too(P<0.01 ). The incidence of pulmonary infection and multiple organ dysfunction syndrome(MODS) and mortality of the former were lower than those of the latter as well(P<0.05). Conclusion: Early mechanical ventilation on patients suffered from flail chest complicated with acute pulmonary contusion can not only get satisfactory internal fixation but also effectively improve hypoxemia,reduce complications such as ARDS, MODS,shorten the time of mechanical ventilation and the time in ICU,and improve the cure rate.%目的:观察不同时期机械通气对连枷胸并发急性肺挫伤的治疗效果.方法:回顾性分析2001年3月-2010年2月我院收治的51例连枷胸并发肺挫伤患者的临床资料.根据受伤后至实施机械通气的间隔时间分

  11. [Pulmonary strongyloidiasis].

    Science.gov (United States)

    Lozada, Heiler; Daza, Jorge E

    2016-10-01

    Strongyloidiasis is an infection caused by the parasite Strongyloides stercoralis, which can be asymptomatic and means a high morbidity and mortality in immunocompromised hosts, severe malnutrition and coinfection with HTLV-1 virus. The parasite has the potential to produce and multiply internal autoinfection in humans, thus an hyperinfection can be developed. A case of pulmonary infection by this parasite is presented in this study, infection which advanced into a respiratory failure and required mechanical ventilation and hemodynamic support in an intensive care unit. The standard treatment combined with ivermectin and albendazole was provided, achieving an appropriate response.

  12. Methodology for ventilation/perfusion SPECT

    DEFF Research Database (Denmark)

    Bajc, Marika; Neilly, Brian; Miniati, Massimo;

    2010-01-01

    radiolabeled liquid aerosols are not restricted to the presence of obstructive lung disease. Radiolabeled macroaggregated human albumin is the imaging agent of choice for perfusion scintigraphy. An optimal combination of nuclide activities and acquisition times for ventilation and perfusion, collimators......Ventilation/perfusion single-photon emission computed tomography (V/Q SPECT) is the scintigraphic technique of choice for the diagnosis of pulmonary embolism and many other disorders that affect lung function. Data from recent ventilation studies show that the theoretic advantages of Technegas over......, and imaging matrix yields an adequate V/Q SPECT study in approximately 20 minutes of imaging time. The recommended protocol based on the patient remaining in an unchanged position during the initial ventilation study and the perfusion study allows presentation of matching ventilation and perfusion slices...

  13. [Effect of oxygen tubing connection site on percutaneous oxygen partial pressure and percutaneous carbon dioxide partial pressure in patients with chronic obstructive pulmonary disease during noninvasive positive pressure ventilation].

    Science.gov (United States)

    Mi, S; Zhang, L M

    2017-04-12

    Objective: We evaluated the effects of administering oxygen through nasal catheters inside the mask or through the mask on percutaneous oxygen partial pressure (PcO(2))and percutaneous carbon dioxide partial pressure (PcCO(2)) during noninvasive positive pressure ventilation (NPPV) to find a better way of administering oxygen, which could increase PcO(2) by increasing the inspired oxygen concentration. Methods: Ten healthy volunteers and 9 patients with chronic obstructive pulmonary disease complicated by type Ⅱ respiratory failure were included in this study. Oxygen was administered through a nasal catheter inside the mask or through the mask (oxygen flow was 3 and 5 L/min) during NPPV. PcO(2) and PcCO(2) were measured to evaluate the effects of administering oxygen through a nasal catheter inside the mask or through the mask, indirectly reflecting the effects of administering oxygen through nasal catheter inside the mask or through the mask on inspired oxygen concentration. Results: Compared to administering oxygen through the mask during NPPV, elevated PcO(2) was measured in administering oxygen through the nasal catheter inside the mask, and the differences were statistically significant (P0.05). Conclusion: Administering oxygen through a nasal catheter inside the mask during NPPV increased PcO(2) by increasing the inspired oxygen concentration but did not increase PcCO(2). This method of administering oxygen could conserve oxygen and be suitable for family NPPV. Our results also provided theoretical basis for the development of new masks.

  14. Clinical observation on noninvasive positive pressure ventilation in treatment of acute cardiogenic pulmonary edema%无创正压通气治疗急性心源性肺水肿的临床观察

    Institute of Scientific and Technical Information of China (English)

    周永明; 李文强

    2012-01-01

    Objective: To evaluate the effect of noninvasive positive pressure ventilation ( NIPPV) via face mask in treatment of acute cardiogenic pulmonary edema (ACPE). Methods: Fifty-four adult patients with severe acute respiratory failure resulted from cardiogenic pulmonary edema received NIPPV based on conventional treatments consisting of oxygen, nitrates,and diuretics. Patients'arterial blood gas analysis, Borg dyspnea score,vital signs,and requirement for endotracheal intubation (ETI) were observed before and after treatments. Results: Patients'blood pH,PaCO2 ,PaO2 ,SaO2 ,Borg score and respiratory rate were improved significantly after treatment with NIPPV for 60 minutes than those before treatment ( P < 0.05). The symptoms were improved in 49 patients (90.7% ) ,5 patients complicated with severe chronic obstructive pulmonary disease (COPD) and required ETI. No complication occurred in patients with NIPPV. Conclusion; NIPPV can improve hypoxemia rapidly. It is an effective treatment for ACPE and may help to avoid ETI.%目的:评估经面罩压力支持非侵入性正压通气(NIPPV)对急性心源性肺水肿(ACPE)患者的疗效.方法:54例急诊就诊、ACPE所致急性呼吸衰竭需要气管插管的成年患者,除了常规给予持续氧疗、硝酸酯类药物和利尿剂,还应用NIPPV治疗.观察治疗前、后患者动脉血气分析、Borg呼吸困难评分、生命体征和是否需要气管内插管.结果:54例患者NIPPV治疗60 min后的血pH、PaCO2、PaO2、SaO2、Borg评分、呼吸频率较治疗前明显改善(均P <0.05).49例患者(90.7%)症状改善后,停止应用NIPPV,5例合并严重慢性阻塞性肺病(COPD)患者需要气管内插管.NIPPV治疗患者无并发症出现.结论:NIPPV能迅速改善ACPE患者低氧血症,使其避免了气管插管,是抢救ACPE的一种安全有效的方法.

  15. 急救中早期比例辅助通气治疗急性心源性肺水肿的临床效果分析%Early application of assisted ventilation in acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    王元华

    2016-01-01

    目的:探讨急救中早期比例辅助通气治疗急性心源性肺水肿的临床效果。方法:收集2012年5月-2014年5月于我院接受治疗的急性心源性肺水肿患者90例,根据治疗方法分为三组,其中常规治疗患者共27例,作为对照组;常规治疗联合早期比例辅助通气治疗患者31例,作为A组;常规治疗联合双水平正压通气治疗患者32例,作为B组。比较三组患者治疗前后的临床效果。结果:三组患者治疗后PaO2、PaCO2、 SpO2、pH值、呼吸频率、心率明显优于治疗前(P<0.05),且A组、B组患者的PaO2、PaCO2、 SpO2、pH值、呼吸频率、心率优于对照组(P<0.05)。A组患者的舒适度为(3.51±0.55),低于B组的(4.58±0.39)(P<0.05)。A组患者的气压峰值为(10.78±1.12)cm H2O,低于B组的(14.54±1.92)cm H2O(P<0.05)。结论:急救中早期比例辅助通气治疗急性心源性肺水肿的临床效果良好,可改善患者症状,值得临床推广及应用。%Objective: To investigate cffcacy of assisted ventilation on acute cardiogenic pulmonary edema. Methods: 90 patients were divided into three groups; 27 patients were treated by conventional therapy, as the control group; 31 patients received conventional therapy combined with early proportional assist ventilation, as the group A; conventional therapy combined with BiPAP therapy in 32 patients, as the group B. Results: After treatment, PaO2, PaCO2, SpO2, pH value, respiratory rate, heart rate were signiifcantly better than before treatment (P<0.05), and the patients, PaO2, PaCO2, SpO2, pH value, respiratory rate, heart rate in the group A and group B were better than the control group (P<0.05). Conclusion: Clinical effects of assisted ventilation on acute cardiogenic pulmonary edema is good, can improve symptoms, and is worthy of promotion and application.

  16. Reorganisation of acute referral to an emergency department resulted in fewer admissions for chronic obstructive pulmonary disease but in higher rates of non-invasive ventilation

    DEFF Research Database (Denmark)

    Titlestad, Ingrid Louise; Bryde, Jonas; Oberg-Hansen, Bo

    2014-01-01

    .3%) compared with 2010 (36 admissions; 4.5%), but no referrals to the intensive care unit or deaths were registered during the hospitalisation in either of the groups, but one patient died within 30 days after admission from the DEM. FUNDING: This project was funded by an Odense University Hospital research...... medical records were retrieved from two COPD cohorts: 1) all patients admitted to DEM between 1 July and 31 December 2012 and 2) all patients admitted to the Medical Emergency Ward, Odense University Hospital (MEW) in 2010. RESULTS: There were 300 eligible admissions comprising 236 unique patients in DEM......INTRODUCTION: We performed an audit on all admissions with chronic obstructive pulmonary disease (COPD) in ex-acerbation to the Department of Emergency Medicine, Odense University Hospital (DEM) in the second half of 2012 to evaluate if an organisational change had altered visitation, treatment...

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

    Institute of Scientific and Technical Information of China (English)

    喻文亮

    2010-01-01

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

  18. Effects of mechanical ventilation with lower tidal volume and positive end-expiratory pressure on pulmonary function during laparoscopic surgery in patients with chronic obstructive pulmonary disease%低潮气量联合呼气末正压通气对慢性阻塞性肺疾病患者腹腔镜手术时肺功能的影响

    Institute of Scientific and Technical Information of China (English)

    陈志远; 吴健华; 王玉珍; 李岩; 许小婷

    2013-01-01

    Objective To investigate the effects of mechanicl ventilation with lower tidal volume and positive end-expiratory pressure (PEEP) on pulmonary function during laparoscopic surgery in patients with chronic obstructive pulmonary disease (COPD).Methods Forty patients with COPD,aged 60-82 yr,with body mass index of 16-29 kg/m2,undergoing elective laparoscopic surgery,were randomly divided into 2 groups (n =20 each) using a random number table:conventional ventilation group (group Ⅰ) and mechanical ventilation with lower tidal volume and PEEP group (group Ⅱ).Anesthesia was induced with midazolam,sufentanil,cisatracurium and propofol and maintained with iv infusion of propofol,cisawacurium and remifentanil.The patients were endotracheally ventilated and mechanically ventilated.In group Ⅰ,fresh gas flow was set at 2 L/min,VT at 10 ml/kg,and I∶E at 1∶2 during ventilation.In group Ⅱ,fresh gas flow was set at 2 L/min,VT at 6 ml/kg,I∶E at 1∶2 and PEEP at 6 cm H2O during ventilation.PErCO2 was maintained at 35-45 mm Hg in both groups.Airway peak pressure (Pp~),airway plateau pressure (Pplat),airway resistance (Raw) and dynamic lung compliance (Cdyn) were measured at 5 min after intubation (T1),45 min of pneumoperitoneum (T2),and 15 min after the end of pneumoperitoneum (T3).Arterial blood samples were obtained at T1,T2 and T3 for blood gas analysis.Alveolar-arterial oxygen gradiant (A-aDO2),oxygenation index (PaO2/FiO2),respiratory index (RI) and physiologic dead space fraction (VD/VT) were calculated.The extubation time and development of complications were recorded within 48 h after operation.Results Compared with group Ⅰ,Ppeak and Plat at T2 and Raw at T1,2 were significantly decreased,Cdyn at T2 and PaO2/FiO2 at T1-3 were significantly increased,RI,VD/VT and A-aDO2 were significantly decreased at T1-3,and the incidence of hyoxemia,atelectasis and rales was decreased within 48 h after operation in group Ⅱ (P < 0.05).There was no significant difference

  19. SPECT/CT imaging of lung perfusion in the diagnosis of pulmonary embolism: Comparison with planar ventilation-perfusion lung scintigraphy; La perfusion pulmonaire en morphoTEMP dans le diagnostic de l'embolie pulmonaire: comparaison a la scintigraphie pulmonaire planaire de ventilation/perfusion

    Energy Technology Data Exchange (ETDEWEB)

    Revel, C.; Poisson, T.; Revel, A.; Daragon, N.; Grandpierre, S.; Netter, F.; Scigliano, S.; Djaballah, W.; Olivier, P.; Karcher, G.; Marie, P.Y. [CHU de Nancy-Brabois, Service de Biophysique et de Medecine Nucleaire, 54 - Vandoeuvre (France)

    2008-06-15

    The aim of this study is to assess a new tool for the diagnosis of acute pulmonary embolism (PE): single-photon emission computed tomography lung perfusion imaging associated with unenhanced computed tomography (SPECT/CT) compared to planar ventilation-perfusion (V.Q.) lung scintigraphy. Methods One hundred and three patients with suspected acute PE underwent V.Q. scintigraphy (two scans were not interpretable) followed by perfusion SPECT/CT. The two types of images were analysed separately: (1) according to the modified P.I.O.P.E.D. scintigraphic criteria for V.Q. lung scan and (2) with regard to SPECT/CT mismatches suggestive acute PE (segmental perfusion defects detected on SPECT images not matched with CT abnormalities). Results On average, the number of segmental perfusion defects per patient was higher with SPECT/CT than with planar scintigraphy (4.3 {+-}3.6 versus 2.8 {+-}2.6; p < 0.001). A mismatch was found with SPECT-CT in 0% (0/18) of normal scintigraphy, and 8% (3/39) for low, 32% (8/25) for intermediate and 74% (14/19) for high probabilities of PE at scintigraphy. The presence of a SPECT/CT mismatch was also associated with higher pretest probability of acute PE (p = 0.001), even for the 25 patients in the intermediate-probability subgroup (p = 0.02). Finally, a SPECT/CT match was found in 29 patients that was not suggestive of acute PE due to the presence, in areas with perfusion defects on SPECT images, of the following CT abnormalities: hypo density and/or emphysema (71%), condensation or atelectasis (38%), pleural disease (7%), extra-pulmonary structure (14%) and/or bronchial obstruction (7%). Conclusion In patients with suspected acute PE, the results obtained with pulmonary SPECT/CT images are consistent with those obtained with V.Q. scintigraphy and the pretest probability of PE. Further studies comparing SPECT/CT imaging with angiographic techniques are now required to evaluate more specifically the diagnostic value of this new tool. (authors)

  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 use of a prospective audit proforma to improve door-to-mask times for acute exacerbations chronic obstructive pulmonary disease (COPD) requiring non-invasive ventilation (NIV).

    Science.gov (United States)

    Mandal, S; Howes, T Q; Parker, M; Roberts, C M

    2014-12-01

    Non-invasive ventilation (NIV) is an evidence based management of acidotic, hypercapnic exacerbations of COPD. Previous national and international audits of clinical practice have shown variation against guideline standards with significant delays in initiating NIV. We aimed to map the clinical pathway to better understand delays and reduce the door-to-NIV time to less than 3 hours for all patients with acidotic, hypercapnic exacerbations of COPD requiring this intervention, by mandating the use of a guideline based educational management proforma.The proforma was introduced at 7 acute hospitals in North London and Essex and initiated at admission of the patient. It was used to record the clinical pathway and patient outcomes until the point of discharge or death. Data for 138 patients were collected. 48% of patients commenced NIV within 3 hours with no reduction in door-to-mask time during the study period. Delays in starting NIV were due to: time taken for review by the medical team (101 minutes) and time taken for NIV to be started once a decision had been made (49 minutes). There were significant differences in door-to-NIV decision and mask times between differing respiratory on-call systems, p < 0.05). The introduction of the proforma had no effect on door-to-mask times over the study period. Main reasons for delay were related to timely access to medical staff and to NIV equipment; however, a marked variation in practice within these hospitals was been noted, with a 9-5 respiratory on-call system associated with shorter NIV initiation times.

  2. Estimation of Lung Ventilation

    Science.gov (United States)

    Ding, Kai; Cao, Kunlin; Du, Kaifang; Amelon, Ryan; Christensen, Gary E.; Raghavan, Madhavan; Reinhardt, Joseph M.

    Since the primary function of the lung is gas exchange, ventilation can be interpreted as an index of lung function in addition to perfusion. Injury and disease processes can alter lung function on a global and/or a local level. MDCT can be used to acquire multiple static breath-hold CT images of the lung taken at different lung volumes, or with proper respiratory control, 4DCT images of the lung reconstructed at different respiratory phases. Image registration can be applied to this data to estimate a deformation field that transforms the lung from one volume configuration to the other. This deformation field can be analyzed to estimate local lung tissue expansion, calculate voxel-by-voxel intensity change, and make biomechanical measurements. The physiologic significance of the registration-based measures of respiratory function can be established by comparing to more conventional measurements, such as nuclear medicine or contrast wash-in/wash-out studies with CT or MR. An important emerging application of these methods is the detection of pulmonary function change in subjects undergoing radiation therapy (RT) for lung cancer. During RT, treatment is commonly limited to sub-therapeutic doses due to unintended toxicity to normal lung tissue. Measurement of pulmonary function may be useful as a planning tool during RT planning, may be useful for tracking the progression of toxicity to nearby normal tissue during RT, and can be used to evaluate the effectiveness of a treatment post-therapy. This chapter reviews the basic measures to estimate regional ventilation from image registration of CT images, the comparison of them to the existing golden standard and the application in radiation therapy.

  3. Naturlig ventilation med varmegenvinding

    DEFF Research Database (Denmark)

    Hviid, Christian Anker; Svendsen, Svend

    2006-01-01

    Naturlig ventilation i kontorbyggerier har været et alternativ til me-kanisk ventilation i små 10 år. Naturlig ventilation har den klare fordel, at der ikke forbruges elenergi ved ventilering af bygningen, fordi ventilatorer ikke er påkrævet. Imidlertid lider naturlig ventila-tion under de ulemper...

  4. Acid-base balance and electrolyte changes in patients with acute exacerbation of chronic obstructive pulmonary disease after mechanical ventilation%慢性阻塞性肺疾病急性加重机械通气治疗后酸碱平衡状态及电解质的变化

    Institute of Scientific and Technical Information of China (English)

    李慧平; 张睢扬; 王英; 马建新; 王东霞

    2013-01-01

    Objective To explore the acid-base balance and electrolyte changes caused by mechanical ventilation,to improve the level of application of mechanical ventilation technology.It was important to improve the survival rate of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and chronic obstructive pulmonary disease (COPD) prognosis.Methods A retrospective analysis of 62 patients with AECOPD associated with type Ⅱ respiratory failure which were treated using mechanical ventilation was carried out.35 patients of AECOPD were treated with the non-invasive mechanical ventilation and 27 patients were treated with invasive mechanical ventilation.Observation and comparison of arterial blood gas and ion sodium,potassium,calcium were made before using mechanical ventilation and after using mechanical ventilation for 1 hour,2 hours,3 hours,24 hours,72 hours and end ventilation.The acid-base balance status and electrolyte changes were summarized in patients before and after using mechanical ventilation.Results There were significantly improved in the arterial blood pH,PaO2,PaCO2,PaO2/FiO2 and SaO2 in 2 groups of patients compared with before and after using mechanical ventilation (P < 0.05).After 3 h ventilation,there were 6 cases (17.14%) of decompensated metabolic alkalosis occurred and after 72 h ventilation,22 cases (62.86%) metabolic alkalosis (including compensatory and decompensated) were occurred including 7 cases (25.93%) decompensated alkalosis which achieved the peak of alkalosis incidence in non-invasive ventilation group.After 2 h ventilation,there were 7 cases(25.93%) of decompensated metabolic alkalosis occurred,and 21 cases (77.77%) metabolic alkalosis occurred after 3 h ventilation which included decompensated alkalosis 9 cases (33.33%) in invasive ventilation group.There were lower Na+ and higher K+ before ventilated,however Na + and K + were restored to normal after ventilation in both group.There were lower Na + and lower K

  5. Liquid Ventilation

    Directory of Open Access Journals (Sweden)

    Peter N Cox

    1996-01-01

    Full Text Available There has been a recent explosion of interest in the use of liquid ventilation. Over time humans have lost the physiological attributes necessary for respiration in water. However, perfluorocarbons have high solubilities for oxygen and carbon dioxide, as well as a low surface tension. These characteristics allow them to be used as a medium to assist gas exchange and recruit atelectatic-dependent lung zones in respiratory distress syndrome. Current trials may prove perfluorocarbon to be a useful adjunct in lung protective strategies in respiratory distress syndrome.

  6. Reflections on Pediatric High-Frequency Oscillatory Ventilation From a Physiologic Perspective

    NARCIS (Netherlands)

    Kneyber, Martin C. J.; van Heerde, Marc; Markhorst, Dick G.

    2012-01-01

    Mechanical ventilation using low tidal volumes has become universally accepted to prevent ventilator-induced lung injury. High-frequency oscillatory ventilation (HFOV) allows pulmonary gas exchange using very small tidal volume (1-2 mL/kg) with concomitant decreased risk of atelectrauma. However, it

  7. Protocol of keeping track of pulmonary and cardio pulmonary transplanted persons by ventilation with [sup 133] Xe and by tomography of perfusion with macro aggregates of technetied albumin. Protocole de suivi des transplantes pulmonaires et cardiopulmonaires par ventilation au Xenon 133 et par tomographie de perfusion aux macroagregats d'albumine technetiee

    Energy Technology Data Exchange (ETDEWEB)

    Cammilleri, D.; Khelifa, F.; Dumon, J.F.; Viard, L.; Gaubert, J.Y.; Noirclerc, M.; Giudicelli, R.; Kaphan, G. (Hopital de la Timone, 13 - Marseille (France)); Colt, H. (California Univ., San Diego, CA (United States))

    1992-12-01

    Here are presented the results of 27 pulmonary transplanted patients who were surveyed from january 1991 to september 1992. The scintigraphy allowed to discover anomalies, especially acute rejections; only one rejection had a normal scintigraphy. It can be used to detect a post surgery vascular stenosis or to control the apparition of bronchiolitis. 5 refs.

  8. 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...

  9. 有创机械通气辅助治疗急性危重心源性肺水肿的疗效观察%Effects of invasive mechanical ventilation in adjunctive therapy of patients with acute severe cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    刚丽; 张新莉; 张绪新; 寇露鑫; 蒋志宏; 张蕾

    2011-01-01

    目的 探讨有创机械通气治疗急性危重心源性肺水肿的治疗效果.方法 对82例急性危重型肺水肿患者,应用机械通气治疗,运用彩色超声仪记录正压通气时二尖瓣、三尖瓣、肺动脉瓣.主动脉瓣口的血流速度.结果 急性危重心源性肺水肿患者通过机械通气,可迅速改善通气,纠正缺氧,心率、呼吸频率较机械通气前均有显著下降,动脉血气较机械通气前显著改善,机械通气期间未出现血流动力学恶化的情况.正压吸气末主动脉瓣血流速度最大,在呼气末速度逐渐减低,与呼气相相比,吸气相肺膨胀时左心功能增强.结论 机械通气技术是急救急性肺水肿的重要手段之一,可改善患者的预后.%Objective To discuss the therapeutic efficacy of positive pressure mechanical ventilation on acute cardio-genic pulmonary edema. Methods Retrospective analysis of 82 cases of acute cardiogenic pulmonary edema, After u-sing mechanical ventilation,all vital signs were observed,using color echocardiographic and pulse wave Doppler echo-cardiogram (PWDE) to record blood flow velocity at mitral valve,tricuspid valve,pulmonary valve,and aortic valve orifice under positive pressure mechanical ventilation. Results With ventilation treatment.all patients showed significant improvement. Invasive ventilation was effective in improving gas exchange and hypoxia.and did not observe rapid hemodynamic changes. Blood flow rate reached to the highest level in artery valve and mitral valve at positive end nhalation pressure and decrease at end expiratory,which meaned that left ventricle output was highest at end-inhalation point in each respiration cycle and same as in mitral valve, appeared at end inhalation. The results showed that compared to expiratory phase,left cardiac function was improved. Conclusion Invasive positive pressure ventilation is a safe and effective means of improving.

  10. 有创呼吸机实施无创正压通气与常规吸氧治疗急性心源性肺水肿的对比研究%Comparative study of the treatment in acute cardiogenic pulmonary edema between the noninvasive positive pressure ventilation by invasive ventilator and the conventional oxygen therapy

    Institute of Scientific and Technical Information of China (English)

    尚云波; 李嘉嘉; 孙海燕; 张留定; 李华; 钱智刚

    2012-01-01

    Objective To evaluale the effects of noninvasive posilive pressure venlilalion (NPPV) on acute cardiogenic pulmonary edema by invasive venlilalor. Methods 82 palienls with acute cardiogenic pulmonary edema were divided into Lwo groups; 43 palienls were randomized to receive NPPV by invasive venlilalor based on conventional therapy as NPPV group; 39 palienls were randomized lo receive conventional oxygen therapy based on conventional therapy as conventional oxygen therapy group. We evaluale the trealmenl effecls by measuring the success rale of 2 h rescue and the general trealmenl efficiency of 2 h ( the success rale of 2 h rescue and the trealmenl efficiency of 2 h) , the inlubalion rale, the residence lime in emergency room and the rale of discharging from hospital, and by observing and comparing the complications and the side -effecls. Results Success rale of 2 h rescue; NPPV group was 60. 47% ( 26 of 43 ) , conventional oxygen therapy group was 17. 95% ( 7 of 39, P < 0.01); the general trealmenl efficiency of 2 h;NPPV group was 97. 67% (42 of 43 ) , conventional oxygen therapy group was 89. 74% (35 of 39,P = 0. 19) ;inlubalion rale;NPPV group was 2. 33% (1 of 43) , conventional oxygen therapy group was 15. 38% (6 of 39 ,P = 0. 035) ; residence lime in emergency room;NPPV group was (2.61 ±0.23) h,conventional oxygen therapy group was (5.36 ±0.58) h,P < 0.01 ;lhe rale of discharging from hospital;NPPV group was 97. 67% (42 of 43) , conventional oxygen therapy group was 89. 74% (35 of 39, P = 0. 068) ;side - effect rale:NPPV group was 11. 63% (5 of 43) ,conventional oxygen therapy group was 5. 13% (2 of 39 ,P =0. 293) . Conclusion The therapy of noninvasive positive pressure ventilation could increase the successful treatment rate of acute cardiogenic pulmonary edema by correctly using invasive ventilator, reducing intubation rate, shortening the residence time in emergency room, and could be used as adjunctive treatment of acute cardiogenic pulmonary edema in

  11. 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 .

  12. Sedative Effect of Touch for Chronic Obstructive Pulmonary Disease Patients Undergoing Mechanical Ventilation of Clinical Observation%抚触对慢性阻塞性肺疾病机械通气31例的影响

    Institute of Scientific and Technical Information of China (English)

    郭春梅; 江涛

    2016-01-01

    Objective To observe the clinical sedative1 efficacy of treating chronic obstructive pulmonary disease patients undergoing mechanical ventilation by touch.Methods 60 patients with chronic obstructive pulmonary disease undergoing mechanical ventilation were randomly divided into treatment group and control group.In both groups,medazolam and fentanyl were given intravenously continually for sedation and analgesia,the treatment group were treated by touch.The dose of medazolam was regulated by Riker sedative and rest-less score.The amount of fentanyl was adjusted according to Prince -Henry analgesic score.The amount of medazolam and fentanyl was significantly smaller,and incidence of side -effects such as hypotension,bradycardia was significantly lower.Result In all the patients in two groups expected sedative and analgesia scores were obtained.In the treatment group,the dose of medazolam and fentanyl for seda-tion and analgesia was significantly smaller.Conclusion It results the rates of hypotension and brdycarcardia significantly lower.%目的:观察抚触对慢性阻塞性肺疾病机械通气患者镇静镇痛有益干预的影响。方法:60例慢性阻塞性肺疾病患者使用机械通气,随机分成2组,两组患者均常规采用咪达唑仑、芬太尼镇静、镇痛,实验组加用抚触治疗。观察两组镇静镇痛药物用量以及低血压、心动过缓等不良反应发生率。结果:实验组和对照组均能使患者达到镇静及镇痛,实验组更能保持安静。与对照组相比,实验组咪达唑仑用量明显减少(P <0.05),芬太尼用量明显减少(P <0.05),低血压发生率、心动过缓发生率明显降低(P <0.05)。组间疗效比较,差异有统计学意义(P <0.05)。结论:慢性阻塞性肺疾病患者使用机械通气过程中运用抚触治疗有利于镇静,并减少镇静药物使用过量导致的低血压、心动过缓等副作用发生。

  13. 双侧肺同期手术中不同体位和单肺通气对病人呼吸力学的影响%Effects of different positions and one-lung ventilation modes on respiratory mechanics of patients during bilateral pulmonary surgery

    Institute of Scientific and Technical Information of China (English)

    马宏伟; 耿恩江; 李凤茹; 杨永斌; 丁丽景; 马辉

    2012-01-01

    Objective To investigate the effects of different positions and one-lung ventilation modes on respiratory mechanics of patients during bilateral pulmonary surgery. Methods Analysis on 142 cases who underwent bilateral pulmonary surgery from June, 2007 to December, 2010. PIP,Pplat,Raw and Cdyn measures were continuous monitored by side stream spirometry while SpO2 and PETCO2 were observed on the Patient Monitor. After dual cavity bronchus vessel was fixed and different ventilation modes were applied, blood gas analyses were made after 10 min with patients in lateral positions. Results When patient was changed to a lateral position under double-lung ventilation and when one-lung ventilation mode was applied, PIP、PplatRaw increased while Cdyn decreased, and PH decreased while PETCO2 and PaCO2 increased with SpO2 and PaO2 decreasing( P < 0. 05 ). When a different ventilation mode was applied under double-lung ventilation, PIP, Pplat and Raw decreased while Cdyn increased, PH decreased while PaO2 、SpO2 、PaCO2、PETCO2 increased ( P <0. 05 );when 38 cases were applied with a different ventilation mode under one-lung ventilation, PIP, Pplat and Raw decreased significantly while Cdyn increased, PH,PaO2 and SpO2 increased while PaCO2 and PETCO2 decreased( P <0. 05 ). Conclusion Different positions and ventilation modes have great effect on respiratory mechanics of patients during bilateral pulmonary surgery, and appropriate ventilation modes can improve respiratory mechanics and prevent hypoxemia, hypercarbia and barotraumas to protect lungs.%目的 观察双侧肺同期手术中体位改变和单肺通气时对病人呼吸力学的影响.方法 选取我院2007年6月至2010年12月双侧肺同期手术病人142例,经气道旁路采用旁气流通气连续监测病人PIP、Pplat、Raw、Cdyn等呼吸力学指标,监测SpO2、PETCO2指标,分别在双腔支气管导管定位后,平卧改侧卧,单肺通气及改换通气方式后10 min抽取动

  14. Effectiveness and safety of noninvasive positive-pressure ventilation for severe hypercapnic encephalopathy due to acute exacerbation of chronic obstructive pulmonary disease:a prospective case-control study

    Institute of Scientific and Technical Information of China (English)

    ZHU Guang-fa; ZHANG Wei; ZONG Hua; XU Qiu-fen; LIANG Ying

    2007-01-01

    Background Although severe encephalopathy has been proposed as a possible contraindication to the use of noninvasive positive-pressure ventilation(NPPV),increasing clinical reports showed it was effective in patients with impaired consciousness and even coma secondary to acute respiratory failure,especially hypercapnic acute respiratory failure(HARF).To further evaluate the effectiveness and safety of NPPV for severe hypercapnic encephalopathy,a prospective case-control study was conducted at a university respiratory intensive care unit(RICU)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)during the past 3 years.Methods Forty-three of 68 consecutive AECOPD patients requiring ventilatory support for HARF were divided into 2 groups,which were carefully matched for age,sex,COPD course,tobacco use and previous hospitalization history,according to the severity of encephalopathy,22 patients with Glasgow coma scale(GCS)0.05),but group A needed an average of 7 cmH2O higher of maximal pressure support during NPPV,and 4,4 and 7 days longer of NPPV time,RICU stay and hospital stay respectively than group B(P<0.05 or P<0.01).NPPV therapy failed in 12 patients(6 in each group)because of excessive airway secretions(7 patients),hemodynamic instability(2),worsening of dyspnea and deterioration of gas exchange(2),and gastric content aspiration(1).Conclusions Selected patients with severe hypercapnic encephalopathy secondary to HARF can be treated as effectively and safely with NPPV as awake patients with HARF due to AECOPD;a trial of NPPV should be instituted to reduce the need of endotracheal intubation in patients with severe hypercapnic encephalopathy who are otherwise good candidates for NPPV due to AECOPD.

  15. Application of Mechanical Ventilation and Nursing in Organophosphorous Poisoning Pulmonary Edema%机械通气在有机磷中毒肺水肿中的应用及护理

    Institute of Scientific and Technical Information of China (English)

    肖红媛; 贺松; 杨连忠

    2011-01-01

    Objective To discuss the application and nursing of mechanical ventilation in organophosphorous poisoning pulmonary edema.Methods The patients were divided into experimental and control groups by minimum imbalancd index.The pacasestients in the control gr%探讨机械通气在急性有机磷农药中毒肺水肿中的应用及护理对策.方法将患者以最小不平衡指数方法分为实验组和对照组.对照组依常规治疗护理,实验组在常规治疗的同时加用机械通气辅助呼吸,观察两组病人动脉血气中pH、PaO2、PaCO2、SpO2的变化、患者生命体征和临床征象变化.结果实验组通气治疗后患者临床症状明显改善,pH、PaO2、PaCO2、SpO2等指标与对照组比较差异有显著性(P〈0.05),且顺利脱机.抢救成功率86.2%,死亡率13.8%.对照组抢救成功率62.7%,死亡率37.6%(χ2=8.812,

  16. Effect of one-lung ventilation on pulmonary uptake of sevoflurane%单肺通气对七氟醚吸入麻醉肺摄取的影响

    Institute of Scientific and Technical Information of China (English)

    王伟芝; 罗艳华; 董桂敏; 王绍明

    2014-01-01

    目的 观察吸入麻醉过程中单肺通气(one-lung ventilation,OLV)与双肺通气(two-lung ventilation,TLV)比较七氟醚的肺摄取情况. 方法 选择食道癌根治术患者15例(OLV组)和胃癌根治术患者15例(TLV组),分别于全麻诱导后插入双腔支气管导管或单腔气管导管控制呼吸,行七氟醚吸入麻醉,记录每组患者各个时点的脑电双频指数(bispectral index,BIS)、七氟醚吸入气浓度(Fi)和呼出气浓度(Et),并计算Et/Fi,进行组间及组内各时间点的比较. 结果 组间:OLV组BIS高于TLV组(P<0.05);OLV组Et/Fi高于TLV组(P<0.01).OLV组:BIS呈逐渐下降趋势,5min达到临床麻醉水平(60),5min~120 min维持在临床麻醉深度(40~60);Et呈逐渐上升趋势,2 min~30 min未进入稳态(P<0.05),30 min达到稳态.Et/Fi呈逐渐升高趋势,2 min~50 min内未进入稳态(P<0.05),50 min达到稳态(连续30 min)(P>0.05),50 min~120 min变化无统计学意义(P>0.05).TLV组:BIS呈逐渐下降趋势,2min达到临床麻醉水平(60),2 min~70 min维持在临床麻醉深度(40~60),70 min~120 min低于40;Et呈逐渐上升趋势,2 min~20 min未进入稳态(P<0.05),20 min达到稳态(连续30 min)(P>0.05).Et/Fi呈逐渐升高趋势,2 min达到稳态,2min~120 min变化无统计学意义(P>0.05). 结论 OLV对七氟醚的肺摄取有一定影响.OLV摄取总量少于TLV,2min~50 min摄取速率高于TLV.OLV与TLV均可达到满足手术要求的麻醉深度,但TLV组在70 min后应适当调整吸入浓度以避免麻醉过深.与TLV比较,OLV麻醉深度较浅,达到稳定麻醉状态的时间较长.%Objective To observe the effect of one-lung ventilation (OLV) or two-lung ventilation (TLV) on pulmonary uptake of sevoflurane.Methods Fifteen patients with esophageal tumorectomy and fifteen patients with stomach tumorectomy were selected for OLV and TLV during the operation,respectively.Sevoflurane was used for the general anesthesia.Bispectral index (BIS),Fi and Et

  17. 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

  18. 慢性阻塞性肺疾病机械通气患者肺部真菌感染的病原学及治疗方法分析%The Etiology of Pulmonary Fungus Infection and Treatment Method Analysis in Elderly Chronic Obstructive Pulmonary Disease Patients with Mechanical Invasive Ventilation

    Institute of Scientific and Technical Information of China (English)

    李光才; 胡克

    2014-01-01

    目的:对行有创机械通气的慢性阻塞性肺疾病急性加重期(AECOPD)患者进行真菌感染病原学分析,并对治疗方法和合理用药做探讨。方法从2010年6月~2013年5月中在我院接受机械通气治疗的AECOPD患者中选取120例作为研究对象,120例患者均接受了有创机械通气治疗,并进行真菌菌株检测和药敏实验,真菌感染的患者服用氟康唑,观察临床治疗效果。结果从机械通气患者中分离得到73株真菌,以假丝酵母菌感染为主,占所有培养菌株的95.89%。用抗真菌药氟康唑治疗AECOPD,治疗后总有效率91.78%,用药后,痰镜检和真菌培养转阴60例,真菌清除率82.2%,6例患者出现不良反应,不良反应发生率为8.22%。效果良好。结论最多见的慢性阻塞性肺疾病急性加重病原学原因是细菌或病毒感染,而患者常反复多次住院治疗,须长期使用抗生素,加之常免疫功能低下,对AECOPD患者机械通气后可增加肺部真菌感染的机率,故评价慢性阻塞性肺疾病行机械通气后肺部真菌感染情况,尽早获得治疗机会是降低深部真菌感染加重病情和死亡率的关键,本实验使用氟康唑治疗AECOPD合并真菌感染效果显著。%Objective:Analyzing the etiology of pulmonary fungus infection and treatment method in elderly Chronic Obstructive Pulmonary Disease (COPD) Patients with Mechanical InvasiveVentilation. Methods:120 elderly patients with COPD in Our hospital are chosen as research object to accept mechanical invasive ventilation therapy during June 2010 and May 2013.And then,fungal strains detection and drug sensitive experiment are performed. Treat the fungal infected patients with fluconazole,observe its clinical therapeutic ef ect. Results:73 fungus strains were isolated from patients with mechanical invasion ventilation,mainly candida yeast infection,accounted for 95.89% of al cultivation strains.Treat senile

  19. Isolated Left Pulmonary Artery Agenesis: A Case Report

    Directory of Open Access Journals (Sweden)

    Tansel Ansal Balcı

    2012-08-01

    Full Text Available Unilateral pulmonary artery agenesis without any cardiovascular malformation is a rare anomaly. We present the imaging findings of a patient who was diagnosed as isolated left pulmonary artery agenesis. A 27-year-old female patient was admitted to our hospital due to dyspnea during exercise for five years. Chest X-ray revealed minimally small left pulmonary hilum and left lung. She was admitted to our clinic with the suspicion of pulmonary artery pathology. Absent perfusion of the left lung with normal ventilation was visualized on scintigraphy. MDCT angiography of pulmonary arteries showed absent left main pulmonary artery with systemic collaterals around left hemithorax. Pulmonary artery agenesis can be asymptomatic and isolated until adulthood. Both scintigraphy and CT angiography images of pulmonary artery agenesis of a patient are rare in the literature. Pulmonary ventilation- perfusion scintigraphy can be used not only for pulmonary embolism but also pathologies involving pulmonary artery and its branches. (MIRT 2012;21:80-83

  20. 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.

  1. Feasibility of noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease complicated with coma and forecasting study of curative effect%无创正压通气治疗慢阻肺昏迷患者的可行性及疗效预测研究

    Institute of Scientific and Technical Information of China (English)

    吴俊

    2016-01-01

    Objective To evaluate the feasibility of noninvasive positive pressure ventilation(NPPV)in pa-tients with chronic obstructive pulmonary disease complicated with coma, and to investigate the forecasting study of clinical pulmonary infection score(CPIS)on curative effect. Methods The patients were divided into two groups randomly:the ventilation group(24 cases)and the control group(14 cases). Arterial gas analysis, heart rate(HR), and respiratory rate(RR)were observed before and after the treatment. The CPIS was calculated, and the changes of arterial blood gas analysis in the patients with different CPIS were observed. Results There was no signif-icant statistical difference in the above mentioned indexes before treatment. The value of pH, PaCO2 , HR and RR improved obviously after treatment in the ventilation group(P0. 05). Compared with the control group, PaCO2, HR and RR of the ventilation group were lower(P0.05).治疗1天及结束时通气组PaCO2、HR、RR低于对照组(P<0.05),PH高于对照组(P<0.01).CPIS<6通气组患者PaCO2及PH改善有非常显著性意义(P<0.01).结论 无创通气治疗慢阻肺昏迷患者具有一定的可行性,且CPIS评分对疗效有一定预测性.

  2. 慢性阻塞性肺疾病机械通气患者早期肠内营养的疗效观察%Clinical Application of Early Enteral Nutrition in the Patients of Chronic Obstructive Pulmonary Disease with Mechanical Ventilation

    Institute of Scientific and Technical Information of China (English)

    翟哲; 高岩; 毕宏远; 王鹏; 刘小伟

    2012-01-01

    Objective: To explore the effect of early enteral nutrition (EEN) in the patients of chronic obstructive pulmonary disease with mechanical ventilation. Methods: 60 patients of chronic obstructive pulmonary disease and repiratory failure with mechanical ventilation were divided into experimental group(EEN) (n=30) and control group (n=30). The experimental group received early enteral nutrition and the control group received the regular clinical therapy(EN+PN). The mechanical ventilation time, occurrence rate of ventilator-associated pneumonia (VAP) and nutrition costs in one week, were compared between the two groups. The levels of serumtotal protein, prealbumin hematoglobulin and T cell subset indexes in the period of treatment were examined in two groups. Results: In the ENN group, prealbumins and T cell subset indexes increased obviously than those before therapy or those in control group at same stage. (P< 0.05, respectively). The mechanical ventilation time,occurrence rate of pneumonia associated with ventilation(VAP) and nutrition costs in one week, in EEN group were significantly higher thanthat in the control group(P<0.05). Conclusions: Early enteral nutrition optimization strategy costs less and may obviously improve the nutrition parameters of chronic obstructive pulmonary disease with mechanical ventilation, shorten the mechanical ventilation time, reduce the occurrence rate of ventilator-associated pneumonia. When the gut works, and can be used safely, use it early.%目的:评价早期肠内营养(EEN)对慢性阻塞性肺疾病(COPD)机械通气患者的疗效.方法:选择COPD合并呼吸衰竭行机械通气患者60例,分为两组:分别给予相同热量及氮量,EEN组30例,接受早期肠内营养治疗,按照肠内营养优化策略喂养;对照组接受肠内营养联合肠外营养(EN+PN)30例,接受常规营养治疗.观察两组治疗前后营养指标,机械通气时间、1周平均营养费用、呼吸机相关性

  3. 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.

  4. 机械通气联合蛇毒血凝酶治疗新生儿肺出血的疗效观察%Study on Clinical Efficacy of the Mechanical Ventilation Combined with Snake Venom Blood Clotting Enzyme on the Treatment of Neonatal Pulmonary Hhemorrhage

    Institute of Scientific and Technical Information of China (English)

    徐丽; 唐文燕; 谭玮

    2014-01-01

    Objective To investigate the clinical efficacy of condensing enzymetreatment of neo-natal pulmonary hemorrhage mechanical ventilation combined with venom blood.Methods 40 cases of neonatal pulmonar were selected from our hospital in 2013,and randomly divided into observation group and control group which were treated with mechanical ventilation combined with adrenaline and mechanical ventilation combined with hemocoagulase respectively.Then the effects were observed.Results The mechanical ventilation time and pulmonary haemorrhage stop time were (1.16±0.47) d and (3.66 ±1.23) d repsectively in observation group,while those for the control group were (2.00 ±0.67) d and (5.17 ±1.55) d., which was significantly different ( P<0.05);Two groups of children did not have allergic reaction, thrombosis, and or-gan functional injury diseases, etc..There was 1 case of death in the control group, while there was none in observation group.Conclusion It is effective to combine mechanical ventilation with hemocoagulasecan in the treatment of neonatal pulmonary hemorrhage.%目的:探讨机械通气联合蛇毒血凝酶治疗新生儿肺出血的临床疗效。方法选取40例新生儿肺出血患儿作为研究对象,随机分为观察组和对照组,分别采用机械通气联合肾上腺素盐水和机械通气联合蛇毒血凝酶治疗,观察两组患者的治疗疗效。结果观察组机械通气时间、肺出血停止时间均明显少于对照组( P<0.05);两组患儿均未发生过敏反应、血栓及器官功能性损伤疾病等,对照组患儿1例死亡,观察组无死亡病例。结论机械通气联合蛇毒血凝酶可以有效治疗新生儿肺出血,具有临床应用及推广价值。

  5. 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.

  6. Pharmacological therapy of chronic obstructive pulmonary disease

    African Journals Online (AJOL)

    response and the presence of systemic manifestations.1 Treatment of COPD is ... oxygen therapy in hypoxaemic patients, non-invasive ventilation, and lung ... shown to improve pulmonary function, dyspnoea, and exercise performance in ...

  7. VENTILATION NEEDS DURING CONSTRUCTION

    Energy Technology Data Exchange (ETDEWEB)

    C.R. Gorrell

    1998-07-23

    The purpose of this analysis is to determine ventilation needs during construction and development of the subsurface repository and develop systems to satisfy those needs. For this analysis, construction is defined as pre-emplacement excavation and development is excavation that takes place simultaneously with emplacement. The three options presented in the ''Overall Development and Emplacement Ventilation Systems'' analysis (Reference 5.5) for development ventilation will be applied to construction ventilation in this analysis as well as adding new and updated ventilation factors to each option for both construction and development. The objective of this analysis is to develop a preferred ventilation system to support License Application Design. The scope of this analysis includes: (1) Description of ventilation conditions; (2) Ventilation factors (fire hazards, dust control, construction logistics, and monitoring and control systems); (3) Local ventilation alternatives; (4) Global ventilation options; and (5) Evaluation of options.

  8. Correlation between timing of tracheostomy and duration of mechanical ventilation in patients with potentially normal lungs admitted to intensive care unit

    Directory of Open Access Journals (Sweden)

    Mehrdad Masoudifar

    2012-01-01

    Conclusion: Our study with mentioned sample size could not show any relationship between timing of tracheostomy and duration of mechanical ventilation in patients under mechanical ventilation with good pulmonary function in ICU.

  9. A ventilation technique for oxygenation and carbon dioxide elimination in CPR: Continuous insufflation of oxygen at three levels of pressure in a pig model

    NARCIS (Netherlands)

    Ordelman, S.C.; Aelen, P.; Woerlee, P.H.; Berkom, P.F. van; Scheffer, G.J.; Noordergraaf, G.J.

    2015-01-01

    AIM: Pulmonary ventilation remains an important part of cardiopulmonary resuscitation, affecting gas exchange and haemodynamics. We designed and studied an improved method of ventilation for CPR, constructed specifically to support both gas exchange and haemodynamics. This method uses continuous ins

  10. Metabolism, temperature, and ventilation.

    Science.gov (United States)

    Mortola, Jacopo P; Maskrey, Michael

    2011-10-01

    In mammals and birds, all oxygen used (VO2) must pass through the lungs; hence, some degree of coupling between VO2 and pulmonary ventilation (VE) is highly predictable. Nevertheless, VE is also involved with CO2 elimination, a task that is often in conflict with the convection of O2. In hot or cold conditions, the relationship between VE and VO2 includes the participation of the respiratory apparatus to the control of body temperature and water balance. Some compromise among these tasks is achieved through changes in breathing pattern, uncoupling changes in alveolar ventilation from VE. This article examines primarily the relationship between VE and VO2 under thermal stimuli. In the process, it considers how the relationship is influenced by hypoxia, hypercapnia or changes in metabolic level. The shuffling of tasks in emergency situations illustrates that the constraints on VE-VO2 for the protection of blood gases have ample room for flexibility. However, when other priorities do not interfere with the primary goal of gas exchange, VE follows metabolic rate quite closely. The fact that arterial CO2 remains stable when metabolism is changed by the most diverse circumstances (moderate exercise, cold, cold and exercise combined, variations in body size, caloric intake, age, time of the day, hormones, drugs, etc.) makes it unlikely that VE and metabolism are controlled in parallel by the condition responsible for the metabolic change. Rather, some observations support the view that the gaseous component of metabolic rate, probably CO2, may provide the link between the metabolic level and VE.

  11. 急性心源性肺水肿时非侵入性呼吸机治疗的研究%The use of noninvasive ventilation in the treatment of acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    徐秋萍; 平玉坤; 张烨斐; 杨云梅; 丁晨彦; 张舸

    2001-01-01

    Objective To evaluate the clinical applications of noninvasive ventilation in the treatment of acute cardiogenic pulmonary edema.Methods Thirty one patients with acute cardiogenic pulmonary edema(ACPE)were treated with noninvasive nasal mask bilevel positive airway pressure(BiPAP).Before and after ventilatory support,the heart rate,breathing rate,urine volume,MAP,SaO2,PetCO2,PaO2,PaCO2 and heart function were recorded.Results After 2~6 hours treatment,the heart rate and breathing rate were significantly reduced(P<0.001).The urine volume,SaO2 and PaO2 were markedly increased (P<0.001).The MAP were decreased in hypertensive patients(P<0.001).All patients’ heart function was improvement.PetCO2and PaCO2 were not changed very much(P>0.05).Conclusion The noninvasive nasal mask BiPAP is a kind of safe and effective method in the treatment of ACPE.It can be recommended for clinical use.%目的 研究应用非侵入性呼吸机治疗急性心源性肺水肿的临床价值。方法 对31名难治性急性心源性肺水肿的患者应用非侵入性鼻面罩双相气道正压通气(BiPAP)治疗,观察通气前后心率、尿量、平均血压(MAP)、血氧饱和度(SaO2)、呼吸频率、呼气末二氧化碳分压(PetCO2)、血气分析和心功能等指标的变化。结果 患者经2~6h的鼻面罩BiPAP治疗后心率明显减慢(P<0.001)、尿量明显增加(P<0.001)、PaO2和SaO2明显提高(P<0.001)、PaCO2和PetCO2改变不明显(P>0.05)、心功能明显改善、高血压心脏病者MAP下降显著(P<0.001)。结论 对急性心源性肺水肿应用非侵入性鼻面罩BiPAP治疗是安全而有效的,值得在临床推广使用。

  12. Relative Tissue Factor Deficiency Attenuates Ventilator-Induced Coagulopathy but Does Not Protect against Ventilator-Induced Lung Injury in Mice

    Directory of Open Access Journals (Sweden)

    Esther K. Wolthuis

    2012-01-01

    Full Text Available Preventing tissue-factor-(TF- mediated systemic coagulopathy improves outcome in models of sepsis. Preventing TF-mediated pulmonary coagulopathy could attenuate ventilator-induced lung injury (VILI. We investigated the effect of relative TF deficiency on pulmonary coagulopathy and inflammation in a murine model of VILI. Heterozygous TF knockout (TF+/− mice and their wild-type (TF+/+ littermates were sedated (controls or sedated, tracheotomized, and mechanically ventilated with either low or high tidal volumes for 5 hours. Mechanical ventilation resulted in pulmonary coagulopathy and inflammation, with more injury after mechanical ventilation with higher tidal volumes. Compared with TF+/+ mice, TF+/− mice demonstrated significantly lower pulmonary thrombin-antithrombin complex levels in both ventilation groups. There were, however, no differences in lung wet-to-dry ratio, BALF total protein levels, neutrophil influx, and lung histopathology scores between TF+/− and TF+/+ mice. Notably, pulmonary levels of cytokines were significantly higher in TF+/− as compared to TF+/+ mice. Systemic levels of cytokines were not altered by the relative absence of TF. TF deficiency is associated with decreased pulmonary coagulation independent of the ventilation strategy. However, relative TF deficiency does not reduce VILI and actually results in higher pulmonary levels of inflammatory mediators.

  13. 多药耐药菌肺感染患者应用改良后呼吸机对病室环境卫生学影响%Multi-Drug Resistant Pulmonary Infection in Patients with the Improved Ventilator Impact on Wards Environmental Health

    Institute of Scientific and Technical Information of China (English)

    姚源; 穆丽焕; 王红韶; 赵金英; 王磊

    2012-01-01

    目的:探讨应用改良后的呼吸机对病室环境卫生学的影响.方法:对10例产碳青霉烯酶肺炎克雷伯菌肺感染应用呼吸机的患者和40例肺部感染耐甲氧西林金黄色葡萄球菌(MRSA)使用呼吸机的患者进行分组试验,对痛室环境卫生学监测结果进行统计分析.机器改良方法是呼吸机的呼气阀处连接一条螺纹管,将带菌空气引出,消毒后排放.结果:肺部感染产碳青霉烯酶肺炎克雷伯菌应用改良后呼吸机的一组在空气、床头桌、水池、操作中人员手的阳性率分别为20%、10%、20%、10%,较未改良的对照组为80%、70%、70%、50%有明显的下降.肺部感染MRSA使用有创改良呼吸机组空气、床头桌、水池、操作中人员手的阳性率分别为10%、10%、5%、10%均低于无创改良组的20%、20%、10%、20%.结论:此种方法有效地降低了环境的污染程度,降低了医源性医院感染的风险.加强洗手和隔离等卫生预防学措施可以有效的降低MRSA的医院感染率.%To study the impact of wards environmental health with the improved ventilator. Methods: In order to make statistical analysis of monitoring results about wards environmental health , 10 cases of klebsiella pneumonuiae carbapenemase (KPC) pulmonary infection and 40 cases of Methicillin-resistant Staphylococcus aureus (MRSA) pulmonary infection were divided into two groups which were used ventilator. The method of improved ventilator was that the exhalation valve was attached with a threaded pipe which accessed to the adjacent empty wards direct and the air of disinfection with air sterilizer was discharged into the outdoor. Results: The group of klebsiella pneumonuiae carbapenemase (KPC) pulmonary infection positive rate were 20%,10%,20%,10% in air, bedside table, pool, hands of operator which was used improved ventilator, obviously decreased when compared with control group without improved ventilator which

  14. Advance and strategy in treatment of domestic non-invasive positive pressure ventilation in chronic obstructive pulmonary disease%家庭无创正压机械通气在慢性阻塞性肺疾病中的应用及进展

    Institute of Scientific and Technical Information of China (English)

    赵长芳; 徐鸥

    2013-01-01

    家庭无创正压机械通气(DNPPV)是指通过鼻罩或口鼻罩等将患者与呼吸机相连,在家庭环境中对其实施正压辅助通气.DNPPV在稳定期慢性阻塞性肺疾病患者中已得到越来越广泛的运用.综述从DNPPV的开展情况、安全性、长期并发症、注意事项等方面对其进行讨论.旨在提高临床和社区医师与护理人员认识DNPPV水平,促进患者及家属更有效实施DNPPV.%Domestic noninvasive positive pressure ventilation(DNPPV) is a technique to positively help ventilation at home by linking the patient to the ventilator with nasal mask or oronasal mask.DNPPV has been more and more widely adopted by patients with stable chronic obstructive pulmonary disease.The overview focuses on the prevalence,security,long-term complications,precautions of DNPPV.The objective is to improve the DNPPV awareness of clinicians,community physicians and nurses,and to help the patients and their families to implement DNPPV more efficiently.

  15. Effects of Salbutamol on lung collapse during one-lung ventilation in patients with chronic obstructive pulmonary disease%沙丁胺醇对慢性阻塞性肺疾病患者单肺通气时肺萎陷的影响

    Institute of Scientific and Technical Information of China (English)

    周其富; 蒋宗明; 王海勇

    2012-01-01

    AIM: To study the effects of Sal-butamol aerosol inhalation prior to anesthesia induction on lung collapse during one lung ventilation in patients with chronic obstructive pulmonary disease. METHODS: Fourty patients with concomitant chronic obstructive pulmonary disease , scheduled for lobectomy were randomly allocated into observation group(n = 20) and control group(n = 20) . Salbutamol aerosol 200 μg (two puffs) were administered according to instructions before oxygenation via mask in observation group, whereas in control group no aerosol was given before oxygenation via mask. Anesthesia induction was initiated after 30 minutes' oxygenation in both groups. Extent of lung collapse was evaluated by verbal scale in 10 minutes and 20 minutes after one lung ventilation. Blood gas analysis was assayed in baseline, before anesthesia induction, double lung ventilation and 30 minutes during one lung ventilation (every 10minutes was performed). RESULTS: There was statistical significance in lung collapse score between observation group and control group(P< 0.05), the former was superior to the latter. Compared with the control group, the value of PaCO2 in anesthesia induction, double lung ventilation, 10 minutes and 20 minutes after one lung ventilation were lower than that in observation group, however , the value of PaO2 were higher in respective time. CONCLUSION: Salbutamol aerosol inhalation can accelerate lung collapse in early stage of one lung ventilation and at the same time provide better surgical access condition in patients with chronic obstructive pulmonary disease.%目的:麻醉诱导前吸入硫酸沙丁胺醇气雾剂(万托林),观察其对慢性-阻塞性肺疾病(COPD)患者单肺通气期间的肺萎陷的影响.方法:合并慢性阻塞性肺疾病的拟行肺叶切除手术的患者40例,随机分成观察组和对照组各20例,观察组:患者给予万托林200 μg(2揿)后面罩吸氧;对照组:单纯面罩吸氧,30 min后开始麻

  16. 长期无创正压通气用于慢性阻塞性肺疾病患者的疗效及护理%Clinical Effects and Nursing of Long-term Non-invasive Positive Pressure Ventilation in Chronic Obstructive Pulmonary Disease

    Institute of Scientific and Technical Information of China (English)

    田素霞

    2011-01-01

    目的 探讨长期无创正压通气用于慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的临床疗效及其护理.方法选择因慢性阻塞性肺疾病急性加重并发Ⅱ型呼吸衰竭接受鼻(面)罩无创正压通气(non-invasive positive pressure ventilation,NIV)且通气功能改善后携带家庭型双水平(BiPAP)呼吸机返家的患者45例为治疗组,同期同类患者出院后由于各种原因停用NIV改用吸氧治疗的患者45例设为对照组.观察两组患者住院期间的血气分析和肺功能指标,以及出院后3个月PaCO2和肺动脉压指标.结果 两组患者在实施NIV治疗后,通气功能及肺动脉压均有改善.出院3个月后随访显示,两组PaCO2分别为(30±5.20)和(47±5.62)mmHg(P<0.05)、FEV1分别为(87±4.6)%和(70±6.3)%(P<0 05)、肺动脉压分别为(18±2.8)和(22.2±3.5)mmHg(P<0.05),差异均有统计学意义(均P<0.05).结论 长期无创正压通气治疗能够降低COPD患者肺动脉压力,在经济条件许可的情况下,建议COPD合并呼吸衰竭患者在COPD稳定期仍继续接受家庭型呼吸机治疗,以减少患者反复发作次数、延长患者的生存期,提高患者的生活质量.%Objective To explore the clinical effect and nursing of long-term non-invasive positive pressure ventilation in chronic obstructive pulmonary disease(C()PD). Methods Forty-five COPD patients during acute embittering period combined with type Ⅱ respiratory failure receiving nasal (facial) mask of noninvasive ventilation(NIV) who were discharged with the family-type bi-level(BiPAP) ventilator after their ventilation function were improved were taken as the treatment group. Simultaneously, 45 counterparts discontinuing nasal(facial) mask of NIV after discharge from hospital were taken as the control group. Observations were conducted in blood gas analysis,pulmonary function indicators, PaCO2 and pulmonary artery pressure situatio 3 months after discharge. Results After

  17. 高压力无创通气治疗稳定期慢性阻塞性肺疾病的疗效观察%Observation of the efficacy of High-intensity non-invasive ventilation in stable chronic obstructive pulmonary disease patients with type H respiratory failure

    Institute of Scientific and Technical Information of China (English)

    周琴; 杨力; 郭光云

    2012-01-01

    Objective TO explore efficacy of the high-intensity noninvasive positive pressure ventilation in stable chronic obstructive pulmonary disease patinets with type II respiratory failure. Methods The patients between January 2007 and December 2003 ever hospitalized in our department, 29 stable COPD patients with type II respiratory failure were divided into two groups. FEV[ ,FVC, PaO2 , PaCO2 changes were assessed between high-intensity non-invasive ventilation group( 16 cases) and low-intensity non-invasive ventilation group (13 cases) before and after the treatment of home non-invasive ventilation. Results Before the treatment of non - invasive ventilation in the two groups, FEVj , FVC, PaO2 , PaCO2 difference was not statistically significant (P > 0. 05 ). Affter treatment, the difference of these four indicators of high-intensity ventilation group and PaCO2 of low-intensity ventilation group was statistically significant compared with before treatment (P < 0. 05 ) , other wise, there were significant differences between two groups ( P < 0. 05 ). Conclusion To stable chronic obstructive pulmonary disease patinets with type II respiratory failure, high-intensity non-invasive ventilation can better improve the lung function and carbon dioxide retention, increase blood oxygen pressure more efficiently.%目的 探讨高压力无创正压通气治疗稳定期慢性阻塞性肺疾病合并Ⅱ型呼衰的疗效.方法 2007年1月~2010年12月在我科住院的29例稳定期COPD合并Ⅱ型呼衰的患者,高压力无创通气组(16例)及低压力无创通气组(13例)进行家庭无创通气,比较两组患者治疗前后FEV1、FVC、PaO2、PaCO2的变化.结果 治疗前,FEV1、FVC、PaO2、PaCO2差异无统计学意义(P>0.05);治疗后,高压力通气组上述4指标及低压力通气组PaCO2与治疗前相比差异有统计学意义(P<0.05).结论 高压力无创通气能更好地改善稳定期COPD合并Ⅱ型呼衰患者的肺功能,提高PaO2,改善二氧化碳潴留.

  18. Pulmonary edema

    Science.gov (United States)

    ... congestion; Lung water; Pulmonary congestion; Heart failure - pulmonary edema ... Pulmonary edema is often caused by congestive heart failure . When the heart is not able to pump efficiently, blood ...

  19. Effect of adaptive support ventilation on elderly patients with COPD complicated with pulmonary thromboembo-lism%适应性支持通气在 COPD 合并肺栓塞老年患者中的临床效果与护理体会

    Institute of Scientific and Technical Information of China (English)

    王月霞; 张罗献; 刘豹; 忽新刚

    2015-01-01

    Objective To investigate the clinical value of the adaptive support ventilation(ASV)in elderly pa-tients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary thromboembolism. Methods Fifty-six cases of COPD complicated with pulmonary thromboembolism and respiratory failure needed mechanical ventilation were randomly divided into two groups with 28 cases in each group. The treated group was assigned to adaptive support ventila-tion,while the other 28 cases of the control group were assigned to pressure support synchronized mandatory ventilalion ex-haust ventilation plus positive end-expiratory pressure(P-SIMV + PEEP)support. Both groups were all ventilated until wea-ning,respiratory mechanics indicators were compared between the two groups. Results Compared with the control group, there was significantly reduced respiratory frequency,increased tidal volume(VT),declined plateau pressure(Pplat), peak airway pressure(Ppeak)and inspiratory resistance(R),increased static compliance(Cstat). Reduced WOBimp and PTP,and shorter duration of mechanical ventilation(all P ﹤ 0. 05). Conclusions Compared with P-SIMV mode,ASV support can enhance spontaneous tidal volume,reduce respiratory rate and respiratory muscle work,increase man-machine harmonization,and shorten the duration of mechanical ventilation.%目的:探讨适应性支持通气在慢性阻塞性肺疾病(COPD)合并肺栓塞老年患者中应用效果观察及护理体会。方法选择 COPD 合并肺栓塞老年患者56例,将其随机分为两组,每组28例,在综合治疗的基础上,治疗组患者接受适应性支持通气,对照组压力支持同步间歇指令通气+呼气末正压,比较两组患者机械通气治疗过程中,呼吸力学和临床护理监测指标变化。护理特点:应用呼吸机辅助通气前对患者做好心理护理,同期过程中注意患者的一般情况及呼吸机监控数据变化,注意人工气道

  20. 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.

  1. 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

  2. Hypoxic pulmonary vasoconstriction: physiology and anesthetic implications.

    Science.gov (United States)

    Lumb, Andrew B; Slinger, Peter

    2015-04-01

    Hypoxic pulmonary vasoconstriction (HPV) represents a fundamental difference between the pulmonary and systemic circulations. HPV is active in utero, reducing pulmonary blood flow, and in adults helps to match regional ventilation and perfusion although it has little effect in healthy lungs. Many factors affect HPV including pH or PCO2, cardiac output, and several drugs, including antihypertensives. In patients with lung pathology and any patient having one-lung ventilation, HPV contributes to maintaining oxygenation, so anesthesiologists should be aware of the effects of anesthesia on this protective reflex. Intravenous anesthetic drugs have little effect on HPV, but it is attenuated by inhaled anesthetics, although less so with newer agents. The reflex is biphasic, and once the second phase becomes active after about an hour of hypoxia, this pulmonary vasoconstriction takes hours to reverse when normoxia returns. This has significant clinical implications for repeated periods of one-lung ventilation.

  3. Effects of prone position on pulmonary compliance in patients receiving general anesthesia and mechanical ventilation%俯卧位对不同类型手术病人全身麻醉机械通气下肺顺应性的影响

    Institute of Scientific and Technical Information of China (English)

    许文秀; 徐学武; 王宝宁; 李清波; 钟京; 方伟武

    2012-01-01

    目的 观察俯卧位对全身麻醉机械通气下不同手术类型病人肺顺应性的影响.方法 选择择期行脊柱手术患者53例(其中脊柱侧弯手术病人20例,脊柱普通手术病人33例).麻醉诱导气管插管后,间歇正压通气模式机械呼吸,潮气量6 ~ 10 ml/kg,呼吸频率12次/min.术前仰卧位通气10 min后改为手术俯卧位通气10min,分别经麻醉机采集不同潮气量时压力-容积曲线,计算肺顺应性.结果 全身麻醉机械通气下,脊柱侧弯手术病人术前仰卧位肺顺应性为(33.6±10.0) ml/cmH2O,术前俯卧位的肺顺应性降低为(28.2±8.6) ml/cmH2O,术前仰卧位与俯卧位的肺顺应性之间差异有统计学意义(P<0.05);普通手术组病人术前仰卧位肺顺应性为( 40.2±9.1) ml/cmH2O,其术前俯卧位肺顺应性降低为(36.1±4.2) ml/cmH2O,差异有统计学意义(P<0.05).结论 俯卧位时全身麻醉机械通气下手术病人的肺顺应性下降.%Objective To observe the effects of prone position on pulmonary pompliance in patients receiving different surgery under mechanical ventilation. Methods Fifty three patients undergoing elective orthopaedic vertebral surgeries were selected (20 patients were scoliosis and 33 patients belonged to non-scoliosis prevalent surgeries). After the patient was induced and intubated, the patient was ventilated mechanically in an IPPV mode. Tidal volume (VT) was set as 6 - 10ml/kg, and the respiratory rate (RR) was 12 times per minute. Before operation, all patients were ventilated in supine position for 10 minutes, and then in prone position for 10 minutes. The data under these conditions were collected from the pressure-volume curve through the anesthesia machine. The average pulmonary compliance was calculated using the data at different tidal volume. Results The pulmonary compliance of the patients in the group of scoliosis at supine position before operation was (33. 6 ± 10.0) ml/cmH2O, at prone position was (28.2 ± 8

  4. DEMAND CONTROLLED VENTILATION AND CLASSROOM VENTILATION

    Energy Technology Data Exchange (ETDEWEB)

    Fisk, William J.; Mendell, Mark J.; Davies, Molly; Eliseeva, Ekaterina; Faulkner, David; Hong, Tienzen; Sullivan, Douglas P.

    2014-01-06

    This document summarizes a research effort on demand controlled ventilation and classroom ventilation. The research on demand controlled ventilation included field studies and building energy modeling. Major findings included: ? The single-location carbon dioxide sensors widely used for demand controlled ventilation frequently have large errors and will fail to effectively control ventilation rates (VRs).? Multi-location carbon dioxide measurement systems with more expensive sensors connected to multi-location sampling systems may measure carbon dioxide more accurately.? Currently-available optical people counting systems work well much of the time but have large counting errors in some situations. ? In meeting rooms, measurements of carbon dioxide at return-air grilles appear to be a better choice than wall-mounted sensors.? In California, demand controlled ventilation in general office spaces is projected to save significant energy and be cost effective only if typical VRs without demand controlled ventilation are very high relative to VRs in codes. Based on the research, several recommendations were developed for demand controlled ventilation specifications in the California Title 24 Building Energy Efficiency Standards.The research on classroom ventilation collected data over two years on California elementary school classrooms to investigate associations between VRs and student illness absence (IA). Major findings included: ? Median classroom VRs in all studied climate zones were below the California guideline, and 40percent lower in portable than permanent buildings.? Overall, one additional L/s per person of VR was associated with 1.6percent less IA. ? Increasing average VRs in California K-12 classrooms from the current average to the required level is estimated to decrease IA by 3.4percent, increasing State attendance-based funding to school districts by $33M, with $6.2 M in increased energy costs. Further VR increases would provide additional benefits

  5. 慢性阻塞性肺疾病合并呼吸衰竭患者机械通气撤机时机的分析%Chronic Obstructive Pulmonary Dsease Patients with Respiratory Failure with Mechanical Ventilation Weaning Timing

    Institute of Scientific and Technical Information of China (English)

    张祥标; 叶晓东; 王丽萍

    2016-01-01

    Objective To explore under the guidance of the respiratory system function score mechanical ventilation in COPD with respiratory failure in patients weaning feasibility. Methods June 2013 to February 2015, hospital receiving mechanical ventila-tion in the treatment of COPD and respiratory failure in 90 patients were randomly divided into 3 groups using traditional of weaning ( n=45), respiratory function score of 3 to 4 minutes (n = 30 )and 5 to 6 minutes (n = 15 ). Extubation respiratory function score u-sing respiratory function score guidance weaning. Dynamic observed and compared three groups of patients with mechanical ventilation and oxygenation before ventilation, respiratory function score, while receiving mechanical ventilation longer directly weaning success rate, total weaning success rate, the rate of re-intubation, ventilator-associated pneumonia (VAP) The incidence of pulmonary baro-trauma incidence. Results Compared to 3 to 4 minutes ,direct weaning success rate, the total withdrawal rate of no significant differ-ence (P>0. 05) machine success;traditional mechanical ventilation weaning unit significantly reduced (P﹤0. 05), VAP incidence was lower (P0. 05). Conclusion COPD with respiratory failure patients using mechanical ventilation weaning respiratory function score guidance weaning measures have the safety, feasibility;without affecting the success rate of weaning premise when respiratory system score 3-4 timeshare weaning can reduce the incidence of mechanical ventilation and lung complications.%目的:探讨在呼吸系统功能评分指导下,机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭患者撤机的可行性。方法2013年6月至2015年2月接受机械通气治疗的慢性阻塞性肺疾病呼吸衰竭患者90例,随机分成传统撤机组( n=45人),3~4分撤机组( n=30人),5~6分撤机组( n=15人),撤机组采用呼吸系统功能评分指导撤机。动态观察并比较三组患者撤机成功率、重新插管

  6. Diffuse Ceiling Ventilation

    DEFF Research Database (Denmark)

    Zhang, Chen; Yu, Tao; Heiselberg, Per Kvols

    with conventional ventilation systems (mixing or displacement ventilation), diffuse ceiling ventilation can significantly reduce or even eliminate draught risk in the occupied zone. Moreover, this ventilation system presents a promising opportunity for energy saving, because of the low pressure loss, extended free......Diffuse ceiling ventilation is an innovative ventilation concept where the suspended ceiling serves as an air diffuser to supply fresh air into the room. Due to the large opening area, air is delivered to the room with very low velocity and no fixed direction, therefore the name ‘diffuse’. Compared......-cooling period and night cooling potential. The investment cost of this ventilation system is about 5-10% lower than the conventional ones, because the acoustic ceiling could be directly applied as air diffuser and the use of plenum to distribute air reduces the cost of ductwork. There is a growing interest...

  7. Effect of low tidal volume one lung ventilation plus positive end-expiratory pressure on inflammatory responses of pulmonary in patients with lung cancer operation%低潮气量单肺通气复合呼气末正压对肺癌手术患者肺部炎症反应的影响

    Institute of Scientific and Technical Information of China (English)

    孔岚

    2014-01-01

    Objective To compare the effect of low tidal volume and normal tidal volume one lung ventilation plus positive end-expiratory pressure(PEEP) on inflammatory responses of pulmonary in patients with lung cancer operation.Methods Divided 40 patients with lung cancer operation into PEEP group(group L) and normal tidal volume one lung ventilation group(goup N), 20 cases in each group, tumor necrosis factor-α(TNF-α), Interleukin-6(IL-6), Interleukin-8(IL-8) and Interleukin-10(IL-10) were assessed with ELISA on the following time①two lung ventilation after anesthesia induction(T1); ②60 min after one lung ventilation (T2); ③90 min after one lung ventilation (T3); ④60 min after two lung ventilation(T4); ⑤1d after operation (T5). Results Compared to T1, TNF-α、IL-6、IL-8 and IL-10 were increased in other time point in both groups. The TNF-α、IL-6、IL -8 in group L were significant decreased than group N in T2, T3, T4, T5 time point(P<0.05). The IL-10 in group L were significant increased than group N in T2, T3, T4, T5 time point(P<0.05).Conclusion Low tidal volume one lung ventilation plus positive end-expiratory pressure can lessen pulmonary inflammatory response obviously than normal tidal volume and relieve the lung injury.%目的:对比低潮气量单肺通气复合呼气末正压(PEEP)与正常潮气量单肺通气对肺癌手术患者肺部炎症反应的影响。方法40例择期肺癌手术患者随机分为低潮气量单肺通气复合PEEP组(L组)和正常潮气量单肺通气组(N组),每组20例。两组患者分别在麻醉诱导后双肺通气时(T1)、单肺通气60 min时(T2)、单肺通气90 min时(T3)、术毕双肺通气60 min时(T4)、术后1 d(T5)采取外周静脉血,采用放射酶联免疫吸附法(ELISA)测量肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)及白细胞介素-10(IL-10)水平。结果与T1比较,两组各时点血浆TNF-α, IL-6, IL-8及IL-10水平均持续升高(P<0.05)

  8. 无创机械通气治疗慢性阻塞性肺病合并呼吸衰竭疗效观察%Non-invasive mechanical ventilation in the treatment of chronic obstructive pulmonary disease with respiratory failure Efficacy

    Institute of Scientific and Technical Information of China (English)

    李玉

    2010-01-01

    Objective To explore the bi-level positive airway pressure non-invasive ventilation (BI-PAP) for chronic obstructive pulmonary disease (COPD)with respiratory failure,the value of the cure.Methods COPD patients with type Ⅱ respiratory failure 47 regular bi-level positive airway pressure non-invasive ventilation(BIPAP) ,recorded the change before treatment,on the plane two hours after one day,three days PH,PaO2 ,PaCO2,SPO2 change.Results All patients through the bi-level positive airway pressure non-invasive ventilation,the clinical symptoms significantly improved after treatment,blood gas analysis The PH,PaO2,PaCO2 ,SPO2 a significant improvement compared with before treatment (P < 0.05).Conclusion The bi-level positive airway pressure non-invasive ventilation (BIPAP) for chronic obstructive pulmonary disease (COPD) with respiratory failure has a significant effect.%目的 探讨双水平气道正压无创通气(BIPAP)对慢性阻塞性肺病(COPD)合并呼吸衰竭的冶疗价值.方法 对COPD合并Ⅱ型呼吸衰竭患者47例行双水平气道正压无创通气(BIPAP),记录治疗前,上机后2 h、1 d、3 d的pH、PaO2、PaCO2、SPO2变化.结果 所有患者经过双水平气道正压无创通气后,临床症状有明显好转,治疗后血气分析中的pH、PaO2、PaCO2、SPO2较治疗前有明显改善(P<0.05).结论 双水平气道正压无创通气(BIPAP)对慢性阻塞性肺病(COPD)合并呼吸衰竭患者疗效显著.

  9. 慢性阻塞性肺疾病患者呼吸机相关肺炎的病原菌特点与临床分析%Clinical charateristics and pathogenesis of chronic obstructive pulmonary disease complicated with ventilator-associated pneumonia

    Institute of Scientific and Technical Information of China (English)

    曾惠清; 姚艺辉; 蔡芳荣; 王文娟; 王惠玲

    2008-01-01

    目的 探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者呼吸机相关肺炎(ventilator-associated pneumonia,VAP)的病原菌分布与临床特点.方法 回顾分析对我院呼吸科及重症监护病房COPD并呼吸衰竭患者行插管机械通气发生VAP的52例患者的下呼吸道分泌物、肺泡灌洗液等标本进行细菌培养和药敏实验,并分析临床特点.结果 COPD并VAP的主要病原菌依次是铜绿假单胞菌(25.6%)、肺炎克雷伯菌(15.8%)、耐甲氧西林金黄色葡萄球菌(15.8%)、鲍曼不动杆菌(13.4%)和大肠埃希菌(8.5%),以革兰阴性杆菌为主.结论 COPD并VAP病原菌对常见抗生素耐药性较高,机械通气术前抗生素应用者,VAP的病原菌高度耐药,病死率较高;抗生素治疗应用降阶梯方法病死率较低;迟发性(4 d后)VAP与早发性(4 d内)VAP病死率差异无统计学意义.%Objective To analyze clinical charateristics and pathogenesis of chronic obstructive pulmonary disease(COPD) complicated with ventilator-associated pneumonia(VAP). Methods To review the clinical characteristics, bacterial culture and antibiotics sensitivity of specimen from tracheal secretion and bronchoalveolar lavage. Fifty-two patients of COPD complicated with VAP after mechanical ventilation in respiratory intensive care unit(RICU) were analyzed. Results Pathogenic bacteria for COPD complicated with VAP were mostly gram negative bacteria including Pseudomonas aeruginosa(25.6%), Klebsiella spp (15.8%), Methicillin-resistant Staphylococcus aureus (15.8%), Acinetobaeter baumanii (13.4%) and Escherichia coli(8.5%). Conclusions High resistance to antibiotics among the above pathogenic bacteria of COPD complicated with VAP, and higher mortality especially therapy with antibiotics before mechanic ventilator are shown. De-cascalation therapy with antibiotics can decrease mortality. The rates of mortality are of no statistical significance between early-onset(in four days) VAP

  10. Control of lung ventilation following overwintering conditions in bullfrogs, Lithobates catesbeianus

    National Research Council Canada - National Science Library

    Santin, Joseph M; Hartzler, Lynn K

    2016-01-01

    ... that regulate and enable pulmonary ventilation. Therefore, we performed experiments to determine whether aspects of the respiratory control system of bullfrogs, Lithobates catesbeianus, are maintained or suppressed following minimal use of air...

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    Rose L

    2012-03-01

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

  13. 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.

  14. Inspiratory muscle training followed by non- invasive positive pressure ventilation in patients with severe chronic obstructive pulmonary disease:a randomized controlled trial%呼吸肌肉锻炼加序贯无创正压通气在稳定期重度慢阻肺患者中的应用:临床随机对照试验

    Institute of Scientific and Technical Information of China (English)

    周露茜; 黎晓莹; 李允; 郭炳鹏; 关力理; 陈新; 罗裕文; 罗鹏; 陈荣昌

    2016-01-01

    Objective To investigate the effects of inspiratory muscle training followed by non-invasive positive pressure ventilation in patients with severe chronic obstructive pulmonary disease (COPD). Methods This investigator-initiated randomized, controlled trial recruited 88 patients with stable GOLD stage IV COPD, who were randomized into 4 equal groups to continue oxygen therapy (control group) or to receive inspiratory muscle training followed by non-invasive positive pressure ventilation (IMT-NPPV group), inspiratory muscle training only (IMT group), or noninvasive positive pressure ventilation only (NPPV group) for at least 8 weeks. The outcomes of the patients were assessed including the quality of life (SRI scores), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), dyspnea (MRC scores), 6-min walking distance (6MWD) and lung function. Results Compared to baseline values, SRI scores, 6MWT and MRC scores increased significantly after 8 weeks in IMT-NPPV, IMT and NPPV groups, and the improvements were significantly greater in IMT-NPPV group than in IMT and NPPV groups (P0.05). Conclusion Inspiratory muscle training followed by non-invasive positive pressure ventilation, compared with inspiratory muscle training or non-invasive positive pressure ventilation alone, can better enhance the quality of life, strengthen the respiratory muscles, improve exercise tolerance and relieve the dyspnea in patients with COPD.%目的:探讨呼吸肌肉锻练序贯无创通气的肺康复策略的临床应用价值。方法88例患者随机分为序贯组、呼吸肌肉锻炼组、无创组及对照组并干预8周。评价生活质量(SRI)、呼吸肌力(MIP、MEP)、呼吸困难(MRC)、运动耐量(6MWD)及肺功能。结果序贯组、锻炼组及无创组SRI总分、6MWD、MRC均显著改变(P均0.05)。结论呼吸肌肉锻练序贯无创通气康复策略对于稳定期重度慢阻肺患者而言临床效果最优,与单用呼吸肌

  15. Effects of selective lobar ventilation on intrapulmonary shunt and inflammatory response in patients with pulmonary dysfunction during thoracotomy%选择性肺叶通气对肺功能不全患者开胸术中肺内分流及炎性反应的影响

    Institute of Scientific and Technical Information of China (English)

    周清河; 肖旺频; 安尔丹; 周红梅; 沈颖彦

    2011-01-01

    Objective To investigate the effects of selective lobar ventilation on intrapulmonary shunt and inflammatory response in patients with pulmonary dysfunction during thoracotomy.Methods Thirty-four ASA Ⅱ or Ⅲ patients,aged 64-79 yr,weighing 50-85 kg,with moderate and severe impaired pulmonary function,scheduled for esophageal cancer radical correction,were randomly divided into 2 groups( n =17 each): one-lung ventilation group (group A) and selective lobar ventilation group (group B).In group A,endobronchial blocker tube was used to obstruct bronchus principalis and practice one-lung ventilation.In group B,endobronchial blocker tube was used to obstruct bronchi lobares and practice selective lobar ventilation.The blood samples were taken from arteria radialis and internal jugular vein for blood gas analysis and determination of the plasma concentrations of TNF-α,IL-6 and IL-8 by ELISA before anesthesia induction(T0 ),at 30 min following two-lung ventilation at lateral position (T1),at 60 min following one-lung ventilation or selective lobar ventilation (T2) and at the end of surgery (T3).Ppeak and Plat.were recordeded at the same time.Results The incidence of hypoxemia was significantly lower in group B (0) than in group A(18% )( P <0.05).Compared with group A,Pplat and Ppeak at T1-3,Qs/Qt at T2,TNF-α,IL-6 and IL-8 concentrations at T2-3 were significantly decreased in group B( P < 0.05 ).Conclusion The selective lobar ventilation can reduce intrapulmonary shunt,inhibit inflammatory response to help lessen mechanical ventilation related lung injury during thoracotomy in patients with pulmonary function.%目的 评价选择性肺叶通气对肺功能不全患者开胸术中肺内分流和炎性反应的影响.方法 择期行食管癌根治术患者34例,年龄64~79岁,体重50~85 kg,ASA分级Ⅱ或Ⅲ级,合并中重度肺功能不全,采用随机数字表法,将其随机分为2组(n=17):单肺通气组(A组)和选择性肺叶通气组(B组).A组患

  16. Long Term Follow-up of Ventilated Patients with Thoracic Restriction and Neuromuscular Disease

    Directory of Open Access Journals (Sweden)

    Dina Brooks

    2002-01-01

    Full Text Available OBJECTIVE: To evaluate the long term effects of home mechanical ventilation (HMV on pulmonary function, nighttime gas exchange, daytime arterial blood gases, sleep architecture and functional exercise capacity (6 min walk. Patients with respiratory failure attributable to thoracic restrictive disease (TRD (kyphoscoliosis or neuromuscular disease (NMD were assessed, ventilated, trained and followed in a dedicated unit for the care of patients requiring long term ventilation.

  17. Effect of continuous positive airway pressure during one lung ventilation on pulmonary function in patients undergoing video-assisted thoracoscopic repair of atrial septal defect%单肺通气期间连续气道正压通气对胸腔镜房间隔缺损修补术患者肺功能的影响

    Institute of Scientific and Technical Information of China (English)

    王磊; 陈宇; 钱燕宁; 丁正年; 孙杰

    2010-01-01

    目的 探讨单肺通气期间连续气道正压通气(CPAP)对胸腔镜房间隔缺损修补术患者肺功能的影响.方法 拟行房间隔缺损修补术的患者20例,年龄16~30岁,体重41~64 kg,性别不限,ASA分级Ⅱ级,随机分为2组(n=10):对照组和CPAP组.两组单肺通气时VT 8 ml/kg,呼吸频率12~16次/min,吸呼比1:2,维持PET CO2 35~40 mm Hg.CPAP组单肺通气期间,非通气侧肺采用CPAP,压力为6 cm H2O.术中监测氧合指数、肺顺应性和气道压,记录拔管时间、单肺通气期间心血管事件和低氧血症的发生情况.结果 与对照组比较,CPAP组氧合指数和肺顺应性升高,拔管时间缩短,低氧血症发生率低(P<0.01),两组患者气道压力在正常范围且未发生心血管事件.结论 单肺通气期间行CPAP(6 cm H2O)可改善胸腔镜房间隔缺损修补术患者的肺功能.%Objective To investigate the effect of continuous positive airway pressure(CPAP)during one lung ventilation on pulmonary function in patients undergoing video-assisted thoracoscopic repair of atrial septal defect.Methods Twenty ASA Ⅱ patients of both sexes,aged 16-30 yr,weighing 41-64 kg,scheduled for video-assisted thoracoscopic repair of atrial septal defect,were randomly divided into 2 groups(n = 10 each): control group and CPAP group.One lung ventilation(VT 8 ml/kg,RR 12-16 bpm,I:E 1:2,PETCO2 35-40 mm Hg)was perform in both groups.CPAP(6 cm H2O)was perform during one lung ventilation in group CPAP.The oxygenation index,pulmonary compliance and airway pressure were recorded during operation.The cardiovascular events,hyoxemia and extubation time were recorded.Results The oxygenation index and pulmonary compliance were significantly higher,extubation time was shorter,and the incidence of hyoxemia was lower in CPAP group than in control group(P < 0.01).The airway pressure was in the normal range in both groups.No cardiovascular events was found in both groups.Conclusion CPAP(6cm H2O)during one lung

  18. Clinical observation and nursing of double level positive pressure ventilation in the treatment of acute cardiac pulmonary edema%双水平正压通气治疗急性心源性肺水肿的临床观察及护理

    Institute of Scientific and Technical Information of China (English)

    杨莉; 白引珠

    2015-01-01

    目的:探讨双水平正压通气治疗急性心源性肺水肿的临床效果及针对性治疗护理的应用效果。方法选取急性心源性肺水肿患者84例随机分为观察组和对照组各42例,对照组患者采用吸氧、扩血管、强心等常规治疗及护理,观察组患者在对照组的基础上采用双水平正压通气及针对性治疗护理措施。比较2组患者治疗前后 p(CO2)、p(O2)、血氧饱和度等血气指标的变化,并调查患者的满意度。结果双水平正压通气能降低急性心源性肺水肿患者 p(CO2),升高 p(O2)、血氧饱和度,观察组治疗后 p(CO2)、p(O2)、血氧饱和度与对照组比较,差异具有统计学意义(P <0.05);观察组患者的护理满意度显著高于对照组,差异具有统计学意义(P <0.05)。结论双水平正压通气治疗急性心源性肺水肿的临床效果好,采用针对性治疗护理措施能提高患者的满意度。%Objective To investigate the clinical effect of double level positive pressure ventilation in the treatment of acute cardiac pulmonary edema and targeted therapy.Methods A total of 84 patients with acute cardiac pulmonary edema were randomly divided into observation group and control group,with 42 cases in each group.The control group was treated with conven-tional therapy and nursing,such as oxygen,expanding blood vessel and strong heart,and the ob-servation group were treated with double level positive pressure ventilation and nursing care.The changes of blood gas indexes,p(CO2),p(O2)and blood oxygen saturation of two groups before and after treatment were compared,and the satisfaction of patients were investigated.Results Double level positive pressure ventilation can reduce the acute cardiogenic pulmonary edema in pa-tients could reduce p(CO2 )and increase p(O2 )and blood oxygen saturation.After treatment, there were significant difference in p(CO2),p(O2),SpO2 in the

  19. Clinical Study of Non-Invasive Positive Pressure Ventilation in Treatment of Severe Acute Cardiogenic Pulmonary Edema%无创正压通气治疗急性重症心源性肺水肿的临床效果分析

    Institute of Scientific and Technical Information of China (English)

    于冰; 林盛翠

    2015-01-01

    Objective To observe and explore the effect of non-invasive positive pressure ventilation in the treatment of severe a-cute cardiogenic pulmonary edema. Methods 60 patients with severe acute cardiogenic pulmonary edema admitted to our hospital from February 2013 to April 2015 were selected and randomly divided into study group and control group. The control group was given conventional drug therapy, while the study group underwent non-invasive positive pressure ventilation based on the methods used in the control group. The changes of clinical symptoms, complications and related parameters before and after treatment were measured. Results After 1-4 h treatment with non-invasive positive pressure ventilation for patients in the study group, their heart rate and respiration rate, and their mean arterial pressure, as well as parameters of arterial blood gases all decreased significantly, P<0.001, and decreased significantly, P<0.001, and related complications improved. Further more, the efficacy was significantly better in the study group than in the control group, and the difference was statistically significant difference, P<0.01. Conclusion Non-invasive positive pressure ventilation could improve hypoxemia and cardiac function, relieve symptoms in patients with severe acute cardiogenic pulmonary edema and shorten the course of heart failure. It is a safe and effective method for treating severe a-cute pulmonary edema, and is worthy of promotion.%目的:观察并分析无创正压通气治疗急性重症心源性肺水肿的临床效果。方法随机选取2013年2月-2015年3月该院收治的60例急性重症心源性肺水肿患者为研究对象,随机分为研究组和对照组,两组均采取常规药物治疗,研究组在此基础上采用无创正压通气治疗,观察并比较两组患者通气前和通气后体征、临床症状以及相关指标等的变化。结果经过1~4 h的无创通气治疗,患者的心率和呼吸频率与

  20. Pulmonary complications in neurosurgical patients

    Directory of Open Access Journals (Sweden)

    Randeep Guleria

    2012-01-01

    Full Text Available Pulmonary complications are a major cause of morbidity and mortality in neurosurgical patients. The common pulmonary complications in neurosurgical patients include pneumonia, postoperative atelectasis, respiratory failure, pulmonary embolism, and neurogenic pulmonary edema. Postoperative lung expansion strategies have been shown to be useful in prevention of the postoperative complications in surgical patients. Low tidal volume ventilation should be used in patients who develop acute respiratory distress syndrome. An antibiotic use policy should be put in practice depending on the local patterns of antimicrobial resistance in the hospital. Thromboprophylactic strategies should be used in nonambulatory patients. Meticulous attention should be paid to infection control with a special emphasis on hand-washing practices. Prevention and timely management of these complications can help to decrease the morbidity and mortality associated with pulmonary complications.

  1. Negative-Pressure Pulmonary Edema.

    Science.gov (United States)

    Bhattacharya, Mallar; Kallet, Richard H; Ware, Lorraine B; Matthay, Michael A

    2016-10-01

    Negative-pressure pulmonary edema (NPPE) or postobstructive pulmonary edema is a well-described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. Patients with NPPE generate very negative airway pressures, which augment transvascular fluid filtration and precipitate interstitial and alveolar edema. Pulmonary edema fluid collected from most patients with NPPE has a low protein concentration, suggesting hydrostatic forces as the primary mechanism for the pathogenesis of NPPE. Supportive care should be directed at relieving the upper airway obstruction by endotracheal intubation or cricothyroidotomy, institution of lung-protective positive-pressure ventilation, and diuresis unless the patient is in shock. Resolution of the pulmonary edema is usually rapid, in part because alveolar fluid clearance mechanisms are intact. In this review, we discuss the clinical presentation, pathophysiology, and management of negative-pressure or postobstructive pulmonary edema.

  2. New generation ventilators.

    Science.gov (United States)

    Bersten, A D; Skowronski, G A; Oh, T E

    1986-08-01

    Desirable features of new generation intensive care ventilators include the ability to ventilate a wide range of patient sizes, an uncomplicated control panel, an appropriate but not excessive variety of ventilatory patterns, adequate patient monitoring and alarm functions, and simplicity of cleaning and routine maintenance. Examples of currently available ventilators include the Servo 900-C, CPU-1, Engstrom Erica, Bear 5, Drager EV-A and Hamilton Veolar. The incorporation of microcomputer control into some of these ventilators has resulted in improved flexibility and a limited number of automatic responses to detected patient changes. However, the function of components provided to allow spontaneous ventilation, such as demand valves, requires considerable improvement. Current trends in ventilator design include further refinement of computer control and the provision of graphic displays showing the results of continuous sophisticated analysis of respiratory function. The extent to which these developments will prove clinically useful will require careful evaluation.

  3. 急性高容量血液稀释对单肺通气病人氧合及肺内分流的影响%Effects of acute hypervolemic hemodilution on oxygenation and pulmonary shunt fraction during one lung ventilation in patients

    Institute of Scientific and Technical Information of China (English)

    司建洛; 邢群智; 陈靖军; 伍军

    2008-01-01

    目的 探讨轻度急性高容量血液稀释(AHHD)对单肺通气(OLV)病人氧合和肺内分流的影响.方法 将40例ASAⅠ~Ⅱ级全麻下行食道癌手术患者,随机分为两组,H组(血液稀释组)和C组(对照组),每组20例,麻醉诱导后插入双腔支气管插管,桡动脉穿刺测量有创血压和采集动脉血标本,中心静脉置入双腔静脉导管,深度17~18cm,血液稀释组经静脉快速输入羟乙基淀粉130/0.4(万汶)15 ml/kg,30 ml/min行急性高容量血液稀释,术中保持红细胞压积(Hct)在30%以上,对照组按常规开胸手术输液管理.分别在双肺通气后20min(T1)、单肺通气后20 min(T2),40,in(T3)、80Min(T4)、再次双肺通气30 min(T5)采动脉血和混合静脉血进行血气分析,按标准公式计算分流率,测动脉血乳酸(Lac)浓度.结果 与双肺通气相比,两组在单肺通气(OLV)期间动脉血氧分压(PaO2)和静脉血氧分压(PrO2)明显降低(P<0.05),两组在OLV期间单肺通气后分流值(Qs/Qt)和气道压力(Paw)明显增加(P<0.05).pH、Lac变化差异无统计学意义(P>0.05).与对照组相比,各时点pH、PaO2、Qs/Qt、Paw、Lac差异无统计学意义(P>0.05).血液稀释组在OLV期间PvO2明显降低(P<0.05),血液稀释组在OLV期间PaCO2明显升高(P<0.05).结论 轻度AHHD不明显增加OLV期间肺内分流率,但对血气有影响,加强OLV期间的通气管理,轻度AHHD可以安全应用于胸科手术.%Objective To investigate the effects of mild acute hypervolemic hemedilution (AHHD) on oxygenation and pul-monary shunt fraction during one lung ventilation (OLV) in patients. Methods Forty ASA Ⅰ-Ⅱ patients who underwent esoph-ageal cancer resection were randomly divided into two groups, group H(twenty patients with AHHD) and group C(twenty patients without AHHD), all patients were induced with 2-4 μg/kg fentanyl, 0.1 mg/kg midazolam,, 0.15 mg/kg vecuronium and 1 mg/kg propofol. Double lumen endobrouchial tube was inserted after

  4. Design Principles for Hybrid Ventilation

    DEFF Research Database (Denmark)

    Heiselberg, Per

    For many years mechanical and natural ventilation systems have developed separately. Naturally, the next step in this development is the development of ventilation concepts that utilize and combine the best features from each system to create a new type of ventilation system -Hybrid Ventilation....... The hybrid ventilation concepts, design challenges and - principles are discussed and illustrated by four building examples....

  5. Influence by budesonide suspension aerosol inhalation on breathing mechanics in chronic obstructive pulmonary disease patients with mechanical ventilation%布地奈德混悬液雾化吸入对慢性阻塞性肺疾病机械通气患者呼吸力学的影响

    Institute of Scientific and Technical Information of China (English)

    高婧; 滕海风

    2016-01-01

    ObjectiveTo research influence by budesonide suspension aerosol inhalation on breathing mechanics in chronic obstructive pulmonary disease (COPD) patients with mechanical ventilation.MethodsA total of 50 COPD patients with complicated respiratory failure (with failed conventional medical treatment and different degree of disturbance of consciousness) were randomly divided into control group (received conventional therapy) with 28 cases and treatment group (received additional budesonide suspension aerosol inhalation) with 22 cases. Observation was made on breathing mechanics and blood gas analysis indexes during mechanical ventilation.ResultsBefore aerosol, there was no statistically significant difference of breathing mechanics and blood gas analysis indexes between the two groups (P>0.05). After aerosol, both groups had improved breathing mechanics and blood gas analysis indexes (P0.05)。雾化后,两组患者呼吸力学指标、血气分析指标均较雾化前改善(P<0.05),且治疗组均优于对照组同期指标(P<0.05)。结论雾化吸入布地奈德混悬液治疗COPD机械通气患者疗效肯定,能明显改善呼吸力学指标,改善预后。

  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. Natural Ventilation in Atria

    DEFF Research Database (Denmark)

    Svidt, Kjeld; Heiselberg, Per; Hendriksen, Ole Juhl

    This case study comprises a monitoring programme as well as a Computational Fluid Dynamics (CFD) analysis of a natural ventilated atrium. The purpose has been to analyse the performance of a typical natural ventilation system in Denmark under both summer and winter conditions.......This case study comprises a monitoring programme as well as a Computational Fluid Dynamics (CFD) analysis of a natural ventilated atrium. The purpose has been to analyse the performance of a typical natural ventilation system in Denmark under both summer and winter conditions....

  8. Investigation of Ventilator Associated Pneumoniae in Intensive Care Patients

    Directory of Open Access Journals (Sweden)

    Hakan Tağrıkulu,

    2016-04-01

    Full Text Available Objective: Mechanical ventilator associated pneumonia is a serious infection occurred frequently in intensive care units and associated with high mortality. In this study we aimed to investigate the incidence of ventilator associated pneumonia, the duration of mechanical ventilation, length of intensive care unit stay, complication occurrence and mortality rates on patients undergoing mechanical ventilation for more than 48 hours. Material and Method: Two hundred twenty patients were included in the study. Demographic data at the time of the admission to intensive care unit (age, sex, height, weight and body mass index, intensive care admission diagnosis and systemic diseases were all recorded. The clinical pulmonary infection score was used for ventilator associated pneumonia diagnosis. Antibiotic usage, duration of stay in intensive care unit, duration of mechanical ventilation stay and mortality were all recorded. Results: Ventilator-associated pneumonia was detected in 51.36% (n=113 of the 220 patients. Clinical pulmonary infection score was found as 8.04±1.03 in patients with ventilator-associated pneumonia and 1.75±1.88 in non- ventilatorassociated pneumonia patients (p=0.001. Higher age was detected in ventilator-associated pneumonia group (58±12.79 years and 51.37±15.87 years, p=0.001. Also hypertension and diabetes mellitus were observed more frequently (p=0.001. Development of enteral nutrition in patients with ventilator-associated pneumonia were significantly higher than those of parenterally fed patients (enteral: by 36.4% and 25.5% p=0.006; parenteral: 25% and 19.1%, p=0.042. The length of stay in intensive care unit (12.38±5.81 and 10.79±5.91 days, p=0.045, duration of mechanical ventilation (9.67±4.84 days and 6.7±3.87 days, p=0.001 and mortality rates (24.5% and 15.5% p=0.019 were significantly higher in the ventilator-associated pneumonia group. Conclusion: Ventilator-associated pneumonia increases the duration of

  9. 3 Level Ventilation: the First Clinical Experience

    Directory of Open Access Journals (Sweden)

    P. Torok

    2008-01-01

    Full Text Available Considering the issues of artificial ventilation (AV in non-homogenous pathological lung processes (acute lung injury (ALI, acute respiratory distress syndrome (ARDS, pneumonia, etc., the authors applied the three-level lung ventilation to a group of 12 patients with non-homogenous lung injury. Three-level ventilation was defined as a type (modification of AV whose basic ventilation level was produced by the modes CMV, PCV or PS (ASB and add-on level, the so-called background ventilation was generated by two levels of PEEP. PEEP (constant and PEEPh (PEEP high with varying frequency and duration of transition between the individual levels of PEEP. Objective: to elucidate whether in cases of considerably non-homogenous gas distribution in acute pathological disorders, three-level ventilation (3LV can correct gas distribution into the so-called slow bronchoalveolar compartments, by decreasing the volume load of the so-called fast compartments and to improve lung gas exchange, by following the principles of safe ventilation. Results. 3LV was applied to 12 patients with severe non-homogenous lung injury/disorder (atypic pneumonia and ARDS/ALI and low-success PCV ventilation after recruitment manoeuvre (PaO2 (kPA /FiO2 = 5—6. There were pronounced positive changes in pulmonary gas exchange within 1—4 hours after initiation of 3LV at a fPCV of 26±4 breaths/min-1 and PEEPh at a fPEEPH of 7±2 breaths/min-1 with a minute ventilation of 12±4 l/min. 3LV reduced a intrapulmonary shunt fraction 50±5 to 30±5%, increased CO2 elimination, with PaCO2 falling to the values below 6±0.3 kPa, and PaO2 to 7.5±1.2 kPa, with FiO2 being decreased to 0.8—0.4. Lung recruitment also improved gas exchange: with PEEP=1.2±0.4 kPa, static tho-racopulmonary compliance (Cst elevated from 0.18±0.02 l/kPa to 0.3±0.02 l/kPa and then to 0.38±0.05 l/kPa. Airways resistance (Raw decreased by more than 30%. Improved lung aeration was also estimated as a manifestation of

  10. 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.

  11. Examination Results of Pulmonary Ventilation Function of 94 Blasters with Silicosis%爆破工矽肺患者94例肺通气功能检查结果分析

    Institute of Scientific and Technical Information of China (English)

    张健杰

    2011-01-01

    [Objective]To study the relationship between pulmonary function and staging silicosis.[Methods]Pulmonary function test instrument was used to measure FVC, FEV1, FEV1 % of blaster with silicosis.[Results]Of 94 patients, 59 ( 62.8% ) had abnormal pulmonary function.The case numbers and degree of abnormal pulmonary function in stage Ⅲ were higher than those of stage Ⅰ or Ⅱ, the difference between each stage was significant.The restrictive and FEV1 abnormal fall were more easily to observe in pulmonary function damage of Silicosis.[Conclusion]The severity and incidence of pulmonary function damage increases with the advancing of silicosis stage, especially for the patients with silicosis stage Ⅲ.The restrictive and FEV1 abnormal fall of pulmonary function damage were observed easily in this study.The silicosis patients with only FEV1 fall are advised to receive pulmonary diffusion function and other pulmonary function test.%目的 探讨尘肺分期与肺功能的关系.方法 采用肺功能测试仪测定爆破工矽肺患者用力肺活量(FVC),一秒钟用力呼气量(FEV1),一秒钟用力呼气量与用力肺活力量比值(FEV1%).结果 94例患者中,肺功能异常59例,占62.8%.Ⅲ期矽肺患者肺损伤例数和程度均明显高于Ⅰ、Ⅱ期,各期比较,差异有统计学意义.矽肺患者肺功能损伤以限制型和单纯FEV1下降比例最高.结论 矽肺患者随矽肺期别增高,其肺功能损伤严重程度和发生率增加,尤其以Ⅲ期患者为著.该文中矽肺患者肺功能损伤以限制型和单纯FEV1下降为主,对于单纯FEV1下降患者建议进行肺弥散功能以及其他肺功能指标检测.

  12. Review of Residential Ventilation Technologies

    Energy Technology Data Exchange (ETDEWEB)

    Armin Rudd

    2005-08-30

    This paper reviews current and potential ventilation technologies for residential buildings, including a variety of mechanical systems, natural ventilation, and passive ventilation. with particular emphasis on North American climates and construction.

  13. Multifamily Ventilation Retrofit Strategies

    Energy Technology Data Exchange (ETDEWEB)

    Ueno, K. [Building Science Corporation (BSC), Somerville, MA (United States); Lstiburek, J. [Building Science Corporation (BSC), Somerville, MA (United States); Bergey, D. [Building Science Corporation (BSC), Somerville, MA (United States)

    2012-12-01

    In multifamily buildings, central ventilation systems often have poor performance, overventilating some portions of the building (causing excess energy use), while simultaneously underventilating other portions (causing diminished indoor air quality). BSC and Innova Services Corporation performed a series of field tests at a mid-rise test building undergoing a major energy audit and retrofit, which included ventilation system upgrades.

  14. VENTILATION MODEL REPORT

    Energy Technology Data Exchange (ETDEWEB)

    V. Chipman

    2002-10-31

    The purpose of the Ventilation Model is to simulate the heat transfer processes in and around waste emplacement drifts during periods of forced ventilation. The model evaluates the effects of emplacement drift ventilation on the thermal conditions in the emplacement drifts and surrounding rock mass, and calculates the heat removal by ventilation as a measure of the viability of ventilation to delay the onset of peak repository temperature and reduce its magnitude. The heat removal by ventilation is temporally and spatially dependent, and is expressed as the fraction of heat carried away by the ventilation air compared to the fraction of heat produced by radionuclide decay. One minus the heat removal is called the wall heat fraction, or the remaining amount of heat that is transferred via conduction to the surrounding rock mass. Downstream models, such as the ''Multiscale Thermohydrologic Model'' (BSC 2001), use the wall heat fractions as outputted from the Ventilation Model to initialize their postclosure analyses.

  15. Diffuse ceiling ventilation

    DEFF Research Database (Denmark)

    Zhang, Chen

    both thermal comfort and energy efficient aspects. The present study aims to characterize the air distribution and thermal comfort in the rooms with diffuse ceiling ventilation. Both the stand-alone ventilation system and its integration with a radiant ceiling system are investigated. This study also...

  16. 慢性阻塞性肺疾病患者采用压力支持通气模式撤机时调节压力上升时间对呼吸形态的影响%Effect of different inspiratory rise time during pressure support ventilation in patients recovering from acute exacerbations of chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    王艳茹; 潘文森; 许晓岚; 张鲁涛

    2011-01-01

    Objective To explore the effects of different inspiratory rise time in patients recovering from acute exacerbation of chronic obstructive pulmonary disease. Methods 23 patients of acute exacerbation of chronic obstructive pulmonary disease were ventilated with pressure support ventilation at two different inspiratory rise time in turn. The parameters in two conditions of respiration, the vital signs and scales of dyspnea were monitored and compared. Results From the shorter to the longer inspiratory rise time, the tidal volume became bigger,inspiratory time extended,the inspiratory peak flow decreased,airway occlusion pressure increased, the visual analogue score and Borg score of dyspnea exacerbated ( P < 0.05 or < 0.01 ). The visual analogue score and Borg score of dyspnea positively correlated with airway occlusion pressure. The coefficients of correlation were 0. 510 and 0. 640 respectively (both P < 0.05). Conclusion To patients recovering from acute exacerbations of chronic obstructive pulmonary disease,ventilation with pressure support ventilation at the shorter inspiratory rise time decreases the effort of breathing and the scales of dyspnea. Airway occlusion pressure, the visual analogue score and Borg score of dyspnea may be helpful to select appropriate inspiratory rise time.%目的 探讨不同压力上升时间设定对采用压力支持通气模式(PSV)撤机的慢性阻塞性肺疾病(COPD)患者的影响.方法 对23例因呼吸衰竭已经气管插管机械通气并至恢复期的COPD患者进行压力支持通气,采用自身前后对照方法,先后给予较短压力上升时间和较长压力上升时间两种设定,观察患者呼吸形态、生命体征和呼吸困难情况.结果 从较短压力上升时间至较长压力上升时间潮气量增加(0.45±0.08)L vs(0.49±0.10)L、吸气时间延长(0.92±0.13)秒vs(0.49±0.10)秒、吸气峰值流速减小(53.92±8.33)L/min vs(41.69±7.53)L/min、气道闭合压增大(1.88±0.08)mmHg vs

  17. Effects of Doxofyline on Intraoperative Pulmonary Function in Patients Undergoing Double Lumen Endotracheal Intubation for One-lung Ventilation%多索茶碱对双腔气管插管单肺通气患者术中肺功能的影响

    Institute of Scientific and Technical Information of China (English)

    王武; 吴绍芳; 潘晓霞; 雷李培

    2016-01-01

    Objective To evaluate the effects of doxofyline on intraoperative pulmonary function in patients receiving double lumen endotracheal intubation for one-lung ventilation. Methods Fifty patients who underwent elective pulmonary lo-bectomy under general anesthesia using double lumen endotracheal intubation were randomly divided into two groups ( n=25 each):control group (group C) and doxofyline group (group D).Doxofyline (4 mg•kg-1) was injected intravenously after double lumen endotracheal intubation in group D,while equal volume of 0.9% sodium chloride was intravenously given in group C.Total intravenous anesthesia with target controlled infusion was performed during the operation.Two milliliter blood samples were taken from the radial artery for blood gas analysis immediately before administration ( t0 ) ,at 30 min ( t1 ) ,60 min ( t2 ) after one-lung ventilation and at the moment of two-lung ventilation after chest closing ( t3 ) . The PaCO2 , PaO2 , peak airway pressure (Ppeak),airway plateau pressure (Pplat),airway resistance (Raw) and lung compliance (Compl) were recorded at t0-3. Results The Ppeak,Pplat and Raw were significantly decreased and the Compl and PaO2 significantly increased at t1-t3 in group D when com-pared with those in group C (P<0.05).The Ppeak,Pplat and Raw were significantly increased and Compl and PaO2 significantly de-creased at t3 as compared with those at t0 in group C ( P<0.05) . Conclusion Doxofyline can improve intraoperative pulmonary function in patients who undergo double lumen endotracheal intubation for one-lung ventilation.%目的:评价多索茶碱对双腔气管插管单肺通气患者术中肺功能的影响。方法择期双腔气管插管全身麻醉下行开胸肺叶切除术患者50例,采用随机数字表法分为对照组( C组)和多索茶碱组( D组)( n=25)。 D组于双腔气管插管后静脉输注多索茶碱4 mg•kg-1;C组静脉输注等量0.9%氯化钠注射液。麻醉维持采用靶控输注全

  18. Pulmonary embolus

    Science.gov (United States)

    ... Blood clot - lung; Embolus; Tumor embolus; Embolism - pulmonary; DVT-pulmonary embolism; Thrombosis - pulmonary embolism ... area). This type of clot is called a deep vein thrombosis (DVT) . The blood clot breaks off and travels ...

  19. Non-invasive ventilation for cystic fibrosis.

    Science.gov (United States)

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

    2017-02-20

    capacity (interface used was unclear) and did not reported on any of the review's primary outcomes. The trial found no clear differences between non-invasive ventilation compared to no non-invasive ventilation for any of our outcomes.Three trials reported on adverse effects. One trial, evaluating non-invasive ventilation for airway clearance, reported that a participant withdrew at the start of the trial due to pain on respiratory muscle testing. One trial evaluating non-invasive ventilation for overnight support reported that one participant could not tolerate an increase in inspiratory positive airway pressure. A second trial evaluating non-invasive ventilation in this setting reported that one participant did not tolerate the non-invasive ventilation mask, one participant developed a pneumothorax when breathing room air and two participants experienced aerophagia which resolved when inspiratory positive airway pressure was decreased. Non-invasive ventilation may be a useful adjunct to other airway clearance techniques, particularly in people with cystic fibrosis who have difficulty expectorating sputum. Non-invasive ventilation, used in addition to oxygen, may improve gas exchange during sleep to a greater extent than oxygen therapy alone in moderate to severe disease. The effect of NIV on exercise is unclear. These benefits of non-invasive ventilation have largely been demonstrated in single treatment sessions with small numbers of participants. The impact of this therapy on pulmonary exacerbations and disease progression remain unclear. There is a need for long-term randomised controlled trials which are adequately powered to determine the clinical effects of non-invasive ventilation in cystic fibrosis airway clearance and exercise.

  20. 低潮气量机械通气对瓣膜置换病人肺换气功能影响的临床研究%Effects of low tidal volume ventilation on pulmonary gas exchange before and after mitral valve replacement with cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    蔡宏伟; 田玉科; 任飞; 张海萍

    2006-01-01

    [Objective] To investigate the effect of low tidal volume ventilation on pulmonary gas exchange in patients undergoing mitral valve replacement with cardiopulmonary bypass (CPB). [Methods] A prospective randomized study was done in university hospital. Thirty patients undergoing mitral valve replacement with CPB were randomized to receive traditional tidal volume ventilation (TV; tidal volume, 9 mL/kg; respiratory rate, 12 times/min),or low tidal volume ventilation with conventional respiratory rate (LV; tidal volume, 7 mL/kg; respiratory rate, 12times/min), or low tidal volume ventilation with high respiratory rate (HR; tidal volume 7 mL/kg, 15 times/min)throughout surgery. During CPB, patients' lungs were kept inflated with 100% oxygen. [Results] Pulmonary gas exchange parameters were determined twice before CPB and after CPB. When final values after CPB were compared with the values before CPB, the arterial oxygen tension-inspired oxygen concentration ratio (PaO2/FiO2) was significantly decreased, and alveolar-artetal (A-a) oxygen gradient [P(A-a)O2] and intrapulmonary shunt (Qs/QT) were significantly increased in group LV. No significant differences were found in either group TV or group HR. [Conclusions] Low tidal volume ventilation with conventional respiratory rate in patients undergoing mitral valve replacement impaired pulmonary gas exchange early after CPB, while low tidal volume ventilation with high respiratory rate did not. These results suggest that low tidal volume ventilation with high respiratory rate may be useful for reducing lung injury caused by CPB and mechanical ventilation in patients undergoing mitral valve replacement.%目的以心输出量和肺换气功能为指标研究低潮气量通气对瓣膜置换病人心肺功能的影响.方法30例择期行二尖瓣置换手术病人随机分成3组:常规(传统)潮气量组(组Ⅰ),潮气量9mL/kg,呼吸频率12次/min;低潮气量常规频率组(组Ⅱ),潮气量7 mL/kg,呼吸频率12次/min

  1. Combined Treatment of Mechanical Ventilation and External Fixation of Chest Wall for Frail Chest Complicated by Pulmonary Contusion%机械通气加胸壁外固定在连枷胸合并肺挫伤治疗中的作用

    Institute of Scientific and Technical Information of China (English)

    王亚莉; 付茂勇

    2009-01-01

    Objective To evaluate the therapeutic effect of combined treatment of mechanical ventilation and external fixation of chest wall for frail chest complicated by pulmonary contusion. Methods A retrospective analysis was conducted based on the clinical data of 21 patients with frail chest complicated by pulmonary contusion between January, 2005 and December, 2008. Results Parameters of the patients' blood gas analysis such as PaO2,SpO2,and PaO2/FiO2 all significantly improved and PaCO2 significantly decreased compared with those before the treatment( P<0.01);meanwhile, the patients' comfort level was significantly improved( P< 0.01).Of 22 patients, 19 were successfully cured and 3 died. Conclusion It was found that the combined treatment of mechanical ventilation and external fixation of chest wall was able to significantly improve the conditions of the patients with frail chest complicated by pulmonary contusion as well as lessen their discomfort.%目的 评价机械通气加胸壁外固定在治疗连枷胸合并急性肺挫伤中的作用.方法 回顾性总结分析我院2005年1月至2008年12月的22例行机械通气加胸壁外固定治疗连枷胸合并肺挫伤的患者临床资料.结果 行机械通气加胸壁外固定术联合治疗后动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、氧合指数(PaO2/FiO2)和脉搏血氧饱和度(SpO2)均较治疗前有明显改善(P<0.01),患者舒适度明显提高(P<0.01);治愈19例,死亡3例.结论 机械通气加胸壁外固定在治疗连枷胸合并急性肺挫伤中能明显改善病情,减轻患者不适.

  2. Inhaled nitric oxide combining high frequency oscillatory ventilation and oral sildenafil for refractory persistent pulmonary hypertension of newborn%iNO联合高频震荡通气并西地那非口服对难治性 PPHN 的作用

    Institute of Scientific and Technical Information of China (English)

    李菊花; 康鹏讲; 张茹; 安媛; 张小敏; 于瑛; 张阿维; 刘俐

    2015-01-01

    Objective To investigate the clinical effect of inhaled nitric oxide (iNO) combining high frequency oscillatory ventilation ( HFOV) and oral sildenafil for refractory persistent pulmonary hypertension of newborns ( PPHN) .Methods Thirteen cases of refractory PPHN, receiving normal frequency ventilation and nitric oxide inhalation without effect in neonatal intensive care unit ( NICU) of Xianyang Pediatrics Hospital from January 2012 to January 2014, accepted HFOV and iNO therapy.The changes of PaO2 , PaCO2 , SaO2 , FiO2 , pulmonary artery pressure, mean pressure and oxygenation index before and after treatment were analyzed.Results Two hours after the treatment, PaCO2 did not change remarkably (t=0.86,P>0.05), while PaO2 was significantly different (t=4.54,P0.05), but pulmonary artery pressure declined by 28%compared with that before treatment (t=7.51, P0.05),而PaO2 干预前后存在显著统计学差异(t=4.54,P0.05),而肺动脉压较治疗前显著下降28%(t=7.51,P<0.01). 治疗后24h与治疗后2h比较,FiO2 较前持续下降约31%(t=6.76,P<0.01),氧合指数提高约83%(t=5.92,P<0.01),存在显著统计学差异. 经治疗有效12例,无效1例,有效率为92.3%. 结论 iNO联合高频震荡通气并西地那非口服治疗能够有效改善患儿血氧指标,对难治性新生儿持续肺动脉高压疗效显著,增加了持续性肺动脉高压抢救成活率.

  3. Ventilation rates and health

    DEFF Research Database (Denmark)

    Sundell, Jan; Levin, H; Nazaroff, W W

    2011-01-01

    The scientific literature through 2005 on the effects of ventilation rates on health in indoor environments has been reviewed by a multidisciplinary group. The group judged 27 papers published in peer-reviewed scientific journals as providing sufficient information on both ventilation rates...... and health effects to inform the relationship. Consistency was found across multiple investigations and different epidemiologic designs for different populations. Multiple health endpoints show similar relationships with ventilation rate. There is biological plausibility for an association of health outcomes...... studies of the relationship between ventilation rates and health, especially in diverse climates, in locations with polluted outdoor air and in buildings other than offices. PRACTICAL IMPLICATIONS: Ventilation with outdoor air plays an important role influencing human exposures to indoor pollutants...

  4. CFD and Ventilation Research

    DEFF Research Database (Denmark)

    Li, Y.; Nielsen, Peter V.

    2011-01-01

    There has been a rapid growth of scientific literature on the application of computational fluid dynamics (CFD) in the research of ventilation and indoor air science. With a 1000–10,000 times increase in computer hardware capability in the past 20 years, CFD has become an integral part of scienti......There has been a rapid growth of scientific literature on the application of computational fluid dynamics (CFD) in the research of ventilation and indoor air science. With a 1000–10,000 times increase in computer hardware capability in the past 20 years, CFD has become an integral part...... of scientific research and engineering development of complex air distribution and ventilation systems in buildings. This review discusses the major and specific challenges of CFD in terms of turbulence modelling, numerical approximation, and boundary conditions relevant to building ventilation. We emphasize...... analysis in ventilation research, rather it has become an increasingly important partner....

  5. Shrinking the room for invasive ventilation in hypercapnic respiratory failure

    Directory of Open Access Journals (Sweden)

    Scarpazza P

    2013-03-01

    Full Text Available Paolo Scarpazza,1 Cristoforo Incorvaia,2 Chiara Melacini,1 Roberta Cattaneo,1 Cristiano Bonacina,1 Gian Galeazzo Riario-Sforza,2 Walter Casali1 1Pneumology Unit, Ospedale Civile, Vimercate, 2Pulmonary Rehabilitation, Istituti Clinici di Perfezionamento, Milan, Italy Abstract: Noninvasive ventilation (NIV was introduced as an alternative to invasive mechanical ventilation for acute respiratory failure caused from exacerbations of chronic obstructive pulmonary disease in the 1980s, and its use gradually rose worldwide. Seventy-eight patients (57 males, mean age 78.3 ± 9.2 years undergoing NIV were evaluated. Of them, 48 (62.3% had acute hypercapnic respiratory failure because of a chronic obstructive pulmonary disease exacerbation, and the remaining 30 had acute hypercapnic respiratory failure from other causes, mainly cardiac failure. All patients were treated by NIV using the bi-level positive airway pressure set up at high pressure/high backup rate. NIV was successful in 67 subjects (85.9% and the patients were discharged, 57 of whom continued NIV at home and ten had spontaneous breathing. NIV was unsuccessful in eleven patients, ten of whom died and one was successfully treated by invasive mechanical ventilation. Significant differences were detected for a higher basal Glasgow Coma Scale score in successfully treated patients (P = 0.007, a higher basal Acute Physiology and Chronic Health Evaluation score in unsuccessfully treated patients (P = 0.004, and a lower pH after 1 hour in unsuccessfully treated patients (P = 0.015. These findings show a very high rate of success of NIV in patients with acute hypercapnic respiratory failure not only from chronic obstructive pulmonary disease but also from cardiac failure. This suggests that the use of invasive mechanical ventilation may be further reduced, with a decrease in its known complications as well. Keywords: invasive ventilation, noninvasive ventilation, acute respiratory failure

  6. 不同通气模式在重症肺源性心脏病呼吸衰竭中的应用效果%The application effect of different modes of ventilation on severe respira-tory failure due to pulmonary heart disease

    Institute of Scientific and Technical Information of China (English)

    李风波

    2015-01-01

    目的:探讨不同通气模式在重症肺源性心脏病呼吸衰竭中的应用效果。方法选取本院2011年1月~2014年1月收治的50例重症肺源性心脏病呼吸衰竭患者,随机分为观察组和对照组,每组25例。两组患者均给予常规处理,观察组实施有创-无创序贯通气,对照组行有创通气。观察两组治疗过程中的呼吸、血压、动脉血气指标改变情况;记录机械通气时间和住院时间。结果观察组呼吸频率、动脉收缩压、心率、氧分压、二氧化碳分压、pH值分别与对照组比较,差异无统计学意义(P>0.05)。观察组患者机械通气时间和住院时间短于对照组,呼吸机相关肺炎发生率低于对照组,差异有统计学意义(P0.05).The mechanical ventilation and hospitalization time in the observation group was shorter than that of control group,the incidence of ventilator associated pneumonia was lower than that in the control group,the difference was significant (P<0.05). Conclusion Sequential invasive-non-invasive mechanical ventilation on patients severe respiratory failure due to pulmonary heart disease has significant ef-fect,which can shorten the time of hospitalization and reduce ventilator complications,the therapy is worthy of reference.

  7. Narcoanalysis of pneumonorestion with video-assisted thoracic surgery during one-lung ventilation

    Institute of Scientific and Technical Information of China (English)

    Lairong Sun; Lianbing Gu

    2012-01-01

    Objective: The aim of our study was to analyze the anesthesia of pneumonoresection in lung cancer patients with video-assisted thoracic surgery during one-lung ventilation. Methods: After fast-speed venous induced anesthesia, double-lumen bronchial catheter or endobronchial blocker tube were intubated in 551 patients, the position of double-lumen endobronchial tube or single lumen tube + endobronchial blocker tube was confirmed with fiber-optic bronchoscope after intubation. Interstitial positive pressure ventilation were used in all patients with video-assisted thoracic surgery (VATS) interstitial positive pressure ventilation, positive end expiratory pressure and continuous positive airway pressure in collapse lobers of lung were used in one lung ventilation, and ventilation parameters were adjusted necessarily. Results: 541 cases double-tubes bronchial catheter intubation and endobronchial blocker tube used by fiberscope were located very well. The level of SPO2, PEtCO2 could be maintained normal. Ten cases were forced to converse video-assisted thoracic surgery to thoracotomy because of 4 cases pulmonary adhesion, 4 cases severe pulmonary dysfunction hard to correct hyoxemia and 2 case abnormal anatomy respectively. Conclusion: Anesthesia key of video-assisted thoracic surgery is that double lung must separated completely. Effective management of one lung ventilation could make patients to pass perioperation smoothly. Long-time one lung ventilation such as pulmonary adhesion, severe pulmonary dysfunction should be considered to be relative contraindication.

  8. Chest trauma: A case for single lung ventilation.

    Science.gov (United States)

    Pandharikar, Nagaraj; Sachdev, Anil; Gupta, Neeraj; Gupta, Suresh; Gupta, Dhiren

    2016-04-01

    Chest trauma is one of the important causes of mortality and morbidity in pediatric trauma patients. The complexity, magnitude, and type of lung injury make it extremely challenging to provide optimal oxygenation and ventilation while protecting the lung from further injury due to mechanical ventilation. Independent lung ventilation is used sporadically in these patients who do not respond to these conventional ventilatory strategies using double-lumen endotracheal tubes, bronchial blocker balloons, etc. However, this equipment may not be easily available in developing countries, especially for pediatric patients. Here, we present a case of severe chest trauma with pulmonary contusion, flail chest, and bronchopleural fistula, who did not respond to conventional lung protective strategies. She was successfully managed with bronchoscopy-guided unilateral placement of conventional endotracheal tube followed by single lung ventilation leading to resolution of a chest injury.

  9. Chest trauma: A case for single lung ventilation

    Directory of Open Access Journals (Sweden)

    Nagaraj Pandharikar

    2016-01-01

    Full Text Available Chest trauma is one of the important causes of mortality and morbidity in pediatric trauma patients. The complexity, magnitude, and type of lung injury make it extremely challenging to provide optimal oxygenation and ventilation while protecting the lung from further injury due to mechanical ventilation. Independent lung ventilation is used sporadically in these patients who do not respond to these conventional ventilatory strategies using double-lumen endotracheal tubes, bronchial blocker balloons, etc. However, this equipment may not be easily available in developing countries, especially for pediatric patients. Here, we present a case of severe chest trauma with pulmonary contusion, flail chest, and bronchopleural fistula, who did not respond to conventional lung protective strategies. She was successfully managed with bronchoscopy-guided unilateral placement of conventional endotracheal tube followed by single lung ventilation leading to resolution of a chest injury.

  10. Regional ventilation/perfusion mismatch pattern in patient with Swyer James (MacLeod′s syndrome

    Directory of Open Access Journals (Sweden)

    Sait Sager

    2014-01-01

    Full Text Available Swyer James (McLeod′s syndrome (SJMS is an uncommon disease, which occurs as a result of childhood bronchiolitis obliterans. Patients may not be diagnosed until later in their life. A 46-year-old man underwent ventilation/perfusion scintigraphy for acute onset of dyspnea. The scan showed markedly diminished ventilation and perfusion unilaterally on the right middle and inferior lobes. However, mismatched ventilation-perfusion pattern was shown on the upper right lobe, which was consistent with pulmonary embolism. Unilaterally matched ventilation/perfusion defect can see in SJMS in lung scintigraphy; however, when pulmoner embolism may accompany, scintigraphy should be carefully examined.

  11. The patient simulator for training of anesthesia residents in the management of one lung ventilation.

    Science.gov (United States)

    Hassan, Zaki-Udin; Dorfling, Johannes; McLarney, John T; Sloan, Paul A

    2008-01-01

    Simulators are used extensively for the training of medical personnel. All anesthesia providers should be prepared and trained in the management of one lung ventilation for pulmonary surgery, yet familiarization with one lung ventilation may not be possible on a routine basis in the operating room. Therefore, this reports details the first use of the patient simulator (PS) to enhance the training of anesthesia residents in the management of one lung ventilation. A detailed report of our computer program for simulating one lung ventilation is included.

  12. Effects of Salbutamol on Respiratory Mechanics during One-lung Ventilation Early in Patients with Chronic Obstructive Pulmonary Disease%沙丁胺醇对慢性阻塞性肺疾病患者单肺通气早期呼吸力学的影响

    Institute of Scientific and Technical Information of China (English)

    周其富; 俞渭生

    2012-01-01

    OBJECTIVE To study the effects of salbutamol aerosol inhalation prior to anesthesia induction on respiratory mechanics during one lung ventilation early in patients with chronic obstructive pulmonary disease. METHODS Forty patients with concomitant COPD, scheduled for lobectomy were randomly allocated into observation group(n=20) and control group(n=20) . Salbutamol aerosol 200 ug (two puffs) were administered according to instructions before oxygenation via mask in observation group, whereas in control group no aerosol was given before oxygenation via mask. Anesthesia induction was initiated after 30 min oxygenation in both groups. Changes of blood gas analysis, peak and platform pressure of airway, airway resistance and chest-lung compliance were monitored. RESULTS Compared with control group, value of PaCO2 in anesthesia induction , double lung ventilation, 10 minutes and 20 minutes after one lung ventilation were lower in observation group, however, PaO2 were higher in respective time, P<0.05 or P<0.01; When compared with control group,the peak of and platform pressure of airway, airway resistance in double lung ventilation, 10 minutes and 20 minutes after one lung ventilation were lower in observation group and chest-lung compliance was higher in observation group, P<0.05. CONCLUSION Salbutamol aerosol inhalation can reduce airway pressure and airway resistance and increase chest-lung compliance during one lung ventilation in patients with COPD. It can improve anestheia safety and it is advantageous for breathing management during operation.%目的 麻醉诱导前吸入硫酸沙丁胺醇气雾剂(万托林),观察其对单肺通气早期呼吸力学的影响.方法 合并慢性肺阻塞疾患(COPD)拟行肺叶切除手术的患者40例,随机分成观察组和对照组各20例,观察组:患者给予万托林200 μg(2揿)后面罩吸氧;对照组:单纯面罩吸氧,30 min后开始麻醉诱导.记录监测时点的血气分析以及气道峰压、气道平台

  13. The effects of sufentanil on oxygenation and pulmonary shunt fraction during one-lung ventilation%单肺通气期间舒芬太尼和芬太尼镇痛对血液氧合和肺内分流的影响

    Institute of Scientific and Technical Information of China (English)

    钱梅; 陈士寿; 鲁显福; 顾尔伟; 李元海

    2014-01-01

    Objective To evaluate the effects of sufentanil and fentanyl on oxygenation and pulmonary shunt fraction during one-lung ventilation (OLV).Methods Twenty six patients (ASA Ⅰ-Ⅱ) undergoing thoracic surgery for esophagectomy were randomly divided into 2 groups (n=13):sufentanil group (group A) and fentanyl group (group B).Anesthesia was induced with midazolam 0.1 mg/kg,propofol 1 mg/kg-2 mg/kg,sufentanil 0.3 μg/kg (group A) or fentanyl 3 μg/kg (group B) and vecuronium 0.1 mg/kg.Anesthesia was maintained with propofol 3 mg·kg-1· h-1-6 mg· kg-1 ·h-1 to the end,vecuronium 0.05 mg/kg when necessary and sufentanil 0.1 μg/kg-0.2 μg/kg or fentanyl 1 μg/kg-2 μg/kg before cut off the skin and after the end of OLV.Blood samples were obtained from radial artery and right internal jugular vein respectively for determining arterial partial pressure of oxygen (PaO2) and pulmonary shunt fraction (Qs/Qt) at total-lung ventilation (TLV-T0) and 30 (OLV 30 min),60 min (OLV 60 min) after OLV.Results PaO2 was significantly decreased at OLV 30 min and OLV 60 min compared with TLV-T0 [Group A:OLV 30 min-PaO2 (138±29) mmHg(1 mmHg=0.133 kPa),OLV 60 min PaO2 (135±26) mmHg,TLV-T0-PaO2 (225±30) mmHg.Group B:OLV 30 min-PaO2 (121±31) mmHg,OLV 60 min PaO2 (120±29) mmHg,TLV-T0-PaO2 (217±29) mmHg](P<0.05).But PaO2,Qs/Qt,PvO2,blood oxygen saturation(SaO2) and arterial oxygen content(CaO2) have no significantly differences between two groups during one-lung ventilation.Conclusions Compared with fentanyl,sufentanil have no significantly improving function on oxygenation and pulmonary shunt fraction during OLV.%目的 研究单肺通气(one-lung ventilation,OLV)期间舒芬太尼和芬太尼对血液氧合及肺内分流的影响. 方法 择期食道癌根治术患者26例,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,采用随机数字表法分为A、B两组(每组13例),A组麻醉诱导:咪达唑仑0.1 mg/kg、丙泊酚l mg/kg~2 mg/kg、舒芬太尼0.3 μg/kg、维库溴铵0

  14. 双水平气道正压通气与同步间歇指令通气治疗新生儿肺出血%Clinical outcomes of bi-level positive airway pressure and synchronous intermittent mandato-ry ventilation for neonates with pulmonary hemorrhage

    Institute of Scientific and Technical Information of China (English)

    张士发; 邰海服; 胡芳; 陈爱斌; 茅双根

    2014-01-01

    目的:探讨双水平气道正压通气( BIPAP)与同步间歇指令通气( SIMV)模式联合气管内滴注凝血酶治疗新生儿肺出血的疗效。方法:将63例肺出血新生儿随机分为SIMV组(30例)和BIPAP组(33例),两组均同时采用气管内滴注注射血凝酶治疗,每种模式通气12 h,稳定后分别记录两组的呼吸力学指标RR、Vte、PIP( PEEPH )、Pmean、Crs、氧动力学指标PaCO2、PaO2、SaO2、PaO2/FiO2;并比较两组患儿最终的病死率、肺出血停止平均时间、撤离呼吸机时间、镇静剂(咪达唑仑)使用总剂量(mg)和并发症发生率。结果:两组的呼吸力学指标:RR、PIP(PEEPH)和Pmean BIPAP组低于SlMV组(P<0.05),而Crs BI-PAP组高于SIMV组(P<0.05);氧动力学指标:PaO2和PaO2/FiO2BIPAP组高于SIMV组(P<0.05);病死率两组差异无统计学意义( P>0.05);肺出血停止平均时间、撤离呼吸机时间、镇静剂(咪达唑仑)使用总剂量BIPAP组均低于SlMV组( P<0.05),BIPAP组并发症发生率高于SlMV组(4.00%vs 31.82%,P<0.05)。结论:BIPAP通气模式人机协同性好;通过改善氧合及呼吸力学效应,有效防治肺出血,缩短病程,减少呼吸机相关并发症的发生,治疗新生儿肺出血优于SIMV。%Objective:To observe the clinical effects of endotracheal use of hemocoagulase via bi-level positive airway pressure( BIPAP) and synchronous intermittent mandatory ventilation(SIMV) on the neonates with pulmonary hemorrhage.Methods:Sixty-three neonates with pulmonary hemorrhage were randomly allocated to group of SIMV(n=30) and BIPAP(n=33).The two groups were managed with endotracheal drip of hemocoagulase for 12 h by ei-ther ventilation modality,and maintained regarding the indexes of respiratory mechanics (RR,Vte,PIP,Pmean,Crs) and oxygen kinetics(PaCO2,PaO2, SaO2,PaO2/FiO2) upon stable status.Still,the two groups were

  15. Changes in expression of aquaporin 1 and aquaporin 4 in lung tissues during one-lung ventilation in patients undergoing pulmonary lobectomy%肺叶切除术患者单肺通气时肺组织水通道蛋白1和水通道蛋白4表达的变化

    Institute of Scientific and Technical Information of China (English)

    李玮; 林飞; 潘灵辉; 黄冰; 梁锐; 魏玥

    2013-01-01

    Objective To evaluate the changes in the expression of aquaporin 1 (AQP1) and aquaporin4 (AQP4) in lung tissues during one-lung ventilation in patients undergoing pulmonary lobectomy.Methods Forty ASA physical status Ⅰ or Ⅱ patients,aged 30-64 yr,weighing 45-79kg,undergoing pulmonary lobectomy,were randomly divided into 2 groups(n=20 each):two-lung ventilation group (group T) and one-lung ventilation group (group O).Anesthesia was induced with iv injection of midazolam,fentanyl,vecuronium and propofol.In group T,the patients were intubated with a single-lumen endotracheal tube and two-lung ventilation was performed.In group O,double-lumen endobranchial tube was inserted,and two-lung ventilation was performed followed by onelung ventilation after chest opening.PET CO2 was maintained at 5.3-24.0 kPa and SpO2 was maintained > 92%.Anesthesia was maintained with iv infusion of remifentanil,propofol and vecuronium.The normal lung tissues were obtained from the site near the pathologic changes for microscopic examination (with light microscope) and examination of the ultrastructure (with transmission electron microscope),and for determination of W/D lung weight ratio,the expression of AQP1 mRNA and AQP4 mRNA (by RT-PCR) and the expression of AQP1 protein and AQP4 protein (by Western blot).Results Compared with group T,W/D lung weight ratio was significantly increased,the expression of AQP1 mRNA and protein was down-regulated in group O (P < 0.05),and no significant changes were found in the expression of AQP4 mRNA and protein in group O (P > 0.05).Pathological changes were observed in group O.Conclusion Down-regulation of AQP1 expression may be involved in the acute lung injury induced by one-lung ventilation in patients undergoing pulmonary lobectomy,however,AQP4 has no such effect.%目的 评价肺叶切除术患者单肺通气时肺组织水通道蛋白1(AQP1)和水通道蛋白4(AQP4)表达的变化.方法 择期拟行肺叶切除术患者40

  16. Clinical research of different ventilation modes combined with pulmonary surfactant and ;mucosolvan in the treatment of preterm newborns with hyaline membrane disease%不同通气模式联合肺表面活性物质、沐舒坦治疗早产儿肺透明膜病的临床研究

    Institute of Scientific and Technical Information of China (English)

    吴杰斌; 周彬; 翟敬芳; 金宝; 张艳艳

    2015-01-01

    Objective To investigate the clinical application effect of different ventilation modes combined with pulmonary surfactant and mucosolvan in the treatment of preterm newborns with hyaline membrane disease (HMD). Methods 76 cases of preterm infants with HMD (Ⅲ-Ⅳgrade) from Xuzhou central hospital neonatal intensive care unit (neonatal intensive care unit, NICU) from 2013 January to 2015 February were randomly divided into two group, high frequency oscillatory ventilation (HFOV) group 40 cases and conventional mechanical ventilation (CMV) group 36 cases, at the beginning of mechanical ventilation, the two groups began to use the pulmonary surfactant (PS), while HFOV group used intravenous mucosolvan 30 mg/kg daily. The main observation was the comparison of blood gas indicators before and after mechanical ventilator, the indicators changes of related respiratory function and the complication rate, et al. Results PaO2, PaO2/FiO2, Oxygenation index (OI=100×MAP×FiO2/ PaO2) and arterial/alveolar oxygen partial pressure ratio (713×FiO2-PaCO2/0.8) were improved significantly in HFOV group compared with CMV group (P<0.05). There was no statistical significance between both groups in the number of deaths, ventilation time, gas leak syndrome, bronchopulmonary dysplasia (BPD), retinopathy of premature children (ROP), intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL). Conclusion High-frequency oscillatory ventilation mode combined with pulmonary surfactant and mucosolvan could improve arterial blood gas index and respiratory function index and improve oxygenation, it has application value and should be applied extensively.%目的:观察不同通气模式联合肺表面活性物质(PS)、沐舒坦治疗早产儿肺透明膜病的疗效。方法收集2013年1月至2015年2月徐州市中心医院新生儿重症监护病房(NICU)收治76例患肺透明膜病(HMD)(Ⅲ~Ⅳ级)机械通气早产儿,采用随机数字表法将患

  17. Effects of different intensity jogging on female college students’body composition and pulmonary ventilation function%不同强度健身跑对女大学生身体成分和肺通气功能的影响

    Institute of Scientific and Technical Information of China (English)

    郑美霞; 王斌; 孟江华

    2014-01-01

    In order to improve the effectiveness of long-distance running in winter in College Students' Sunshine Sports and discuss the different aerobic fitness running effects on female college students ’body composition and pulmonary ventilation function, this paper chose our school’s 60 healthy female college students in the second grade as the research object. Through 16 weeks of different strength group fitness running experiments, results showed that:low and Medium intensity group has the greater influence on body composition, three indexes such as the largest percentage of fat, body mass index and waist hip ratio of the average magnitude of the change have the most significant difference (p<0.01).High intensity group is the smallest. According to two indices of pulmonary function test of the different groups, three intensity jogging enable students to increase pulmonary function indices, but the pulmonary function of students of medium intensity of jogging can be improved significantly. There are significant differences (p<0.01) between two pulmonary ventilation indicators.%为提高大学生阳光体育冬季长跑的实效性,探讨不同强度有氧健身跑对女大学生身体成分和肺通气功能的影响,选择北京林业大学60名大二健康女大学生为研究对象,运用文献资料法、教学实验法和数理统计法,进行了16周不同强度组别健身跑实验。结果发现:中、小强度健身跑锻炼对学生身体成分的影响显著,在脂肪百分比、身体质量指数、腰臀比指标均值改变的幅度最大,差异最显著(p<0.01);高强度健身跑锻炼对身体成分的影响较小;通过对不同强度组学生两项肺功能指标测试,三种强度的健身跑使学生的肺功能指标均有一定幅度的提高,但中等强度健身跑对学生肺功能影响最大,提高幅度最明显,两项指标均呈现显著性差异(p<0.01)。

  18. Application value of end-tidal carbon dioxide partial pressure monitoring in patients with acute cardiogenic pulmonary edema receiving early nonivasive positive pressure ventilation%潮气末二氧化碳分压监测在急性心源性肺水肿患者早期无创正压通气救治中的应用价值

    Institute of Scientific and Technical Information of China (English)

    唐友勇; 王正艳; 杨中卫; 李威; 石明; 邝军

    2016-01-01

    目的 探讨潮气末二氧化碳分压(PETCO2)监测在急性心源性肺水肿患者早期无创正压通气救治中的应用价值.方法 选择2011年2月至2015年5月在湖北医药学院附属东风医院急性心源性肺水肿患者88例,均给予无创正压通气治疗,在通气前后进行血流动力学(心率、收缩压、舒张压、平均动脉压(MAP)、心排血量、心脏指数、心搏指数)、血气指标[pH、动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)]与PETCO2监测,并随访调查预后情况.结果 通气后患者的心排血量、心脏指数与心搏指数值明显降低,与通气前比较差异有统计学意义[(3.3±1.1) L/min比(4.1 ±1.1)L/min、(2.1 ±0.4)L/(min·m2)比(2.6 ±0.6) L/(min·m2)、(25±7)ml/m2比(29±4)ml/m2,P<0.05];心率、收缩压、舒张压与MAP通气前后差异无统计学意义(P>0.05).通气后患者的血气pH、PaO2值较通气前高,而PaCO2值较通气前低,差异有统计学意义[(7.35±0.45)比(7.23±0.24)、(88 ±9) mmHg(1 mmHg =0.133 kPa)比(52±8) mmHg、(39±8)mmHg比(47±9) mmHg,P<0.05].通气后患者的PETCO2为(34±5) mmHg,明显高于通气前的(28±5)mmHg,差异有统计学意义(P<0.05).随访至2016年1月,88例患者中发生联合心血管不良事件12例,发生率为13.6%;Pearson相关分析显示急性心源性肺水肿的预后与通气前的PETCO2、心脏指数、心搏指数及PaCO2存在明显相关性(r=0.443、0.342、0.294、0.331,P<0.05).结论 无创正压通气早期救治急性心源性肺水肿能有效改善心功能与血气状况,对于PETCO2也有明显影响,而PETCO2监测能有效判定病情,预测预后情况.%Objective To investigate the application value of end-tidal carbon dioxide partial pressure (PETCO2) monitoring in patients with acute cardiogenic pulmonary edema receiving early nonivasive positive pressure ventilation.Methods Totally 88 patients confirmed as acute cardiogenic pulmonary edema from February 2011 to May 2015

  19. 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

  20. Triazolam, obesity and non cardiac pulmonary edema

    Directory of Open Access Journals (Sweden)

    Fabio Di Stefano

    2012-12-01

    Full Text Available Introduction Triazolam belongs to the group of benzodiazepines and may have side effects on the respiratory system which include not only respiratory depression, but also transient benign non cardiac pulmonary edema.Case report A 52 year old obese woman developed pulmonary edema after she was taking triazolam for almost two weeks without any other medications. All possible cardiogenic and non cardiogenic causes were excluded. The condition was severe enough to require non invasive ventilation.Discussion This case differs from the other report of triazolam associated non cardiac pulmonary edema for its severity requiring non invasive ventilation. The pathogenetic mechanism is unknown. Despite the lack of objective evidence to explain pulmonary venous hypertensive changes in our case, we want to advice that triazolam should be used with caution in obese patients, as obesity might aggravate this described drug adverse reaction.

  1. EFFECT OF CARDIOPULMONARY BYPASS ON PULMONARY FUNCTION IN INFANTS

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To evaluate the effect of the cardiopulmonary bypass (CPB) on the pulmonary function in infants with or without pulmonary hypertension in congential ventricular septal defect (VSD). Methods Twenty infants with VSD were enrolled in the study from Jan. to Dec. 2004. They were divided into two groups: pulmonary hypertension group and non-pulmonary hypertension group, ten infants respectively. Pulmonary function parameters were measured before CPB and 3, 6, 9, 12, 15, 18, 21, 24h after CPB, the following data were recorded: duration for mechanical ventilation (Tmv) and staying in the cardiac intensive care unit (Tcicu) after cardiac surgery. Results Before CPB, the pulmonary function parameters in non-pulmonary hypertension group were more superior than in pulmonary hypertension group ( P < 0. 01 ). By contraries, the pulmonary function parameters in every time stage after CPB statistically significant decreased in non-pulmonary hypertension group ( P < 0. 05),especially at 6, 9, and 15h after CPB ( P < 0. 01 ). In pulmonary hypertension group, the pulmonary function parameters in 3h after CPB were more improved than before CPB, though there was no statistical significance. But they had statistically significant decreased at 9, 12, 15h after CPB ( P <0. 05). There was a similar change in pulmonary function between two groups at 21,24h after CPB. Conclusion Exposure to CPB adversely affects pulmonary function after surgical repair of VSD in infants. We consider that the benefits of the surgical correction in infants with pulmonary hypertension outweight the negative effects of CPB on pulmonary function. We should improve cardiac function to avoid the presence of the nadir trough in pulmonary function. The infants with pulomonary hypertension also have ability to wean from mechanical ventilation as soon as possible, if the hemodynamics is stable, and without the responsive pulmonary hypertension or pulmonary hypertension crisis after surgical repair.

  2. Why We Ventilate

    Energy Technology Data Exchange (ETDEWEB)

    Logue, Jennifer M.; Sherman, Max H.; Price, Phil N.; Singer, Brett C.

    2011-09-01

    It is widely accepted that ventilation is critical for providing good indoor air quality (IAQ) in homes. However, the definition of"good" IAQ, and the most effective, energy efficient methods for delivering it are still matters of research and debate. This paper presents the results of work done at the Lawrence Berkeley National Lab to identify the air pollutants that drive the need for ventilation as part of a larger effort to develop a health-based ventilation standard. First, we present results of a hazard analysis that identified the pollutants that most commonly reach concentrations in homes that exceed health-based standards or guidelines for chronic or acute exposures. Second, we present results of an impact assessment that identified the air pollutants that cause the most harm to the U.S. population from chronic inhalation in residences. Lastly, we describe the implications of our findings for developing effective ventilation standards.

  3. Home Ventilator Guide

    Science.gov (United States)

    ... fit the ventilator under the seat in front. Second, its protected electronic panel prevents the settings from being changed inadvertently. Third, the Trilogy has six hours of battery life – three hours of internal battery and three hours ...

  4. 气道分级管理应用于慢性阻塞性肺疾病机械通气患者的效果分析%Effect analysis on airway management based on different grades applied in mechanically ventilated patients with chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    冯洁惠; 浦其斌; 高春华; 方琏; 徐建宁

    2012-01-01

    Objective To evaluate the intervention effect of airway management based on different grades applied in mechanically ventilated patients with chronic obstructive pulmonary disease(COPD). Method Divide 65 patients into observation group (n=33) and control group (n=32) by order. Patients in control group receive routine airway management of chest physiotherapy every 2 hours. Patients in observation group receive airway management based on different grades of chest physiotherapy on different frequency according to airway scores. Compare the tidal volume, respiratory rate, PaCOf2 and scores of acute physiology and chronic health of two groups on the 5th and 10th day undergoing mechanical ventilation. Compare the mechanical ventilation time and hospitalization time. Result Tidal volume, respiratory rate, PaCOf2 and scores of acute physiology and chronic health arc significantly better in observation group. Mechanical ventilation time is significantly shorter in observation group. There is no significant difference on hospitalization time between two groups. Conclusion Airway management based on different grades can improve the respiratory function for patients with chronic obstructive pulmonary disease effectively.%目的 评价慢性阻塞性肺疾病患者机械通气期间采用气道分级管理的干预效果.方法 按患者入科顺序将65例患者分为观察组33例和对照组32例.对照组按常规气道管理,每2 h予胸部物理治疗;观察组按气道评分实施气道分级管理,行不同频次物理治疗.比较两组机械通气第5天、第10天的潮气量、呼吸频率、动脉血二氧化碳分压及急性生理与慢性健康评分,比较两组机械通气时间和住院时间.结果 机械通气第10天,观察组潮气量、呼吸频率、动脉血二氧化碳分压的监测值优于对照组,急性生理与慢性健康评分低于对照组,机械通气时间明显少于对照组,经比较,差异均有统计学意义;两组住院时间比

  5. 肺表面活性物质联合机械通气治疗足月新生儿呼吸窘迫综合征的临床观察%Pulmonary surfactant combined with mechanical ventilation for term neonates with respiratory distress syndrome

    Institute of Scientific and Technical Information of China (English)

    冯远征; 丘小其; 梁启慧; 汤世君; 黄婉仪

    2015-01-01

    目的 探讨肺表面活性物质联合机械通气治疗足月新生儿呼吸窘迫综合征临床效果.方法 选取2013年3月至2014年8月我院儿科收治60例呼吸窘迫综合征足月新生儿随机分为观察组和对照组,对照组采用肺表面活性物质治疗,观察组在对照组基础上联合机械通气治疗,比较两组新生儿治疗效果及治疗前、治疗后1h、24 h PaO2、PaCO2及pH值.结果 观察组患儿治疗总有效率为96.66%明显高于对照组总有效率83.33%,两组比较差异有统计学意义(P<0.05);观察组患儿治疗1h及24 h后PaO2、pH值明显高于对照组,PaCO2值明显低于对照组,两组间各值比较有差异统计学意义(P<0.05).结论 肺表面活性物质联合机械通气治疗足月新生儿呼吸窘迫综合征可改善患儿PaO2、PaCO2及pH值,具有显著临床治疗效果,值得在临床中推广应用.%Objective To investigate the clinical effect of pulmonary surfactant combined mechanical ventilation for term neonates with respiratory distress syndrome.Methods 60 term newborns with respiratory distress syndrome admitted into our department from March,2013 to August,2014 were selected and were randomly divided into an observation group and a control group.The control group were treated with pulmonary surfactant;in addition,the observation group with mechanical ventilation.The treatment effect and the PaO2,PaCO2,and pH value before and 1 and 24 hours after the treatment were compared between these two groups.Results The total efficacy was 96.66% in the observation group and was 83.33% in the control group,with a statistical difference(P<0.05).1 and 24 hours after the treatment,the PaO2 level and pH value were significantly higher and the PaCO2 level was significantly lower in the observation group than in the control group,with statistical differences(P<0.05).Conclusions Pulmonary surfactant combined with mechanical ventilation for term newborns with respiratory

  6. Clinical analysis of BiPAP non-invasive ventilation in treatment of patients with acute cardiogenic pul-monary edema%双水平气道正压无创通气治疗急性心源性肺水肿患者的临床分析

    Institute of Scientific and Technical Information of China (English)

    屈健民; 赵云峰

    2014-01-01

    Objective To observe the clinical efficacy of non-invasive bi-level positive airway pres-sure ventilation (BiPAP)in the treatment of patients with acute cardiogenic pulmonary edema.Methods Eighty-five patients with acute cardiogenic pulmonary edema were retrospectively analyzed and assigned into two groups.In the treatment group,fifty cases were treated with BiPAP non-invasive ventilation on the basis of anti-heart failure treatment such as positive inotropic,diuretics and vasoactive drugs.In the control group,35 pa-tients underwent oxygen masks based upon anti-heart failure therapy.The clinical effects in two groups were compared.Results Compared with the control group,the clinical symptoms of the patients,who treated with BiPAP non-invasive ventilation,were significantly improved,and 6-hour lactic acid clearance rate and effective rate were significantly higher (all P <0.05),whereas endotracheal intubation rate and mortality were signifi-cantly lower (both P <0.05).Conclusion BiPAP can alleviate the symptoms of patients with acute cardio-genic pulmonary edema and reduce endotracheal intubation rate and mortality.%目的:观察双水平气道正压(BiPAP)无创通气治疗急性心源性肺水肿患者的临床疗效。方法收集85例急性心源性肺水肿患者的治疗情况,其中给予正性肌力药物、利尿药、血管活性药物等常规抗心力衰竭治疗的基础上行 BiPAP 无创通气治疗的50例患者作为治疗组,给予面罩吸氧等常规抗心力衰竭治疗的35例患者为对照组。比较两组的临床疗效。结果与对照组比较,治疗组患者经 BiPAP 无创通气治疗后,患者的临床症状改善更明显,6 h 乳酸清除率及治疗有效率均明显高于对照组(P 均<0.05),气管插管率及病死率均明显低于对照组(P 均<0.05)。结论BiPAP 无创通气能迅速改善急性心源性肺水肿患者的临床症状,降低气管插管率及病死率。

  7. 双水平气道正压无创通气治疗急性心源性肺水肿的临床观察%Clinical observation of BiPAP noninvasive ventilation in the treatment of acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    封凯旋; 俞国忠; 凌杰斌; 马斌

    2011-01-01

    目的 探讨在重症监护病房中双水平正压(BiPAP)无创通气治疗急性心源性肺水肿的疗效.方法 将80例急性心源性肺水肿患者随机分成两组:对照组40例,给予常规治疗(吸氧、镇静、强心、利尿、血管扩张药、激素、解痉平喘等);治疗组40例,在常规治疗的基础上,加用无创正压通气治疗.观察两组患者治疗前后临床症状、体征和动脉血气分析的变化.结果 治疗组进行无创机械通气后,37例患者在2 h内症状好转,呼吸减慢,心率下降,肺部湿哆音减少,动脉氧分压(PaCO2)上升,动脉二氧化碳分压(PaCO2)下降,总有效率为92.5%;对照组在相应时间仅23例好转,有效率为57.5%;两组相比差异有统计学意义(P<0.05).结论 在发生急性心源性肺水肿时,双水平正压无创通气治疗安全,效果显著.%Objective To investigate the clinical value of Bi - level positive airway pressure( Bi-PAP) noninvasive ventilation on acute cardiogeni(c) pulmonary edema. Methods Eighty patients with a cute cardiogenic pulmonary edema were randomly divided into two groups: treatment group and control group. Forty patients in the treatment group were treated with noninvasive mask Bi -level positive airway pressure (BiPAP) ventilation in addition to conventional treatment. Forty patients in the control group were treated by nasal pipe with oxygen in addition to conventional treatment. Patients were observed before and after the clinical symptoms,signs and arterial blood gas analysis. Results After BiPAP ventilation,the clinical symptoms of 37 patients in the treatment group had been improved significantly in two hours.Also, the clinical symptoms and arterial blood gas parameters ( pH, PaO2, PaCO2, SaO2 ) showed a statistical differences ( P <0. 05 ) compared with control group. The total efficiency rate of treatment group was 92.5% ,while that of control group was only 57.5%. Conclusions Bi - level positive airway pressure therapy is

  8. 高压力家庭无创通气对稳定期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的疗效研究%Study of the Efficacy of High-intensity Non-invasive Ventilation in Stable Chronic Obstructive Pulmonary Disease Patients with TypeⅡ Respiratory Failure

    Institute of Scientific and Technical Information of China (English)

    李强; 饶常红; 黄渤

    2016-01-01

    Objective:To study the efficacy of high-intensity non-invasive ventilation in stable chronic obstructive pulmonary disease patients with type Ⅱ respiratory failure.Method:36 patients with chronic obstructive pulmonary exacerbation and type Ⅱ respiratory failure in our department from July 2013 to February 2016 were selected,after treatment,the disease was still stable with carbon dioxide retention.According to the random number table method,they were divided into the experimental group and control group,each of 18 cases.Two groups of patients were discharged from hospital at home to continue the use of noninvasive ventilation,the experimental group used the high-inspiratory pressure,the control group used the conventional inspiratory pressure,before and after treatment for 6 months,the FVC,FEV1,PaCO2,PaO2 and dyspnea scores in the two groups were compared.Result:After treatment,the two groups of PaCO2 and PaO2 compared with before treatment, the differences were statistically significant(P0.05).After treatment,between the dyspnea score of the two groups compared,there was no significant difference (P>0.05).Conclusion:To stable chronic obstructive pulmonary disease patinets with type Ⅱ respiratory failure home high-intensity non-invasive ventilation can better decrease carbon dioxide retention,but it can’t better improve lung function and exercise power.%目的:研究高压力家庭无创通气对稳定期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的疗效。方法:选取2013年7月-2016年2月因慢性阻塞性肺急性加重且合并Ⅱ型呼吸衰竭在本科室住院,经治疗后病情平稳仍伴有二氧化碳潴留的患者36例。按照随机数字表法分为试验组和对照组,各18例。两组患者均出院后在家中继续使用无创通气,试验组使用高吸气压力,对照组使用常规吸气压力,比较治疗前与治疗6个月后两组患者的FVC、FEV1、PaCO2、PaO2数值及呼吸困难评分。结

  9. 右美托咪定对肺癌根治术患者单肺通气时的肺保护作用%Pulmonary protection of dexmedetomidine during one-lung ventilation in patients undergoing radical operation for lung cancer

    Institute of Scientific and Technical Information of China (English)

    王东昕; 阚红莉; 于晓东; 刘卓

    2014-01-01

    Objective To evaluate the pulmonary protection of dexmedetomidine during one-lung ventilation in patients undergoing radical operation for lung cancer.Methods Thirty patients of both sexes,aged 40-70 yr,weighing 50-80 kg,of ASA physical status Ⅰ-Ⅲ,scheduled for elective radical operation for lung cancer,were randomized into 2 groups (n =15 each):dexmedetomidine group (group D) and control group (group C).Before induction of anesthesia,a loading dose of dexmedetomidine 1.0 μg/kg was infused over 10 min,followed by continuous infusion of dexmedetomidine at a rate of 0.6 μg· kg-1 · h-1 until the chest was closed in group D,while the equal volume of normal saline was given in group C.Immediately after induction of anesthesia,at 30 and 60 min of one-lung ventilation,and at the end of operation,arterial blood samples were collected for determination of the serum concentrations of TNF-α,IL-6 and IL-8,and for blood gas analysis.Oxygenation index was calculated.Results Compared with group C,the serum concentrations of TNF-α,IL-6 and IL-8 were significantly decreased,and oxygenation index was increased in group D.Conclusion Dexmedetomidine can mitigate inflammatory responses during one-lung ventilation and improve pulmonary function,thus providing pulmonary protection in patients undergoing radical operation for lung cancer.%目的 评价右美托咪定对肺癌根治术患者单肺通气时的肺保护作用.方法 择期拟行肺癌根治术患者30例,性别不限,年龄40 ~ 70岁,体重50 ~ 80 kg,ASA分级Ⅰ-Ⅲ级.采用随机数字表法,将其分为2组(n=15):右美托咪定组(D组)和对照组(C组).D组于麻醉诱导前经10 min静脉输注右美托咪定负荷量1.0 μg/kg,随后以0.6 μg·kg-1 ·h-1速率静脉输注至关胸.C组给予等容量生理盐水.于麻醉诱导后即刻(T1)、单肺通气30 min (T2)、60 min (T3)、术毕(T4)时分别采集动脉血,采用ELISA法测定血清TNF-α、IL-6及IL-8的浓度,并行动脉血气

  10. Sympathetic crashing acute pulmonary edema.

    Science.gov (United States)

    Agrawal, Naman; Kumar, Akshay; Aggarwal, Praveen; Jamshed, Nayer

    2016-12-01

    Sympathetic crashing acute pulmonary edema (SCAPE) is the extreme end of the spectrum of acute pulmonary edema. It is important to understand this disease as it is relatively common in the emergency department (ED) and has better outcomes when managed appropriately. The patients have an abrupt redistribution of fluid in the lungs, and when treated promptly and effectively, these patients will rapidly recover. Noninvasive ventilation and intravenous nitrates are the mainstay of treatment which should be started within minutes of the patient's arrival to the ED. Use of morphine and intravenous loop diuretics, although popular, has poor scientific evidence.

  11. Reexpansion pulmonary edema following thoracentesis

    Directory of Open Access Journals (Sweden)

    Ansuman Mukhopadhyay

    2016-01-01

    Full Text Available Reexpansion pulmonary edema is an uncommon complication of the treatment of lung atelectasis, pleural effusion or pneumothorax and pathogenesis is unknown. An elderly male patient presented to us with right-sided pleural effusion. 2 h after thoracentesis, he felt chest discomfort and increased breathlessness. His chest examination showed right-sided crackles. Chest radiograph showed right-sided heterogeneous opacity in right lower zone consistent with unilateral pulmonary edema. He was managed conservatively along with bilevel positive airway pressure ventilator support. His condition improved gradually and was discharged successfully after 2 days.

  12. 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.

  13. [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.

  14. 肺通气/灌注显像在慢性血栓栓塞性肺动脉高压诊断中的临床价值%Lung ventilation/perfusion imaging in the diagnosis of chronic thromboembolic pulmonary hypertension in comparison with CT pulmonary angiography

    Institute of Scientific and Technical Information of China (English)

    张春; 王铁; 马展鸿; 丁毅; 曲士颖; 黄京伟

    2013-01-01

    Objective To evaluate the lung V/Q imaging in the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH).Methods Seventy-six patients (46 males,30 females,age 27-84 y) with clinically suspected CTEPH who had undergone lung V/Q imaging,CT pulmonary angiography (CTPA),pulmonary angiography (PA) and right heart cardiac catheterization were studied.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of lung V/Q imaging in detecting CTEPH were calculated and compared with those of CTPA.The x2 test was used for statistical analysis with SPSS 11.5.The distribution of involvement of segments in 47 patients with CTEPH was analyzed.Results Forty-seven patients had a final diagnosis of CTEPH and 29 had non-CTEPH etiology.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of lung V/Q imaging were 97.9% (46/47),86.2% (25/29),93.4% (71/76),92.0% (46/50) and 96.2% (25/26),while those of CTPA were 78.7% (37/47),93.1% (27/29),84.2% (64/76),94.9% (37/39) and 73.0% (27/37),respectively.The sensitivity (x2 =5.818,P=0.012) and negative predictive value (x2 =5.693,P =0.017) for lung V/Q imaging were significantly higher than those of CTPA.V/Q imaging could identify patients with CTEPH from those with idiopathic PAH and familial PAH based on the almost normal ventilation imaging.The lung perfusion SPECT imaging detected 585 (62.2%) of involved segments among 940 segments in 47 patients with CTEPH,with an average of 12.4 involved segments in each patient.The number of involved segments in the right lung was significantly higher than that in the left lung (36.2% (340/940) vs 26.1% (245/940) ; x2 =40.85,P<0.01).Conclusions Lung V/Q imaging plays an important role in diagnosis of CTEPH and in identification of CTEPH from other types of PAH.A normal V/Q imaging can effectively exclude CTEPH.In addition,V/Q imaging can provide more diagnostic information in patients with a

  15. Investigation of application effects by different ventilation modes for respiratory failure and severe pulmonary heart disease%探讨不同通气模式在重症肺源性心脏病呼吸衰竭中的应用效果

    Institute of Scientific and Technical Information of China (English)

    刘德智

    2016-01-01

    目的 分析对重症肺源性心脏病呼吸衰竭患者实施不同通气模式的临床治疗效果.方法 80例重症肺源性心脏病呼吸衰竭患者, 按照不同的通气模式分为研究组和对照组, 各40例.对照组进行有创通气治疗, 研究组进行有创无创序贯法通气治疗.比较两组患者的临床指标改善情况.结果 治疗后, 研究组动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)均优于对照组(P0.05);研究组的机械通气时间、平均住院时间短于对照组(P0.05). The research group had shorter mechanical ventilation time and average hospital stay time than the control group (P<0.05). The research group had lower incidence of pneumonia as 5% than 20% of the control group (P<0.05).Conclusion Application of sequential treatment by invasive and non-invasive ventilation in treating respiratory failure and severe pulmonary heart disease can effectively improve clinical indexes and accelerate body function rehabilitation in patients. This method shows remarkable clinical application effect.

  16. Management of blunt pulmonary injury.

    Science.gov (United States)

    Gallagher, John J

    2014-01-01

    Thoracic injuries account for 25% of all civilian deaths. Blunt force injuries are a subset of thoracic injuries and include injuries of the tracheobronchial tree, pleural space, and lung parenchyma. Early identification of these injuries during initial assessment and resuscitation is essential to reduce associated morbidity and mortality rates. Management of airway injuries includes definitive airway control with identification and repair of tracheobronchial injuries. Management of pneumothorax and hemothorax includes pleural space drainage and control of ongoing hemorrhage, along with monitoring for complications such as empyema and chylothorax. Injuries of the lung parenchyma, such as pulmonary contusion, may require support of oxygenation and ventilation through both conventional and nonconventional mechanical ventilation strategies. General strategies to improve pulmonary function and gas exchange include balanced fluid resuscitation to targeted volume-based resuscitation end points, positioning therapy, and pain management.

  17. OUTCOME OF VENTILATION IN HYALINE MEMBRANE DISEASE: THE INDIAN EXPERIENCE

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    Nayana Prabha

    2016-06-01

    Full Text Available OBJECTIVE To study the short-term outcome of both preterm and term babies requiring assisted ventilation for hyaline membrane disease and report the complications contributing to morbidity and mortality of these patients from a regional medical college with limited resources. DESIGN Retrospective file review. SETTING Regional Medical College. PARTICIPANTS All babies ventilated for HMD over a 6-year period from June 2008 to June 2014. OUTCOME MEASURES Outcome of ventilation and factors contributing to mortality. RESULTS Out of 100 babies with hyaline membrane disease who were ventilated, 82% survived. Increasing gestational age and birth weight was associated with survival. The commonest complication was shock (77% and the commonest cause of mortality was septicaemia (77%. Septicaemia, Disseminated Intravascular Coagulation (DIC and pulmonary haemorrhage were significantly more common complications babies who died (p<0.05. Binary logistic regression analysis showed that DIC (Odds ratio 5.2 [Confidence intervals (C.I. 1.1-27.1] and pulmonary haemorrhage (OR 18 [1.72-45.2] to be predictors of mortality. The incidence of intraventricular haemorrhage was 1% and that of pneumothorax was 2%. The initial peak inspiratory pressure administered was significantly lower (p=0.033 and maximum peak end expiratory pressure was significantly higher in those who expired (p=0.027. CONCLUSION Outcome of ventilation for hyaline membrane disease improves with increasing gestational age and birth weight. The commonest cause of mortality and morbidity were septicaemia and shock respectively.

  18. 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.

  19. New-Onset Neonatal Pulmonary Hypertension Associated with a Rhinovirus Infection

    OpenAIRE

    Nishit Patel; The, Tiong G

    2012-01-01

    A 3.5-week-old male neonate who developed an upper and lower respiratory tract rhinovirus infection that was temporally associated with the development of severe pulmonary hypertension is described. Rhinovirus has not previously been associated with pulmonary hypertension. This child developed severe pulmonary hypertension with right ventricular failure, requiring mechanical ventilation, nitric oxide inhalation and, eventually, extracorporeal membrane oxygenation.

  20. 机械通气联合雾化吸入治疗COPD呼吸衰竭疗效观察%Observation of the Efficacy of mechanical ventilation combined with aerosolization inhalation to treat respiratory failure in patients with chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    姜远普

    2012-01-01

    Objective Observation of the efficacy of bi - level positive airway pressure ventilation( BiPAP ) combined with drug aerosolization inhalation to treat respiratory failure in patients with acute exacerbation of chronic obstructive pulmonary disease ( AECO-PD ). Methods 52 patients were randomly divided into group A and group B with based on routine therapies, group A received BiPAP treatment. Group B were received BiPAP combined drug aerosolization inhalation treatment. Changes of clinical situation, time of mechanical ventilation and days of hospitalization in ICU were observed. Results Arterial blood gas( PaO2、PaCO2 )、PaO2/FiO2 and respiratory rate of group B had significant improvement over group A after treatment ( P < 0. 05 ) . Time of mechanical ventilation and days of hospitalization in ICU of group B were also fewer than group A. Conclusion BiPAP combined with drug aerosolization inhalation to treat respiratory failure in AECOPD is more effective.%目的 双水平无创正压通气(BiPAP)联合药物雾化吸入治疗AECOPD Ⅱ型呼吸衰竭疗效观察.方法 52例AECOPD Ⅱ型呼吸衰竭患者在常规治疗基础上随机分为A、B两组,A组BiPAP治疗.B组BiPAP联合药物雾化吸入治疗,观察两组临床情况变化及机械通气时间、住ICU天数.结果 治疗后B组血气指标、氧合指数、呼吸频率较A组改善明显(P<0.05),B组机械通气时间、住ICU天数少于A组.结论 BiPAP联合药物雾化吸入治疗AECOPD Ⅱ型呼吸衰竭疗效好.

  1. [Development and clinical significance of SEA-1 emergency micro-ventilator].

    Science.gov (United States)

    Tu, W; Mao, H

    1998-06-01

    To improve the work of emergency care and early cardio-pulmonary-brin resuscitation in our county, which is characteristic of abruptness and contingency, a new type of ventilator is highly required. It is hoped that such a ventilafor has a simple safe valve and does not need electric current from the mains. Also, the ventilator should be small in size, light in weight, simple in operation, easy to carry, swift to assembly, and reliable in ventilation. With the principle of pneumatic logic elements and the design of the integration of pneumatic circuits, we have successfully developed the Emergency Micro-ventilator, which accords with the above requirements. It has been confirmed that the ventilator is very effectual and reliable in ventilation support for the patients(n = 55) under general anesthesia without any case of hypoxemia, hypercapnia, hypotension, arrhythmia and so on, and the mechanical performances are stable.

  2. Pressure Dynamic Characteristics of Pressure Controlled Ventilation System of a Lung Simulator

    Directory of Open Access Journals (Sweden)

    Yan Shi

    2014-01-01

    Full Text Available Mechanical ventilation is an important life support treatment of critically ill patients, and air pressure dynamics of human lung affect ventilation treatment effects. In this paper, in order to obtain the influences of seven key parameters of mechanical ventilation system on the pressure dynamics of human lung, firstly, mechanical ventilation system was considered as a pure pneumatic system, and then its mathematical model was set up. Furthermore, to verify the mathematical model, a prototype mechanical ventilation system of a lung simulator was proposed for experimental study. Last, simulation and experimental studies on the air flow dynamic of the mechanical ventilation system were done, and then the pressure dynamic characteristics of the mechanical system were obtained. The study can be referred to in the pulmonary diagnostics, treatment, and design of various medical devices or diagnostic systems.

  3. 肺保护性通气策略对烟雾吸入性损伤犬氧合和肺组织炎症反应的影响%Effect of lung protective ventilation strategy on oxygenation and pulmonary inflammatory response in dogs with severe smoke inhalation injury

    Institute of Scientific and Technical Information of China (English)

    廖新成; 郭光华; 王年云

    2015-01-01

    Objective To observe the effect of lung protective ventilation strategy on oxygenation and pulmonary inflammatory response in dogs with severe smoke inhalation injury.Methods Twelve local healthy male dogs were selected and anesthetized underwent endotracheal intubation, the time controlled smoke was applied to replicate the model of severe smoke inhalation injury, and they were divided into two groups according to the random number table: conventional ventilation group (CV group) and protective ventilation group (PV group), each receiving corresponding ventilation mode for 8 hours respectively. The blood gas analyses were detected before injury, immediately after injury and at ventilation for 2, 4, 6, 8 hours. The contents of tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10) in serum were detected by the enzyme-linked immunosorbent assay (ELISA) at each time point. Animals were killed after 8-hour ventilation, and different parts of the lung tissues were obtained for pathological examinations of lung tissues and evaluation of injury scores. The levels of inflammatory factors as TNF-α and IL-10 in lung homogenates were measured by ELISA.Results The arterial partial pressure (PaO2) levels in CV and PV groups were significantly decreased after injury compared with those before injury [mmHg (1 mmHg = 0.133 kPa): 57±19 vs. 128±31, 58±15 vs. 126±22, bothP 0.05). At 6 hours ventilation, PaO2 level in PV group was significantly higher than that in CV group (mmHg: 121±11 vs. 105±11,P 0.05). The histopathological changes revealed that there were alveolar tissue edema and inflammatory cells infiltration in both groups, the degree of severity in CV group was more prominent and its pulmonary tissue injury score was higher than that in PV group (3.68±0.22 vs. 3.27±0.35, P 0.05);通气治疗6 h PV组PaO2水平显著高于同期CV组(mmHg:121±11比105±11,P0.05).PV组肺泡腔组织水肿及炎性细胞浸润程度较明显CV组减轻,CV组肺组织

  4. 全麻不同潮气量机械通气对老年患者肺功能的影响#%The Effect of Different Tidal Volume Ventilation on Pulmonary Function in Old Man

    Institute of Scientific and Technical Information of China (English)

    林梁; 刘风; 汪延斌

    2012-01-01

    目的:探讨全麻不同潮气量机械通气对老年人肺功能的影响.方法:年龄大于60岁的老年直肠癌患者60例,随机分为三组,潮气量10ml/kg组(Ⅰ组),潮气量8ml/kg(Ⅱ组)和潮气量6ml/kg组(Ⅲ组),每组20例.机械通气后抽血测在麻醉后(T1)、麻醉后1h(T2)、麻醉后2h(T3)、麻醉后6h(T4)和麻醉后24h(T5)的TNF-а,IL-6,IL-10水平和RI值.结果:三组患者在麻醉后(T1)TNF-а,IL-6的水平无明显差异(P>0.05);Ⅲ组在T2~4的TNF-а,IL-6均低于Ⅰ、Ⅱ组,有显著性差异(P0.05),Ⅲ组在T3~5的RI均低于Ⅰ、Ⅱ组,有显著差异性(P0.05).But at T2-T5,the level of the TNF- a , IL-6 and Respiratory index in group Ⅲ has significant lower than the in group Ⅰ , Ⅱ (P0.05).Conclusion:Low tidal volume ventilation could alleviate ventilation induced lung injury and maintain balance of inflamm-antiflam cytokine in the old patients.

  5. What can computed tomography and magnetic resonance imaging tell us about ventilation?

    Science.gov (United States)

    Simon, Brett A.; Kaczka, David W.; Bankier, Alexander A.

    2012-01-01

    This review provides a summary of pulmonary functional imaging approaches for determining pulmonary ventilation, with a specific focus on multi-detector x-ray computed tomography and magnetic resonance imaging (MRI). We provide the important functional definitions of pulmonary ventilation typically used in medicine and physiology and discuss the fact that some of the imaging literature describes gas distribution abnormalities in pulmonary disease that may or may not be related to the physiological definition or clinical interpretation of ventilation. We also review the current state-of-the-field in terms of the key physiological questions yet unanswered related to ventilation and gas distribution in lung disease. Current and emerging imaging research methods are described, including their strengths and the challenges that remain to translate these methods to more wide-spread research and clinical use. We also examine how computed tomography and MRI might be used in the future to gain more insight into gas distribution and ventilation abnormalities in pulmonary disease. PMID:22653989

  6. Pulmonary hypertension and chronic cor pulmonale in COPD.

    Science.gov (United States)

    Shujaat, Adil; Minkin, Ruth; Eden, Edward

    2007-01-01

    Hypoxia and endothelial dysfunction play a central role in the development of pulmonary hypertension. Cor pulmonale is a maladaptive response to pulmonary hypertension. The presence of peripheral edema in cor pulmonale is almost invariably associated with hypercapnia. Correction of abnormalities of gas exchange and ventilation can ameliorate pulmonary hypertension and improve survival. This review focuses on new information about the pathogenesis and treatment of pulmonary hypertension in COPD including information derived from lung volume reduction surgery, the role of brain natriuretic peptide, exhaled nitric oxide for diagnosis, and the treatment of cor pulmonale with recently available specific pulmonary vasodilators.

  7. Chronic Thromboembolic Pulmonary Hypertension: Treat the Patient Not the Haemodynamics

    Directory of Open Access Journals (Sweden)

    Ben Dunne

    2012-01-01

    Full Text Available Chronic thromboembolic pulmonary hypertension (CTEPH is a disabling condition that is being increasingly recognised. It is unique as a cause of pulmonary hypertension in that it is surgically curable. We wish to highlight the importance of recognition and early referral of any patient who may have CTEPH even in the absence of resting pulmonary hypertension as excellent results can be achieved by restoring pulmonary vascular anatomy, reducing exercise-induced pulmonary hypertension, and reducing dead-space ventilation. We present a case that illustrates these points and discuss our experience as a referral centre for CTEPH.

  8. Comparison of ventilation-perfusion single-photon emission computed tomography (V/Q SPECT) versus dual-energy CT perfusion and angiography (DECT) after 6 months of pulmonary embolism (PE) treatment

    Energy Technology Data Exchange (ETDEWEB)

    Meysman, M., E-mail: marc.meysman@uzbrussel.be [Respiratory Division, Department of Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels (Belgium); Everaert, H., E-mail: nucgeth@gmail.com [Department of Nuclear Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels (Belgium); Buls, N., E-mail: nico.buls@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels (Belgium); Nieboer, K., E-mail: koenraad.nieboer@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels (Belgium); Mey, J. de, E-mail: Johan.deMey@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels (Belgium)

    2015-09-15

    Highlights: • Incomplete resolution of pulmonary emboli occurs frequently. • Residual V/Q-SPECT defects correspond in the majority of cases with defects seen on DECT. • Some (11.1%) defects on V/Q-SPECT are not present on comparable DECT images. - Abstract: Background: The natural evolution of treated symptomatic pulmonary embolism shows often incomplete resolution of pulmonary thrombi. The prevalence of perfusion defects depend on the image modality used. This study directly compares V/Q SPECT with DECT. Methods: A single-center prospective observational cohort study of patients with intermediate risk PE, reassessed at the end of treatment with V/Q SPECT. Abnormal V/Q SPECT images were compared with DECT. Results: We compared DECT en V/Q SPECT in 28 consecutive patients with persistent V/Q mismatch on V/Q SPECT, 13 men and 15 woman, mean age 60 (+17), range 23–82 year. One patient was excluded from the final analysis due to inferior quality DECT. In 18/27 (66.7%) the results were concordant between CTPA (persistent embolus visible), DECT (segmentary defects on iodine map) and V/Q SPECT (segmentary ventilation–perfusion mismatch). In 3/18 (11.1% of the total group) the partialy matched V/Q SPECT defect could be explained on DECT lung images by lung infarction. In 6/27 (22.1%) only hypoperfusion was seen on DECT iodine map. In 3/27 (11.1%) results were discordant between V/Q SPECT and DECT images. Conclusion: Six months after diagnosis of first or recurrent PE, residual pulmonary perfusion-defects encountered on V/Q-SPECT corresponds in the majority of patients with chronic thromboembolic disease seen on DECT. In 22.1% of patients V/Q SPECT mismatch only corresponds with hypoperfusion on iodine map DECT scan. Some (11.1%) of the chronic thromboembolic lesions seen on V/Q SPECT can not be explained by DECT results.

  9. 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

  10. 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、

  11. Clinical analysis on mechanical ventilation combined with inhaled nitric oxide in the treat-ment of persistent pulmonary hypertension of newborn%机械通气联合一氧化氮治疗新生儿持续肺动脉高压临床分析

    Institute of Scientific and Technical Information of China (English)

    牛佳慧; 唐军; 白小红; 陈娟

    2015-01-01

    Objective To explore the main causes of persistent pulmonary hypertension of newborn ( PPHN) and the effects of mechanical ventilation combined with inhaled nitric oxide ( iNO) in the treatment of the disease .Methods The perinatal conditions , primary disease and main ventilator parameters ,arterial blood gas indexes and heart rate before and after treatment in 26 PPHN cases were retrospectively analyzed.These patients were admitted to our hospital from Jan .2008 to May.2014.Results Of these patients,14 cases(53.85%) with a history of perinatal asphyxia ,10 cases(38.46%) had amniotic fluid contamination and 21 cases(80.77%) had primary etiologies of pulmonary diseases .Further,19 patients received mechanical ventilation combined with iNO .After six-hour of therapy,values of SpO2and PaO2were significantly greater than that of pre-therapy(P<0.05).The value of FiO2 was increased at the time point of 6 h and then fell off.PaO2/FiO2 was gradually increased and pH,PaO2,HCO3-and SpO2were significantly different be-tween before and after therapy .Of the 26 cases,excluding 4 cases with less than 3-hour-hospitalization,13 were cured and 1 discharged with improvement .The therapeutic effective rate was 73.68%.One patient developed methemoglobinemia , one had thrombocytopenia and 2 developed digestive tract hemorrhage .Conclusion Perinatal asphyxia ,amniotic fluid contamination and pulmonary diseases still are the main causes of PPHN .Timely mechanical ventilation combined with iNO therapy can effectively improve the hemoglobin oxygen saturation and swiftly correct metabolic acidosis .%目的:探讨新生儿持续肺动脉高压( persistent pulmonary hypertension of newborn, PPHN)的主要病因及机械通气联合一氧化氮( NO)治疗的临床疗效。方法回顾性分析2008年1月至2014年5月我院收治的26例PPHN患儿的围产期情况、原发病以及机械通气联合NO治疗前后的主要呼吸机参数、血气指标、心率等。结果26

  12. 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.

  13. Pulmonary hypertension

    Science.gov (United States)

    ... clots in the lung ( pulmonary embolism ) Heart failure Heart valve disease HIV infection Low oxygen levels in the blood for a long time (chronic) Lung disease, such as COPD or pulmonary fibrosis Medicines (for example, certain diet drugs) Obstructive sleep ...

  14. Pulmonary Edema

    Science.gov (United States)

    ... Accessed March 13, 2014. Pinto DS, et al. Pathophysiology of cardiogenic pulmonary edema. http://www.uptodate.com/ ... hvd/. Accessed March 10, 2014. What is pulmonary hypertension? National Heart, Lung, and Blood Institute. http://www. ...

  15. Pulmonary Fibrosis

    Science.gov (United States)

    Pulmonary fibrosis is a condition in which the tissue deep in your lungs becomes scarred over time. This ... blood may not get enough oxygen. Causes of pulmonary fibrosis include environmental pollutants, some medicines, some connective tissue ...

  16. Pulmonary Rehabilitation

    Science.gov (United States)

    ... shortness of breath and increase your ability to exercise. You may have heard that pulmonary rehabilitation is only for people with COPD (chronic obstructive pulmonary disease). We now know that ...

  17. Diffuse Ceiling Ventilation

    DEFF Research Database (Denmark)

    Zhang, Chen; Yu, Tao; Heiselberg, Per Kvols

    -cooling period and night cooling potential. The investment cost of this ventilation system is about 5-10% lower than the conventional ones, because the acoustic ceiling could be directly applied as air diffuser and the use of plenum to distribute air reduces the cost of ductwork. There is a growing interest...... is not well structured with this system. These become the motivations in developing the design guide. This design guide aims to establish a systematic understanding of diffuse ceiling ventilation and provide assistance in designing of such a system. The guide is targeted at design engineers, architects...... and manufacturers and the users of diffuse ceiling technology. The design guide introduces the principle and key characteristics of room air distribution with diffuse ceiling ventilation. It provides an overview of potential benefit and limitations of this technology. The benefits include high thermal comfort, high...

  18. CFD and Ventilation Research

    DEFF Research Database (Denmark)

    Li, Y.; Nielsen, Peter V.

    2011-01-01

    There has been a rapid growth of scientific literature on the application of computational fluid dynamics (CFD) in the research of ventilation and indoor air science. With a 1000–10,000 times increase in computer hardware capability in the past 20 years, CFD has become an integral part...... of scientific research and engineering development of complex air distribution and ventilation systems in buildings. This review discusses the major and specific challenges of CFD in terms of turbulence modelling, numerical approximation, and boundary conditions relevant to building ventilation. We emphasize...... the growing need for CFD verification and validation, suggest on-going needs for analytical and experimental methods to support the numerical solutions, and discuss the growing capacity of CFD in opening up new research areas. We suggest that CFD has not become a replacement for experiment and theoretical...

  19. Comparison of patient-ventilator asynchrony during pressure support ventilation and proportional assist ventilation modes in surgical Intensive Care Unit: A randomized crossover study

    Directory of Open Access Journals (Sweden)

    Parshotam Lal Gautam

    2016-01-01

    Full Text Available Background: The patient-ventilator asynchrony is almost observed in all modes of ventilation, and this asynchrony affects lung mechanics adversely resulting in deleterious outcome. Innovations and advances in ventilator technology have been trying to overcome this problem by designing newer modes of ventilation. Pressure support ventilation (PSV is a commonly used flow-cycled mode where a constant pressure is delivered by ventilator. Proportional assist ventilation (PAV is a new dynamic inspiratory pressure assistance and is supposed to be better than PSV for synchrony and tolerance, but reports are still controversial. Moreover, most of these studies are conducted in chronic obstructive pulmonary disease patients with respiratory failure; the results of these studies may not be applicable to surgical patients. Thus, we proposed to do compare these two modes in surgical Intensive Care Unit (ICU patients as a randomized crossover study. Aims: Comparison of patient-ventilator asynchrony between PSV and PAV plus (PAV+ in surgical patients while weaning. Subjects and Methods: After approval by the Hospital Ethics Committee, we enrolled twenty patients from surgical ICU of tertiary care institute. The patients were ventilated with pressure support mode (PSV and PAV+ for 12 h as a crossover from one mode to another after 6 h while weaning. Results: Average age and weight of patients were 41.80 ± 15.20 years (mean ± standard deviation [SD] and 66.50 ± 12.47 (mean ± SD kg, respectively. Comparing the asynchronies between the two modes, the mean number of total asynchronous recorded breaths in PSV was 7.05 ± 0.83 and 4.35 ± 5.62, respectively, during sleep and awake state, while the same were 6.75 ± 112.24 and 10.85 ± 11.33 in PAV+. Conclusion: Both PSV and PAV+ modes of ventilation performed similarly for patient-ventilator synchrony in surgical patients. In surgical patients with acute respiratory failure, dynamic inspiratory pressure

  20. Ventilation with heat recovery

    DEFF Research Database (Denmark)

    Tommerup, Henrik M.; Svendsen, Svend

    2005-01-01

    This paper presents the experiences from the use of ventilation with heat recovery in several experimental single-family houses developed and built within the last four years to meet the new Danish energy requirements of 2005. Included are descriptions of the ventilation system components...... and the main functional demands as well as measurements of the thermal efficiency, electricity consumptions and building air tightness. The paper addresses the aspects of minimizing the heat loss from the duct system and the heat recovery unit (when placed in an unheated attic space) in order to obtain...

  1. Ventilation with heat recovery

    DEFF Research Database (Denmark)

    Tommerup, Henrik M.; Svendsen, Svend

    2005-01-01

    and the main functional demands as well as measurements of the thermal efficiency, electricity consumptions and building air tightness. The paper addresses the aspects of minimizing the heat loss from the duct system and the heat recovery unit (when placed in an unheated attic space) in order to obtain......This paper presents the experiences from the use of ventilation with heat recovery in several experimental single-family houses developed and built within the last four years to meet the new Danish energy requirements of 2005. Included are descriptions of the ventilation system components...

  2. Ventilator Circuits, Humidification and Ventilator-Associated Pneumonia

    Directory of Open Access Journals (Sweden)

    Dean Hess

    1996-01-01

    Full Text Available Technical issues in the care of mechanically ventilated patients include those related to the ventilator circuit, humidification and ventilator-associated pneumonia. Principal issues related to ventilator circuits include leaks and compression volume. Circuit compression volume affects delivered tidal volume as well as measurements of auto-positive end-expiratory pressure and mixed expired PCO2. Resistance through the ventilator circuit contributes to patient-ventilator dyssynchrony during assisted modes of mechanical ventilation. Adequate humidification of inspired gas is necessary to prevent heat and moisture loss. Common methods of humidification of inspired gas during mechanical ventilation include use of active heated humidifiers and passive artificial noses. Artificial noses are less effective than active humidifiers and are best suited to short term use. With active humidifiers, the circuit can be heated to avoid condensate formation. However, care must be exercised when heated circuits are used to avoid delivery of a low relative humidity and subsequent drying of secretions in the artificial airway. Although pneumonia is a complication of mechanical ventilation, these pneumonias are usually the result of aspiration of pharyngeal secretions and are seldom related to the ventilator circuit. Ventilator circuits do not need to be changed more frequently than weekly for infection control purposes, and the incidence of ventilator-associated pneumonia may be greater with more frequent circuit changes.

  3. Meeting Residential Ventilation Standards Through Dynamic Control of Ventilation Systems

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, Max H.; Walker, Iain S.

    2011-04-01

    Existing ventilation standards, including American Society of Heating, Refrigerating, and Air-conditioning Engineers (ASHRAE) Standard 62.2, specify continuous operation of a defined mechanical ventilation system to provide minimum ventilation, with time-based intermittent operation as an option. This requirement ignores several factors and concerns including: other equipment such as household exhaust fans that might incidentally provide ventilation, negative impacts of ventilation when outdoor pollutant levels are high, the importance of minimizing energy use particularly during times of peak electricity demand, and how the energy used to condition air as part of ventilation system operation changes with outdoor conditions. Dynamic control of ventilation systems can provide ventilation equivalent to or better than what is required by standards while minimizing energy costs and can also add value by shifting load during peak times and reducing intake of outdoor air contaminants. This article describes the logic that enables dynamic control of whole-house ventilation systems to meet the intent of ventilation standards and demonstrates the dynamic ventilation system control concept through simulations and field tests of the Residential Integrated Ventilation-Energy Controller (RIVEC).

  4. Pulmonary embolism. The implications of prospective investigation of pulmonary embolism diagnosis.

    Science.gov (United States)

    Ralph, D D

    1994-07-01

    PIOPED represents a milestone in the study of pulmonary embolism diagnosis because of its well-designed protocol, proper execution, and the large number of patients enrolled. The most important conclusions of the study are 1. Interobserver agreement is good for classifying ventilation-perfusion scans either as normal or as high probability for pulmonary embolism, but interobserver agreement is lower for classifying scans as intermediate or low probability. 2. About 40% of patients with pulmonary embolism have high probability ventilation-perfusion scans, 40% have intermediate probability scans, and 20% have low probability scans. Few (less than 1%) patients with normal perfusion scans have pulmonary embolism. 3. Eighty-seven percent of patients with high probability scans have pulmonary embolism, and 30% of patients with intermediate probability scans have embolism. Unfortunately, 14% of patients with low probability scans have pulmonary embolism. 4. Clinical suspicion can be combined with the ventilation-perfusion scan results to improve the accuracy of diagnosis of pulmonary embolism. About 90% of patients with high probability scans and high or intermediate clinical suspicion for pulmonary embolism indeed have embolism. At the other extreme, only 4% of patients with both low probability scans and low clinical suspicion have embolism. In the remaining combinations of categories 6% to 66% of patients have embolism. 5. Suggested modifications of the original PIOPED criteria for classifying ventilation-perfusion scans make the analysis simpler and more useful. New studies have examined subgroups from PIOPED to refine guidelines for clinical practice further and to incorporate the results of tests for deep venous thrombosis into the diagnostic evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Quantification of right ventricular function in acute pulmonary embolism: relation to extent of pulmonary perfusion defects

    DEFF Research Database (Denmark)

    Kjaergaard, J.; Schaadt, B.K.; Lund, J.O.;

    2008-01-01

    and regional RV dysfunction in 58 consecutive patients with non-massive PE. Methods and results Patients were compared with 58 age-matched controls that had normal ventilation/perfusion scintigraphies. A 2D, Doppler and Tissue Doppler echocardiography performed on the same day, quantified RV pressure...... and global and regional performance. Intermediate and large pulmonary emboli were associated with a significant impact on RV pressure and function. For small pulmonary emboli obstructing

  6. 无创正压通气治疗急性心源性肺水肿临床分析%Noninvasive positive pressure ventilation in treatment of acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    田庾

    2010-01-01

    目的:观察无创正压通气(noninvasive positive pressure ventilation,NPPV)治疗急性心源性肺水肿的疗效.方法:对26例急性心源性肺水肿引起的急性呼吸衰竭患者行NPPV,观察治疗期间心率和经皮血氧饱和度的变化,比较治疗前、治疗后2 h血气情况.结果:急性心源性肺水肿患者治疗2 h缺氧症状得到明显改善,心悸、呼吸困难及紫绀明显好转,心功能评级明显降低(P<0.01).结论:对急性心源性肺水肿引起的急性呼吸衰竭行NPPV疗效显著.

  7. 不同无创正压通气模式治疗心源性肺水肿的疗效及其对心肌酶学的影响%The Effect of Different Noninvasive Positive Pressure Ventilation on Patients with Cardiogenic Pulmonary Edema and it ’s Enzymology

    Institute of Scientific and Technical Information of China (English)

    马君武; 欧相林; 邱翰忠; 邓秀凡

    2015-01-01

    Objective:To compare the clinical efficacy of different noninvasive positive pressure ventilation in the treatment of cardiogenic pulmonary edema and the impact of enzymology. Methods:120 patients with cardiogenic pulmonary edema were randomly divided into the observation group and the control group,and each group was 60 cases in the department of emergency and ICU from Dec 2011 to Dec 2014. Control group was used continuous positive airway pressure (CPAP) therapy, while observation group was used Bi-level positive airway pressure (BiPAP) therapy. The clinical efficacy and the impact of enzymology were compared between the two groups. Results:The total effective rate in the observation group and control group was not significant difference (90.0% vs 86.7%,P>0.05). Compared to before treatment,CK and CK-MB were significantly higher after the treatment in both groups (P0.05). Conclusion: For patients with cardiogenic pulmonary edema as soon as possible the need for non-invasive positive pressure ventilation therapy,CPAP and BiPAP modes are able to achieve better results, but need to monitor cardiac function enzymatic changes.%目的:对比不同无创正压通气模式治疗心源性肺水肿的临床疗效及其对心肌酶学的影响。方法:将广东省韶关市第一人民医院急诊科和ICU2011年12月-2014年12月收治的心源性肺水肿患者120例随机分为观察组和对照组各60例,对照组采用持续气道内正压通气(CPAP)治疗,观察组采用双水平气道正压通气(BiPAP)治疗,比较两组疗效及心肌酶学。结果:观察组与对照组的总有效率无明显差异(90.0% vs 86.7%,P>0.05)。治疗后两组CK和CK-MB均显著高于治疗前(P<0.05),但治疗后两组CK和CK-MB无明显差异(P>0.05)。结论:对心源性肺水肿进行无创持续气道内正压通气和双水平气道正压通气模式治疗,均能够取得好疗效,但需监测心肌酶学的变化。

  8. 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.

  9. Pulmonary contusion in the pediatric population.

    Science.gov (United States)

    Hamrick, Miller Carlton; Duhn, Ryan Donsworth; Carney, David Edward; Boswell, William Carson; Ochsner, Mims Gage

    2010-07-01

    Pulmonary contusion in the adult population is an independent risk factor for respiratory failure, ventilator associated pneumonia, and acute respiratory distress syndrome. Pilot studies in adults note an increased risk when volume of pulmonary contusion exceeds 20 per cent of total lung volume. The purpose of this study was to determine if children with pulmonary contusion suffer the same morbidity as adults. From January 2005 to May 2007, all trauma patients ages 3 to 18-years-old were assessed for CT evidence of pulmonary contusion. Children were excluded if injury included confounding variables, which could result in respiratory failure independent of contusion status. CT images were reviewed and pulmonary contusion was calculated as a percentage of total lung volume. Outcomes including need for invasive ventilation, pneumonia, and development of oxygenation problems were recorded. Data collected included patient age, Injury Severity Score, arterial blood gas findings, and number of rib fractures. Twenty-six patients met criteria for the study with a mean age of 13.35 years and mean Injury Severity Score of 24. The mean percentage of pulmonary contusion was 19.81 per cent. No patients required intubation. Pediatric pulmonary contusion does not carry the same morbidity as noted in the adult population. Invasive airway management is rarely required.

  10. 家庭无创正压通气在慢性阻塞性肺疾病稳定期患者中的疗效%Clinical value of home non-invasive positive pressure ventilation in patients with stable-phase chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    王峰; 李艳丽; 刘占祥

    2010-01-01

    目的 研究稳定期慢性阻塞性肺疾病并慢性呼吸衰竭患者家庭氧疗加用无创正压通气与单独应用家庭氧疗治疗的疗效.方法 慢性阻塞性肺疾病稳定期并慢性呼吸衰竭患者使用家庭氧疗加无创正压通气与单纯长期家庭氧疗患者比较在治疗1年中的病情恶化次数、住院次数、住院时间以及治疗前与治疗12个月后的血气指标和肺功能参数的变化和症状、体征.结果 随访12个月后,家庭氧疗加用无创正压通气治疗组病情恶化次数和住院次数均较单纯氧疗组明显减少.在治疗12个月随访时,家庭氧疗加用无创正压通气治疗组的动脉血氧分压(PaO2),动脉血二氧化碳分压(PaCO2),血液pH与单纯氧疗组比较均有显著改善,差异有统计学意义(P<0.05).结论 无创正压通气是慢性阻塞性肺疾病稳定期并慢性呼吸衰竭患者积极和有效的治疗措施.%Objective To study the clinical value of home non-invasive positive pressure ventilation(NIPPV) in patients with stable-phase chronic obstructive pulmonary disease(COPD)and chronic respiratory failure.Methods Stable COPD patients complicated with chronic respiratory failure received Bi-level positive airway pressure ventilation.The frequency of acute exacerbation,admissiontimes-admission expending,blood gas analysis were compared in these patients with those received long term oxygen therapy. Results After one year home non-invasive positive pressure ventilation,PaCO2,HCO-3 were decreased,while pH and PaO2 increased.Compared with patients received long term oxygen therapy,PaCO2 was greatly ameliorated and the frequency of acute exacerbation,admission times and admission expending declined.Conclusions Home non-invasive positive pressure ventilation will do good to COPD patients with hypercapnic respiratory failure during stable phase.

  11. Rationale and study design of PROVHILO - a worldwide multicenter randomized controlled trial on protective ventilation during general anesthesia for open abdominal surgery

    Directory of Open Access Journals (Sweden)

    Hedenstierna Göran

    2011-05-01

    Full Text Available Abstract Background Post-operative pulmonary complications add to the morbidity and mortality of surgical patients, in particular after general anesthesia >2 hours for abdominal surgery. Whether a protective mechanical ventilation strategy with higher levels of positive end-expiratory pressure (PEEP and repeated recruitment maneuvers; the "open lung strategy", protects against post-operative pulmonary complications is uncertain. The present study aims at comparing a protective mechanical ventilation strategy with a conventional mechanical ventilation strategy during general anesthesia for abdominal non-laparoscopic surgery. Methods The PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure ("PROVHILO" trial is a worldwide investigator-initiated multicenter randomized controlled two-arm study. Nine hundred patients scheduled for non-laparoscopic abdominal surgery at high or intermediate risk for post-operative pulmonary complications are randomized to mechanical ventilation with the level of PEEP at 12 cmH2O with recruitment maneuvers (the lung-protective strategy or mechanical ventilation with the level of PEEP at maximum 2 cmH2O without recruitment maneuvers (the conventional strategy. The primary endpoint is any post-operative pulmonary complication. Discussion The PROVHILO trial is the first randomized controlled trial powered to investigate whether an open lung mechanical ventilation strategy in short-term mechanical ventilation prevents against postoperative pulmonary complications. Trial registration ISRCTN: ISRCTN70332574

  12. Demand controlled ventilation; Behovsstyrt ventilasjon

    Energy Technology Data Exchange (ETDEWEB)

    Soerensen, Henning Holm

    2006-07-01

    The terms CAV and VAV have been known terms for many years in the ventilation business. The terms are also included in building regulations, but the time is now right to focus on demand controlled ventilation (DCV). The new building regulations and the accompanying energy framework underline the need for a more nuanced thinking when it comes to controlling ventilation systems. Descriptions and further details of the ventilation systems are provided (ml)

  13. Pulmonary vasculitis.

    Science.gov (United States)

    Lally, Lindsay; Spiera, Robert F

    2015-05-01

    Pulmonary vasculitis encompasses inflammation in the pulmonary vasculature with involved vessels varying in caliber from large elastic arteries to capillaries. Small pulmonary capillaries are the vessels most commonly involved in vasculitis affecting the lung. The antineutrophil cytoplasmic antibody-associated vasculitides, which include granulomatosis with polyangiitis (formerly Wegener granulomatosis), microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome), are the small vessel vasculitides in which pulmonary vasculitis is most frequently observed and are the major focus of this review. Vasculitic involvement of the large pulmonary vessels as may occur in Behçet syndrome and Takayasu arteritis is also discussed.

  14. 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.

  15. Ventilation/perfusion scintigraphy in children with post-infectious bronchiolitis obliterans: a pilot study.

    Directory of Open Access Journals (Sweden)

    Bo-Qia Xie

    Full Text Available PURPOSE: Childhood post-infectious bronchiolitis obliterans (BO is an infrequent lung disease leading to narrowing and/or complete obliteration of small airways. Ventilation and perfusion (V/Q scan can provide both regional and global pulmonary information. However, only few retrospective researches investigating post-infectious BO involved V/Q scan, the clinical value of this method is unknown. This preliminary prospective study was aimed to evaluate the correlation of V/Q scan with disease severity, pulmonary function test results, and prognosis in children with post-infectious BO. METHODS: Twenty-five post-infectious BO children (18 boys and 7 girls; mean age, 41 months underwent V/Q scan and pulmonary function tests. Patients were followed after their inclusion. Ventilation index and perfusion index obtained from V/Q scan were used to measure pulmonary abnormalities. Spearman's rank correlation test of ventilation index and perfusion index on disease severity, lung function tests indices, and follow-up results were performed. RESULTS: The median follow-up period was 4.6 years (range, 2.2 to 5.0 years. Ventilation index and perfusion index were both correlated with disease severity (r = 0.72, p<0.01 and r = 0.73, p<0.01, but only ventilation index was related to pulmonary function tests results (all p<0.05. In addition, Spearman test yielded significant correlations between perfusion index and prognosis (r = 0.77, p<0.01, and ventilation index and prognosis (r = 0.63, p = 0.01. CONCLUSIONS: For children with post-infectious BO, the present study preliminarily indicated that the degree of ventilation and perfusion abnormalities evaluated by V/Q scan may be used to assess disease severity, and may be predictive of patient's outcome.

  16. Hybrid Ventilation Air Flow Process

    DEFF Research Database (Denmark)

    Heiselberg, Per Kvols

    The scope of this annex is therefore to obtain better knowledge of the use of hybrid ventilation technologies. The annex focus on development of control strategies for hybrid ventilation, on development of methods to predict hybrid ventilation performance in office buildings and on implementation...

  17. Ventilator and viral induced inflammation

    NARCIS (Netherlands)

    Hennus, M.P.

    2013-01-01

    This thesis expands current knowledge on ventilator induced lung injury and provides insights on the immunological effects of mechanical ventilation during viral respiratory infections. The experimental studies in the first part of this thesis improve our understanding of how mechanical ventilation

  18. Iloprost drug delivery during infant conventional and high-frequency oscillatory ventilation

    OpenAIRE

    Robert M. DiBlasi; Crotwell, Dave N.; Shen, Shuijie; Zheng, Jiang; Fink, James B.; Yung, Delphine

    2016-01-01

    Iloprost is a selective pulmonary vasodilator approved for inhalation by the Food and Drug Administration. Iloprost has been increasingly used in the management of critically ill neonates with hypoxic lung disease. This in vitro study was designed to test the hypothesis that aerosol drug delivery could be effectively administered to infants with both conventional ventilation and high-frequency oscillatory ventilation (HFOV). A neonatal test lung model configured with newborn lung mechanics wa...

  19. Reporting ventilation-perfusion lung scintigraphy: impact on subsequent use of anticoagulation therapy.

    OpenAIRE

    Kaboli, P.; Buscombe, J. R.; Ell, P J

    1993-01-01

    Ventilation and perfusion lung scintigraphy is an established and safe noninvasive technique which has been used for nearly 30 years to establish the diagnosis of pulmonary embolism. Recently, in common with other diagnostic tests, there has arisen the need to reassess the effectiveness of this test in the clinical setting. A retrospective analysis of 244 patients undergoing ventilation-perfusion lung scintigraphy was performed. A total of 203 case notes were available. It was found that the ...

  20. 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)...

  1. Inert gas analysis of ventilation-perfusion matching during hemodialysis.

    OpenAIRE

    1984-01-01

    The mechanism of hypoxemia during hemodialysis was investigated by the multiple inert gas elimination technique in anesthetized, paralyzed, mechanically ventilated dogs. Profound leukopenia occurred in the first hour of a 2-h hemodialysis with a cuprophan membrane and dialysate that contained acetate. Arterial partial pressure of O2 and CO2 and oxygen consumption remained unchanged during dialysis. Pulmonary carbon dioxide elimination and lung respiratory exchange ratio decreased with the ini...

  2. Measure Guideline: Ventilation Cooling

    Energy Technology Data Exchange (ETDEWEB)

    Springer, D.; Dakin, B.; German, A.

    2012-04-01

    The purpose of this measure guideline on ventilation cooling is to provide information on a cost-effective solution for reducing cooling system energy and demand in homes located in hot-dry and cold-dry climates. This guideline provides a prescriptive approach that outlines qualification criteria, selection considerations, and design and installation procedures.

  3. Elforbrug til mekanisk ventilation

    DEFF Research Database (Denmark)

    Olufsen, P.

    I Energi 2000 er ventilationsområdet udpeget som et af de områder, hvor der bør tages initiativ til at fremme elbesparelser. I rapporten beskrives og analyseres målinger af elforbruget til ventilation i 12 bygninger, der alle anvendes til administration eller lignende formål. På grundlag af...

  4. Pulmonary Complications due to Esophagectomy

    Directory of Open Access Journals (Sweden)

    Yashar Talebi

    2011-08-01

    Full Text Available Introduction: Esophageal carcinoma is the scourge of human beings. Pulmonary compli-cations in patients who have undergone operation are common (20-30% of cases and there are no suitable tools and ways to predict these complications. Methods: During a period of 10 years, from March 1998 to February 2007, 200 patients (150 male and 50 female underwent Esophagectomy due to esophageal carcinoma in thoracic surgery ward retrospectively. Complications include the length of hospitalization, mechanical ventilation, morbidity and mortality. Patients’ risk factors include age, preoperative chemo-radiotherapy, stage of the disease and preoperative spirometry condition. Results: We grouped our patients into three categories: Normal (FEV1 ≥ 80% predicted, mildly impaired (FEV1 65% to 79% predicted, more severely impaired (FEV1 < 65% predicted.Although almost all patients had radiographic pulmonary abnormalities, significant pulmonary complications occurred in 40 patients (20% which underwent Esophagectomy. Pleural effusion and atelectasia in 160 patients (80%. 24 patients needed chest-tube insertion. 20 patients (10% developed ARDS. 14 patients (7% developed chylothorax. 20 patients (10% of patients died during their postoperative hospital stay. 30 patients (15% required mechanical ventilation for greater than 48 hours. Conclusion: We reviewed a number of preoperative clinical variables to determine whether they contributed to postoperative pulmonary complications as well as other outcomes. In general, age, impaired pulmonary function especially in those patients with FEV1 less than 65% predicted was associated with prolonged hospital length of stay (LOS. In fact pulmonary complications rate after Esophagectomy are high and there was associated mortality and morbidity.

  5. [Congenital pulmonary capillary hemangiomatosis in a newborn].

    Science.gov (United States)

    Sposito Cavallo, Sandra L; Macias Sobrino, Luciano A; Marenco Altamar, Luifer J; Mejía Alquichire, Andrés F

    2017-02-01

    Pulmonary capillary hemangiomatosis is a rare entity characterized by the proliferation of capillaries into alveolar walls, interlobular septa, pleura and pulmonary interstitium, without malignant characteristics, with almost constant association with pulmonary hypertension. Until now two cases of congenital presentation have been reported in the literature. This is the third case in a newborn; he has not followed the usual pattern associated with pulmonary hypertension as occurs in most patients with this pathology; the highest incidence is among 20-40 years old. We report a preterm newborn patient of 36 weeks of gestation with progressive respiratory distress requiring mechanical ventilation by constant desaturation during his clinical evolution without clinical, radiological or ultrasonographic signs of pulmonary hypertension.

  6. Effect of coexistent restrictive ventilation impairment on pulmonary diffusing capacity and motion activity in patients with stable moderate to severe COPD%合并限制性通气功能障碍对稳定期Ⅱ、Ⅲ级慢性阻塞性肺疾病患者运动能力的影响

    Institute of Scientific and Technical Information of China (English)

    陈宇清; 吕成坚; 周新; 朱东

    2012-01-01

    Objective To study the change in pulmonary diffusing capacity, motion activity and respiratory muscle strength in chronic obstructive pulmonary disease (COPD) patients accompanied with restrictive ventilation impairment. Methods Sixty-eight stable COPD patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade D -III [post-bronchodilator forced expiratory volume in one second (FEVj) ranging from 31%-79% predicted value] were enrolled. Pulmonary function test (PFT) and diffusing capacity for carbon monoxide (DLco) by single-breath method were measured after bronchodilator (salbutamol 400 |xg) inhalation, and six minute walk test (6MWT) was performed. Results Compare with health elderly people, COPD patients were found to have severe limited expiratory flow and hyperinflation. Thirty-six patients were diagnosed as having coexistent restrictive ventilation impairment defined as TLC0.05]. Conclusions Low BMI resultes in severe impairment of respiratory muscle strength and motion activity, leading to restrictive ventilation impairment in patients with COPD. DLco declines significantly in COPD patients with coexisting restrictive ventilation impairment and 6 minute walking distance decreases significantly, but DLco/VA is not affected.%目的:观察合并限制性通气功能障碍对稳定期Ⅱ、Ⅲ级慢性阻塞性肺疾病(COPD)患者的肺功能和运动能力的影响.方法:将68例稳定期Ⅱ、Ⅲ级COPD患者根据肺总量(TLC)<80%预计值分为单纯气流阻塞组(32例)和合并限制性通气功能障碍组(阻塞合并限制组)(36例),受试前8h内均未应用支气管舒张剂.2组患者在吸入沙丁胺醇400 μg后接受常规肺通气功能、弥散功能和呼吸肌力测试,并进行6 min步行试验(6MWT).结果:与正常老年人相比,稳定期Ⅱ~Ⅲ级COPD患者存在较严重的呼出气流受限,导致肺过度充气,肺残气量/肺总量比值(RV/TLC)显著增高.对于合并限制性通气

  7. TH-E-BRF-02: 4D-CT Ventilation Image-Based IMRT Plans Are Dosimetrically Comparable to SPECT Ventilation Image-Based Plans

    Energy Technology Data Exchange (ETDEWEB)

    Kida, S [UC Davis School of Medicine, Sacramento, CA (United States); University of Tokyo Hospital, Bunkyo, Tokyo (Japan); Bal, M [Philips Healthcare (Netherlands); Kabus, S [Philips Research, Hamburg (Germany); Loo, B [Stanford University, Stanford, CA (United States); Keall, P [University of Sydney, Camperdown (Australia); Yamamoto, T [UC Davis School of Medicine, Sacramento, CA (United States); Stanford University, Stanford, CA (United States)

    2014-06-15

    Purpose: An emerging lung ventilation imaging method based on 4D-CT can be used in radiotherapy to selectively avoid irradiating highly-functional lung regions, which may reduce pulmonary toxicity. Efforts to validate 4DCT ventilation imaging have been focused on comparison with other imaging modalities including SPECT and xenon CT. The purpose of this study was to compare 4D-CT ventilation image-based functional IMRT plans with SPECT ventilation image-based plans as reference. Methods: 4D-CT and SPECT ventilation scans were acquired for five thoracic cancer patients in an IRB-approved prospective clinical trial. The ventilation images were created by quantitative analysis of regional volume changes (a surrogate for ventilation) using deformable image registration of the 4D-CT images. A pair of 4D-CT ventilation and SPECT ventilation image-based IMRT plans was created for each patient. Regional ventilation information was incorporated into lung dose-volume objectives for IMRT optimization by assigning different weights on a voxel-by-voxel basis. The objectives and constraints of the other structures in the plan were kept identical. The differences in the dose-volume metrics have been evaluated and tested by a paired t-test. SPECT ventilation was used to calculate the lung functional dose-volume metrics (i.e., mean dose, V20 and effective dose) for both 4D-CT ventilation image-based and SPECT ventilation image-based plans. Results: Overall there were no statistically significant differences in any dose-volume metrics between the 4D-CT and SPECT ventilation imagebased plans. For example, the average functional mean lung dose of the 4D-CT plans was 26.1±9.15 (Gy), which was comparable to 25.2±8.60 (Gy) of the SPECT plans (p = 0.89). For other critical organs and PTV, nonsignificant differences were found as well. Conclusion: This study has demonstrated that 4D-CT ventilation image-based functional IMRT plans are dosimetrically comparable to SPECT ventilation image

  8. Human response to ductless personalized ventilation coupled with displacement ventilation

    DEFF Research Database (Denmark)

    Dalewski, Mariusz; Veselý, Michal; Melikov, Arsen K.

    2012-01-01

    A human subject experiment was carried out to investigate the extent to which ductless personalized ventilation (DPV) in conjunction with displacement ventilation can improve perceived air quality (PAQ) and thermal comfort at elevated room air temperature in comparison with displacement ventilation...... alone. The experimental conditions comprised displacement ventilation alone (room air temperature of 23 °C, 26 °C, 29 °C) and DPV with displacement ventilation (26 °C, 29 °C), both operating at supply air temperatures 3, 5 or 6K lower than room air temperature, as well as mixing ventilation (23 °C, 3 K......). During one hour exposure participants answered questionnaires regarding PAQ and thermal comfort. PAQ was significantly better with DPV than without DPV at the same background conditions. Thermal comfort improved when DPV was used. Combining DPV with displacement ventilation showed the potential...

  9. Effect of pelvic floor muscle exercises on pulmonary function

    Science.gov (United States)

    Han, DongWook; Ha, Misook

    2015-01-01

    [Purpose] This study aimed to determine the correlation between pelvic floor muscle strength and pulmonary function. In particular, we examined whether pelvic floor muscle exercises can improve pulmonary function. [Subjects] Thirty female college students aged 19–21 with no history of nervous or musculoskeletal system injury were randomly divided into experimental and control groups. [Methods] For the pulmonary function test, spirometry items included forced vital capacity and maximal voluntary ventilation. Pelvic floor muscle exercises consisted of Kegel exercises performed three times daily for 4 weeks. [Results] Kegel exercises performed in the experimental group significantly improved forced vital capacity, forced expiratory volume in 1 second, PER, FEF 25–75%, IC, and maximum voluntary ventilation compared to no improvement in the control group. [Conclusion] Kegel exercises significantly improved pulmonary function. When abdominal pressure increased, pelvic floor muscles performed contraction at the same time. Therefore, we recommend that the use of pelvic floor muscle exercises be considered for improving pulmonary function. PMID:26644681

  10. The Value of Mechanical Ventilation in Treatment of Cardiogenic Pulmonary Edema%机械通气在治疗心源性肺水肿中的价值

    Institute of Scientific and Technical Information of China (English)

    王琳; 林立

    2005-01-01

    机械通气是抢救各种原因所导致急性呼吸衰竭(acute respiratory failure,ARF)的有效手段。急性心源性肺水肿(acute cardiogenic pulmonary edema,ACPE)是急性呼吸衰竭(ARF)的病因之一,传统的药物、氧疗、体位等疗效有限。除去除病因外,纠正缺氧对终止心肺功能障碍的恶性循环至关重要。20世纪70年代机械通气开始被用于治疗心源性肺水肿,通过迅速改善缺氧,改善心肺功能,挽救患者生命。当前,在机械通气治疗ACPE方面取得了很大的进展,尤其是在无创正压通气(Non-invasive positive pressure ventilation,NIPPV)方面。

  11. Planar and SPECT ventilation/perfusion imaging and computed tomography for the diagnosis of pulmonary embolism: A systematic review and meta-analysis of the literature, and cost and dose comparison

    Energy Technology Data Exchange (ETDEWEB)

    Phillips, J.J., E-mail: jimphillips@nhs.net [Nuclear Medicine, Aberdeen Royal Infirmary, NHS Grampian, Foresterhill Road, Aberdeen AB25 2ZN (United Kingdom); Straiton, J. [Radiology, Aberdeen Royal Infirmary, NHS Grampian, Foresterhill Road, Aberdeen AB25 2ZN (United Kingdom); Staff, R.T. [Nuclear Medicine, Aberdeen Royal Infirmary, NHS Grampian, Foresterhill Road, Aberdeen AB25 2ZN (United Kingdom)

    2015-07-15

    Diagnosing acute pulmonary embolism (PE) is an indication for scintillation V/Q imaging (planar and SPECT) and/or CTPA. This study reviews, compares and aggregates the published diagnostic performance of each modality and assesses the short-term consequences in terms of diagnostic outcomes, monetary cost, and radiation burden. We performed a formal literature review of available data and aggregated the finding using a summary receiver operating characteristic. A decision tree approach was used to estimate cost and dose per correct diagnosis. The review found 19 studies, which comprised 27 data sets (6393 examinations, from 5923 patients). The results showed that planar V/Q was significantly inferior to both V/Q SPECT and CTPA with no difference between the latter two. CTPA represents best value; £129 per correct diagnosis compared to £243 (SPECT) and £226 (planar). In terms of radiation burden V/Q SPECT was the most effective with a dose of 2.12 mSv per correct diagnosis compared with 3.46 mSv (planar) and 4.96 (CTPA) mSv. These findings show no performance difference between V/Q SPECT and CTPA; planar V/Q is inferior. CTPA is clearly the most cost effective technique. V/Q SPECT should be considered in situations where radiation dose is of concern or CTPA is inappropriate.

  12. Successful one-lung ventilation in a patient with the Fontan circulation undergoing thoracoscopic procedure.

    Science.gov (United States)

    Cvetkovic, Draginja; Ramzy, Wassim; Vitale, Salvatore; Malekan, Ramin; Warsy, Irfan

    2014-12-01

    Over the course of the past 4 decades, the survival of patients with the Fontan circulation has improved and today they often present for noncardiac surgery anesthesia care. In patients with the Fontan circulation, pulmonary blood flow is passive and anesthetic management is directed at reducing pulmonary vascular resistance and maintaining adequate cardiac output. One-lung ventilation can have unfavorable effects on the Fontan circulation due to hypoxia, hypercarbia, and increased airway pressure. We present a case of successful one-lung ventilation in a patient with the Fontan circulation and describe the perioperative anesthetic management.

  13. Design Procedure for Hybrid Ventilation

    DEFF Research Database (Denmark)

    Heiselberg, Per; Tjelflaat, Per Olaf

    Mechanical and natural ventilation systems have developed separately during many years. The natural next step in this development is development of ventilation concepts that utilises and combines the best features from each system into a new type of ventilation system - Hybrid Ventilation....... Buildings with hybrid ventilation often include other sustainable technologies and an energy optimisation requires an integrated approach in the design of the building and its mechanical systems. Therefore, the hybrid ventilation design procedure differs from the design procedure for conventional HVAC....... The first ideas on a design procedure for hybrid ventilation is presented and the different types of design methods, that is needed in different phases of the design process, is discussed....

  14. Aplicação terapêutica da ventilação colateral com drenagem pulmonar no tratamento do enfisema pulmonar difuso: relato dos três primeiros casos Therapeutic application of collateral ventilation with pulmonary drainage in the treatment of diffuse emphysema: report of the first three cases

    Directory of Open Access Journals (Sweden)

    Roberto Saad Junior

    2009-01-01

    Full Text Available OBJETIVO: Relatar os resultados obtidos no pré- e pós-operatório de três pacientes portadores de enfisema pulmonar difuso grave, empregando uma nova técnica: ventilação colateral com drenagem do parênquima pulmonar. MÉTODOS: Para a avaliação da drenagem pulmonar, foram selecionados pacientes que já haviam sido submetidos à terapêutica clínica máxima, incluindo a reabilitação pulmonar, e que ainda assim sofriam de falência respiratória com dispnéia incapacitante. Os pacientes foram submetidos, no pré- e no pós operatório, à pletismografia e ao teste da caminhada de seis minutos, assim como responderam aos seguintes questionários de qualidade de vida: Medical Outcomes Study 36-item Short-Form Health Survey, Saint George's Respiratory Questionnaire, Eastern Cooperative Oncology Group Performance Status e Medical Research Council Scale. Todos os pacientes tiveram seguimento de no mínimo 300 dias de pós-operatório. Os testes foram realizados no pré-operatório, entre 30 e 40 dias de pós-operatório e após 300 dias de pós-operatório. Os dados foram analisados pelo método de gráficos de perfis de médias. RESULTADOS: Quando comparados os resultados do pré-operatório com os do pós-operatório nos dois momentos, verificou-se que houve melhora em todos os parâmetros estudados. CONCLUSÕES: Os resultados sugerem que a técnica operatória proposta para o tratamento de doentes portadores de enfisema pulmonar difuso grave foi capaz de diminuir os sintomas debilitantes destes pacientes, tornando sua qualidade de vida muito melhor.OBJECTIVE: To report the results obtained in three patients with diffuse pulmonary emphysema during the pre- and post-operative periods following a new surgical technique: collateral ventilation with lung parenchyma drainage. METHODS: Patients suffering from pulmonary failure and disabling dyspnea, despite having received the gold standard treatment, including pulmonary rehabilitation, were

  15. ASHRAE and residential ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, Max H.

    2003-10-01

    In the last quarter of a century, the western world has become increasingly aware of environmental threats to health and safety. During this period, people psychologically retreated away from outdoors hazards such as pesticides, smog, lead, oil spills, and dioxin to the seeming security of their homes. However, the indoor environment may not be healthier than the outdoor environment, as has become more apparent over the past few years with issues such as mold, formaldehyde, and sick-building syndrome. While the built human environment has changed substantially over the past 10,000 years, human biology has not; poor indoor air quality creates health risks and can be uncomfortable. The human race has found, over time, that it is essential to manage the indoor environments of their homes. ASHRAE has long been in the business of ventilation, but most of the focus of that effort has been in the area of commercial and institutional buildings. Residential ventilation was traditionally not a major concern because it was felt that, between operable windows and envelope leakage, people were getting enough outside air in their homes. In the quarter of a century since the first oil shock, houses have gotten much more energy efficient. At the same time, the kinds of materials and functions in houses changed in character in response to people's needs. People became more environmentally conscious and aware not only about the resources they were consuming but about the environment in which they lived. All of these factors contributed to an increasing level of public concern about residential indoor air quality and ventilation. Where once there was an easy feeling about the residential indoor environment, there is now a desire to define levels of acceptability and performance. Many institutions--both public and private--have interests in Indoor Air Quality (IAQ), but ASHRAE, as the professional society that has had ventilation as part of its mission for over 100 years, is the

  16. Diagnosing chronic thromboembolic pulmonary hypertension: current perspectives

    Directory of Open Access Journals (Sweden)

    Hadinnapola C

    2014-09-01

    Full Text Available Charaka Hadinnapola, Deepa Gopalan, David P Jenkins Papworth Hospital National Health Service Foundation Trust, Papworth Everard, Cambridge, United Kingdom Abstract: Chronic thromboembolic pulmonary hypertension is a rare and relatively poorly understood disease. It remains underdiagnosed and is often not recognized in primary and secondary care, as its symptoms are nonspecific and there are few clinical signs until late in the disease process. However, pulmonary endarterectomy (PEA offers a potential cure for patients with this type of pulmonary hypertension; therefore, it is important that they are identified and diagnosed in a timely manner. PEA is associated with a 2.2%–5% risk of significant morbidity and mortality, even in experienced PEA centers. Therefore, once chronic thromboembolic pulmonary hypertension is diagnosed, further assessment of operability and patient selection is crucial. Assessment of operability involves determining the distribution and burden of chronic thromboembolic disease, assessing pulmonary hemodynamics, and assessing the functional impairment of the patient. Ventilation perfusion scintigraphy is of value in screening for the presence of chronic thromboembolic disease. However, computer tomography pulmonary angiography and magnetic resonance pulmonary angiography are now increasingly used to image the vascular occlusions directly. This allows assessment of the surgically accessible disease burden. Some centers still advocate conventional selective pulmonary angiography for the latter. Right-heart catheterization remains the gold standard for assessing pulmonary hemodynamics. Higher pulmonary vascular resistances are associated with poorer outcomes as well as increased risks at the time of surgery. This is in part because of the presence of more distal chronic thromboembolic material and distal pulmonary artery remodeling. However, in experienced centers, these patients are being operated on safely and with good

  17. High Frequency Oscillatory Ventilation

    Directory of Open Access Journals (Sweden)

    AC Bryan

    1996-01-01

    Full Text Available High frequency oscillatory (HFO ventilation using low tidal volume and peak airway pressures is extremely efficient at eliminating carbon dioxide and raising pH in the newborn infant with acute respiratory failure. Improvement in oxygenation requires a strategy of sustained or repetitive inflations to 25 to 30 cm H2O in order to place the lung on the deflation limb of the pressure-volume curve. This strategy has also been shown to decrease the amount of secondary lung injury in animal models. Experience of the use of HFO ventilation as a rescue therapy as well as several published controlled trials have shown improved outcomes and a decrease in the use of extracorporeal membrane oxygenation when it has been used in newborns.

  18. The effects of repetitive transcranial magnetic stimulation combined with abdominal muscle electrical stimulation on the pulmonary ventilation of patients with cervical spinal cord injury%重复功能性磁刺激联合腹直肌电刺激对颈髓损伤患者肺通气功能的影响

    Institute of Scientific and Technical Information of China (English)

    李宁; 袁华; 牟翔; 杜起; 毛利; 惠楠

    2013-01-01

    Objective To observe the effects of repetitive transcranial magnetic stimulation (rTMS) combined with abdominal muscle electrical stimulation on the pulmonary ventilation of patients with cervical spinal cord injury.Methods Twenty-five patients with cervical spinal cord injury were randomized into an experimental group (n =13) and a control group (n =12).The control group was given comprehensive rehabilitation treatment,including upper limb movements,standing training and training of respiratory function,while the experimental group was given repetitive transcranial magnetic stimulation and abdominal muscle electrical stimulation in addition to the comprehensive rehabilitation treatment.The patients' maximum lung capacity (VC),forced expiratory volume for 1 second (FEV1),peak expiratory flow rate (PEF) and tidal volume (VT) were measured at the outset and after 3 months of treatment.Results The lung function indexes increased in both groups after treatment,but each index improved significantly more in the experimental group,on average,than in the control group.Conclusion As a supplement to routine respiratory function training,repetitive transcranial magnetic stimulation combined with abdominal intermediate frequency electrical stimulation can improve the pulmonary ventilation function of patients with middle and lower cervical spinal cord injury.%目的 观察重复功能性磁刺激(rFMS)联合腹直肌电刺激对中、低位颈髓损伤(CSCI)患者肺通气功能的影响.方法 共选取25例中、低位CSCI患者,采用随机数字表法将其分为治疗组及对照组.对照组给予上肢主动运动、站立训练、呼吸功能训练等综合康复治疗,治疗组在此基础上辅以rFMS及腹直肌中频电刺激.分别于治疗前、治疗3个月后对2组患者肺功能[包括最大肺活量(VC)、1秒钟用力呼气量(FEV1)、呼气峰值流速(PEF)及潮气量(VT)等指标]进行评定.结果 2组患者分别经3个

  19. Effect of inhaling ipratropium bromide to patients with chronic obstructive pulmonary disease on ventilation and exercise capacity during exercise%吸入异丙托溴胺对慢性阻塞性肺疾病患者运动肺功能的影响

    Institute of Scientific and Technical Information of China (English)

    李建国; 吴浩; 冉丕鑫; 莫晓能; 蒋龙元; 李依群; 黄子通

    2008-01-01

    Objective To evaluate the effect of inhaling ipratropium bromide(IPB)to patients with chronic obstructive pulmonary disease(COPD)on ventilation and exercise capacity during exercise.Methods All 12 stable patients were diagnosed as COPD.Before and after inhaling single-dose IPB,symptom-limited progressive cycle ergometer exercise tests were performed.Results The maximal rate of work,maximal oxygen uptake,the maximal volume of ventilation per minute and the maximal ratio of tidal volume to inspiratory capacity increased significantly after inhaling IPB solution of four times the standard dose.The maximal dead space/tidal volume ratio and the maximal ventilatory equivalent for CO2 had no change.There was a significant correlation between the amount of the maximal ratio of tidal volume to inspiratory capacity improved and amount of maximal oxygen uptake improved(r=0.598,P<0.05).Another significant correlation exited between the amount of maximal rate of work improved and amount of the maximal ratio of tidal volume to inspiratory capacity improved(r=0.743,P<0.05).Conclusions Inhaling single-dose IPB will be helpful in improving exercise tolerance of patients.The improvement of maximal ratio of tidal volume to inspiratory capacity could be an important factor about inhaling IPB how to improve exercise tolerance of patients.%目的 评价吸入异丙托溴胺(ipratropium bromide,IPB)是否改善慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的静态肺功能,运动通气功能和运动耐量.方法 随机抽取稳定期COPD患者12例,吸入IPB溶液2 mg,吸人前后分别进行静态肺功能和运动肺功能测定.结果 吸入IPB后,COPD患者最大运动功率(Wmax)、最大耗氧量(VO2max)、最大运动时每分钟通气量(Vemax)和比潮气量(Vtmax/IC),较吸人前均有显著增加;死腔通气(VD/VT)和二氧化碳通气当量(Vemax/VCO2max)无明显改变.Vtmax/IC的变化(⊿Vtmax/IC)与VO2max的变化(⊿VO2max

  20. Pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Lauro Martins Júnior

    2014-12-01

    Full Text Available Pulmonary hypertension is a pathological condition associated with various diseases, which must be remembered by the physicians, since early diagnosis may anticipate and avoid dangerous complications and even death if appropriate measures were not taken. The relationship with chronic obstructive pulmonary disease (COPD, important pathological process that is in increasing prevalence in developing countries, and leading position as cause of death, emphasizes its importance. Here are presented the classifications, pathophysiology, and general rules of treatment of pulmonary hypertension.

  1. Ventilation perfusion radionuclide imaging in cryptogenic fibrosing alveolitis

    Energy Technology Data Exchange (ETDEWEB)

    Bourke, S.J.; Hawkins, T.; Keavey, P.M.; Gascoigne, A.D.; Corris, P.A. (Freeman Hospital, Newcastle upon Tyne (United Kingdom))

    1993-06-01

    There is increasing interest in ventilation perfusion (V/Q) imaging in cryptogenic fibrosing alveolitis because of the data these scans provide on the dynamic V/Q relationships in such patients undergoing single lung transplantation. We analysed the V/Q scans of 45 consecutive patients with advanced cryptogenic fibrosing alveolitis being considered for single lung transplantation. Scans were classified according to the presence, severity and degree of matching of defects in ventilation and perfusion images and the results were compared with the data obtained from lung function tests. Ventilation images showed defects in 13 (29%) and ''washout delay'' in 15 (33%) patients; 10 (22%) patients had asymmetric distribution of ventilation with one lung receiving >60% of total ventilation. Perfusion images showed normal perfusion in 8 (18%), mild defects in 18 (40%) and major defects in 19 (42%) patients. The distribution of perfusion between lungs was significantly asymmetric in 20 (45%) patients. V/Q images were matched in 15 (33%), mildly mismatched in 15 (33%) and severely mismatched in 15 (33%) patients, but the degree of V/Q mismatch did not show a relationship to KCO, PaO[sub 2] or A-aO[sub 2] gradient. The appearances were atypical of pulmonary embolism in eight patients. (Author).

  2. [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.

  3. [Pulmonary scintigraphy in the diagnosis of pulmonary embolism].

    Science.gov (United States)

    Favretto, Giuseppe

    2002-01-01

    Pulmonary scintigraphy constitutes an important step in the non invasive diagnosis of pulmonary embolism (PE). This technique may be employed for the evaluation of the pulmonary perfusion alone, as in Italy and in the PISA-PED study, or else even for the evaluation of the pulmonary ventilation (as in Anglo-Saxon countries and in the PIOPED study). In the present study, the reasons which have prompted the ANMCO-SIC Commission for the Guidelines for The Prophylaxis, Diagnosis and Therapy of Pulmonary Thromboembolism to propose, for the diagnostic work-up of the patient with clinically suspected PE, the use of perfusion scintigraphy alone and of the classification criteria employed in the PISA-PED study instead of the more commonly utilized ventilatory-perfusion scintigraphy and of the criteria included in the PIOPED article, are discussed. Besides, the Commission's decision to consider PE as being present in case of agreement between the scintigraphic and clinical pictures, and to exclude this condition when the scintigraphic outcome is normal/almost normal regardless of the clinical probabilities, is also motivated.

  4. 慢性阻塞性肺疾病合并呼吸衰竭应用无创正压通气临床疗效%Clinical effect of non-invasive positive pressure ventilation for chronic obstructive pulmonary disease combined with respiratory failure

    Institute of Scientific and Technical Information of China (English)

    刘冲; 余洁

    2015-01-01

    目的 探讨慢性阻塞性肺疾病合并呼吸衰竭应用无创正压通气治疗的临床疗效.方法 80例慢性阻塞性肺疾病合并呼吸衰竭患者, 随机分为观察组和对照组, 每组40例, 对照组患者应用常规治疗, 观察组在对照组治疗的基础上给予无创正压通气治疗, 对比分析两组患者治疗前后呼吸频率、心率、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、pH值.结果 治疗前两组患者心率、呼吸频率、PaCO2、PaO2、pH值比较差异无统计学意义(P>0.05), 治疗后观察组患者心率、呼吸频率、PaCO2、PaO2、pH值均明显优于对照组(P0.05). After treatment, the observation group had obviously better heart rate, respiratory rate, PaCO2, PaO2, and pH than the control group (P<0.05).Conclusion Non-invasive positive pressure ventilation provides precise effect in treating chronic obstructive pulmonary disease combined with respiratory failure. It can effectively improve clinical symptoms, prevent progression of disease, and correct respiratory failure. This method is worthy of clinical promotion and application.

  5. Efficacy analysis of long-term home non-invasive assisted ventilation in stable chronic obstructive pulmonary disease combined with typeⅡ respiratory failure%长期家庭无创辅助通气对稳定期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的疗效分析

    Institute of Scientific and Technical Information of China (English)

    赵静; 古力·卡德尔; 王丽霞; 阿迪拉; 雍楠

    2013-01-01

    目的 探讨长期家庭无创辅助通气对稳定期慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者的治疗效果.方法 确诊稳定期COPD合并Ⅱ型呼吸衰竭患者共78例,按患者意愿分为治疗组26例和对照组52例,对照组予以常规治疗,包括吸入沙美特罗/氟替卡松+长期家庭氧疗(LTOT);治疗组在常规治疗基础上加用无创辅助通气治疗,每日6~8h,疗程12个月,观察两组血气分析指标[pH值、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)]、肺功能指标[第1秒用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1%)]、6 min步行试验(6-MWT)距离、圣乔治呼吸问卷(SGRQ)评分及急性发作住院次数.结果 随访12个月,治疗组无一例因急性发作行气管插管,无一例死亡.对照组有5例因急性发作行气管插管、有创机械通气,其中1例死亡.治疗后两组肺功能指标(FEV1、FEV1%)较治疗前均有改善(P<0.05).但治疗组治疗后FEV1、FEV1%显著高于同期对照组(P<0.05).治疗组治疗后血气分析指标(pH值、PaCO2、PaO2)较治疗前显著改善(P<0.05).对照组治疗后PaO2较治疗前显著改善(P<0.05),但对照组治疗后pH值、PaCO2与治疗前比较差异无统计学意义(P>0.05).两组患者治疗后6-MWT距离、SGRQ评分较治疗前均有改善,差异有统计学意义(P<0.05),治疗组治疗后6-MWT距离显著高于同期对照组、SGRQ评分显著低于同期对照组,差异均有统计学意义(P<0.05).随访12个月,治疗组平均每人急性发作次数(0.84±0.16)次,对照组(1.49±0.78)次,差异有统计学意义(t=-3.65,P<0.05).结论 家庭无创辅助通气治疗可以改善稳定期COPD合并Ⅱ型呼吸衰竭患者的肺功能、血气分析,增加运动耐量,提高生活质量,减少急性发作次数及插管率.%Objective To investigate the clinical effect of long-term home non-invasive assisted ventilation in stable chronic obstructive pulmonary disease

  6. Effects of combined application of fentanyl and midazolam on pulmonary function in patients with mechanical ventilation%芬太尼及咪唑安定联合应用对机械通气患者肺功能的影响

    Institute of Scientific and Technical Information of China (English)

    柳东之

    2014-01-01

    Objective To investigate the effects of combined application of fentanyl and midazolam on pulmo-nary function in patients with mechanical ventilation. Methods 63 cases of acute respiratory distress syndrome ( ARDS) patients in our hospital from March 2010 to September 2013 were selected,they were randomly divided into control group(n=31)and observation group(n=32),all patients received oral endotracheal intubation mechanical ven-tilation and conventional treatment,observation group used remifentanil and midazolam sedation and analgesia therapy on the basis of control group. The changes of lung function before and after treatment in two groups were compared. Results After treatment,plateau airway pressure of two groups(Pplat)significantly decreased,there were significant differences(P<0. 05). After 24,48 h treatment,Pplat of treatment group were(22. 12 ± 2. 31)cmH2O and(19. 56 ± 2. 37)cmH2O respectively,which were significantly lower than those of control group,the differences were significant (P<0. 05). After treatment,pulmonary compliance(Cst)and Oxygenation index(PaO2/FiO2)of the two groups signif-icantly increased,there were significant differences(P<0. 05). Cst of treatment group were(33. 92 ±7. 58)cmH2O and (35. 45 ±5. 87)cmH2O,and PaO2/FiO2were 242. 67 ±62. 01 and 289. 36 ±55. 09 after 24,48 h treatment ,which were significant higher than those of control group. Conclusion Fentanyl combined with midazolam can improve the lung oxygenation index and compliance of mechanical ventilation patients,and protect the lung function.%目的:探讨芬太尼及咪唑安定联合应用对机械通气患者肺功能的影响。方法抽选我院2010年3月至2013年9月收治的63例急性呼吸窘迫综合征( Acute respiratory distress syndrome,ARDS)患者,采用分层随机分组法分为对照组(31例)和观察组(32例),均经口气管插管机械通气及常规治疗,观察组在对照组基础上予以芬太尼+咪唑安定镇痛镇静治疗,比较两

  7. Nicotinamide exacerbates hypoxemia in ventilator-induced lung injury independent of neutrophil infiltration.

    Directory of Open Access Journals (Sweden)

    Heather D Jones

    development of significant hypoxemia. These findings suggest that pulmonary neutrophilia is not linked to hypoxemia in ventilator-induced lung injury, and that nicotinamide exacerbates hypoxemia during VILI.

  8. Nicotinamide Exacerbates Hypoxemia in Ventilator-Induced Lung Injury Independent of Neutrophil Infiltration

    Science.gov (United States)

    Jones, Heather D.; Yoo, Jeena; Crother, Timothy R.; Kyme, Pierre; Ben-Shlomo, Anat; Khalafi, Ramtin; Tseng, Ching W.; Parks, William C.; Arditi, Moshe

    2015-01-01

    paradoxically also leads to the development of significant hypoxemia. These findings suggest that pulmonary neutrophilia is not linked to hypoxemia in ventilator-induced lung injury, and that nicotinamide exacerbates hypoxemia during VILI. PMID:25875775

  9. Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs.

    Science.gov (United States)

    Bhatt, Sasmira; Alison, Beth J; Wallace, Euan M; Crossley, Kelly J; Gill, Andrew W; Kluckow, Martin; te Pas, Arjan B; Morley, Colin J; Polglase, Graeme R; Hooper, Stuart B

    2013-04-15

    Delayed cord clamping improves circulatory stability in preterm infants at birth, but the underlying physiology is unclear. We investigated the effects of umbilical cord clamping, before and after ventilation onset, on cardiovascular function at birth. Prenatal surgery was performed on lambs (123 days) to implant catheters into the pulmonary and carotid arteries and probes to measure pulmonary (PBF), carotid (CaBF) and ductus arteriosus blood flows. Lambs were delivered at 126 ± 1 days and: (1) the umbilical cord was clamped at delivery and ventilation was delayed for about 2 min (Clamp 1st; n = 6), and (2) umbilical cord clamping was delayed for 3-4 min, until after ventilation was established (Vent 1st; n = 6). All lambs were subsequently ventilated for 30 min. In Clamp 1st lambs, cord clamping rapidly (within four heartbeats), but transiently, increased pulmonary and carotid arterial pressures (by ∼30%) and CaBF (from 30.2 ± 5.6 to 40.1 ± 4.6 ml min(-1) kg(-1)), which then decreased again within 30-60 s. Following ventilation onset, these parameters rapidly increased again. In Clamp 1st lambs, cord clamping reduced heart rate (by ∼40%) and right ventricular output (RVO; from 114.6 ± 14.4 to 38.8 ± 9.7 ml min(-1) kg(-1)), which were restored by ventilation. In Vent 1st lambs, cord clamping reduced RVO from 153.5 ± 3.8 to 119.2 ± 10.6 ml min(-1) kg(-1), did not affect heart rates and resulted in stable blood flows and pressures during transition. Delaying cord clamping for 3-4 min until after ventilation is established improves cardiovascular function by increasing pulmonary blood flow before the cord is clamped. As a result, cardiac output remains stable, leading to a smoother cardiovascular transition throughout the early newborn period.

  10. Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs

    Science.gov (United States)

    Bhatt, Sasmira; Alison, Beth J; Wallace, Euan M; Crossley, Kelly J; Gill, Andrew W; Kluckow, Martin; te Pas, Arjan B; Morley, Colin J; Polglase, Graeme R; Hooper, Stuart B

    2013-01-01

    Delayed cord clamping improves circulatory stability in preterm infants at birth, but the underlying physiology is unclear. We investigated the effects of umbilical cord clamping, before and after ventilation onset, on cardiovascular function at birth. Prenatal surgery was performed on lambs (123 days) to implant catheters into the pulmonary and carotid arteries and probes to measure pulmonary (PBF), carotid (CaBF) and ductus arteriosus blood flows. Lambs were delivered at 126 ± 1 days and: (1) the umbilical cord was clamped at delivery and ventilation was delayed for about 2 min (Clamp 1st; n = 6), and (2) umbilical cord clamping was delayed for 3–4 min, until after ventilation was established (Vent 1st; n = 6). All lambs were subsequently ventilated for 30 min. In Clamp 1st lambs, cord clamping rapidly (within four heartbeats), but transiently, increased pulmonary and carotid arterial pressures (by ∼30%) and CaBF (from 30.2 ± 5.6 to 40.1 ± 4.6 ml min−1 kg−1), which then decreased again within 30–60 s. Following ventilation onset, these parameters rapidly increased again. In Clamp 1st lambs, cord clamping reduced heart rate (by ∼40%) and right ventricular output (RVO; from 114.6 ± 14.4 to 38.8 ± 9.7 ml min−1 kg−1), which were restored by ventilation. In Vent 1st lambs, cord clamping reduced RVO from 153.5 ± 3.8 to 119.2 ± 10.6 ml min−1 kg−1, did not affect heart rates and resulted in stable blood flows and pressures during transition. Delaying cord clamping for 3–4 min until after ventilation is established improves cardiovascular function by increasing pulmonary blood flow before the cord is clamped. As a result, cardiac output remains stable, leading to a smoother cardiovascular transition throughout the early newborn period. PMID:23401615

  11. March 2013 pulmonary journal club

    Directory of Open Access Journals (Sweden)

    Mathew M

    2013-03-01

    Full Text Available No abstract available. Article truncated at 150 words. Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F, Clavel M, Frat JP, Plantefeve G, Quenot JP, Lascarrou JB; Clinical Research in Intensive Care and Sepsis (CRICS Group. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA. 2013;309(3:249-56. The March pulmonary journal club reviewed the article looking at the effect of gastric residual volume and ventilator associated pneumonia. Most of us would agree that enteral nutrition in the critically ill patient is important but how early and how much is still debatable. In many institutions gastric residual volumes are used to assess gastric motility and help guide rate and cessation of enteral nutrition. This study evaluated the effect of not monitoring gastric residual volume and its effect on ventilator associated pneumonia. The study was a randomized multicenter non- inferiority …

  12. Compression of the Right Pulmonary Artery by a Massive Defects on Pulmonary Scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Makis, William [Brandon Regional Health Centre, Brandon (Canada); Derbekyan, Vilma [McGill Univ. Health Centre, Montreal (Canada)

    2012-03-15

    A 67 year old woman, who presented with a 2 month history of dyspnea, had a vectilation and perfusion lung scan that showed absent perfusion of the entire right lung scan that showed absent perfusion of the entire right lung with normal ventilation, as well as a rounded matched defect in the left lower lung adjacent to mialine, suspicious for an aortic aneurysm or dissection. CT pulmonary angiography revealed a massive descending aortic aneurysm compressing the right pulmonary artery as well as the left lung parenchyma, accounting for the bilateral perfusion scan defects. We present the Xe 133 ventilation, Tc 99m MAA perfusion and CT pulmonary angiography imaging findings of this rare case.

  13. Pretest Predictions for Ventilation Tests

    Energy Technology Data Exchange (ETDEWEB)

    Y. Sun; H. Yang; H.N. Kalia

    2007-01-17

    The objective of this calculation is to predict the temperatures of the ventilating air, waste package surface, concrete pipe walls, and insulation that will be developed during the ventilation tests involving various test conditions. The results will be used as input to the following three areas: (1) Decisions regarding testing set-up and performance. (2) Assessing how best to scale the test phenomena measured. (3) Validating numerical approach for modeling continuous ventilation. The scope of the calculation is to identify the physical mechanisms and parameters related to thermal response in the ventilation tests, and develop and describe numerical methods that can be used to calculate the effects of continuous ventilation. Sensitivity studies to assess the impact of variation of linear power densities (linear heat loads) and ventilation air flow rates are included. The calculation is limited to thermal effect only.

  14. Analysis of Multivariate Factors for Noninvasive Ventilation In the Patients with Acute Cardiogenic Pulmona-ry Edema%无创通气治疗急性心源性肺水肿失败的多因素分析

    Institute of Scientific and Technical Information of China (English)

    钱风华; 钱义明; 朱亮; 顼志兵; 祁丽丽; 赵雷

    2010-01-01

    Objective To analyze the multivariate factors associated with failure of applying noninvasive ven-tilation(NIV)in the patients with acute cardiogenic pulmonary edema(ACPE).Methods 65 patients with ACPE re-ceived NIV treatment,and were divided into NIV syccess group and NIV failure group according to the result with NIV therapy.Compared with the exchanges of the relevant parameters before the treatment and in the treatment between these two groups,analysis the alert factors and observational factors of the failure in NIV treatment.Resylts 27 cases in failure on NIV were elders,with acute myocardial infarction,decline on PaCO_2,raise on PH,low on MPA,compared with the success group.In NIV treatment and observing the changes of RR,PaO2,PaCO_2,there is a obviously differ-ence(P<0.05)on the HR improvement in the patients of the success group compared with the patients of the failure group.Conclusion The factors of elder,acute myocardial infarction,decline on PaCO_2,raise on PH,low on MPA could be seemed as the alert factors before the NIV treatment,the efficiency of therapy of NIV could be judged through observing HR,RR,PaO_2,PaCO_2 in NIV treatment.%目的 分析应用无创通气(NIV)治疗急性心源性肺水肿(ACPE)失败的多种因素.方法 65例ACPE患者在应用NIV治疗后根据结果分为NIV成功组和NIV失败组,将两组治疗前的相关因素和治疗时相关指标的变化进行比较,分析NIV治疗失败的预警因素和观察指标.结果 27例NIV治疗失败,与成功组比较,NIV失败组年龄偏大、患急性心肌梗死、PaCO_2下降、PH增高、MPA低.NIV治疗期间治疗成功组患者HR的改善优于失败组(P<0.05).结论 NIV治疗前,高龄、急性心肌梗死患者、PaCO_2下降、PH增高、MPA低可以作为预警因素;NIV期间观察HR、RR、PaO_2、PaCO_2可以及时判断NIV治疗的有效性.

  15. [Continuous positive airway pressure and high-frequency independent lung ventilation in patients with chronic obstructive lung diseases].

    Science.gov (United States)

    Fedorova, E A; Vyzhigina, M A; Gal'perin, Iu S; Zhukova, S G; Titov, V A; Godin, A V

    2004-01-01

    The original hypoxemia, hypercapnia, high pulmonary hypertension, high resistance of microcirculation vessels, right volumetric ventricular overload, persistent sub-edema of pulmonary intersticium as well as disparity of ventilation and perfusion between both lungs are the main problems in patients with chronic obstructive disease of the lungs (CODL). Such patients are, as a rule, intolerant to the independent lung collaboration or artificial single-stage ventilation (ASV). Patients with respiratory insufficiency, stages 2 and 3, and with a pronounced impaired type of ventilation have originally a deranged blood gas composition, like hypoxemia or hypercapnia. The application of volume-controllable bi-pulmonary ASV in such patients maintains an adequate gas exchange hemodynamics. However, ASV is accompanied by a significantly reduced gas-exchange function of the single ventilated lung and by essentially worsened intrapulmonary hemodynamics. Therefore, what is needed is to use alternative methods of independent lung ventilation in order to eliminate the gas-exchange impairments and to enable surgical interventions at thoracic organs in such patients (who are intolerant to ASV). A choice of a method and means of oxygen supply to the independent lung is of great importance. The possibility to avoid a high pressure in the airways, while maintaining, simultaneously, an adequate gas exchange, makes the method related with maintaining a constant positive pressure in the airways (CPPA) a priority one in case of CODL patients. The use of constant high-frequency ventilation in the independent lung in patients with obstructive pulmonary lesions does not improve the gas exchange or hemodynamics. Simultaneously, a growing total pulmonary resistance and an increasing pressure in the pulmonary artery are observed. Consequently, the discussed method must not be used for the ventilation support of the independent lung in patients with the obstructive type of the impaired external

  16. Design Principles for Natural and Hybrid Ventilation

    DEFF Research Database (Denmark)

    Heiselberg, Per

    For many years mechanical and natural ventilation systems have developed separately. Naturally, the next step in this development is the development of ventilation concepts that utilize and combine the best features from each system to create a new type of ventilation system- Hybrid Ventilation....... The hybrid ventilation concepts, design challenges and principles are discussed and illustrated by four building examples....

  17. VENTILATOR ASSOCIATED PNEUMONIA IN INTENS