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Sample records for refereeris peep kngas

  1. Professor Peep Veski meie meenutustes

    Index Scriptorium Estoniae

    2014-01-01

    Mälestusi Tartu Ülikooli Farmaatsia instituudi juhatajast Peep Veskist jagavad: Eve-Irene Lepist, Urve Paaver, Karin Kogermann, Kristian Semjonov, Jaak Koppel, Kristin Raudsepp, Imre Klebovich, Filiz Hincal, A. Atilla Hincal ja Elmar Arak

  2. The Neopuff's PEEP valve is flow sensitive.

    LENUS (Irish Health Repository)

    Hawkes, Colin Patrick

    2012-01-31

    AIM: The current recommendation in setting up the Neopuff is to use a gas flow of 5-15 L\\/min. We investigated if the sensitivity of the positive end expiratory pressure (PEEP) valve varies at different flow rates within this range. METHODS: Five Neopuffs were set up to provide a PEEP of 5 cm H(2) O. The number of clockwise revolutions to complete occlusion of the PEEP valve and the mean and range of pressures at each quarter clockwise revolution were recorded at gas flow rates between 5 and 15 L\\/min. Results: At 5, 10 and 15 L\\/min, 0.5, 1.7 and 3.4 full clockwise rotations were required to completely occlude the PEEP valve, and pressures rose from 5 to 11.4, 18.4 and 21.5 cm H(2) O, respectively. At a flow rate of 5 L\\/min, half a rotation of the PEEP dial resulted in a rise in PEEP from 5 to 11.4cm H(2) O. At 10 L\\/min, half a rotation resulted in a rise from 5 to 7.7cm H(2) O, and at 15 L\\/min PEEP rose from 5 to 6.8cm H(2) O. CONCLUSION: Users of the Neopuff should be aware that the PEEP valve is more sensitive at lower flow rates and that half a rotation of the dial at 5 L\\/min gas flow can more than double the PEEP.

  3. The Neopuff's PEEP valve is flow sensitive.

    LENUS (Irish Health Repository)

    Hawkes, Colin Patrick

    2011-03-01

    The current recommendation in setting up the Neopuff is to use a gas flow of 5-15 L\\/min. We investigated if the sensitivity of the positive end expiratory pressure (PEEP) valve varies at different flow rates within this range.

  4. Model-based PEEP optimisation in mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Chiew Yeong Shiong

    2011-12-01

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

  5. Assessment of Factors Related to Auto-PEEP.

    Science.gov (United States)

    Natalini, Giuseppe; Tuzzo, Daniele; Rosano, Antonio; Testa, Marco; Grazioli, Michele; Pennestrì, Vincenzo; Amodeo, Guido; Marsilia, Paolo F; Tinnirello, Andrea; Berruto, Francesco; Fiorillo, Marialinda; Filippini, Matteo; Peratoner, Alberto; Minelli, Cosetta; Bernardini, Achille

    2016-02-01

    Previous physiological studies have identified factors that are involved in auto-PEEP generation. In our study, we examined how much auto-PEEP is generated from factors that are involved in its development. One hundred eighty-six subjects undergoing controlled mechanical ventilation with persistent expiratory flow at the beginning of each inspiration were enrolled in the study. Volume-controlled continuous mandatory ventilation with PEEP of 0 cm H2O was applied while maintaining the ventilator setting as chosen by the attending physician. End-expiratory and end-inspiratory airway occlusion maneuvers were performed to calculate respiratory mechanics, and tidal flow limitation was assessed by a maneuver of manual compression of the abdomen. The variable with the strongest effect on auto-PEEP was flow limitation, which was associated with an increase of 2.4 cm H2O in auto-PEEP values. Moreover, auto-PEEP values were directly related to resistance of the respiratory system and body mass index and inversely related to expiratory time/time constant. Variables that were associated with the breathing pattern (tidal volume, frequency minute ventilation, and expiratory time) did not show any relationship with auto-PEEP values. The risk of auto-PEEP ≥5 cm H2O was increased by flow limitation (adjusted odds ratio 17; 95% CI: 6-56.2), expiratory time/time constant ratio 15 cm H2O/L s (3; 1.3-6.9), age >65 y (2.8; 1.2-6.5), and body mass index >26 kg/m(2) (2.6; 1.1-6.1). Flow limitation, expiratory time/time constant, resistance of the respiratory system, and obesity are the most important variables that affect auto-PEEP values. Frequency expiratory time, tidal volume, and minute ventilation were not independently associated with auto-PEEP. Therapeutic strategies aimed at reducing auto-PEEP and its adverse effects should be primarily oriented to the variables that mainly affect auto-PEEP values. Copyright © 2016 by Daedalus Enterprises.

  6. Peep Põldsamm lõi kampa Skype'i loojatega

    Index Scriptorium Estoniae

    2008-01-01

    Peep Põldsamm asus juhtima Modesat Communications OÜd, mille omanik on Skype'i kaasasutajatele kuuluv investeerimisfirma Ambient Sound Investments. Modesat plaanib saavutada modemitehnoloogia rahvusvahelisel turul viieprotsendilise turuosa. Vt. samas: Põldsamm: olen uute äride ülesehitaja

  7. Automatic detection of AutoPEEP during controlled mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Nguyen Quang-Thang

    2012-06-01

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

  8. Peep Vain - the Best-known Training Guru in the Baltics = Peep Vain - Baltikumi tuntuim koolitusguru / Marit Sillavee

    Index Scriptorium Estoniae

    Sillavee, Marit

    2006-01-01

    Koolitusfirma Vain & Partnerid osaniku Peep Vainu karjäärist ja koolitajatööst. Vt. samas: Spiritual Trainer toTop Sportsmen = Tippsportlaste vaimutreener ; Lead Billing in Estonia's Highest-Grossing Documentary = Eesti edukaima dokfilmi peategelane

  9. Control of positive end-expiratory pressure (PEEP for small animal ventilators

    Directory of Open Access Journals (Sweden)

    Leão Nunes Marcelo V

    2010-07-01

    Full Text Available Abstract Background The positive end-expiratory pressure (PEEP for the mechanical ventilation of small animals is frequently obtained with water seals or by using ventilators developed for human use. An alternative mechanism is the use of an on-off expiratory valve closing at the moment when the alveolar pressure is equal to the target PEEP. In this paper, a novel PEEP controller (PEEP-new and the PEEP system of a commercial small-animal ventilator, both based on switching an on-off valve, are evaluated. Methods The proposed PEEP controller is a discrete integrator monitoring the error between the target PEEP and the airways opening pressure prior to the onset of an inspiratory cycle. In vitro as well as in vivo experiments with rats were carried out and the PEEP accuracy, settling time and under/overshoot were considered as a measure of performance. Results The commercial PEEP controller did not pass the tests since it ignores the airways resistive pressure drop, resulting in a PEEP 5 cmH2O greater than the target in most conditions. The PEEP-new presented steady-state errors smaller than 0.5 cmH2O, with settling times below 10 s and under/overshoot smaller than 2 cmH2O. Conclusion The PEEP-new presented acceptable performance, considering accuracy and temporal response. This novel PEEP generator may prove useful in many applications for small animal ventilators.

  10. Cardiorespiratory effects of balancing PEEP with intra-abdominal pressures during laparoscopic cholecystectomy.

    Science.gov (United States)

    Kundra, Pankaj; Subramani, Yamini; Ravishankar, M; Sistla, Sarath C; Nagappa, Mahesh; Sivashanmugam, T

    2014-06-01

    Applying appropriate positive end-expiratory pressure (PEEP) to corresponding intra-abdominal pressure (IAP) can improve gas exchange during capnoperitoneum without any hemodynamic effects. A total of 75 patients were randomly allocated to group 0PEEP (n=25), group 5PEEP (n=25), and group 10PEEP (n=25) according to the level of PEEP, in whom capnoperitoneum was created with IAP of 14, 8, and 14 mm Hg, respectively. Hemodynamic and respiratory parameters were recorded up to 30 minutes after capnoperitoneum. In 0PEEP group, mean end-tidal carbon dioxide demonstrated significant rise 2 minutes after capnoperitoneum and plateaued at about 15 minutes but remained at high level for up to 30 minutes when compared with the 5PEEP and 10PEEP groups (Phigher at 30 minutes when compared with 5PEEP (37.8±2.7 mm Hg) and 10PEEP (37.2±3.9 mm Hg) groups. The oxygenation was better preserved in 5PEEP and 10PEEP groups with significantly higher PaO2/Fio2 ratio. Heart rate, mean arterial pressure, and cardiac output remained stable throughout the study in all the 3 groups. Application of appropriate PEEP corresponding to the IAP helped maintain CO2 elimination and improved oxygenation without any hemodynamic disturbance in patients undergoing laparoscopic cholecystectomy.

  11. Peep Vain - koolitaja või vaid õhumüüja? / Siim Saidla

    Index Scriptorium Estoniae

    Saidla, Siim, 1981-

    2002-01-01

    Koolitusfirma Vain SMD juhatuse esimehest ja omanikust Peep Vainust räägivad tema koolitustel osalenud. Lisad: Peep Vainu CV; "Kui täna oleks 6. septembri hommik, siis teeksin teisiti" - katkendid Peep Vainu intervjuust iseendaga. Kommenteerivad Mare Pork ja Aune Past

  12. English for lawyers / Liina Soobik ; [preface: Peep Pruks

    Index Scriptorium Estoniae

    Soobik, Liina, 1955-

    2001-01-01

    Kasutatud tekstide autorid: Peep Pruks, Merit-Ene Ilja, Ilona Nurmela, Kristi Raba, Andreas Kangur, Raul Narits, Peeter Roosma, Kalle Merusk, Maret Altnurme, Jaan Ginter, Aare Tark, Norman Aas, Lasse Lehis, Hannes Veinla, Jaan Sootak, Eerik Kergandberg, Paul Varul, Jaanus Ots, Urve Liin, Irene Kull, Merle Muda, Gaabriel Tavits, Andres Vutt, Kadri Siibak, Ellen Ridaste, Heiki Pisuke, Andrus Siibak

  13. Effect of intraoperative PEEP application on colonic anastomoses healing: An experimental animal study.

    Science.gov (United States)

    Turkoglu, Mehmet; Bostancı, Erdal Birol; Bilgili, Hasan; Türkoğlu, Yıldız; Karadeniz, Ümit; Aydoğ, Gülden; Erçin, Uğur; Bilgihan, Ayşe; Özer, İlter; Akoğlu, Musa

    2015-07-27

    This study aimed to assess the effect of intraoperative PEEP intervention on the healing of colonic anastomoses in rabbits. Thirty-two New Zealand type male rabbits were divided into two groups of sixteen animals each. Following ventilation with tracheostomy, colonic resection and anastomosis were performed in both groups. While 10 cm H2O PEEP level was applied in Group I (PEEP), Group II (ZEEP) was ventilated without PEEP throughout the surgery. Half of the both PEEP and ZEEP group animals were killed on the third postoperative day, while the remaining half on the seventh. Anastomotic bursting pressures, the tissue concentrations in hydroxyproline, and histological assessments were performed. Besides, intraoperative oxygen saturation and postoperative arterial blood gas parameters were also compared. On the first postoperative day, both arterial oxygen tension (PO2) and oxygen saturation (SO2) in the PEEP group were significantly higher than in the ZEEP group. On the seventh postoperative day, the bursting pressures of the anastomoses were significantly higher in the PEEP group, however the hydroxyproline content was significantly lower in the PEEP group than that in the ZEEP group. At day 7, PEEP group was significantly associated with increased neoangiogenesis compared with the ZEEP group. The anastomotic healing process is positively influenced by the intraoperative PEEP application.

  14. Effects of peep on lung injury, pulmonary function, systemic circulation and mortality in animals with uninjured lungs-a systematic review

    NARCIS (Netherlands)

    Algera, Anna Geke; Pisani, Luigi; Chaves, Renato Carneiro de Freitas; Amorim, Thiago Chaves; Cherpanath, Thomas; Determann, Rogier; Dongelmans, Dave A.; Paulus, Frederique; Tuinman, Pieter Roel; Pelosi, Paolo; Gama de Abreu, Marcelo; Schultz, Marcus J.; Serpa Neto, Ary

    2018-01-01

    2O, in the 'high PEEP' or 'PEEP' arms, and in the 'low PEEP' or 'no PEEP' arms, respectively. Definitions used for lung injury were quite diverse, as were other outcome measures. The effects of PEEP, at any level, on lung injury was not straightforward, with some trials showing less injury with

  15. Lugejate valik : Peep Vain on parim / Marko Liibak

    Index Scriptorium Estoniae

    Liibak, Marko

    2007-01-01

    Aripaev.ee ja ajaleht Äripäev korraldasid lugejate seas küsitluse, mille käigus valiti Eesti parimaks koolitajaks Vain & Partnerite omanik ning koolituskonsultant Peep Vain. Teisele kohale tuli koolitaja, juhtimiskonsultant ja nõustaja ning Tallinn Ülikooli kliinilise psühholoogia professor Mare Pork. Järgnesid Ülo Vihma, Indrek Saul, Tiit Valm, Mihkel Pärjamäe ning Alexander Kotchubei

  16. Hyperdynamic sepsis modifies a PEEP-mediated redistribution in organ blood flows

    International Nuclear Information System (INIS)

    Bersten, A.D.; Gnidec, A.A.; Rutledge, F.S.; Sibbald, W.J.

    1990-01-01

    Changes in organ blood flow (Q) produced by 20 cm H2O positive end-expiratory pressure (PEEP) were measured before and after the induction of hyperdynamic sepsis in nine unanesthetized sheep. During the baseline nonseptic study, PEEP was associated with a 9% fall in thermodilution-measured systemic Q, although arterial perfusing pressures were unaffected. Concurrently, microsphere-derived Q was maintained to the brain and heart, but fell to liver, spleen, pancreas, kidney, large intestine, and gastrocnemius. Twenty-four to 36 h after cecal ligation and perforation, a pre-PEEP septic study demonstrated an increase in all of the cardiac index (CI) and systemic O2 delivery when compared with the nonseptic study, whereas whole-body O2 extraction was depressed. Although PEEP depressed systemic Q during the septic study to a greater extent than during the nonseptic study (p less than 0.02), absolute organ Q fell only to pancreas, liver, and spleen. Relative to the simultaneous fall in the CI, Q to some splanchnic organs was not depressed by PEEP to the same magnitude in the septic as in the nonseptic study. When an infusion of Ringer's lactate subsequently restored systemic Q to pre-PEEP septic levels, individual flows that had been depressed by PEEP were not restored. Furthermore, Q-kidney continued to fall, such that the postfluid Q-kidney (-19%) was significantly less than was demonstrated in the pre-PEEP septic study. We postulate that differences noted in the distribution of organ Q between the nonseptic and hyperdynamic septic studies after the application of PEEP were secondary to the vasculopathy of sepsis and/or an alteration in the function of specific organ microcirculations. However, these data do not address whether the changes in organ Q distribution after a PEEP-mediated depression in systemic Q during sepsis significantly restricted tissue DO2

  17. Optimizing PEEP by Electrical Impedance Tomography in a Porcine Animal Model of ARDS.

    Science.gov (United States)

    Hochhausen, Nadine; Biener, Ingeborg; Rossaint, Rolf; Follmann, Andreas; Bleilevens, Christian; Braunschweig, Till; Leonhardt, Steffen; Czaplik, Michael

    2017-03-01

    Mechanical ventilation is necessary in diverse clinical circumstances. Especially in the context of ARDS, so-called protective ventilation strategies must be followed. It is already known that PEEP might enhance oxygenation in ARDS. However, determining the optimal PEEP settings in clinical routines is challenging. Electrical impedance tomography (EIT) is a promising technique with which to adjust ventilator settings. We investigated whether the combination of different EIT parameters, namely the global inhomogeneity and hyperdistension indices, may lead to a feasible and safe PEEP setting. ARDS was induced by a double-hit approach in 18 pigs weighing, on average, 34.8 ± 3.97 kg. First, a surfactant washout was conducted; second, the tidal volume was increased to 20 mL/kg body weight, triggering a ventilator-induced lung injury. Subsequently, pigs were randomized to either the EIT or control groups, followed by an observation time of 24 h. In the control group, PEEP was set according to the ARDS network table. In the EIT group, a PEEP trial was conducted to determine an appropriate PEEP. At defined time points, hemodynamic measures, ventilation parameters, and EIT recordings, as well as blood samples, were taken. After euthanization, lungs were removed for subsequent histopathological and cytological examination. The combination of PEEP and F IO 2 differed between groups, although respiratory compliance, gas exchange, and histopathological examinations, as well as hemodynamics, did not show any statistical differences between the EIT and control groups. However, in the control group, the PEEP/F IO 2 settings followed the given coupling; in the EIT group, divergent individual combinations of PEEP and F IO 2 ranges occurred. PEEP setting by EIT facilitates a more individual ventilation therapy. However, in our relatively short ARDS observation period of 24 h, no significant differences appeared in common clinical parameters compared with a control group. Copyright

  18. Double-lumen tubes and auto-PEEP during one-lung ventilation.

    Science.gov (United States)

    Spaeth, J; Ott, M; Karzai, W; Grimm, A; Wirth, S; Schumann, S; Loop, T

    2016-01-01

    Double-lumen tubes (DLT) are routinely used to enable one-lung-ventilation (OLV) during thoracic anaesthesia. The flow-dependent resistance of the DLT's bronchial limb may be high as a result of its narrow inner diameter and length, and thus potentially contribute to an unintended increase in positive end-expiratory pressure (auto-PEEP). We therefore studied the impact of adult sized DLTs on the dynamic auto-PEEP during OLV. In this prospective clinical study, dynamic auto-PEEP was determined in 72 patients undergoing thoracic surgery, with right- and left-sided DLTs of various sizes. During OLV, air trapping was provoked by increasing inspiration to expiration ratio from 1:2 to 2:1 (five steps). Based on measured flow rate, airway pressure (Paw) and bronchial pressure (Pbronch), the pressure gradient across the DLT (ΔPDLT) and the total auto-PEEP in the respiratory system (i.e. the lungs, the DLT and the ventilator circuit) were determined. Subsequently the DLT's share in total auto-PEEP was calculated. ΔPDLT was 2.3 (0.7) cm H2O over the entire breathing cycle. At the shortest expiratory time the mean total auto-PEEP was 2.9 (1.5) cm H2O (range 0-5.9 cm H2O). The DLT caused 27 to 31% of the total auto-PEEP. Size and side of the DLT's bronchial limb did not impact auto-PEEP significantly. Although the DLT contributes to the overall auto-PEEP, its contribution is small and independent of size and side of the DLT's bronchial limb. The choice of DLT does not influence the risk of auto-PEEP during OLV to a clinically relevant extent. DRKS00005648. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Voyeuristi alla finestra: Peeping Tom, dalla leggenda al cinema

    Directory of Open Access Journals (Sweden)

    Laura Staiano

    2015-01-01

    Full Text Available This essay deals with voyeuristic attitudes and ʹscopic powerʹ, i.e. the power to gaze at forbidden things and people without being seen. Indeed, its object par excellence coincides with female nakedness, while its subject is an invisible masculinity, which takes delight in looking. The paper is based on a study of the Anglo-Saxon legend of Lady Godiva and it is strictly connected with the subject of my dissertation in progress – metaphorical and physical blindness in 18th century French literature (since several voyeurs got blind because of their instincts and desires. Lady Godiva’s voyeur, called Peeping Tom, is struck blind for having looked out of his window and seen the noblewoman riding naked. This legend has inspired many artists in different fields, and nowadays its heroine is very famous and venerated. In particular, this essay focuses on the relation between this legend and compulsive looking (or scopophilia in two renowned films, Rear Window by Alfred Hitchcock, and Peeping Tom by Michael Powell.

  20. Peep Aaviksoo kukutas EMT-kesksus / Jaan Männik ; interv. Vallo Toomet

    Index Scriptorium Estoniae

    Männik, Jaan, 1945-

    2003-01-01

    EMT nõukogu esimees ja Eesti Telekomi juhatuse esimees Jaan Männik vastab küsimustele, mis on seotud Peep Aaviksoo lahkumisega Eesti Mobiiltelefoni juhi kohalt. Vt. samas: Aaviksoo selgitab lahkumise põhjusi. Peep Aaviksoo kiri. Kommenteerivad Radiolinja Eesti juhatuse esimees Sami Seppänen, Tele2 Eesti juhatuse esimees Üllar Jaaksoo, Ühispanga analüütik Sven Kunsing

  1. Effect of PEEP, blood volume, and inspiratory hold maneuvers on venous return.

    Science.gov (United States)

    Berger, David; Moller, Per W; Weber, Alberto; Bloch, Andreas; Bloechlinger, Stefan; Haenggi, Matthias; Sondergaard, Soren; Jakob, Stephan M; Magder, Sheldon; Takala, Jukka

    2016-09-01

    According to Guyton's model of circulation, mean systemic filling pressure (MSFP), right atrial pressure (RAP), and resistance to venous return (RVR) determine venous return. MSFP has been estimated from inspiratory hold-induced changes in RAP and blood flow. We studied the effect of positive end-expiratory pressure (PEEP) and blood volume on venous return and MSFP in pigs. MSFP was measured by balloon occlusion of the right atrium (MSFPRAO), and the MSFP obtained via extrapolation of pressure-flow relationships with airway occlusion (MSFPinsp_hold) was extrapolated from RAP/pulmonary artery flow (QPA) relationships during inspiratory holds at PEEP 5 and 10 cmH2O, after bleeding, and in hypervolemia. MSFPRAO increased with PEEP [PEEP 5, 12.9 (SD 2.5) mmHg; PEEP 10, 14.0 (SD 2.6) mmHg, P = 0.002] without change in QPA [2.75 (SD 0.43) vs. 2.56 (SD 0.45) l/min, P = 0.094]. MSFPRAO decreased after bleeding and increased in hypervolemia [10.8 (SD 2.2) and 16.4 (SD 3.0) mmHg, respectively, P waterfall. Copyright © 2016 the American Physiological Society.

  2. Evaluation of lung and chest wall mechanics during anaesthesia using the PEEP-step method.

    Science.gov (United States)

    Persson, P; Stenqvist, O; Lundin, S

    2018-04-01

    Postoperative pulmonary complications are common. Between patients there are differences in lung and chest wall mechanics. Individualised mechanical ventilation based on measurement of transpulmonary pressures would be a step forward. A previously described method evaluates lung and chest wall mechanics from a change of ΔPEEP and calculation of change in end-expiratory lung volume (ΔEELV). The aim of the present study was to validate this PEEP-step method (PSM) during general anaesthesia by comparing it with the conventional method using oesophageal pressure (PES) measurements. In 24 lung healthy subjects (BMI 18.5-32), three different sizes of PEEP steps were performed during general anaesthesia and ΔEELVs were calculated. Transpulmonary driving pressure (ΔPL) for a tidal volume equal to each ΔEELV was measured using PES measurements and compared to ΔPEEP with limits of agreement and intraclass correlation coefficients (ICC). ΔPL calculated with both methods was compared with a Bland-Altman plot. Mean differences between ΔPEEP and ΔPL were mechanical properties among the lung healthy patients stresses the need for individualised ventilator settings based on measurements of lung and chest wall mechanics. The agreement between ΔPLs measured by the two methods during general anaesthesia suggests the use of the non-invasive PSM in this patient population. NCT 02830516. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. PEEP-ZEEP technique: cardiorespiratory repercussions in mechanically ventilated patients submitted to a coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Auler José

    2011-09-01

    Full Text Available Abstract Background The PEEP-ZEEP technique is previously described as a lung inflation through a positive pressure enhancement at the end of expiration (PEEP, followed by rapid lung deflation with an abrupt reduction in the PEEP to 0 cmH2O (ZEEP, associated to a manual bilateral thoracic compression. Aim To analyze PEEP-ZEEP technique's repercussions on the cardio-respiratory system in immediate postoperative artery graft bypass patients. Methods 15 patients submitted to a coronary artery bypass graft surgery (CABG were enrolled prospectively, before, 10 minutes and 30 minutes after the technique. Patients were curarized, intubated, and mechanically ventilated. To perform PEEP-ZEEP technique, saline solution was instilled into their orotracheal tube than the patient was reconnected to the ventilator. Afterwards, the PEEP was increased to 15 cmH2O throughout 5 ventilatory cycles and than the PEEP was rapidly reduced to 0 cmH2O along with manual bilateral thoracic compression. At the end of the procedure, tracheal suction was accomplished. Results The inspiratory peak and plateau pressures increased during the procedure (p Conclusion The PEEP-ZEEP technique seems to be safe, without alterations on hemodynamic variables, produces elevated expiratory flow and seems to be an alternative technique for the removal of bronchial secretions in patients submitted to a CABG.

  4. Differential Effects of Intraoperative Positive End-expiratory Pressure (PEEP) on Respiratory Outcome in Major Abdominal Surgery Versus Craniotomy

    DEFF Research Database (Denmark)

    de Jong, Myrthe A C; Ladha, Karim S; Melo, Marcos F Vidal

    2015-01-01

    OBJECTIVES: In this study, we examined whether (1) positive end-expiratory pressure (PEEP) has a protective effect on the risk of major postoperative respiratory complications in a cohort of patients undergoing major abdominal surgeries and craniotomies, and (2) the effect of PEEP is differed......: Within the entire study population (major abdominal surgeries and craniotomies), we found an association between application of PEEP ≥5 cmH2O and a decreased risk of postoperative respiratory complications compared with PEEP 5 cmH2O was associated with a significant lower...... undergoing major abdominal surgery. Our data suggest that default mechanical ventilator settings should include PEEP of 5-10 cmH2O during major abdominal surgery....

  5. Raudna põhikooli spordihoone Heimtalis = Raudna School Sports Facility in Heimtali / Peep Jänes

    Index Scriptorium Estoniae

    Jänes, Peep, 1936-

    2009-01-01

    2008. a. valminud spordihoonest, mille autor on Peep Jänes, projekteerija GS-Dis, sisekujundajad Signe ja Gildardas Stokas. Spordihoone rajati 1860. a. ehitatud mõisa ringtalli välismüüri sisealale ja restaureeriti ajalooline ringmüür

  6. Ventilation area measured with eit in order to optimize peep settings in mechanically ventilated patients

    NARCIS (Netherlands)

    Blankman, P; Groot Jebbink, E; Preis, C; Bikker, I.; Gommers, D.

    2012-01-01

    INTRODUCTION. Electrical Impedance Tomography (EIT) is a non-invasive imaging technique, which can be used to visualize ventilation. Ventilation will be measured by impedance changes due to ventilation. OBJECTIVES. The aim of this study was to optimize PEEP settings based on the ventilation area of

  7. Bussijuhtide kindrali rasked päevad / Peep Peterson ; interv. Tanel Raig

    Index Scriptorium Estoniae

    Peterson, Peep, 1975-

    2007-01-01

    Eesti Transpordi- ja Teetöötajate Ametiühingu esimees Peep Peterson vastab bussijuhtide ja tööandjate vahelisi lahkhelisid, ametiühinguliikumist ning kokkuleppe sõlmimist puudutavatele küsimustele. Kommenteerivad: Villem Tori. Streikija iseloomuga raske vastane; Henn Pärn. Peterson saavutas maksimumide maksimumi; Harri Taliga. Ametiühingu liidritel erinevad arusaamad. Lisa: Fakte eluloost

  8. Effect of patient position and PEEP on hepatic, portal and central venous pressures during liver resection.

    Science.gov (United States)

    Sand, L; Rizell, M; Houltz, E; Karlsen, K; Wiklund, J; Odenstedt Hergès, H; Stenqvist, O; Lundin, S

    2011-10-01

    It has been suggested that blood loss during liver resection may be reduced if central venous pressure (CVP) is kept at a low level. This can be achieved by changing patient position but it is not known how position changes affect portal (PVP) and hepatic (HVP) venous pressures. The aim of the study was to assess if changes in body position result in clinically significant changes in these pressures. We studied 10 patients undergoing liver resection. Mean arterial pressure (MAP) and CVP were measured using fluid-filled catheters, PVP and HVP with tip manometers. Measurements were performed in the horizontal, head up and head down tilt position with two positive end expiratory pressure (PEEP) levels. A 10° head down tilt at PEEP 5 cm H(2) O significantly increased CVP (11 ± 3 to 15 ± 3 mmHg) and MAP (72 ± 8 to 76 ± 8 mmHg) while head up tilt at PEEP 5 cm H(2) O decreased CVP (11 ± 3 to 6 ± 4 mmHg) and MAP (72 ± 8 to 63 ± 7 mmHg) with minimal changes in transhepatic venous pressures. Increasing PEEP from 5 to 10 resulted in small increases, around 1 mmHg in CVP, PVP and HVP. There was no significant correlation between changes in CVP vs. PVP and HVP during head up tilt and only a weak correlation between CVP and HVP by head down tilt. Changes of body position resulted in marked changes in CVP but not in HVPs. Head down or head up tilt to reduce venous pressures in the liver may therefore not be effective measures to reduce blood loss during liver surgery. 2011 The Authors Acta Anaesthesiologica Scandinavica, 2011 The Acta Anaesthesiologica Scandinavica Foundation.

  9. Between preservation and transformation. First considerations about the recovery of the peep districts in Parma

    Directory of Open Access Journals (Sweden)

    Luca Gullì

    2012-10-01

    Full Text Available The regeneration policy of the PEEP districts, can contribute to the enrichment of the theoretical framework formulated for the protection of the heritage of the Modern Movement. In 2011, the Municipality of Parma, showing a new awareness in relation to assets until now rarely considered, devices a specific field of study within its structural urbanistic plan. In the absence of a regulatory framework of reference, it is crucial to build up the appropriate frameworks of knowledge directed to operational decisions. This can be done by specifically dedicated archives to which to entrust with the definition of a body of rules of urban planning and housing tailored to the particularities of these settlements and to the real questions of transformation that can arise in them.

  10. Effect of PEEP and inhaled nitric oxide on pulmonary gas exchange during gaseous and partial liquid ventilation with small volumes of perfluorocarbon.

    Science.gov (United States)

    Max, M; Kuhlen, R; Falter, F; Reyle-Hahn, M; Dembinski, R; Rossaint, R

    2000-04-01

    Partial liquid ventilation, positive end-expiratory pressure (PEEP) and inhaled nitric oxide (NO) can improve ventilation/perfusion mismatch in acute lung injury (ALI). The aim of the present study was to compare gas exchange and hemodynamics in experimental ALI during gaseous and partial liquid ventilation at two different levels of PEEP, with and without the inhalation of nitric oxide. Seven pigs (24+/-2 kg BW) were surfactant-depleted by repeated lung lavage with saline. Gas exchange and hemodynamic parameters were assessed in all animals during gaseous and subsequent partial liquid ventilation at two levels of PEEP (5 and 15 cmH2O) and intermittent inhalation of 10 ppm NO. Arterial oxygenation increased significantly with a simultaneous decrease in cardiac output when PEEP 15 cmH2O was applied during gaseous and partial liquid ventilation. All other hemodynamic parameters revealed no relevant changes. Inhalation of NO and instillation of perfluorocarbon had no additive effects on pulmonary gas exchange when compared to PEEP 15 cmH2O alone. In experimental lung injury, improvements in gas exchange are most distinct during mechanical ventilation with PEEP 15 cmH2O without significantly impairing hemodynamics. Partial liquid ventilation and inhaled NO did not cause an additive increase of PaO2.

  11. FCT (functional computed tomography) evaluation of the lung volumes at different PEEP (positive-end expiratory pressure) ventilation pattern, in mechanical ventilated patients

    International Nuclear Information System (INIS)

    Papi, M.G.; Di Segni, R.; Mazzetti, G.; Staffa, F.; Conforto, F.; Calimici, R.; Salvi, A.; Matteucci, G.

    2007-01-01

    Purpose To evaluate with FCT (functional computed tomography) total lung volume and fractional lung volumes at different PEEP (positive end expiratory pressure) values in acute mechanically ventilated patients. Methods Nine ICU (intensive care unity) patients (1 lung pneumonia, 2 polytrauma, 2 sepsis, 3 brain surgery, 1 pulmonary embolism); mean age 48 ± 15 years, 6 male, 3 female; GE 16 MDCT scan was performed with acquisition from apex to diaphragma in seven seca at different PEEP values. Raw CT data were analysed by an advantage workstation to obtain volume density masks and histograms of both lungs and each lung and these density ranges were applied: - 1000 - 950 hyper-ventilated lung, -900 - 650 well aerated lung, -950 - 500 all aerated lung, -500 + 200 lung tissue. Total and fractional lung volumes, Hounsfield unit (HU) were calculated and compared at different PEEP values (0, 5, 10, 15 cm H 2 O). In four patients lung volumes were compared between the more and the less involved lung at increased PEEP. Statistic analysis: comparison means-medians tests. Results Data calculated at five PEEP showed unexpected decrease of total lung volume and increase of lung density (HU); proportionally no significant improvement of oxigenation. (orig.)

  12. FCT (functional computed tomography) evaluation of the lung volumes at different PEEP (positive-end expiratory pressure) ventilation pattern, in mechanical ventilated patients

    Energy Technology Data Exchange (ETDEWEB)

    Papi, M.G.; Di Segni, R.; Mazzetti, G.; Staffa, F. [Dept. of Radiology, S. Giovanni HS, Rome (Italy); Conforto, F.; Calimici, R.; Salvi, A. [Dept. of Anesthesiology, S. Giovanni HS, Rome (Italy); Matteucci, G. [Dept. of Pneumology, S. Giovanni HS, Rome (Italy)

    2007-06-15

    Purpose To evaluate with FCT (functional computed tomography) total lung volume and fractional lung volumes at different PEEP (positive end expiratory pressure) values in acute mechanically ventilated patients. Methods Nine ICU (intensive care unity) patients (1 lung pneumonia, 2 polytrauma, 2 sepsis, 3 brain surgery, 1 pulmonary embolism); mean age 48 {+-} 15 years, 6 male, 3 female; GE 16 MDCT scan was performed with acquisition from apex to diaphragma in seven seca at different PEEP values. Raw CT data were analysed by an advantage workstation to obtain volume density masks and histograms of both lungs and each lung and these density ranges were applied: - 1000 - 950 = hyper-ventilated lung, -900 - 650 well aerated lung, -950 - 500 all aerated lung, -500 + 200 lung tissue. Total and fractional lung volumes, Hounsfield unit (HU) were calculated and compared at different PEEP values (0, 5, 10, 15 cm H{sub 2}O). In four patients lung volumes were compared between the more and the less involved lung at increased PEEP. Statistic analysis: comparison means-medians tests. Results Data calculated at five PEEP showed unexpected decrease of total lung volume and increase of lung density (HU); proportionally no significant improvement of oxigenation. (orig.)

  13. "THE EVALUATION OF THE POSSIBLE EFFECT OF POSITIVE END EXPIRATORY PRESSURE (PEEP ON PHARMACOKINETICS OF PHENYTOIN IN PATIENTS WITH ACUTE BRAIN INJURY UNDER MECHANICAL VENTILATION."

    Directory of Open Access Journals (Sweden)

    "Elham Hadidi

    2005-04-01

    Full Text Available Positive ventilation has shown to have an influence on pharmacokinetic and disposition of some drugs.Beacause phenytoin with a narrow therapautic range, is the most commonly used drug for prophylaxis and treatment of early seizures after acute brain injuries, in the present study the effect of short term PEEP (5-10 cm H2O for at least 8 hours on phenytoin serum concentration and pharmacokinetic parameters such as Vmax and clearance in brain injured patients under mechanical ventilation was examined. Ten patients with moderate to severe acute brain injury who were placed on mechanical ventilation with an initial PEEP level of 0-5 cm H2O were included in the study. Patients received phenytoin loading dose of 15 mg/kg followed by a maintenance daily dose of 3-7 mg/kg initiated within 12 hours of loading dose. Sampels were taken on two different occasions before and after PEEP elevation. Total phenytoin serum concentrations were determined by HPLC method. A time invarient Michaelis-Menten pharmacokinetic model was used to calculate Vmax and clearance for each patient.Derrived variables were calculated as follows: Vmax, 3.5-6.8 and 3.7-8.2 mg/kg/day; Clearance, 0.1-0.7 and 0.1-1.2 l/kg/day (before and after PEEP elevation, respectively. Our data have shown a wide range of variability (2.6-32.5 mg/l in phenytoin serum concentrations. There were no statistically significant differences in the measured total concentrations (p=0.721 and calculated Vmax and clearance (p=0.285before and after PEEP elevation. Administration of fluid and inotropic agents, limitation in application of higher levels of PEEP and drug interactions, shall be considered as possible explanations for these findings.

  14. Rasked vestlused. Kuidas ma talle seda ütlen / Irene Metsis, Sami Seppänen, Peep Sooman ; intervjueerinud Heli Lehtsaar

    Index Scriptorium Estoniae

    Metsis, Irene

    2009-01-01

    Skanska EMV administratsioonijuhi Irene Metsise, AS-i Elisa Eesti tegevdirektori Sami Seppäneni ja Pindi Kinnisvara juhatuse liikme Peep Soomani soovitused negatiivse sõnumi edastamiseks töötajale. Vt. samas: 4 nõuannet juhile, kuidas end keeruliseks vestluseks ette valmistada

  15. Monitoring of intratidal lung mechanics: a Graphical User Interface for a model-based decision support system for PEEP-titration in mechanical ventilation.

    Science.gov (United States)

    Buehler, S; Lozano-Zahonero, S; Schumann, S; Guttmann, J

    2014-12-01

    In mechanical ventilation, a careful setting of the ventilation parameters in accordance with the current individual state of the lung is crucial to minimize ventilator induced lung injury. Positive end-expiratory pressure (PEEP) has to be set to prevent collapse of the alveoli, however at the same time overdistension should be avoided. Classic approaches of analyzing static respiratory system mechanics fail in particular if lung injury already prevails. A new approach of analyzing dynamic respiratory system mechanics to set PEEP uses the intratidal, volume-dependent compliance which is believed to stay relatively constant during one breath only if neither atelectasis nor overdistension occurs. To test the success of this dynamic approach systematically at bedside or in an animal study, automation of the computing steps is necessary. A decision support system for optimizing PEEP in form of a Graphical User Interface (GUI) was targeted. Respiratory system mechanics were analyzed using the gliding SLICE method. The resulting shapes of the intratidal compliance-volume curve were classified into one of six categories, each associated with a PEEP-suggestion. The GUI should include a graphical representation of the results as well as a quality check to judge the reliability of the suggestion. The implementation of a user-friendly GUI was successfully realized. The agreement between modelled and measured pressure data [expressed as root-mean-square (RMS)] tested during the implementation phase with real respiratory data from two patient studies was below 0.2 mbar for data taken in volume controlled mode and below 0.4 mbar for data taken in pressure controlled mode except for two cases with RMS rational decision-making model for PEEP-titration.

  16. Mida arvate ideest, et kõrgkoole võiks juhtida ülikoolivälistest inimestest koosnev nõukogu? / Jaak Aaviksoo, Maris Mälzer, Peeter Kreitzberg, Peep Sürje

    Index Scriptorium Estoniae

    2010-01-01

    Küsimusele vastavad Tartu Ülikooli eelmine rektor Jaak Aaviksoo, Eesti Üliõpilaskondade Liidu esimees Maris Mälzer, Riigikogu kultuurikomisjoni esimees Peeter Kreitzberg ja Tallinna Tehnikaülikooli rektor Peep Sürje

  17. Kas omakeelsel haridusel ja teadusel on tulevikku? / Kirsti Siitonen, Jolanta Zabarskaite, Josep Soler-Carbonell, Rainer Enrique Hamel ; intervjueerinud Peep Nemvalts ; tõlkinud Doris Kareva, Aili Künstler

    Index Scriptorium Estoniae

    2011-01-01

    TLÜ teaduskeelekeskus korraldas koos TLÜ eesti keele ja kultuuri instituudiga 29. ja 30. augustil rahvusvahelise konverentsi "Rahvuskeeled teaduses ja kõrghariduses". Sel teemal vastavad TLÜ teaduskeelekeskuse juhataja Peep Nemvaltsi küsimustele konverentsi rahvusvahelised esinejad

  18. "THE EVALUATION OF THE POSSIBLE EFFECT OF POSITIVE END EXPIRATORY PRESSURE (PEEP) ON PHARMACOKINETICS OF PHENYTOIN IN PATIENTS WITH ACUTE BRAIN INJURY UNDER MECHANICAL VENTILATION."

    OpenAIRE

    "Elham Hadidi; Mojtaba Mojtahedzadeh; Mohammad Reza Rouini; Behzad Eftekhar; Mohammad Abdollahi; Atabak Najafi; Mohammad R. Khajavi; Saeed Rezaee; Reza Ghaffari; Minoo Afshar"

    2005-01-01

    Positive ventilation has shown to have an influence on pharmacokinetic and disposition of some drugs.Beacause phenytoin with a narrow therapautic range, is the most commonly used drug for prophylaxis and treatment of early seizures after acute brain injuries, in the present study the effect of short term PEEP (5-10 cm H2O for at least 8 hours) on phenytoin serum concentration and pharmacokinetic parameters such as Vmax and clearance in brain injured patients under mechanical ventilation was e...

  19. Uus töölpeinguseadus : nagu Soomes lama ajal? Ei, veel karmim / Maret Maripuu, Tarmo Kriis, Peep Peterson ; interv. Külli-Riin Tigasson

    Index Scriptorium Estoniae

    Maripuu, Maret, 1974-

    2008-01-01

    Uue töölepingu seaduse eelnõust. Vestlusringis on sotsiaalminister Maret Maripuu, Eesti tööandjate keskliidu juhataja Tarmo Kriis ja transpordi ametiühingu juhatuse esimees Peep Peterson. Lisatud: mida eelnõu muudab? ; ametiühingute keskliidu juhi Harri Taliga kommentaar: dzhungliseaduste tagasitulek? ; Helmes ASi nõukogu esimehe Jaan Pillesaare kommentaar: praegune seadus on tobe

  20. NOAA People Empowered Products (PeEP): Combining social media with scientific models to provide eye-witness confirmed products

    Science.gov (United States)

    Codrescu, S.; Green, J. C.; Redmon, R. J.; Minor, K.; Denig, W. F.; Kihn, E. A.

    2013-12-01

    NOAA products and alerts rely on combinations of models and data to provide the public with information regarding space and terrestrial weather phenomena and hazards. This operational paradigm, while effective, neglects an abundant free source of measurements: millions of eyewitnesses viewing weather events. We demonstrate the capabilities of a prototype People Empowered Product (PeEP) that combines the OVATION prime auroral model running at the NOAA National Geophysical Data Center with Twitter reports of observable aurora. We introduce an algorithm for scoring Tweets based on keywords to improve the signal to noise of this dynamic data source. We use the location of the aurora derived from this new database of crowd sourced observations to validate the OVATION model for use in auroral forecasting. The combined product displays the model aurora in real time with markers showing the location and text of tweets from people actually observing the aurora. We discuss how the application might be extended to other space weather products such as radiation related satellite anomalies.

  1. Efecto del incremento de la PEEP en la actividad muscular respiratoria evaluado con electromiografía de superficie en individuos sanos bajo ventilación espontánea

    Directory of Open Access Journals (Sweden)

    Hernández-Valdivieso, Alher Mauricio

    2016-07-01

    Full Text Available Introduction: In a mechanically ventilated patient with increased airway resistance, the expiratory time span is insufficient to exhale all the inspired volume. In order to maintain oxygenation and to reduce the workload of respiratory muscles, it is common to apply an extrinsic positive end-expiratory pressure (PEEP that reduces tissue collapsibility, counterbalancing the increased resistance. Several studies have shown the usefulness of surface electromyography (sEMG to quantify the work of breathing (WOB, particularly in patients with obstructive diseases. Objective: To assess the effect of incremental PEEP in the respiratory muscle activity through sEMG in healthy volunteers noninvasively ventilated. Methods: Study of muscle activity in 10 healthy male volunteers, noninvasively ventilated for 20 minutes. The extrinsic PEEP was applied from 0 to 5 cm H2O in steps of 1 cm H2O at 30 seconds intervals. Results: The bio-potentials of diaphragm and sternocleidomastoid muscles revealed different breathing patterns in response to incremental PEEP: 1 increase in the workload of both muscles during inspiration and expiration; 2 increase in the workload of only one muscle; 3 a remarkable increase in muscle activity only in expiration. Conclusion: In noninvasively ventilated volunteers, sEMG quantitatively relates the PEEP level with changes in sternocleidomastoid and diaphragm activity.

  2. Keskkond / Peep Pobbul

    Index Scriptorium Estoniae

    Pobbul, Peep

    2004-01-01

    Ilmunud ka: 2003 : annual report : [Eesti Raudtee]. - Tallinn, 2004, lk. 40-41; 2003 : godovoi ottshjot : [Eesti Raudtee]. - Tallinn, 2004, lk. 40-41. AS-i Eesti Raudtee keskkonna-alastest projektidest

  3. The Peep Show

    Science.gov (United States)

    Gamble, David L.

    2010-01-01

    Three years ago, the author and Linda Arbuckle (University of Florida ceramic professor and internationally known majolica clay artist) were on the phone discussing how electric kilns just don't have any artistic design flair to them. The round kiln has basic properties that allow it to function properly, but its looks are far from exciting. They…

  4. Influence of posture and positive end-tidal expiratory pressure (PEEP) on clearance of Tc99m-DTPA from the lungs

    International Nuclear Information System (INIS)

    Mason, G.R.; Maublant, J.; Sietsema, K.; Effros, R.M.; Mena, I.

    1984-01-01

    The clearance of Tc99m-DTPA aerosols from the lung has been used to detect and quantitate alterations in the permeability of the pulmonary epithelium. Clearance of the radionuclide is accelerated by both chronic and acute injuries to the lung and by smoking. Several laboratories have reported that Tc99m-DTPA clearance from upper lobes exceeded that from lower lobes in upright subjects. To investigate this phenomenon further the authors studied subjects with simultaneous anterior and posterior cameras in upright and supine positions. In the upright position, clearance from both the anterior and posterior upper regions of interest (ROI's) exceeded the lower regions (-1.64 +- .42 S.D. vs. -0.75 +- .41, anterior, p < .05, n=6), -1.04 +- .23 vs. -0.50 +- .36, posterior. All units = %/min. This difference was not observed in the supine subjects. Clearance from the anterior chest exceeded that from the posterior chest in the supine subjects (-1.28 +- .45 vs. -0.05 +- 1.08) and a small increase in radio-activity was observed in at least one ROI of 5 of 6 subjects from the posterior camera. An increase in activity is likely to be secondary to labeling of blood pool, which would have greatest affect where pulmonary blood volume is largest. Computer processing of the entire lung without observer bias in ROI placement showed similar effects of posture over non-peripheral ROI's. Five subjects breathed on PEEP to cause airspace distention, causing clearance to double. Both dependency and airspace distention appear to influence clearance of aerosolized DTPA, the latter may occur by stretching of epithelial pores

  5. Investigation of continuous effect modifiers in a meta-analysis on higher versus lower PEEP in patients requiring mechanical ventilation--protocol of the ICEM study.

    Science.gov (United States)

    Kasenda, Benjamin; Sauerbrei, Willi; Royston, Patrick; Briel, Matthias

    2014-05-20

    Categorizing an inherently continuous predictor in prognostic analyses raises several critical methodological issues: dependence of the statistical significance on the number and position of the chosen cut-point(s), loss of statistical power, and faulty interpretation of the results if a non-linear association is incorrectly assumed to be linear. This also applies to a therapeutic context where investigators of randomized clinical trials (RCTs) are interested in interactions between treatment assignment and one or more continuous predictors. Our goal is to apply the multivariable fractional polynomial interaction (MFPI) approach to investigate interactions between continuous patient baseline variables and the allocated treatment in an individual patient data meta-analysis of three RCTs (N = 2,299) from the intensive care field. For each study, MFPI will provide a continuous treatment effect function. Functions from each of the three studies will be averaged by a novel meta-analysis approach for functions. We will plot treatment effect functions separately for each study and also the averaged function. The averaged function with a related confidence interval will provide a suitable basis to assess whether a continuous patient characteristic modifies the treatment comparison and may be relevant for clinical decision-making. The compared interventions will be a higher or lower positive end-expiratory pressure (PEEP) ventilation strategy in patients requiring mechanical ventilation. The continuous baseline variables body mass index, PaO2/FiO2, respiratory compliance, and oxygenation index will be the investigated potential effect modifiers. Clinical outcomes for this analysis will be in-hospital mortality, time to death, time to unassisted breathing, and pneumothorax. This project will be the first meta-analysis to combine continuous treatment effect functions derived by the MFPI procedure separately in each of several RCTs. Such an approach requires individual

  6. Kutsekeskkooli õpilaste koosseisust / Peep Leppik

    Index Scriptorium Estoniae

    Leppik, Peep

    2001-01-01

    Helme Kutsekeskkoolis 1985-1988, 1991-1992.a. läbi viidud uuringutest, milles määrati õpilaste IQ, käitumine, õppetöös edasijõudmine. Võrdluseks teisi Eesti koolide õpilaste seas läbi viidud intelligentsusuuringuid (Juhan Tork, 1939 ; Eda Heinla, 1988-1990 ; Juha Sõerd, 1973 ; A.Sukamägi, K.Tamm, 1994)

  7. Weimar, Euroopa kultuuripealinn / Peep Pillak

    Index Scriptorium Estoniae

    Pillak, Peep, 1957-

    1999-01-01

    1999. a. Euroopa kultuuripealinnast Weimarist. Linna minevikust, Weimaris elanud suurmehi, juubelitest, mida tähistatakse 1999. a. 1552. a. asus Weimarisse Lucas Cranach, isa alustatut jätkas Lucas Cranach noorem. 1919. a. alustas Walter Gropiuse juhtimisel Weimaris tegevust Bauhaus, kus aastatel 1922-1925 töötasid ka Wassily Kandinsky, Paul Klee

  8. Pommisatelliit Eesti kohal / Peep Pedmanson

    Index Scriptorium Estoniae

    Pedmanson, Peep, 1963-

    1997-01-01

    Discovery Channel Europe presenteeris Pirital toimunud telemessil videofilmi "Profid. Pommirühm" ("Professionals : Bomb Squad"), stsenarist, režissöör ja operaator Rein Kotov : Inglismaa - Eesti - Taani 1997

  9. Tarbekunstist ja kunstitarbest / Peep Ilmet

    Index Scriptorium Estoniae

    Ilmet, Peep, pseud., 1948-

    2010-01-01

    4. rahvusvahelisest köitekunsti näitusest "Scripta manent" Eesti Tarbekunsti- ja Disainimuuseumis, näituse arengust, eesti köitekunstist, autori soovitused eesti köitekunsti rikastamiseks. Raamatu sisu kaitse ja ligipääsetavuse nõudest

  10. Efeitos da compressão torácica manual versus a manobra de PEEP-ZEEP na complacência do sistema respiratório e na oxigenação de pacientes submetidos à ventilação mecânica invasiva Effects of manual rib-cage compression versus PEEP-ZEEP maneuver on respiratory system compliance and oxygenation in patients receiving mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Flavio Renato Antunes dos Santos

    2009-06-01

    Full Text Available OBJETIVOS: Os pacientes com incapacidade de desempenhar suas funções ventilatórias podem ser submetidos à ventilação mecânica invasiva. A fisioterapia respiratória atua no tratamento destes pacientes com a finalidade de melhorar sua função pulmonar. O objetivo do estudo foi avaliar os efeitos da compressão torácica manual versus a manobra de pressão expiratória final positiva-pressão expiratória final zero (PEEP-ZEEP na complacência do sistema respiratório e na oxigenação de pacientes em ventilação mecânica invasiva. MÉTODOS: Foi realizado um estudo bicêntrico, prospectivo, randomizado e crossover, incluindo pacientes em ventilação mecânica invasiva em modo controlado por um período superior a 48 horas. Os protocolos de fisioterapia respiratória foram realizados de forma aleatória, com intervalo de 24 horas entre eles. Dados da complacência do sistema respiratório e da oxigenação foram coletados antes da aplicação dos protocolos e 30 minutos após a aplicação dos mesmos. RESULTADOS: Doze pacientes completaram o estudo. Na análise intragrupo, em ambas as técnicas houve aumento estatisticamente significativo do volume corrente (p=0,002, da complacência estática (p=0,002 e complacência dinâmica (p=0,002. Com relação à oxigenação, no grupo compressão torácica manual, a saturação periférica de oxigênio aumentou com diferença significativa (p=0,011. CONCLUSÕES: A compressão torácica manual e a manobra de PEEP-ZEEP têm efeitos clínicos positivos e não diferem entre si. Em relação à oxigenação encontramos um comportamento favorável da saturação periférica de oxigênio no grupo compressão torácica manual.OBJECTIVES: Patients unable to perform breathing functions may be submitted to invasive mechanical ventilation. Chest physiotherapy acts directly on the treatment of these patients for the purpose of improving their lung function. The objective of this study was to evaluate the

  11. Midagi enamat kui hea film / Peep Pedmanson

    Index Scriptorium Estoniae

    Pedmanson, Peep

    2006-01-01

    Mängufilm "Libahundi needus" : stsenaristid Margus Kasterpalu, Ilmar Raag ja Rainer Sarnet : režissöör Rainer Sarnet : osades Katariina Lauk, Rene Reinumägi : Shop of Dreams - Eesti Televisioon 2005

  12. IFLA 39. aastakongress Baltimaades / Peep Moorast

    Index Scriptorium Estoniae

    Moorast, Peep

    2002-01-01

    Rahvusvaheline maastikuarhitektide föderatsiooni IFLA 39. kongress deviisiga "Muutused maastikus" Baltimaades 7.-13. X 2002. Kongressi peakorterist Riias korraldati väljasõite Lätisse, Eestisse ja Leetu. Eesti Põllumajandusülikoolis sümpoosionil esinesid Eestist Tiina Tammet ja Peeter Vassiljev. Eestile esitati kutse astuda IFLA liikmeks

  13. Eesti mood esitles end Stockholmis / Peep Sooman

    Index Scriptorium Estoniae

    Sooman, Peep, 1978-

    1999-01-01

    Eesti moepäevadel Stockholmis esitleti moeshow'l üle 80 rõivakollektsiooni, osalesid: Baltika, Klementi, Sangar, Zik-Zak (Ivo Nikkolo), Katrin Kuldma Moemaja, Arne Studio, Hipo, Uljas & Tütred, Virulane, Althea.

  14. Andmekaitseõigusest andmekaitseasutuse pilguga / Peep Viljar

    Index Scriptorium Estoniae

    Peep, Viljar, 1970-

    2018-01-01

    Euroopa Liidu ja USA andmekaitseõiguse alusvalikute võrdlus, selgitatakse, millele keskendudb Eesti Andmekaitse Inspektsioon oma töös, andmekaitse üldmääruse trahvide regulatsioonist ja sellega seotud probleemidest Eestis

  15. Mälestustahvel Oslo valitsusele / Peep Pillak

    Index Scriptorium Estoniae

    Pillak, Peep, 1957-

    2016-01-01

    Otsustati tähistada Oslos asuv hoone, kus 1953. aastal nimetati ametiise Eesti Vabariigi valitsus eksiilis. Sõjajärgsetel aastatel organiseerusid eestlased Rootsis. Kuna Rootsis oli pagulaste poliitiline tegevus keelatud, siis toimus eksiilvalitsuse ametisse määramine Oslos. Kui 20. augustil 1991 taastati iseseisev Eesti riik, siis tunnustas seda ka Eesti Vabariigi valitsus eksiilis. Vabariigi valitsus eksiilis lõpetas oma tegevuse 7. oktoobril 1992. aastal. 2. oktoobril 2015 toimunud mälestustahvli avamisest

  16. Poliitikauuringud ja õiguspoliitika kujundamine Eestis / Peep Pruks

    Index Scriptorium Estoniae

    Pruks, Peep, 1963-

    2000-01-01

    Poliitikauuringutest lääneriikides (USA-s) ning Ida- ja Kesk-Euroopa üleminekuühiskondades. Mõttekeskustest (think tank), Eesti poliitikauuringute keskusest PRAXIS ning projektidest "Avaliku sektori ja kolmanda sektori õigusloome alane koostöö" ja "Eesti kriminaalmenetluse optimeerimine"

  17. Privacy : Plug the Internet Peep Hole

    OpenAIRE

    Denebo, Petra; Linder, Anna-Katrine

    2001-01-01

    The Internet is a relatively new technology that has developed explosively during the last 10 years. The Internet-technology has been accepted rapidly by users, but the legal and ethical aspects have not been updated at the same rapid rate. Trust in electronic services or products is founded on knowledge and an understanding of what happens during a session and of the effects that might occur. Within electronically based services there are obvious risks for invisible and undesired results suc...

  18. Production of Energy Efficient Preform Structures (PEEPS)

    Energy Technology Data Exchange (ETDEWEB)

    Dr. John A. Baumann

    2012-06-08

    Due to its low density, good structural characteristics, excellent fabrication properties, and attractive appearance, aluminum metal and its alloys continue to be widely utilized. The transportation industry continues to be the largest consumer of aluminum products, with aerospace as the principal driver for this use. Boeing has long been the largest single company consumer of heat-treated aluminum in the U.S. The extensive use of aluminum to build aircraft and launch vehicles has been sustained, despite the growing reliance on more structurally efficient carbon fiber reinforced composite materials. The trend in the aerospace industry over the past several decades has been to rely extensively on large, complex, thin-walled, monolithic machined structural components, which are fabricated from heavy billets and thick plate using high speed machining. The use of these high buy-to-fly ratio starting product forms, while currently cost effective, is energy inefficient, with a high environmental impact. The widespread implementation of Solid State Joining (SSJ) technologies, to produce lower buy-to-fly ratio starting forms, tailored to each specific application, offers the potential for a more sustainable manufacturing strategy, which would consume less energy, require less material, and reduce material and manufacturing costs. One objective of this project was to project the energy benefits of using SSJ techniques to produce high-performance aluminum structures if implemented in the production of the world fleet of commercial aircraft. A further objective was to produce an energy consumption prediction model, capable of calculating the total energy consumption, solid waste burden, acidification potential, and CO2 burden in producing a starting product form - whether by conventional or SSJ processes - and machining that to a final part configuration. The model needed to be capable of computing and comparing, on an individual part/geometry basis, multiple possible manufacturing pathways, to identify the best balance of energy consumption and environmental impact. This model has been created and populated with energy consumption data for individual SSJ processes and process platforms. Technology feasibility cases studies were executed, to validate the model, and confirm the ability to create lower buy-to-fly ratio performs and machine these to final configuration aircraft components. This model can now be used as a tool to select manufacturing pathways that offer significant energy savings and, when coupled with a cost model, drive implementation of the SSJ processes.

  19. Dr. Heinz von zur Mühlen - teenekas Tallinna ajaloo uurija / Peep Pillak ; foto: Peep Pillak

    Index Scriptorium Estoniae

    Pillak, Peep

    2003-01-01

    ülevaade üheks paremaks Eesti ja Liivimaa, eriti aga Tallinna keskaja asjatundjaks peetava baltisakslasest ajaloolase eluteest ja teaduslikest uurimustöödest, mille eest pälvis 11. sept. 2002 Tallinna teenetemärgi

  20. Kas kvaliteeti saab odavalt? / tekst ja fotod Kyösti Isosaari ja Vesä Jääskeläinen ; refereeris Ingrid Maasik

    Index Scriptorium Estoniae

    Isosaari, Kyösti

    2008-01-01

    Odavate tööriistade võrdlus. Akutrellid Biltema 17-056, Gern DAN165, Power Craft 66191; elektrilised lööktrellid AWD AWD650, Biltema 17-016, Kraft 500W 13MM; tikksaed Alpha-Tools PS600E, Deuzer M1Q-55T, GeLb M1Q-LB-55; nurklihvmasinad Alpha-Tools WS115, Pro Wor PWS115, Probuilder 44023; taldlihvmasinad Co/Tech 30-8939, Power Craft VM-135, PowerPlus X040

  1. Eesti nimekaim ilukirurg jagab enesekindlust / Peep Pree ; intevjueerinud Priit Pullerits

    Index Scriptorium Estoniae

    Pree, Peep, 1958-

    2006-01-01

    Vestlus Tartu esteetilise kirurgia erakliiniku Clinica juhatajaga tööst, vastutustundest, ebaõnnestumistest. Kommenteerivad Tartu linnapea Laine Jänes ja Tartu Ülikooli arstiteaduskonna emeriitprofessor Ennu Sepp

  2. Kolm jääaegset triumfi / Peep Pedmanson

    Index Scriptorium Estoniae

    Pedmanson, Peep

    2002-01-01

    Tallinnas ja Tartus tuli ekraanile USA joonisfilm "Jääaeg" ("Ice Age"), mille dubleerimisse on režissöör Janno Põldma juhtimisel kaasatud parimad eesti näitlejad. Eriti Anu Lambi meisterlikkusest laisklooma dubleerimisel ning arvutianimatsiooni kõrgest tasemest

  3. Kuidas kirjutada eesti rahva vastupanust okupatsioonivõimudele? / Peep Varju

    Index Scriptorium Estoniae

    Varju, Peep

    2009-01-01

    Eestlaste vastupanust Teise maailmasõja ajal, ajalootõlgendusest taasiseseisvumise esimestel aastatel. Ettekanne Jüri Kuke mälestusele pühendatud Langenud Vabadusvõitlejate Päeva XIII aulakonverentsil Tartu Ülikoolis 28. märtsil 2009

  4. Sõjakurjategijate ja nende ohvrite kohtlemisest Eesti Vabariigis / Peep Varju

    Index Scriptorium Estoniae

    Varju, Peep

    2009-01-01

    Autor kritiseerib 1949. aasta märtsiküüditamises kannatanute võimalusi õigusabile ja küüditajate üle kohtumõistmise venimist. Viited okupatsioonirežiimide poolt represseeritud isiku seadusele

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

    OpenAIRE

    Haitsma, Jack

    2002-01-01

    textabstractLung protective ventilation such as the ARDSnet low tidal volumes strategy can reduce mortality in ARDS patients. The lmowledge that an essential therapy such as mechanical ventilation on the intensive care influences patient outcome has given rise to the re-evaluation of current ventilation practices. This review addresses the current state of lung protective strategies and their physiological rationale. Latest knowledge on the instigation and progression of lung injury by mechan...

  6. Gerd Kanter alistas keerulised tuuled ja tugevad vastased / Peep Pahv

    Index Scriptorium Estoniae

    Pahv, Peep, 1970-

    2008-01-01

    Vt. ka Postimees : na russkom jazõke 17. märts, lk. 13. Maailmameister Gerd Kanter võitis viiendat korda Euroopa talvised karikavõistlused. Mihkel Kukk viskas oda 78.41 ning täitis Pekingi olümpia B-normi

  7. Ettevaatust, bussid jäävad seisma! / Peep Peterson

    Index Scriptorium Estoniae

    Peterson, Peep, 1975-

    2004-01-01

    Ilmunud ka: Severnoje Poberezhje, 23. okt. 2004, lk. 2; Narva Postiljon, 23. okt. 2004, lk. 5; Narvskaja Gazeta, 23. okt. 2004, lk. 4; Sakala, 26. okt. 2004, lk. 2; Võrumaa Teataja, 26. okt. 2004, lk. 2; Vooremaa, 26. okt. 2004, lk. 2; Meie Maa, 26. okt. 2004, lk. 2; Harjumaa, 26. okt. 2004, lk. 2; Järva Teataja, 28. okt. 2004, lk. 2; Hiiu Leht, 29. okt. 2004, lk. 2; Pärnu Postimees, 29. okt. 2004, lk. 15; Linnaleht : Pärnu, 29. okt. 2004, lk. A4; Valgamaalane, 6. nov. 2004, lk. 2. Transpordi ametiühing andis autoettevõtete liidule üle nõudmise, milles taotleb kõigile bussijuhtidele lisatasudeta Eesti keskmist palka. Kokkuleppele tuleb jõuda enne 2005. aasta 1. jaanuari

  8. ``Peeps,'' cream, heads, and food coloring in a vacuum jar

    Science.gov (United States)

    DePino, Andrew

    2001-01-01

    This note describes some methods of adding interest to the standard vacuum jar demonstrations. Marshmallow animals, shaving cream, doll heads, and food coloring add some spark to these demos. These new twists have been well received by the students.

  9. "Scientific peep show": the human body in contemporary science museums.

    Science.gov (United States)

    Canadelli, Elena

    2011-01-01

    The essay focuses on the discourse about the human body developed by contemporary science museums with educational and instructive purposes directed at the general public. These museums aim mostly at mediating concepts such as health and prevention. The current scenario is linked with two examples of past museums: the popular anatomical museums which emerged during the 19th century and the health museums thrived between 1910 and 1940. On the museological path about the human body self-care we went from the emotionally involving anatomical Venuses to the inexpressive Transparent Man, from anatomical specimens of ill organs and deformed subjects to the mechanical and electronic models of the healthy body. Today the body is made transparent by the new medical diagnostics and by the latest discoveries of endoscopy. The way museums and science centers presently display the human body involves computers, 3D animation, digital technologies, hands-on models of large size human parts.

  10. Loe raha, ole paindlik ning kuula klienti / Peep Ehasalu

    Index Scriptorium Estoniae

    Ehasalu, Peep, 1966-

    2004-01-01

    Eesti ettevõtete TOP 100 1. koht. Kolmandat aastat järjest edetabeli tippu jõudnud Tele2 edu rajaneb kolmel sambal. Lisad: Tele2 Eesti AS; Tele2 pürgib maruliselt kõrgustesse. Kommenteerivad Andrus Hiiepuu, Inna Kramer ja Agne Kivisaar.

  11. Eesti arhiivid Euroopa kontekstis / Lea Kõiv, Peep Pillak

    Index Scriptorium Estoniae

    Kõiv, Lea, 1961-

    2013-01-01

    2005. aastal toimus konverents "Eesti arhiivid Euroopa kontekstis". Selle konverentsil esitatud ettekannete baasil ilmunud kogumikust "Die Archive Estlands im Europäischen Kontxt/Estonian Archives in the European Context". Kogumikus sisalduvatest artiklitest

  12. Schaulust und Horror Soziokulturelle - Perspektiven auf PEEPING TOM

    Directory of Open Access Journals (Sweden)

    Thomas Ballhausen

    2010-09-01

    Full Text Available Die Geschichte des Kinos und des Films ist mindestens ebenso sehr eine Geschichte des Schreckens (und der damit verbundenen Schaulust wie sie eine Geschichte des Dokumentarischen zu sein scheint. Es sind die außergewöhnlichen Körper und deren Bewegungen, die das Publikum zu allen Zeiten faszinierten, schockierten und zum Schauen und Sehen lockten. Besonders das Genre des Horrorfilms ist mit diesem zentralen Aspekt des Kinos besonders deutlich verbunden.

  13. Avati mälestuskivi Heinrich Marga sünnikohas / Peep Pillak ; fotod: Peep Pillak ja Valitsuse Kommunikatsioonibüroo

    Index Scriptorium Estoniae

    Pillak, Peep

    2008-01-01

    1. oktoobril avati mälestuskivi Eesti Vabariigi valitsuse eksiilis peaministri presidendi ülesannetes Heinrich Marga sünnikohas Põlvamaal Kõlleste (Krootuse) vallas Ihamaru külas Otsa talu juures

  14. Heterogeneity of O blood group in India: Peeping through the window of molecular biology

    Directory of Open Access Journals (Sweden)

    Harita Gogri

    2018-01-01

    Results And Discussion: Overall, ten different genotypes were identified. Three rare alleles, namely, O05, O11, and O26 were seen in the mixed group category. These results suggest that there is an internal heterogeneity in the mixed group while Dhodias and Parsis, the groups which were screened earlier, seem to be more homogenous groups. An important piece of information emerges out from this study, that is, O01O02 genotype is expressing some selective force in population groups screened in India as well as many other groups worldwide. Conclusion: In the future, molecular genotyping of the ABO blood group system among different ethnic and tribal Indian groups would help in generating data to fill up the gaps in the molecular ABO map of the world.

  15. Tunni analüüs - mis see on? / Peep Leppik

    Index Scriptorium Estoniae

    Leppik, Peep

    2001-01-01

    Tunni analüüs, õppe-kasvatustöö eesmärgid. Tunni analüüs on hinnangu andmine protsessidele, mille kutsub esile õpetaja tegevus (või tegevusetus) tunnis. Tunni läbiviimise protsessi mõjutavad õpilaste koosseis klassis, erinevate õppevormide ja õppemeetodite kasutamine, kasutatud õppevõtete otstarbekus, erinevad metoodikad ja õppesüsteemid

  16. Kuulus velotuur võib jõuda Eesti teedele / Peep Pahv

    Index Scriptorium Estoniae

    Pahv, Peep, 1970-

    2007-01-01

    Vt. ka Postimees : na russkom jazõke 29. nov., lk. 12. Maailma mainekaima velotuuri Tour de France korraldajad on pöördunud Eesti kultuuriministeeriumi poole ettepanekuga alustada 2018. aasta võidusõitu Tallinnast

  17. Heterogeneity of O blood group in India: Peeping through the window of molecular biology.

    Science.gov (United States)

    Gogri, Harita; Ray, Sabita; Agrawal, Snehal; Aruna, S; Ghosh, Kanjaksha; Gorakshakar, Ajit

    2018-01-01

    Molecular genotyping of ABO blood group system has identified more than 60 "O" group alleles based on the single-nucleotide polymorphisms present in the ABO gene. Heterogeneity of O group alleles has been observed in various countries from South America, Europe, Middle East, and Asia. India is a vast country with more than 1300 million population which is divided into various ethnic and tribal groups. However, very little is known about the heterogeneity of O alleles in Indians. A total of 116 O group individuals from the mixed population of Mumbai, India, were enrolled in the present study. DNA was extracted using the standard phenol-chloroform method. The exons 6 and 7 of the ABO gene were genotyped by polymerase chain reaction-single-strand conformation polymorphism and/or DNA sequencing. The genotyping results were compared with our earlier findings. Overall, ten different genotypes were identified. Three rare alleles, namely, O05, O11, and O26 were seen in the mixed group category. These results suggest that there is an internal heterogeneity in the mixed group while Dhodias and Parsis, the groups which were screened earlier, seem to be more homogenous groups. An important piece of information emerges out from this study, that is, O01O02 genotype is expressing some selective force in population groups screened in India as well as many other groups worldwide. In the future, molecular genotyping of the ABO blood group system among different ethnic and tribal Indian groups would help in generating data to fill up the gaps in the molecular ABO map of the world.

  18. Eesti Memento Liidu tööst nimekirjade koostamisel aastail 1989-2004 / Peep Varju

    Index Scriptorium Estoniae

    Varju, Peep

    2007-01-01

    1991. aasta sügisel sõlmiti leping Eesti Riigiarhiivi ja Vene Föderatsiooni Arhiiviameti vahel. 1992. aasta juulis alustas tööd Okupatsioonide repressiivpoliitika uurimise riiklik komisjon (ORURK). ORURKi andmete võrdlus Memento tulemustega. Olulise tähtsusega andmete kogumisel oli töine kontakt Tomskis elava Vadim Maķejeviga, kelle abiga avanesid täies ulatuses kohalikud arhiivid. Uurimistöö tulemusena ilmunud väljaannetest

  19. El moep y el Peep Luces amarillas en el tablero de las decisiones empresariales

    Directory of Open Access Journals (Sweden)

    Alfredo Kaplan

    2009-10-01

    Full Text Available Entre la variada gama de posibilidades que debe manejar uma organizacion, en el momento de tomar decisiones o politicas con respecto a lineas de producto, puntos de yenta etc., es posible que se plantee la eleccion de continuar con la produccion o comercializacion de un determinado producto o servicio.

  20. Kes kaitseks Eesti ohvitsere NKVD-KGB laimu eest? / Peep Varju

    Index Scriptorium Estoniae

    Varju, Peep

    2008-01-01

    Autor polemiseerib Eesti Ekspressis ilmunud artiklitega Eesti endiste ohvitseride kohta, kus käsitletakse nende väidetavat koostööd KGBga. Vaatluse all on ohvitserid Ain Mere, Harald Nugiseks, Alfons Rebane ja Harald Riipalu

  1. Prügiveo hind hakkab olenema inimesest endast / Peep Aaviksoo ; interv. Jaan Rõõmussaar

    Index Scriptorium Estoniae

    Aaviksoo, Peep, 1956-

    2004-01-01

    Ilmunud ka: Stolitsa, 5. nov. 2004, lk. 3. AS-i Tallinna Prügila taotles prügi ladestamishinna tõstmist, ettevõtlusameti hinna ja tarbijakaitse osakond pidas taotletavat hinda liiga kõrgeks. Tallinna abilinnapea vastab küsimustele prügimajanduse kota

  2. Politsei on tsiviilühiskonna lihased / Ignar Fjuk ; interv. Peep Lillemägi

    Index Scriptorium Estoniae

    Fjuk, Ignar, 1953-

    2001-01-01

    Ilmunud ka: Nädaline, 18. sept. 2001, lk. 6; Meie Maa, 18. sept. 2001, lk. 2; Virumaa Teataja, 20. sept. 2001, lk. 7; Valgamaalane, 20. sept. 2001, lk. 2; Vooremaa, 25. sept. 2001, lk. 2. Hinnang politseireformi sildi all toimunud koondamistele. Autor: Reformierakond. Parlamendisaadik

  3. Kuues üritus tõi Roman Šebrlele maailmameistritiitli / Raigo Pajula, Peep Pahv

    Index Scriptorium Estoniae

    Pajula, Raigo, 1971-

    2007-01-01

    32-aastane tšehh Roman Šeberle on nüüd mitmevõistlejana triumfeerinud kõikidel tiitlivõistlustel. Jaapanis Osakas sai ta MMi kuldmedali. Esimest korda suurvõistlusel osalenud Andres Raja sai 16. koha

  4. Remo Holsmer: mees Kalevi pingi taga / Remo Holsmer ; interv. Peep Lillemägi

    Index Scriptorium Estoniae

    Holsmer, Remo, 1980-

    2009-01-01

    Reformierakonna Tallinna piirkonnajuht Remo Holsmer vastab küsimustele, mis puudutavad tema tööd Kalevi korvpalliklubi managerina, korvpalli taset Eestis, Kalevisse välismängijate leidmist, Tallinna Kalev-Tartu Rock vastasseisu ning suhteid Jaak Salumetsaga

  5. Johan Kõpu pärand on mitmekülgne / Peep Pillak

    Index Scriptorium Estoniae

    Pillak, Peep

    2008-01-01

    rets. rmt.: Rohtmets, Priit. Rektor Johan Kõpp / toimetaja Mart Orav; resümeede tõlge: saksa keelde Reet Bender, inglise keelde Saskia Kangro, vene keelde A & A Lingua; kujundus Kalle Toompere. Tallinn : Aasta Raamat, 2007. 144 lk.

  6. Rastotshitelstvo - glavnaja problema tsentristskoi upravõ / Remo Holsmer ; interv. Peep Lillemägi

    Index Scriptorium Estoniae

    Holsmer, Remo, 1980-

    2008-01-01

    Tallinna linnavolikogu Eesti Reformierakonna fraktsiooni esimehe hinnangul ajab Keskerakond Tallinnas riigi omale vastandlikku poliitikat, tähelepanu on suunatud vaid Lasnamäel ja Põhja-Tallinnas elavatele toetajatele. Reformierakonna fraktsioon on algatanud eelnõu lasteaedadele makstava nn. pearaha tõstmise kohta 2009. a. ja teinud ettepaneku vähendada maamaksu

  7. Vabale turule pole alternatiivi / Johnny Munkhammar ; interv. Lillemägi, Peep

    Index Scriptorium Estoniae

    Munkhammar, Johnny

    2008-01-01

    Konverentsil Restart esinenud Rootsi majandusanalüütik ja kommentaator võrdleb praegust kriisi 1929. aasta omaga, tema arvates on tegu poliitikute möödalaskmistega, mitte turumajanduse läbikukkumistega. Nüüd oli vaja valitsuste sekkumist, kuid kaugemas perspektiivis pole valitsuste sekkumine turumehhanismide toimimisse õige

  8. Peeping thread from a laparotomy scar: Misery of an old man

    Directory of Open Access Journals (Sweden)

    Ramesh Aggarwal

    2012-01-01

    Full Text Available Despite availability of modern methods of various surgical techniques for treating complicated patients, there are still some unreported incidents in day to day practice where simple surgical procedure ends up in unwanted complications. This may be attributed sometimes to the negligence of treating doctors and sometime to the patient himself. We present here one such case where unnecessary morbidity added to the patient after surgery.

  9. Kuusalus saab rattad alla autotreileritööstus / Peep Talimaa

    Index Scriptorium Estoniae

    Talimaa, Peep

    2008-01-01

    OÜ-le Trucks & Trailers kuuluvast Kuusalu treileritehasest. Lisa: Kuusalu treileritehase ajalugu ja eellugu; Autotreileri valmimine; Üldandmeid treilerite kohta; Kuusalu treileritehase ajalugu ja eellugu

  10. Nuclear physics in India: a perspective and a peep into future

    International Nuclear Information System (INIS)

    Hans, H.S.

    1986-01-01

    Research in the field of nuclear physics in India began some 40 years ago. A brief account of the research activities in both experimental and theoretical nuclear physics is given. It is noted, that the research so far made and being conducted does not match the international standards. So far no new experimental or calculational techniques in accelerator technology has been developed in India. So also no new experiment based on an experimental or theoretical idea developed for the first time in India has been performed. Reasons for giving high priority to the development of nuclear physics as one of the most basic subjects of physics are discussed. Programmes for future must be formulated in such a way that the available funds are put to optimum use. For this purpose it is suggested that: (1) there should be a partnership between universities and the Department of Atomic Energy in setting up of the experimental facilities, (2) there should be corresponding change in the administrative procedures of the universities (3) collaborative programmes with foreign countries should be taken up with the aim of achieving self-sufficiency and to raise the level of research to that of international standards, (4) an attempt should be made to develop an Asian Centre of Nuclear Physics in India which should house a proton synchrotron and a high energy linear accelerator around which research activities in medium energy range can be developed, (5) the universities should be encouraged to develop strong theoretical nuclear physics centres, and (6) schools of theoretical nuclear physics around very good senior research scientists should be developed. (M.G.B.)

  11. Millised mõtted on peidus parimate töösturite peas? / Peep Talimaa

    Index Scriptorium Estoniae

    Talimaa, Peep

    2008-01-01

    Ettevõtluse Auhind 2008 parima tööstusettevõtte tiitli võitnud AS Favor edu põhjustest, tulevikuperspektiividest ja ootustest riigile. Vt. samas: Eesti parimad ettevõtted on ABB ja Tallink Grupp. Lisa: Konkursi "Ettevõtluse auhind 2008" laureaadid ja kandidaadid

  12. Eesti tipprallimehed koondusid ühise kaubamärgi alla / Peep Pahv

    Index Scriptorium Estoniae

    Pahv, Peep, 1970-

    2008-01-01

    WRC-sarjas osalevad Urmo Aava ja Kuldar Sikk, PWRC-sarjas startivad Martin Rauam ja Silver Kütt ning juunioride sarjas sõitvad Jaan Mölder ja kaardilugeja Frederic Miclotte on tänavusteks võistlusteks registreerinud võistkonna World Rally Team Estonia

  13. Universiteedi instituudid / Peep Nemvalts ; kommenteerivad Peeter Vihma, Hagi Šein, Andi Kivinukk

    Index Scriptorium Estoniae

    Nemvalts, Peep

    2007-01-01

    Tallinna ülikooli struktuuri muutustest ning terminite instituut, teaduskond ja osakond kasutusest, sisaldab sotsioloogia magistrandi, Rahvusvaheliste ja Sotsiaaluuringute Instituudi riigiteaduste osakonna assistendi Peeter Vihma, Balti Filmi- ja Meediakooli direktori Hagi Šeini, matemaatika-loodusteaduskonna dekaani Andi Kivinuki kommentaare

  14. Jahindus = Hunting / Jüri Tõnisson, Kaarel Roht, Peep Männil

    Index Scriptorium Estoniae

    Tõnisson, Jüri, 1946-

    2007-01-01

    Jahimeeste poolt loendatavate ulukite arvukus ja küttimine. Statistilised andmed 1985-2005. aasta jahihooajast. Põdra arvukus ja küttimine 1960-2005. Erinevate jahiulukite populatsioonide seisund Eesti metsades. Tabelid, diagrammid, graafikud

  15. Jahindus = Hunting / Jüri Tõnisson, Kaarel Roht, Peep Männil

    Index Scriptorium Estoniae

    Tõnisson, Jüri, 1946-

    2008-01-01

    Jahimeeste poolt loendatavate ulukite arvukus ja küttimine. Statistilised andmed 1985-2006. aasta jahihooajast. Põdra arvukus ja küttimine 1960-2006. Erinevate jahiulukite populatsioonide seisund Eesti metsades. Tabelid, diagrammid, graafikud

  16. A Peep into the Uncertainty-Complexity-Relevance Modeling Trilemma through Global Sensitivity and Uncertainty Analysis

    Science.gov (United States)

    Munoz-Carpena, R.; Muller, S. J.; Chu, M.; Kiker, G. A.; Perz, S. G.

    2014-12-01

    Model Model complexity resulting from the need to integrate environmental system components cannot be understated. In particular, additional emphasis is urgently needed on rational approaches to guide decision making through uncertainties surrounding the integrated system across decision-relevant scales. However, in spite of the difficulties that the consideration of modeling uncertainty represent for the decision process, it should not be avoided or the value and science behind the models will be undermined. These two issues; i.e., the need for coupled models that can answer the pertinent questions and the need for models that do so with sufficient certainty, are the key indicators of a model's relevance. Model relevance is inextricably linked with model complexity. Although model complexity has advanced greatly in recent years there has been little work to rigorously characterize the threshold of relevance in integrated and complex models. Formally assessing the relevance of the model in the face of increasing complexity would be valuable because there is growing unease among developers and users of complex models about the cumulative effects of various sources of uncertainty on model outputs. In particular, this issue has prompted doubt over whether the considerable effort going into further elaborating complex models will in fact yield the expected payback. New approaches have been proposed recently to evaluate the uncertainty-complexity-relevance modeling trilemma (Muller, Muñoz-Carpena and Kiker, 2011) by incorporating state-of-the-art global sensitivity and uncertainty analysis (GSA/UA) in every step of the model development so as to quantify not only the uncertainty introduced by the addition of new environmental components, but the effect that these new components have over existing components (interactions, non-linear responses). Outputs from the analysis can also be used to quantify system resilience (stability, alternative states, thresholds or tipping points) in the face of environmental and anthropogenic change (Perz, Muñoz-Carpena, Kiker and Holt, 2013), and through MonteCarlo mapping potential management activities over the most important factors or processes to influence the system towards behavioral (desirable) outcomes (Chu-Agor, Muñoz-Carpena et al., 2012).

  17. Avati mälestuskivi Heinrich Marga sünnikohas / Peep Pillak ; Peeter Margna

    Index Scriptorium Estoniae

    Pillak, Peep, 1957-

    2008-01-01

    1. oktoobril 2008 avati mälestuskivi Heinrich Margale (1. oktoober 1911 - 2. august 2004) Põlvamaal Kõlleste vallas Ihamaru külas Otsa talus. Heinrich Mark õppis Tartu Ülikooli õigusteaduskonnas aastatel 1933-1938. Lisatud Peeter Margna sõnavõtt Heinrich Marga mälestuskivi avamisel

  18. Peeping through heart′s window: A case report of Fallots tetralogy

    Directory of Open Access Journals (Sweden)

    Bhowate R

    2005-03-01

    Full Text Available Tetralogy of Fallot is a congenital heart defect. A combination of four abnormalities in heart allow oxygen rich and oxygen-depleted blood to mix. The resulting low-oxygen blood then circulates through the body. A child with the condition tends to develop slowly, eat poorly and grow slowly and may experience "blue" spells on crying and dyspnea on exertion. A 12 year old child with this congenital heart defect and cleft palate with cleft lip is discussed. Details of the latest diagnostic and treatment procedures are also presented.

  19. Uudiste lõpp ehk kuidas Facebook ajakirjanduse alla neelas / Priit Hõbemägi

    Index Scriptorium Estoniae

    Hõbemägi, Priit, 1957-

    2016-01-01

    Priit Hõbemägi refereeris Cambridge ülikooli professori ja Columbia ajakirjanduskooli digitaalse ajakirjanduse keskuse direktori Emily Belli meedia­maailmas laineid löönud kõnet sotsiaalmeedia ettevõtete mõju kasvust uudiste levitamise ja sellega raha teenimise üle

  20. Peeping into human renal calcium oxalate stone matrix: characterization of novel proteins involved in the intricate mechanism of urolithiasis.

    Directory of Open Access Journals (Sweden)

    Kanu Priya Aggarwal

    Full Text Available BACKGROUND: The increasing number of patients suffering from urolithiasis represents one of the major challenges which nephrologists face worldwide today. For enhancing therapeutic outcomes of this disease, the pathogenic basis for the formation of renal stones is the need of hour. Proteins are found as major component in human renal stone matrix and are considered to have a potential role in crystal-membrane interaction, crystal growth and stone formation but their role in urolithiasis still remains obscure. METHODS: Proteins were isolated from the matrix of human CaOx containing kidney stones. Proteins having MW>3 kDa were subjected to anion exchange chromatography followed by molecular-sieve chromatography. The effect of these purified proteins was tested against CaOx nucleation and growth and on oxalate injured Madin-Darby Canine Kidney (MDCK renal epithelial cells for their activity. Proteins were identified by Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF MS followed by database search with MASCOT server. In silico molecular interaction studies with CaOx crystals were also investigated. RESULTS: Five proteins were identified from the matrix of calcium oxalate kidney stones by MALDI-TOF MS followed by database search with MASCOT server with the competence to control the stone formation process. Out of which two proteins were promoters, two were inhibitors and one protein had a dual activity of both inhibition and promotion towards CaOx nucleation and growth. Further molecular modelling calculations revealed the mode of interaction of these proteins with CaOx at the molecular level. CONCLUSIONS: We identified and characterized Ethanolamine-phosphate cytidylyltransferase, Ras GTPase-activating-like protein, UDP-glucose:glycoprotein glucosyltransferase 2, RIMS-binding protein 3A, Macrophage-capping protein as novel proteins from the matrix of human calcium oxalate stone which play a critical role in kidney stone formation. Thus, these proteins having potential to modulate calcium oxalate crystallization will throw light on understanding and controlling urolithiasis in humans.

  1. Suur põgenemine 1944 : eestlaste lahkumine läände ning selle mõjud / Peep Pillak

    Index Scriptorium Estoniae

    Pillak, Peep, 1957-

    2005-01-01

    Välis-Eesti uuringute keskuse ja Rootsi Eesti saatkonna korraldatud teaduskonverensist (Tartu, 22. okt. 2004), kus arutluse all oli 1944. a. suur põgenemine läände ja selle mõjud tänasesse päeva

  2. Giving peeps to my props: Using 3D printing to shed new light on particle transport in fractured rock.

    Science.gov (United States)

    Walsh, S. D.; Du Frane, W. L.; Vericella, J. J.; Aines, R. D.

    2014-12-01

    Smart tracers and smart proppants promise new methods for sensing and manipulating rock fractures. However, the correct use and interpretation of these technologies relies on accurate models of their transport. Even for less exotic particles, the factors controlling particle transport through fractures are poorly understood. In this presentation, we will describe ongoing research at Lawrence Livermore National Laboratory into the transport properties of particles in natural rock fractures. Using three dimensional printing techniques, we create clear-plastic reproductions of real-world fracture surfaces, thereby enabling direct observation of the particle movement. We will also discuss how particle tracking of dense particle packs can be further enhanced by using such specially tailored flow cells in combination with micro-encapsulated tracer particles. Experimental results investigating the transport behavior of smart tracers and proppants close to the neutrally buoyant limit will be presented and we will describe how data from these experiments can be used to improve large-scale models of particle transport in fractures. This work performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344.

  3. Omavalitsuste ühinemine väärib tähelepanu ja toetust / Peep Aru

    Index Scriptorium Estoniae

    Aru, Peep, 1953-

    2004-01-01

    Ilmunud ka: Võrumaa Teataja, 27. märts 2004, lk. 2; Harjumaa, 30. märts 2004, lk. 2; Hiiu Leht, 30. märts 2004, lk. 2; Koit, 30. märts 2004, lk. 6; Vali Uudised, 31. märts 2004, lk. 2; Valgamaalane, 1. apr. 2004, lk. 2; Sakala, 2. apr. 2004, lk. 2; Põhjarannik, 2. apr. 2004, lk. 2; Severnoje Poberezhje, 2. apr. 2004, lk. 2; Nädaline, 6. apr. 2004, lk. 4; Vooremaa, 13. apr. 2004, lk. 2; Meie Maa, 13. apr. 2004, lk. 2. Reformierakonna toetusest omavalitsuste kiirele ühinemisele

  4. Kolonel Arthur von Buxhoevedeni (VR 1/2) ja tema abikaasa Kira ümbermatmine kodumaa mulda / Peep Pillak

    Index Scriptorium Estoniae

    Pillak, Peep, 1957-

    2015-01-01

    Vabadusristi kavaler kolonel Arthur von Buxhoeveden ja tema abikaasa Kira sängitati sõjaväeliste austusavaldustega kodumaa mulda Tallinna Kaitseväe kalmistul 12. septembril. Kolonel Arthur von Buxhoeveden'i elukäigust

  5. Eesti NSV julgeolekukomitee esimees sõpru võitmas ja inimesi mõjustamas / Peep Pillak

    Index Scriptorium Estoniae

    Pillak, Peep, 1957-

    2016-01-01

    Hoiuraamatukokku jõudnud trükistest. ENSV KGB esimehe Karl Kortelaineni pühenduse ja allkirjaga trükisest. Tegemist on koopiaga Dale Carnegie raamatust "Kuidas võita sõpru ja mõjustada inimesi" vene keeles

  6. Complejo residencial económico y popular - P.E.E.P. - Nueva Liguria – Italia

    Directory of Open Access Journals (Sweden)

    Ceroni, Eugenio

    1979-03-01

    Full Text Available This article describes the construction of a building compound, built with government funds. This group contains, besides the housing units, both in 21 m-high tower form and in 18 m-high elongated building, a series of public and private services, namely: — Parking lots. — Underground garages. — Landscaped areas. — Play and sports grounds. — Religious, social, medical, cultural, and shopping centres, etc.

    Se describe en este artículo la realización de un complejo de edificios, construidos con ayuda estatal. Este complejo, además de los edificios destinados a viviendas —cuya tipología varía desde edificios-torre, con una altura de 21 m, hasta edificios lineales con una altura de 18 m—, está dotado de una serie de servicios públicos y privados tales como: — Aparcamientos. — Garajes subterráneos. — Zonas verdes. — Campos de juego. — Centros religioso, social, médico, cultural, comercial, etc.

  7. Act on Gender: A Peep into Intra-Household Water Use in the Australian Capital Territory (ACT) Region

    Science.gov (United States)

    Lahiri-Dutt, Kuntala; Harriden, Kate

    2008-01-01

    Intra-household water use and management from a gender perspective has remained a relatively under-researched theme in developed countries. Australia is no exception, with the lack of research particularly evident in the many rural and peri-urban communities. These communities have experienced significant water scarcity in recent years. In this…

  8. IMF soovitab uue töölepinguseaduse kiiresti vastu võtta / Peep Lillemägi

    Index Scriptorium Estoniae

    Lillemägi, Peep, 1967-

    2008-01-01

    Ilmunud ka: Tallinnskii Vestnik juuli 2008, lk. 3. Eestis viibinud IMF-i delegatsiooni hinnangul sõltub Eesti majanduskasvu taastumine suurel määral majanduse konkurentsivõimest, delegatsioon toetab kavatsust leida edasisi võimalusi kokkuhoiuks ning soovitab töölepinguseaduse eelnõu kiiresti vastu võtta ja ellu viia. Rahandusminister Ivari Padari arvamus IMF-i hinnangute kohta

  9. Changes in ventilatory mechanics caused by variations in PEEP and pressure support: study in healthy subjects under non-invasive mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Isabel Cristina Muñoz

    2017-04-01

    Conclusions: The proposed technique allowed to find compliance and resistance values consistent with those set in the mechanical simulator, which, in turn, coincide with those reported in the literature for healthy subjects. This information is useful for decision-making in intensive care units..

  10. Õigushariduse akrediteerimise õiguslikest alustest ja protsessist Eestis (Tartu Ülikooli õigusteaduskonna näitel) / Kalle Merusk, Raul Narits, Peep Pruks

    Index Scriptorium Estoniae

    Merusk, Kalle, 1949-

    1998-01-01

    Õigusteaduse õppekavade akrediteerimisest eri kõrgkoolides ning Tartu Ülikooli õigusteaduskonna tegevusest. Lisatud ülevaade olulisematest teadustöödest Tartu Ülikooli avaliku õiguse instituudis ja eraõiguse instituudis 1997. a. ning Tartu Ülikooli õigusteaduskonnas 1993.-1998. a. kaitstud magistritööde ja teaduskonna õppejõudude poolt mujal kaitstud tööde nimekiri

  11. On legal bases and process of accreditation of teaching of law in Estonia (University of Tartu Faculty of Law case) / Kalle Merusk, Raul Narits, Peep Pruks

    Index Scriptorium Estoniae

    Merusk, Kalle, 1949-

    1998-01-01

    Õigusharidust andvate õppeasutuste akrediteerimisest; Tartu Ülikooli õigusteaduskonnast ning selle avaliku õiguse ja eraõiguse instituutidest, õppeprogrammist, magistri- ja doktoriõppest ning teadustegevusest. Lisatud andmed 1993.-1998. a. kaitstud teadustööde kohta, õppejõudude osalemise kohta seaduseelnõude ettevalmistamisel ning publikatsioonide kohta

  12. Juridica minevikust, tulevikust ja veebist 200. numbri künnisel / Peep Pruks ; komment. Hanno Pevkur, Priit Pikamäe, Norman Aas ...[jt.

    Index Scriptorium Estoniae

    Pruks, Peep, 1963-

    2013-01-01

    Vastused küsimusele, mida on Juridica seni andnud kasulikku ja mida ootaksite ajakirjalt tulevikus rohkem. Valiku statistilistest andmetest, mida Google Analyticsi abil on võimalik veebis Juridica kasutamise kohta tuvastada. Tabel. Graafikud

  13. Julgesti, vennad, nüüd tööle : haiglajuht seletab valitsusele, et vajalik palgaraha on haigekassa reservis / Peep Põdder

    Index Scriptorium Estoniae

    Põdder, Peep, 1964-

    2007-01-01

    Jõgeva haigla juhataja kirjutab tervishoiuprobleemidest, pidades tervishoidu esimeseks julgeolekuküsimuseks ning kritiseerides ekssotsiaalminister Eiki Nestori tegevust ja andes nõu sotsiaalminister Jaak Aabile

  14. Õigusteaduse osa Eesti õiguskorra kujunemises : teaduskonverents professor Kalle Meruski 60. juubeli auks / koost. Peep Pruks. K. Meruski bibliograafia: Maia Ruttu

    Index Scriptorium Estoniae

    2009-01-01

    Sisu: Programm. Õigusteaduse rollist Eesti Vabariigi põhiseaduse aluspõhimõtete sisustamisel / Raul Narits. Keskkonnaõiguse kodifitseerimise teaduslikud alused / Hannes Veinla. "Kord Vestmann peal ja Piibeleht all, siis jälle..." : praktika ja õigusteaduse vahekord õiguse kujundamisel 19. sajandi Läänemereprovintsides / Marju Luts-Sootak. Teaduslik analüüs tsiviilõigusloomes / Paul Varul. Õiguslaenud ja võrdlev õigusteadus Eesti eraõiguse süsteemi kujundamisel / Irene Kull. Professor Meruski juubeliks / Märt Rask. Kolleegi kiituseks / Raul Narits. Professor Kalle Merusk : õpetaja ja inimene / Ivo Pilving. Kalle Merusk : valikbibliograafia 1990-2009 / koost. Maia Ruttu

  15. A randomized pilot study comparing the role of PEEP, O2 flow, and high-flow air for weaning of ventilatory support in very low birth weight infants

    Directory of Open Access Journals (Sweden)

    Chang-Yo Yang

    2018-04-01

    Full Text Available Background: There is a lack of evidence to guide step-wise weaning of positive pressure respiratory support for premature infants. This study sought to compare the efficacy of three weaning protocols we designed to facilitate weaning of very low birth weight (VLBW, less than 1500 g preterm infants from nasal continuous positive airway pressure (NCPAP support. Methods: This was a prospective, randomized, controlled trial of VLBW preterm infants who received positive pressure ventilatory support in our neonatal intensive care unit (NICU from April 2008 through March 2009. When these infants were weaned to CPAP as their last step of respiratory support, they would be randomly assigned to one of the following three groups as their further weaning methods (M: (M1 CPAP group, (M2 O2 flow group, and (M3 air flow group. The time period they needed to wean off any kind of respiratory support, as well as the likelihood of developing relevant prematurity related morbidities, were compared among patients using different weaning modalities. Results: 181 patients were enrolled in the study. Their gestational age (GA and birth weight (BW were 29.1 ± 2.5, 28.7 ± 2.4, 28.7 ± 2.4 (mean ± SD weeks and 1142 ± 232, 1099 ± 234, 1083 ± 219 g, in M1, M2 and M3, respectively. The time (period needed to wean off support was 16.0 ± 10.0 days (M1, 11.6 ± 6.4 days (M2, and 15.0 ± 8.9 days (M3, respectively (p = .033. Incidence of retinopathy of prematurity (ROP and bronchopulmonary dysplasia (BPD were both significantly higher in the O2 flow group (p = .048. Conclusions: Although using low oxygen flow significantly shortens CPAP weaning time, it may increase risks of BPD and ROP, both known to be related to oxygen toxicity. Unless the infant has BPD and is O2-dependent, clinicians should consider using air flow or just splinting with no support at all when weaning NCPAP. Key Words: weaning, nasal continuous positive airway pressure, very low birth weight, nasal air flow

  16. Hemodynamic responses to external counterbalancing of auto-positive end-expiratory pressure in mechanically ventilated patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Baigorri, F; de Monte, A; Blanch, L; Fernández, R; Vallés, J; Mestre, J; Saura, P; Artigas, A

    1994-11-01

    To study the effect of positive end-expiratory pressure (PEEP) on right ventricular hemodynamics and ejection fraction in patients with chronic obstructive pulmonary disease and positive alveolar pressure throughout expiration by dynamic hyperinflation (auto-PEEP). Open, prospective, controlled trial. General intensive care unit of a community hospital. Ten patients sedated and paralyzed with an acute exacerbation of chronic obstructive pulmonary disease undergoing mechanical ventilation. Insertion of a pulmonary artery catheter modified with a rapid response thermistor and a radial arterial catheter. PEEP was then increased from 0 (PEEP 0) to auto-PEEP level (PEEP = auto-PEEP) and 5 cm H2O above that (PEEP = auto-PEEP +5). At each level of PEEP, airway pressures, flow and volume, hemodynamic variables (including right ventricular ejection fraction by thermodilution technique), and blood gas analyses were recorded. The mean auto-PEEP was 6.6 +/- 2.8 cm H2O and the total PEEP reached was 12.2 +/- 2.4 cm H2O. The degree of lung inflation induced by PEEP averaged 145 +/- 87 mL with PEEP = auto-PEEP and 495 +/- 133 mL with PEEP = auto-PEEP + 5. The PEEP = auto-PEEP caused a right ventricular end-diastolic pressure increase, but there was no other significant hemodynamic change. With PEEP = auto-PEEP + 5, there was a significant increase in intravascular pressures; this amount of PEEP reduced cardiac output (from 4.40 +/- 1.38 L/min at PEEP 0 to 4.13 +/- 1.48 L/min; p 10% in only five cases and this group of patients had significantly lower right ventricular volumes than the group with less cardiac output variation (right ventricular end-diastolic volume: 64 +/- 9 vs. 96 +/- 26 mL/m2; right ventricular end-systolic volume: 38 +/- 6 vs. 65 +/- 21 mL/m2; p < .05) without significant difference in the other variables that were measured. Neither right ventricular ejection fraction nor right ventricle volumes changed as PEEP increased, but there were marked interpatient

  17. Setting individualized positive end-expiratory pressure level with a positive end-expiratory pressure decrement trial after a recruitment maneuver improves oxygenation and lung mechanics during one-lung ventilation.

    Science.gov (United States)

    Ferrando, Carlos; Mugarra, Ana; Gutierrez, Andrea; Carbonell, Jose Antonio; García, Marisa; Soro, Marina; Tusman, Gerardo; Belda, Francisco Javier

    2014-03-01

    We investigated whether individualized positive end-expiratory pressure (PEEP) improves oxygenation, ventilation, and lung mechanics during one-lung ventilation compared with standardized PEEP. Thirty patients undergoing thoracic surgery were randomly allocated to the study or control group. Both groups received an alveolar recruitment maneuver at the beginning and end of one-lung ventilation. After the alveolar recruitment maneuver, the control group had their lungs ventilated with a 5 cm·H2O PEEP, while the study group had their lungs ventilated with an individualized PEEP level determined by a PEEP decrement trial. Arterial blood samples, lung mechanics, and volumetric capnography were recorded at multiple timepoints throughout the procedure. The individualized PEEP values in study group were higher than the standardized PEEP values (10 ± 2 vs 5 cm·H2O; P decrement trial than with a standardized 5 cm·H2O of PEEP.

  18. Rein Lang: Eesti kõige väärtuslikum ressurss on mõistus / Rein Lang ; interv. Peep Lillemägi ; komment. Siim Kallas, Jüri Pihl, Väino Linde

    Index Scriptorium Estoniae

    Lang, Rein, 1957-

    2009-01-01

    Justiitsminister Rein Lang vastab küsimustele, mis puudutavad Ameerika Ühendriike kui vabaduse kantsi, ettevõtlusvabadust Ameerika Ühendriikides ja Eestis, tööd justiitsministrina, varasemat karjääri, Eesti põhiseaduse loomist, Euroopa Liidu aluslepingu välja töötamist, avaliku võimu rolli tänapäeva maailmas ning Eesti jõudmist Euroopa rikkamate riikide hulka

  19. Clinical assessment of auto-positive end-expiratory pressure by diaphragmatic electrical activity during pressure support and neurally adjusted ventilatory assist.

    Science.gov (United States)

    Bellani, Giacomo; Coppadoro, Andrea; Patroniti, Nicolò; Turella, Marta; Arrigoni Marocco, Stefano; Grasselli, Giacomo; Mauri, Tommaso; Pesenti, Antonio

    2014-09-01

    Auto-positive end-expiratory pressure (auto-PEEP) may substantially increase the inspiratory effort during assisted mechanical ventilation. Purpose of this study was to assess whether the electrical activity of the diaphragm (EAdi) signal can be reliably used to estimate auto-PEEP in patients undergoing pressure support ventilation and neurally adjusted ventilatory assist (NAVA) and whether NAVA was beneficial in comparison with pressure support ventilation in patients affected by auto-PEEP. In 10 patients with a clinical suspicion of auto-PEEP, the authors simultaneously recorded EAdi, airway, esophageal pressure, and flow during pressure support and NAVA, whereas external PEEP was increased from 2 to 14 cm H2O. Tracings were analyzed to measure apparent "dynamic" auto-PEEP (decrease in esophageal pressure to generate inspiratory flow), auto-EAdi (EAdi value at the onset of inspiratory flow), and IDEAdi (inspiratory delay between the onset of EAdi and the inspiratory flow). The pressure necessary to overcome auto-PEEP, auto-EAdi, and IDEAdi was significantly lower in NAVA as compared with pressure support ventilation, decreased with increase in external PEEP, although the effect of external PEEP was less pronounced in NAVA. Both auto-EAdi and IDEAdi were tightly correlated with auto-PEEP (r = 0.94 and r = 0.75, respectively). In the presence of auto-PEEP at lower external PEEP levels, NAVA was characterized by a characteristic shape of the airway pressure. In patients with auto-PEEP, NAVA, compared with pressure support ventilation, led to a decrease in the pressure necessary to overcome auto-PEEP, which could be reliably monitored by the electrical activity of the diaphragm before inspiratory flow onset (auto-EAdi).

  20. Positive end expiratory pressure during one-lung ventilation: Selecting ideal patients and ventilator settings with the aim of improving arterial oxygenation

    Directory of Open Access Journals (Sweden)

    Hoftman Nir

    2011-01-01

    Full Text Available The efficacy of positive end-expiratory pressure (PEEP in treating intraoperative hypoxemia during one-lung ventilation (OLV remains in question given conflicting results of prior studies. This study aims to (1 evaluate the efficacy of PEEP during OLV, (2 assess the utility of preoperative predictors of response to PEEP, and (3 explore optimal intraoperative settings that would maximize the effects of PEEP on oxygenation. Forty-one thoracic surgery patients from a single tertiary care university center were prospectively enrolled in this observational study. After induction of general anesthesia, a double-lumen endotracheal tube was fiberoptically positioned and OLV initiated. Intraoperatively, PEEP = 5 and 10 cmH 2 O were sequentially applied to the ventilated lung during OLV. Arterial oxygenation, cardiovascular performance parameters, and proposed perioperative variables that could predict or enhance response to PEEP were analysed. T-test and c2 tests were utilized for continuous and categorical variables, respectively. Multivariate analyses were carried out using a classification tree model of binary recursive partitioning. PEEP improved arterial oxygenation by ≥20% in 29% of patients (n = 12 and failed to do so in 71% (n = 29; however, no cardiovascular impact was noted. Among the proposed clinical predictors, only intraoperative tidal volume per kilogram differed significantly between responders to PEEP and non-responders (mean 6.6 vs. 5.7 ml/kg, P = 0.013; no preoperative variable predicted response to PEEP. A multivariate analysis did not yield a clinically significant model for predicting PEEP responsiveness. PEEP improved oxygenation in a subset of patients; larger, although still protective tidal volumes favored a positive response to PEEP. No preoperative variables, however, could be identified as reliable predictors for PEEP responders.

  1. Effects of positive end-expiratory pressure titration and recruitment maneuver on lung inflammation and hyperinflation in experimental acid aspiration-induced lung injury.

    Science.gov (United States)

    Ambrosio, Aline M; Luo, Rubin; Fantoni, Denise T; Gutierres, Claudia; Lu, Qin; Gu, Wen-Jie; Otsuki, Denise A; Malbouisson, Luiz M S; Auler, Jose O C; Rouby, Jean-Jacques

    2012-12-01

    In acute lung injury positive end-expiratory pressure (PEEP) and recruitment maneuver are proposed to optimize arterial oxygenation. The aim of the study was to evaluate the impact of such a strategy on lung histological inflammation and hyperinflation in pigs with acid aspiration-induced lung injury. Forty-seven pigs were randomly allocated in seven groups: (1) controls spontaneously breathing; (2) without lung injury, PEEP 5 cm H2O; (3) without lung injury, PEEP titration; (4) without lung injury, PEEP titration + recruitment maneuver; (5) with lung injury, PEEP 5 cm H2O; (6) with lung injury, PEEP titration; and (7) with lung injury, PEEP titration + recruitment maneuver. Acute lung injury was induced by intratracheal instillation of hydrochloric acid. PEEP titration was performed by incremental and decremental PEEP from 5 to 20 cm H2O for optimizing arterial oxygenation. Three recruitment maneuvers (pressure of 40 cm H2O maintained for 20 s) were applied to the assigned groups at each PEEP level. Proportion of lung inflammation, hemorrhage, edema, and alveolar wall disruption were recorded on each histological field. Mean alveolar area was measured in the aerated lung regions. Acid aspiration increased mean alveolar area and produced alveolar wall disruption, lung edema, alveolar hemorrhage, and lung inflammation. PEEP titration significantly improved arterial oxygenation but simultaneously increased lung inflammation in juxta-diaphragmatic lung regions. Recruitment maneuver during PEEP titration did not induce additional increase in lung inflammation and alveolar hyperinflation. In a porcine model of acid aspiration-induced lung injury, PEEP titration aimed at optimizing arterial oxygenation, substantially increased lung inflammation. Recruitment maneuvers further improved arterial oxygenation without additional effects on inflammation and hyperinflation.

  2. Neonatal Pneumothorax Pressures Surpass Higher Threshold in Lung Recruitment Maneuvers: An In Vivo Interventional Study.

    Science.gov (United States)

    González-Pizarro, Patricio; García-Fernández, Javier; Canfrán, Susana; Gilsanz, Fernando

    2016-02-01

    Causing pneumothorax is one of the main concerns of lung recruitment maneuvers in pediatric patients, especially newborns. Therefore, these maneuvers are not performed routinely during anesthesia. Our objective was to determine the pressures that cause pneumothorax in healthy newborns by a prospective experimental study of 10 newborn piglets (pneumothorax. Animals under anesthesia and bilateral chest tube catheterization were randomly allocated to 2 groups: one with PEEP and fixed inspiratory driving pressure of 15 cm H2O (PEEP group) and the second one with PEEP = 0 cm H2O and non-fixed inspiratory driving pressure (zero PEEP group). In both groups, the ventilation mode was pressure-controlled, and PIP was raised at 2-min intervals, with steps of 5 cm H2O until air leak was observed through the chest tubes. The PEEP group raised PIP through 5-cm H2O PEEP increments, and the zero PEEP group raised PIP through 5-cm H2O inspiratory driving pressure increments. Pneumothorax was observed with a PIP of 90.5 ± 15.7 cm H2O with no statistically significant differences between the PEEP group (92 ± 14.8 cm H2O) and the zero PEEP group (89 ± 18.2 cm H2O). The zero PEEP group had hypotension, with a PIP of 35 cm H2O; the PEEP group had hypotension, with a PIP of 60 cm H2O (P = .01). The zero PEEP group presented bradycardia, with PIP of 40 cm H2O; the PEEP group presented bradycardia, with PIP of 70 cm H2O (P = .002). Performing recruitment maneuvers in newborns without lung disease is a safe procedure in terms of pneumothorax. Pneumothorax does not seem to occur in the clinically relevant PIPs of pneumothorax PIP in poorly compliant lungs. Copyright © 2016 by Daedalus Enterprises.

  3. Aaviksoo võistleb Donald Trumpiga

    Index Scriptorium Estoniae

    2007-01-01

    Peep Aaviksoole ja tema äripartneritele kuuluv IPC Investment tegeleb Rumeenias lisaks kinnisvarainvesteeringutele ka ehitusmaterjalide tootmisega. USA kinnisvaramagnaat Donald Trump on otsustanud riiki investeerida miljard eurot

  4. Alveolar Tidal recruitment/derecruitment and Overdistension During Four Levels of End-Expiratory Pressure with Protective Tidal Volume During Anesthesia in a Murine Lung-Healthy Model.

    Science.gov (United States)

    Soares, Joao Henrique Neves; Carvalho, Alysson Roncally; Bergamini, Bruno Curty; Gress, Maria Alice Kuster; Jandre, Frederico Caetano; Zin, Walter Araujo; Giannella-Neto, Antonio

    2018-06-01

    We compared respiratory mechanics between the positive end-expiratory pressure of minimal respiratory system elastance (PEEP minErs ) and three levels of PEEP during low-tidal-volume (6 mL/kg) ventilation in rats. Twenty-four rats were anesthetized, paralyzed, and mechanically ventilated. Airway pressure (P aw ), flow (F), and volume (V) were fitted by a linear single compartment model (LSCM) P aw (t) = E rs  × V(t) + R rs  × F(t) + PEEP or a volume- and flow-dependent SCM (VFDSCM) P aw (t) = (E 1  + E 2  × V(t)) × V(t) + (K 1  + K 2  × |F(t)|) × F(t) + PEEP, where E rs and R rs are respiratory system elastance and resistance, respectively; E 1 and E 2 × V are volume-independent and volume-dependent E rs , respectively; and K 1 and K 2  × F are flow-independent and flow-dependent R rs , respectively. Animals were ventilated for 1 h at PEEP 0 cmH 2 O (ZEEP); PEEP minErs ; 2 cmH 2 O above PEEP minErs (PEEP minErs+2 ); or 4 cmH 2 O above PEEP minErs (PEEP minErs+4 ). Alveolar tidal recruitment/derecruitment and overdistension were assessed by the index %E 2  = 100 × [(E 2  × V T )/(E 1  + |E 2 | × V T )], and alveolar stability by the slope of E rs (t). %E 2 varied between 0 and 30% at PEEP minErs in most respiratory cycles. Alveolar Tidal recruitment/derecruitment (%E 2   30) were predominant in the absence of PEEP and in PEEP levels higher than PEEP minErs , respectively. The slope of E rs (t) was different from zero in all groups besides PEEP minErs+4 . PEEP minErs presented the best compromise between alveolar tidal recruitment/derecruitment and overdistension, during 1 h of low-V T mechanical ventilation.

  5. Influence of Positive End-Expiratory Pressure on Myocardial Strain Assessed by Speckle Tracking Echocardiography in Mechanically Ventilated Patients

    Directory of Open Access Journals (Sweden)

    Federico Franchi

    2013-01-01

    Full Text Available Purpose. The effects of mechanical ventilation (MV on speckle tracking echocardiography- (STE-derived variables are not elucidated. The aim of the study was to evaluate the effects of positive end-expiratory pressure (PEEP ventilation on 4-chamber longitudinal strain (LS analysis by STE. Methods. We studied 20 patients admitted to a mixed intensive care unit who required intubation for MV and PEEP titration due to hypoxia. STE was performed at three times: (T1 PEEP = 5 cmH2O; (T2 PEEP = 10 cmH2O; and (T3 PEEP = 15 cmH2O. STE analysis was performed offline using a dedicated software (XStrain MyLab 70 Xvision, Esaote. Results. Left peak atrial-longitudinal strain (LS was significantly reduced from T1 to T2 and from T2 to T3 (. Right peak atrial-LS and right ventricular-LS showed a significant reduction only at T3 (. Left ventricular-LS did not change significantly during titration of PEEP. Cardiac chambers’ volumes showed a significant reduction at higher levels of PEEP (. Conclusions. We demonstrated for the first time that incremental PEEP affects myocardial strain values obtained with STE in intubated critically ill patients. Whenever performing STE in mechanically ventilated patients, care must be taken when PEEP is higher than 10 cmH2O to avoid misinterpreting data and making erroneous decisions.

  6. Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.

    LENUS (Irish Health Repository)

    McCaul, Conán

    2009-10-01

    Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pulmonary vascular resistance, and potentially improve cardiac output, its use during CPR would increase survival.

  7. Pharmacologic Interventions to Improve Splanchnic Oxygenation During Ventilation with Positive End-Expiratory Pressure

    NARCIS (Netherlands)

    Fournell, A.; Scheeren, T. W. L.; Picker, O.; Schwarte, L. A.; Wolf, M; Bucher, HU; Rudin, M; VanHuffel, S; Wolf, U; Bruley, DF; Harrison, DK

    2012-01-01

    Mechanical ventilation with positive end-expiratory pressure (PEEP) is an indispensable tool in the management of respiratory failure to preserve or improve lung function and systemic oxygenation. However, PEEP per se may also, as has been shown in experimental animals, impair regional

  8. Salt Lake Cityst Torinoni / Olev Remsu

    Index Scriptorium Estoniae

    Remsu, Olev, 1947-

    2006-01-01

    Dokumentaalfilm Eesti suusameeskonna valmistumisest Torino olümpiamängudeks "Tiim" : idee autorid Peep Puks, Hans Roosipuu : režissöör Peep Puks : F-Seitse 2006. Esilinastus toimus 26. mail Otepääl, ETVs 31. mail

  9. Männik ohverdas Aaviksoo

    Index Scriptorium Estoniae

    2003-01-01

    Eesti Telekomi nõukogu otsusest vabastada ametist EMT juhatuse esimees Peep Aaviksoo, uuest kandidaadist Valdo Kalmust ning EMT ja Elioni võimalikust ühinemisest. Diagramm: EMT turuosa libiseb Tele2-le. Vt. samas: EMT lahkuva juhi Peep Aaviksoo avalik kiri. Kommenteerivad Sami Seppänen, Üllar Jaaksoo, Monika Salu, Jaak Aaviksoo, Toomas Tamsar

  10. Ma olen Turist, ma elan siin / Mait Väljas

    Index Scriptorium Estoniae

    Väljas, Mait

    2006-01-01

    Endise valuutapoe, praeguse klubi "Parlament" lammutamisplaanist Tallinnas Tartu mnt. 17. Arhitektid Peep Jänes ja Henno Sepmann, sisearhitekt Toivo Gans, sisekujundaja Aulo Padar. Ehitamisel osalesid ka soome arhitektid Kalle-Heiki Narinen ja Tapio Hänninen. Kommentaar Peep Jäneselt ja Aulo Padarilt

  11. Respiratory effects of low versus high tidal volume with or without positive end-expiratory pressure in anesthetized dogs with healthy lungs.

    Science.gov (United States)

    De Monte, Valentina; Bufalari, Antonello; Grasso, Salvatore; Ferrulli, Fabienne; Crovace, Alberto Maria; Lacitignola, Luca; Staffieri, Francesco

    2018-05-01

    OBJECTIVE To evaluate the impact of 2 tidal volumes (T V s) with or without positive end-expiratory pressure (PEEP) on lung mechanics, aeration, and gas exchange in healthy anesthetized dogs. ANIMALS 40 mixed-breed dogs with healthy lungs. PROCEDURES Anesthetized dogs were randomly assigned to 4 groups (n = 10/group) with different ventilatory settings: T V of 8 mL/kg and PEEP of 0 cm H 2 O (low T V group), T V of 8 mL/kg and PEEP of 5 cm H 2 O (low T V plus PEEP group), T V of 15 mL/kg and PEEP of 0 cm H 2 O (high T V group), or T V of 15 mL/kg and PEEP of 5 cm H 2 O (high T V plus PEEP group). Expired CO 2 and respiratory rate were titrated on the basis of a predetermined stepwise protocol. Gas exchange, respiratory mechanics, and pulmonary aeration were evaluated by means of CT 30 minutes after starting mechanical ventilation at the assigned setting. RESULTS Partial pressures of arterial and expired CO 2 were higher in the low T V and low T V plus PEEP groups than in the high T V and high T V plus PEEP groups. Peak and plateau airway pressures were higher in the PEEP group than in the other groups. Static lung compliance was higher in the high T V plus PEEP group than in the low T V group. Relative percentages of atelectatic and poorly aerated lung were lower in the high T V plus PEEP group than in the other groups. Oxygenation was similar among groups. CONCLUSIONS AND CLINICAL RELEVANCE Differences in T V and PEEP application during mechanical ventilation may affect respiratory function in anesthetized dogs with healthy lungs. Ventilation with a T V of 15 mL/kg and PEEP of 5 cm H 2 O significantly improved lung compliance and reduced the amount of atelectatic and poorly aerated lung.

  12. Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Bluth, T; Teichmann, R; Kiss, T; Bobek, I; Canet, J; Cinnella, G; De Baerdemaeker, L; Gregoretti, C; Hedenstierna, G; Hemmes, S N; Hiesmayr, M; Hollmann, M W; Jaber, S; Laffey, J G; Licker, M J; Markstaller, K; Matot, I; Müller, G; Mills, G H; Mulier, J P; Putensen, C; Rossaint, R; Schmitt, J; Senturk, M; Serpa Neto, A; Severgnini, P; Sprung, J; Vidal Melo, M F; Wrigge, H; Schultz, M J; Pelosi, P; Gama de Abreu, M

    2017-04-28

    Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multicenter, two-arm, international randomized controlled trial. In total, 2013 obese patients with body mass index ≥35 kg/m 2 scheduled for at least 2 h of surgery under general anesthesia and at intermediate to high risk for PPCs will be included. Patients are ventilated intraoperatively with a low tidal volume of 7 ml/kg (predicted body weight) and randomly assigned to PEEP of 12 cmH 2 O with lung recruitment maneuvers (high PEEP) or PEEP of 4 cmH 2 O without recruitment maneuvers (low PEEP). The occurrence of PPCs will be recorded as collapsed composite of single adverse pulmonary events and represents the primary endpoint. To our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs. ClinicalTrials.gov identifier: NCT02148692. Registered on 23 May 2014; last updated 7 June 2016.

  13. Impact of Different Ventilation Strategies on Driving Pressure, Mechanical Power, and Biological Markers During Open Abdominal Surgery in Rats.

    Science.gov (United States)

    Maia, Lígia de A; Samary, Cynthia S; Oliveira, Milena V; Santos, Cintia L; Huhle, Robert; Capelozzi, Vera L; Morales, Marcelo M; Schultz, Marcus J; Abreu, Marcelo G; Pelosi, Paolo; Silva, Pedro L; Rocco, Patricia Rieken Macedo

    2017-10-01

    Intraoperative mechanical ventilation may yield lung injury. To date, there is no consensus regarding the best ventilator strategy for abdominal surgery. We aimed to investigate the impact of the mechanical ventilation strategies used in 2 recent trials (Intraoperative Protective Ventilation [IMPROVE] trial and Protective Ventilation using High versus Low PEEP [PROVHILO] trial) on driving pressure (ΔPRS), mechanical power, and lung damage in a model of open abdominal surgery. Thirty-five Wistar rats were used, of which 28 were anesthetized, and a laparotomy was performed with standardized bowel manipulation. Postoperatively, animals (n = 7/group) were randomly assigned to 4 hours of ventilation with: (1) tidal volume (VT) = 7 mL/kg and positive end-expiratory pressure (PEEP) = 1 cm H2O without recruitment maneuvers (RMs) (low VT/low PEEP/RM-), mimicking the low-VT/low-PEEP strategy of PROVHILO; (2) VT = 7 mL/kg and PEEP = 3 cm H2O with RMs before laparotomy and hourly thereafter (low VT/moderate PEEP/4 RM+), mimicking the protective ventilation strategy of IMPROVE; (3) VT = 7 mL/kg and PEEP = 6 cm H2O with RMs only before laparotomy (low VT/high PEEP/1 RM+), mimicking the strategy used after intubation and before extubation in PROVHILO; or (4) VT = 14 mL/kg and PEEP = 1 cm H2O without RMs (high VT/low PEEP/RM-), mimicking conventional ventilation used in IMPROVE. Seven rats were not tracheotomized, operated, or mechanically ventilated, and constituted the healthy nonoperated and nonventilated controls. Low VT/moderate PEEP/4 RM+ and low VT/high PEEP/1 RM+, compared to low VT/low PEEP/RM- and high VT/low PEEP/RM-, resulted in lower ΔPRS (7.1 ± 0.8 and 10.2 ± 2.1 cm H2O vs 13.9 ± 0.9 and 16.9 ± 0.8 cm H2O, respectively; Pmechanical power (63 ± 7 and 79 ± 20 J/min vs 110 ± 10 and 120 ± 20 J/min, respectively; P = .007). Low VT/high PEEP/1 RM+ was associated with less alveolar collapse than low VT/low PEEP/RM- (P = .03). E-cadherin expression was higher in

  14. Eesti Vabariigi põhiseadus : kommenteeritud väljaanne / toimetuskolleegium: Eerik-Juhan Truuväli, Berit Aaviksoo, Oliver Kask, Lasse Lehis, Lauri Madise, Ülle Madise, Kalle Merusk, Lauri Mälksoo, Raul Narits, Vallo Olle, Peep Pruks

    Index Scriptorium Estoniae

    2008-01-01

    Kommentaaride autorid ja sisu: Sissejuhatus / Raul Narits, Lauri Madise, Heinrich Schneider. Preambul / Raul Narits, Heinrich Schneider. I ptk. / Kalle Merusk, Taavi Annus, Madis Ernits, Heiki Lindpere, Lauri Madise. II ptk. / Oliver Kask, Madis Ernits, Taavi Annus, Peeter Roosma, Rait Maruste, Eerik Kergandberg, Ivo Pilving, Uno Lõhmus, Merilin Kiviorg, Einar Vene, Ülle Madise. III ptk. / Oliver Kask. IV ptk. / Lauri Madise, Aaro Mõttus, Jüri Põld, Tiina Runthal. V ptk. / Eerik-Juhan Truuväli, Ülle Madise, Jüri Põld, Urmas Reinsalu. VI ptk. / Kalle Merusk, Jüri Põld. VII ptk. / Eerik-Juhan Truuväli, Jüri Liventaal, Jüri Põld. VIII ptk. / Lasse Lehis. IX ptk. / Kristi Land, Heiki Lindpere, Lauri Madise, Heiki Pisuke. X ptk. / Oliver Kask, Enn Markvart, Jüri Põld. XI ptk. / Ülle Madise, Janek Laidvee, Heinrich Schneider. XII ptk. / Berit Aaviksoo, Mihkel Allik, Enn Markvart, Raul Narits, Aare Reenumägi, Peeter Roosma. XIII ptk. / Raul Narits, Uno Lõhmus, Madis Ernits, Jüri Põld. XIV ptk. / Vallo Olle, Arno Almann, Jüri Liventaal, Ülle Madise. XV ptk. / Eerik-Juhan Truuväli, Aaro Mõttus. Eesti Vabariigi põhiseaduse rakendamise seadus / Oliver Kask, Raul Narits, Peeter Roosma. Eesti Vabariigi põhiseaduse täiendamise seadus / Berit Aaviksoo, Julia Laffranque, Ülle Madise, Jüri Põld. Eesti Vabariigi põhiseadus 1990-2008 : bibliograafia (seisuga september 2008) / koost. Maia Ruttu

  15. Relationship of end-expiratory pressure, lung volume, and /sup 99m/Tc-DTPA clearance

    International Nuclear Information System (INIS)

    Cooper, J.A.; van der Zee, H.; Line, B.R.; Malik, A.B.

    1987-01-01

    We investigated the dose-response effect of positive end-expiratory pressure (PEEP) and increased lung volume on the pulmonary clearance rate of aerosolized technetium-99m-labeled diethylenetriaminepentaacetic acid (99mTc-DTPA). Clearance of lung radioactivity was expressed as percent decrease per minute. Base-line clearance was measured while anesthetized sheep (n = 20) were ventilated with 0 cmH 2 O end-expiratory pressure. Clearance was remeasured during ventilation at 2.5, 5, 10, 15, or 20 cmH 2 O PEEP. Further studies showed stepwise increases in functional residual capacity (FRC) (P less than 0.05) measured at 0, 2.5, 5, 10, 15, and 20 cmH 2 O PEEP. At 2.5 cmH 2 O PEEP, the clearance rate was not different from that at base line (P less than 0.05), although FRC was increased from base line. Clearance rate increased progressively with increasing PEEP at 5, 10, and 15 cmH 2 O (P less than 0.05). Between 15 and 20 cmH 2 O PEEP, clearance rate was again unchanged, despite an increase in FRC. The pulmonary clearance of aerosolized /sup 99m/Tc-DTPA shows a sigmoidal response to increasing FRC and PEEP, having both threshold and maximal effects. This relationship is most consistent with the hypothesis that alveolar epithelial permeability is increased by lung inflation

  16. Respiratory System Mechanics During Low Versus High Positive End-Expiratory Pressure in Open Abdominal Surgery: A Substudy of PROVHILO Randomized Controlled Trial.

    Science.gov (United States)

    D'Antini, Davide; Huhle, Robert; Herrmann, Jacob; Sulemanji, Demet S; Oto, Jun; Raimondo, Pasquale; Mirabella, Lucia; Hemmes, Sabrine N T; Schultz, Marcus J; Pelosi, Paolo; Kaczka, David W; Vidal Melo, Marcos Francisco; Gama de Abreu, Marcelo; Cinnella, Gilda

    2018-01-01

    In the 2014 PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure (PROVHILO) trial, intraoperative low tidal volume ventilation with high positive end-expiratory pressure (PEEP = 12 cm H2O) and lung recruitment maneuvers did not decrease postoperative pulmonary complications when compared to low PEEP (0-2 cm H2O) approach without recruitment breaths. However, effects of intraoperative PEEP on lung compliance remain poorly understood. We hypothesized that higher PEEP leads to a dominance of intratidal overdistension, whereas lower PEEP results in intratidal recruitment/derecruitment (R/D). To test our hypothesis, we used the volume-dependent elastance index %E2, a respiratory parameter that allows for noninvasive and radiation-free assessment of dominant overdistension and intratidal R/D. We compared the incidence of intratidal R/D, linear expansion, and overdistension by means of %E2 in a subset of the PROVHILO cohort. In 36 patients from 2 participating centers of the PROVHILO trial, we calculated respiratory system elastance (E), resistance (R), and %E2, a surrogate parameter for intratidal overdistension (%E2 > 30%) and R/D (%E2 mechanical ventilation with protective tidal volumes in patients undergoing open abdominal surgery, lung recruitment followed by PEEP of 12 cm H2O decreased the incidence of intratidal R/D and did not worsen overdistension, when compared to PEEP ≤2 cm H2O.

  17. Open lung approach versus standard protective strategies: Effects on driving pressure and ventilatory efficiency during anesthesia - A pilot, randomized controlled trial.

    Science.gov (United States)

    Ferrando, Carlos; Suarez-Sipmann, Fernando; Tusman, Gerardo; León, Irene; Romero, Esther; Gracia, Estefania; Mugarra, Ana; Arocas, Blanca; Pozo, Natividad; Soro, Marina; Belda, Francisco J

    2017-01-01

    Low tidal volume (VT) during anesthesia minimizes lung injury but may be associated to a decrease in functional lung volume impairing lung mechanics and efficiency. Lung recruitment (RM) can restore lung volume but this may critically depend on the post-RM selected PEEP. This study was a randomized, two parallel arm, open study whose primary outcome was to compare the effects on driving pressure of adding a RM to low-VT ventilation, with or without an individualized post-RM PEEP in patients without known previous lung disease during anesthesia. Consecutive patients scheduled for major abdominal surgery were submitted to low-VT ventilation (6 ml·kg-1) and standard PEEP of 5 cmH2O (pre-RM, n = 36). After 30 min estabilization all patients received a RM and were randomly allocated to either continue with the same PEEP (RM-5 group, n = 18) or to an individualized open-lung PEEP (OL-PEEP) (Open Lung Approach, OLA group, n = 18) defined as the level resulting in maximal Cdyn during a decremental PEEP trial. We compared the effects on driving pressure and lung efficiency measured by volumetric capnography. OL-PEEP was found at 8±2 cmH2O. 36 patients were included in the final analysis. When compared with pre-RM, OLA resulted in a 22% increase in compliance and a 28% decrease in driving pressure when compared to pre-RM. These parameters did not improve in the RM-5. The trend of the DP was significantly different between the OLA and RM-5 groups (p = 0.002). VDalv/VTalv was significantly lower in the OLA group after the RM (p = 0.035). Lung recruitment applied during low-VT ventilation improves driving pressure and lung efficiency only when applied as an open-lung strategy with an individualized PEEP in patients without lung diseases undergoing major abdominal surgery. ClinicalTrials.gov NCT02798133.

  18. 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.

  19. Prima Vista toob pargiraamatukogu

    Index Scriptorium Estoniae

    2005-01-01

    5. ja 6. mail 2005 toimub teine Tartu kirjandusfestival "Prima Vista". Avatakse pargiraamatukogu, kus esinevad 5. mail Jürgen Rooste, Merca, Aapo Ilves, Peep Ilmet, Marko Martinson, Jüri Kaldmaa, Jaan Pehk

  20. Prevention of pectus excavatum for children with spinal muscular atrophy type 1.

    Science.gov (United States)

    Bach, John R; Bianchi, Carlo

    2003-10-01

    To demonstrate the elimination of pectus excavatum and promotion of more normal lung growth and chest wall development by the use of high-span positive inspiratory pressure plus positive end-expiratory pressure (PIP+PEEP), patients with spinal muscular atrophy type 1 with paradoxical breathing were placed on high-span PIP+PEEP when sleeping from the point of diagnosis of spinal muscular atrophy. Although the appearance of pectus excavatum is ubiquitous in untreated infants with spinal muscular atrophy type 1, after institution of high-span PIP+PEEP, pectus resolves and lungs and chest walls grow more normally. High-span PIP+PEEP is indicated for all infants diagnosed with spinal muscular atrophy who demonstrate paradoxical breathing for the purpose of promoting more normal lung and chest development.

  1. Norma majandustulemuste ootused käivad üksteisele vastu / Gea Velthut-Sokka

    Index Scriptorium Estoniae

    Velthut-Sokka, Gea, 1977-

    2004-01-01

    LHV ja Hansapanga analüütikud ennustavad Normale suurenenud kasumit ja aktsiahinna tõusu, Suprema ennustab nii käibe kui ka kasumi vähenemist. Kommenteerib Norma tegevdirektor Peep Siimon. Diagramm

  2. Põldsamm : 3G lepingu kaotus pole maailma lõpp / Toivo Tänavsuu

    Index Scriptorium Estoniae

    Tänavsuu, Toivo

    2006-01-01

    Kolmanda põlvkonna mobiiltelefonivõrgu neljanda sagedusloa väljaandmise avaliku konkursi võitis Venemaa äriühingutele Alkominvest ja Praim kuuluv OÜ Crosson Capital. Bravocomi juhi Peep Põldsammi arvamus

  3. Vastuolud annavad märku muutuste vajadusest / Marit Pukk

    Index Scriptorium Estoniae

    Pukk, Marit

    2002-01-01

    Kiiresti areneva firma struktuur vajab muutmist. Kommenteerivad gasellettevõtete juhid Argo Schneider (OÜ Albion Reisid), Peep Nork (AS Euro Truck Trade Center), Riinu Värk (AS Meditsiinigrupp) ja Tiit Elenurm

  4. "Oravad" tõmbavad Eesti Energia börsileminekule piduri peale / Raimo Poom

    Index Scriptorium Estoniae

    Poom, Raimo

    2010-01-01

    Riigikogu Reformierakonna fraktsiooni kohtumisest Eesti Energia juhi Sandor Liive ning majandus- ja kommunikatsiooniministeeriumi esindajatega. Fraktsiooni esimees Peep Aru räägib küsimustest, mis on seotud Eesti Energia börsilemineku kavaga

  5. Sihtasutus Eesti Rahvuskultuuri Fond...

    Index Scriptorium Estoniae

    2002-01-01

    15. oktoobrini võetakse vastu 2003. a. stipendiumide ja kultuuriprojektide finantseerimise taotlusi. Esimest korda jagatakse stipendiume Peep Keskküla (toetatakse Eesti kunstielu arengut), Renate Jõesaare (stipendium eesti rahvusest isikule, kes on tegev kujutava kunsti alal) jt. fondidest

  6. Kas eesti keelt kummitab sõnavaravaegus? / Virve Liivanõmm

    Index Scriptorium Estoniae

    Liivanõmm, Virve

    2009-01-01

    Terminoloogiakonverentsist "Eestikeelne ülikool" Tartus ning Eesti teaduskeele konverentsist Tallinna Ülikoolis. Konverentsidel võtsid sõna Peeter Päll, Mats Estonius, Peeter Saari, Igor Gräzin, Peep Nemvalts, Krista Kerge, Toomas Silk

  7. Titanic või turist? / Karin Paulus

    Index Scriptorium Estoniae

    Paulus, Karin, 1975-

    2006-01-01

    Tallinnas Tartu maanteel asuva endise Turisti poe (arhitektid Peep Jänes, Henno Sepmann) asemele tahavad hoone omanikud ehitada kõrghoone nimega Titanic. Hoone ajutine võtmine muinsuskaitse alla on põhjustanud kohtuvaidluse

  8. 40 aastat uurivat õpetajat / Raivo Juurak

    Index Scriptorium Estoniae

    Juurak, Raivo, 1949-

    2001-01-01

    ÜPUI asutamisest, minevikust ja ka tulevikust. Vestlusringis on Ühiskondliku Pedagoogika Uurimise Instituudi asutajad ja eestvedajad - Helme kutsekooli õpetaja Peep Leppik, TÜ kasvatusteaduste dotsent Inger Kraav, TPÜ emeriitprofessor Inge Unt, TPÜ dotsent Viivi Maanso

  9. Takistusriba avalikule teabele / Ivar Tallo

    Index Scriptorium Estoniae

    Tallo, Ivar, 1964-

    2004-01-01

    Autori arvates on riiklike registrite poolt jagatava teabe eest tasu võtmine avaliku teabe seadusega vastuolus ega vasta kaasaegsetele infotehnoloogilistele lahendustele. Vastuseks vt.Viljar Peep. Registritest 6.aug. Postimees lk. 10

  10. Samaja bolshaja stroiploshtshadka v Estonii / Konstantin Morenko

    Index Scriptorium Estoniae

    Morenko, Konstantin

    2004-01-01

    Tallinna linnavalitsus korraldas ümarlaua linna rannaalade hetkeseisu ja arenguvõimaluste hindamiseks, mille töös osalesid ka Euroopa tuntud linnaplaneerimise konsultandid. Arvamust avaldavad Peep Aaviksoo, Lutz Schleich, Giorgio Risicaris ja Stefan Boltz

  11. Bravocom süüdistab Tele2 ja EMT-d alatus konkurentsivõitluses / Kristiina Viiron

    Index Scriptorium Estoniae

    Viiron, Kristiina, 1971-

    2007-01-01

    Kallines Tele2 ja EMT võrgust Bravocomi mobiilinumbritele helistamise minutihind. Bravocomi juhatuse esimees Peep Põldsamm peab nii kalli hinna - 4.50 minut - kehtestamist konkurentsivõitluseks. Tabelid: Hinnavõrdlus. Lisa: Tele2 ja EMT kommentaarid

  12. Nukufilm lasi käiku pooletunnise 3D-seiklusfilmi / Tiit Tuumalu

    Index Scriptorium Estoniae

    Tuumalu, Tiit, 1971-

    2009-01-01

    Stuudios Nukufilm algasid pooletunnise 3D-nukufilmi "Lisa Limone ja Maroc Orange'i tormakas armulugu" võtted. Filmi režissöör on Mait Laas, stsenaristid Kati Kovacs ja Peep Pedmanson, produtsent Arvo Nuut

  13. Verba volant, scripta manent / Milvi Tedremaa

    Index Scriptorium Estoniae

    Tedremaa, Milvi, 1937-2012

    1999-01-01

    Rets. rmt.: Meie õppisime raamatukogundust Tartu Ülikoolis / koost. Maare Kümnik, Kaja Noodla. Tartu, 1998. Vastukaja: Peep, Laine. Mitte ainult Milvi Tedremaale // Raamatukogu (1999) nr. 4, lk. 44

  14. Ajakirjanikud ajasid metsas hundijälgi / Liisi Seil

    Index Scriptorium Estoniae

    Seil, Liisi, 1971-

    2003-01-01

    Hundiuurija Marko Kübarsepp viis teabepäevast "Elu koos hundiga" osalejad Soomaa metsadesse hundijälgi otsima. Kiskja kohta jagasid veel teavet Tõnu Traks, Ilmar Rootsi, Peep Männil ja Jaak Volmer

  15. Meeleavaldajad rõhutavad Bonnis kliimaleppe olulisust / Merit Kopli

    Index Scriptorium Estoniae

    Kopli, Merit, 1969-

    2001-01-01

    Bonnis peetaval kliimakonverentsil pole seni kasvuhoonegaaside vähendmist sätestava Kyoto lepingu osas edu saavutatud. Eesti Rohelise Liikumise koordinaator Peep Mardiste meeleavaldusest Bonnis. Eesti keskkonnaministeeriumi ametnik Andres Kratonits Bonni kliimakonverentsist

  16. Who named it in anaesthesia?

    African Journals Online (AJOL)

    Few words existed before 1846 and majority naturally came after. A peep is made .... He had discovered many elements, such as potassium, sodium, barium .... Jokichi Takamine (1854–1922), a Japanese scientist, were trying to isolate and ...

  17. Väljaspool iseennast / Aita Kivi

    Index Scriptorium Estoniae

    Kivi, Aita, 1954-

    2000-01-01

    Sisu : Jaan Kaplinski. Silm. Hektor; John Grisham. Aguliadvokaat; Kerttu Rakke. Kalevipoeg; luulekogu "Armastuse valgus", koost. Peep Ilmet; James Woodall. John Lennon ja Yoko Ono; Donald Braider. El Greco eraelu; Åke Edwardson. Tants ingliga

  18. Tallinna Sakala keskuse projekt kütab kirgi / Aivo Vahemets

    Index Scriptorium Estoniae

    Vahemets, Aivo

    2004-01-01

    Raine Karbi projekteeritud hoone ümberehituse projekt telliti Inglismaalt büroost Burrow&Cave, OÜ Arhitektuuriagentuuri projektist loobuti. Eesti Arhitektide Liidu esinaise Margit Mutso ja arhitektuurinõukogu esimehe Peep Aaviksoo kommentaar

  19. Eesti animafilmid võitsid Raumas

    Index Scriptorium Estoniae

    pPIK mare 2010

    1999-01-01

    VI Sinise Mere filmifestivalil Raumas jagasid A-sarjas esikohta Mait Laasi "Päevavalgus" ja Peep Pedmansoni "Just Märried", teiseks jäi Märt Sildvee "Guardian Angel" ja kolmandaks Riho Undi - Hardi Volmeri "Primavera"

  20. compliance of the respiratory system as a predictor for successful

    African Journals Online (AJOL)

    clinical, ventilatory and blood gas criteria were studied. ... pressure (PIP) and positive end-expiratory pressure (PEEP) represented ... criteria for extubation, we found that bedside measurement of total ... position in neutral head-neck posture.

  1. Vene kriis kukutas Norma juhid / Raul Ranne

    Index Scriptorium Estoniae

    Ranne, Raul

    1998-01-01

    AS Norma vallandas ettevõtte tegevjuhi Peep Aaviksoo, sest ei olnud rahul ettevõtte tegevusega Venemaal. Tabelid: Norma aktsia on kukkunud, Norma kuukasum miinuses. Ilmunud ka: Delovõje Vedomosti, 9. sept. 1998, lk. 10

  2. Experimental intra-abdominal hypertension influences airway pressure limits for lung protective mechanical ventilation.

    Science.gov (United States)

    Cortes-Puentes, Gustavo A; Cortes-Puentes, Luis A; Adams, Alexander B; Anderson, Christopher P; Marini, John J; Dries, David J

    2013-06-01

    Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) may complicate monitoring of pulmonary mechanics owing to their impact on the respiratory system. However, recommendations for mechanical ventilation of patients with IAH/ACS and the interpretation of thoracoabdominal interactions remain unclear. Our study aimed to characterize the influence of elevated intra-abdominal pressure (IAP) and positive end-expiratory pressure (PEEP) on airway plateau pressure (PPLAT) and bladder pressure (PBLAD). Nine deeply anesthetized swine were mechanically ventilated via tracheostomy: volume-controlled mode at tidal volume (VT) of 10 mL/kg, frequency of 15, inspiratory-expiratory ratio of 1:2, and PEEP of 1 and 10 cm H2O (PEEP1 and PEEP10, respectively). A tracheostomy tube was placed in the peritoneal cavity, and IAP levels of 5, 10, 15, 20, and 25 mm Hg were applied, using a continuous positive airway pressure system. At each IAP level, PBLAD and airway pressure measurements were performed during both PEEP1 and PEEP10. PBLAD increased as experimental IAP rose (y = 0.83x + 0.5; R = 0.98; p < 0.001 at PEEP1). Minimal underestimation of IAP by PBLAD was observed (-2.5 ± 0.8 mm Hg at an IAP of 10-25 mm Hg). Applying PEEP10 did not significantly affect the correlation between experimental IAP and PBLAD. Approximately 50% of the PBLAD (in cm H2O) was reflected by changes in PPLAT, regardless of the PEEP level applied. Increasing IAP did not influence hemodynamics at any level of IAP generated. With minimal underestimation, PBLAD measurements closely correlated with experimentally regulated IAP, independent of the PEEP level applied. For each PEEP level applied, a constant proportion (approximately 50%) of measured PBLAD (in cm H2O) was reflected in PPLAT. A higher safety threshold for PPLAT should be considered in the setting of IAH/ACS as the clinician considers changes in VT. A strategy of reducing VT to cap PPLAT at widely recommended values may not be

  3. Effect of Positive End-Expiratory Pressure on Central Venous Pressure in Patients under Mechanical Ventilation.

    Science.gov (United States)

    Shojaee, Majid; Sabzghabaei, Anita; Alimohammadi, Hossein; Derakhshanfar, Hojjat; Amini, Afshin; Esmailzadeh, Bahareh

    2017-01-01

    Finding the probable governing pattern of PEEP and CVP changes is an area of interest for in-charge physicians and researchers. Therefore, the present study was designed with the aim of evaluating the relationship between the mentioned pressures. In this quasi-experimental study, patients under mechanical ventilation were evaluated with the aim of assessing the effect of PEEP change on CVP. Non-trauma patients, over 18 years of age, who were under mechanical ventilation and had stable hemodynamics, with inserted CV line were entered. After gathering demographic data, patients underwent 0, 5, and 10 cmH 2 O PEEPs and the respective CVPs of the mentioned points were recorded. The relationship of CVP and PEEP in different cut points were measured using SPSS 21.0 statistical software. 60 patients with the mean age of 73.95 ± 11.58 years were evaluated (68.3% male). The most frequent cause of ICU admission was sepsis with 45.0%. 5 cmH 2 O increase in PEEP led to 2.47 ± 1.53 mean difference in CVP level. If the PEEP baseline is 0 at the time of 5 cmH 2 O increase, it leads to a higher raise in CVP compared to when the baseline is 5 cmH 2 O (2.47 ± 1.53 vs. 1.57 ± 1.07; p = 0.039). The relationship between CVP and 5 cmH 2 O (p = 0.279), and 10 cmH 2 O (p = 0.292) PEEP changes were not dependent on the baseline level of CVP. The findings of this study revealed the direct relationship between PEEP and CVP. Approximately, a 5 cmH 2 O increase in PEEP will be associated with about 2.5 cmH 2 O raise in CVP. When applying a 5 cmH 2 O PEEP increase, if the baseline PEEP is 0, it leads to a significantly higher raise in CVP compared to when it is 5 cmH 2 O (2.5 vs. 1.6). It seems that sex, history of cardiac failure, baseline CVP level, and hypertension do not have a significant effect in this regard.

  4. Effect of Positive End-Expiratory Pressure on Central Venous Pressure in Patients under Mechanical Ventilation

    Directory of Open Access Journals (Sweden)

    Majid Shojaee

    2016-12-01

    Full Text Available Introduction: Finding the probable governing pattern of PEEP and CVP changes is an area of interest for in-charge physicians and researchers. Therefore, the present study was designed with the aim of evaluating the relationship between the mentioned pressures. Methods: In this quasi-experimental study, patients under mechanical ventilation were evaluated with the aim of assessing the effect of PEEP change on CVP. Non-trauma patients, over 18 years of age, who were under mechanical ventilation and had stable hemodynamics, with inserted CV line were entered. After gathering demographic data, patients underwent 0, 5, and 10 cmH2O PEEPs and the respective CVPs of the mentioned points were recorded. The relationship of CVP and PEEP in different cut points were measured using SPSS 21.0 statistical software. Results: 60 patients with the mean age of 73.95 ± 11.58 years were evaluated (68.3% male. The most frequent cause of ICU admission was sepsis with 45.0%. 5 cmH2O increase in PEEP led to 2.47 ± 1.53 mean difference in CVP level. If the PEEP baseline is 0 at the time of 5 cmH2O increase, it leads to a higher raise in CVP compared to when the baseline is 5 cmH2O (2.47 ± 1.53 vs. 1.57 ± 1.07; p = 0.039. The relationship between CVP and 5 cmH2O (p = 0.279, and 10 cmH2O (p = 0.292 PEEP changes were not dependent on the baseline level of CVP. Conclusion: The findings of this study revealed the direct relationship between PEEP and CVP. Approximately, a 5 cmH2O increase in PEEP will be associated with about 2.5 cmH2O raise in CVP. When applying a 5 cmH2O PEEP increase, if the baseline PEEP is 0, it leads to a significantly higher raise in CVP compared to when it is 5 cmH2O (2.5 vs. 1.6. It seems that sex, history of cardiac failure, baseline CVP level, and hypertension do not have a significant effect in this regard.

  5. Potential hazard of the Neopuff T-piece resuscitator in the absence of flow limitation.

    LENUS (Irish Health Repository)

    Hawkes, C P

    2012-01-31

    OBJECTIVE: (1) To assess peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP) and maximum pressure relief (P(max)) at different rates of gas flow, when the Neopuff had been set to function at 5 l\\/min. (2) To assess maximum PIP and PEEP at a flow rate of 10 l\\/min with a simulated air leak of 50%. DESIGN: 5 Neopuffs were set to a PIP of 20, PEEP of 5 and P(max) of 30 cm H(2)O at a gas flow of 5 l\\/min. PIP, PEEP and P(max) were recorded at flow rates of 10, 15 l\\/min and maximum flow. Maximum achievable pressures at 10 l\\/min gas flow, with a 50% air leak, were measured. RESULTS: At gas flow of 15 l\\/min, mean PEEP increased to 20 (95% CI 20 to 21), PIP to 28 (95% CI 28 to 29) and the P(max) to 40 cm H(2)O (95% CI 38 to 42). At maximum flow (85 l\\/min) a PEEP of 71 (95% CI 51 to 91) and PIP of 92 cm H(2)O (95% CI 69 to 115) were generated. At 10 l\\/min flow, with an air leak of 50%, the maximum PEEP and PIP were 21 (95% CI 19 to 23) and 69 cm H(2)O (95% CI 66 to 71). CONCLUSIONS: The maximum pressure relief valve is overridden by increasing the rate of gas flow and potentially harmful PIP and PEEP can be generated. Even in the presence of a 50% gas leak, more than adequate pressures can be provided at 10 l\\/min gas flow. We recommend the limitation of gas flow to a rate of 10 l\\/min as an added safety mechanism for this device.

  6. Cardiac effects of positive pressure ventilation in ARDS assessed by NT-proBNP, Troponin T and Troponin I

    Directory of Open Access Journals (Sweden)

    Yasser Sadek Nassar

    2013-01-01

    Although the increase in cardiac markers are insignificant, yet they point to the potentially harmful role played by high PEEP, low PH and low PaO2/FiO2 ratio on the heart. Currently, no clinically relevant conclusion can be drawn apart from the recommendation to attempt to lower PEEP and shorten the duration of positive pressure ventilation, even in patients with structurally normal hearts.

  7. Comparison of lung protective ventilation strategies in a rabbit model of acute lung injury.

    Science.gov (United States)

    Rotta, A T; Gunnarsson, B; Fuhrman, B P; Hernan, L J; Steinhorn, D M

    2001-11-01

    To determine the impact of different protective and nonprotective mechanical ventilation strategies on the degree of pulmonary inflammation, oxidative damage, and hemodynamic stability in a saline lavage model of acute lung injury. A prospective, randomized, controlled, in vivo animal laboratory study. Animal research facility of a health sciences university. Forty-six New Zealand White rabbits. Mature rabbits were instrumented with a tracheostomy and vascular catheters. Lavage-injured rabbits were randomized to receive conventional ventilation with either a) low peak end-expiratory pressure (PEEP; tidal volume of 10 mL/kg, PEEP of 2 cm H2O); b) high PEEP (tidal volume of 10 mL/kg, PEEP of 10 cm H2O); c) low tidal volume with PEEP above Pflex (open lung strategy, tidal volume of 6 mL/kg, PEEP set 2 cm H2O > Pflex); or d) high-frequency oscillatory ventilation. Animals were ventilated for 4 hrs. Lung lavage fluid and tissue samples were obtained immediately after animals were killed. Lung lavage fluid was assayed for measurements of total protein, elastase activity, tumor necrosis factor-alpha, and malondialdehyde. Lung tissue homogenates were assayed for measurements of myeloperoxidase activity and malondialdehyde. The need for inotropic support was recorded. Animals that received a lung protective strategy (open lung or high-frequency oscillatory ventilation) exhibited more favorable oxygenation and lung mechanics compared with the low PEEP and high PEEP groups. Animals ventilated by a lung protective strategy also showed attenuation of inflammation (reduced tracheal fluid protein, tracheal fluid elastase, tracheal fluid tumor necrosis factor-alpha, and pulmonary leukostasis). Animals treated with high-frequency oscillatory ventilation had attenuated oxidative injury to the lung and greater hemodynamic stability compared with the other experimental groups. Both lung protective strategies were associated with improved oxygenation, attenuated inflammation, and

  8. Combined Effects of Ventilation Mode and Positive End-Expiratory Pressure on Mechanics, Gas Exchange and the Epithelium in Mice with Acute Lung Injury

    Science.gov (United States)

    Thammanomai, Apiradee; Hamakawa, Hiroshi; Bartolák-Suki, Erzsébet; Suki, Béla

    2013-01-01

    The accepted protocol to ventilate patients with acute lung injury is to use low tidal volume (VT) in combination with recruitment maneuvers or positive end-expiratory pressure (PEEP). However, an important aspect of mechanical ventilation has not been considered: the combined effects of PEEP and ventilation modes on the integrity of the epithelium. Additionally, it is implicitly assumed that the best PEEP-VT combination also protects the epithelium. We aimed to investigate the effects of ventilation mode and PEEP on respiratory mechanics, peak airway pressures and gas exchange as well as on lung surfactant and epithelial cell integrity in mice with acute lung injury. HCl-injured mice were ventilated at PEEPs of 3 and 6 cmH2O with conventional ventilation (CV), CV with intermittent large breaths (CVLB) to promote recruitment, and a new mode, variable ventilation, optimized for mice (VVN). Mechanics and gas exchange were measured during ventilation and surfactant protein (SP)-B, proSP-B and E-cadherin levels were determined from lavage and lung homogenate. PEEP had a significant effect on mechanics, gas exchange and the epithelium. The higher PEEP reduced lung collapse and improved mechanics and gas exchange but it also down regulated surfactant release and production and increased epithelial cell injury. While CVLB was better than CV, VVN outperformed CVLB in recruitment, reduced epithelial injury and, via a dynamic mechanotransduction, it also triggered increased release and production of surfactant. For long-term outcome, selection of optimal PEEP and ventilation mode may be based on balancing lung physiology with epithelial injury. PMID:23326543

  9. Effects of positive end-expiratory pressure on renal function.

    Science.gov (United States)

    Järnberg, P O; de Villota, E D; Eklund, J; Granberg, P O

    1978-01-01

    The effects were studied positive end-expiratory pressure (PEEP) on renal function in eight patients with acute respiratory failure, requiring mechanical ventilation. On application of PEEP + 10 cm H2O, central venous pressure increased, systolic blood pressure decreased, urine flow and PAH-clearance were reduced, while inulin clearance remained stable. There was a marked increase in fractional sodium reabsorption and a concurrent decrease in fractional osmolal excretion. Fractional free-water clearance and the ratio UOsm/POsm did change.

  10. Tidal Volume Delivery and Endotracheal Tube Leak during Cardiopulmonary Resuscitation in Intubated Newborn Piglets with Hypoxic Cardiac Arrest Exposed to Different Modes of Ventilatory Support.

    Science.gov (United States)

    Mendler, Marc R; Weber, Claudia; Hassan, Mohammad A; Huang, Li; Mayer, Benjamin; Hummler, Helmut D

    2017-01-01

    There are few data available on the interaction of inflations, chest compressions (CC), and delivery of tidal volumes in newborn infants undergoing resuscitation in the presence of endotracheal tube (ET) leaks. To determine the effects of different respiratory support strategies along with CC on changes in tidal volume and ET leaks in hypoxic newborn piglets with cardiac arrest. Asphyxiated newborn piglets, intubated with weight-adapted uncuffed ET, were randomized into three groups and resuscitated according to ILCOR 2010 guidelines: (1) T-piece resuscitator (TPR) group = peak inspiratory pressure (PIP)/positive end-expiratory pressure (PEEP) 25/5 cm H2O, rate 30/min, inflations interposed between CC (3:1 ratio); (2) self- inflating bag (SIB) group = PIP 25 cm H2O without PEEP, rate 30/min, inflations interposed between CC (3:1 ratio), and (3) ventilator group = PIP/PEEP of 25/5 cm H2O, rate 30/min. CC were applied with a rate of 120/min without synchrony to inflations. We observed a significant increase of leak (average increase 11.4%) when CC was added to respiratory support (p = 0.0001). Expired tidal volume was larger in the SIB group than in the two other modes which both applied PEEP. However, tidal volumes caused by CC only were larger in the two groups with PEEP than in the SIB group (without PEEP). There is interaction between lung inflations and CC affecting leak and delivery of tidal volume, which may be influenced by the mode/device used for respiratory support. Leak is larger in the presence of PEEP. However, CC cause additional tidal volume which is larger in the presence of PEEP. © 2016 S. Karger AG, Basel.

  11. Application of dead space fraction to titrate optimal positive end-expiratory pressure in an ARDS swine model.

    Science.gov (United States)

    Bian, Weishuai; Chen, Wei; Chao, Yangong; Wang, Lan; Li, Liming; Guan, Jian; Zang, Xuefeng; Zhen, Jie; Sheng, Bo; Zhu, Xi

    2017-04-01

    This study aimed to apply the dead space fraction [ratio of dead space to tidal volume (VD/VT)] to titrate the optimal positive end-expiratory pressure (PEEP) in a swine model of acute respiratory distress syndrome (ARDS). Twelve swine models of ARDS were constructed. A lung recruitment maneuver was then conducted and the PEEP was set at 20 cm H 2 O. The PEEP was reduced by 2 cm H 2 O every 10 min until 0 cm H 2 O was reached, and VD/VT was measured after each decrement step. VD/VT was measured using single-breath analysis of CO 2 , and calculated from arterial CO 2 partial pressure (PaCO 2 ) and mixed expired CO 2 (PeCO 2 ) using the following formula: VD/VT = (PaCO 2 - PeCO 2 )/PaCO 2 . The optimal PEEP was identified by the lowest VD/VT method. Respiration and hemodynamic parameters were recorded during the periods of pre-injury and injury, and at 4 and 2 cm H 2 O below and above the optimal PEEP (Po). The optimal PEEP in this study was found to be 13.25±1.36 cm H 2 O. During the Po period, VD/VT decreased to a lower value (0.44±0.08) compared with that during the injury period (0.68±0.10) (P<0.05), while the intrapulmonary shunt fraction reached its lowest value. In addition, a significant change of dynamic tidal respiratory compliance and oxygenation index was induced by PEEP titration. These results indicate that minimal VD/VT can be used for PEEP titration in ARDS.

  12. Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment.

    Science.gov (United States)

    Spadaro, Savino; Mauri, Tommaso; Böhm, Stephan H; Scaramuzzo, Gaetano; Turrini, Cecilia; Waldmann, Andreas D; Ragazzi, Riccardo; Pesenti, Antonio; Volta, Carlo Alberto

    2018-01-31

    Assessing alveolar recruitment at different positive end-expiratory pressure (PEEP) levels is a major clinical and research interest because protective ventilation implies opening the lung without inducing overdistention. The pressure-volume (P-V) curve is a validated method of assessing recruitment but reflects global characteristics, and changes at the regional level may remain undetected. The aim of the present study was to compare, in intubated patients with acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS), lung recruitment measured by P-V curve analysis, with dynamic changes in poorly ventilated units of the dorsal lung (dependent silent spaces [DSSs]) assessed by electrical impedance tomography (EIT). We hypothesized that DSSs might represent a dynamic bedside measure of recruitment. We carried out a prospective interventional study of 14 patients with AHRF and ARDS admitted to the intensive care unit undergoing mechanical ventilation. Each patient underwent an incremental/decremental PEEP trial that included five consecutive phases: PEEP 5 and 10 cmH 2 O, recruitment maneuver + PEEP 15 cmH 2 O, then PEEP 10 and 5 cmH 2 O again. We measured, at the end of each phase, recruitment from previous PEEP using the P-V curve method, and changes in DSS were continuously monitored by EIT. PEEP changes induced alveolar recruitment as assessed by the P-V curve method and changes in the amount of DSS (p Recruited volume measured by the P-V curves significantly correlated with the change in DSS (r s  = 0.734, p recruitment measured using the P-V curve technique. EIT might provide useful information to titrate personalized PEEP. ClinicalTrials.gov, NCT02907840 . Registered on 20 September 2016.

  13. Positive end-expiratory pressure improves gas exchange and pulmonary mechanics during partial liquid ventilation.

    Science.gov (United States)

    Kirmse, M; Fujino, Y; Hess, D; Kacmarek, R M

    1998-11-01

    Partial liquid ventilation (PLV) with perflubron (PFB) has been proposed as an adjunct to the current therapies for the acute respiratory distress syndrome (ARDS). Because PFB has been also referred to as "liquid PEEP," distributing to the most gravity-dependent regions of the lung, less attention has been paid to the amount of applied positive end-expiratory pressure (PEEP). We hypothesized that higher PEEP levels than currently applied are needed to optimize gas exchange, and that the lower inflection point (LIP) of the pressure-volume curve could be used to estimate the amount of PEEP needed when the lung is filled with PFB. Lung injury was induced in 23 sheep by repeated lung lavage with warmed saline until the PaO2/FIO2 ratio fell below 150. Five sheep were used to investigate the change of the LIP when the lung was filled with PFB in increments of 5 ml/kg/body weight to a total of 30 ml/kg/body weight. To evaluate the impact of PEEP set at LIP +1 cm H2O we randomized an additional 15 sheep to three groups with different doses (7.5 ml, 15 ml, 30 ml/kg/body weight) of PFB. In random order a PEEP of 5 cm H2O or PEEP at LIP +1 cm H2O was applied. The LIP decreased with incremental filling of PFB to a minimum at 10 ml (p PFB shifts the LIP to the left, and that setting PEEP at LIP +1 cm H2O improves gas exchange at moderate to high doses of PFB.

  14. The MOST - Monitor for Oxygenation of Surface and Tissue.

    Science.gov (United States)

    1995-10-01

    anesthesia Effectiveness of COR Bio-feedback for peripheral vasodilation Relationship of CPAP and PEEP to atelectasis Waveforms Diagnosis of irregularities...deliberate hypoxia in premature infants Servo-controlled saturation, prematures Converse 02 in home 02 therapy Determine optimal PEEP and CPAP Monitor...Kusakawa I, Ohata J, Kawano T, Honma Y. Use of Pulse Oximetry In Neonatal Anesthe- sia. J Perinatology. 1987:7;343-5. Nishimura S, Tomita Y, Horiuchi T

  15. Prediction of high airway pressure using a non-linear autoregressive model of pulmonary mechanics.

    Science.gov (United States)

    Langdon, Ruby; Docherty, Paul D; Schranz, Christoph; Chase, J Geoffrey

    2017-11-02

    For mechanically ventilated patients with acute respiratory distress syndrome (ARDS), suboptimal PEEP levels can cause ventilator induced lung injury (VILI). In particular, high PEEP and high peak inspiratory pressures (PIP) can cause over distension of alveoli that is associated with VILI. However, PEEP must also be sufficient to maintain recruitment in ARDS lungs. A lung model that accurately and precisely predicts the outcome of an increase in PEEP may allow dangerous high PIP to be avoided, and reduce the incidence of VILI. Sixteen pressure-flow data sets were collected from nine mechanically ventilated ARDs patients that underwent one or more recruitment manoeuvres. A nonlinear autoregressive (NARX) model was identified on one or more adjacent PEEP steps, and extrapolated to predict PIP at 2, 4, and 6 cmH 2 O PEEP horizons. The analysis considered whether the predicted and measured PIP exceeded a threshold of 40 cmH 2 O. A direct comparison of the method was made using the first order model of pulmonary mechanics (FOM(I)). Additionally, a further, more clinically appropriate method for the FOM was tested, in which the FOM was trained on a single PEEP prior to prediction (FOM(II)). The NARX model exhibited very high sensitivity (> 0.96) in all cases, and a high specificity (> 0.88). While both FOM methods had a high specificity (> 0.96), the sensitivity was much lower, with a mean of 0.68 for FOM(I), and 0.82 for FOM(II). Clinically, false negatives are more harmful than false positives, as a high PIP may result in distension and VILI. Thus, the NARX model may be more effective than the FOM in allowing clinicians to reduce the risk of applying a PEEP that results in dangerously high airway pressures.

  16. Barbarid, plastiliinijänes, Miriam ja Frank Muller / Annika Koppel

    Index Scriptorium Estoniae

    Koppel, Annika

    2003-01-01

    Nukufilm näitab 4 uut filmi : "Barbarid" (stsenaristid Andrus Kivirähk ja Hardi Volmer, režissöör H. Volmer), "Porgand" (stsenarist Peep Pedmanson, režissöör Pärtel Tall), "Miriami jõulupäkapikk" (stsenaristid Leelo Tungal ja Peep Pedmanson, režissöör Mait Laas), "Kuuvaatleja" (reklaamitreiler Frank Mulleri kellafirmale ; stsenarist, režissöör, kunstnik Mati Kütt)

  17. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury.

    Science.gov (United States)

    Wolthuis, Esther K; Choi, Goda; Dessing, Mark C; Bresser, Paul; Lutter, Rene; Dzoljic, Misa; van der Poll, Tom; Vroom, Margreeth B; Hollmann, Markus; Schultz, Marcus J

    2008-01-01

    Mechanical ventilation with high tidal volumes aggravates lung injury in patients with acute lung injury or acute respiratory distress syndrome. The authors sought to determine the effects of short-term mechanical ventilation on local inflammatory responses in patients without preexisting lung injury. Patients scheduled to undergo an elective surgical procedure (lasting > or = 5 h) were randomly assigned to mechanical ventilation with either higher tidal volumes of 12 ml/kg ideal body weight and no positive end-expiratory pressure (PEEP) or lower tidal volumes of 6 ml/kg and 10 cm H2O PEEP. After induction of anesthesia and 5 h thereafter, bronchoalveolar lavage fluid and/or blood was investigated for polymorphonuclear cell influx, changes in levels of inflammatory markers, and nucleosomes. Mechanical ventilation with lower tidal volumes and PEEP (n = 21) attenuated the increase of pulmonary levels of interleukin (IL)-8, myeloperoxidase, and elastase as seen with higher tidal volumes and no PEEP (n = 19). Only for myeloperoxidase, a difference was found between the two ventilation strategies after 5 h of mechanical ventilation (P volumes and PEEP may limit pulmonary inflammation in mechanically ventilated patients without preexisting lung injury. The specific contribution of both lower tidal volumes and PEEP on the protective effects of the lung should be further investigated.

  18. Intratidal recruitment/derecruitment persists at low and moderate positive end-expiratory pressure in paediatric patients.

    Science.gov (United States)

    Wirth, Steffen; Artner, Lisa; Broß, Tobias; Lozano-Zahonero, Sara; Spaeth, Johannes; Schumann, Stefan

    2016-12-01

    In paediatric patients positive end-expiratory pressure (PEEP) is traditionally set lower than in adults. We investigated whether moderately higher PEEP improves respiratory mechanics and regional ventilation. Therefore, 40 children were mechanically ventilated with PEEP 2 and 5cmH 2 O. Volume-dependent compliance profiles were analysed as a measure of intratidal recruitment/derecruitment. Regional ventilation was assessed using electrical impedance tomography. Mean compliance was 17.9±9.9mLcmH 2 O -1 (PEEP 2cmH 2 O), and 19.0±10.9mLcmH 2 O -1 (PEEP 5 cmH 2 O, pventilation. In conclusion, mechanically ventilated paediatric patients undergo intratidal recruitment/derecruitment which occurs more prominently in younger than in older children. A PEEP of 5cmH 2 O does not fully prevent intratidal recruitment/derecruitment but homogenizes regional ventilation in comparison to 2cmH 2 O. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Protective versus Conventional Ventilation for Surgery: A Systematic Review and Individual Patient Data Meta-analysis.

    Science.gov (United States)

    Serpa Neto, Ary; Hemmes, Sabrine N T; Barbas, Carmen S V; Beiderlinden, Martin; Biehl, Michelle; Binnekade, Jan M; Canet, Jaume; Fernandez-Bustamante, Ana; Futier, Emmanuel; Gajic, Ognjen; Hedenstierna, Göran; Hollmann, Markus W; Jaber, Samir; Kozian, Alf; Licker, Marc; Lin, Wen-Qian; Maslow, Andrew D; Memtsoudis, Stavros G; Reis Miranda, Dinis; Moine, Pierre; Ng, Thomas; Paparella, Domenico; Putensen, Christian; Ranieri, Marco; Scavonetto, Federica; Schilling, Thomas; Schmid, Werner; Selmo, Gabriele; Severgnini, Paolo; Sprung, Juraj; Sundar, Sugantha; Talmor, Daniel; Treschan, Tanja; Unzueta, Carmen; Weingarten, Toby N; Wolthuis, Esther K; Wrigge, Hermann; Gama de Abreu, Marcelo; Pelosi, Paolo; Schultz, Marcus J

    2015-07-01

    Recent studies show that intraoperative mechanical ventilation using low tidal volumes (VT) can prevent postoperative pulmonary complications (PPCs). The aim of this individual patient data meta-analysis is to evaluate the individual associations between VT size and positive end-expiratory pressure (PEEP) level and occurrence of PPC. Randomized controlled trials comparing protective ventilation (low VT with or without high levels of PEEP) and conventional ventilation (high VT with low PEEP) in patients undergoing general surgery. The primary outcome was development of PPC. Predefined prognostic factors were tested using multivariate logistic regression. Fifteen randomized controlled trials were included (2,127 patients). There were 97 cases of PPC in 1,118 patients (8.7%) assigned to protective ventilation and 148 cases in 1,009 patients (14.7%) assigned to conventional ventilation (adjusted relative risk, 0.64; 95% CI, 0.46 to 0.88; P ventilation with low VT and high PEEP levels and 63 cases in 525 patients (12%) assigned to ventilation with low VT and low PEEP levels (adjusted relative risk, 0.93; 95% CI, 0.64 to 1.37; P = 0.72). A dose-response relationship was found between the appearance of PPC and VT size (R2 = 0.39) but not between the appearance of PPC and PEEP level (R2 = 0.08). These data support the beneficial effects of ventilation with use of low VT in patients undergoing surgery. Further trials are necessary to define the role of intraoperative higher PEEP to prevent PPC during nonopen abdominal surgery.

  20. Pulmonary lesion induced by low and high positive end-expiratory pressure levels during protective ventilation in experimental acute lung injury.

    Science.gov (United States)

    Pássaro, Caroline P; Silva, Pedro L; Rzezinski, Andréia F; Abrantes, Simone; Santiago, Viviane R; Nardelli, Liliane; Santos, Raquel S; Barbosa, Carolina M L; Morales, Marcelo M; Zin, Walter A; Amato, Marcelo B P; Capelozzi, Vera L; Pelosi, Paolo; Rocco, Patricia R M

    2009-03-01

    To investigate the effects of low and high levels of positive end-expiratory pressure (PEEP), without recruitment maneuvers, during lung protective ventilation in an experimental model of acute lung injury (ALI). Prospective, randomized, and controlled experimental study. University research laboratory. Wistar rats were randomly assigned to control (C) [saline (0.1 mL), intraperitoneally] and ALI [paraquat (15 mg/kg), intraperitoneally] groups. After 24 hours, each group was further randomized into four groups (six rats each) at different PEEP levels = 1.5, 3, 4.5, or 6 cm H2O and ventilated with a constant tidal volume (6 mL/kg) and open thorax. Lung mechanics [static elastance (Est, L) and viscoelastic pressure (DeltaP2, L)] and arterial blood gases were measured before (Pre) and at the end of 1-hour mechanical ventilation (Post). Pulmonary histology (light and electron microscopy) and type III procollagen (PCIII) messenger RNA (mRNA) expression were measured after 1 hour of mechanical ventilation. In ALI group, low and high PEEP levels induced a greater percentage of increase in Est, L (44% and 50%) and DeltaP2, L (56% and 36%) in Post values related to Pre. Low PEEP yielded alveolar collapse whereas high PEEP caused overdistension and atelectasis, with both levels worsening oxygenation and increasing PCIII mRNA expression. In the present nonrecruited ALI model, protective mechanical ventilation with lower and higher PEEP levels than required for better oxygenation increased Est, L and DeltaP2, L, the amount of atelectasis, and PCIII mRNA expression. PEEP selection titrated for a minimum elastance and maximum oxygenation may prevent lung injury while deviation from these settings may be harmful.

  1. Differing responses in right and left ventricular filling, loading and volumes during positive end-expiratory pressure

    International Nuclear Information System (INIS)

    Schulman, D.S.; Biondi, J.W.; Matthay, R.A.; Zaret, B.L.; Soufer, R.

    1989-01-01

    Using a combined hemodynamic and radionuclide technique, 20 patients with varied ventricular function were evaluated during positive end-expiratory pressure (PEEP) application. Left ventricular (LV) and right ventricular (RV) ejection fractions and cardiac output were measured, and ventricular volumes were derived. Seven patients (group 1) who had an increase in LV end-diastolic volume with PEEP and 13 patients (group 2) who had the more typical response, a decrease in LV end-diastolic volume with PEEP, were identified. Compared with group 2, group 1 patients had a higher incidence of coronary artery disease (5 of 7 vs 1 of 13, p less than 0.005) and lower cardiac output (3.9 +/- 1.6 vs 9.1 +/- 3.2 liters/min, p less than 0.005), LV ejection fraction (27 +/- 13 vs 51 +/- 21%, p less than 0.05), RV ejection fraction (15 +/- 6 vs 32 +/- 8%, p less than 0.005) and peak filling rate (1.32 +/- 0.43 vs 3.51 +/- 1.70 end-diastolic volumes/s, p less than 0.05). LV and RV volumes increased and peak filling rate decreased with PEEP in group 1, whereas in group 2 LV volume decreased and RV volume and peak filling rate remained unchanged. Using stepwise regression analysis, the change in LV volume with PEEP was related directly to baseline systemic vascular resistance and inversely to baseline blood pressure. Similarly, the change in peak filling rate with PEEP was inversely related to the change in RV end-diastolic volume. Thus, the hemodynamic response to PEEP is heterogeneous and may be related to LV ischemia

  2. OPTIMUM LEVEL OF POSITIVE END-EXPIRATORY PRESSURE IN ACUTE RESPIRATORY DISTRESS SYNDROME CAUSED BY INFLUENZA A(H1NI)PDM09: BALANCE BETWEEN MAXIMAL END-EXPIRATORY VOLUME AND MINIMAL ALVEOLAR OVERDISTENSION.

    Science.gov (United States)

    Yaroshetskiym A I; Protsenko, D N; Boytsov, P V; Chentsov, V B; Nistratov, S L; Kudlyakov, O N; Solov'ev, V V; Banova, Zh I; Shkuratova, N V; Rezenov, N A; Gel'fand, B R

    2016-11-01

    to determine optimum level ofpositive end-expiratory pressure (PEEP) according to balance between maxi- mal end-expiratory lung volume (EEL V)(more than predicted) and minimal decrease in exhaled carbon dioxide volume (VCO) and then to develop the algorithm of gas exchange correction based on prognostic values of EEL K; alveolar recruitability, PA/FiO2, static compliance (C,,,) and VCO2. 27 mechanically ventilatedpatients with acute respiratory distress syndrome (ARDS) caused by influenza A (HINJ)pdm09 in Moscow Municipal Clinics ICU's from January to March 2016 were included in the trial. At the beginning of the study patients had the following characteristic: duration offlu symptoms 5 (3-10) days, p.0/FiO2 120 (70-50) mmHg. SOFA 7 (5-9), body mass index 30.1 (26.4-33.8) kg/m², static compliance of respiratory system 35 (30-40) ml/mbar: Under sedation and paralysis we measured EELV, C VCO and end-tidal carbon dioxide concentration (EtCO) (for CO₂ measurements we fixed short-term values after 2 min after PEEP level change) at PEEP 8, 11,13,15,18, 20 mbar consequently, and incase of good recruitability, at 22 and 24 mbar. After analyses of obtained data we determined PEEP value in which increase in EELV was maximal (more than predicted) and depression of VCO₂ was less than 20%, change in mean blood pressure and heart rate were both less than 20% (measured at PEEP 8 mbar). After that we set thus determined level of PEEP and didn't change it for 5 days. Comparision of predicted and measured EELV revealed two typical points of alveloar recruiment: the first at PEEP 11-15 mbar, the second at PEEP 20-22 mbar. EELV measured at PEEP 18 mbar appeared to be higher than predicted at PEEP 8 mbar by 400 ml (approx.), which was the sign of alveolar recruitment-1536 (1020-1845) ml vs 1955 (1360-2320) ml, p=0,001, Friedman test). we didn't found significant changes of VCO₂ when increased PEEP in the range from 8 to 15 mbar (p>0.05, Friedman test). PEEP increase from 15 to

  3. Influence of tidal volume on ventilation inhomogeneity assessed by electrical impedance tomography during controlled mechanical ventilation

    International Nuclear Information System (INIS)

    Becher, T; Kott, M; Schädler, D; Vogt, B; Meinel, T; Weiler, N; Frerichs, I

    2015-01-01

    The global inhomogeneity (GI) index is a parameter of ventilation inhomogeneity that can be calculated from images of tidal ventilation distribution obtained by electrical impedance tomography (EIT). It has been suggested that the GI index may be useful for individual adjustment of positive end-expiratory pressure (PEEP) and for guidance of ventilator therapy. The aim of the present work was to assess the influence of tidal volume (V_T) on the GI index values. EIT data from 9 patients with acute respiratory distress syndrome ventilated with a low and a high V_T of 5   ±   1 (mean  ±  SD) and 9   ±   1 ml kg"−"1 predicted body weight at a high and a low level of PEEP (PEEP_h_i_g_h, PEEP_l_o_w) were analyzed. PEEP_h_i_g_h and PEEP_l_o_w were set 2 cmH_2O above and 5 cmH_2O below the lower inflection point of a quasi-static pressure volume loop, respectively. The lower inflection point was identified at 8.1   ±   1.4 (mean  ±  SD) cmH_2O, resulting in a PEEP_h_i_g_h of 10.1   ±   1.4 and a PEEP_l_o_w of 3.1   ±   1.4 cmH_2O. At PEEP_h_i_g_h, we found no significant trend in GI index with low V_T when compared to high V_T (0.49   ±   0.15 versus 0.44   ±   0.09, p = 0.13). At PEEP_l_o_w, we found a significantly higher GI index with low V_T compared to high V_T (0.66   ±   0.19 versus 0.59   ±   0.17, p = 0.01). When comparing the PEEP levels, we found a significantly lower GI index at PEEP_h_i_g_h both for high and low V_T. We conclude that high V_T may lead to a lower GI index, especially at low PEEP settings. This should be taken into account when using the GI index for individual adjustment of ventilator settings. (paper)

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

    Science.gov (United States)

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

    2007-01-01

    Acute respiratory distress syndrome causes a heterogeneous lung injury, and without protective mechanical ventilation a secondary ventilator-induced lung injury can occur. To ventilate noncompliant lung regions, high inflation pressures are required to 'pop open' the injured alveoli. The temporal impact, however, of these elevated pressures on normal alveolar mechanics (that is, the dynamic change in alveolar size and shape during ventilation) is unknown. In the present study we found that ventilating the normal lung with high peak pressure (45 cmH(2)0) and low positive end-expiratory pressure (PEEP of 3 cmH(2)O) did not initially result in altered alveolar mechanics, but alveolar instability developed over time. Anesthetized rats underwent tracheostomy, were placed on pressure control ventilation, and underwent sternotomy. Rats were then assigned to one of three ventilation strategies: control group (n = 3, P control = 14 cmH(2)O, PEEP = 3 cmH(2)O), high pressure/low PEEP group (n = 6, P control = 45 cmH(2)O, PEEP = 3 cmH(2)O), and high pressure/high PEEP group (n = 5, P control = 45 cmH(2)O, PEEP = 10 cmH(2)O). In vivo microscopic footage of subpleural alveolar stability (that is, recruitment/derecruitment) was taken at baseline and than every 15 minutes for 90 minutes following ventilator adjustments. Alveolar recruitment/derecruitment was determined by measuring the area of individual alveoli at peak inspiration (I) and end expiration (E) by computer image analysis. Alveolar recruitment/derecruitment was quantified by the percentage change in alveolar area during tidal ventilation (%I - E Delta). Alveoli were stable in the control group for the entire experiment (low %I - E Delta). Alveoli in the high pressure/low PEEP group were initially stable (low %I - E Delta), but with time alveolar recruitment/derecruitment developed. The development of alveolar instability in the high pressure/low PEEP group was associated with histologic lung injury. A large change in

  5. Open lung approach versus standard protective strategies: Effects on driving pressure and ventilatory efficiency during anesthesia - A pilot, randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Carlos Ferrando

    Full Text Available Low tidal volume (VT during anesthesia minimizes lung injury but may be associated to a decrease in functional lung volume impairing lung mechanics and efficiency. Lung recruitment (RM can restore lung volume but this may critically depend on the post-RM selected PEEP. This study was a randomized, two parallel arm, open study whose primary outcome was to compare the effects on driving pressure of adding a RM to low-VT ventilation, with or without an individualized post-RM PEEP in patients without known previous lung disease during anesthesia.Consecutive patients scheduled for major abdominal surgery were submitted to low-VT ventilation (6 ml·kg-1 and standard PEEP of 5 cmH2O (pre-RM, n = 36. After 30 min estabilization all patients received a RM and were randomly allocated to either continue with the same PEEP (RM-5 group, n = 18 or to an individualized open-lung PEEP (OL-PEEP (Open Lung Approach, OLA group, n = 18 defined as the level resulting in maximal Cdyn during a decremental PEEP trial. We compared the effects on driving pressure and lung efficiency measured by volumetric capnography.OL-PEEP was found at 8±2 cmH2O. 36 patients were included in the final analysis. When compared with pre-RM, OLA resulted in a 22% increase in compliance and a 28% decrease in driving pressure when compared to pre-RM. These parameters did not improve in the RM-5. The trend of the DP was significantly different between the OLA and RM-5 groups (p = 0.002. VDalv/VTalv was significantly lower in the OLA group after the RM (p = 0.035.Lung recruitment applied during low-VT ventilation improves driving pressure and lung efficiency only when applied as an open-lung strategy with an individualized PEEP in patients without lung diseases undergoing major abdominal surgery.ClinicalTrials.gov NCT02798133.

  6. A Recruiting Maneuver Algorithm in Patients with Early Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    D. I. Levikov

    2011-01-01

    Full Text Available Objective: to evaluate the efficiency of a recruiting maneuver (RM and adjustment of positive end-expiratory pressure (PEEP in patients with early acute respiratory distress syndrome (ARDS. Subjects and methods. The study enrolled 16 patients (14 men and 2 women aged 46 to 78 years (range 62±5.6 years with ARDS of various genesis. RM was made, by stepwisely increasing PEEP and inspiratory pressure under the control of dynamic lung compliance and hemodynamic parameters. The values of blood gas composition and hemodynamics were determined during the study. Results. RM caused an increase in oxygenation index (OI from 153.5±48.3 to 348.5±53.2 mm Hg. Oxygenation values returned to the baseline levels 30—40 min after the PEEP was set at the closure point of +2 cm H2O. If the set PEEP was 8—10 cm H2O higher than the objective, the effect of RM was retained for as long as 24 hours. When RM was performed using the maximum pressure of 50—60 cm H2O, the cardiac index (CI was lower in all the patients and 30—50% of the baseline values were achieved in all cases, which required the optimization of cardiotonic therapy. The time of this pronounced reduction in cardiac output with RM was not longer than 5 min. After RM, during mechanical ventilation with 18—26 cm H2O PEEP, the CI did not practically differ from the baseline values (3.31±0.41 and 3.37±0.36 l/min/m2, respectively, though the dopamine dose required to maintain normal hemodynamics was somewhat higher (7.5±2.3 and 6.3±2.6 ^g/kg/min. Conclusion. Analysis of the given cases suggests that RM is highly effective in patients at the early stages of acute lung injury. The duration of RM effects may depend on the set PEEP level in individual cases. Setting PEEP at a level of +2—4 cm H2O fails to prevent repeated alveolar derecruitment in a number of patients. In these cases, it is expedient to individually adjust PEEP levels, by taking into account the long-term changes in OI and Cdyn. In

  7. Setting ventilation parameters guided by electrical impedance tomography in an animal trial of acute respiratory distress syndrome

    Science.gov (United States)

    Czaplik, Michael; Biener, Ingeborg; Leonhardt, Steffen; Rossaint, Rolf

    2014-03-01

    Since mechanical ventilation can cause harm to lung tissue it should be as protective as possible. Whereas numerous options exist to set ventilator parameters, an adequate monitoring is lacking up to date. The Electrical Impedance Tomography (EIT) provides a non-invasive visualization of ventilation which is relatively easy to apply and commercially available. Although there are a number of published measures and parameters derived from EIT, it is not clear how to use EIT to improve clinical outcome of e.g. patients suffering from acute respiratory distress syndrome (ARDS), a severe disease with a high mortality rate. On the one hand, parameters should be easy to obtain, on the other hand clinical algorithms should consider them to optimize ventilator settings. The so called Global inhomogeneity (GI) index bases on the fact that ARDS is characterized by an inhomogeneous injury pattern. By applying positive endexpiratory pressures (PEEP), homogeneity should be attained. In this study, ARDS was induced by a double hit procedure in six pigs. They were randomly assigned to either the EIT or the control group. Whereas in the control group the ARDS network table was used to set the PEEP according to the current inspiratory oxygen fraction, in the EIT group the GI index was calculated during a decremental PEEP trial. PEEP was kept when GI index was lowest. Interestingly, PEEP was significantly higher in the EIT group. Additionally, two of these animals died ahead of the schedule. Obviously, not only homogeneity of ventilation distribution matters but also limitation of over-distension.

  8. A Case of Shunting Postoperative Patent Foramen Ovale Under Mechanical Ventilation Controlled by Different Ventilator Settings.

    Science.gov (United States)

    Pragliola, Claudio; Di Michele, Sara; Galzerano, Domenico

    2017-06-07

    A 56-year old male with ischemic heart disease and an unremarkable preoperative echocardiogram underwent surgical coronary revascularization. An intraoperative post pump trans-esophageal echocardiogram (TOE) performed while the patient was being ventilated at a positive end expiratory pressure (PEEP) of 8 cm H 2 O demonstrated a right to left interatrial shunt across a patent foramen ovale (PFO). Whereas oxygen saturation was normal, a reduction of the PEEP to 3 cm H 2 O led to the complete resolution of the shunt with no change in arterial blood gases. Attempts to increase the PEEP level above 3 mmHg resulted in recurrence of the interatrial shunt. The remaining of the TEE was unremarkable. Mechanical ventilation, particularly with PEEP, causes an increase in intrathoracic pressure. The resulting rise in right atrial pressure, mostly during inspiration, may unveil and pop open an unrecognized PFO, thus provoking a right to left shunt across a seemingly intact interatrial septum. This phenomenon increases the risk of paradoxical embolism and can lead to hypoxemia. The immediate management would be to adjust the ventilatory settings to a lower PEEP level. A routine search for a PFO should be performed in ventilated patients who undergo a TEE.

  9. A case of shunting postoperative patent foramen ovale under mechanical ventilation controlled by different ventilator settings

    Directory of Open Access Journals (Sweden)

    Claudio Pragliola

    2017-08-01

    Full Text Available A 56-year old male with ischemic heart disease and an unremarkable preoperative echocardiogram underwent surgical coronary revascularization. An intraoperative post pump trans-esophageal echocardiogram (TOE performed while the patient was being ventilated at a positive end expiratory pressure (PEEP of 8 cm H2O demonstrated a right to left interatrial shunt across a patent foramen ovale (PFO. Whereas oxygen saturation was normal, a reduction of the PEEP to 3 cm H2O led to the complete resolution of the shunt with no change in arterial blood gases. Attempts to increase the PEEP level above 3 mmHg resulted in recurrence of the interatrial shunt. The remaining of the TEE was unremarkable. Mechanical ventilation, particularly with PEEP, causes an increase in intrathoracic pressure. The resulting rise in right atrial pressure, mostly during inspiration, may unveil and pop open an unrecognized PFO, thus provoking a right to left shunt across a seemingly intact interatrial septum. This phenomenon increases the risk of paradoxical embolism and can lead to hypoxemia. The immediate management would be to adjust the ventilatory settings to a lower PEEP level. A routine search for a PFO should be performed in ventilated patients who undergo a TEE.

  10. Sustained Aeration of Infant Lungs (SAIL) trial: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Foglia, Elizabeth E; Owen, Louise S; Thio, Marta; Ratcliffe, Sarah J; Lista, Gianluca; Te Pas, Arjan; Hummler, Helmut; Nadkarni, Vinay; Ades, Anne; Posencheg, Michael; Keszler, Martin; Davis, Peter; Kirpalani, Haresh

    2015-03-15

    Extremely preterm infants require assistance recruiting the lung to establish a functional residual capacity after birth. Sustained inflation (SI) combined with positive end expiratory pressure (PEEP) may be a superior method of aerating the lung compared with intermittent positive pressure ventilation (IPPV) with PEEP in extremely preterm infants. The Sustained Aeration of Infant Lungs (SAIL) trial was designed to study this question. This multisite prospective randomized controlled unblinded trial will recruit 600 infants of 23 to 26 weeks gestational age who require respiratory support at birth. Infants in both arms will be treated with PEEP 5 to 7 cm H2O throughout the resuscitation. The study intervention consists of performing an initial SI (20 cm H20 for 15 seconds) followed by a second SI (25 cm H2O for 15 seconds), and then PEEP with or without IPPV, as needed. The control group will be treated with initial IPPV with PEEP. The primary outcome is the combined endpoint of bronchopulmonary dysplasia or death at 36 weeks post-menstrual age. www.clinicaltrials.gov , Trial identifier NCT02139800 , Registered 13 May 2014.

  11. Bench performance of ventilators during simulated paediatric ventilation.

    Science.gov (United States)

    Park, M A J; Freebairn, R C; Gomersall, C D

    2013-05-01

    This study compares the accuracy and capabilities of various ventilators using a paediatric acute respiratory distress syndrome lung model. Various compliance settings and respiratory rate settings were used. The study was done in three parts: tidal volume and FiO2 accuracy; pressure control accuracy and positive end-expiratory pressure (PEEP) accuracy. The parameters set on the ventilator were compared with either or both of the measured parameters by the test lung and the ventilator. The results revealed that none of the ventilators could consistently deliver tidal volumes within 1 ml/kg of the set tidal volume, and the discrepancy between the delivered volume and the volume measured by the ventilator varied greatly. The target tidal volume was 8 ml/kg, but delivered tidal volumes ranged from 3.6-11.4 ml/kg and the volumes measured by the ventilator ranged from 4.1-20.6 ml/kg. All the ventilators maintained pressure within 20% of the set pressure, except one ventilator which delivered pressures of up to 27% higher than the set pressure. Two ventilators maintained PEEP within 10% of the prescribed PEEP. The majority of the readings were also within 10%. However, three ventilators delivered, at times, PEEPs over 20% higher. In conclusion, as lung compliance decreases, especially in paediatric patients, some ventilators perform better than others. This study highlights situations where ventilators may not be able to deliver, nor adequately measure, set tidal volumes, pressure, PEEP or FiO2.

  12. Positive end-expiratory pressure increases pulmonary clearance of inhaled 99mTc-DTPA in nonsmokers but not in healthy smokers

    International Nuclear Information System (INIS)

    Nolop, K.B.; Braude, S.; Royston, D.; Maxwell, D.L.; Hughes, J.M.B.

    1987-01-01

    Positive end-expiratory pressure (PEEP) is widely used in the treatment of severe pulmonary oedema, although its effects on the clearance of water and small solutes from alveolus to blood are not well characterized. We studied the effect of the application of 10 cmH 2 O of PEEP on the flux of inhaled 99 mTc-diethylene-triamine-penta-acetic acid (DTPA) from lung to blood in six healthy smoking and six nonsmoking subjects. The rate of flux was corrected for possible changes in pulmonary blood volume during PEEP by use of an intravenous injection of 99m Tc-DTPA. The baseline clearance rate (K,%.min -1 ) for nonsmokers was 1.48±0.12 (mean±SE) and increased to 2.40±0.29 during PEEP (p<0.05). In contrast, the mean clearance rate for smokers was 3.26±0.82 at baseline and 3.03±0.82 during PEEP (p=NS). The application of positive end-expiratory pressure appears to increase alveolar solute flux in nonsmokers but not in smokers, suggesting that the pathway for solute clearance in smokers is governed by different rate-limiting steps to those of nonsmokers

  13. Positional effects on distribution of ventilation in chronic obstructive pulmonary disease

    International Nuclear Information System (INIS)

    Shim, C.; Chun, K.J.; Williams, M.H. Jr.; Blaufox, M.D.

    1986-01-01

    Ventilation is distributed predominantly to the dependent lung in normal persons in the decubitus position. We evaluated the distribution of ventilation in four patients with mild-to-moderate chronic obstructive pulmonary disease using 81mKr gas. Patients were tested in the sitting and right and left decubitus positions with and without the application of positive end expiratory pressure (PEEP). In contrast to findings in controls, ventilation was predominantly distributed to the nondependent lung in patients in the decubitus position. Mean ventilation in the right lung decreased from 51% of the total in the sitting position to 31% in the right decubitus position; it increased with the application of 10 cm PEEP. Reduced ventilation in the dependent lung most likely is caused by closure of the airways after a decrease in volume. Application of PEEP resulted in increased lung volume and preferential distribution of ventilation to the dependent lung

  14. Low pulmonary artery flush perfusion pressure combined with high positive end-expiratory pressure reduces oedema formation in isolated porcine lungs

    International Nuclear Information System (INIS)

    Schumann, Stefan; Schließmann, Stephan J; Wagner, Giskard; Goebel, Ulrich; Priebe, Hans-Joachim; Guttmann, Josef; Kirschbaum, Andreas

    2010-01-01

    Flush perfusion of the pulmonary artery with organ protection solution is a standard procedure before lung explantation. However, rapid flush perfusion may cause pulmonary oedema which is deleterious in the lung transplantation setting. In this study we tested the hypotheses that high pulmonary perfusion pressure contributes to the development of pulmonary oedema and positive end-expiratory pressure (PEEP) counteracts oedema formation. We expected oedema formation to increase weight and decrease compliance of the lungs on the basis of a decrease in alveolar volume as fluid replaces alveolar air spaces. The pulmonary artery of 28 isolated porcine lungs was perfused with a low-potassium dextrane solution at low (mean 27 mmHg) or high (mean 40 mmHg) pulmonary artery pressure (PAP) during mechanical ventilation at low (4 cmH 2 O) or high (8 cmH 2 O) PEEP, respectively. Following perfusion and storage, relative increases in lung weight were smaller (p < 0.05) during perfusion at low PAP (62 ± 32% and 42 ± 26%, respectively) compared to perfusion at high PAP (133 ± 54% and 87 ± 30%, respectively). Compared to all other PAP–PEEP combinations, increases in lung weight were smallest (44 ± 9% and 27 ± 12%, respectively), nonlinear intratidal lung compliance was largest (46% and 17% respectively, both p < 0.05) and lung histology showed least infiltration of mononuclear cells in the alveolar septa, and least alveolar destruction during the combination of low perfusion pressure and high PEEP. The findings suggest that oedema formation during pulmonary artery flush perfusion in isolated and ventilated lungs can be reduced by choosing low perfusion pressure and high PEEP. PAP–PEEP titration to minimize pulmonary oedema should be based on lung mechanics and PAP monitoring

  15. Low tidal volume and high positive end-expiratory pressure mechanical ventilation results in increased inflammation and ventilator-associated lung injury in normal lungs.

    Science.gov (United States)

    Hong, Caron M; Xu, Da-Zhong; Lu, Qi; Cheng, Yunhui; Pisarenko, Vadim; Doucet, Danielle; Brown, Margaret; Aisner, Seena; Zhang, Chunxiang; Deitch, Edwin A; Delphin, Ellise

    2010-06-01

    Protective mechanical ventilation with low tidal volume (Vt) and low plateau pressure reduces mortality and decreases the length of mechanical ventilation in patients with acute respiratory distress syndrome. Mechanical ventilation that will protect normal lungs during major surgical procedures of long duration may improve postoperative outcomes. We performed an animal study comparing 3 ventilation strategies used in the operating room in normal lungs. We compared the effects on pulmonary mechanics, inflammatory mediators, and lung tissue injury. Female pigs were randomized into 3 groups. Group H-Vt/3 (n = 6) was ventilated with a Vt of 15 mL/kg predicted body weight (PBW)/positive end-expiratory pressure (PEEP) of 3 cm H(2)O, group L-Vt/3 (n = 6) with a Vt of 6 mL/kg PBW/PEEP of 3 cm H(2)O, and group L-Vt/10 (n = 6) with a Vt of 6 mL/kg PBW/PEEP of 10 cm H(2)O, for 8 hours. Hemodynamics, airway mechanics, arterial blood gases, and inflammatory markers were monitored. Bronchoalveolar lavage (BAL) was analyzed for inflammatory markers and protein concentration. The right lower lobe was assayed for mRNA of specific cytokines. The right lower lobe and right upper lobe were evaluated histologically. In contrast to groups H-Vt/3 and L-Vt/3, group L-Vt/10 exhibited a 6-fold increase in inflammatory mediators in BAL (P ventilation with high PEEP resulted in increased production of inflammatory markers. Low PEEP resulted in lower levels of inflammatory markers. High Vt/low PEEP resulted in less histologic lung injury.

  16. [A comparison of leak compensation in six acute care ventilators during non-invasive ventilation].

    Science.gov (United States)

    Hu, X S; Wang, Y; Wang, Z T; Yan, P; Zhang, X G; Zhao, S F; Xie, F; Gu, H J; Xie, L X

    2017-02-12

    Objective: To compare the ability of leak compensation in 6 medical ventilators during non-invasive ventilation. Methods: Six medical ventilators were selected, including 3 non-invasive ventilators (V60, Flexo and Stellar150), and 3 invasive ventilators(Avea, Servo I and BellaVist). Using a lung simulator, the ability of leak compensation was evaluated during triggering and cycling in 2 respiratory mechanics conditions (high airway resistance condition and high elastance resistance condition), and each condition was performed under 2 PEEP levels (4, and 8 cmH(2)O, 1 mmHg=0.098 kPa) at 4 air leak level conditions (L0: 2-3 L/min, L1: 8-10 L/min, L2: 22-27 L/min, L3: 35-40 L/min). Results: In the high elastance resistance condition (L2, L3)with different leak levels, the number of auto-triggering and miss-triggering of the non-invasive ventilator Flexo was significantly less than those of the others (L2: 1, 1; L3: 1.67, 1.33, P ventilators ( P ventilators (1, 0.67, 0, P ventilators in both high airway resistance and high elastance resistance conditions with L0 and L1 leak levels and PEEP levels [ARDS, PEEP=4: (109.8±1.8) ms, (112.0±0.6) ms; ARDS, PEEP=8: (103.1±0.7) ms, (109.7±0.7) ms; COPD, PEEP=4: (207.3±1.1) ms, (220.8±1.1) ms; COPD, PEEP=8: (195.6±6.7) ms, (200.0±1.2) ms , P ventilators could be synchronized, among which V60, Stellar150 and Flexo presented a good performance features in specific conditions.

  17. Nonassociative learning promotes respiratory entrainment to mechanical ventilation.

    Directory of Open Access Journals (Sweden)

    Shawna M MacDonald

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

  18. Evaluation of lung recruitment maneuvers in acute respiratory distress syndrome using computer simulation.

    Science.gov (United States)

    Das, Anup; Cole, Oana; Chikhani, Marc; Wang, Wenfei; Ali, Tayyba; Haque, Mainul; Bates, Declan G; Hardman, Jonathan G

    2015-01-12

    Direct comparison of the relative efficacy of different recruitment maneuvers (RMs) for patients with acute respiratory distress syndrome (ARDS) via clinical trials is difficult, due to the heterogeneity of patient populations and disease states, as well as a variety of practical issues. There is also significant uncertainty regarding the minimum values of positive end-expiratory pressure (PEEP) required to ensure maintenance of effective lung recruitment using RMs. We used patient-specific computational simulation to analyze how three different RMs act to improve physiological responses, and investigate how different levels of PEEP contribute to maintaining effective lung recruitment. We conducted experiments on five 'virtual' ARDS patients using a computational simulator that reproduces static and dynamic features of a multivariable clinical dataset on the responses of individual ARDS patients to a range of ventilator inputs. Three recruitment maneuvers (sustained inflation (SI), maximal recruitment strategy (MRS) followed by a titrated PEEP, and prolonged recruitment maneuver (PRM)) were implemented and evaluated for a range of different pressure settings. All maneuvers demonstrated improvements in gas exchange, but the extent and duration of improvement varied significantly, as did the observed mechanism of operation. Maintaining adequate post-RM levels of PEEP was seen to be crucial in avoiding cliff-edge type re-collapse of alveolar units for all maneuvers. For all five patients, the MRS exhibited the most prolonged improvement in oxygenation, and we found that a PEEP setting of 35 cm H2O with a fixed driving pressure of 15 cm H2O (above PEEP) was sufficient to achieve 95% recruitment. Subsequently, we found that PEEP titrated to a value of 16 cm H2O was able to maintain 95% recruitment in all five patients. There appears to be significant scope for reducing the peak levels of PEEP originally specified in the MRS and hence to avoid exposing the lung to

  19. Andres Ellamaa : suurperede seostamine asotsiaalsusega mõjub koletislikult / Andres Ellamaa ; interv. Indrek Veiserik

    Index Scriptorium Estoniae

    Ellamaa, Andres, 1944-

    2008-01-01

    Vestlus doktor Andres Ellamaaga suurperede toetamisest, kunstlikust viljastamisest. Lisaks: Kuidas kommenteerite dr. Andres Ellamaa 2. juuni Postimehes ilmunud artikli järel tekkinud diskussiooni avalikkuses ja meedias? Kommenteerivad Tallinna Arstide Liidu juhatuse liige Peeter Mardna ja Jõgeva haigla juhataja Peep Põdder

  20. Kriisiaasta - tasu tõusis 300 000krooni : Ülikoolid: rektorite sissetulek kasvab / Kadri Paas

    Index Scriptorium Estoniae

    Paas, Kadri, 1982-

    2010-01-01

    Eesti suuremate kõrgkoolide rektorite sissetulek on aastaid kerkinud, sõltumata sellest, kas majandus õitseb või langeb. Mullust edetabelit juhib Tallinna Tehnikaülikooli rektor Peep Sürje, kelle aastatasu kerkis 300 000 krooni võrra. Ka Tartu Ülikooli rektori Alar Karise ja Tallinna Ülikooli rektori Rein Raua palkadest

  1. Eesti funktsionalismi näitus Jyväskyläs / Karin Hallas-Murula

    Index Scriptorium Estoniae

    Hallas-Murula, Karin, 1957-

    2002-01-01

    6. VIII-15. IX Alvar Aalto muuseumis Eesti Arhitekuurimuuseumi näitus "Funktsionalism Eestis". Eksponeeritakse 1930. aastate originaalprojekte, digitaliseeritud ajaloolisi fotosid ning makette. Näituse ja kataloogi on koostanud Karin Hallas-Murula, näituse kujundanud Peeter Mauer, kataloogi kujundanud Jaanus Tamme ja Jaak Peep (Tank)

  2. Millise mängufilmi tellis Sõõrumaa Falcki peoks / Andris Feldmanis

    Index Scriptorium Estoniae

    Feldmanis, Andris, 1982-

    2006-01-01

    Mängufilm või pseudodokumentaalfilm "Hundi agoonia", mis valminud ärimees Urmas Sõõrumaa tellimustööna turvafirma Falck 15-ks sünnipäevaks : režissöör Asko Kase, produtsent Artur Talvik, stsenarist Peep Pedmanson : RUUT Pictures 2006

  3. Urmas Sõõrumaa rentis peoks terve linnahalli / Kirsti Vainküla

    Index Scriptorium Estoniae

    Vainküla, Kirsti, 1972-

    2006-01-01

    Peol esilinastub mängufilm "Hundi agoonia", mis valminud tellimustööna : režissöör Asko Kase, produtsent Artur Talvik, stsenarist Peep Pedmanson : RUUT Pictures 2006. Lisaks sõnum "Miljonäri äriimpeerium"

  4. "Siis sõi Sõõrumaa Punamütsikese ka ära..." / Jüri Muttika

    Index Scriptorium Estoniae

    Muttika, Jüri

    2006-01-01

    Mängufilm või pseudodokumentaalfilm "Hundi agoonia", mis valminud ärimees Urmas Sõõrumaa tellimustööna turvafirma Falck 15-ks sünnipäevaks : režissöör Asko Kase, produtsent Artur Talvik, stsenarist Peep Pedmanson : RUUT Pictures 2006. Lisaks tutvustus "Hundi agoonia"

  5. Norma juht hämas Venemaa osas / Annika Matson

    Index Scriptorium Estoniae

    Matson, Annika, 1976-

    2005-01-01

    Norma juhatuse esimees Peep Siimon teatas osalise tööaja rakendamise vajadust 551 töötaja puhul ning põhjendab seda keerulise olukorraga Venemaal. Diagramm: Vene autoturg kasvab. Vt. samas: Eesti analüütikud osalise tööaja teadet ei pelga. Kommenteerib Valentin Jurkin

  6. Atonen ja Aaviksoo tegid eile esimese 3G kõne / Viktoria Korpan

    Index Scriptorium Estoniae

    Korpan, Viktoria, 1976-

    2003-01-01

    Majandusminister Meelis Atonen ja Eesti Mobiiltelefoni juht Peep Aaviksoo pidasid EMT tehnoloogiakeskuses esimese ametliku kõne 3G testvõrgus. Lisaks tavakõnele videokõnet ja kiiret andmesidet võimaldav teenus jõuab kommertskasutusse orienteeruvalt aastal 2005, lubas Aaviksoo

  7. Surfactant impairment after mechanical ventilation with large alveolar surface area changes and effects of positive end-expiratory pressure

    NARCIS (Netherlands)

    S.J.C. Verbrugge (Serge); S.H. Bohm; D.A.M.P.J. Gommers (Diederik); L.J.I. Zimmermann (Luc); B.F. Lachmann (Burkhard)

    1998-01-01

    textabstractWe have assessed the effects of overinflation on surfactant function and composition in rats undergoing ventilation for 20 min with 100% oxygen at a peak inspiratory pressure of 45 cm H2O, with or without PEEP 10 cm H2O (groups 45/10 and 45/0, respectively).

  8. Suurfirmade 2008. aasta eelarved kinnitavad majanduse jahtumist / Mikk Salu

    Index Scriptorium Estoniae

    Salu, Mikk, 1975-

    2008-01-01

    Eesti suurettevõtete juhid räägivad, kuidas nad oma ettevõtte uue aasta eelarvet on planeerinud, kui palju on arvestanud palgakasvuks. Pindi Kinnisvara arvestab oma tulude 20-protsendilise langusega. Peep Sooman, Enn Saar, Vahur Roossaar, Tarmo Noop, Siim Kallast ja Meelis Milder vastavad küsimusele, millist palgatõusu nad prognoosivad 2008. aastal

  9. Oistrahhi-festival võtab vastu belgia muusikuid / Toivo Traks

    Index Scriptorium Estoniae

    Traks, Toivo

    2006-01-01

    Belgia rahvuspühale pühendatud kontsertidest: fagotimängija Pierre Dubuisson'i esinemisest 21. juulil Pärnu raekoja saalis ja belgia bass-baritoni Lione Lhote ning Peep Lassmanni kontserdist 21. juulil Eliisabeti kirikus, Vanbrugh Quarteti kontserdist Tallinnas

  10. Effects of a preemptive alveolar recruitment strategy on arterial oxygenation during one-lung ventilation with different tidal volumes in patients with normal pulmonary function test.

    Science.gov (United States)

    Jung, Jong Dal; Kim, Sang Hun; Yu, Byung Sik; Kim, Hye Ji

    2014-08-01

    Hypoxemia during one-lung ventilation (OLV) remains a major concern. The present study compared the effect of alveolar recruitment strategy (ARS) on arterial oxygenation during OLV at varying tidal volumes (Vt) with or without positive end-expiratory pressure (PEEP). In total, 120 patients undergoing wedge resection by video assisted thoracostomy were randomized into four groups comprising 30 patients each: those administered a 10 ml/kg tidal volume with or without preemptive ARS (Group H and Group H-ARS, respectively) and those administered a 6 ml/kg tidal volume and a 8 cmH2O PEEP with or without preemptive ARS (Group L and Group L-ARS, respectively). ARS was performed using pressure-controlled ventilation with a 40 cmH2O plateau airway pressure and a 15 cmH2O PEEP for at least 10 breaths until OLV began. Preemptive ARS significantly improved the PaO2/FiO2 ratio compared to the groups that did not receive ARS (P volume combined with 8 cmH2O PEEP after preemptive ARS may reduce the risk of pulmonary injury caused by high tidal volume during one-lung ventilation in patients with normal pulmonary function.

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

    Directory of Open Access Journals (Sweden)

    Altemeier William A

    2010-05-01

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

  12. Lung-protective ventilation in intensive care unit and operation room : Tidal volume size, level of positive end-expiratory pressure and driving pressure

    NARCIS (Netherlands)

    Serpa Neto, A.

    2017-01-01

    Several investigations have shown independent associations between three ventilator settings – tidal volume size, positive end–expiratory pressure (PEEP) and driving pressure – and outcomes in patients with the acute respiratory distress syndrome (ARDS). There is an increasing notion that similar

  13. Lung-protective perioperative mechanical ventilation

    NARCIS (Netherlands)

    Hemmes, S.N.T.

    2015-01-01

    Intraoperative ventilation has the potential to cause lung injury and possibly increase risk of pulmonary complications after surgery. Use of large tidal volumes could cause overdistension of lung tissue, which can be aggravated by too high levels of positive end-expiratory pressure (PEEP). Too low

  14. Respiratory System Mechanics During Low Versus High Positive End-Expiratory Pressure in Open Abdominal Surgery: A Substudy of PROVHILO Randomized Controlled Trial

    NARCIS (Netherlands)

    D'Antini, Davide; Huhle, Robert; Herrmann, Jacob; Sulemanji, Demet S.; Oto, Jun; Raimondo, Pasquale; Mirabella, Lucia; Hemmes, Sabrine N. T.; Schultz, Marcus J.; Pelosi, Paolo; Kaczka, David W.; Vidal Melo, Marcos Francisco; Gama de Abreu, Marcelo; Cinnella, Gilda

    2018-01-01

    In the 2014 PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure (PROVHILO) trial, intraoperative low tidal volume ventilation with high positive end-expiratory pressure (PEEP = 12 cm H2O) and lung recruitment maneuvers did not decrease postoperative pulmonary complications

  15. [Alveolar ventilation and recruitment under lung protective ventilation].

    Science.gov (United States)

    Putensen, Christian; Muders, Thomas; Kreyer, Stefan; Wrigge, Hermann

    2008-11-01

    Goal of mechanical ventilation is to improve gas exchange and reduce work of breathing without contributing to further lung injury. Besides providing adequate EELV and thereby arterial oxygenation PEEP in addition to a reduction in tidal volume is required to prevent cyclic alveolar collapse and tidal recruitment and hence protective mechanical ventilation. Currently, there is no consensus if and if yes at which price alveolar recruitment with high airway pressures should be intended ("open up the lung"), or if it is more important to reduce the mechanical stress and strain to the lungs as much as possible ("keep the lung closed"). Potential of alveolar recruitment differs from patient to patient but also between lung regions. Potential for recruitment depends probably more on regional lung mechanics - especially on lung elastance - than on the underlying disease. Based on available data neither high PEEP nor other methods used for alveolar recruitment could demonstrate a survival benefit in patients with ARDS. These results may support an individualized titration of PEEP or other manoeuvres used for recruitment taking into consideration the regional effects. Bedside imaging techniques allowing titration of PEEP or other manoeuvres to prevent end-expiratory alveolar collapse (tidal recruitment) and inspiratory overinflation may be a promising development.

  16. Early Phonological Development: Creating an Assessment Test

    Science.gov (United States)

    Stoel-Gammon, Carol; Williams, A. Lynn

    2013-01-01

    This paper describes a new protocol for assessing the phonological systems of two-year-olds with typical development and older children with delays in vocabulary acquisition. The test (Profiles of Early Expressive Phonological Skills ("PEEPS"), Williams & Stoel-Gammon, in preparation) differs from currently available assessments in…

  17. Parts pakub pensionilisa kinnisvara tagatisel / Kadri Bank

    Index Scriptorium Estoniae

    Bank, Kadri

    2008-01-01

    Ilmunud ka: Delovõje Vedomosti 30. jaan. lk. 4. Majandusminister Juhan Parts pakub välja ideed, mis võimaldaks pensionäril saada oma kinnisvara eest igakuist pensionilisa. Vt. samas: Skeem: Pensionilisa kinnisvara tagatisel; Vanurid koduga riskima ei tõtta. Kommenteerivad Valdek Mikkal, Triin Messimas ja Peep Sooman

  18. Teated

    Index Scriptorium Estoniae

    2008-01-01

    Kontserdid TÜ aulas: Tartu Ülikooli kammerkoori kevadkontsert 16. märtsil, pianist Peep Lassmann 18. märtsil (kavas: Sumera "Pala aastast 1981", Liszt-Rossini "Stabat Mater", Liszt-Verdi "Rigoletto parafraas", Liszt "Tuisk" ja "Hispaania rapsoodia"), saksofonikvartett Sax-Est 19. märtsil, kontsert "Richard Ritsing - 105" 28. märtsil

  19. The effect of positive end-expiratory pressure on pulse pressure ...

    African Journals Online (AJOL)

    The effect of positive end-expiratory pressure on pulse pressure variation. FJ Smith, M Geyser, I Schreuder, PJ Becker. Abstract. Objectives: To determine the effect of different levels of positive end-expiratory pressure (PEEP) on pulse pressure variation (PPV). Design: An observational study. Setting: Operating theatres of a ...

  20. Masin ei küsi kõrgemat palka / Teeli Remmelg

    Index Scriptorium Estoniae

    Remmelg, Teeli

    2007-01-01

    Ettevõtjad näevad tööjõupuuduse nappuse lahendusena uute masinate ostmist ja töödistsipliini parandamist. Kommenteerib Ott Licht. Küsimusele vastavad Peep Siimon, Jaanus Vihand, Viktor Valkiainen, Erkki Pärtin, Peeter Mõrd ja Triin Kaasik

  1. Virmaliste valge kuma / Piret Veigel

    Index Scriptorium Estoniae

    Veigel, Piret, 1961-

    2004-01-01

    Kirsi ja Marko Ekströmi valge modernne ridaelamukorter (73 mø) Helsingis. Köögimööbel valmistati Eesti firmas Idema, projekti autor Peep Savason. Idemas tehti ka tualettruumi sisustus. K. Ekströmi kommentaarid. 13 ill

  2. Director läks ja küsis / Indrek Randveer, Evelyn Karming, Priit Palk ... [jt.

    Index Scriptorium Estoniae

    2010-01-01

    EMT teenindus- ja müügidirektor Indrek Randveer, Estraveli müügidirektor Evelyn Karming, ABC King/Nero/SHU/Suurtüki turundusjuht Anne-Liis Ostov, kohvik-restoran Crepp juhataja Priit Palk ja Sokos Hotel Viru kommunikatsioonijuht Peep Ehasalu vastavad küsimustele, mis puudutavad nende kogemusi keerukate ja absurdsete kliendikaebuste kohta

  3. Eestil odava tööjõu eelis kadunud / Liis Kängsepp

    Index Scriptorium Estoniae

    Kängsepp, Liis, 1981-

    2005-01-01

    Database Central Europe'i tehtud tööjõu maksumuse uuringu järgi on tööjõukulu Eestis tunduvalt suurem kui Lätis, Leedus ning mitmes Ida-Euroopa riigis. Diagrammid. Kommenteerivad: Peep Siimon, Taavi Veskimägi, Jaak Leimann ja Ilmar Petersen

  4. The value of laparoscopic classifications in decision on definitive ...

    African Journals Online (AJOL)

    The value of laparoscopic classifications in decision on definitive surgery in patients ... was to present our clinical experience with the laparoscopic approach in patients ... in 10 cases in whom cord structures were seen entering the internal inguinal ring. ... Four canalicular testes (peeping) were treated with open orchiopexy.

  5. Teater täis sära ja müstikat / Ell-Maaja Randküla

    Index Scriptorium Estoniae

    Randküla, Ell-Maaja, 1939-2016

    2005-01-01

    Tallinnas Pärnu mnt. 5 asuva Eesti Draamateatri renoveerimine. Sisekujundus: Mari Kurismaa, Stuudio Kurismaa. Arhitektuurne lahendus: AB Kolde Grupp ( arhitektid Peep Jänes, Indrek Suigusaar). Ehitus: AS Estconde E. Mari Kurismaast, tema tähtsamad loomingulised saavutused maalikunstnikuna ja sisearhitektina. M. Kurismaa kommentaarid. Ill.: plaan, 10 värv. vaadet

  6. 32 CFR Appendix D to Part 154 - Reporting of Nonderogatory Cases

    Science.gov (United States)

    2010-07-01

    ... travel, education, visits, correspondence, relatives, or contact with persons from or living in a foreign..., window-peeping, and similar situations from whatever source. Unlisted full-time employment or education; full-time education or employment that cannot be verified by any reference or record source or that...

  7. Tallinna ülikool ehitab uue Ursa maja / Mihkel Tamm

    Index Scriptorium Estoniae

    Tamm, Mihkel

    2017-01-01

    2018. a. veebruaris kavatseb Tallinna Ülikool hakata lammutama loodus- ja terviseteaduste õppehoonet ehk Ursa maja. Amortiseerunud hoone asemele ehitatakse uus, mille uksed loodetakse tudengitele avada 2019. aasta sügissemestriks. Selgitusi uue hoone kahta jagab TLÜ kantsler Peep Jonas ning kavandatava õueala kohta keskkonnakorralduse professor Helen Sooväli-Sepping

  8. Köitekunstist pärikarva / Maarja Undusk

    Index Scriptorium Estoniae

    Undusk, Maarja

    2000-01-01

    Rahvusvahelisest köitekunsti ja kalligraafianäirusest "Scripta manent II" Tallinna Kunstihoones. Miks valiti tekstiautoreiks J. Kaplinski ja D. Kareva. Peeter Brambati ja Peep Laansalu videofilmis näidatakse köiteid ka seestpoolt. Filmi muusika - Peeter Vähi

  9. An experimental randomized study of six different ventilatory modes in a piglet model with normal lungs

    DEFF Research Database (Denmark)

    Nielsen, J B; Sjöstrand, U H; Henneberg, S W

    1991-01-01

    -controlled intermittent positive-pressure ventilation; and SV-20P denotes pressure-controlled intermittent positive-pressure ventilation. With all modes of ventilation a PEEP of 7.5 cm H2O was used. In the abbreviations used, the number denotes the ventilatory frequency in breaths per minute (bpm). HFV indicates that all...

  10. Yli 100 syytä mennä Viroon / Terhi Pääskylä-Malmström

    Index Scriptorium Estoniae

    Pääskylä-Malmström, Terhi, 1979-

    2015-01-01

    Tutvustus: Did you know that there are over 100 exciting, quirky, unique and important reasons to visit Estonia! = Tiesitkö että on yli 100 jännittävää, outoa, ainutlaatuista ja tärkeää syytä tulla Viroon? / koostanud Jussi-Pekka Aukia, Peep Ehasalu. Tallinn : AS Sokotel, 2015

  11. Mis on "Sõrmuste isanda" edu saladus?

    Index Scriptorium Estoniae

    2002-01-01

    Toimetuse küsimusele vastavad Ilmar Raag ja Peep Pedmanson. Küsimuse all on Peter Jacksoni esimene film J.R.R. Tolkieni triloogia "Sõrmuste isand" alusel - "Sõrmuse vennaskond", "The Lord of the Rings : The Fellowship of the Ring" : Uus-Meremaa, Ameerika Ühendriigid 2001

  12. Effects of Inhaled Fenoterol and Positive End-Expiratory Pressure on the Respiratory Mechanics of Patients with Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Claude Guerin

    2005-01-01

    Full Text Available BACKGROUND: During acute ventilatory failure in patients with chronic obstructive pulmonary disease (COPD, applying external positive end-expiratory pressure (PEEPe will reopen small airways and, thus, may enhance peripheral deposition as well as the physiological effects of inhaled beta-2 agonists.

  13. Eesti seep saab hoo sisse / Maria Ulfsak

    Index Scriptorium Estoniae

    Ulfsak, Maria, 1981-

    2003-01-01

    Kanal 2s algab uus kodumaine komöödiasari "Õpetajate tuba", mille käsikiri on Peep Pedmansonilt, lavastus Ivo Eensalult, näitlejad on Ita Ever, Eino Baskin, Madis Milling, Henrik Normann, Maria Klenskaja, Margus Tabor jt., tootjafirmaks "Ruut"

  14. Läänemere filmiamatöörid Tallinnas

    Index Scriptorium Estoniae

    2002-01-01

    5. ja 6. oktoobril peeti Tallinna Kinomajas 33. avatud Balti amatöörfilmide festival, mille žüriid juhtis Peep Puks. Ühe II auhinna sai Daniel Müntineni alias Dan Leadi animafilm "Punapäine päikeseloojang" ja ühe III auhinna Elen Lotmani tõsielufilm "Homo sapiens"

  15. Partial liquid ventilation improves lung function in ventilation-induced lung injury

    NARCIS (Netherlands)

    G.F. Vazquez de Anda; R.A. Lachmann; S.J.C. Verbrugge (Serge); D.A.M.P.J. Gommers (Diederik); J.J. Haitsma (Jack); B.F. Lachmann (Burkhard)

    2001-01-01

    textabstractDisturbances in lung function and lung mechanics are present after ventilation with high peak inspiratory pressures (PIP) and low levels of positive end-expiratory pressure (PEEP). Therefore, the authors investigated whether partial liquid ventilation can re-establish

  16. Effects of positive end expiratory pressure administration during non-invasive ventilation in patients affected by amyotrophic lateral sclerosis: A randomized crossover study.

    Science.gov (United States)

    Crescimanno, Grazia; Greco, Francesca; Arrisicato, Salvo; Morana, Noemi; Marrone, Oreste

    2016-10-01

    No studies have evaluated the impact of different settings of non-invasive ventilation (NIV) in patients affected by amyotrophic lateral sclerosis (ALS). We explored consequences of positive end-expiratory pressure (PEEP) application on effectiveness of ventilation, sleep architecture and heart rate variability (HRV) in patients with ALS naïve to ventilatory treatment. In two consecutive nights, 25 patients received in random order 0 or 4 cm H2 0 of PEEP during nocturnal NIV administration (Idea Ultra ResMed) with the same level of total positive inspiratory pressure. Polysomnographies were performed to evaluate sleep and NIV quality, as well as HRV. HRV was analyzed on 4-h periods and on 5-min segments of stable NREM sleep. We did not observe differences in gas exchanges during NIV with and without PEEP. Conversely, during PEEP application increases in leaks (41.4 ± 29.3% vs 31.0 ± 25.7%, P = 0.0007) and in autotriggerings (4.2 (IQR 1.3-10.0) vs 0.9 (IQR 0.0-3.0) events/h, P NIV was associated with worse NIV and sleep quality and with higher sympathetic activity. © 2016 Asian Pacific Society of Respirology.

  17. Õpetaja, kus asub Kennedy neem? / Marii Karell

    Index Scriptorium Estoniae

    Karell, Marii, 1980-

    2003-01-01

    Kanal 2s algab uus kodumaine komöödiaseriaal "Õpetajate tuba", mille käsikiri on Peep Pedmansonilt, lavastaja Ivo Eensalu, kes artiklis meenutab oma kooliaegu. Lisaks sõnumid "Eino Baskin sokutas õpetaja istumise alla siili" ja "Madis Milling - rohkem kõnemees kui tangensite tagaajaja"

  18. Tallinna linn või aukude plombeerimine = City of Tallinn or filling of holes / Veljo Kaasik

    Index Scriptorium Estoniae

    Kaasik, Veljo

    1999-01-01

    "Eesti Päevalehes" ilmunud arhitektide viimase aja karakteersemate tööde hindamistabelist, selles olevast Nissani keskusest (Andres Siim, Hanno Kreis), Hansapanga hoonest ja Stockmanni kaubamajast (Peep Jänes). Tallinna arhitektuurist kui tervikust. Tallinnas on palju tühje krunte, rekonstrueerimist ootavaid linnaosi ja suuri üksikhooneid. Linn realiseerub läbi investorite majandusliku huvitatuse

  19. Torontos peeti eesti dokfilmifestivali "Estdoc's" / Olev Remsu

    Index Scriptorium Estoniae

    Remsu, Olev, 1947-

    2006-01-01

    Toronto eesti dokumentaalfilmide festival "Estdoc's". Demonstreeriti filme: "Sinimäed" (Raimo Jõerand), "Tiim" (Peep Puks), "Mikk" (Rein Raamat, Peeter Brambat), "6 tundi" (Rein Kotov), "Erna retk" (Vaado Sarapuu), "Tõrjutud mälestused" (Imbi Paju), "Middendorfi jälgedes" (Riho Västrik), "Mehed unustatud armeest" (Indrek Treufeldt), "Nagu noor jumal" ja "Orjus Eestis" (mõlema autor Olev Remsu)

  20. Ilo Pariisi varjus / Kaia Sisask

    Index Scriptorium Estoniae

    Sisask, Kaia

    2003-01-01

    Portreefilm Pariisis giidina töötavast kirjanik Juhan Jaigi tütrest Ilo Jaik-Riedbergist "Ilo Pariisis" : stsenarist ja režissöör Peep Puks : operaatorid Arvo Vilu, Ago Ruus, Heli Arvo Vilu, Henn Liiva, Jüri Vaher : teksti loeb Anu Lamp : muusikaline kujundus Merike Vaino : filmi direktor Maie Kerma : Pro-Film 2002

  1. Telesügis: uued omasaated ja õnnemängud / Erika Klaats

    Index Scriptorium Estoniae

    Klaats, Erika, 1954-

    2010-01-01

    ETV ekraanile jõudvatest draamasarjadest "Klass: elu pärast" ja "ENSV" ning Mati Talviku ajaloosarjast "Ajavaod". Kanal 2 ekraanile jõudvast draamasarjast "Pilvede all", dokumentaalsarjast "Eesti maffia", saatest "Tantsud tähtedega". TV 3 ekraanile jõudvast saatest "Eesti talent" ja komöödiasarjast "Kälimehed" (stsenarist Peep Pedmanson)

  2. Persistent puhnonary hypertension ofthe neonate in a developing ...

    African Journals Online (AJOL)

    the study period. Their clinical characteristics are dis- played in Tables IT and ITl. Comparison of the clinical, ventilatory and laboratory findings of the survivors v. the non-survivors .... Fio, = fractional concentration of inspired oxygen; PEEP = positive end expiratory ... had multi-organ failure and was assessed as having a.

  3. Kutseõpetaja - ideaalid ja reaalsus / Ülo Tikk

    Index Scriptorium Estoniae

    Tikk, Ülo

    2003-01-01

    Kutseõpetajate koolituse üle vahetavad mõtteid TPÜ töö- ja kutseõpetuse osakonna professor Ants Tarraste, Tallinna Ehituskooli direktor Kaljo-Ilmar Tiitso, Paide Kutsekeskkooli direktori kt. Mare Veermaa, Valga Kutseõppekeskuse õpetaja Peep Leppik ja Tartu abilinnapea Vladimir ?okman

  4. Maardu ja Jõelähtme maa alla võib tulla elektrijaam / Erik Müürsepp

    Index Scriptorium Estoniae

    Müürsepp, Erik

    2009-01-01

    OÜ Maardu Graniidikaevandus taotleb graniidikaevanduse luba, ettevõtte juhi Peep Siitami väitel oleks kaeveõõnte hilisem kasutamine pump-hüdroakumulatsioonijaama asukohana parim võimalus kuni 1000 megavati võimsuse ulatuses tuulikuparkide töö ühtlustamiseks

  5. Eramu Suurupis = A House in Suurupi / Tiina Mang

    Index Scriptorium Estoniae

    Mang, Tiina

    2002-01-01

    2002. a. valminud eramu projekteeris Arhitektibüroo Emil Urbel. Arhitektid Emil Urbel ja Indrek Erm, sisearhitekt Tiina Mang, konstruktor Peep Rosenberg. Projekt 2000-2001. 7 ill.: I korruse plaan, sise- ja välisvaated.Emil Urbel (arhitektibüroo).

  6. Obesity does not influence the onset and offset of sevoflurane effect as measured by the hysteresis between sevoflurane concentration and bispectral index.

    Science.gov (United States)

    Cortínez, Luis I; Gambús, Pedro; Trocóniz, Iñaki F; Echevarría, Ghislaine; Muñoz, Hernán R

    2011-07-01

    The onset and offset of action of anesthetic gases might be delayed by respiratory changes and gas exchange alterations present in obese patients. In this study, we assessed the influence of obesity on the hysteresis between sevoflurane and its effect as measured by the bispectral index (BIS). Because the use of positive end-expiratory pressure (PEEP) in obese patients has improved gas exchange, we also assessed the influence of PEEP on hysteresis. Fifteen obese and 15 normal-weight patients, ASA physical status I and II, 20 to 50 years old, scheduled to undergo general anesthesia for elective laparoscopic surgery, were prospectively studied. Anesthesia was induced with propofol and maintained with sevoflurane and fentanyl. At the end of surgery and after stable BIS values of 60 to 65, the inspired concentration of sevoflurane was increased to 5 vol% for 5 minutes or until BIS was rate constant was not influenced by body mass index or PEEP (P > 0.05). Neither obesity nor PEEP showed any influence on the PK/PD descriptors. Our results do not support the hypothesis that obesity prolongs induction or recovery times when sevoflurane, a poorly soluble anesthetic, is used to maintain anesthesia from 90 to 120 minutes.

  7. Lilleküla jalgpallistaadion = Lilleküla Football Stadium / Haldo Oravas

    Index Scriptorium Estoniae

    Oravas, Haldo, 1960-

    2001-01-01

    Arhitekt, projekti ja detailplaneeringu (AS Eesti Projekt, 1999) autor Haldo Oravas. Projekteerijad: ETP Grupp, projektijuht Aare Uusalu, arhitekt Peep Urb. Sisekujundaja Sirje Pohl. Projekt 2000-2001. 8 ill.: V korruse ja asendiplaan, tribüüni lõige, vaated

  8. Afbrydelsens kronotopi i britisk litteratur, 1840-1870

    DEFF Research Database (Denmark)

    Damkjær, Maria

    2017-01-01

    -1866), combined with a new historicist reading of Victorian advice literature, this article argues that narrative marginalisation was paradoxically a viable strategy for showing an otherwise invisible temporality. In the background, peeping out whenever the plot interrupts, is an enduring and ongoing time......, mediated by unnamed and underrepresented servants, that gives the middle-class home temporal depth and realism....

  9. Õpetatud Eesti Selts 1988-1991 : [Ülevaade koosolekutest] / Tiit Rosenberg, Maris Pruuli

    Index Scriptorium Estoniae

    Rosenberg, Tiit, 1946-

    1995-01-01

    Lisa: Õpetatud Eesti Seltsi taasasutamise ürik : [26 apr. 1988]. Allakirjutanute hulgas Paul Ariste, Eduard Laugaste, Leo Metsar, Aino Põldmäe, Harald Peep, Juhan Peegel, Imbi Pelkonen, Heno Sarv, Arne Merilai, Margus Kasterpalu, Heli Laanekask, Eva Aaver, Paul Hagu, Hando Runnel

  10. Effects of respiratory rate, plateau pressure, and positive end-expiratory pressure on PaO2 oscillations after saline lavage.

    Science.gov (United States)

    Baumgardner, James E; Markstaller, Klaus; Pfeiffer, Birgit; Doebrich, Marcus; Otto, Cynthia M

    2002-12-15

    One of the proposed mechanisms of ventilator-associated lung injury is cyclic recruitment of atelectasis. Collapse of dependent lung regions with every breath should lead to large oscillations in PaO2 as shunt varies throughout the respiratory cycle. We placed a fluorescence-quenching PO2 probe in the brachiocephalic artery of six anesthetized rabbits after saline lavage. Using pressure-controlled ventilation with oxygen, ventilator settings were varied in random order over three levels of positive end-expiratory pressure (PEEP), respiratory rate (RR), and plateau pressure minus PEEP (Delta). Dependence of the amplitude of PaO2 oscillations on PEEP, RR, and Delta was modeled by multiple linear regression. Before lavage, arterial PO2 oscillations varied from 3 to 22 mm Hg. After lavage, arterial PO2 oscillations varied from 5 to 439 mm Hg. Response surfaces showed markedly nonlinear dependence of amplitude on PEEP, RR, and Delta. The large PaO2 oscillations observed provide evidence for cyclic recruitment in this model of lung injury. The important effect of RR on the magnitude of PaO2 oscillations suggests that the static behavior of atelectasis cannot be accurately extrapolated to predict dynamic behavior at realistic breathing frequencies.

  11. Associations between positive end-expiratory pressure and outcome of patients without ARDS at onset of ventilation: a systematic review and meta-analysis of randomized controlled trials

    NARCIS (Netherlands)

    Serpa Neto, Ary; Filho, Roberto Rabello; Cherpanath, Thomas; Determann, Rogier; Dongelmans, Dave A.; Paulus, Frederique; Tuinman, Pieter Roel; Pelosi, Paolo; de Abreu, Marcelo Gama; Schultz, Marcus J.

    2016-01-01

    The aim of this investigation was to compare ventilation at different levels of positive end-expiratory pressure (PEEP) with regard to clinical important outcomes of intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) at onset of ventilation. Meta-analysis of

  12. Multifilm kui tõsine asi / Marko Mägi

    Index Scriptorium Estoniae

    Mägi, Marko

    1998-01-01

    Esilinastus 6 animafilmi : "Vares ja hiired", autorid Priit Tender ja Mikk Rand; "Just märried", autor Peep Pedmanson; "Päevavalgus", autor Mait Laas; "Tom ja Fluffy", režissöörid Janno Põldma ja Heiki Ernits; "Bermuda", autor Ülo Pikkov; "Primavera", režissöörid Riho Unt ja Hardi Volmer

  13. Eesti animafilme igale maitsele / Sulev Teinemaa

    Index Scriptorium Estoniae

    Teinemaa, Sulev, 1947-

    1998-01-01

    Esilinastus 6 animafilmi : "Vares ja hiired", autorid Priit Tender ja Mikk Rand; "Just märried", autor Peep Pedmanson; "Päevavalgus", autor Mait Laas; "Tom ja Fluffy", režissöörid Janno Põldma ja Heiki Ernits; "Bermuda", autor Ülo Pikkov; "Primavera", režissöörid Riho Unt ja Hardi Volmer

  14. Kuus uut Eesti filmi korraga ekraanil / Tarmo Teder

    Index Scriptorium Estoniae

    Teder, Tarmo

    1998-01-01

    21. mail esilinastuvad kinos Sõprus 'Just märried', rezh. Peep Pedmanson; 'Päevavalgus', rezh. Mait Laas; 'Primavera', rezh. Riho Unt ja Hardi Volmer; 'Vares ja hiired', rezh. Priit Tender ja Mikk Rand; 'Bermuda', rezh. Ülo Pikkov; 'Tom ja Fluffy', rezh. Janno Põldma ja Heiki Ernits

  15. Aimdusi tsivilisatsioonist / Tarmo Teder

    Index Scriptorium Estoniae

    Teder, Tarmo, 1958-

    1998-01-01

    Esilinastus 6 animafilmi : "Vares ja hiired", autorid Priit Tender ja Mikk Rand; "Just märried", autor Peep Pedmanson; "Päevavalgus", autor Mait Laas; "Tom ja Fluffy", režissöörid Janno Põldma ja Heiki Ernits; "Bermuda", autor Ülo Pikkov; "Primavera", režissöörid Riho Unt ja Hardi Volmer

  16. Animaalselt ja humaanselt / Karlo Funk

    Index Scriptorium Estoniae

    Funk, Karlo, 1971-

    1998-01-01

    Esilinastus 6 animafilmi : "Vares ja hiired", autorid Priit Tender ja Mikk Rand; "Just märried", autor Peep Pedmanson; "Päevavalgus", autor Mait Laas; "Tom ja Fluffy", režissöörid Janno Põldma ja Heiki Ernits; "Bermuda", autor Ülo Pikkov; "Primavera", režissöörid Riho Unt ja Hardi Volmer

  17. Raudna põhikooli spordihoone Heimtalis = Sports facility at Raudna Basic School in Heimtali / Margit Mutso

    Index Scriptorium Estoniae

    Mutso, Margit, 1966-

    2009-01-01

    Heimtali mõisa ringtalli müüride vahele rajatud spordihoonest, žürii hinnang ehitisele, mille arhitekt Peep Jänes pälvis arhitektuuri sihtkapitali aastapreemia 2008. Muinsuskaitse eritingimused koostas Anu Kulbach, sisearhitektid Signe ja Gildardas Stokas, peaprojekteerija K & H

  18. Austraallased huvituvad ETV toodangust / Karin Leemet

    Index Scriptorium Estoniae

    Leemet, Karin

    2000-01-01

    ETV saadet "Simson Seakülast" näidatakse peagi Austraalia telekanalil The Special Broadcasting Service. 1995. a. valminud kunstisaade on eesti skulptorist Aivar Simsonist, saate autorid Mariina Mälk, Peeter Brambat, operaator Peep Laansalu. Mari Sobolev A. Simsoni töödest

  19. Kunstigaleriist pART on võimalik tellida näitust tutvustavaid loenguid / Ülle Lätte

    Index Scriptorium Estoniae

    Lätte, Ülle, 1955-

    2008-01-01

    Kunstigalerii pART näitusel "Nad rõõmustavad meid" eksponeeritakse Põltsamaalt pärit kunstnike Tiit Pääsukese, Peeter Alliku, Toivo Raidmetsa, Viive Väljaotsa, Mare Tralla, Ave Nahkuri, Peep Pedmansoni loomingut

  20. The effects of intraoperative lung protective ventilation with positive end-expiratory pressure on blood loss during hepatic resection surgery: A secondary analysis of data from a published randomised control trial (IMPROVE).

    Science.gov (United States)

    Neuschwander, Arthur; Futier, Emmanuel; Jaber, Samir; Pereira, Bruno; Eurin, Mathilde; Marret, Emmanuel; Szymkewicz, Olga; Beaussier, Marc; Paugam-Burtz, Catherine

    2016-04-01

    During high-risk abdominal surgery the use of a multi-faceted lung protective ventilation strategy composed of low tidal volumes, positive end-expiratory pressure (PEEP) and recruitment manoeuvres, has been shown to improve clinical outcomes. It has been speculated, however, that mechanical ventilation using PEEP might increase intraoperative bleeding during liver resection. To study the impact of mechanical ventilation with PEEP on bleeding during hepatectomy. Post-hoc analysis of a randomised controlled trial. Seven French university teaching hospitals from January 2011 to August 2012. Patients scheduled for liver resection surgery. In the Intraoperative Protective Ventilation trial, patients scheduled for major abdominal surgery were randomly assigned to mechanical ventilation using low tidal volume, PEEP between 6 and 8  cmH2O and recruitment manoeuvres (lung protective ventilation strategy) or higher tidal volume, zero PEEP and no recruitment manoeuvres (non-protective ventilation strategy). The primary endpoint was intraoperative blood loss volume. A total of 79 (19.8%) patients underwent liver resections (41 in the lung protective and 38 in the non-protective group). The median (interquartile range) amount of intraoperative blood loss was 500 (200 to 800)  ml and 275 (125 to 800)  ml in the non-protective and lung protective ventilation groups, respectively (P = 0.47). Fourteen (35.0%) and eight (21.5%) patients were transfused in the non-protective and lung protective groups, respectively (P = 0.17), without a statistically significant difference in the median (interquartile range) number of red blood cells units transfused [2.5 (2 to 4) units and 3 (2 to 6) units in the two groups, respectively; P = 0.54]. During hepatic surgery, mechanical ventilation using PEEP within a multi-faceted lung protective strategy was not associated with increased bleeding compared with non-protective ventilation using zero PEEP. The current study was not

  1. Do we deliver the pressures we intend to when using a T-piece resuscitator?

    Directory of Open Access Journals (Sweden)

    Evelien Roegholt

    Full Text Available BACKGROUND: A T-piece resuscitator (TPR uses a built-in manometer to set the inflation pressures, but we are not informed what pressures are actually delivered distally. Aim of this study was to measure the proximal and distal pressures under different gas conditions when using a TPR. METHODOLOGY/FINDINGS: A test lung was ventilated using a TPR (PIP 25 cmH₂O, PEEP 5 cmH₂O with a gas flow rate of 8 L/min. A Pressure delivered by six different TPRs was tested. To test variability 20 participants were asked to set PEEP and PIP pressures to 25/5 cmH₂O. B PIP and PEEP were measured proximal and distal of the TPR when using standard tubing or heated tubing with or without a humidifier. In experiment A mean (SD proximal PIP and PEEP of the TPRs were respectively 20.3 (0.3 cmH₂O (19.9-20.6 cmH₂O and 4.9 (0.1 cmH₂O. When 20 participants set pressures; PIP 26.7 (0.5 cm H₂O and PEEP 5.9 (0.44 cmH2O were measured. Experiment B showed that the decrease of PIP between proximal and distal pressures was not clinically significant. However there was a significant decrease of PEEP using the standard tubing (5.1 (0.1 cmH₂O proximally versus 4.8 (0.2 cmH₂O distally; p<0.001 compared to, when using a humidifier with associated tubing and the humidifier turned on, 5.1 (0.1 proximally versus 3.9 (0.2 cmH₂O distally; (p<0.001. CONCLUSION/SIGNIFICANCE: The accuracy of the built-in manometer of a TPR is acceptable. Most pressures set proximally are comparable to the actual pressures delivered distally. However, when using tubing associated with the humidifier PEEP decreases distally by 1.1-1.2 cmH₂O and users should anticipate on this.

  2. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data.

    Science.gov (United States)

    Neto, Ary Serpa; Hemmes, Sabrine N T; Barbas, Carmen S V; Beiderlinden, Martin; Fernandez-Bustamante, Ana; Futier, Emmanuel; Gajic, Ognjen; El-Tahan, Mohamed R; Ghamdi, Abdulmohsin A Al; Günay, Ersin; Jaber, Samir; Kokulu, Serdar; Kozian, Alf; Licker, Marc; Lin, Wen-Qian; Maslow, Andrew D; Memtsoudis, Stavros G; Reis Miranda, Dinis; Moine, Pierre; Ng, Thomas; Paparella, Domenico; Ranieri, V Marco; Scavonetto, Federica; Schilling, Thomas; Selmo, Gabriele; Severgnini, Paolo; Sprung, Juraj; Sundar, Sugantha; Talmor, Daniel; Treschan, Tanja; Unzueta, Carmen; Weingarten, Toby N; Wolthuis, Esther K; Wrigge, Hermann; Amato, Marcelo B P; Costa, Eduardo L V; de Abreu, Marcelo Gama; Pelosi, Paolo; Schultz, Marcus J

    2016-04-01

    Protective mechanical ventilation strategies using low tidal volume or high levels of positive end-expiratory pressure (PEEP) improve outcomes for patients who have had surgery. The role of the driving pressure, which is the difference between the plateau pressure and the level of positive end-expiratory pressure is not known. We investigated the association of tidal volume, the level of PEEP, and driving pressure during intraoperative ventilation with the development of postoperative pulmonary complications. We did a meta-analysis of individual patient data from randomised controlled trials of protective ventilation during general anesthaesia for surgery published up to July 30, 2015. The main outcome was development of postoperative pulmonary complications (postoperative lung injury, pulmonary infection, or barotrauma). We included data from 17 randomised controlled trials, including 2250 patients. Multivariate analysis suggested that driving pressure was associated with the development of postoperative pulmonary complications (odds ratio [OR] for one unit increase of driving pressure 1·16, 95% CI 1·13-1·19; pprotective ventilation on development of pulmonary complications (p=0·027). In two studies that compared low with high PEEP during low tidal volume ventilation, an increase in the level of PEEP that resulted in an increase in driving pressure was associated with more postoperative pulmonary complications (OR 3·11, 95% CI 1·39-6·96; p=0·006). In patients having surgery, intraoperative high driving pressure and changes in the level of PEEP that result in an increase of driving pressure are associated with more postoperative pulmonary complications. However, a randomised controlled trial comparing ventilation based on driving pressure with usual care is needed to confirm these findings. None. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Physiologic effects of alveolar recruitment and inspiratory pauses during moderately-high-frequency ventilation delivered by a conventional ventilator in a severe lung injury model.

    Directory of Open Access Journals (Sweden)

    Ricardo Luiz Cordioli

    Full Text Available To investigate whether performing alveolar recruitment or adding inspiratory pauses could promote physiologic benefits (VT during moderately-high-frequency positive pressure ventilation (MHFPPV delivered by a conventional ventilator in a porcine model of severe acute respiratory distress syndrome (ARDS.Prospective experimental laboratory study with eight pigs. Induction of acute lung injury with sequential pulmonary lavages and injurious ventilation was initially performed. Then, animals were ventilated on a conventional mechanical ventilator with a respiratory rate (RR = 60 breaths/minute and PEEP titrated according to ARDS Network table. The first two steps consisted of a randomized order of inspiratory pauses of 10 and 30% of inspiratory time. In final step, we removed the inspiratory pause and titrated PEEP, after lung recruitment, with the aid of electrical impedance tomography. At each step, PaCO2 was allowed to stabilize between 57-63 mmHg for 30 minutes.The step with RR of 60 after lung recruitment had the highest PEEP when compared with all other steps (17 [16,19] vs 14 [10, 17]cmH2O, but had lower driving pressures (13 [13,11] vs 16 [14, 17]cmH2O, higher P/F ratios (212 [191,243] vs 141 [105, 184] mmHg, lower shunt (23 [20, 23] vs 32 [27, 49]%, lower dead space ventilation (10 [0, 15] vs 30 [20, 37]%, and a more homogeneous alveolar ventilation distribution. There were no detrimental effects in terms of lung mechanics, hemodynamics, or gas exchange. Neither the addition of inspiratory pauses or the alveolar recruitment maneuver followed by decremental PEEP titration resulted in further reductions in VT.During MHFPPV set with RR of 60 bpm delivered by a conventional ventilator in severe ARDS swine model, neither the inspiratory pauses or PEEP titration after recruitment maneuver allowed reduction of VT significantly, however the last strategy decreased driving pressures and improved both shunt and dead space.

  4. Effects of positive end-expiratory pressure on intraoperative core temperature in patients undergoing posterior spine surgery: prospective randomised trial.

    Science.gov (United States)

    Seo, Hyungseok; Do Son, Je; Lee, Hyung-Chul; Oh, Hyung-Min; Jung, Chul-Woo; Park, Hee-Pyoung

    2018-03-01

    Objective Positive end-expiratory pressure (PEEP) causes carotid baroreceptor unloading, which leads to thermoregulatory peripheral vasoconstriction. However, the effects of PEEP on intraoperative thermoregulation in the prone position remain unknown. Methods Thirty-seven patients undergoing spine surgery in the prone position were assigned at random to receive either 10 cmH 2 O PEEP (Group P) or no PEEP (Group Z). The primary endpoint was core temperature 180 minutes after intubation. Secondary endpoints were delta core temperature (difference in core temperature between 180 minutes and immediately after tracheal intubation), incidence of intraoperative hypothermia (core temperature of peripheral vasoconstriction-related data. Results The median [interquartile range] core temperature 180 minutes after intubation was 36.1°C [35.9°C-36.2°C] and 36.0°C [35.9°C-36.4°C] in Groups Z and P, respectively. The delta core temperature and incidences of intraoperative hypothermia and peripheral vasoconstriction were not significantly different between the two groups. The peripheral vasoconstriction threshold (36.2°C±0.5°C vs. 36.7°C±0.6°C) was lower and the onset of peripheral vasoconstriction (66 [60-129] vs. 38 [28-70] minutes) was slower in Group Z than in Group P. Conclusions Intraoperative PEEP did not reduce the core temperature decrease in the prone position, although it resulted in an earlier onset and higher threshold of peripheral vasoconstriction.

  5. Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis.

    Science.gov (United States)

    Guo, Lei; Wang, Weiwei; Zhao, Nana; Guo, Libo; Chi, Chunjie; Hou, Wei; Wu, Anqi; Tong, Hongshuang; Wang, Yue; Wang, Changsong; Li, Enyou

    2016-07-22

    It has been shown that the application of a lung-protective mechanical ventilation strategy can improve the prognosis of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). However, the optimal mechanical ventilation strategy for intensive care unit (ICU) patients without ALI or ARDS is uncertain. Therefore, we performed a network meta-analysis to identify the optimal mechanical ventilation strategy for these patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, MEDLINE, CINAHL, and Web of Science for studies published up to July 2015 in which pulmonary compliance or the partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FIO2) ratio was assessed in ICU patients without ALI or ARDS, who received mechanical ventilation via different strategies. The data for study characteristics, methods, and outcomes were extracted. We assessed the studies for eligibility, extracted the data, pooled the data, and used a Bayesian fixed-effects model to combine direct comparisons with indirect evidence. Seventeen randomized controlled trials including a total of 575 patients who received one of six ventilation strategies were included for network meta-analysis. Among ICU patients without ALI or ARDS, strategy C (lower tidal volume (VT) + higher positive end-expiratory pressure (PEEP)) resulted in the highest PaO2/FIO2 ratio; strategy B (higher VT + lower PEEP) was associated with the highest pulmonary compliance; strategy A (lower VT + lower PEEP) was associated with a shorter length of ICU stay; and strategy D (lower VT + zero end-expiratory pressure (ZEEP)) was associated with the lowest PaO2/FiO2 ratio and pulmonary compliance. For ICU patients without ALI or ARDS, strategy C (lower VT + higher PEEP) was associated with the highest PaO2/FiO2 ratio. Strategy B (higher VT + lower PEEP) was superior to the other strategies in improving pulmonary

  6. Within-breath arterial PO2 oscillations in an experimental model of acute respiratory distress syndrome.

    Science.gov (United States)

    Williams, E M; Viale, J P; Hamilton, R M; McPeak, H; Sutton, L; Hahn, C E

    2000-09-01

    Tidal ventilation causes within-breath oscillations in alveolar oxygen concentration, with an amplitude which depends on the prevailing ventilator settings. These alveolar oxygen oscillations are transmitted to arterial oxygen tension, PaO2, but with an amplitude which now depends upon the magnitude of venous admixture or true shunt, QS/QT. We investigated the effect of positive end-expiratory pressure (PEEP) on the amplitude of the PaO2 oscillations, using an atelectasis model of shunt. Blood PaO2 was measured on-line with an intravascular PaO2 sensor, which had a 2-4 s response time (10-90%). The magnitude of the time-varying PaO2 oscillation was titrated against applied PEEP while tidal volume, respiratory rate and inspired oxygen concentration were kept constant. The amplitude of the PaO2 oscillation, delta PaO2, and the mean PaO2 value varied with the level of PEEP applied. At zero PEEP, both the amplitude and the mean were at their lowest values. As PEEP was increased to 1.5 kPa, both delta PaO2 and the mean PaO2 increased to a maximum. Thereafter, the mean PaO2 increased but delta PaO2 decreased. Clear oscillations of PaO2 were seen even at the lowest mean PaO2, 9.5 kPa. Conventional respiratory models of venous admixture predict that these PaO2 oscillations will be reduced by the steep part of the oxyhaemoglobin dissociation curve if a constant pulmonary shunt exists throughout the whole respiratory cycle. The facts that the PaO2 oscillations occurred at all mean PaO2 values and that their amplitude increased with increasing PEEP suggest that QS/QT, in the atelectasis model, varies between end-expiration and end-inspiration, having a much lower value during inspiration than during expiration.

  7. Avaliação da função pulmonar de recém-nascidos com síndrome do desconforto respiratório em diferentes pressões finais expiratórias positivas Assessment of pulmonary function of preterm newborn infants with respiratory distress syndrome at different positive end expiratory pressure levels

    Directory of Open Access Journals (Sweden)

    Luiz C.T. Consolo

    2002-09-01

    Full Text Available RESUMO\tABSTRACT \t Objetivo: verificar as alterações da função pulmonar: complacência dinâmica (Cdyn, volume corrente inspiratório (V Tinsp, pressão arterial de dióxido de carbono (PaCO2, em recém-nascidos pré-termo com síndrome do desconforto respiratório. Pacientes e Métodos: estudo de caso controle, incluindo 11 pré-termos com idade gestacional Objective: to verify the alterations of pulmonary function in preterm newborn infants with respiratory distress syndrome (RDS. The parameters analyzed were Dynamic Compliance (Cdyn, Inspiratory Tidal Volume (TVinsp, partial arterial pressure of carbon dioxide (PaCO2. Methods: eleven preterm newborn infants, with gestational age < 35 weeks, and birth weight < 2.500 g, were include in a control case study. All infants presented RDS and were treated with 120 mg/Kg of porcine surfactant. The initial positive end expiratory pressure (PEEP was 3 cm H2O. A pneumotachograph with a graphical monitor was used to assess the pulmonary function. After each increase in the PEEP (4 and 6 cm H2O, there was an interval of 20 minutes before measuring the arterial data of pulmonary function and arterial gases. Results: there were three males and eight females (1:2,7 among the infants with RDS. The mean gestational age was 30.78. 2.05 weeks, ranging from 26 to 34 weeks. The increase in the PEEP from 3 to 6 cm H2O caused significant decrease in the TVinsp (6.46 ±3.43 to 4.20 ±2.35, P=0.0262. With the increase in the PEEP from 4 to 6 cm H2O, there was also a decrease in the TVinsp (5.98.± 3.33 to 4.20.± 2.35, (P=0.0044. Regarding the Cdyn, when there was an increase in the PEEP from 3 to 6 cm H2O, the reduction was statistically significant (0.58.± 0.27 to 0.46± 0.25, P=0.0408 and from 4 to 6 cm H2O, the reduction in the Cdyn was also important (0.77± 0.27 to 0.46± 0.25, (P=0.0164. Increases in the PEEP from 4 to 6 cm H2O caused increases in the PaCO2 (52.81± 15.49 to 64.90± 12.69, (P= 0,0141. A

  8. Lung-Protective Ventilation Strategies for Relief from Ventilator-Associated Lung Injury in Patients Undergoing Craniotomy: A Bicenter Randomized, Parallel, and Controlled Trial

    Directory of Open Access Journals (Sweden)

    Chaoliang Tang

    2017-01-01

    Full Text Available Current evidence indicates that conventional mechanical ventilation often leads to lung inflammatory response and oxidative stress, while lung-protective ventilation (LPV minimizes the risk of ventilator-associated lung injury (VALI. This study evaluated the effects of LPV on relief of pulmonary injury, inflammatory response, and oxidative stress among patients undergoing craniotomy. Sixty patients undergoing craniotomy received either conventional mechanical (12 mL/kg tidal volume [VT] and 0 cm H2O positive end-expiratory pressure [PEEP]; CV group or protective lung (6 mL/kg VT and 10 cm H2O PEEP; PV group ventilation. Hemodynamic variables, lung function indexes, and inflammatory and oxidative stress markers were assessed. The PV group exhibited greater dynamic lung compliance and lower respiratory index than the CV group during surgery (P0.05. Patients receiving LPV during craniotomy exhibited low perioperative inflammatory response, oxidative stress, and VALI.

  9. Common-path Fourier domain optical coherence tomography of irradiated human skin and ventilated isolated rabbit lungs

    Science.gov (United States)

    Popp, A.; Wendel, M.; Knels, L.; Knuschke, P.; Mehner, M.; Koch, T.; Boller, D.; Koch, P.; Koch, E.

    2005-08-01

    A compact common path Fourier domain optical coherence tomography (FD-OCT) system based on a broadband superluminescence diode is used for biomedical imaging. The epidermal thickening of human skin after exposure to ultraviolet radiation is measured to proof the feasibility of FD-OCT for future substitution of invasive biopsies in a long term study on natural UV skin protection. The FD-OCT system is also used for imaging lung parenchyma. FD-OCT images of a formalin fixated lung show the same alveolar structure as scanning electron microscopy images. In the ventilated and blood-free perfused isolated rabbit lung FD-OCT is used for real-time cross-sectional image capture of alveolar mechanics throughout tidal ventilation. The alveolar mechanics changing from alternating recruitment-derecruitment at zero positive end-expiratory pressure (PEEP) to persistent recruitment after applying a PEEP of 5 cm H2O is observed in the OCT images.

  10. [Lung protective ventilation. Ventilatory modes and ventilator parameters].

    Science.gov (United States)

    Schädler, Dirk; Weiler, Norbert

    2008-06-01

    Mechanical ventilation has a considerable potential for injuring the lung tissue. Therefore, attention has to be paid to the proper choice of ventilatory mode and settings to secure lung-protective ventilation whenever possible. Such ventilator strategy should account for low tidal volume ventilation (6 ml/kg PBW), limited plateau pressure (30 to 35 cm H2O) and positive end-expiratory pressure (PEEP). It is unclear whether pressure controlled or volume controlled ventilation with square flow profile is beneficial. The adjustment of inspiration and expiration time should consider the actual breathing mechanics and anticipate the generation of intrinsic PEEP. Ventilatory modes with the possibility of supporting spontaneous breathing should be used as soon as possible.

  11. Evaluation of right and left ventricular function during adult respiratory distress syndrom using radionuclide angiocardiography conventional and tomographic approaches

    International Nuclear Information System (INIS)

    Devaux, J.Y.; Dhainaut, J.F.; Roucayrol, J.C.; Brunol, J.

    1982-01-01

    Despite numerous experimental and clinical studies, the cardiovascular effects of mechanical ventilation with positive-end-expiratory pressure (PEEP) are unclear. Specially, the constant fall in cardiac output is not well undestood. The purpose of this study was to investigate the effects of PEEP on right and left ventricular systolic and diastolic performance before and after volume expansion using angioscintigraphy with red blood cells, in vitro labelled with 99m Tc, a reliable, non invasive method to assess right and left ventricular dimensions and global and segmental contractility. First results in patients with adult respiratory distress syndrom (ARDS) confirm the capabilities of such a method for evaluation of regional wall motion in both ventricles

  12. Application of the Novel Ventilation Mode FLow-Controlled EXpiration (FLEX): A Crossover Proof-of-Principle Study in Lung-Healthy Patients.

    Science.gov (United States)

    Wirth, Steffen; Springer, Sebastian; Spaeth, Johannes; Borgmann, Silke; Goebel, Ulrich; Schumann, Stefan

    2017-10-01

    Traditionally, mechanical ventilation is achieved via active lung inflation during inspiration and passive lung emptying during expiration. By contrast, the novel FLEX (FLow-controlled EXpiration) ventilator mode actively decreases the rate of lung emptying. We investigated whether FLEX can be used during intraoperative mechanical ventilation of lung-healthy patients. In 30 adult patients scheduled for neurosurgical procedures, we studied respiratory system mechanics, regional ventilation, oxygenation, and hemodynamics during ventilation with and without FLEX at positive end-expiratory pressure (PEEP) of 5 and 7 cm H2O. The FLEX system was integrated into the expiratory limb and modified the expiratory flow profile by continuously changing expiratory resistance according to a computer-controlled algorithm. Mean airway pressure increased with PEEP by 1.9 cm H2O and with FLEX by 1 cm H2O (all P ventilated during general anesthesia. FLEX improves the homogeneous distribution of ventilation in the lungs.

  13. Influencia del reclutamiento alveolar sobre los efectos del surfactante exógeno Influence of pulmonary recruitment on exogenous surfactant effects

    Directory of Open Access Journals (Sweden)

    Néstor R. Herrera

    2006-02-01

    Full Text Available Se investigaron los efectos producidos por una maniobra de insuflación sostenida previa a la administración de surfactante exógeno y los producidos por diferentes patrones ventilatorios sobre la respuesta al mismo. Se estudiaron 20 ratas albinas adultas a las que se les produjo una injuria pulmonar por repetidos lavados con solución fisiológica. Se evaluó el pH, PaO2, PaCO2, la presión arterial sistólica, la compliance toracopulmonar y la histología. Los animales se dividieron en 2 grupos según se les hubiera aplicado o no insuflación sostenida para evaluar el efecto inmediato de la misma. Posteriormente los grupos citados fueron subdivididos en función de la capacidad residual funcional (CRF aplicada, quedando conformados 4 grupos experimentales. El grupo 1 recibió previo al surfactante una insuflación sostenida de 30 cm H2O durante 15 segundos y se ventiló posteriormente con presión al final de la espiración (PEEP de10 cm H2O. El grupo 2, no recibió insuflación sostenida y se ventiló con PEEP 10 cm H2O. El grupo 3, recibió insuflación sostenida y se ventiló con PEEP 4 cm H2O y el grupo 4, sin insuflación sostenida se ventiló con PEEP 4 cm H2O. Los efectos inmediatos del surfactante no fueron modificados por la aplicación previa de insuflación sostenida. Se verificó durante el transcurso de la experiencia un aumento de la PaO2 asociada al aumento de la capacidad residual funcional (Grupo1 p=0.0001; Grupo2 p= 0.0001, e independiente de la insuflación sostenida. El uso de insuflación sostenida previo a la administración de surfactante sumado a la ventilación con capacidad residual funcional alta se asoció con infiltración de polimorfonucleares debajo del epitelio bronquiolar (p = 0.008. Nuestros resultados no avalan el uso de insuflación sostenida previo a la administración de surfactante exógeno.An experimental modelwas devised to study the effects of a sustained insufflation maneuver on the immediate

  14. Rahvusooperi Estonia teatrihoone publikuruumide restaureerimistöödest / Liivi Künnapu

    Index Scriptorium Estoniae

    Künnapu, Liivi, 1953-

    2006-01-01

    Arhitektuuriajalooline ülevaade. 2005. a. restaureerimistöödest: garderoob-vestibüülist, peatrepist, ringfuajeedest, teatri- ja Valgest saalist, keldrikorruse ruumidest. Muinsuskaitse eritingimused, järelevalve: Liivi Künnapu. Projekteerijad: Peep Jänes, Indrek Suigussaar, AB Kolde Grupp. Sisekujundus: Juta Lember, Aulo Padar. Teostus: Koger ja Partnerid, projektijuht Indrek Võeras. Laemaali (E. Okas, E. Kits, R. Sagrits) restaureerimine, uuringud: KAR-Grupp. Akustik: Linda Madalik. Bibliogr. lk. 25. 8 vaadet

  15. Coherent Change Detection with COSMO SkyMed Data-experimental Results

    OpenAIRE

    A. Mishra; D. Chaudhuri; C. Bhattacharya; Y.S. Rao

    2013-01-01

    Change detection is a technique in which we try to find changes between two acquisitions. These acquisitions can be from different platforms and sensors. Acquisition from satellite using synthetic aperture radar (SAR) is of immense interest to military applications. Satellite has the ability to peep into the enemy territory while SAR has the capability of day and night operations, being an active sensor. Coherent change detection (CCD) can be used to detect minute changes between two images. ...

  16. Ground water in Delhi area, problems and prospects under fast urbanisation- a nuclear aided study

    International Nuclear Information System (INIS)

    Mookerjee, P.; Datta, P.S.; Chandrasekharan, H.; Tyagi, S.K.; Singh, R.V.

    1994-01-01

    The work presented in this paper constitutes a peep into the components of urbanization in the two decades which affected the quality and availability of ground water in the Delhi territory. The recharge studies conducted in Delhi villages employing oxygen 18 and tritium tagging have been described with a view to focus attention on the sustainability of the ground water potential. 1 fig., 1 tab

  17. Estimation of lung volume and pulmonary blood volume from radioisotopic images

    International Nuclear Information System (INIS)

    Kanazawa, Minoru

    1989-01-01

    Lung volume and pulmonary blood volume in man were estimated from the radioisotopic image using single photon emission computed tomography (SPECT). Six healthy volunteers were studied in a supine position with normal and altered lung volumes by applying continuous negative body-surface pressure (CNP) and by positive end-expiratory pressure (PEEP). 99m Tc labeled human serum albumin was administered as an aerosol to image the lungs. The CNP caused the diaphragm to be lowered and it increased the mean lung tissue volume obtained by SPECT from 3.09±0.49 l for baseline to 3.67±0.62 l for 10 cmH 2 O (p 2 O (p 2 O), respectively. The PEEP also increased the lung tissue volume to 3.68±0.68 l for 10 cmH 2 O as compared with the baseline (p 2 O PEEP. The lung tissue volume obtained by SPECT showed a positive correlation with functional residual capacity measured by the He dilution method (r=0.91, p 99m Tc-labeled red blood cells. The L/H ratio decreased after either the CNP or PEEP, suggesting a decrease in the blood volume per unit lung volume. However, it was suggested that the total pulmonary blood volume increased slightly either on the CNP (+7.4% for 10 cmH 2 O, p 2 O,p<0.05) when we extrapolated the L/H ratio to the whole lungs by multiplying the lung tissue volume obtained by SPECT. We concluded that SPECT could offer access to the estimation of lung volume and pulmonary blood volume in vivo. (author)

  18. Летняя кухня - функционально и красиво / Тийна Кольк

    Index Scriptorium Estoniae

    Кольк, Тийна

    2010-01-01

    Valik arhitektuurikonkursile "Väike 2007-2009" esitatud väikeobjektidest. Korvamäe suveköök (Urmas Muru, Peeter Pere, Reet Viigipuu, Karl Õiger), Mähe puhkemaja väliköök (Emil Urbel, Indrek Erm), aiamaja Pelgulinnas (Madis Eek), Suurupi aiapaviljon (Peep Roosmann), Tabasalu vaskeramu grillikoht (Urmas Muru, Peeter Pere, Anna-Maria Erik, Ago Kuddu)

  19. Grillipaviljon, väliköök, varjualune... / Tiina Kolk

    Index Scriptorium Estoniae

    Kolk, Tiina

    2010-01-01

    Tutvustatakse valikut arhitektuurikonkursile "Väike 2007-2009" esitatud õueobjektidest. Suurupi aiapaviljon (Peep Roosmann), aiamaja Pelgulinnas (Madis Eek), Mähe puhkemaja väliköök (Emil Urbel, Indrek Erm), Korvamäe suveköök (Urmas Muru, Peeter Pere, Reet Viigipuu, Karl Õiger), Tabasalu vaskeramu grillikoht (Urmas Muru, Peeter Pere, Anna-Maria Erik, Ago Kuddu)

  20. Ventilator-driven xenon ventilation studies

    International Nuclear Information System (INIS)

    Chilcoat, R.T.; Thomas, F.D.; Gerson, J.I.

    1984-01-01

    A modification of a common commercial Xe-133 ventilation device is described for mechanically assisted ventilation imaging. The patient's standard ventilator serves as the power source controlling the ventilatory rate and volume during the xenon study, but the gases in the two systems are not intermixed. This avoids contamination of the ventilator with radioactive xenon. Supplemental oxygen and positive end-expiratory pressure (PEEP) are provided if needed. The system can be converted quickly for conventional studies with spontaneous respiration

  1. Mitogen-activated protein kinase phosphatase-1 modulates regional effects of injurious mechanical ventilation in rodent lungs.

    Science.gov (United States)

    Park, Moo Suk; He, Qianbin; Edwards, Michael G; Sergew, Amen; Riches, David W H; Albert, Richard K; Douglas, Ivor S

    2012-07-01

    Mechanical ventilation induces heterogeneous lung injury by mitogen-activated protein kinase (MAPK) and nuclear factor-κB. Mechanisms regulating regional injury and protective effects of prone positioning are unclear. To determine the key regulators of the lung regional protective effects of prone positioning in rodent lungs exposed to injurious ventilation. Adult rats were ventilated with high (18 ml/kg, positive end-expiratory pressure [PEEP] 0) or low Vt (6 ml/kg; PEEP 3 cm H(2)O; 3 h) in supine or prone position. Dorsal-caudal lung mRNA was analyzed by microarray and MAPK phosphatases (MKP)-1 quantitative polymerase chain reaction. MKP-1(-/-) or wild-type mice were ventilated with very high (24 ml/kg; PEEP 0) or low Vt (6-7 ml/kg; PEEP 3 cm H(2)O). The MKP-1 regulator PG490-88 (MRx-108; 0.75 mg/kg) or phosphate-buffered saline was administered preventilation. Injury was assessed by lung mechanics, bronchioalveolar lavage cell counts, protein content, and lung injury scoring. Immunoblotting for MKP-1, and IκBα and cytokine ELISAs were performed on lung lysates. Prone positioning was protective against injurious ventilation in rats. Expression profiling demonstrated MKP-1 20-fold higher in rats ventilated prone rather than supine and regional reduction in p38 and c-jun N-terminal kinase activation. MKP-1(-/-) mice experienced amplified injury. PG490-88 improved static lung compliance and injury scores, reduced bronchioalveolar lavage cell counts and cytokine levels, and induced MKP-1 and IκBα. Injurious ventilation induces MAPK in an MKP-1-dependent fashion. Prone positioning is protective and induces MKP-1. PG490-88 induced MKP-1 and was protective against high Vt in a nuclear factor-κB-dependent manner. MKP-1 is a potential target for modulating regional effects of injurious ventilation.

  2. Personalizing mechanical ventilation for acute respiratory distress syndrome.

    Science.gov (United States)

    Berngard, S Clark; Beitler, Jeremy R; Malhotra, Atul

    2016-03-01

    Lung-protective ventilation with low tidal volumes remains the cornerstone for treating patient with acute respiratory distress syndrome (ARDS). Personalizing such an approach to each patient's unique physiology may improve outcomes further. Many factors should be considered when mechanically ventilating a critically ill patient with ARDS. Estimations of transpulmonary pressures as well as individual's hemodynamics and respiratory mechanics should influence PEEP decisions as well as response to therapy (recruitability). This summary will emphasize the potential role of personalized therapy in mechanical ventilation.

  3. Personalizing mechanical ventilation for acute respiratory distress syndrome

    OpenAIRE

    Berngard, S. Clark; Beitler, Jeremy R.; Malhotra, Atul

    2016-01-01

    Lung-protective ventilation with low tidal volumes remains the cornerstone for treating patient with acute respiratory distress syndrome (ARDS). Personalizing such an approach to each patient's unique physiology may improve outcomes further. Many factors should be considered when mechanically ventilating a critically ill patient with ARDS. Estimations of transpulmonary pressures as well as individual's hemodynamics and respiratory mechanics should influence PEEP decisions as well as response ...

  4. Žürii kommenteerib Kultuurkapitali arhitektuuripreemiaid 2008 / Marika Lõoke, Laila Põdra, Liina Jänes... [jt.

    Index Scriptorium Estoniae

    2009-01-01

    Peapreemia: Markus Kaasik, Andres Ojari, Ilmar Valdur, Mihkel Tüür, Kalle Komissarov (Pärnu Keskraamatukogu hoone), tegevuspreemia: Maarja Kask, Ralf Lõoke, Neeme Külm, Ingrid Ruudi (projekt Gaasitoru 11. Veneetsia arhitektuuribiennaalil), aastapreemia: Maarja Kask, Ralf Lõoke, Karli Luik (Tartu Kesklinna Kooli juurdeehitus) ja Peep Jänes (Raudna Põhikooli spordihoone), sisearhitektuuri preemia: Tea Tammelaan, Malle Jürgenson, Krista Lepland, restaureerimispreemia: Mari Hammer, Tiiu Lõhmus, Helve Ilves, Villu Kadakas (Vanalinna Hariduskolleegiumi hoone)

  5. Short outlines of books by Estonian authors : [annotations] / Rutt Hinrikus, Janika Kronberg

    Index Scriptorium Estoniae

    Hinrikus, Rutt, 1946-

    1999-01-01

    Ehin, Andres. Seljatas sada meest; Ilmet, Peep. Tuuldunud luule; Kaplinski, Jaan. Öölinnud. Öömõtted; Kender, Kaur. Iseseisvuspäev; Kesküla, Kalev. Vabariigi laulud; Luik, Viivi. Maa taevas; Nõu, Helga. Hundi silmas; Raun, Mait. Wake up; Remsu, Olev. Haapsalu tragöödia; Sauter, Peeter. Kogu moos; Undusk, Jaan. Maagiline müstiline keel; Vint, Toomas. Kunstnikuromaan

  6. Kolmepoolne koostöölepe Tehnikaülikooli, OÜ TTÜ Sport ja SEB Ühispanga vahel

    Index Scriptorium Estoniae

    2006-01-01

    Tallinna Tehnikaülikool rektor Peep Sürje, Osaühing TTÜ Sport juhatuse esimees Andres Öpik ja AS SEB Eesti Ühispank juhatuse esimees Mart Altvee allkirjastasid kolmepoolse koostöölepingu, milles nähakse ette ühistegevused TTÜ üliõpilastele õppekavadega seotud äriplaanikonkursi korraldamisel, üliõpilaste sporditegevuse edasiarendamisel ning üliõpilastele osutatud pangateenuste parandamisel

  7. Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation.

    Science.gov (United States)

    Cruces, Pablo; González-Dambrauskas, Sebastián; Quilodrán, Julio; Valenzuela, Jorge; Martínez, Javier; Rivero, Natalia; Arias, Pablo; Díaz, Franco

    2017-10-06

    Analysis of respiratory mechanics during mechanical ventilation (MV) is able to estimate resistive, elastic and inertial components of the working pressure of the respiratory system. Our aim was to discriminate the components of the working pressure of the respiratory system in infants on MV with severe bronchiolitis admitted to two PICU's. Infants younger than 1 year old with acute respiratory failure caused by severe bronchiolitis underwent neuromuscular blockade, tracheal intubation and volume controlled MV. Shortly after intubation studies of pulmonary mechanics were performed using inspiratory and expiratory breath hold. The maximum inspiratory and expiratory flow (QI and QE) as well as peak inspiratory (PIP), plateau (PPL) and total expiratory pressures (tPEEP) were measured. Inspiratory and expiratory resistances (RawI and RawE) and Time Constants (K TI and K TE ) were calculated. We included 16 patients, of median age 2.5 (1-5.8) months. Bronchiolitis due to respiratory syncytial virus was the main etiology (93.8%) and 31.3% had comorbidities. Measured respiratory pressures were PIP 29 (26-31), PPL 24 (20-26), tPEEP 9 [8-11] cmH2O. Elastic component of the working pressure was significantly higher than resistive and both higher than threshold (tPEEP - PEEP) (P mechanics of infants with severe bronchiolitis receiving MV shows that the elastic component of the working pressure of the respiratory system is the most important. The elastic and resistive components in conjunction with flow profile are characteristic of restrictive diseases. A better understanding of lung mechanics in this group of patients may lead to change the traditional ventilatory approach to severe bronchiolitis.

  8. Eesti täispikad dokumentaalfilmid 2005. aastal / Marianne Kõrver

    Index Scriptorium Estoniae

    Kõrver, Marianne, 1980-

    2006-01-01

    Portreefilmid : Priit Pärnast "Pärnograafia" (Hardi Volmer), Ivar Heinmaast "Kutse" (Peep Puks), Veljo Tormisest "Tormise regi" (Sulev Keedus), Rein Tammikust "Teekond ruudulisel laudlinal" (Peeter Urbla), "Afanassi" (Liina Trishkina) ; probleemfilmid : "Parema elu nimel" (Märt Sildvee), "Piisa torn" (Arko Okk) ; sõjateemalised dokumentaalid : "Afganistani armid" (Ivar Heinmaa), "Hauka grupp" (Rene Vilbre), "Tõrjutud mälestused" (Imbi Paju) ; loodusfilm "Eesti kotkad" (Rein Maran)

  9. El proyecto «escuela: espacio de paz» como elementos de mejora de la convivencia escolar

    Directory of Open Access Journals (Sweden)

    M.ª Ángeles DÍAZ LINARES

    2010-11-01

    Full Text Available En la tesis doctoral presentada se aborda el estudio llevado a cabo en centros públicos y concertados, de distintos niveles educativos no universitarios de la Comunidad Autónoma de Andalucía, con el fin de determinar si los Proyectos «escuela: espacio de Paz» (PeeP son instrumentos capaces de prevenir la violencia y mejorar la convivencia, en el marco del Proyecto educativo de los centros escolares.

  10. Battery life of portable home ventilators: effects of ventilator settings.

    Science.gov (United States)

    Falaize, Line; Leroux, Karl; Prigent, Hélène; Louis, Bruno; Khirani, Sonia; Orlikowski, David; Fauroux, Brigitte; Lofaso, Frédéric

    2014-07-01

    The battery life (BL) of portable home ventilator batteries is reported by manufacturers. The aim of this study was to evaluate the effects of ventilator mode, breathing frequency, PEEP, and leaks on the BL of 5 commercially available portable ventilators. The effects of the ventilator mode (volume controlled-continuous mandatory ventilation [VC-CMV] vs pressure support ventilation [PSV]), PEEP 5 cm H2O, breathing frequency (10, 15, and 20 breaths/min), and leaks during both volume-targeted ventilation and PSV on the BL of 5 ventilators (Elisée 150, Monnal T50, PB560, Vivo 50, and Trilogy 100) were evaluated. Each ventilator was ventilated with a test lung at a tidal volume of 700 ml and an inspiratory time of 1.2 s in the absence of leaks. Switching from PSV to VC-CMV or the addition of PEEP did not significantly change ventilator BL. The increase in breathing frequency from 10 to 20 breaths/min decreased the BL by 18 ± 11% (P = .005). Leaks were associated with an increase in BL during the VC-CMV mode (18 ± 20%, P = .04) but a decrease in BL during the PSV mode (-13 ± 15%, P = .04). The BL of home ventilators depends on the ventilator settings. BL is not affected by the ventilator mode (VC-CMV or PSV) or the addition of PEEP. BL decreases with an increase in breathing frequency and during leaks with a PSV mode, whereas leaks increase the duration of ventilator BL during VC-CMV. Copyright © 2014 by Daedalus Enterprises.

  11. Multifaceted bench comparative evaluation of latest intensive care unit ventilators.

    Science.gov (United States)

    Garnier, M; Quesnel, C; Fulgencio, J-P; Degrain, M; Carteaux, G; Bonnet, F; Similowski, T; Demoule, A

    2015-07-01

    Independent bench studies using specific ventilation scenarios allow testing of the performance of ventilators in conditions similar to clinical settings. The aims of this study were to determine the accuracy of the latest generation ventilators to deliver chosen parameters in various typical conditions and to provide clinicians with a comprehensive report on their performance. Thirteen modern intensive care unit ventilators were evaluated on the ASL5000 test lung with and without leakage for: (i) accuracy to deliver exact tidal volume (VT) and PEEP in assist-control ventilation (ACV); (ii) performance of trigger and pressurization in pressure support ventilation (PSV); and (iii) quality of non-invasive ventilation algorithms. In ACV, only six ventilators delivered an accurate VT and nine an accurate PEEP. Eleven devices failed to compensate VT and four the PEEP in leakage conditions. Inspiratory delays differed significantly among ventilators in invasive PSV (range 75-149 ms, P=0.03) and non-invasive PSV (range 78-165 ms, Pventilation algorithms efficiently prevented the decrease in pressurization capacities and PEEP levels induced by leaks in, respectively, 10 and 12 out of the 13 ventilators. We observed real heterogeneity of performance amongst the latest generation of intensive care unit ventilators. Although non-invasive ventilation algorithms appear to maintain adequate pressurization efficiently in the case of leakage, basic functions, such as delivered VT in ACV and pressurization in PSV, are often less reliable than the values displayed by the device suggest. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  12. Clearance of 99mTc-labeled albumin from lungs in anesthetized guinea pigs

    International Nuclear Information System (INIS)

    Connelly, J.C.; Peterson, B.T.

    1993-01-01

    Gamma imaging was used to measure the rate of clearance of aerosolized 99m Tc-human serum albumin (HSA) from the lungs of control guinea pigs and guinea pigs that received increased lung inflation or lung injury. Anesthetized guinea pigs were ventilated for 6 min with an aerosol of HSA and the radioactivity in the chest was monitored for 2 h with a gamma camera to determine whether the clearance rate would be a reliable assessment of lung epithelial permeability. Increased lung volumes were effected by application of 5 or 7 cm H 2 O positive end-expired pressure (5-PEEP and 7-PEEP, respectively). Lung injury was induced either by intravenous oleic acid (OA, 27-73 μl/kg) or inhalation of nitrogen dioxide (NO 2 , 80-100 ppm) for 2 h. Postmortem extravascular lung water volume (EVLW) provided an assessment of the degree of lung injury. Tracer clearance rates in animals receiving 5 or 7 cm H 2 O PEEP were not significantly different from controls (K = 0.15 ± 0.05 and 0.24 ± 0.10 vs 0.12 ± 0.03%/min, respectively, p > .05). Animals exposed to NO 2 had faster tracer clearance rates (K = 0.33 ± 0.21%/min, p 2 -exposed guinea pigs correlated well with injury as assessed by EVLW (r = .93, p 2 O PEEP (K = 0.58 ± 0.41%/min, EVLW = 8.1 ± 0.8 mL/g dry lung tissue, p < .05), but there was no correlation between these parameters in this injury model. It is concluded that imaging of the disappearance of radiolabeled HSA in the guinea pig can be a useful index of lung epithelial permeability, but this technique is limited to certain models of lung injury. 33 refs

  13. Suur esilinastamine

    Index Scriptorium Estoniae

    1998-01-01

    21.5. esilinastuvad kinos "Sõprus" 6 animafilmi : "Vares ja hiired", autorid Priit Tender ja Mikk Rand; "Just märried", autor Peep Pedmanson; "Päevavalgus", autor Mait Laas; "Tom ja Fluffy", režissöörid Janno Põldma ja Heiki Ernits; "Bermuda", autor Ülo Pikkov; "Primavera", režissöörid Riho Unt ja Hardi Volmer. Aut. : M.R

  14. Animatsiooni vastu ei saa ükski / Mikk Rand

    Index Scriptorium Estoniae

    Rand, Mikk, 1970-

    1998-01-01

    21.5. esilinastuvad kinos "Sõprus" 6 animafilmi : "Vares ja hiired", autorid Priit Tender ja Mikk Rand; "Just märried", autor Peep Pedmanson; "Päevavalgus", autor Mait Laas; "Tom ja Fluffy", režissöörid Janno Põldma ja Heiki Ernits; "Bermuda", autor Ülo Pikkov; "Primavera", režissöörid Riho Unt ja Hardi Volmer

  15. Esilinastuvad eesti animafilmid

    Index Scriptorium Estoniae

    1998-01-01

    21.5. esilinastuvad kinos "Sõprus" 6 animafilmi : "Vares ja hiired", autorid Priit Tender ja Mikk Rand; "Just märried", autor Peep Pedmanson; "Päevavalgus", autor Mait Laas; "Tom ja Fluffy", režissöörid Janno Põldma ja Heiki Ernits; "Bermuda", autor Ülo Pikkov; "Primavera", režissöörid Riho Unt ja Hardi Volmer

  16. Kuus uut Eesti filmi korraga ekraanil / Tarmo Teder

    Index Scriptorium Estoniae

    Teder, Tarmo, 1958-

    1998-01-01

    21.5. esilinastuvad kinos "Sõprus" 6 animafilmi : "Vares ja hiired", autorid Priit Tender ja Mikk Rand; "Just märried", autor Peep Pedmanson; "Päevavalgus", autor Mait Laas; "Tom ja Fluffy", režissöörid Janno Põldma ja Heiki Ernits; "Bermuda", autor Ülo Pikkov; "Primavera", režissöörid Riho Unt ja Hardi Volmer

  17. Experiential Marketing Sebagai Suatu Strategi Dalam Menciptakan Customer Satisfaction Dan Repeat Buying Untuk Meningkatkan Kinerja Pemasaran

    OpenAIRE

    Indriani, Farida

    2006-01-01

    Experiential marketing represent the alternative from excellence competition had by company as asset able to improve the marketing performance. Experiential marketing had by company can assist the company to peep out the new idea in each planning compilation, peculiarly in compiling marketing strategy. That way also by improving experiential marketing strategy continously, company quickly can anticipate the change that happened around company through the strategy which application. And with ...

  18. Mäss Norma pardal / Annika Matson, Katre Pilvinski

    Index Scriptorium Estoniae

    Matson, Annika, 1976-

    2008-01-01

    Norma väikeaktsionärid nõuavad Norma juhilt Peep Siimonilt suuremat dividendi ja et ettevõte ostaks neilt kuni kümnendiku aktsiaid tagasi turuhinnast ligi kaks korda kõrgema hinnaga. Diagramm: Norma dividendimaksed. Kommenteerib Sander Danil. Vt. ka Enn Tossi art. "Norma tegevus ajab väikeaktsionäri vihale" Äripäev 8. mai lk. 3

  19. Seitse raamatut ühtmoodi loodusest, kuid kõik erinevad / Ulvar Käärt, Mari Klein

    Index Scriptorium Estoniae

    Käärt, Ulvar, 1982-

    2009-01-01

    Arvustus: Järva, Jaanus. Looduse aasta. Tallinn : Varrak, 2008; Järva, Jaanus. Raba : vaikuses ja varjus. Tallinn : Pegasus, 2008; Savisaar, Remo. Loodus kutsub. Tallinn : Varrak, 2008; Relve, Hendrik. Eesti looduse vägi. Tallinn : Koolibri, 2008; Tartes, Urmas, Põder, Jaak. Legendiloomad. Tallinn : Varrak, 2008; Eesti maastikud. Tallinn : Tänapäev, 2008; Veedla, Peep. Lindudega sõbraks / pildid joonistanud Triinu Ootsing. Tallinn : Berit Grupp, 2008

  20. Väike luulekaleidoskoop. III / Jürgen Rooste

    Index Scriptorium Estoniae

    Rooste, Jürgen, 1979-

    2009-01-01

    Ülevaade järgmistest luuleraamatutest: Anmann, Aarne. Südametunnistuse mälestuseks. Tartu : A. Anmann, 2009 ; Ilmet, Peep. Meilmail. Tallinn : Varrak, 2009 ; Kasemaa, Andrus. Lagunemine. Tallinn : Eesti Keele Sihtasutus, 2009 ; Kuus, Anti ; Oll, Sulev. Öö mõte on kuus. Tallinn : Akta A. K., 2008 ; Meres, Triinu. Lagunemine. Tartu : Hermes, 2009 ; Tasuja, Triin. Provintsiluule. Tartu : Värske Rõhk, 2009

  1. Postural lung recruitment assessed by lung ultrasound in mechanically ventilated children.

    Science.gov (United States)

    Tusman, Gerardo; Acosta, Cecilia M; Böhm, Stephan H; Waldmann, Andreas D; Ferrando, Carlos; Marquez, Manuel Perez; Sipmann, Fernando Suarez

    2017-10-13

    Atelectasis is a common finding in mechanically ventilated children with healthy lungs. This lung collapse cannot be overcome using standard levels of positive end-expiratory pressure (PEEP) and thus for only individualized lung recruitment maneuvers lead to satisfactory therapeutic results. In this short communication, we demonstrate by lung ultrasound images (LUS) the effect of a postural recruitment maneuver (P-RM, i.e., a ventilatory strategy aimed at reaerating atelectasis by changing body position under constant ventilation). Data was collected in the operating room of the Hospital Privado de Comunidad, Mar del Plata, Argentina. Three anesthetized children undergoing mechanical ventilation at constant settings were sequentially subjected to the following two maneuvers: (1) PEEP trial in the supine position PEEP was increased to 10 cmH 2 O for 3 min and then decreased to back to baseline. (2) P-RM patient position was changed from supine to the left and then to the right lateral position for 90 s each before returning to supine. The total P-RM procedure took approximately 3 min. LUS in the supine position showed similar atelectasis before and after the PEEP trial. Contrarily, atelectasis disappeared in the non-dependent lung when patients were placed in the lateral positions. Both lungs remained atelectasis free even after returning to the supine position. We provide LUS images that illustrate the concept and effects of postural recruitment in children. This maneuver has the advantage of achieving recruitment effects without the need to elevate airways pressures.

  2. Ventilation therapy for patients suffering from obstructive lung diseases.

    Science.gov (United States)

    Jungblut, Sven A; Heidelmann, Lena M; Westerfeld, Andreas; Frickmann, Hagen; Körber, Mareike K; Zautner, Andreas E

    2014-01-01

    Severe bronchial obstruction due to one of the major pulmonary diseases: asthma, COPD, or emphysema often requires mechanical ventilation support. Otherwise, patients are at risk of severe hypooxygenation with consecutive overloading and dilatation of the right cardiac ventricle with subsequent failure. This review focuses on how to manage a calculated ventilation therapy of patients suffering from bronchial obstruction and relevant patents. Options and pitfalls of invasive and non-invasive ventilation in the intensive care setting regarding clinical improvement and final outcome are discussed. The non-invasive ventilation is very efficient in treating acute or chronic respiratory failure in COPD patients and is capable of shortening the duration of hospitalization. Further non-invasive ventilation can successfully support the weaning after a long-lasting ventilation therapy and improve the prognosis of COPD patients. "Permissive hypercapnia" is unequivocally established in invasive ventilation therapy of severe bronchial obstruction in situations of limited ventilation. When intrinsic positive end-expiratory pressure (PEEP) and elevated airways resistance are present PEEP may be useful although external-PEEP application relieves over-inflation only in selected patients with airway obstruction during controlled mechanical ventilation. Upper limit of airways peak pressure used in "protective ventilation" of adult respiratory distress syndrome (ARDS) patients can be exceeded under certain circumstances.

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

    Science.gov (United States)

    Hemmes, Sabrine N T; Severgnini, Paolo; Jaber, Samir; Canet, Jaume; Wrigge, Hermann; Hiesmayr, Michael; Tschernko, Edda M; Hollmann, Markus W; Binnekade, Jan M; Hedenstierna, Göran; Putensen, Christian; de Abreu, Marcelo Gama; Pelosi, Paolo; Schultz, Marcus J

    2011-05-06

    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. 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 cmH(2)O with recruitment maneuvers (the lung-protective strategy) or mechanical ventilation with the level of PEEP at maximum 2 cmH(2)O without recruitment maneuvers (the conventional strategy). The primary endpoint is any post-operative pulmonary complication. 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. ISRCTN: ISRCTN70332574.

  4. High tidal volume ventilation in infant mice.

    Science.gov (United States)

    Cannizzaro, Vincenzo; Zosky, Graeme R; Hantos, Zoltán; Turner, Debra J; Sly, Peter D

    2008-06-30

    Infant mice were ventilated with either high tidal volume (V(T)) with zero end-expiratory pressure (HVZ), high V(T) with positive end-expiratory pressure (PEEP) (HVP), or low V(T) with PEEP. Thoracic gas volume (TGV) was determined plethysmographically and low-frequency forced oscillations were used to measure the input impedance of the respiratory system. Inflammatory cells, total protein, and cytokines in bronchoalveolar lavage fluid (BALF) and interleukin-6 (IL-6) in serum were measured as markers of pulmonary and systemic inflammatory response, respectively. Coefficients of tissue damping and tissue elastance increased in all ventilated mice, with the largest rise seen in the HVZ group where TGV rapidly decreased. BALF protein levels increased in the HVP group, whereas serum IL-6 rose in the HVZ group. PEEP keeps the lungs open, but provides high volumes to the entire lungs and induces lung injury. Compared to studies in adult and non-neonatal rodents, infant mice demonstrate a different response to similar ventilation strategies underscoring the need for age-specific animal models.

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

    International Nuclear Information System (INIS)

    Ganzert, Steven; Kramer, Stefan; Guttmann, Josef

    2012-01-01

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

  6. Neopuff T-piece resuscitator mask ventilation: Does mask leak vary with different peak inspiratory pressures in a manikin model?

    Science.gov (United States)

    Maheshwari, Rajesh; Tracy, Mark; Hinder, Murray; Wright, Audrey

    2017-08-01

    The aim of this study was to compare mask leak with three different peak inspiratory pressure (PIP) settings during T-piece resuscitator (TPR; Neopuff) mask ventilation on a neonatal manikin model. Participants were neonatal unit staff members. They were instructed to provide mask ventilation with a TPR with three PIP settings (20, 30, 40 cm H 2 O) chosen in a random order. Each episode was for 2 min with 2-min rest period. Flow rate and positive end-expiratory pressure (PEEP) were kept constant. Airway pressure, inspiratory and expiratory tidal volumes, mask leak, respiratory rate and inspiratory time were recorded. Repeated measures analysis of variance was used for statistical analysis. A total of 12 749 inflations delivered by 40 participants were analysed. There were no statistically significant differences (P > 0.05) in the mask leak with the three PIP settings. No statistically significant differences were seen in respiratory rate and inspiratory time with the three PIP settings. There was a significant rise in PEEP as the PIP increased. Failure to achieve the desired PIP was observed especially at the higher settings. In a neonatal manikin model, the mask leak does not vary as a function of the PIP when the flow rate is constant. With a fixed rate and inspiratory time, there seems to be a rise in PEEP with increasing PIP. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  7. Performance of the New Turbine Mid-Level Critical Care Ventilators.

    Science.gov (United States)

    Delgado, Carlos; Romero, Jose E; Puig, Jaume; Izquierdo, Ana; Ferrando, Carlos; Belda, F Javier; Soro, Marina

    2017-01-01

    During recent years, ventilators using turbines as flow-generating systems have become increasingly more relevant. This bench study was designed to compare triggering and pressurization of 7 turbine mid-level ICU ventilators. We used a dual-chamber lung model to test 7 mid-level ICU ventilators in pressure support mode with levels of 10, 15, and 20 cm H 2 O with 2 PEEP levels of 5 cm H 2 O and the minimum level allowed by the ventilator. A ventilator was connected to the master chamber to simulate 2 different effort levels. Pressure drop, trigger delay time, time to minimum pressure, and pressure time products (PTP) during trigger and the first 300 and 500 ms were analyzed. In the trigger evaluation, the Savina had the highest delay time, whereas the C2, the V60, and the Trilogy had the lowest pressure drops and PTP values in both effort levels. In pressurization capacity assessment using ideal PTP300 and PTP500 percentages, the C2 and the V680 had the best results, and the Carina and the Savina had lower values, with no differences between both effort levels. Differences between PEEP levels did not seem to be relevant. Pressure support mode for tested ventilators worked properly, but pressurization capacity and trigger function performance were clearly superior in the newest machines. The use of PEEP did not modify the results. Copyright © 2017 by Daedalus Enterprises.

  8. 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

  9. Design and Construction of a Microcontroller-Based Ventilator Synchronized with Pulse Oximeter.

    Science.gov (United States)

    Gölcük, Adem; Işık, Hakan; Güler, İnan

    2016-07-01

    This study aims to introduce a novel device with which mechanical ventilator and pulse oximeter work in synchronization. Serial communication technique was used to enable communication between the pulse oximeter and the ventilator. The SpO2 value and the pulse rate read on the pulse oximeter were transmitted to the mechanical ventilator through transmitter (Tx) and receiver (Rx) lines. The fuzzy-logic-based software developed for the mechanical ventilator interprets these values and calculates the percentage of oxygen (FiO2) and Positive End-Expiratory Pressure (PEEP) to be delivered to the patient. The fuzzy-logic-based software was developed to check the changing medical states of patients and to produce new results (FiO2 ve PEEP) according to each new state. FiO2 and PEEP values delivered from the ventilator to the patient can be calculated in this way without requiring any arterial blood gas analysis. Our experiments and the feedbacks from physicians show that this device makes it possible to obtain more successful results when compared to the current practices.

  10. Assessment of regional ventilation distribution: comparison of vibration response imaging (VRI) with electrical impedance tomography (EIT).

    Science.gov (United States)

    Shi, Chang; Boehme, Stefan; Bentley, Alexander H; Hartmann, Erik K; Klein, Klaus U; Bodenstein, Marc; Baumgardner, James E; David, Matthias; Ullrich, Roman; Markstaller, Klaus

    2014-01-01

    Vibration response imaging (VRI) is a bedside technology to monitor ventilation by detecting lung sound vibrations. It is currently unknown whether VRI is able to accurately monitor the local distribution of ventilation within the lungs. We therefore compared VRI to electrical impedance tomography (EIT), an established technique used for the assessment of regional ventilation. Simultaneous EIT and VRI measurements were performed in the healthy and injured lungs (ALI; induced by saline lavage) at different PEEP levels (0, 5, 10, 15 mbar) in nine piglets. Vibration energy amplitude (VEA) by VRI, and amplitudes of relative impedance changes (rel.ΔZ) by EIT, were evaluated in seven regions of interest (ROIs). To assess the distribution of tidal volume (VT) by VRI and EIT, absolute values were normalized to the VT obtained by simultaneous spirometry measurements. Redistribution of ventilation by ALI and PEEP was detected by VRI and EIT. The linear correlation between pooled VT by VEA and rel.ΔZ was R(2) = 0.96. Bland-Altman analysis showed a bias of -1.07±24.71 ml and limits of agreement of -49.05 to +47.36 ml. Within the different ROIs, correlations of VT-distribution by EIT and VRI ranged between R(2) values of 0.29 and 0.96. ALI and PEEP did not alter the agreement of VT between VRI and EIT. Measurements of regional ventilation distribution by VRI are comparable to those obtained by EIT.

  11. [Clinical research of using optimal compliance to determine positive end-expiratory pressure].

    Science.gov (United States)

    Xu, Lei; Feng, Quan-sheng; Lian, Fu; Shao, Xin-hua; Li, Zhi-bo; Wang, Zhi-yong; Li, Jun

    2012-07-01

    To observe the availability and security of optimal compliance strategy to titrate the optimal positive end-expiratory pressure (PEEP), compared with quasi-static pressure-volume curve (P-V curve) traced by low-flow method. Fourteen patients received mechanical ventilation with acute respiratory distress syndrome (ARDS) admitted in intensive care unit (ICU) of Tianjin Third Central Hospital from November 2009 to December 2010 were divided into two groups(n = 7). The quasi-static P-V curve method and the optimal compliance titration were used to set the optimal PEEP respectively, repeated 3 times in a row. The optimal PEEP and the consistency of repeated experiments were compared between groups. The hemodynamic parameters, oxygenation index (OI), lung compliance (C), cytokines and pulmonary surfactant-associated protein D (SP-D) concentration in plasma before and 2, 4, and 6 hours after the experiment were observed in each group. (1) There were no significant differences in gender, age and severity of disease between two groups. (2)The optimal PEEP [cm H(2)O, 1 cm H(2)O=0.098 kPa] had no significant difference between quasi-static P-V curve method group and the optimal compliance titration group (11.53 ± 2.07 vs. 10.57 ± 0.87, P>0.05). The consistency of repeated experiments in quasi-static P-V curve method group was poor, the slope of the quasi-static P-V curve in repeated experiments showed downward tendency. The optimal PEEP was increasing in each measure. There was significant difference between the first and the third time (10.00 ± 1.58 vs. 12.80 ± 1.92, P vs. 93.71 ± 5.38, temperature: 38.05 ± 0.73 vs. 36.99 ± 1.02, IL-6: 144.84 ± 23.89 vs. 94.73 ± 5.91, TNF-α: 151.46 ± 46.00 vs. 89.86 ± 13.13, SP-D: 33.65 ± 8.66 vs. 16.63 ± 5.61, MAP: 85.47 ± 9.24 vs. 102.43 ± 8.38, CCI: 3.00 ± 0.48 vs. 3.81 ± 0.81, OI: 62.00 ± 21.45 vs. 103.40 ± 37.27, C: 32.10 ± 2.92 vs. 49.57 ± 7.18, all P safety and usability.

  12. Evaluation of the Efficiency of Alveolar Opening in Cardiosurgical Patients with Low Left Ventricular Ejection Fraction

    Directory of Open Access Journals (Sweden)

    Yu. G Zorina

    2009-01-01

    Full Text Available Objective: to determine the optimum alveolar opening parameters for the improvement of postoperative pulmonary oxygenizing function in patients with a left ventricular ejection fraction (LVEF of less or more than 40% after aortocoronary bypass surgery (ACBS. Subjects and methods. Twenty patients with a LVEF of less than 40% after ACBS and with postoperative pulmonary oxygenizing dysfunction (PaO2/FiO2 less than 250 (Group 1 were examined. A control group consisted of 20 patients with a LVEF of more than 40% (Group 2. Gas exchange, respiration biomechanics, and central hemodynamic (CH parameters were monitored (a Vigilance monitor (Edvard LifeScience. Alveolar mobilization was carried out on Drager Evita-2 apparatuses in the BIPAP mode, by taking into account the previous artificial ventilation (AV parameters. The low pressure phase corresponded to the positive end-expiratory pressure (PEEP with volume AV, the high pressure phase was Pplato; the duration of both phases — that of inspiration and expiration (the high pressure phase was inspiration time; the low pressure phase was expiration time. Then the values of Pplato and PEEP were simultaneously increased by 2 cm H2O with a duration of 10 breathing cycles, by continuously monitoring Vt and SaO2 over this interval. By continuously monitoring Vt, a stepwise increase in PEEP and Pplato was continued until there was a Vt reduction or a negative impact of AV on CH. All alveoli were considered to be open when the maximum Vt and SaO2 were achieved. Conclusion. In Group 1 patients with Pinsp of 27—30 cm H2O, PEEP of 10—12 cm H2O, there are increases in PaO2/FiO2 and Cst. In Group 2, the increase of PaO2/FiO2 and Cst is observed with Pinsp of 30—35 cm H2O and PEEP 12—14 cm H2O. With these AV indices, there is an allowable hemodynamic reduction that results in no negative consequences and development of cardiovascular events. After switching to AV in an individually chosen mode, all

  13. Low Tidal Volume versus Non-Volume-Limited Strategies for Patients with Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Walkey, Allan J; Goligher, Ewan C; Del Sorbo, Lorenzo; Hodgson, Carol L; Adhikari, Neill K J; Wunsch, Hannah; Meade, Maureen O; Uleryk, Elizabeth; Hess, Dean; Talmor, Daniel S; Thompson, B Taylor; Brower, Roy G; Fan, Eddy

    2017-10-01

    Trials investigating use of lower tidal volumes and inspiratory pressures for patients with acute respiratory distress syndrome (ARDS) have shown mixed results. To compare clinical outcomes of mechanical ventilation strategies that limit tidal volumes and inspiratory pressures (LTV) to strategies with tidal volumes of 10 to 15 ml/kg among patients with ARDS. This is a systematic review and meta-analysis of clinical trials investigating LTV mechanical ventilation strategies. We used random effects models to evaluate the effect of LTV on 28-day mortality, organ failure, ventilator-free days, barotrauma, oxygenation, and ventilation. Our primary analysis excluded trials for which the LTV strategy was combined with the additional strategy of higher positive end-expiratory pressure (PEEP), but these trials were included in a stratified sensitivity analysis. We performed metaregression of tidal volume gradient achieved between intervention and control groups on mortality effect estimates. We used Grading of Recommendations Assessment, Development, and Evaluation methodology to determine the quality of evidence. Seven randomized trials involving 1,481 patients met eligibility criteria for this review. Mortality was not significantly lower for patients receiving an LTV strategy (33.6%) as compared with control strategies (40.4%) (relative risk [RR], 0.87; 95% confidence interval [CI], 0.70-1.08; heterogeneity statistic I 2  = 46%), nor did an LTV strategy significantly decrease barotrauma or ventilator-free days when compared with a lower PEEP strategy. Quality of evidence for clinical outcomes was downgraded for imprecision. Metaregression showed a significant inverse association between larger tidal volume gradient between LTV and control groups and log odds ratios for mortality (β, -0.1587; P = 0.0022). Sensitivity analysis including trials that protocolized an LTV/high PEEP cointervention showed lower mortality associated with LTV (nine trials and 1

  14. T-piece resuscitators: how do they compare?

    Science.gov (United States)

    Hinder, Murray; McEwan, Alistair; Drevhammer, Thomas; Donaldson, Snorri; Tracy, Mark Brian

    2018-05-04

    The T-piece resuscitator (TPR) has seen increased use as a primary resuscitation device with newborns. Traditional TPR design uses a high resistance expiratory valve to produce positive end expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) at resuscitation. A new TPR device that uses a dual flow ratio valve (fluidic flip) to produce PEEP/CPAP is now available (rPAP). We aimed to compare the measured ventilation performance of different TPR devices in a controlled bench test study. Single operator provided positive pressure ventilation to an incremental testlung compliance (Crs) model (0.5-5 mL/cmH 2 O) with five different brands of TPR device (Atom, Neopuff, rPAP, GE Panda warmer and Draeger Resuscitaire). At recommended peak inflation pressure (PIP) 20 cmH 2 O, PEEP of 5 cmH 2 O and rate of 60 inflations per minute. 1864 inflations were analysed. Four of the five devices tested demonstrated inadvertent elevations in mean PEEP (5.5-10.3 cmH 2 O, p<0.001) from set value as Crs was increased, while one device (rPAP) remained at the set value. Measured PIP exceeded the set value in two infant warmer devices (GE and Draeger) with inbuilt TPR at Crs of 0.5 (24.5 and 23.5 cmH 2 O, p<0.001). Significant differences were seen in tidal volumes across devices particularly at higher Crs (p<0.001). Results show important variation in delivered ventilation from set values due to inherent TPR device design characteristics with a range of lung compliances expected at birth. Device-generated inadvertent PEEP and overdelivery of PIP may be clinically deleterious for term and preterm newborns or infants with larger Crs during resuscitation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Different Techniques of Respiratory Support Do Not Significantly Affect Gas Exchange during Cardiopulmonary Resuscitation in a Newborn Piglet Model.

    Science.gov (United States)

    Mendler, Marc R; Maurer, Miriam; Hassan, Mohammad A; Huang, Li; Waitz, Markus; Mayer, Benjamin; Hummler, Helmut D

    2015-01-01

    There are no evidence-based recommendations on the use of different techniques of respiratory support and chest compressions (CC) during neonatal cardiopulmonary resuscitation (CPR). We studied the short-term effects of different ventilatory support strategies along with CC representing clinical practice on gas exchange [arterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2)], hemodynamics and cerebral oxygenation. We hypothesized that in newborn piglets with cardiac arrest, use of a T-piece resuscitator (TPR) providing positive end-expiratory pressure (PEEP) improves gas exchange as measured by SaO2 during CPR as compared to using a self-inflating bag (SIB) without PEEP. Furthermore, we explored the effects of a mechanical ventilator without synchrony to CC. Thirty newborn piglets with asystole were randomized into three groups and resuscitated for 20 min [fraction of inspired oxygen (FiO2) = 0.21 for 10 min and 1.0 thereafter]. Group 1 received ventilation using a TPR [peak inspiratory pressure (PIP)/PEEP of 20/5 cm H2O, rate 30/min] with inflations interposed between CC (3:1 ratio). Group 2 received ventilation using a SIB (PIP of 20 cm H2O without PEEP, rate 30/min) with inflations interposed between CC (3:1 ratio). Group 3 received ventilation using a mechanical ventilator (PIP/PEEP of 20/5 cm H2O, rate 30/min). CC were applied with a rate of 120/min without synchrony to inflations. We found no significant differences in SaO2 between the three groups. However, there was a trend toward a higher SaO2 [TPR: 28.0% (22.3-40.0); SIB: 23.7% (13.4-52.3); ventilator: 44.1% (39.2-54.3); median (interquartile range)] and a lower PaCO2 [TPR: 95.6 mm Hg (82.1-113.6); SIB: 100.8 mm Hg (83.0-108.0); ventilator: 74.1 mm Hg (68.5-83.1); median (interquartile range)] in the mechanical ventilator group. We found no significant effect on gas exchange using different respiratory support strategies

  16. Efeitos de diferentes volumes correntes e da pressão expiratória final positiva sobre a troca gasosa na fístula broncopleural experimental Effects of different tidal volumes and positive end expiratory pressure on gas exchange in experimental bronchopleural fistula

    Directory of Open Access Journals (Sweden)

    Maria Gabriela Cavicchia Toneloto

    2008-09-01

    Full Text Available OBJETIVO: O presente estudo foi desenhado para identificar o efeito da pressão expiratória final positiva (PEEP e o volume corrente pulmonar ideal para ventilar animais com fístula broncopleural produzida cirurgicamente, com o intuito de reduzir a vazão da fístula sem afetar a troca gasosa. MÉTODOS: Avaliação hemodinâmica e respiratória da troca gasosa foi obtida em cinco porcos jovens, saudáveis, da linhagem Large White, ventilados mecanicamente no modo ventilatório volume controlado com FiO2 de 0.4 e relação inspiração:expiração em torno de 1:2, com freqüência respiratória mantida em 22 cpm. A fístula broncopleural foi produzida pela ressecção da língula. Um sistema de drenagem a selo d'água foi instalado e o tórax foi hermeticamente fechado. A troca gasosa e o débito da fístula broncopleural foram medidos com animais ventilados sequencialmente com volumes correntes de 4 ml/kg, 7 ml/kg e 10 ml/Kg alternando zero de pressão expiratória final positiva (ZEEP e PEEP de 10 cmH2O, sempre na mesma ordem. RESULTADOS: Esses dados são atribuídos à ventilação alveolar reduzida e às anormalidades da ventilação/perfusão que foram atenuadas com volumes correntes mais altos. PEEP aumentou o vazamento de ar pela fístula, mesmo com baixos volumes, de 2.0 ± 2,8mL para 31 ± 20,7mL (p= 0,006 e diminuiu a ventilação alveolar em todos os volumes correntes. A ventilação alveolar melhorou com altos volumes correntes, mas aumentou o débito da fístula (4 ml/kg - 2,0 ± 2,8mL e 10 mL/kg - 80,2 ± 43,9mL; p=0,001. Baixos volumes correntes resultaram em hipercapnia (ZEEP - 83,7± 6,9 mmHg e com PEEP 10 -93 ± 10,1mmHg e diminuição significativa da saturação de oxigênio arterial, em torno de 84%. CONCLUSÃO: O volume corrente de 7 ml/kg com ZEEP foi considerado o melhor volume corrente, visto que, apesar da hipercapnia moderada, a saturação de oxigênio arterial é sustentada em torno de 90%. A ventilação alveolar

  17. Intratidal Overdistention and Derecruitment in the Injured Lung: A Simulation Study.

    Science.gov (United States)

    Amini, Reza; Herrmann, Jacob; Kaczka, David W

    2017-03-01

    Ventilated patients with the acute respiratory distress syndrome (ARDS) are predisposed to cyclic parenchymal overdistention and derecruitment, which may worsen existing injury. We hypothesized that intratidal variations in global mechanics, as assessed at the airway opening, would reflect such distributed processes. We developed a computational lung model for determining local instantaneous pressure distributions and mechanical impedances continuously during a breath. Based on these distributions and previous literature, we simulated the within-breath variability of airway segment dimensions, parenchymal viscoelasticity, and acinar recruitment in an injured canine lung for tidal volumes( V T ) of 10, 15, and 20 mL·kg -1 and positive end-expiratory pressures (PEEP) of 5, 10, and 15 cm H 2 O. Acini were allowed to transition between recruited and derecruited states when exposed to stochastically determined critical opening and closing pressures, respectively. For conditions of low V T and low PEEP, we observed small intratidal variations in global resistance and elastance, with a small number of cyclically recruited acini. However, with higher V T and PEEP, larger variations in resistance and elastance were observed, and the majority of acini remained open throughout the breath. Changes in intratidal resistance, elastance, and impedance followed well-defined parabolic trajectories with tracheal pressure, achieving minima near 12 to 16 cm H 2 O. Intratidal variations in lung mechanics may allow for optimization of ventilator settings in patients with ARDS, by balancing lung recruitment against parenchymal overdistention. Titration of airway pressures based on variations in intratidal mechanics may mitigate processes associated with injurious ventilation.

  18. Respiratory Management of Perioperative Obese Patients.

    Science.gov (United States)

    Imber, David Ae; Pirrone, Massimiliano; Zhang, Changsheng; Fisher, Daniel F; Kacmarek, Robert M; Berra, Lorenzo

    2016-12-01

    With a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique. Although strong evidence and research are lacking regarding how to best ventilate the obese surgical patient, we aim with this review to provide an assessment of the small amount of research that has been conducted and the pathophysiology we believe influences the apparent results. We will provide a basic overview of the anatomy and pathophysiology of the obese respiratory system and review studies concerning pre-, intra-, and postoperative respiratory care. Our focus in this review centers on the best approach to keeping the lung recruited through the prevention of compression atelectasis and the maintaining of physiological lung volumes. We recommend the use of PEEP via noninvasive ventilation (NIV) before induction and endotracheal intubation, the use of both PEEP and periodic recruitment maneuvers during mechanical ventilation, and the use of PEEP via NIV after extubation. It is our hope that by studying the underlying mechanisms that make ventilating obese patients so difficult, future research can be better tailored to address this increasingly important challenge to the field of anesthesia. Copyright © 2016 by Daedalus Enterprises.

  19. Nanotoxicity comparison of four amphiphilic polymeric micelles with similar hydrophilic or hydrophobic structure.

    Science.gov (United States)

    Zhao, Bo; Wang, Xue-Qing; Wang, Xiao-You; Zhang, Hua; Dai, Wen-Bing; Wang, Jun; Zhong, Zhen-Lin; Wu, Hou-Nan; Zhang, Qiang

    2013-10-03

    Nanocarriers represent an attractive means of drug delivery, but their biosafety must be established before their use in clinical research. Four kinds of amphiphilic polymeric (PEG-PG-PCL, PEEP-PCL, PEG-PCL and PEG-DSPE) micelles with similar hydrophilic or hydrophobic structure were prepared and their in vitro and in vivo safety were evaluated and compared. In vitro nanotoxicity evaluations included assessments of cell morphology, cell volume, inflammatory effects, cytotoxicity, apoptosis and membrane fluidity. An umbilical vein cell line (Eahy.926) and a kind of macrophages (J774.A1) were used as cell models considering that intravenous route is dominant for micelle delivery systems. In vivo analyses included complete blood count, lymphocyte subset analysis, detection of plasma inflammatory factors and histological observations of major organs after intravenous administration to KM mice. All the micelles enhanced inflammatory molecules in J774.A1 cells, likely resulting from the increased ROS levels. PEG-PG-PCL and PEEP-PCL micelles were found to increase the J774.A1 cell volume. This likely correlated with the size of PEG-PG-PCL micelles and the polyphosphoester structure in PEEP-PCL. PEG-DSPE micelles inhibited the growth of Eahy.926 cells via inducing apoptosis. This might relate to the structure of DSPE, which is a type of phospholipid and has good affinity with cell membrane. No evidence was found for cell membrane changes after treatment with these micelles for 24 h. In the in vivo study, during 8 days of 4 time injection, each of the four nanocarriers altered the hematic phase differently without changes in inflammatory factors or pathological changes in target organs. These results demonstrate that the micelles investigated exhibit diverse nanotoxicity correlated with their structures, their biosafety is different in different cell model, and there is no in vitro and in vivo correlation found. We believe that this study will certainly provide more

  20. Feasibility of Protective Ventilation During Elective Supratentorial Neurosurgery: A Randomized, Crossover, Clinical Trial.

    Science.gov (United States)

    Ruggieri, Francesco; Beretta, Luigi; Corno, Laura; Testa, Valentina; Martino, Enrico A; Gemma, Marco

    2017-06-30

    Traditional ventilation approaches, providing high tidal volumes (Vt), produce excessive alveolar distention and lung injury. Protective ventilation, employing lower Vt and positive end-expiratory pressure (PEEP), is an attractive alternative also for neuroanesthesia, when prolonged mechanical ventilation is needed. Nevertheless, protective ventilation during intracranial surgery may exert dangerous effects on intracranial pressure (ICP). We tested the feasibility of a protective ventilation strategy in neurosurgery. Our monocentric, double-blind, 1:1 randomized, 2×2 crossover study aimed at studying the effect size and variability of ICP in patients undergoing elective supratentorial brain tumor removal and alternatively ventilated with Vt 9 mL/kg-PEEP 0 mm Hg and Vt 7 mL/kg-PEEP 5 mm Hg. Respiratory rate was adjusted to maintain comparable end-tidal carbon dioxide between ventilation modes. ICP was measured through a subdural catheter inserted before dural opening. Forty patients were enrolled; 8 (15%) were excluded after enrollment. ICP did not differ between traditional and protective ventilation (11.28±5.37, 11 [7 to 14.5] vs. 11.90±5.86, 11 [8 to 15] mm Hg; P=0.541). End-tidal carbon dioxide (28.91±2.28, 29 [28 to 30] vs. 28.00±2.17, 28 [27 to 29] mm Hg; Pprotective ventilation. Blood pressure, heart rate, and body temperature did not differ between ventilation modes. Dural tension was "acceptable for surgery" in all cases. ICP differences between ventilation modes were not affected by ICP values under traditional ventilation (coefficient=0.067; 95% confidence interval, -0.278 to 0.144; P=0.523). Protective ventilation is a feasible alternative to traditional ventilation during elective neurosurgery.

  1. [Effect of transpulmonary pressure-directed mechanical ventilation on respiration in severe acute pancreatitis patient with intraabdominal hypertension].

    Science.gov (United States)

    Wu, Xiaoyan; Zheng, Ruiqiang; Lin, Hua; Zhuang, Zhiqing; Zhang, Min; Yan, Peixia

    2015-10-20

    To assess the effect of mehanical ventilation (MV) guided by transpulmonary pressure (Ptp) on respiratory mechanics and gas exchange in severe acute pancreatitis patient with intraabdominal hypertension. Twelve severe acute pancreatitis patient with intraabdominal hypertension and acute respiratory distress syndrome(ARDS) underwent mechanical ventilation were involved from Jan to Dec 2013. PEEP levels were set to achieve a Ptp of 0 to 10 cm of water at end expiration. We also limited tidal volume to keep Ptp at less than 25 cm of water at end inspiration. Respiratory mechanics and gas-exchange were measured. Plat pressure (Pplat) increased and the compliance of chest wall (Ccw) decreased when intraabdominal pressure (IAP) increased. Pplat correlated with IAP positively (r2=0.741 9, P0.05). Compared with baseline, after guiding MV with Ptp, the Level of PEEP (14.6±4.2) cmH2O vs (8.3±2.0) cmH2O, and Ptp-e (1.5±0.5) cmH2O vs (-2.3±1.4) cmH2O increased (P0.05). Ptp-e correlated with PEEP (r2=0.549, P0.05). Compared with baseline, lung compliance (CL) (48.1±10.3) cmH2O vs (25.7±6.4) cmH2O and oxygenation index (PaO2/FiO2) (235±48) mmHg vs (160±35) mmHg improved obviously (P0.05). Transpulmonary pressure-directed mechanical ventilation in ARDS secondary to severe acute pancreatitis patient with intraabdominal hypertension could not only recruit the collapsed alveoli, improve lung compliance, increase oxygenation index and decrease dead space ventilation but also monitor lung stress to avoid alveoli overinflation, which might be lung protective.

  2. Pneumoperitoneum deteriorates intratidal respiratory system mechanics: an observational study in lung-healthy patients.

    Science.gov (United States)

    Wirth, Steffen; Biesemann, Andreas; Spaeth, Johannes; Schumann, Stefan

    2017-02-01

    Pneumoperitoneum during laparoscopic surgery leads to atelectasis and impairment of oxygenation. Positive end-expiratory pressure (PEEP) is supposed to counteract atelectasis. We hypothesized that the derecruiting effects of pneumoperitoneum would deteriorate the intratidal compliance profile in patients undergoing laparoscopic surgery. In 30 adult patients scheduled for surgery with pneumoperitoneum, respiratory variables were measured during mechanical ventilation. We calculated the dynamic compliance of the respiratory system (C RS ) and the intratidal volume-dependent C RS curve using the gliding-SLICE method. The C RS curve was then classified in terms of indicating intratidal recruitment/derecruitment (increasing profile) and overdistension (decreasing profile). During the surgical interventions, the PEEP level was maintained nearly constant at 7 cm H 2 O. Data are expressed as mean [confidence interval]. Baseline C RS was 60 [54-67] mL cm H 2 O -1 . Application of pneumoperitoneum decreased C RS to 40 [37-43] mL cm H 2 O -1 which partially recovered to 54 [50-59] mL cm H 2 O -1 (P < 0.001) after removal but remained below the value measured before pneumoperitoneum (P < 0.001). Baseline compliance profiles indicated intratidal recruitment/derecruitment in 48 % patients. After induction of pneumoperitoneum, intratidal recruitment/derecruitment was indicated in 93 % patients (P < 0.01), and after removal intratidal recruitment/derecruitment was indicated in 59 % patients. Compliance profiles showing overdistension were not observed. Analyses of the intratidal compliance profiles reveal that pneumoperitoneum during laparoscopic surgery causes intratidal recruitment/derecruitment which partly persists after its removal. The analysis of the intratidal volume-dependent C RS profiles could be used to guide intraoperative PEEP adjustments during elevated intraabdominal pressure.

  3. [A comparative study between inflation and deflation pressure-volume curve in determining the optimal positive end-expiratory pressure].

    Science.gov (United States)

    Gang, Li; Sun, Xiao-yi; Xu, Jin-quan; Zhang, Xin-li; Kou, Lu-xin; Jiang, Zhi-hong; Zhang, Lei

    2012-02-01

    To determine the optimal positive end-expiratory pressure (PEEP) according to inflation and deflation pressure-volume curve (P-V curve) in patients with acute respiratory distress syndrome (ARDS). ARDS models were reproduced in 20 dogs, and they were randomly divided into two groups. In both groups, Levenberg-Marquardt iterative algorithm was employed using software to explore parameters fitting with Boltzmann formula, by which the real inflection point of pressure (Pinf d) in deflation limb or lower inflection point pressure (PLip) in inflation limb on P-V curve were defined. For the control group (inflation curve) P-V curve of PLip + 2 cm H(2)O [1 cm H(2)O = 0.098 kPa] was applied as the best PEEP value. In the experimental group (deflation curve) the Pinf d was taken as the best PEEP value. The heart rate (HR), blood pressure (BP), fingertip pulse oxygen saturation [SpO(2)], static lung compliance (Cst), arterial partial pressure of oxygen [PaO(2)] and arterial partial pressure of carbon dioxide [PaCO(2)] were monitored at 0, 2, 6, 12, 24 and 48 hours. Oxygenation index increased significantly both in control and experimental groups. In experimental group, oxygenation index (mm Hg, 1 mm Hg = 0.133 kPa) of 12, 24 and 48 hours was respectively significantly higher than that of the control group (12 hours: 177.63 ± 8.94 vs. 165.60 ± 8.90, 24 hours: 194.19 ± 10.67 vs. 168.70 ± 10.60, 48 hours: 203.15 ± 13.21 vs. 171.26 ± 9.21, all P deflation P-V curve was better than that of inflation curve.

  4. Measurement of tidal volume using respiratory ultrasonic plethysmography in anaesthetized, mechanically ventilated horses.

    Science.gov (United States)

    Russold, Elena; Ambrisko, Tamas D; Schramel, Johannes P; Auer, Ulrike; Van Den Hoven, Rene; Moens, Yves P

    2013-01-01

    To compare tidal volume estimations obtained from Respiratory Ultrasonic Plethysmography (RUP) with simultaneous spirometric measurements in anaesthetized, mechanically ventilated horses. Prospective randomized experimental study. Five experimental horses. Five horses were anaesthetized twice (1 week apart) in random order in lateral and in dorsal recumbency. Nine ventilation modes (treatments) were scheduled in random order (each lasting 4 minutes) applying combinations of different tidal volumes (8, 10, 12 mL kg(-1)) and positive end-expiratory pressures (PEEP) (0, 10, 20 cm H(2)O). Baseline ventilation mode (tidal volume=15 mL kg(-1), PEEP=0 cm H(2)O) was applied for 4 minutes between all treatments. Spirometry and RUP data were downloaded to personal computers. Linear regression analyses (RUP versus spirometric tidal volume) were performed using different subsets of data. Additonally RUP was calibrated against spirometry using a regression equation for all RUP signal values (thoracic, abdominal and combined) with all data collectively and also by an individually determined best regression equation (highest R(2)) for each experiment (horse versus recumbency) separately. Agreement between methods was assessed with Bland-Altman analyses. The highest correlation of RUP and spirometric tidal volume (R(2)=0.81) was found with the combined RUP signal in horses in lateral recumbency and ventilated without PEEP. The bias ±2 SD was 0±2.66 L when RUP was calibrated for collective data, but decreased to 0±0.87 L when RUP was calibrated with individual data. A possible use of RUP for tidal volume measurement during IPPV needs individual calibration to obtain limits of agreement within ±20%. © 2012 The Authors. Veterinary Anaesthesia and Analgesia. © 2012 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists.

  5. Reliability of transpulmonary pressure-time curve profile to identify tidal recruitment/hyperinflation in experimental unilateral pleural effusion.

    Science.gov (United States)

    Formenti, P; Umbrello, M; Graf, J; Adams, A B; Dries, D J; Marini, J J

    2017-08-01

    The stress index (SI) is a parameter that characterizes the shape of the airway pressure-time profile (P/t). It indicates the slope progression of the curve, reflecting both lung and chest wall properties. The presence of pleural effusion alters the mechanical properties of the respiratory system decreasing transpulmonary pressure (Ptp). We investigated whether the SI computed using Ptp tracing would provide reliable insight into tidal recruitment/overdistention during the tidal cycle in the presence of unilateral effusion. Unilateral pleural effusion was simulated in anesthetized, mechanically ventilated pigs. Respiratory system mechanics and thoracic computed tomography (CT) were studied to assess P/t curve shape and changes in global lung aeration. SI derived from airway pressure (Paw) was compared with that calculated by Ptp under the same conditions. These results were themselves compared with quantitative CT analysis as a gold standard for tidal recruitment/hyperinflation. Despite marked changes in tidal recruitment, mean values of SI computed either from Paw or Ptp were remarkably insensitive to variations of PEEP or condition. After the instillation of effusion, SI indicates a preponderant over-distension effect, not detected by CT. After the increment in PEEP level, the extent of CT-determined tidal recruitment suggest a huge recruitment effect of PEEP as reflected by lung compliance. Both SI in this case were unaffected. We showed that the ability of SI to predict tidal recruitment and overdistension was significantly reduced in a model of altered chest wall-lung relationship, even if the parameter was computed from the Ptp curve profile.

  6. A importância da pressão pleural na avaliação da mecânica respiratória La importancia de la presión pleural en la evaluación de la mecánica respiratoria Importance of pleural pressure for the evaluation of respiratory mechanics

    Directory of Open Access Journals (Sweden)

    Cláudia Regina Fernandes

    2006-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Para a partição das medidas de mecânica do sistema respiratório em seus componentes pulmão e parede torácica, faz-se necessário o conhecimento da pressão pleural. A finalidade desta revisão foi discutir sobre medidas alternativas à obtenção da pressão pleural para o cálculo da mecânica pulmonar, relatar as peculiaridades do método do balão esofágico para obtenção indireta da pressão pleural, as particularidades da obtenção da medida da pressão esofágica em pacientes sedados ou anestesiados, discorrer sobre a medida direta da pressão pleural e sua correlação com a pressão esofágica, assim como relatar sobre o reflexo da PEEP nas pressões pleural e esofágica. CONTEÚDO: A variação da pressão intra-esofágica reflete a variação da pressão intrapleural, podendo ser usada como medida alternativa à pressão pleural direta, no estudo da mecânica dos componentes pulmão e parede do sistema respiratório. A medida da pressão esofágica pode ser realizada por meio de um delicado balão posicionado no interior do esôfago. O método e a técnica foram observados e validados em seres humanos e animais em diferentes condições e posturas corporais. O emprego da PEEP em pacientes sob ventilação controlada mecânica está consolidado; no entanto, existem controvérsias da correlação próxima entre a pressão esofágica e a pressão pleural em pacientes ventilados com PEEP, o que pode resultar em erros de cálculo de mecânica respiratória considerando a pressão esofágica. CONCLUSÕES: O método do balão esofágico é o mais utilizado para a obtenção da medida indireta da pressão pleural. Em pacientes sedados ou anestesiados sem alterações significativas da complacência respiratória, a variação da pressão esofágica corresponde à variação da pressão pleural quando a PEEP é aplicada.JUSTIFICATIVA Y OBJETIVOS: Para la partición de las medidas de mecánica del sistema

  7. Human or monitor feedback to improve mask ventilation during simulated neonatal cardiopulmonary resuscitation.

    Science.gov (United States)

    Binder, Corinna; Schmölzer, Georg M; O'Reilly, Megan; Schwaberger, Bernhard; Urlesberger, Berndt; Pichler, Gerhard

    2014-03-01

    To investigate if external chest compressions (ECC) increase mask leak, and if human or technical feedback improves mask ventilation during simulated neonatal cardiopulmonary resuscitation (CPR). In this observational study, 32 participants delivered positive pressure ventilation (PPV) to a modified, leak-free manikin via facemask. Mask leak, tidal volume (VT), positive end expiratory pressure (PEEP) and respiratory rate (RR) were measured with a respiratory function monitor (RFM). Participants had to perform four studies. In the first study, participants performed PPV alone as baseline. Thereafter, three studies were performed in random order. In the PPV+ECC+manometer group, participants had to observe the manometer while the RFM was covered; in the PPV+ECC+RFM group, the RFM was used while the manometer was covered; and in the PPV+ECC+verbal feedback group, the RFM and manometer were covered while a team leader viewed the RFM and provided verbal feedback to the participants. Median (IQR) mask leak of all studies was 15% (5-47%). Comparing the studies, PPV+ECC+RFM and PPV+ECC+verbal feedback had significantly less mask leak than PPV+ECC+manometer. Mean (SD) VT of all studies was 9.5±3.5 mL. Comparing all studies, PPV+ECC+RFM had a significantly higher VT than PPV and PPV+ECC+manometer. As well, PPV+ECC+verbal feedback had a significantly higher VT than PPV. PEEP and RR were within our target, mean (SD) PEEP was 6±2 cmH2O and RR was 36±13/min. During simulated neonatal CPR, ECCs did not influence mask leak, and a RFM and verbal feedback were helpful methods to reduce mask leak and increase VT significantly.

  8. Kas teie arvates tuleks Ülejõe pargid Emajõe vasakkaldal taashoonestada? / intervjueerinud Ivi Drikkit ja Jüri Saar

    Index Scriptorium Estoniae

    2011-01-01

    Vastasid: Mati Tolmoff, Veljo Ipits, Toomas Savi, Verni Loodmaa, Väino Kull, Toomas Kapp, Triin Anette Kaasik, Kristjan Karis, Hele Everaus, Margot Fjuk, Janika Mölder, Hannes Astok, Jaak Adamsoo, Martin Parmas, Toivo Kabanen, Oleg Nesterenko, Tõnu Ints, Piret Uluots, Peep Peterson, Marju Lauristin, Jarno Laur, Arno Arukask, Ülo Veldre, Toomas Jürgenstein, Veera Sirg, Maie Pastik, Elmut Paavel, Avo Rosenvald, Toivo Maimets, Peeter Tulviste, Joel Luhamets, Jüri Kõre, Ants Kask, Enn Tarto, Tarmo Punger, Merle Jääger, Vladimir Šokman, Boris Habramov, Jevgenia Lindevaldt, Harri Jallajas, Natalja Trošina, Olev Raju, Nikolai Põdramägi

  9. Imageology and clinical examination: Two sides of the same coin

    Directory of Open Access Journals (Sweden)

    Deepa Das

    2011-01-01

    Full Text Available The continuous and rapid transition of techniques from research lab into clinical practice has been the pattern of development in radiology and imaging, and this has put the concept of clinical imaging into a different perspective. From a passive role of pattern recognition, distinguishing a radiograph from normal to abnormal, the task of a radiologist today has been elevated to reporting a comprehensive clinical imaging assay, giving information at a level profound enough to be useful for scientists working in allied fields. A peep into the literature shows how radiological and clinical examination can be two sides of the same coin.

  10. Lung Transcriptomics during Protective Ventilatory Support in Sepsis-Induced Acute Lung Injury.

    Directory of Open Access Journals (Sweden)

    Marialbert Acosta-Herrera

    Full Text Available Acute lung injury (ALI is a severe inflammatory process of the lung. The only proven life-saving support is mechanical ventilation (MV using low tidal volumes (LVT plus moderate to high levels of positive end-expiratory pressure (PEEP. However, it is currently unknown how they exert the protective effects. To identify the molecular mechanisms modulated by protective MV, this study reports transcriptomic analyses based on microarray and microRNA sequencing in lung tissues from a clinically relevant animal model of sepsis-induced ALI. Sepsis was induced by cecal ligation and puncture (CLP in male Sprague-Dawley rats. At 24 hours post-CLP, septic animals were randomized to three ventilatory strategies: spontaneous breathing, LVT (6 ml/kg plus 10 cmH2O PEEP and high tidal volume (HVT, 20 ml/kg plus 2 cmH2O PEEP. Healthy, non-septic, non-ventilated animals served as controls. After 4 hours of ventilation, lung samples were obtained for histological examination and gene expression analysis using microarray and microRNA sequencing. Validations were assessed using parallel analyses on existing publicly available genome-wide association study findings and transcriptomic human data. The catalogue of deregulated processes differed among experimental groups. The 'response to microorganisms' was the most prominent biological process in septic, non-ventilated and in HVT animals. Unexpectedly, the 'neuron projection morphogenesis' process was one of the most significantly deregulated in LVT. Further support for the key role of the latter process was obtained by microRNA studies, as four species targeting many of its genes (Mir-27a, Mir-103, Mir-17-5p and Mir-130a were found deregulated. Additional analyses revealed 'VEGF signaling' as a central underlying response mechanism to all the septic groups (spontaneously breathing or mechanically ventilated. Based on this data, we conclude that a co-deregulation of 'VEGF signaling' along with 'neuron projection

  11. Kuidas ühiskondlikus leppes lubatud hea tuntavaks tehakse? / Jaak Aaviksoo, Jüri Tamm, Kaul Nurm...[jt.

    Index Scriptorium Estoniae

    2003-01-01

    Küsimusele "missugune oleks nende panus ja plaan esimese aasta jooksul ühiskondlikus leppes fikseeritud eesmärkide saavutamiseks" vastavad Tartu Ülikooli rektor Jaak Aaviksoo, EOK asepresident Jüri Tamm, Eestimaa Talupidajate Keskliidu peadirektor Kaul Nurm, Eesti Kirikute Nõukogu täitevsekretär Eerik Jõks, Eesti Ühistegelise Liidu juhatuse esimees Urmas Laht, Eesti Väike- ja Keskettevõtjate Assotsiatsiooni juhataja Riina Danilson ning Reformierakonna pressinõunik Peep Lillemägi. Samas ka karikatuur

  12. Ernesto Achille Preatoni

    Index Scriptorium Estoniae

    2001-01-01

    Äripäeva ajakirjanike Peeter Raidla, Sulev Olli, Peep Soomani ja Inno tähismaa artiklid Ernesto Preatoni tegevusest Eestis ja välismaal: Ühispanga hõivamine; Grandioossed plaanid; Sõprus Arco Varaga; Minek börsile ja naaberriikidesse; Kiire kõrvalpõige väikepankadesse; Oma panga loomine; Eesti kodaniku ajastu; Pro Kapitali kodusõda; Lõppvaatus ja Tallinna börsilt lahkumine; Pro Kapital tegutses; Võitlus eesti ajakirjandusega; Kaubanduskeskuse ja sinimajade tooja

  13. Lung Transcriptomics during Protective Ventilatory Support in Sepsis-Induced Acute Lung Injury

    Science.gov (United States)

    Acosta-Herrera, Marialbert; Lorenzo-Diaz, Fabian; Pino-Yanes, Maria; Corrales, Almudena; Valladares, Francisco; Klassert, Tilman E.; Valladares, Basilio; Slevogt, Hortense; Ma, Shwu-Fan

    2015-01-01

    Acute lung injury (ALI) is a severe inflammatory process of the lung. The only proven life-saving support is mechanical ventilation (MV) using low tidal volumes (LVT) plus moderate to high levels of positive end-expiratory pressure (PEEP). However, it is currently unknown how they exert the protective effects. To identify the molecular mechanisms modulated by protective MV, this study reports transcriptomic analyses based on microarray and microRNA sequencing in lung tissues from a clinically relevant animal model of sepsis-induced ALI. Sepsis was induced by cecal ligation and puncture (CLP) in male Sprague-Dawley rats. At 24 hours post-CLP, septic animals were randomized to three ventilatory strategies: spontaneous breathing, LVT (6 ml/kg) plus 10 cmH2O PEEP and high tidal volume (HVT, 20 ml/kg) plus 2 cmH2O PEEP. Healthy, non-septic, non-ventilated animals served as controls. After 4 hours of ventilation, lung samples were obtained for histological examination and gene expression analysis using microarray and microRNA sequencing. Validations were assessed using parallel analyses on existing publicly available genome-wide association study findings and transcriptomic human data. The catalogue of deregulated processes differed among experimental groups. The ‘response to microorganisms’ was the most prominent biological process in septic, non-ventilated and in HVT animals. Unexpectedly, the ‘neuron projection morphogenesis’ process was one of the most significantly deregulated in LVT. Further support for the key role of the latter process was obtained by microRNA studies, as four species targeting many of its genes (Mir-27a, Mir-103, Mir-17-5p and Mir-130a) were found deregulated. Additional analyses revealed 'VEGF signaling' as a central underlying response mechanism to all the septic groups (spontaneously breathing or mechanically ventilated). Based on this data, we conclude that a co-deregulation of 'VEGF signaling' along with 'neuron projection

  14. Maaülikooli uksed uutele tulijatele valla / Sirje Pärismaa

    Index Scriptorium Estoniae

    Pärismaa, Sirje, 1958-

    2008-01-01

    Oma õpingutest räägivad maaülikooli tudengid: Kadi Avi (majandusarvestus ja finantsjuhtimine III), Kaiti Pilk (maastikuarhitekt III), Mart Kelk (metsatööstuse magistrantuur I), Karin Ojamäe (rakendushüdrobioloogia III), Heidi Heitur (ökonoomika ja ettevõtlus I); Margus Paesalu (metsatööstus III), Kadri Kalle ( maastikukaitse ja -hoolduse magistrantuur I), Liisi Õunapuu (loodusvarade kasutamine ja kaitse III), Laura Niemelä (veterinaarmeditsiin IV) ja Peep Teppo (metsamajanduse magistrantuur II) ning õppeprorektor Jüri Lehtsaar

  15. Performance of ventilators compatible with magnetic resonance imaging: a bench study.

    Science.gov (United States)

    Chikata, Yusuke; Okuda, Nao; Izawa, Masayo; Onodera, Mutsuo; Nishimura, Masaji

    2015-03-01

    Magnetic resonance imaging (MRI) is indispensable for diagnosing brain and spinal cord abnormalities. Magnetic components cannot be used during MRI procedures; therefore, patient support equipment must use MRI-compatible materials. However, little is known of the performance of MRI-compatible ventilators. At commonly used settings, we tested the delivered tidal volume (V(T)), F(IO2), PEEP, and operation of the high-inspiratory-pressure-relief valves of 4 portable MRI-compatible ventilators (Pneupac VR1, ParaPAC 200DMRI, CAREvent MRI, iVent201) and one ICU ventilator (Servo-i). Each ventilator was set in volume control/continuous mandatory ventilation mode. Breathing frequency and V(T) were tested at 10 breaths/min and 300, 500, and 700 mL, respectively. The Pneupac VR1 has fixed V(T) and frequency combinations, so it was tested at V(T) = 300 mL and 20 breaths/min, V(T) = 500 mL and 12 breaths/min, and V(T) = 800 mL and 10 breaths/min. F(IO2) was 0.6 and 1.0. At the air-mix setting, F(IO2) was fixed at 0.5 with the Pneupac VR1, 0.45 with the ParaPAC 200DMRI, and 0.6 with the CAREvent MRI. PEEP was set at 5 and 10 cm H2O, and pressure relief was set at 30 and 40 cm H2O. V(T) error varied widely among ventilators (-28.1 to 25.5%). As V(T) increased, error decreased with the Pneupac VR1, ParaPAC 200DMRI, and CAREvent MRI (P ventilators (-29.2 to 42.5%). Only the Servo-i maintained V(T), F(IO2), and PEEP at set levels. The pressure-relief valves worked in all ventilators. None of the MRI-compatible ventilators maintained V(T), F(IO2), and PEEP at set levels. Vital signs of patients with unstable respiratory mechanics should be monitored during transport and MRI. Copyright © 2015 by Daedalus Enterprises.

  16. Fluorescent supramolecular micelles for imaging-guided cancer therapy

    Science.gov (United States)

    Sun, Mengmeng; Yin, Wenyan; Dong, Xinghua; Yang, Wantai; Zhao, Yuliang; Yin, Meizhen

    2016-02-01

    A novel smart fluorescent drug delivery system composed of a perylene diimide (PDI) core and block copolymer poly(d,l-lactide)-b-poly(ethyl ethylene phosphate) is developed and named as PDI-star-(PLA-b-PEEP)8. The biodegradable PDI-star-(PLA-b-PEEP)8 is a unimolecular micelle and can self-assemble into supramolecular micelles, called as fluorescent supramolecular micelles (FSMs), in aqueous media. An insoluble drug camptothecin (CPT) can be effectively loaded into the FSMs and exhibits pH-responsive release. Moreover, the FSMs with good biocompatibility can also be employed as a remarkable fluorescent probe for cell labelling because the maximum emission of PDI is beneficial for bio-imaging. The flow cytometry and confocal laser scanning microscopy analysis demonstrate that the micelles are easily endocytosed by cancer cells. In vitro and in vivo tumor growth-inhibitory studies reveal a better therapeutic effect of FSMs after CPT encapsulation when compared with the free CPT drug. The multifunctional FSM nanomedicine platform as a nanovehicle has great potential for fluorescence imaging-guided cancer therapy.A novel smart fluorescent drug delivery system composed of a perylene diimide (PDI) core and block copolymer poly(d,l-lactide)-b-poly(ethyl ethylene phosphate) is developed and named as PDI-star-(PLA-b-PEEP)8. The biodegradable PDI-star-(PLA-b-PEEP)8 is a unimolecular micelle and can self-assemble into supramolecular micelles, called as fluorescent supramolecular micelles (FSMs), in aqueous media. An insoluble drug camptothecin (CPT) can be effectively loaded into the FSMs and exhibits pH-responsive release. Moreover, the FSMs with good biocompatibility can also be employed as a remarkable fluorescent probe for cell labelling because the maximum emission of PDI is beneficial for bio-imaging. The flow cytometry and confocal laser scanning microscopy analysis demonstrate that the micelles are easily endocytosed by cancer cells. In vitro and in vivo tumor growth

  17. The Clinical Utilisation of Respiratory Elastance Software (CURE Soft): a bedside software for real-time respiratory mechanics monitoring and mechanical ventilation management.

    Science.gov (United States)

    Szlavecz, Akos; Chiew, Yeong Shiong; Redmond, Daniel; Beatson, Alex; Glassenbury, Daniel; Corbett, Simon; Major, Vincent; Pretty, Christopher; Shaw, Geoffrey M; Benyo, Balazs; Desaive, Thomas; Chase, J Geoffrey

    2014-09-30

    Real-time patient respiratory mechanics estimation can be used to guide mechanical ventilation settings, particularly, positive end-expiratory pressure (PEEP). This work presents a software, Clinical Utilisation of Respiratory Elastance (CURE Soft), using a time-varying respiratory elastance model to offer this ability to aid in mechanical ventilation treatment. CURE Soft is a desktop application developed in JAVA. It has two modes of operation, 1) Online real-time monitoring decision support and, 2) Offline for user education purposes, auditing, or reviewing patient care. The CURE Soft has been tested in mechanically ventilated patients with respiratory failure. The clinical protocol, software testing and use of the data were approved by the New Zealand Southern Regional Ethics Committee. Using CURE Soft, patient's respiratory mechanics response to treatment and clinical protocol were monitored. Results showed that the patient's respiratory elastance (Stiffness) changed with the use of muscle relaxants, and responded differently to ventilator settings. This information can be used to guide mechanical ventilation therapy and titrate optimal ventilator PEEP. CURE Soft enables real-time calculation of model-based respiratory mechanics for mechanically ventilated patients. Results showed that the system is able to provide detailed, previously unavailable information on patient-specific respiratory mechanics and response to therapy in real-time. The additional insight available to clinicians provides the potential for improved decision-making, and thus improved patient care and outcomes.

  18. A novel mechanical lung model of pulmonary diseases to assist with teaching and training

    Directory of Open Access Journals (Sweden)

    Shaw Geoffrey M

    2006-08-01

    Full Text Available Abstract Background A design concept of low-cost, simple, fully mechanical model of a mechanically ventilated, passively breathing lung is developed. An example model is built to simulate a patient under mechanical ventilation with accurate volumes and compliances, while connected directly to a ventilator. Methods The lung is modelled with multiple units, represented by rubber bellows, with adjustable weights placed on bellows to simulate compartments of different superimposed pressure and compliance, as well as different levels of lung disease, such as Acute Respiratory Distress Syndrome (ARDS. The model was directly connected to a ventilator and the resulting pressure volume curves recorded. Results The model effectively captures the fundamental lung dynamics for a variety of conditions, and showed the effects of different ventilator settings. It was particularly effective at showing the impact of Positive End Expiratory Pressure (PEEP therapy on lung recruitment to improve oxygenation, a particulary difficult dynamic to capture. Conclusion Application of PEEP therapy is difficult to teach and demonstrate clearly. Therefore, the model provide opportunity to train, teach, and aid further understanding of lung mechanics and the treatment of lung diseases in critical care, such as ARDS and asthma. Finally, the model's pure mechanical nature and accurate lung volumes mean that all results are both clearly visible and thus intuitively simple to grasp.

  19. Functional flexibility in wild bonobo vocal behaviour

    Directory of Open Access Journals (Sweden)

    Zanna Clay

    2015-08-01

    Full Text Available A shared principle in the evolution of language and the development of speech is the emergence of functional flexibility, the capacity of vocal signals to express a range of emotional states independently of context and biological function. Functional flexibility has recently been demonstrated in the vocalisations of pre-linguistic human infants, which has been contrasted to the functionally fixed vocal behaviour of non-human primates. Here, we revisited the presumed chasm in functional flexibility between human and non-human primate vocal behaviour, with a study on our closest living primate relatives, the bonobo (Pan paniscus. We found that wild bonobos use a specific call type (the “peep” across a range of contexts that cover the full valence range (positive-neutral-negative in much of their daily activities, including feeding, travel, rest, aggression, alarm, nesting and grooming. Peeps were produced in functionally flexible ways in some contexts, but not others. Crucially, calls did not vary acoustically between neutral and positive contexts, suggesting that recipients take pragmatic information into account to make inferences about call meaning. In comparison, peeps during negative contexts were acoustically distinct. Our data suggest that the capacity for functional flexibility has evolutionary roots that predate the evolution of human speech. We interpret this evidence as an example of an evolutionary early transition away from fixed vocal signalling towards functional flexibility.

  20. Effects of vertical positioning on gas exchange and lung volumes in acute respiratory distress syndrome.

    Science.gov (United States)

    Richard, Jean-Christophe M; Maggiore, Salvatore Maurizio; Mancebo, Jordi; Lemaire, François; Jonson, Bjorn; Brochard, Laurent

    2006-10-01

    Supine position may contribute to the loss of aerated lung volume in patients with acute respiratory distress syndrome (ARDS). We hypothesized that verticalization increases lung volume and improves gas exchange by reducing the pressure surrounding lung bases. Prospective observational physiological study in a medical ICU. In 16 patients with ARDS we measured arterial blood gases, pressure-volume curves of the respiratory system recorded from positive-end expiratory pressure (PEEP), and changes in lung volume in supine and vertical positions (trunk elevated at 45 degrees and legs down at 45 degrees ). Vertical positioning increased PaO(2) significantly from 94+/-33 to 142+/-49 mmHg, with an increase higher than 40% in 11 responders. The volume at 20 cmH(2)O measured on the PV curve from PEEP increased using the vertical position only in responders (233+/-146 vs. -8+/-9 1ml in nonresponders); this change was correlated to oxygenation change (rho=0.55). End-expiratory lung volume variation from supine to vertical and 1 h later back to supine, measured in 12 patients showed a significant increase during the 1-h upright period in responders (n=7) but not in nonresponders (n=5; 215+/-220 vs. 10+/-22 ml), suggesting a time-dependent recruitment. Vertical positioning is a simple technique that may improve oxygenation and lung recruitment in ARDS patients.

  1. [USE OF PROTECTIVE LUNG VENTILATION REGIMEN IN CARDIAC SURGERY PATIENTS.

    Science.gov (United States)

    Pshenichniy, T A; Akselrod, B A; Titova, I V; Trekova, N A; Khrustaleva, M V

    2017-09-01

    In cardiac surgery, protective lung ventilation and/or preventive brdnchoscopy (PB) are able to decrease lung injury effects of cardiopulmonary bypass (CPB) and mechanical ventilation. define lung complication risks, evaluate the effect ofprotective lung ventilation (PLV) on lung functioning, and investigate the feasibility ofpreventive PB in higher pulmonary risk (PR) patients. 66 patients participated in prospective randomized research. Allocation was based on PR and intraoperative mechanical ventilation type. PLV includedfollowing parameters: PCK PIP - up to 20 cm H20, Vt - 6 ml/ kg of PBW, PEEP - 5-10 cm H20, IE ratio - 1:1.5-1:1, EtCO2 - 35-42 mm Hg, FiO2 - 45-60%, lung ventilation during CPB, alveolar recruitment. Four groups were formed: A - higher PR plus PLV- B - higher PR plus conventional LV (CLV), C - lower PR plus PLV- D - lower PR plus CLV PIP PEEP dynamic compliance, p/f ratio and intrapulmonary shunt (Qs/Qt) were recorded. Seventeen patients of group A underwent PB. Advanced dynamic compliance, higher p/f ratio and lower Qs/Qt were seen in group A, in comparison with group B (pProtective lung ventilation improves lung biomechanics and oxygenating function in higher risk patients and decreases intrapulmonary shunt fraction in higher and lower risk patients. Addictive preventive bronchoscopy can be successfully used in higher risk patients.

  2. Lung-protective ventilation in abdominal surgery.

    Science.gov (United States)

    Futier, Emmanuel; Jaber, Samir

    2014-08-01

    To provide the most recent and relevant clinical evidence regarding the use of prophylactic lung-protective mechanical ventilation in abdominal surgery. Evidence is accumulating, suggesting an association between intraoperative mechanical ventilation strategy and postoperative pulmonary complications in patients undergoing abdominal surgery. Nonprotective ventilator settings, especially high tidal volume (>10-12 ml/kg), very low level of positive end-expiratory pressure (PEEP, ventilator-associated lung injury in patients with healthy lungs. Stimulated by the previous findings in patients with acute respiratory distress syndrome, the use of lower tidal volume ventilation is becoming increasingly more common in the operating room. However, lowering tidal volume, though important, is only part of the overall multifaceted approach of lung-protective mechanical ventilation. Recent data provide compelling evidence that prophylactic lung-protective mechanical ventilation using lower tidal volume (6-8 ml/kg of predicted body weight), moderate PEEP (6-8 cm H2O), and recruitment maneuvers is associated with improved functional or physiological and clinical postoperative outcome in patients undergoing abdominal surgery. The use of prophylactic lung-protective ventilation can help in improving the postoperative outcome.

  3. Feasibility and safety of low-flow extracorporeal CO2 removal managed with a renal replacement platform to enhance lung-protective ventilation of patients with mild-to-moderate ARDS.

    Science.gov (United States)

    Schmidt, Matthieu; Jaber, Samir; Zogheib, Elie; Godet, Thomas; Capellier, Gilles; Combes, Alain

    2018-05-10

    Extracorporeal carbon-dioxide removal (ECCO 2 R) might allow ultraprotective mechanical ventilation with lower tidal volume (VT) (ventilator-induced lung injury. This study was undertaken to assess the feasibility and safety of ECCO 2 R managed with a renal replacement therapy (RRT) platform to enable very low tidal volume ventilation of patients with mild-to-moderate acute respiratory distress syndrome (ARDS). Twenty patients with mild (n = 8) or moderate (n = 12) ARDS were included. VT was gradually lowered from 6 to 5, 4.5, and 4 ml/kg, and PEEP adjusted to reach 23 ≤ P plat  ≤ 25 cmH 2 O. Standalone ECCO 2 R (no hemofilter associated with the RRT platform) was initiated when arterial PaCO 2 increased by > 20% from its initial value. Ventilation parameters (VT, respiratory rate, PEEP), respiratory system compliance, P plat and driving pressure, arterial blood gases, and ECCO 2 R-system operational characteristics were collected during at least 24 h of very low tidal volume ventilation. Complications, day-28 mortality, need for adjuvant therapies, and data on weaning off ECCO 2 R and mechanical ventilation were also recorded. While VT was reduced from 6 to 4 ml/kg and P plat kept ventilation with moderate increase in PaCO 2 in patients with mild-to-moderate ARDS. ClinicalTrials.gov, NCT02606240. Registered on 17 November 2015.

  4. Time course of lung inflammatory and fibrogenic responses during protective mechanical ventilation in healthy rats.

    Science.gov (United States)

    Krebs, Joerg; Pelosi, Paolo; Tsagogiorgas, Charalambos; Haas, Jenny; Yard, Benito; Rocco, Patricia R M; Luecke, Thomas

    2011-09-15

    This study aimed to assess pulmonary inflammatory and fibrogenic responses and their impact on lung mechanics and histology in healthy rats submitted to protective mechanical ventilation for different experimental periods. Eighteen Wistar rats were randomized to undergo open lung-mechanical ventilation (OL-MV) for 1, 6 or 12 h. Following a recruitment maneuver, a decremental PEEP trial was performed and PEEP set according to the minimal respiratory system static elastance. Respiratory system, lung, and chest-wall elastance and gas-exchange were maintained throughout the 12 h experimental period. Histological lung injury score remained low at 1 and 6 h, but was higher at 12 h due to overinflation. A moderate inflammatory response was observed with a distinct peak at 6h. Compared to unventilated controls, type I procollagen mRNA expression was decreased at 1 and 12h, while type III procollagen expression decreased throughout the 12h experimental period. In conclusion, OL-MV in healthy rats yielded overinflation after 6 h even though respiratory elastance and gas-exchange were preserved for up to 12 h. Copyright © 2011 Elsevier B.V. All rights reserved.

  5. Comparison between conventional and protective one-lung ventilation for ventilator-assisted thoracic surgery.

    Science.gov (United States)

    Ahn, H J; Kim, J A; Yang, M; Shim, W S; Park, K J; Lee, J J

    2012-09-01

    Recent papers suggest protective ventilation (PV) as a primary ventilation strategy during one-lung ventilation (OLV) to reduce postoperative pulmonary morbidity. However, data regarding the advantage of the PV strategy in patients with normal preoperative pulmonary function are inconsistent, especially in the case of minimally invasive thoracic surgery. Therefore we compared conventional OLV (VT 10 ml/kg, FiO2 1.0, zero PEEP) to protective OLV (VT 6 ml/kg, FiO2 0.5, PEEP 5 cmH2O) in patients with normal preoperative pulmonary function tests undergoing video-assisted thoracic surgery. Oxygenation, respiratory mechanics, plasma interleukin-6 and malondialdehyde levels were measured at baseline, 15 and 60 minutes after OLV and 15 minutes after restoration of two-lung ventilation. PaO2 and PaO2/FiO2 were higher in conventional OLV than in protective OLV (PProtective ventilation did not provide advantages over conventional ventilation for video-assisted thoracic surgery in this group of patients with normal lung function.

  6. The effect of lung deflation on the position of the pleura during subclavian vein cannulation in infants receiving mechanical ventilation: an ultrasound study.

    Science.gov (United States)

    Jang, Y-E; Lee, J-H; Park, Y-H; Byon, H-J; Kim, H-S; Kim, C-S; Kim, J-T

    2013-10-01

    We evaluated the effect of lung deflation on the relative position of the pleura compared with a reference line during supra- and infraclavicular approaches to the right subclavian vein. The reference line was drawn relative to the predicted pathway of the needle. The distances between the pleura and the reference line for supra- and infraclavicular approaches were measured during inspiration and expiration in 41 infants. Measurements were repeated with the application of 5 cmH2O positive end-expiratory pressure (PEEP) and in the Trendelenburg position. Lung deflation during the supraclavicular approach significantly decreased the volume of lung crossing the reference line by a median (IQR [range]) of 1.0 (0.6 to 1.3 [0.0 to 4.8]) mm, p deflation showed no change in the distance of the pleura from the reference line regardless of PEEP or patient position. We conclude that lung deflation moves the lung apex caudally and can reduce the potential risk of pneumothorax during a supraclavicular approach to the right subclavian vein in infants. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

  7. Lastekirjandus vallutab uusi tippe : eesti lastekirjandus 2009 / Jaanus Vaiksoo

    Index Scriptorium Estoniae

    Vaiksoo, Jaanus, 1967-

    2010-01-01

    Ülevaade 2009. aasta eesti lastekirjandusest. Pikemalt käsitletakse järgmisi autoreid ja nende teoseid: Kadi Hinrikus "Kui emad olid väikesed", Kristiina Kass "Peeter ja mina", Mika Keränen "Varastatud oranž jalgratas", Andrus Kivirähk "Kaka ja kevad", Aino Pervik "Ühes väikses veidras linnas", Maarja Undusk "Päkapikk Ingo", Ilmar Tomusk "Vend Johannes", Indrek Koff "Enne kooli", Piret Raud "Härra Linnu lugu", Wimberg "Suur pidusöök", Artur Jurin "Puru kuningriigi lood II", Joonas Sildre "Maailma naba", kogumik "Uued eesti muinasjutud", Aino Pervik "Tirilinna lood", Aimeé Beekman "Päästekoer Walter", Eve Ernis "Karupoeg Nummi seiklused", Priit Aimla "Torisev vanatoi", Juhani Püttsepp "Väikese hundi lood" ja "Lauajupi Madonna", Epp Petrone "Siis, kui seened veel rääkisid", Heiki Vilep "Habemega nali", "Nõiutud linn", Leelo Tungal "Naljatilgad lähevad laulupeole", "Kama üks ja kama kaks", koos Peep Pedmansoniga Miriami lood"(esimene 3D-piltidega lasteraamat), Aidi Vallik "Pints ja Tutsik" 2. osa, Mare Müürsepp "Viis vaba kutsikat", Tiia Selli "Kass Kriibik", Aleksei Turovski "Kassipoeg Võilill", Kaider Vardja "Vana maja lugu", Merca "Mullivesi", Ülle Kütsen "Väike puu ja rändur kuu", Lehte Hainsalu "Mängiks midagi", Peep Veedla "Pöialpoiss"

  8. A Quality Improvement Initiative to Reduce the Need for Mechanical Ventilation in Extremely Low Gestational Age Neonates.

    Science.gov (United States)

    Templin, Ludivine; Grosse, Camille; Andres, Virginie; Robert, Clotilde Des; Fayol, Laurence; Simeoni, Umberto; Boubred, Farid

    2017-07-01

    Objective  Limiting early intubation and mechanical ventilation in extremely low gestational age neonates (ELGAN) may decrease neonatal morbidity and mortality. The aim of our study was to demonstrate the feasibility, efficacy, and tolerability of a delivery room respiratory management protocol, including delayed umbilical cord clamping (DUCC) in combination with optimized nCPAP with high PEEP levels and less invasive surfactant administration (LISA). Study Design  This cohort quality improvement study analyzed the respiratory and neonatal outcomes of all consecutive infants born between 24 +0 and 26 +6 weeks' gestation before (period 1, n  = 40) and after (period 2, n  = 52) implementing the new protocol. Results  Compared with the period 1 infants, the period 2 infants had a lower rate of intubation in the delivery room (31 vs. 90%, p  = 0.001) and were less likely to need mechanical ventilation on day 3 (28 vs. 62%, p  = 0.002) and during the hospital stay (75 vs. 92.5%, p  < 0.05). The two groups did not differ in terms of mortality or neonatal morbidity. Conclusion  A delivery room respiratory management protocol based on DUCC, optimized nCPAP with high PEEP levels, and LISA procedure is both feasible and safe, and improved ELGAN respiratory outcomes. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. Data-driven classification of ventilated lung tissues using electrical impedance tomography

    International Nuclear Information System (INIS)

    Gómez-Laberge, Camille; Hogan, Matthew J; Elke, Gunnar; Weiler, Norbert; Frerichs, Inéz; Adler, Andy

    2011-01-01

    Current methods for identifying ventilated lung regions utilizing electrical impedance tomography images rely on dividing the image into arbitrary regions of interest (ROI), manually delineating ROI, or forming ROI with pixels whose signal properties surpass an arbitrary threshold. In this paper, we propose a novel application of a data-driven classification method to identify ventilated lung ROI based on forming k clusters from pixels with correlated signals. A standard first-order model for lung mechanics is then applied to determine which ROI correspond to ventilated lung tissue. We applied the method in an experimental study of 16 mechanically ventilated swine in the supine position, which underwent changes in positive end-expiratory pressure (PEEP) and fraction of inspired oxygen (F I O 2 ). In each stage of the experimental protocol, the method performed best with k = 4 and consistently identified 3 lung tissue ROI and 1 boundary tissue ROI in 15 of the 16 subjects. When testing for changes from baseline in lung position, tidal volume, and respiratory system compliance, we found that PEEP displaced the ventilated lung region dorsally by 2 cm, decreased tidal volume by 1.3%, and increased the respiratory system compliance time constant by 0.3 s. F I O 2 decreased tidal volume by 0.7%. All effects were tested at p < 0.05 with n = 16. These findings suggest that the proposed ROI detection method is robust and sensitive to ventilation dynamics in the experimental setting

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

    Science.gov (United States)

    Nakamura, Maria Aparecida Miyuki; Costa, Eduardo Leite Vieira; Carvalho, Carlos Roberto Ribeiro; Tucci, Mauro Roberto

    2014-01-01

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

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

    Science.gov (United States)

    Nakamura, Maria Aparecida Miyuki; Costa, Eduardo Leite Vieira; Carvalho, Carlos Roberto Ribeiro; Tucci, Mauro Roberto

    2014-01-01

    Objective: Discomfort and noncompliance with noninvasive ventilation (NIV) interfaces are obstacles to NIV success. Total face masks (TFMs) are considered to be a very comfortable NIV interface. However, due to their large internal volume and consequent increased CO2 rebreathing, their orifices allow proximal leaks to enhance CO2 elimination. The ventilators used in the ICU might not adequately compensate for such leakage. In this study, we attempted to determine whether ICU ventilators in NIV mode are suitable for use with a leaky TFM. Methods: This was a bench study carried out in a university research laboratory. Eight ICU ventilators equipped with NIV mode and one NIV ventilator were connected to a TFM with major leaks. All were tested at two positive end-expiratory pressure (PEEP) levels and three pressure support levels. The variables analyzed were ventilation trigger, cycling off, total leak, and pressurization. Results: Of the eight ICU ventilators tested, four did not work (autotriggering or inappropriate turning off due to misdetection of disconnection); three worked with some problems (low PEEP or high cycling delay); and one worked properly. Conclusions: The majority of the ICU ventilators tested were not suitable for NIV with a leaky TFM. PMID:25029653

  12. Effects of positive end-expiratory pressure on arthroscopic shoulder surgery under general anesthesia.

    Science.gov (United States)

    Ersoy, Ayşın; Çakırgöz, Mensure; Ervatan, Zekeriya; Kıran, Özlem; Türkmen, Aygen; Esenyel, Cem Zeki

    2016-01-01

    Our study is a prospective, randomized study on patients undergoing arthroscopic shoulder surgery in the beach-chair position to evaluate the effects of positive end-expiratory pressure (PEEP) on hemodynamic stability, providing a bloodless surgical field and surgical satisfaction. Fifty patients were divided into two groups. Group I (n=25) had zero end-expiratory pressure (ZEEP) administered under general anesthesia, and group II (n=25) had +5 PEEP administered. During surgery, intraarticular hemorrhage and surgical satisfaction were evaluated on a scale of 0-10. During surgery, at the 5th, 30th, 60th, and 90th minutes and at the end of surgery, heart rate, mean arterial pressure (MAP), and positive inspiratory pressure were recorded. At the end of the surgery, the amount of bleeding and duration of the operation were recorded. In group I, the duration of operation and amount of bleeding were found to be significantly greater than those in group II (pshoulder surgery in the beach-chair position reduces the amount of hemorrhage in the surgical field and thus increases surgical satisfaction without requiring the creation of controlled hypotension.

  13. Glutamine Attenuates Acute Lung Injury Caused by Acid Aspiration

    Directory of Open Access Journals (Sweden)

    Chih-Cheng Lai

    2014-08-01

    Full Text Available Inadequate ventilator settings may cause overwhelming inflammatory responses associated with ventilator-induced lung injury (VILI in patients with acute respiratory distress syndrome (ARDS. Here, we examined potential benefits of glutamine (GLN on a two-hit model for VILI after acid aspiration-induced lung injury in rats. Rats were intratracheally challenged with hydrochloric acid as a first hit to induce lung inflammation, then randomly received intravenous GLN or lactated Ringer’s solution (vehicle control thirty min before different ventilator strategies. Rats were then randomized to receive mechanical ventilation as a second hit with a high tidal volume (TV of 15 mL/kg and zero positive end-expiratory pressure (PEEP or a low TV of 6 mL/kg with PEEP of 5 cm H2O. We evaluated lung oxygenation, inflammation, mechanics, and histology. After ventilator use for 4 h, high TV resulted in greater lung injury physiologic and biologic indices. Compared with vehicle treated rats, GLN administration attenuated lung injury, with improved oxygenation and static compliance, and decreased respiratory elastance, lung edema, extended lung destruction (lung injury scores and lung histology, neutrophil recruitment in the lung, and cytokine production. Thus, GLN administration improved the physiologic and biologic profiles of this experimental model of VILI based on the two-hit theory.

  14. Toward improved surveillance: the impact of ventilator-associated complications on length of stay and antibiotic use in patients in intensive care units.

    Science.gov (United States)

    Hayashi, Yoshiro; Morisawa, Kenichiro; Klompas, Michael; Jones, Mark; Bandeshe, Hiran; Boots, Robert; Lipman, Jeffrey; Paterson, David L

    2013-02-01

    Hospitals and quality improvement agencies are vigorously focusing on reducing rates of hospital-acquired infection. Ventilator-associated pneumonia (VAP) is notoriously difficult to diagnose and surveillance is thwarted by the subjectivity of many components of the surveillance definition. Alternative surveillance strategies are needed. Ventilator-associated complications (VAC) is a simple, objective measure of respiratory deterioration. VAC is defined by increases in fraction of inspired oxygen (FiO(2)) by ≥ 15% or positive end-expiratory pressure (PEEP) by ≥ 2.5 cm H(2)O lasting ≥ 2 days after stable or decreasing FiO(2) or PEEP lasting ≥ 2 days. We retrospectively assessed patients on mechanical ventilation for ≥ 48 hours in our study intensive care unit (ICU) using electronic medical record data. We analyzed the association between VAC and clinical diagnoses, ICU length of stay, duration of mechanical ventilation, antibiotic use, and mortality. We assessed 153 patients with VAC and 390 without VAC. VAC events were associated with significantly increased ICU length of stay, duration of mechanical ventilation, and consumption of broad-spectrum antibiotics but not with longer hospital stays or ICU mortality. Surveillance for VAP is subjective and labor intensive. VAC is an objective measure which can be readily obtained from electronic records. It is associated with adverse outcomes and increased broad-spectrum antibiotic usage. VAC may be a useful surveillance tool. The utility of VAC prevention bundles merits assessment.

  15. Anesthetic management of the SRS™ Endoscopic Stapling System for gastro-esophageal reflux disease.

    Science.gov (United States)

    Topuz, Ufuk; Umutoglu, Tarik; Bakan, Mefkur; Ozturk, Erdogan

    2013-01-14

    The SRS(TM) Endoscopic Stapling System (Medigus, Tel Aviv, Israel) is a new tool capable of creating a totally endoscopic fundoplication, combined with an endoscope, endoscopic ultrasound and a surgical stapler. SRS(TM) endoscopic stapling for gastro-esophageal reflux disease is a minimally invasive, outpatient procedure, which requires general anesthesia with positive-pressure ventilation. Keeping the patient on positive end-expiratory pressure (PEEP) may minimize the pressure gradient between the esophagus and the mediastinum, as well as help to prevent air from leaking around the screws and causing pneumomediastinum. In addition, in patients with hiatal hernia, higher PEEP levels may be required to increase intra-thoracic pressure and to force the stomach to slide into the abdomen for ease of endoscopy. We advise smoother emergence from anesthesia, taking precautions for retching, postoperative nausea and vomiting (PONV), while coughing and gagging during extubation and PONV may affect the success of the procedure. Total intravenous anesthesia with propofol and remifentanil seems to be a good choice for these reasons.

  16. [The influence of positive end-expiratory pressure on cerebral blood flow and cerebrovascular autoregulation in patients with acute respiratory distress syndrome].

    Science.gov (United States)

    Yang, Chunli; Chen, Zhi; Lu, Yuanhua; He, Huiwei; Zeng, Weihua

    2014-05-01

    To explore the influence of different positive end-expiratory pressure (PEEP) levels on cerebral blood flow (CBF) and cerebrovascular autoregulation in patients with acute respiratory distress syndrome(ARDS). A prospective study was conducted. Moderate or severe ARDS patients admitted to Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from January 1st, 2013 to October 1st, 2013 were enrolled. The changes in hemodynamics, respiratory mechanics and gas exchange under different levels of PEEP were observed. CBF velocity of middle cerebral artery (MCA) was measured using transcranial Doppler (TCD), and breath-holding index (BHI) was also calculated. 35 patients with ARDS were included. The oxygenation index (OI), peak inspiratory pressure (PIP), plat pressure (Pplat) and central venous pressure (CVP) were markedly elevated (OI: 324.7±117.2 mmHg vs. 173.4±95.8 mmHg, t=5.913, P=0.000; PIP: 34.7±9.1 cmH2O vs. 26.1±7.9 cmH2O,t=4.222, P=0.000; Pplat: 30.5±8.4 cmH2O vs. 22.2±7.1 cmH2O, t=4.465, P=0.000; CVP: 12.1±3.5 mmHg vs. 8.8±2.2 mmHg, t=4.723, P=0.000) when PEEP was increased from (6.4±1.0) cmH2O to (14.5±2.0) cmH2O (1 cmH2O=0.098 kPa). But no significant difference in the heart rate (85.5±19.1 beats/min vs. 82.7±17.3 beats/min, t=0.643, P=0.523), mean arterial pressure (73.5±12.4 mmHg vs. 76.4±15.1 mmHg, t=0.878, P=0.383) and CBF velocity of MCA [peak systolic flow velocity (Vmax): 91.26±17.57 cm/s vs. 96.64±18.71 cm/s, t=1.240, P=0.219; diastolic flow velocity (Vmin): 31.54±7.71 cm/s vs. 33.87±8.53 cm/s, t=1.199, P=0.235; mean velocity (Vmean): 51.19±12.05 cm/s vs. 54.27±13.36 cm/s, t=1.013, P=0.315] was found. 18 patients with BHI<0.1 at baseline demonstrated that cerebral vasomotor reactivity was poor. BHI was slightly decreased with increase in PEEP (0.78±0.16 vs. 0.86±0.19, t=1.905, P=0.061). Some of moderate or severe ARDS patients without central nervous system disease have independent of preexisting cerebral

  17. 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

  18. Modes of mechanical ventilation for the operating room.

    Science.gov (United States)

    Ball, Lorenzo; Dameri, Maddalena; Pelosi, Paolo

    2015-09-01

    Most patients undergoing surgical procedures need to be mechanically ventilated, because of the impact of several drugs administered at induction and during maintenance of general anaesthesia on respiratory function. Optimization of intraoperative mechanical ventilation can reduce the incidence of post-operative pulmonary complications and improve the patient's outcome. Preoxygenation at induction of general anaesthesia prolongs the time window for safe intubation, reducing the risk of hypoxia and overweighs the potential risk of reabsorption atelectasis. Non-invasive positive pressure ventilation delivered through different interfaces should be considered at the induction of anaesthesia morbidly obese patients. Anaesthesia ventilators are becoming increasingly sophisticated, integrating many functions that were once exclusive to intensive care. Modern anaesthesia machines provide high performances in delivering the desired volumes and pressures accurately and precisely, including assisted ventilation modes. Therefore, the physicians should be familiar with the potential and pitfalls of the most commonly used intraoperative ventilation modes: volume-controlled, pressure-controlled, dual-controlled and assisted ventilation. Although there is no clear evidence to support the advantage of any one of these ventilation modes over the others, protective mechanical ventilation with low tidal volume and low levels of positive end-expiratory pressure (PEEP) should be considered in patients undergoing surgery. The target tidal volume should be calculated based on the predicted or ideal body weight rather than on the actual body weight. To optimize ventilation monitoring, anaesthesia machines should include end-inspiratory and end-expiratory pause as well as flow-volume loop curves. The routine administration of high PEEP levels should be avoided, as this may lead to haemodynamic impairment and fluid overload. Higher PEEP might be considered during surgery longer than 3 h

  19. Effect of protective lung ventilation strategy combined with lung recruitment maneuver in patients with acute respiratory distress syndrome (ARDS

    Directory of Open Access Journals (Sweden)

    Sheng Yu

    2017-01-01

    Full Text Available Objective: To evaluate the efficacy and safety of protective lung ventilation strategy combined with lung recruitment maneuver (RM in the treatment patients with acute respiratory distress syndrome (ARDS.Methods: Totally 74 patients with ARDS admitted to the Department of Intensive Care Unit, Changshu Second People's Hospital in Jiangsu Province between September 2010 and June 2013 were selected and randomly divided into lung recruitment group and non-lung recruitment group, and the initial ventilation solution for both groups was synchronized intermittent mandatory ventilation (SIMV. For RM, SIMV mode (pressure control and pressure support was adopted. Positive end expiratory pressure (PEEP was increased by 5 cm H2O every time and maintained for 40-50 s before entering the next increasing period, and the peak airway pressure was kept below 45 cm H2O. After PEEP reached the maximum value, it was gradually reduced by 5 cm H2O every time and finally maintained at 15 cm H2O for 10 min.Results: A total of 74 patients with mean age of (49.0±18.6 years old were enrolled, 36 patients were enrolled in lung recruitment maneuver (RM group and 38 patients were enrolled into non-lung recruitment maneuver (non-RM group. 44 were male and accounted for 59.5% of all the patients. For the indicators such as PEEP, pressure support (PS, plateau airway pressure (Pplat, peak airway pressure (Ppeak, vital capacity (VC and fraction of inspired oxygen (FiO2, no statistical differences in the indicators were found between the RM group and non-RM group on D1, D3 and D7 (P>0.05, except that only FiO2 of RM group on D7 was significantly lower than that of non-RM group (47.2±10.0 vs. (52.2±10.5, P0.05. 28-day mortality, ICU mortality and in-hospital mortality were 25% vs. 28.9%, 25% vs. 26.3% and 36.1% vs. 39.5% respectively between RM group and non-RM group (all P>0.05.Conclusion: Protective lung ventilation strategy combined with lung recruitment maneuver can improve

  20. Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study.

    Science.gov (United States)

    Ladha, Karim; Vidal Melo, Marcos F; McLean, Duncan J; Wanderer, Jonathan P; Grabitz, Stephanie D; Kurth, Tobias; Eikermann, Matthias

    2015-07-14

    To evaluate the effects of intraoperative protective ventilation on major postoperative respiratory complications and to define safe intraoperative mechanical ventilator settings that do not translate into an increased risk of postoperative respiratory complications. Hospital based registry study. Academic tertiary care hospital and two affiliated community hospitals in Massachusetts, United States. 69,265 consecutively enrolled patients over the age of 18 who underwent a non-cardiac surgical procedure between January 2007 and August 2014 and required general anesthesia with endotracheal intubation. Protective ventilation, defined as a median positive end expiratory pressure (PEEP) of 5 cmH2O or more, a median tidal volume of less than 10 mL/kg of predicted body weight, and a median plateau pressure of less than 30 cmH2O. Composite outcome of major respiratory complications, including pulmonary edema, respiratory failure, pneumonia, and re-intubation. Of the 69,265 enrolled patients 34,800 (50.2%) received protective ventilation and 34,465 (49.8%) received non-protective ventilation intraoperatively. Protective ventilation was associated with a decreased risk of postoperative respiratory complications in multivariable regression (adjusted odds ratio 0.90, 95% confidence interval 0.82 to 0.98, P=0.013). The results were similar in the propensity score matched cohort (odds ratio 0.89, 95% confidence interval 0.83 to 0.97, P=0.004). A PEEP of 5 cmH2O and median plateau pressures of 16 cmH2O or less were associated with the lowest risk of postoperative respiratory complications. Intraoperative protective ventilation was associated with a decreased risk of postoperative respiratory complications. A PEEP of 5 cmH2O and a plateau pressure of 16 cmH2O or less were identified as protective mechanical ventilator settings. These findings suggest that protective thresholds differ for intraoperative ventilation in patients with normal lungs compared with those used for patients

  1. Evaluating the effects of protective ventilation on organ-specific cytokine production in porcine experimental postoperative sepsis.

    Science.gov (United States)

    Sperber, Jesper; Lipcsey, Miklós; Larsson, Anders; Larsson, Anders; Sjölin, Jan; Castegren, Markus

    2015-05-10

    Protective ventilation with lower tidal volume (VT) and higher positive end-expiratory pressure (PEEP) reduces the negative additive effects of mechanical ventilation during systemic inflammatory response syndrome. We hypothesised that protective ventilation during surgery would affect the organ-specific immune response in an experimental animal model of endotoxin-induced sepsis-like syndrome. 30 pigs were laparotomised for 2 hours (h), after which a continuous endotoxin infusion was started at 0.25 micrograms × kg(-1) × h(-1) for 5 h. Catheters were placed in the carotid artery, hepatic vein, portal vein and jugular bulb. Animals were randomised to two protective ventilation groups (n = 10 each): one group was ventilated with VT 6 mL × kg(-1) during the whole experiment while the other group was ventilated during the surgical phase with VT of 10 mL × kg(-1). In both groups PEEP was 5 cmH2O during surgery and increased to 10 cmH2O at the start of endotoxin infusion. A control group (n = 10) was ventilated with VT of 10 mL × kg(-1) and PEEP 5 cm H20 throughout the experiment. In four sample locations we a) simultaneously compared cytokine levels, b) studied the effect of protective ventilation initiated before and during endotoxemia and c) evaluated protective ventilation on organ-specific cytokine levels. TNF-alpha levels were highest in the hepatic vein, IL-6 levels highest in the artery and jugular bulb and IL-10 levels lowest in the artery. Protective ventilation initiated before and during endotoxemia did not differ in organ-specific cytokine levels. Protective ventilation led to lower levels of TNF-alpha in the hepatic vein compared with the control group, whereas no significant differences were seen in the artery, portal vein or jugular bulb. Variation between organs in cytokine output was observed during experimental sepsis. We see no implication from cytokine levels for initiating protective ventilation before endotoxemia. However, during endotoxemia

  2. Comparative analysis of parameters of oxygenation, ventilation and acid-base status during intraoperative application of conventional and protective lung ventilation

    Directory of Open Access Journals (Sweden)

    Videnović N.

    2015-01-01

    Full Text Available The aim of this study was to perform a comparative analysis applied conventional (traditional and protective mechanical lung ventilation in clinical conditions with regard to intraoperative parameters changes of oxygenation, ventilation and acid-base status. This was a prospective study that included 240 patients. All patients underwent the same elective surgery (classic cholecystectomy. Patients were divided into two groups of 120 patients, A and B. In group A during the operation had received conventional lung ventilation with tidal volume of 10-15 ml/kg body weight, respiratory rate 12/min. and a PEEP zero. In group B was applied protective lung ventilation with a tidal volume of 6-8 ml/kg body weight, respiratory rate 12/min. and a PEEP of 7 mbar. Monitoring of oxygenation included the monitoring SaO2 and PaO2. Monitoring of ventilation included the determination of the value of tidal volume and minute volume ventilation, peak inspiratory pressure (Ppeak, medium pressure in the airway (Paw.mean, PEEP, PaCO2 and EtCO2. Monitoring of acid-base status was performed via determination of the pH values of arterial blood. Monitoring was carried out in four intervals: T1 - 5-10 minutes after the establishment of the airway, T2 - after opening peritoneum, T3 - after removal of the gallbladder, T4 - after the closure of the abdominal wall. All monitoring results are presented as mean. The statistical significance of differences in mean values was tested by t - test mean values in the case of two independent samples. As a statistical significance test taken as standard values p <0.01 and p <0.001. Comparative analysis of the value of SaO2, PaO2, Ppeak did not reach statistical significance. Statistical significance there is in the analysis of values of tidal volume and Paw.mean (p <0.001. Analysis of PaCO2 and pH of arterial blood showed no statistical significance in the first interval measurements but did interval T2-T4 (p <0.001. Based on the

  3. Application of mid-frequency ventilation in an animal model of lung injury: a pilot study.

    Science.gov (United States)

    Mireles-Cabodevila, Eduardo; Chatburn, Robert L; Thurman, Tracy L; Zabala, Luis M; Holt, Shirley J; Swearingen, Christopher J; Heulitt, Mark J

    2014-11-01

    Mid-frequency ventilation (MFV) is a mode of pressure control ventilation based on an optimal targeting scheme that maximizes alveolar ventilation and minimizes tidal volume (VT). This study was designed to compare the effects of conventional mechanical ventilation using a lung-protective strategy with MFV in a porcine model of lung injury. Our hypothesis was that MFV can maximize ventilation at higher frequencies without adverse consequences. We compared ventilation and hemodynamic outcomes between conventional ventilation and MFV. This was a prospective study of 6 live Yorkshire pigs (10 ± 0.5 kg). The animals were subjected to lung injury induced by saline lavage and injurious conventional mechanical ventilation. Baseline conventional pressure control continuous mandatory ventilation was applied with V(T) = 6 mL/kg and PEEP determined using a decremental PEEP trial. A manual decision support algorithm was used to implement MFV using the same conventional ventilator. We measured P(aCO2), P(aO2), end-tidal carbon dioxide, cardiac output, arterial and venous blood oxygen saturation, pulmonary and systemic vascular pressures, and lactic acid. The MFV algorithm produced the same minute ventilation as conventional ventilation but with lower V(T) (-1 ± 0.7 mL/kg) and higher frequency (32.1 ± 6.8 vs 55.7 ± 15.8 breaths/min, P ventilation and MFV for mean airway pressures (16.1 ± 1.3 vs 16.4 ± 2 cm H2O, P = .75) even when auto-PEEP was higher (0.6 ± 0.9 vs 2.4 ± 1.1 cm H2O, P = .02). There were no significant differences in any hemodynamic measurements, although heart rate was higher during MFV. In this pilot study, we demonstrate that MFV allows the use of higher breathing frequencies and lower V(T) than conventional ventilation to maximize alveolar ventilation. We describe the ventilatory or hemodynamic effects of MFV. We also demonstrate that the application of a decision support algorithm to manage MFV is feasible. Copyright © 2014 by Daedalus Enterprises.

  4. Bench evaluation of 7 home-care ventilators.

    Science.gov (United States)

    Blakeman, Thomas C; Rodriquez, Dario; Hanseman, Dennis; Branson, Richard D

    2011-11-01

    Portable ventilators continue to decrease in size while increasing in performance. We bench-tested the triggering, battery duration, and tidal volume (V(T)) of 7 portable ventilators: LTV 1000, LTV 1200, Puritan Bennett 540, Trilogy, Vela, iVent 101, and HT50. We tested triggering with a modified dual-chamber test lung to simulate spontaneous breathing with weak, normal, and strong inspiratory effort. We measured battery duration by fully charging the battery and operating the ventilator with a V(T) of 500 mL, a respiratory rate of 20 breaths/min, and PEEP of 5 cm H(2)O until breath-delivery ceased. We tested V(T) accuracy with pediatric ventilation scenarios (V(T) 50 mL or 100 mL, respiratory rate 50 breaths/min, inspiratory time 0.3 s, and PEEP 5 cm H(2)O) and an adult ventilation scenario (V(T) 400 mL, respiratory rate 30 breaths/min, inspiratory time 0.5 s, and PEEP 5 cm H(2)O). We measured and analyzed airway pressure, volume, and flow signals. At the adult settings the measured V(T) range was 362-426 mL. On the pediatric settings the measured V(T) range was 51-182 mL at the set V(T) of 50 mL, and 90-141 mL at the set V(T) of 100 mL. The V(T) delivered by the Vela at both the 50 mL and 100 mL, and by the HT50 at 100 mL, did not meet the American Society for Testing and Materials standard for V(T) accuracy. Triggering response and battery duration ranged widely among the tested ventilators. There was wide variability in battery duration and triggering sensitivity. Five of the ventilators performed adequately in V(T) delivery across several settings. The combination of high respiratory rate and low V(T) presented problems for 2 of the ventilators.

  5. A high-flow nasal cannula system with relatively low flow effectively washes out CO2 from the anatomical dead space in a sophisticated respiratory model made by a 3D printer.

    Science.gov (United States)

    Onodera, Yu; Akimoto, Ryo; Suzuki, Hiroto; Okada, Masayuki; Nakane, Masaki; Kawamae, Kaneyuki

    2018-03-15

    Although clinical studies of the high-flow nasal cannula (HFNC) and its effect on positive end-expiratory pressure (PEEP) have been done, the washout effect has not been well evaluated. Therefore, we made an experimental respiratory model to evaluate the respiratory physiological effect of HFNC. An airway model was made by a 3D printer using the craniocervical 3D-CT data of a healthy 32-year-old male. CO 2 was infused into four respiratory lung models (normal-lung, open- and closed-mouth models; restrictive- and obstructive-lung, open-mouth models) to maintain the partial pressure of end-tidal CO 2 (P ET CO 2 ) at 40 mmHg. HFNC flow was changed from 10 to 60 L/min. Capnograms were recorded at the upper pharynx, oral cavity, subglottic, and inlet sites of each lung model. With the normal-lung, open-mouth model, 10 L/min of HFNC flow decreased the subglottic P ET CO 2 to 30 mmHg. Increasing the HFNC flow did not further decrease the subglottic P ET CO 2 . With the normal-lung, closed-mouth model, HFNC flow of 40 L/min was required to decrease the P ET CO 2 at all sites. Subglottic P ET CO 2 reached 30 mmHg with an HFNC flow of 60 L/min. In the obstructive-lung, open-mouth model, P ET CO 2 at all sites had the same trend as in the normal-lung, open-mouth model. In the restrictive-lung, open-mouth model, 20 L/min of HFNC flow decreased the subglottic P ET CO 2 to 25 mmHg, and it did not decrease further. As HFNC flow was increased, PEEP up to 7 cmH 2 O was gradually generated in the open-mouth models and up to 17 cmH 2 O in the normal-lung, closed-mouth model. The washout effect of the HFNC was effective with relatively low flow in the open-mouth models. The closed-mouth model needed more flow to generate a washout effect. Therefore, HFNC flow should be considered based on the need for the washout effect or PEEP.

  6. Behavioural consequences of visual deprivation occurring at hatch or in the early life of chickens

    DEFF Research Database (Denmark)

    Hocking, Paul M.; Haldane, Kirsty-Anne; Davidson, Emma M.

    2015-01-01

    characteristic behaviours of both blind and sighted birds. Individual behaviour, group aggregation and behavioural synchrony were compared at 1, 5 and 9 weeks of age (experiment 1) and in the parents of these chicks at 9–13 months of age (experiment 2). Responses to visual and physical isolation were assessed...... at 1, 5 and 9 weeks. Analyses of home-pen behaviour showed that both rdd and beg had difficulty locating or consuming food during the first week of life. WL and rdd did not engage in abnormal behaviour (circle walking, air pecking, star gazing) at 1, 5 and 9 weeks whereas both beg and rdd adults did so...... visual isolation from conspecifics rdd chicks behaved like blind birds in some respects (e.g. decreased movement) and as sighted birds in others (e.g. peeping). The vision of rdd was apparently diminished compared with sighted controls (WL) even from an early age. It was concluded that abnormal...

  7. MANAGEMENT OF A PATIENT WITH ARDS: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Preethi Thomas

    2014-12-01

    Full Text Available Acute Respiratory Distress Syndrome (ARDS is a permeability pulmonary edema characterized by increased permeability of pulmonary capillary endothelial cells and alveolar epithelial cells, leading to hypoxemia that is refractory to usual oxygen therapy. ARDS is characterized by a brief precipitating event followed by rapidly developing dyspnea. These patients have markedly impaired respiratory system compliance and reduced lung volume. The hypoxemia is refractory to low fraction of oxygen concentration and low positive end expiratory pressure (PEEP. The mortality of ARDS is around 35-40%. Current therapy of ARDS resolves around treatment of underlying cause, lung protective ventilatory strategy and appropriate fluid management. We present a case of ARDS managed in our ICU along with a detailed discussion about the pathophysiology and treatment modalities for the management of a patient with ARDS.

  8. [Acute pulmonary edema in adult caused by tonsillar hypertrophy following removal of laryngeal mask airway].

    Science.gov (United States)

    Iizuka, Toru; Shimoyama, Naohito; Notoya, Atsuko

    2010-12-01

    Negative pressure pulmonary edema (NPPE) has been described after acute airway obstruction. In the following case, we observed a rare occurrence of pulmonary edema caused by chronic tonsillar hypertrophy in a woman following removal of laryngeal mask airway (LMA). A 38-year-old woman with breast cancer underwent mastectomy under general anesthesia using the LMA. With the patient fully awake, the LMA was removed. Abruptly 7 minutes afterward, she showed signs of intense dyspnea, generalized rhonchus and progressive desaturation, and obstructive tonsillar hypertrophy was noticed. Acute lung edema was suspected and treatment started with oxygen therapy, bronchodilators, intravenous corticoids and loop diuretics. She was then intubated to secure airway and provide adequate ventilation with PEEP. Fortunately, the symptoms progressively remitted satisfactorily, and she was subsequently extubated 18 hours later with no complications. NPPE is an infrequent medical emergency and its early diagnosis and recognition are likely to lead to successful management of this potentially serious complication.

  9. Acute Respiratory Distress Syndrome (ARDS After Nitric Acid Inhalation

    Directory of Open Access Journals (Sweden)

    Gülay Kır

    2014-12-01

    Full Text Available Lung injury resulting from inhalation of chemical products continues to be associated with high morbidity and mortality. Concentrated nitric acids are also extremely corrosive fuming chemical liquids. Fumes of nitric acid (HNO3 and various oxides of nitrogen such as nitric oxide (NO and nitrogen dioxide (NO2 may cause fatal illnesses such as severe pulmonary edema and acute respiratory distress syndrome (ARDS when inhaled. Intensive respiratory management including mechanical ventilation with positive end expiratory pressure (PEEP, inverse ratio ventilation, replacement of surfactant and extracorporeal membrane oxygenation (ECMO, steroids and n-acetylcysteine (NAC may improve survival. In this case report we present the diagnosis and successful treatment of a 57 years old male patient who developed ARDS following pulmonary edema due to nitric acid fumes inhalation.

  10. KEEN Wave Simulations: Comparing various PIC to various fixed grid Vlasov to Phase-Space Adaptive Sparse Tiling & Effective Lagrangian (PASTEL) Techniques

    Science.gov (United States)

    Afeyan, Bedros; Larson, David; Shadwick, Bradley; Sydora, Richard

    2017-10-01

    We compare various ways of solving the Vlasov-Poisson and Vlasov-Maxwell equations on rather demanding nonlinear kinetic phenomena associated with KEEN and KEEPN waves. KEEN stands for Kinetic, Electrostatic, Electron Nonlinear, and KEEPN, for electron-positron or pair plasmas analogs. Because these self-organized phase space structures are not steady-state, or single mode, or fluid or low order moment equation limited, typical techniques with low resolution or too much noise will distort the answer too much, too soon, and fail. This will be shown via Penrose criteria triggers for instability at the formation stage as well as particle orbit statistics in fully formed KEEN waves and KEEN-KEEN and KEEN-EPW interacting states. We will argue that PASTEL is a viable alternative to traditional methods with reasonable chances of success in higher dimensions. Work supported by a Grant from AFOSR PEEP.

  11. Mechanical breath profile of airway pressure release ventilation: the effect on alveolar recruitment and microstrain in acute lung injury.

    Science.gov (United States)

    Kollisch-Singule, Michaela; Emr, Bryanna; Smith, Bradford; Roy, Shreyas; Jain, Sumeet; Satalin, Joshua; Snyder, Kathy; Andrews, Penny; Habashi, Nader; Bates, Jason; Marx, William; Nieman, Gary; Gatto, Louis A

    2014-11-01

    Improper mechanical ventilation settings can exacerbate acute lung injury by causing a secondary ventilator-induced lung injury. It is therefore important to establish the mechanism by which the ventilator induces lung injury to develop protective ventilation strategies. It has been postulated that the mechanism of ventilator-induced lung injury is the result of heterogeneous, elevated strain on the pulmonary parenchyma. Acute lung injury has been associated with increases in whole-lung macrostrain, which is correlated with increased pathology. However, the effect of mechanical ventilation on alveolar microstrain remains unknown. To examine whether the mechanical breath profile of airway pressure release ventilation (APRV), consisting of a prolonged pressure-time profile and brief expiratory release phase, reduces microstrain. In a randomized, nonblinded laboratory animal study, rats were randomized into a controlled mandatory ventilation group (n = 3) and an APRV group (n = 3). Lung injury was induced by polysorbate lavage. A thoracotomy was performed and an in vivo microscope was placed on the lungs to measure alveolar mechanics. In the controlled mandatory ventilation group, multiple levels of positive end-expiratory pressure (PEEP; 5, 10, 16, 20, and 24 cm H2O) were tested. In the APRV group, decreasing durations of expiratory release (time at low pressure [T(low)]) were tested. The T(low) was set to achieve ratios of termination of peak expiratory flow rate (T-PEFR) to peak expiratory flow rate (PEFR) of 10%, 25%, 50%, and 75% (the smaller this ratio is [ie, 10%], the more time the lung is exposed to low pressure during the release phase, which decreases end-expiratory lung volume and potentiates derecruitment). Alveolar perimeters were measured at peak inspiration and end expiration using digital image analysis, and strain was calculated by normalizing the change in alveolar perimeter length to the original length. Macrostrain was measured by volume

  12. Rescue therapeutic strategy combining ultra-protective mechanical ventilation with extracorporeal CO2 removal membrane in near-fatal asthma with severe pulmonary barotraumas: A case report.

    Science.gov (United States)

    Pavot, Arthur; Mallat, Jihad; Vangrunderbeeck, Nicolas; Thevenin, Didier; Lemyze, Malcolm

    2017-10-01

    Mechanical ventilation of severe acute asthma is still considered a challenging issue, mainly because of the gas trapping phenomenon with the potential for life-threatening barotraumatic pulmonary complications. Herein, we describe 2 consecutive cases of near-fatal asthma for whom the recommended protective mechanical ventilation approach using low tidal volume of 6 mL/kg and small levels of PEEP was rapidly compromised by giant pneumomediastinum with extensive subcutaneousemphysema. Near fatal asthma. A rescue therapeutic strategy combining extracorporeal CO2 removal membrane with ultra-protective extremely low tidal volume (3 mL/kg) ventilation was applied. Both patients survived hospital discharge. These 2 cases indicate that ECCO2R associated with ultra-protective ventilation could be an alternative to surgery in case of life-threatening barotrauma occurring under mechanical ventilation.

  13. Science and evidence: separating fact from fiction.

    Science.gov (United States)

    Hess, Dean R

    2013-10-01

    Evidence-based medicine (EBM) is the integration of individual clinical expertise with the best available research evidence from systematic research and the patient's values and expectations. A hierarchy of evidence can be used to assess the strength upon which clinical decisions are made. The efficient approach to finding the best evidence is to identify systematic reviews or evidence-based clinical practice guidelines. Respiratory therapies that evidence supports include noninvasive ventilation for appropriately selected patients, lung-protective ventilation, and ventilator discontinuation protocols. Evidence does not support use of weaning parameters, albuterol for ARDS, and high frequency oscillatory ventilation for adults. Therapy with equivocal evidence includes airway clearance, selection of an aerosol delivery device, and PEEP for ARDS. Although all tenets of EBM are not universally accepted, the principles of EBM nonetheless provide a valuable approach to respiratory care practice.

  14. Ultrasound for critical care physicians: the pleura and the answers that lie within

    Directory of Open Access Journals (Sweden)

    Erickson HL

    2015-12-01

    Full Text Available No abstract available. Article truncated after first page. A 67-year-old woman with a 40-pack-year smoking history was admitted to the intensive care unit with acute respiratory failure secondary to adult respiratory distress syndrome (ARDS in the setting of pneumococcal bacteremia. On admission, she required endotracheal intubation and vasopressor support. She was ventilated using a low tidal volume strategy and was relatively easy to oxygenate with a PEEP of 5 and 40% FiO2. After 48 hours of clinical improvement, the patient developed sudden onset tachypnea and increased peak and plateau airway pressures. A bedside ultrasound was subsequently performed (Figures 1 and 2. What is the cause of this patient’s acute respiratory decompensation and increased airway pressures? 1. Pericardial effusion; 2. Pneumothorax; 3. Pulmonary edema; 4. Pulmonary embolism ...

  15. Pulmonary edema and lung injury after severe laryngospasm

    International Nuclear Information System (INIS)

    Saddiqi, R.; Khalique, K.

    2006-01-01

    A young male with no pre-operative medical illness underwent corrective surgery for a deviated nasal septum under general anesthesia. At the end of surgery, patient was extubated but went into severe laryngospasm that did not improve with gentle Intermittent Positive Pressure Ventilation (IPPV) and small dose of Suxamethonium. As the situation worsened and patient developed severe bradycardia and de-saturation, re-intubation was done that revealed pink froth in the endotracheal tube. His portable chest X-ray was suggestive of non-cardiogenic pulmonary edema. With an overnight supportive treatment, using mechanical ventilation with Positive End- Expiratory Pressure (PEEP), morphine infusion and frusemide, patient improved and was subsequently weaned off from ventilator. (author)

  16. A Dedicated Z-Stent for Acquired Saber-Sheath Tracheobronchomalacia

    International Nuclear Information System (INIS)

    Kishi, Kazushi; Fujimoto, Hisashi Kobayashi; Sonomura, Tetsuo; Uetani, Kosaku; Nishida, Norifumi; Ohata, Masahiro; Sato, Morio; Yamada, Ryusaku

    1997-01-01

    The tracheobronchial lumen has a continuous horseshoe arch morphology. We formed Z-stents accordingly to support the weakened cartilagenous portions. With this type of stent we treated a patient with acquired saber-sheath type tracheobronchomalacia (TBM), Rayl's type II, Johnson's grade III, whose condition was aggravated even under positive end expiratory pressure (PEEP) therapy. The patient improved gradually. No immediate complication was observed. Bronchofiberscopic examination revealed that the tracheobronchial arcade was closely strut-braced and showed no expiratory collapse. Six months later, when the patient was intubated due to asthmatic attacks, tissue ingrowth through the stent was found and removed. There was no recurrence of TBM. The patient died 2 years later of pneumoconiosis

  17. A new design for high stability pressure-controlled ventilation for small animal lung imaging

    International Nuclear Information System (INIS)

    Kitchen, M J; Habib, A; Lewis, R A; Fouras, A; Dubsky, S; Wallace, M J; Hooper, S B

    2010-01-01

    We have developed a custom-designed ventilator to deliver a stable pressure to the lungs of small animals for use in imaging experiments. Our ventilator was designed with independent pressure vessels to separately control the Peak Inspiratory Pressure (PIP) and Positive End Expiratory Pressure (PEEP) to minimise pressure fluctuations during the ventilation process. The ventilator was computer controlled through a LabVIEW interface, enabling experimental manipulations to be performed remotely whilst simultaneously imaging the lungs in situ. Mechanical ventilation was successfully performed on newborn rabbit pups to assess the most effective ventilation strategies for aerating the lungs at birth. Highly stable pressures enabled reliable respiratory gated acquisition of projection radiographs and a stable prolonged (15 minute) breath-hold for high-resolution computed tomography of deceased rabbit pups at different lung volumes.

  18. Antenatal and postnatal corticosteroid and resuscitation induced lung injury in preterm sheep

    Directory of Open Access Journals (Sweden)

    Kallapur Suhas G

    2009-12-01

    Full Text Available Abstract Background Initiation of ventilation using high tidal volumes in preterm lambs causes lung injury and inflammation. Antenatal corticosteroids mature the lungs of preterm infants and postnatal corticosteroids are used to treat bronchopulmonary dysplasia. Objective To test if antenatal or postnatal corticosteroids would decrease resuscitation induced lung injury. Methods 129 d gestational age lambs (n = 5-8/gp; term = 150 d were operatively delivered and ventilated after exposure to either 1 no medication, 2 antenatal maternal IM Betamethasone 0.5 mg/kg 24 h prior to delivery, 3 0.5 mg/kg Dexamethasone IV at delivery or 4 Cortisol 2 mg/kg IV at delivery. Lambs then were ventilated with no PEEP and escalating tidal volumes (VT to 15 mL/kg for 15 min and then given surfactant. The lambs were ventilated with VT 8 mL/kg and PEEP 5 cmH20 for 2 h 45 min. Results High VT ventilation caused a deterioration of lung physiology, lung inflammation and injury. Antenatal betamethasone improved ventilation, decreased inflammatory cytokine mRNA expression and alveolar protein leak, but did not prevent neutrophil influx. Postnatal dexamethasone decreased pro-inflammatory cytokine expression, but had no beneficial effect on ventilation, and postnatal cortisol had no effect. Ventilation increased liver serum amyloid mRNA expression, which was unaffected by corticosteroids. Conclusions Antenatal betamethasone decreased lung injury without decreasing lung inflammatory cells or systemic acute phase responses. Postnatal dexamethasone or cortisol, at the doses tested, did not have important effects on lung function or injury, suggesting that corticosteroids given at birth will not decrease resuscitation mediated injury.

  19. Analysis of a Pediatric Home Mechanical Ventilator Population.

    Science.gov (United States)

    Amirnovin, Rambod; Aghamohammadi, Sara; Riley, Carley; Woo, Marlyn S; Del Castillo, Sylvia

    2018-05-01

    The population of children requiring home mechanical ventilation has evolved over the years and has grown to include a variety of diagnoses and needs that have led to changes in the care of this unique population. The purpose of this study was to provide a descriptive analysis of pediatric patients requiring home mechanical ventilation after hospitalization and how the evolution of this technology has impacted their care. A retrospective, observational, longitudinal analysis of 164 children enrolled in a university-affiliated home mechanical ventilation program over 26 years was performed. Data included each child's primary diagnosis, date of tracheostomy placement, duration of mechanical ventilation during hospitalization that consisted of home mechanical ventilator initiation, total length of pediatric ICU stay, ventilator settings at time of discharge from pediatric ICU, and disposition (home, facility, or died). Univariate, bivariate, and regression analysis was used as appropriate. The most common diagnosis requiring the use of home mechanical ventilation was neuromuscular disease (53%), followed by chronic pulmonary disease (29%). The median length of stay in the pediatric ICU decreased significantly after the implementation of a ventilator ward (70 d [30-142] vs 36 d [18-67], P = .02). The distribution of subjects upon discharge was home (71%), skilled nursing facility (24%), and died (4%), with an increase in the proportion of subjects discharged on PEEP and those going to nursing facilities over time ( P = 0.02). The evolution of home mechanical ventilation has allowed earlier transition out of the pediatric ICU and with increasing disposition to skilled nursing facilities over time. There has also been a change in ventilator management, including increased use of PEEP upon discharge, possibly driven by changes in ventilators and in-patient practice patterns. Copyright © 2018 by Daedalus Enterprises.

  20. Application of intraoperative lung-protective ventilation varies in accordance with the knowledge of anaesthesiologists: a single-Centre questionnaire study and a retrospective observational study.

    Science.gov (United States)

    Kim, Seung Hyun; Na, Sungwon; Lee, Woo Kyung; Choi, Hyunwoo; Kim, Jeongmin

    2018-04-02

    The benefits of lung-protective ventilation (LPV) with a low tidal volume (6 mL/kg of ideal body weight [IBW]), limited plateau pressure (ventilator settings according to recognition of lung-protective ventilation. Furthermore, we investigated the changes in the trend for using this form of ventilation during general anaesthesia in the past 10 years. Anaesthesiologists who had received training in LPV were more knowledgeable about this approach. Anaesthesiologists with knowledge of the concept behind LPV strategies applied a lower tidal volume (median (IQR [range]), 8.2 (8.0-9.2 [7.1-10.3]) vs. 9.2 (9.1-10.1 [7.6-10.1]) mL/kg; p = 0.033) and used PEEP more frequently (69/72 [95.8%] vs. 5/8 [62.5%]; p = 0.012; odds ratio, 13.8 [2.19-86.9]) for laparoscopic surgery than did those without such knowledge. Anaesthesiologists who were able to answer a question related to LPV correctly (respondents who chose 'height' to a multiple choice question asking what variables should be considered most important in the initial setting of tidal volume) applied a lower tidal volume in cases of laparoscopic surgery and obese patients. There was an increase in the number of patients receiving LPV (V T  < 10 mL/kgIBW and PEEP ≥5 cm H 2 O) between 2004 and 2014 (0/818 [0.0%] vs. 280/818 [34.2%]; p <  0.001). Our study suggests that the knowledge of LPV is directly related to its implementation, and can explain the increase in LPV use in general anaesthesia. Further studies should assess the impact of using intraoperative LPV on clinical outcomes and should determine the efficacy of education on intraoperative LPV implementation.

  1. Feasibility and safety of low-flow extracorporeal carbon dioxide removal to facilitate ultra-protective ventilation in patients with moderate acute respiratory distress sindrome.

    Science.gov (United States)

    Fanelli, Vito; Ranieri, Marco V; Mancebo, Jordi; Moerer, Onnen; Quintel, Michael; Morley, Scott; Moran, Indalecio; Parrilla, Francisco; Costamagna, Andrea; Gaudiosi, Marco; Combes, Alain

    2016-02-10

    Mechanical ventilation with a tidal volume (VT) of 6 mL/kg/predicted body weight (PBW), to maintain plateau pressure (Pplat) lower than 30 cmH2O, does not completely avoid the risk of ventilator induced lung injury (VILI). The aim of this study was to evaluate safety and feasibility of a ventilation strategy consisting of very low VT combined with extracorporeal carbon dioxide removal (ECCO2R). In fifteen patients with moderate ARDS, VT was reduced from baseline to 4 mL/kg PBW while PEEP was increased to target a plateau pressure--(Pplat) between 23 and 25 cmH2O. Low-flow ECCO2R was initiated when respiratory acidosis developed (pH 60 mmHg). Ventilation parameters (VT, respiratory rate, PEEP), respiratory compliance (CRS), driving pressure (DeltaP = VT/CRS), arterial blood gases, and ECCO2R system operational characteristics were collected during the period of ultra-protective ventilation. Patients were weaned from ECCO2R when PaO2/FiO2 was higher than 200 and could tolerate conventional ventilation settings. Complications, mortality at day 28, need for prone positioning and extracorporeal membrane oxygenation, and data on weaning from both MV and ECCO2R were also collected. During the 2 h run in phase, VT reduction from baseline (6.2 mL/kg PBW) to approximately 4 mL/kg PBW caused respiratory acidosis (pH protective mechanical ventilation strategy in patients with moderate ARDS.

  2. The Society for Translational Medicine: clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy.

    Science.gov (United States)

    Gao, Shugeng; Zhang, Zhongheng; Brunelli, Alessandro; Chen, Chang; Chen, Chun; Chen, Gang; Chen, Haiquan; Chen, Jin-Shing; Cassivi, Stephen; Chai, Ying; Downs, John B; Fang, Wentao; Fu, Xiangning; Garutti, Martínez I; He, Jianxing; He, Jie; Hu, Jian; Huang, Yunchao; Jiang, Gening; Jiang, Hongjing; Jiang, Zhongmin; Li, Danqing; Li, Gaofeng; Li, Hui; Li, Qiang; Li, Xiaofei; Li, Yin; Li, Zhijun; Liu, Chia-Chuan; Liu, Deruo; Liu, Lunxu; Liu, Yongyi; Ma, Haitao; Mao, Weimin; Mao, Yousheng; Mou, Juwei; Ng, Calvin Sze Hang; Petersen, René H; Qiao, Guibin; Rocco, Gaetano; Ruffini, Erico; Tan, Lijie; Tan, Qunyou; Tong, Tang; Wang, Haidong; Wang, Qun; Wang, Ruwen; Wang, Shumin; Xie, Deyao; Xue, Qi; Xue, Tao; Xu, Lin; Xu, Shidong; Xu, Songtao; Yan, Tiansheng; Yu, Fenglei; Yu, Zhentao; Zhang, Chunfang; Zhang, Lanjun; Zhang, Tao; Zhang, Xun; Zhao, Xiaojing; Zhao, Xuewei; Zhi, Xiuyi; Zhou, Qinghua

    2017-09-01

    Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e.g., volume controlled (VCV) versus pressure controlled (PCV)]; (III) use of therapeutic hypercapnia; (IV) use of alveolar recruitment (open-lung) strategy; (V) pre-and post-operative application of positive end expiratory pressure (PEEP); (VI) Inspired Oxygen concentration; (VII) Non-intubated thoracoscopic lobectomy; and (VIII) adjuvant pharmacologic options. The recommendations of class II are non-intubated thoracoscopic lobectomy may be an alternative to conventional one-lung ventilation in selected patients. The recommendations of class IIa are: (I) Therapeutic hypercapnia to maintain a partial pressure of carbon dioxide at 50-70 mmHg is reasonable for patients undergoing pulmonary lobectomy with one-lung ventilation; (II) PV with a tidal volume of 6 mL/kg and PEEP of 5 cmH 2 O are reasonable methods, based on current evidence; (III) alveolar recruitment [open lung ventilation (OLV)] may be beneficial in patients undergoing lobectomy with one-lung ventilation; (IV) PCV is recommended over VCV for patients undergoing lung resection; (V) pre- and post-operative CPAP can improve short-term oxygenation in patients undergoing lobectomy with one-lung ventilation; (VI) controlled mechanical ventilation with I:E ratio of 1:1 is reasonable in patients undergoing one-lung ventilation; (VII) use of lowest inspired oxygen concentration to maintain satisfactory arterial oxygen saturation is reasonable based on physiologic principles; (VIII) Adjuvant drugs

  3. The effect of low level laser therapy on ventilator-induced lung injury in mice (Conference Presentation)

    Science.gov (United States)

    Szabari, Margit V.; Miller, Alyssa J.; Hariri, Lida P.; Hamblin, Michael R.; Musch, Guido; Stroh, Helene; Suter, Melissa J.

    2016-03-01

    Although mechanical ventilation (MV) is necessary to support gas exchange in critically ill patients, it can contribute to the development of lung injury and multiple organ dysfunction. It is known that high tidal volume (Vt) MV can cause ventilator-induced lung injury (VILI) in healthy lungs and increase the mortality of patients with Acute Respiratory Distress Syndrome. Low level laser therapy (LLLT) has demonstrated to have anti-inflammatory effects. We investigated whether LLLT could alleviate inflammation from injurious MV in mice. Adult mice were assigned to 2 groups: VILI+LLLT group (3 h of injurious MV: Vt=25-30 ml/kg, respiratory rate (RR)=50/min, positive end-expiratory pressure (PEEP)=0 cmH20, followed by 3 h of protective MV: Vt=9 ml/kg, RR=140/min, PEEP=2 cmH20) and VILI+no LLLT group. LLLT was applied during the first 30 min of the MV (810 nm LED system, 5 J/cm2, 1 cm above the chest). Respiratory impedance was measured in vivo with forced oscillation technique and lung mechanics were calculated by fitting the constant phase model. At the end of the MV, bronchoalveolar lavage (BAL) was performed and inflammatory cells counted. Lungs were removed en-bloc and fixed for histological evaluation. We hypothesize that LLLT can reduce lung injury and inflammation from VILI. This therapy could be translated into clinical practice, where it can potentially improve outcomes in patients requiring mechanical ventilation in the operating room or in the intensive care units.

  4. Intraoperative mechanical ventilation: state of the art.

    Science.gov (United States)

    Ball, Lorenzo; Costantino, Federico; Orefice, Giulia; Chandrapatham, Karthikka; Pelosi, Paolo

    2017-10-01

    Mechanical ventilation is a cornerstone of the intraoperative management of the surgical patient and is still mandatory in several surgical procedures. In the last decades, research focused on preventing postoperative pulmonary complications (PPCs), both improving risk stratification through the use of predictive scores and protecting the lung adopting so-called protective ventilation strategies. The aim of this review was to give an up-to-date overview of the currently suggested intraoperative ventilation strategies, along with their pathophysiologic rationale, with a focus on challenging conditions, such as obesity, one-lung ventilation and cardiopulmonary bypass. While anesthesia and mechanical ventilation are becoming increasingly safe practices, the contribution to surgical mortality attributable to postoperative lung injury is not negligible: for these reasons, the prevention of PPCs, including the use of protective mechanical ventilation is mandatory. Mechanical ventilation should be optimized providing an adequate respiratory support while minimizing unwanted negative effects. Due to the high number of surgical procedures performed daily, the impact on patients' health and healthcare costs can be relevant, even when new strategies result in an apparently small improvement of outcome. A protective intraoperative ventilation should include a low tidal volume of 6-8 mL/kg of predicted body weight, plateau pressures ideally below 16 cmH2O, the lowest possible driving pressure, moderate-low PEEP levels except in obese patients, laparoscopy and long surgical procedures that might benefit of a slightly higher PEEP. The work of the anesthesiologist should start with a careful preoperative visit to assess the risk, and a close postoperative monitoring.

  5. Implementation of a Goal-Directed Mechanical Ventilation Order Set Driven by Respiratory Therapists Improves Compliance With Best Practices for Mechanical Ventilation.

    Science.gov (United States)

    Radosevich, Misty A; Wanta, Brendan T; Meyer, Todd J; Weber, Verlin W; Brown, Daniel R; Smischney, Nathan J; Diedrich, Daniel A

    2017-01-01

    Data regarding best practices for ventilator management strategies that improve outcomes in acute respiratory distress syndrome (ARDS) are readily available. However, little is known regarding processes to ensure compliance with these strategies. We developed a goal-directed mechanical ventilation order set that included physician-specified lung-protective ventilation and oxygenation goals to be implemented by respiratory therapists (RTs). We sought as a primary outcome to determine whether an RT-driven order set with predefined oxygenation and ventilation goals could be implemented and associated with improved adherence with best practice. We evaluated 1302 patients undergoing invasive mechanical ventilation (1693 separate episodes of invasive mechanical ventilation) prior to and after institution of a standardized, goal-directed mechanical ventilation order set using a controlled before-and-after study design. Patient-specific goals for oxygenation partial pressure of oxygen in arterial blood (Pao 2 ), ARDS Network [Net] positive end-expiratory pressure [PEEP]/fraction of inspired oxygen [Fio 2 ] table use) and ventilation (pH, partial pressure of carbon dioxide) were selected by prescribers and implemented by RTs. Compliance with the new mechanical ventilation order set was high: 88.2% compliance versus 3.8% before implementation of the order set ( P mechanical ventilation, intensive care unit (ICU) length of stay, and in-hospital or ICU mortality. A standardized best practice mechanical ventilation order set can be implemented by a multidisciplinary team and is associated with improved compliance to written orders and adherence to the ARDSNet PEEP/Fio 2 table.

  6. Open lung approach vs acute respiratory distress syndrome network ventilation in experimental acute lung injury.

    Science.gov (United States)

    Spieth, P M; Güldner, A; Carvalho, A R; Kasper, M; Pelosi, P; Uhlig, S; Koch, T; Gama de Abreu, M

    2011-09-01

    Setting and strategies of mechanical ventilation with positive end-expiratory pressure (PEEP) in acute lung injury (ALI) remains controversial. This study compares the effects between lung-protective mechanical ventilation according to the Acute Respiratory Distress Syndrome Network recommendations (ARDSnet) and the open lung approach (OLA) on pulmonary function and inflammatory response. Eighteen juvenile pigs were anaesthetized, mechanically ventilated, and instrumented. ALI was induced by surfactant washout. Animals were randomly assigned to mechanical ventilation according to the ARDSnet protocol or the OLA (n=9 per group). Gas exchange, haemodynamics, pulmonary blood flow (PBF) distribution, and respiratory mechanics were measured at intervals and the lungs were removed after 6 h of mechanical ventilation for further analysis. PEEP and mean airway pressure were higher in the OLA than in the ARDSnet group [15 cmH(2)O, range 14-18 cmH(2)O, compared with 12 cmH(2)O; 20.5 (sd 2.3) compared with 18 (1.4) cmH(2)O by the end of the experiment, respectively], and OLA was associated with improved oxygenation compared with the ARDSnet group after 6 h. OLA showed more alveolar overdistension, especially in gravitationally non-dependent regions, while the ARDSnet group was associated with more intra-alveolar haemorrhage. Inflammatory mediators and markers of lung parenchymal stress did not differ significantly between groups. The PBF shifted from ventral to dorsal during OLA compared with ARDSnet protocol [-0.02 (-0.09 to -0.01) compared with -0.08 (-0.12 to -0.06), dorsal-ventral gradients after 6 h, respectively]. According to the OLA, mechanical ventilation improved oxygenation and redistributed pulmonary perfusion when compared with the ARDSnet protocol, without differences in lung inflammatory response.

  7. Delivery of tidal volume from four anaesthesia ventilators during volume-controlled ventilation: a bench study.

    Science.gov (United States)

    Wallon, G; Bonnet, A; Guérin, C

    2013-06-01

    Tidal volume (V(T)) must be accurately delivered by anaesthesia ventilators in the volume-controlled ventilation mode in order for lung protective ventilation to be effective. However, the impact of fresh gas flow (FGF) and lung mechanics on delivery of V(T) by the newest anaesthesia ventilators has not been reported. We measured delivered V(T) (V(TI)) from four anaesthesia ventilators (Aisys™, Flow-i™, Primus™, and Zeus™) on a pneumatic test lung set with three combinations of lung compliance (C, ml cm H2O(-1)) and resistance (R, cm H2O litre(-1) s(-2)): C60R5, C30R5, C60R20. For each CR, three FGF rates (0.5, 3, 10 litre min(-1)) were investigated at three set V(T)s (300, 500, 800 ml) and two values of PEEP (0 and 10 cm H2O). The volume error = [(V(TI) - V(Tset))/V(Tset)] ×100 was computed in body temperature and pressure-saturated conditions and compared using analysis of variance. For each CR and each set V(T), the absolute value of the volume error significantly declined from Aisys™ to Flow-i™, Zeus™, and Primus™. For C60R5, these values were 12.5% for Aisys™, 5% for Flow-i™ and Zeus™, and 0% for Primus™. With an increase in FGF, absolute values of the volume error increased only for Aisys™ and Zeus™. However, in C30R5, the volume error was minimal at mid-FGF for Aisys™. The results were similar at PEEP 10 cm H2O. Under experimental conditions, the volume error differed significantly between the four new anaesthesia ventilators tested and was influenced by FGF, although this effect may not be clinically relevant.

  8. The Society for Translational Medicine: clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy

    Science.gov (United States)

    Zhang, Zhongheng; Brunelli, Alessandro; Chen, Chang; Chen, Chun; Chen, Gang; Chen, Haiquan; Chen, Jin-Shing; Cassivi, Stephen; Chai, Ying; Downs, John B.; Fang, Wentao; Fu, Xiangning; Garutti, Martínez I.; He, Jianxing; Hu, Jian; Huang, Yunchao; Jiang, Gening; Jiang, Hongjing; Jiang, Zhongmin; Li, Danqing; Li, Gaofeng; Li, Hui; Li, Qiang; Li, Xiaofei; Li, Yin; Li, Zhijun; Liu, Chia-Chuan; Liu, Deruo; Liu, Lunxu; Liu, Yongyi; Ma, Haitao; Mao, Weimin; Mao, Yousheng; Mou, Juwei; Ng, Calvin Sze Hang; Petersen, René H.; Qiao, Guibin; Rocco, Gaetano; Ruffini, Erico; Tan, Lijie; Tan, Qunyou; Tong, Tang; Wang, Haidong; Wang, Qun; Wang, Ruwen; Wang, Shumin; Xie, Deyao; Xue, Qi; Xue, Tao; Xu, Lin; Xu, Shidong; Xu, Songtao; Yan, Tiansheng; Yu, Fenglei; Yu, Zhentao; Zhang, Chunfang; Zhang, Lanjun; Zhang, Tao; Zhang, Xun; Zhao, Xiaojing; Zhao, Xuewei; Zhi, Xiuyi; Zhou, Qinghua

    2017-01-01

    Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e.g., volume controlled (VCV) versus pressure controlled (PCV)]; (III) use of therapeutic hypercapnia; (IV) use of alveolar recruitment (open-lung) strategy; (V) pre-and post-operative application of positive end expiratory pressure (PEEP); (VI) Inspired Oxygen concentration; (VII) Non-intubated thoracoscopic lobectomy; and (VIII) adjuvant pharmacologic options. The recommendations of class II are non-intubated thoracoscopic lobectomy may be an alternative to conventional one-lung ventilation in selected patients. The recommendations of class IIa are: (I) Therapeutic hypercapnia to maintain a partial pressure of carbon dioxide at 50–70 mmHg is reasonable for patients undergoing pulmonary lobectomy with one-lung ventilation; (II) PV with a tidal volume of 6 mL/kg and PEEP of 5 cmH2O are reasonable methods, based on current evidence; (III) alveolar recruitment [open lung ventilation (OLV)] may be beneficial in patients undergoing lobectomy with one-lung ventilation; (IV) PCV is recommended over VCV for patients undergoing lung resection; (V) pre- and post-operative CPAP can improve short-term oxygenation in patients undergoing lobectomy with one-lung ventilation; (VI) controlled mechanical ventilation with I:E ratio of 1:1 is reasonable in patients undergoing one-lung ventilation; (VII) use of lowest inspired oxygen concentration to maintain satisfactory arterial oxygen saturation is reasonable based on physiologic principles; (VIII) Adjuvant drugs

  9. Evaluation of a computerized system for mechanical ventilation of infants.

    Science.gov (United States)

    Tehrani, Fleur T; Abbasi, Soraya

    2009-04-01

    To evaluate a computerized system for mechanical ventilation of infants. FLEX is a computerized system that includes the features of a patented mode known as adaptive-support ventilation (ASV). In addition, it has many other features including adjustment of positive end-expiratory pressure (PEEP), fraction of inspired oxygen (F(IO2)), minute ventilation, and control of weaning. It is used as an open-loop decision support system or as a closed-loop technique. Blood gas and ventilation data were collected from 12 infants in the neonatal intensive care at baseline and at the next round of evaluation. This data were input to open-loop version of FLEX. The system recommendations were compared to clinical determinations. FLEX recommended values for ventilation were on the average within 25% and 16.5% of the measured values at baseline and at the next round of evaluation, respectively. For F(IO2) and PEEP, FLEX recommended values were in general agreement with the clinical settings. FLEX recommendations for weaning were the same as the clinical determinations 50% of the time at baseline and 55% of the time at the next round of evaluation. FLEX did not recommend weaning for infants with weak spontaneous breathing effort or those who showed signs of dyspnea. A computerized system for mechanical ventilation is evaluated for treatment of infants. The results of the study show that the system has good potential for use in neonatal ventilatory care. Further refinements can be made in the system for very low-birth-weight infants.

  10. Transdermal granisetron for the prevention of nausea and vomiting following moderately or highly emetogenic chemotherapy in Chinese patients: a randomized, double-blind, phase III study.

    Science.gov (United States)

    Yang, Liu-Qing; Sun, Xin-Chen; Qin, Shu-Kui; Chen, Ying-Xia; Zhang, He-Long; Cheng, Ying; Chen, Zhen-Dong; Shi, Jian-Hua; Wu, Qiong; Bai, Yu-Xian; Han, Bao-Hui; Liu, Wei; Ouyang, Xue-Nong; Liu, Ji-Wei; Zhang, Zhi-Hui; Li, Yong-Qiang; Xu, Jian-Ming; Yu, Shi-Ying

    2016-12-01

    The granisetron transdermal delivery system (GTDS) has been demonstrated effectiveness in the control of chemotherapy-induced nausea and vomiting (CINV) in previous studies. This is the first phase III study to evaluate the efficacy and tolerability of GTDS in patients receiving moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC) in China. A total of 313 patients were randomized into the GTDS group (one transdermal granisetron patch, 7 days) or the oral granisetron group (granisetron oral 2 mg/day, ≥2 days). The primary endpoint was the percentage of patients achieving complete control (CC) from chemotherapy initiation until 24 h after final administration (PEEP). Chi-square test and Fisher's exact test were used for statistical analysis. Two hundred eighty-one patients were included in the per protocol analysis. During PEEP, CC was achieved by 67 (47.52%) patients in the GTDS group and 83 (59.29%) patients in the oral granisetron group. There was no statistical significance between the groups (P=0.0559). However, the difference of the CC percentage mainly occurred on the first day of chemotherapy between the groups. The CC was 70.13% on day 1 in the GTDS group, which was significantly lower than that of 91.03% in the oral granisetron group in the full analysis set. In the following days of chemotherapy, the CC was similar between the groups. In terms of cisplatin-contained regimen and female, there was statistical significance between the groups. Both treatments were well tolerated and safe. The most common adverse event was constipation. GTDS provided effective and well-tolerated control of CINV in Chinese patients, especially to non-cisplatin-contained regimen.

  11. A Short Period of Ventilation without Perfusion Seems to Reduce Atelectasis without Harming the Lungs during Ex Vivo Lung Perfusion

    Directory of Open Access Journals (Sweden)

    Sandra Lindstedt

    2013-01-01

    Full Text Available To evaluate the lung function of donors after circulatory deaths (DCDs, ex vivo lung perfusion (EVLP has been shown to be a valuable method. We present modified EVLP where lung atelectasis is removed, while the lung perfusion is temporarily shut down. Twelve pigs were randomized into two groups: modified EVLP and conventional EVLP. When the lungs had reached 37°C in the EVLP circuit, lung perfusion was temporarily shut down in the modified EVLP group, and positive end-expiratory pressure (PEEP was increased to 10 cm H2O for 10 minutes. In the conventional EVLP group, PEEP was increased to 10 cm H2O for 10 minutes with unchanged lung perfusion. In the modified EVLP group, the arterial oxygen partial pressure (PaO2 was 18.5 ± 7.0 kPa before and 64.5 ± 6.0 kPa after the maneuver (P<0.001. In the conventional EVLP group, the PaO2 was 16.8 ± 3.1 kPa and 46.8 ± 2.7 kPa after the maneuver (P<0.01; P<0.01. In the modified EVLP group, the pulmonary graft weight was unchanged, while in the conventional EVLP group, the pulmonary graft weight was significantly increased. Modified EVLP with normoventilation of the lungs without ongoing lung perfusion for 10 minutes may eliminate atelectasis almost completely without harming the lungs.

  12. Massive aspiration past the tracheal tube cuff caused by closed tracheal suction system.

    Science.gov (United States)

    Dave, Mital H; Frotzler, Angela; Madjdpour, Caveh; Koepfer, Nelly; Weiss, Markus

    2011-01-01

    Aspiration past the tracheal tube cuff has been recognized to be a risk factor for the development of ventilator-associated pneumonia (VAP). This study investigated the effect of closed tracheal suctioning on aspiration of fluid past the tracheal tube cuff in an in vitro benchtop model. High-volume low pressure tube cuffs of 7.5 mm internal diameter (ID) were placed in a 22 mm ID artificial trachea connected to a test lung. Positive pressure ventilation (PPV) with 15 cm H₂O peak inspiratory pressure and 5 cm H₂O positive end-expiratory pressure (PEEP) was used. A closed tracheal suction system (CTSS) catheter (size 14Fr) was attached to the tracheal tube and suction was performed for 5, 10, 15, or 20 seconds under 200 or 300 cm H₂O suction pressures. Amount of fluid (mL) aspirated along the tube cuff and the airway pressure changes were recorded for each suction procedure. Fluid aspiration during different suction conditions was compared using Kruskal-Wallis and Mann-Whitney test (Bonferroni correction [α = .01]). During 10, 15, and 20 seconds suction, airway pressure consistently dropped down to -8 to -13 cm H₂O (P aspiration was never observed under PPV + PEEP but occurred always during suctioning. Aspiration along the tube cuff was higher with -300 cm H₂O than with -200 cm H₂O suction pressure (P aspiration of fluid occurs along the tracheal tube cuff during suction with the closed tracheal suction system. © SAGE Publications 2011.

  13. Evaluation of transport ventilators at mild simulated altitude: a bench study in a hypobaric chamber.

    Science.gov (United States)

    Boussen, Salah; Coulange, Mathieu; Fournier, Marc; Gainnier, Marc; Michelet, Pierre; Micoli, Christophe; Negrel, Lionel

    2014-08-01

    Previous studies on ventilators used for air transport showed significant effects of altitude, in particular with regard to accuracy of the tidal volume (VT) and breathing frequency. The aim of the study was to evaluate transport ventilators under hypobaric conditions. We conducted a bench study of 6 transport ventilators in a Comex hypobaric chamber to simulate mild altitude (1,500 m [4,920 feet] and 2,500 m [8,200 feet]). The ventilators were connected to a test lung to evaluate their accuracy: (1) to deliver a set VT under normal resistance and compliance conditions at F(IO2) = 0.6 and 1, (2) to establish a set PEEP (0, 5, 10, and 15 cm H2O), and (3) to establish a set inspiratory pressure in pressure controlled mode, (4) at a F(IO2) setting, and (5) and at a frequency setting. Four ventilators kept an average relative error in VT of ventilator was affected by the altitude only at F(IO2) = 1. The Osiris 3 ventilator had > 40% error even at 1,500 m. We found no change in frequency as a function of altitude for any ventilators studied. No clinically important differences were found between all altitudes with the PEEP or inspiratory pressure setting. Although F(IO2) was affected by altitude, the average error did not exceed 11%, and it is unclear whether this fact is an experimental artifact. We have shown that most of the new transport ventilators tested require no setting adjustment at moderate altitude and are as safe at altitude as at sea level under normal respiratory conditions. Older technologies still deliver more volume with altitude in volumetric mode.

  14. Endotracheal tube resistance and inertance in a model of mechanical ventilation of newborns and small infants—the impact of ventilator settings on tracheal pressure swings

    International Nuclear Information System (INIS)

    Hentschel, Roland; Buntzel, Julia; Guttmann, Josef; Schumann, Stefan

    2011-01-01

    Resistive properties of endotracheal tubes (ETTs) are particularly relevant in newborns and small infants who are generally ventilated through ETTs with a small inner diameter. The ventilation rate is also high and the inspiratory time (ti) is short. These conditions effectuate high airway flows with excessive flow acceleration, so airway resistance and inertance play an important role. We carried out a model study to investigate the impact of varying ETT size, lung compliance and ventilator settings, such as peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP) and inspiratory time (ti) on the pressure–flow characteristics with respect to the resistive and inertive properties of the ETT. Pressure at the Y piece was compared to direct measurement of intratracheal pressure (P trach ) at the tip of the ETT, and pressure drop (ΔP ETT ) was calculated. Applying published tube coefficients (Rohrer's constants and inertance), P trach was calculated from ventilator readings and compared to measured P trach using the root-mean-square error. The most relevant for ΔP ETT was the ETT size, followed by (in descending order) PIP, compliance, ti and PEEP, with gas flow velocity being the principle in common for all these parameters. Depending on the ventilator settings ΔP ETT exceeded 8 mbar in the smallest 2.0 mm ETT. Consideration of inertance as an additional effect in this setting yielded a better agreement of calculated versus measured P trach than Rohrer's constants alone. We speculate that exact tracheal pressure tracings calculated from ventilator readings by applying Rohrer's equation and the inertance determination to small size ETTs would be helpful. As an integral part of ventilator software this would (1) allow an estimate of work of breathing and implementation of an automatic tube compensation, and (2) be important for gentle ventilation in respiratory care, especially of small infants, since it enables the physician to

  15. Assessment and monitoring of flow limitation and other parameters from flow/volume loops.

    Science.gov (United States)

    Dueck, R

    2000-01-01

    Flow/volume (F/V) spirometry is routinely used for assessing the type and severity of lung disease. Forced vital capacity (FVC) and timed vital capacity (FEV1) provide the best estimates of airflow obstruction in patients with asthma, chronic obstructive pulmonary disease (COPD) and emphysema. Computerized spirometers are now available for early home recognition of asthma exacerbation in high risk patients with severe persistent disease, and for recognition of either infection or rejection in lung transplant patients. Patients with severe COPD may exhibit expiratory flow limitation (EFL) on tidal volume (VT) expiratory F/V (VTF/V) curves, either with or without applying negative expiratory pressure (NEP). EFL results in dynamic hyperinflation and persistently raised alveolar pressure or intrinsic PEEP (PEEPi). Hyperinflation and raised PEEPi greatly enhance dyspnea with exertion through the added work of the threshold load needed to overcome raised pleural pressure. Esophageal (pleural) pressure monitoring may be added to VTF/V loops for assessing the severity of PEEPi: 1) to optimize assisted ventilation by mask or via endotracheal tube with high inspiratory flow rates to lower I:E ratio, and 2) to assess the efficacy of either pressure support ventilation (PSV) or low level extrinsic PEEP in reducing the threshold load of PEEPi. Intraoperative tidal volume F/V loops can also be used to document the efficacy of emphysema lung volume reduction surgery (LVRS) via disappearance of EFL. Finally, the mechanism of ventilatory constraint can be identified with the use of exercise tidal volume F/V loops referenced to maximum F/V loops and static lung volumes. Patients with severe COPD show inspiratory F/V loops approaching 95% of total lung capacity, and flow limitation over the entire expiratory F/V curve during light levels of exercise. Surprisingly, patients with a history of congestive heart failure may lower lung volume towards residual volume during exercise

  16. Actual performance of mechanical ventilators in ICU: a multicentric quality control study.

    Science.gov (United States)

    Govoni, Leonardo; Dellaca', Raffaele L; Peñuelas, Oscar; Bellani, Giacomo; Artigas, Antonio; Ferrer, Miquel; Navajas, Daniel; Pedotti, Antonio; Farré, Ramon

    2012-01-01

    Even if the performance of a given ventilator has been evaluated in the laboratory under very well controlled conditions, inappropriate maintenance and lack of long-term stability and accuracy of the ventilator sensors may lead to ventilation errors in actual clinical practice. The aim of this study was to evaluate the actual performances of ventilators during clinical routines. A resistance (7.69 cmH(2)O/L/s) - elastance (100 mL/cmH(2)O) test lung equipped with pressure, flow, and oxygen concentration sensors was connected to the Y-piece of all the mechanical ventilators available for patients in four intensive care units (ICUs; n = 66). Ventilators were set to volume-controlled ventilation with tidal volume = 600 mL, respiratory rate = 20 breaths/minute, positive end-expiratory pressure (PEEP) = 8 cmH(2)O, and oxygen fraction = 0.5. The signals from the sensors were recorded to compute the ventilation parameters. The average ± standard deviation and range (min-max) of the ventilatory parameters were the following: inspired tidal volume = 607 ± 36 (530-723) mL, expired tidal volume = 608 ± 36 (530-728) mL, peak pressure = 20.8 ± 2.3 (17.2-25.9) cmH(2)O, respiratory rate = 20.09 ± 0.35 (19.5-21.6) breaths/minute, PEEP = 8.43 ± 0.57 (7.26-10.8) cmH(2)O, oxygen fraction = 0.49 ± 0.014 (0.41-0.53). The more error-prone parameters were the ones related to the measure of flow. In several cases, the actual delivered mechanical ventilation was considerably different from the set one, suggesting the need for improving quality control procedures for these machines.

  17. Methylene Blue in Ventilator-Induced Lung Injury after Pneumonectomy: an Experimental Study

    Directory of Open Access Journals (Sweden)

    Ye. V Suborov

    2007-01-01

    Full Text Available Objective: to study the expediency and efficiency of using methylene blue (MB on a model of pneumectomy (PE and subsequent ventilator-induced lung injury (VILI in sheep. Materials and methods. The study was conducted at the Research Laboratory of University of Tromse. The experiment included 23 sheep weighing 41.0±4.9 kg. Thoracotomy and right-sided pneumonectomy were performed in the animals under general anesthesia and controlled artificial ventilation. After measurement of the parameters of systemic hemodynamics and extravascular water of the lung (EVWL, the animals were divided into 3 groups: 1 a control group (CG, n=7 with a tidal volume (TV of 6 ml/kg and an end-expiratory positive pressure (PEEP of 2 cm H2O; 2 a VILI group (n=9 with a TV of 12 ml/kg and a PEEP of 0 cm H2O; 3 a group of MB (n=7 that was given in parallel with a damaging ventilation mode. The thermodilution technique (using a Cold Z-021 monitor, (Pulsion, Germany was employed to measure volumetric parameters and EVWL. The parameters of pulmonary hemodynamics, respiratory mechanics, and blood gas composition were recorded. Results: After its reduction at PE, EVWL index increased during damaging ventilation in the VILI and MB groups. In addition, there was an increase in pulmonary artery wedge pressure after PE in the MB and VILI groups. In the latter group, arterial hypoxemia was observed at the end of the experiment. Along with this, after PE pulmonary compliance decreased and airway pressure elevated in the VILI and MB groups. Conclusion: In the presented model of VILI, MB does not prevent the development of postp-neumectomic edema of the lung. Key words: thermochromodilution, acute lung injury, pneumectomy, ventilator-induced lung injury, postpneumectomic edema of the lung, methylene blue.

  18. Avaliação das modalidades ventilatórias no período transoperatório por meio de questionário Evaluación de las modalidades ventilatorias en el período transoperatorio por medio de cuestionario Evaluation of transoperatory ventilation modalities by a questionnaire

    Directory of Open Access Journals (Sweden)

    Angel Soubhie

    2010-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Os aparelhos de anestesia vêm possibilitando reduzir repercussões fisiológicas e problemas causados por ventilação mecânica. O objetivo deste estudo foi avaliar, retrospectivamente, os métodos e recursos de suporte ventilatório utilizados por um grupo de anestesiologistas em pacientes sem lesão pulmonar prévia no período intraoperatório. MÉTODO: Um questionário anônimo, com 27 questões objetivas, foi aplicado em um grupo composto por médicos anestesiologistas e em especialização que atuam em diferentes hospitais privados na cidade de São Paulo. Os questionários foram aplicados em um período de 15 dias. Observaram-se os padrões ventilatórios, a pressão positiva ao final da expiração (PEEP, o recrutamento alveolar e o cálculo do volume-corrente empregado com intubação traqueal. RESULTADOS: Os participantes foram predominantemente do sexo masculino, 40,5% com título superior em Anestesiologia (TSA, e a maioria concluiu a especialização há menos de 10 anos. A maior parte dos anestesiologistas faz uso de PEEP rotineiramente, entre 5 e 10 cmH2O. Fluxo de gases frescos acima de 1.000 mL.min-1 ainda é utilizado pela maior parte dos anestesiologistas. Manobras de recrutamento alveolar são realizadas por 80% dos entrevistados, logo após a intubação e antes da desintubação, sendo a estratégia mais comum a insuflação com 40 cmH2O por 15 segundos. Quanto às estratégias protetoras de ventilação, apenas 30% utilizam volume-corrente JUSTIFICATIVA Y OBJETIVOS: Los aparatos de anestesia han venido posibilitando la reducción de las repercusiones fisiológicas y de los problemas causados por la ventilación mecánica. El objetivo de este estudio fue evaluar de forma retrospectiva, los métodos y los recursos de ayuda ventilatoria utilizados por un grupo de anestesiólogos en pacientes sin lesión pulmonar previa en el período intraoperatorio. MÉTODO: Un cuestionario no identificado, con

  19. Estratégias ventilatórias frente à hipoxemia em cirurgia cardíaca: validação de questionário para anestesiologistas no Brasil Estrategias ventilatorias frente a la hipoxemia en cirugía cardíaca: validación de cuestionario para anestesiólogos en Brasil Ventilatory strategies for hypoxemia during cardiac surgery: survey validation for anesthesiologists in Brazil

    Directory of Open Access Journals (Sweden)

    Celso Augusto Martins Parra

    2010-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A hipoxemia perioperatória ocorre frequentemente em cirurgia cardíaca e a atelectasia é sua principal causa. Além disso, podemos citar como causas circulação extracorpórea (CEC, dissecção de artérias torácicas internas, status clínico prévio do paciente, entre outras. O presente estudo elaborou um questionário anônimo para observar as estratégias ventilatórias frente à hipoxemia em cirurgia cardía ca adotadas por cinco mil anestesiologistas distribuídos no país. MÉTODO: Foram enviados questionários por e-mail a cinco mil anestesiologistas do Brasil. RESULTADOS: Dos questionários enviados, foram recebidas 81 respostas válidas. Dentre as respostas, 65 (80% anestesiologistas fazem uso da ventilação controlada a volume (VCV frente a 16 (20% que preferem ventilação controlada à pressão (PCV. O volume (Vt corrente utilizado é inferior a 10 mL.kg-1 para 46 (61% contra 29 (39% que adotam um Vt maior que 10 mL.kg-1. Quarenta e sete (58% usam PEEP e 17 (21% utilizam FiO2 acima de 60%. No caso de hipoxemia intraoperatória, 20,9% aumentam ou introduzem PEEP, 70,3% aumentam a FiO2, 19,7% realizam manobra de recrutamento alveolar, 13,5% aumentam o volume-corrente e 20,9% realizam checagem de falhas no aparelho de anestesia. As respostas foram enviadas de 15 estados. CONCLUSÕES: As condutas descritas nos questionários respondidos são compatíveis com a literatura internacional. Com ajuste no formato do questionário e na abordagem aos anestesiologistas, novos estudos poderão ser realizados.JUSTIFICATIVA Y OBJETIVOS: La hipoxemia perioperatoria ocurre frecuentemente en la cirugía cardíaca, y la atelectasia es su principal causa. Además, podemos citar como causas la circulación extracorpórea (CEC, disección de arterias torácicas internas, status clínico previo del paciente, entre otras. El presente estudio elaboró un cuestionario anónimo para observar las estrategias ventilatorias frente a

  20. Avaliação da função pulmonar em pacientes submetidos à cirurgia cardíaca com circulação extracorpórea Evaluación de la función pulmonar en pacientes sometidos a cirugía cardíaca con circulación extracorpórea Evaluation of pulmonary function in patients undergoing cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Ricardo Antonio Guimarães Barbosa

    2002-11-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: As complicações pulmonares permanecem como um grande problema no pós-operatório de cirurgia cardíaca com circulação extracorpórea (CEC. O objetivo do presente estudo foi avaliar as alterações da função pulmonar ocorridas em pacientes submetidos à cirurgia cardíaca de revascularização miocárdica, comparando-os àqueles submetidos à cirurgia cardíaca de troca valvar. MÉTODO: Quinze pacientes submetidos à revascularização (Grupo RM e 15 pacientes submetidos à troca valvar (Grupo TV foram avaliados através da relação entre a pressão arterial de oxigênio e sua fração inspirada (PaO2/FiO2, do gradiente alvéolo-arterial de oxigênio (GA-aO2, do shunt pulmonar, da PEEP de melhor complacência e da complacência estática, avaliados no pré-operatório, após a indução da anestesia, 1, 3 e 6 horas de pós-operatório e no 1º e 2º dias de pós-operatório. Os dados foram analisados através da análise de variância para medidas repetidas (p JUSTIFICATIVA Y OBJETIVOS: Las complicaciones pulmonares permanecen como un grande problema en el pós-operatorio de cirugía cardíaca con circulación extracorpórea (CEC. El objetivo de este actual estudio fue evaluar las alteraciones de la función pulmonar ocurridas en pacientes sometidos a cirugía cardíaca de revascularización miocárdica, comparándolos a aquellos sometidos a cirugía cardíaca de cambio valvar. MÉTODO: Quince pacientes sometidos a revascularización (Grupo RM y 15 pacientes sometidos a cambio valvar (Grupo TV fueron evaluados a través de la relación entre la presión arterial de oxígeno y su fracción inspirada (PaO2/FiO2, del gradiente alvéolo-arterial de oxígeno (GA-aO2, del shunt pulmonar, de la PEEP de mejor Complacencia y de la Complacencia Estática, evaluados en el pré-operatorio, después de la inducción de la anestesia, 1, 3 y 6 horas de pós-operatorio y en el 1º y 2º dias de pós-operatorio. Los datos fueron

  1. Liberação de pressão de vias aéreas em pacientes pediátricos submetidos à cirurgia cardíaca Airway pressure release ventilation in post operative cardiac surgery in pediatric patients

    Directory of Open Access Journals (Sweden)

    W. B. de Carvalho

    2000-06-01

    Full Text Available OBJETIVO: Comparar três modos de VPM, a ventilação mandatória intermitente com pressão expiratória positiva (VMI+PEEP, a VLPVA e a utilização de pressão positiva contínua em vias aéreas (CPAP em crianças no pós-operatório de cirurgia cardíaca com hipertensão pulmonar e lesão pulmonar leve ou moderada. MÉTODOS: Estudados 10 pacientes com monitorização respiratória (Bear Neonatal Volume Monitor-1®, em VPM com aparelho de fluxo contínuo, ciclado a tempo e limitado a pressão. As variáveis cardiocirculatórias analisadas foram a pressão venosa central (PVC, extração de oxigênio (ExtO2, freqüência cardíaca (FC, pressão arterial sistólica (PAS, pressão arterial média (PAM e a diferença artério-venosa de CO2 (D(A-VCO2. Utilizou-se o teste não-paramétrico de Friedman para comparar as variáveis aferidas nas três modalidades de ventilação e o teste de Wilcoxon para a comparação das variáveis obtidas em duas das modalidades. RESULTADOS: A pressão média de vias aéreas (PMVA apresentou um aumento significante durante a VLPVA em relação à VMI+PEEP (p=0,012. A pressão inspiratória positiva (PIP, o volume minuto e a relação da pressão arterial de O2 com a fração inspirada de O2 (PaO2/FiO2 não mostraram diferença estatística. Houve uma diminuição da freqüência respiratória (FR na VLPVA (p=0,004 e um aumento do volume corrente (VC (p=0,045 comparativamente aos outros dois modos de ventilação. A PVC foi a única variável cardiocirculatória que apresentou alteração mostrando ser maior (p=0,019 na VLPVA. CONCLUSÕES: Devido à metodologia empregada, houve um aumento significativo da PMVA na VLPVA, com conseqüente aumento do VC e manutenção das outras variáveis respiratórias e cardiocirculatórias quando comparados os três modos de VPM, indicando ser a VLPVA um método seguro e de fácil aplicação.OBJECTIVE: Comparison of three modes of MV: intermittent mandatory ventilation with

  2. [Effects of recruitment maneuver in prone position on hemodynamics in patients with severe pulmonary infection].

    Science.gov (United States)

    Fan, Yuan-hua; Liu, Yuan-fei; Zhu, Hua-yong; Zhang, Min

    2012-02-01

    To evaluate effects of recruitment maneuver in prone position on hemodynamics in patients with severe pulmonary infection, based on the protective pulmonary ventilation strategy. Ninety-seven cases with severe pulmonary infection admitted to intensive care unit (ICU) of Ganzhou City People's Hospital undergoing mechanical ventilation were involved. Volume controlled ventilation mode with small tidal volume (8 ml/kg) and positive end-expiratory pressure (PEEP) of 6 cm H(2)O [1 cm H(2)O = 0.098 kPa] was conducted. Each patient underwent recruitment maneuver in supine position and then in prone position [PEEP 20 cm H(2)O+pressure control (PC) 20 cm H(2)O]. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation [SpO(2)] and blood gas analysis data were recorded before and after recruitment maneuver in either position. A double-lumen venous catheter was inserted into internal jugular vein or subclavian vein, and a pulse index contour cardiac output (PiCCO) catheter was introduced into femoral artery. Cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI), intra-thoracic blood volume index (ITBVI), extra vascular lung water index (EVLWI), global end-diastolic volume index (GEDVI), global ejection fraction (GEF), stroke volume variation (SVV) and central vein pressure (CVP) were monitored. (1) Compared with data before recruitment maneuver, there were no significant differences in HR and MAP after supine position and prone position recruitment maneuver, but significant differences in SpO(2) were found between before and after recruitment maneuver when patients' position was changed (supine position: 0.954 ± 0.032 vs. 0.917 ± 0.025, P recruitment maneuver (P recruitment maneuver, CI [L×min(-1)×m(-2)], SVI (ml/m(2)), GEDVI (ml/m(2)) and GEF were decreased significantly during recruitment maneuver (supine position: CI 3.2 ± 0.4 vs. 3.8 ± 0.6, SVI 32.4 ± 5.6 vs. 38.8 ± 6.5, GEDVI 689 ± 44 vs. 766 ± 32, GEF 0.267 ± 0

  3. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial.

    Science.gov (United States)

    Ferrando, Carlos; Soro, Marina; Unzueta, Carmen; Suarez-Sipmann, Fernando; Canet, Jaume; Librero, Julián; Pozo, Natividad; Peiró, Salvador; Llombart, Alicia; León, Irene; India, Inmaculada; Aldecoa, Cesar; Díaz-Cambronero, Oscar; Pestaña, David; Redondo, Francisco J; Garutti, Ignacio; Balust, Jaume; García, Jose I; Ibáñez, Maite; Granell, Manuel; Rodríguez, Aurelio; Gallego, Lucía; de la Matta, Manuel; Gonzalez, Rafael; Brunelli, Andrea; García, Javier; Rovira, Lucas; Barrios, Francisco; Torres, Vicente; Hernández, Samuel; Gracia, Estefanía; Giné, Marta; García, María; García, Nuria; Miguel, Lisset; Sánchez, Sergio; Piñeiro, Patricia; Pujol, Roger; García-Del-Valle, Santiago; Valdivia, José; Hernández, María J; Padrón, Oto; Colás, Ana; Puig, Jaume; Azparren, Gonzalo; Tusman, Gerardo; Villar, Jesús; Belda, Javier

    2018-03-01

    The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m 2 . Patients were randomly assigned (1:1:1:1) online to receive one of four lung-protective ventilation strategies using low tidal volume plus positive end-expiratory pressure (PEEP): open-lung approach (OLA)-iCPAP (individualised intraoperative ventilation [individualised PEEP after a lung recruitment manoeuvre] plus individualised postoperative continuous positive airway pressure [CPAP]), OLA-CPAP (intraoperative individualised ventilation plus postoperative CPAP), STD-CPAP (standard intraoperative ventilation plus postoperative CPAP), or STD-O 2 (standard intraoperative ventilation plus standard postoperative oxygen therapy). Patients were masked to treatment allocation. Investigators were not masked in the operating and postoperative rooms; after 24 h, data were given to a second investigator who was masked to allocations. The primary outcome was a composite of pulmonary and systemic complications during the first 7 postoperative days. We did the primary analysis using the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02158923. Between Jan 2, 2015, and May 18, 2016, we enrolled 1012 eligible patients. Data were available for 967 patients, whom we included in the final analysis. Risk of pulmonary and systemic

  4. Propostas em ventilação mecânica na síndrome da angústia respiratória Propuestas en ventilación mecánica en la síndrome de angustia respiratoria Mechanical ventilatory management in adult respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    José Otávio Costa Auler Junior

    2001-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O objetivo deste artigo é oferecer ao leitor um resumo das normas já consagradas pela literatura a respeito da estratégia atual do manuseio da ventilação durante a Síndrome da Angústia Respiratória Aguda (SARA. Isto é de fundamental importância, já que a ventilação mecânica, como medida terapêutica, tem estado sob constante revisão e muitos artigos têm sido publicados a este respeito. CONTEÚDO: Este trabalho contém a revisão de 29 artigos e um livro, selecionados a partir de pesquisa de palavras-chaves realizada no MEDLINE. CONCLUSÕES: Muito se tem publicado a respeito de ventilação em SARA, porém, tende-se para uma estratégia de proteção pulmonar baseada em baixo volume corrente e altos níveis de PEEP. Outras medidas adjuvantes seriam tomografias computadorizadas seriadas de tórax, ajuste de PaO2, inalação de óxido nítrico, posição prona e ECMO (extracorporeal membrane oxygenation.JUSTIFICATIVA Y OBJETIVOS: El objetivo de este artículo es ofrecer al lector un resumen de las normas ya consagradas por la literatura a respecto de la estrategia actual del manoseo de la ventilación durante la Síndrome de la Angustia Respiratoria Aguda (SARA. Esto es de fundamental importancia, ya que la ventilación mecánica, como medida terapéutica, ha estado bajo constante revisión, muchos artículos han sido publicados a este respecto. CONTENIDO: Este trabajo contiene la revisión de 29 artículos y un libro, seleccionados a partir de la pesquisa de palabras-claves realizada en el MEDLINE. CONCLUSIONES: Mucho se ha publicado a respecto de ventilación en SARA, sin embargo, la tendencia es para una estrategia de protección pulmonar tomando como base el bajo volumen corriente y altos niveles de PEEP. Otras medidas de ayuda serian tomografías computadorizadas seriadas de tórax, ajuste de PaO2, inhalación de óxido nítrico, posición prono y ECMO (extracorporeal membrane oxygenation

  5. Mecânica pulmonar de pacientes em suporte ventilatório na unidade de terapia intensiva. Conceitos e monitorização Concepts and monitoring of pulmonary mechanic in patients under ventilatory support in intensive care unit

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    Eduardo Antonio Faustino

    2007-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Em ventilação mecânica invasiva e não-invasiva, o conhecimento da fisiologia da mecânica respiratória, é imprescindível para tomada de decisões e no manuseio eficiente dos ventiladores modernos. A monitorização dos parâmetros da mecânica pulmonar é recomendada nos trabalhos de revisão e de pesquisas clínicas. O objetivo deste estudo foi rever os conceitos de mecânica pulmonar e os métodos utilizados para obtenção de medidas à beira do leito, enfatizando três parâmetros: resistência, complacência e PEEP intrínseca. MÉTODO: Foi realizada revisão bibliográfica através dos bancos de dados LILACS, MedLine e PubMed, no período de 1996 a 2006. RESULTADOS: Esta revisão abordou os parâmetros de resistência, complacência pulmonar e PEEP intrínseca como fundamentais na compreensão da insuficiência respiratória aguda e suporte ventilatório mecânico, principalmente na doença pulmonar obstrutiva crônica (DPOC e na síndrome da angústia respiratória aguda (SARA. CONCLUSÕES: A monitorização da mecânica pulmonar em pacientes sob ventilação mecânica em unidade de terapia intensiva (UTI pode fornecer dados relevantes e deve ser implementada de forma sistemática e racional.BACKGROUND AND OBJECTIVES: In mechanical ventilation, invasive and noninvasive, the knowledge of respiratory mechanic physiology is indispensable to take decisions and into the efficient management of modern ventilators. Monitoring of pulmonary mechanic parameters is been recommended from all the review works and clinical research. The objective of this study was review concepts of pulmonary mechanic and the methods used to obtain measures in the bed side, preparing a rational sequence to obtain this data. METHODS: It was obtained bibliographic review through data bank LILACS, MedLine and PubMed, from the last ten years. RESULTS: This review approaches parameters of resistance, pulmonary compliance and intrinsic PEEP

  6. Edema pulmonar assimétrico por pressão negativa pós-obstrução de via aérea superior: relato de caso Edema pulmonar asimétrico por presión negativa pós-obstrucción aguda de vía aérea superior: relato de caso Asymmetric negative pressure pulmonary edema after acute upper airway obstruction: case report

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    Aldo José Peixoto

    2002-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Edema pulmonar por pressão negativa pós-obstrução de via aérea é atualmente uma entidade bem descrita, porém, provavelmente pouco diagnosticada e os casos pouco publicados. O objetivo deste relato é apresentar um caso de edema pulmonar por pressão negativa pós-obstrução de via aérea superior, cuja principal característica foi a assimetria do edema pulmonar, sendo muito mais acentuado no pulmão direito. RELATO DO CASO: Menino de 4 anos, 17 kg, estado físico ASA I, foi submetido a adenoamigdalectomia e cauterização de cornetos, sob anestesia geral com sevoflurano/óxido nitroso/O2. A cirurgia durou 1 hora e 30 minutos sem qualquer intercorrência. Com a superficialização da anestesia o paciente, ventilando espontaneamente, reagiu ao tubo traqueal, que foi retirado. Após isto, os esforços ventilatórios resultaram em retração da parede torácica, sem aparente movimento de ar, sendo impossível ventilá-lo com máscara facial, ocorrendo hipoxemia grave (SpO2 de 50%, necessitando ser reintubado. Neste momento foi verificado que o pulmão se encontrava mais duro e havia estertores bilateralmente, caracterizando edema pulmonar. Uma radiografia de tórax mostrou infiltrado pulmonar difuso bilateralmente, porém, com atelectasia do lobo superior direito, mostrando acentuada assimetria do edema pulmonar. O paciente teve que ser ventilado mecanicamente com PEEP durante 20 horas, quando foi extubado. Houve melhora progressiva do edema pulmonar, recebendo alta em 48 horas. CONCLUSÕES: O edema pulmonar por pressão negativa é uma entidade rara com alto grau de morbidade, pouco diagnosticada e exige do anestesiologista conhecimento atualizado e tratamento adequado. Costuma ser bilateral, raramente unilateral e excepcionalmente com expressiva assimetria como no nosso relato. A maioria dos casos é tratada com suporte ventilatório com PEEP ou CPAP, não necessitando de qualquer outra terapia. O prognóstico

  7. Impacto hemodinâmico de manobra de recrutamento alveolar em pacientes evoluindo com choque cardiogênico no pós-operatório imediato de revascularização do miocárdio Impacto hemodinámico de maniobra de reclutamiento alveolar en pacientes evolucionando con choque cardiogénico en el postoperatorio inmediato de revascularización del miocardio Hemodynamic impact of alveolar recruitment maneuver in patients evolving with cardiogenic shock in the immediate postoperative period of myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Luiz Marcelo Sá Malbouisson

    2008-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Manobras de recrutamento alveolar (MRA utilizando pressões de 40 cmH2O nas vias aéreas são efetivas em reverter as atelectasias após revascularização cirúrgica do miocárdio (RM, contudo não existem estudos avaliando o impacto hemodinâmico dessa manobra em pacientes que evoluíram com choque cardiogênico. O objetivo foi testar a tolerância hemodinâmica à MRA em pacientes evoluindo com choque cardiogênico após RM. MÉTODO: Após admissão na UTI e estabilização hemodinâmica, foram estudados dez pacientes hipoxêmicos e em choque cardiogênico após RM. Os ajustes ventilatórios foram volume corrente de 8 mL.kg-1, PEEP 5 cmH2O, FR de 12 ipm e FiO2 de 0,6. Pressão contínua de 40 cmH2O foi aplicada nas vias aéreas por 40 segundos em três ciclos. Entre os ciclos, os pacientes foram ventilados por 30 segundos e após o último ciclo a PEEP foi ajustada em 10 cmH2O. Foram obtidas medidas hemodinâmicas após 1, 10, 30 e 60 minutos da MRA e colhidas amostras sangüíneas arteriais e venosas para mensuração de lactato e gases sangüíneos 10 e 60 minutos após. Dados analisados por meio de ANOVA e teste de Friedman. Valor de p fixado em 0,05. RESULTADOS: A MRA aumentou a relação PaO2/FiO2 de 87 para 129,5 após 10 minutos e 120 após 60 minutos (p JUSTIFICATIVA Y OBJETIVOS: Maniobras de reclutamiento alveolar (MRA utilizando presiones de 40 cmH2O en las vías aéreas son efectivas en revertir las atelectasias después de la revascularización quirúrgica del miocardio (RM, sin embargo, no existen estudios que evalúen el impacto hemodinámico de esta maniobra en pacientes que evolucionaron con choque cardiogénico. El objetivo fue probar la tolerancia hemodinámica a la MRA en pacientes que evolucionan con choque cardiogénico después de la RM. MÉTODO: Después de la entrada en la UCI y de la estabilización hemodinámica, se estudiaron 10 pacientes hipoxémicos y en choque cardiogénico después de

  8. Acute chlorine gas exposure produces transient inflammation and a progressive alteration in surfactant composition with accompanying mechanical dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Massa, Christopher B.; Scott, Pamela; Abramova, Elena; Gardner, Carol; Laskin, Debra L.; Gow, Andrew J., E-mail: Gow@rci.rutgers.edu

    2014-07-01

    Acute Cl{sub 2} exposure following industrial accidents or military/terrorist activity causes pulmonary injury and severe acute respiratory distress. Prior studies suggest that antioxidant depletion is important in producing dysfunction, however a pathophysiologic mechanism has not been elucidated. We propose that acute Cl{sub 2} inhalation leads to oxidative modification of lung lining fluid, producing surfactant inactivation, inflammation and mechanical respiratory dysfunction at the organ level. C57BL/6J mice underwent whole-body exposure to an effective 60 ppm-hour Cl{sub 2} dose, and were euthanized 3, 24 and 48 h later. Whereas pulmonary architecture and endothelial barrier function were preserved, transient neutrophilia, peaking at 24 h, was noted. Increased expression of ARG1, CCL2, RETLNA, IL-1b, and PTGS2 genes was observed in bronchoalveolar lavage (BAL) cells with peak change in all genes at 24 h. Cl{sub 2} exposure had no effect on NOS2 mRNA or iNOS protein expression, nor on BAL NO{sub 3}{sup −} or NO{sub 2}{sup −}. Expression of the alternative macrophage activation markers, Relm-α and mannose receptor was increased in alveolar macrophages and pulmonary epithelium. Capillary surfactometry demonstrated impaired surfactant function, and altered BAL phospholipid and surfactant protein content following exposure. Organ level respiratory function was assessed by forced oscillation technique at 5 end expiratory pressures. Cl{sub 2} exposure had no significant effect on either airway or tissue resistance. Pulmonary elastance was elevated with time following exposure and demonstrated PEEP refractory derecruitment at 48 h, despite waning inflammation. These data support a role for surfactant inactivation as a physiologic mechanism underlying respiratory dysfunction following Cl{sub 2} inhalation. - Highlights: • Effect of 60 ppm*hr Cl{sub 2} gas on lung inflammation and mechanical function examined. • Pulmonary inflammation is transient and minor.

  9. Increasing the inspiratory time and I:E ratio during mechanical ventilation aggravates ventilator-induced lung injury in mice.

    Science.gov (United States)

    Müller-Redetzky, Holger C; Felten, Matthias; Hellwig, Katharina; Wienhold, Sandra-Maria; Naujoks, Jan; Opitz, Bastian; Kershaw, Olivia; Gruber, Achim D; Suttorp, Norbert; Witzenrath, Martin

    2015-01-28

    Lung-protective ventilation reduced acute respiratory distress syndrome (ARDS) mortality. To minimize ventilator-induced lung injury (VILI), tidal volume is limited, high plateau pressures are avoided, and positive end-expiratory pressure (PEEP) is applied. However, the impact of specific ventilatory patterns on VILI is not well defined. Increasing inspiratory time and thereby the inspiratory/expiratory ratio (I:E ratio) may improve oxygenation, but may also be harmful as the absolute stress and strain over time increase. We thus hypothesized that increasing inspiratory time and I:E ratio aggravates VILI. VILI was induced in mice by high tidal-volume ventilation (HVT 34 ml/kg). Low tidal-volume ventilation (LVT 9 ml/kg) was used in control groups. PEEP was set to 2 cm H2O, FiO2 was 0.5 in all groups. HVT and LVT mice were ventilated with either I:E of 1:2 (LVT 1:2, HVT 1:2) or 1:1 (LVT 1:1, HVT 1:1) for 4 hours or until an alternative end point, defined as mean arterial blood pressure below 40 mm Hg. Dynamic hyperinflation due to the increased I:E ratio was excluded in a separate group of animals. Survival, lung compliance, oxygenation, pulmonary permeability, markers of pulmonary and systemic inflammation (leukocyte differentiation in lung and blood, analyses of pulmonary interleukin-6, interleukin-1β, keratinocyte-derived chemokine, monocyte chemoattractant protein-1), and histopathologic pulmonary changes were analyzed. LVT 1:2 or LVT 1:1 did not result in VILI, and all individuals survived the ventilation period. HVT 1:2 decreased lung compliance, increased pulmonary neutrophils and cytokine expression, and evoked marked histologic signs of lung injury. All animals survived. HVT 1:1 caused further significant worsening of oxygenation, compliance and increased pulmonary proinflammatory cytokine expression, and pulmonary and blood neutrophils. In the HVT 1:1 group, significant mortality during mechanical ventilation was observed. According to the "baby lung

  10. Ventilation practices in subarachnoid hemorrhage: a cohort study exploring the use of lung protective ventilation.

    Science.gov (United States)

    Marhong, Jonathan D; Ferguson, Niall D; Singh, Jeffrey M

    2014-10-01

    Acute respiratory distress syndrome (ARDS) is common following aneurysmal subarachnoid hemorrhage (SAH), but the influence of mechanical ventilator settings on its development is unclear. We sought to determine adherence to lung protective thresholds in ventilated patients with SAH and describe the association between ventilator settings and subsequent development of ARDS. We conducted a retrospective cohort study of consecutive patients receiving mechanical ventilation within 72 h of SAH at a single academic center. Ventilator settings and blood gas data were collected twice daily for the first 7 days of ventilation along with ICU and hospital outcomes. Lung protective ventilation was defined as follows: tidal volume ≤8 mL/kg of predicted body weight, positive end-expiratory pressure (PEEP) ≥5 cm H(2)O, and peak or plateau pressure ≤30 cm H(2)O. The development of ARDS was ascertained retrospectively by PaO(2)/FiO(2) ≤300 with new bilateral lung opacities on chest X-ray within one day of hypoxemia. We identified 62 patients who underwent early mechanical ventilation following SAH. PS and Continuous Positive Airway Pressure were common ventilator modes with a median tidal volume of 7.8 mL/kg [interquartile range 6.8-8.8], median peak pressure of 14 cm H(2)O [IQR 12-17], and median PEEP of 5 cm H(2)O [IQR 5-6]. Adherence to tidal volumes ≤8 mL/kg was seen in 64 % of all observations and peak pressures protective criteria were seen in 58 % of all observations. Thirty-one patients (50 %) were determined to have ARDS. ARDS patients were more frequently ventilated with a peak pressure >30 cm H(2)O (11.3 % of ARDS ventilation days vs. 0 % of non-ARDS ventilation days; p mechanical ventilation frequently breathe spontaneously, generating tidal volumes above usual protective thresholds regardless of meeting ARDS criteria. In patients with SAH, the presence of an additional ARDS risk factor should prompt close screening for the development of ARDS and

  11. Adjusting tidal volume to stress index in an open lung condition optimizes ventilation and prevents overdistension in an experimental model of lung injury and reduced chest wall compliance.

    Science.gov (United States)

    Ferrando, Carlos; Suárez-Sipmann, Fernando; Gutierrez, Andrea; Tusman, Gerardo; Carbonell, Jose; García, Marisa; Piqueras, Laura; Compañ, Desamparados; Flores, Susanie; Soro, Marina; Llombart, Alicia; Belda, Francisco Javier

    2015-01-13

    The stress index (SI), a parameter derived from the shape of the pressure-time curve, can identify injurious mechanical ventilation. We tested the hypothesis that adjusting tidal volume (VT) to a non-injurious SI in an open lung condition avoids hypoventilation while preventing overdistension in an experimental model of combined lung injury and low chest-wall compliance (Ccw). Lung injury was induced by repeated lung lavages using warm saline solution, and Ccw was reduced by controlled intra-abdominal air-insufflation in 22 anesthetized, paralyzed and mechanically ventilated pigs. After injury animals were recruited and submitted to a positive end-expiratory pressure (PEEP) titration trial to find the PEEP level resulting in maximum compliance. During a subsequent four hours of mechanical ventilation, VT was adjusted to keep a plateau pressure (Pplat) of 30 cmH2O (Pplat-group, n = 11) or to a SI between 0.95 and 1.05 (SI-group, n = 11). Respiratory rate was adjusted to maintain a 'normal' PaCO2 (35 to 65 mmHg). SI, lung mechanics, arterial-blood gases haemodynamics pro-inflammatory cytokines and histopathology were analyzed. In addition Computed Tomography (CT) data were acquired at end expiration and end inspiration in six animals. PaCO2 was significantly higher in the Pplat-group (82 versus 53 mmHg, P = 0.01), with a resulting lower pH (7.19 versus 7.34, P = 0.01). We observed significant differences in VT (7.3 versus 5.4 mlKg(-1), P = 0.002) and Pplat values (30 versus 35 cmH2O, P = 0.001) between the Pplat-group and SI-group respectively. SI (1.03 versus 0.99, P = 0.42) and end-inspiratory transpulmonary pressure (PTP) (17 versus 18 cmH2O, P = 0.42) were similar in the Pplat- and SI-groups respectively, without differences in overinflated lung areas at end- inspiration in both groups. Cytokines and histopathology showed no differences. Setting tidal volume to a non-injurious stress index in an open lung condition improves

  12. Moderately high frequency ventilation with a conventional ventilator allows reduction of tidal volume without increasing mean airway pressure.

    Science.gov (United States)

    Cordioli, Ricardo Luiz; Park, Marcelo; Costa, Eduardo Leite Vieira; Gomes, Susimeire; Brochard, Laurent; Amato, Marcelo Britto Passos; Azevedo, Luciano Cesar Pontes

    2014-12-01

    The aim of this study was to explore if positive-pressure ventilation delivered by a conventional ICU ventilator at a moderately high frequency (HFPPV) allows a safe reduction of tidal volume (V T) below 6 mL/kg in a porcine model of severe acute respiratory distress syndrome (ARDS) and at a lower mean airway pressure than high-frequency oscillatory ventilation (HFOV). This is a prospective study. In eight pigs (median weight 34 [29,36] kg), ARDS was induced by pulmonary lavage and injurious ventilation. The animals were ventilated with a randomized sequence of respiratory rates: 30, 60, 90, 120, 150, followed by HFOV at 5 Hz. At each step, V T was adjusted to allow partial pressure of arterial carbon dioxide (PaCO2) to stabilize between 57 and 63 mmHg. Data are shown as median [P25th,P75th]. After lung injury, the PaO2/FiO2 (P/F) ratio was 92 [63,118] mmHg, pulmonary shunt 26 [17,31]%, and static compliance 11 [8,14] mL/cmH2O. Positive end-expiratory pressure (PEEP) was 14 [10,17] cmH2O. At 30 breaths/min, V T was higher than 6 (7.5 [6.8,10.2]) mL/kg, but at all higher frequencies, V T could be reduced and PaCO2 maintained, leading to reductions in plateau pressures and driving pressures. For frequencies of 60 to 150/min, V T progressively fell from 5.2 [5.1,5.9] to 3.8 [3.7,4.2] mL/kg (p mechanics, auto-PEEP generation, hemodynamics, or gas exchange. Mean airway pressure was maintained constant and was increased only during HFOV. During protective mechanical ventilation, HFPPV delivered by a conventional ventilator in a severe ARDS swine model safely allows further tidal volume reductions. This strategy also allowed decreasing airway pressures while maintaining stable PaCO2 levels.

  13. Early detection of ventilation-induced brain injury using magnetic resonance spectroscopy and diffusion tensor imaging: an in vivo study in preterm lambs.

    Directory of Open Access Journals (Sweden)

    Béatrice Skiöld

    Full Text Available BACKGROUND AND AIM: High tidal volume (VT ventilation during resuscitation of preterm lambs results in brain injury evident histologically within hours after birth. We aimed to investigate whether magnetic resonance spectroscopy (MRS and/or diffusion tensor imaging (DTI can be used for early in vivo detection of ventilation-induced brain injury in preterm lambs. METHODS: Newborn lambs (0.85 gestation were stabilized with a "protective ventilation" strategy (PROT, n = 7: prophylactic Curosurf, sustained inflation, VT 7 mL/kg, positive end expiratory pressure (PEEP 5 cmH2O or an initial 15 minutes of "injurious ventilation" (INJ, n = 10: VT 12 mL/kg, no PEEP, late Curosurf followed by PROT ventilation for the remainder of the experiment. At 1 hour, lambs underwent structural magnetic resonance imaging (Siemens, 3 Tesla. For measures of mean/axial/radial diffusivity (MD, AD, RD and fractional anisotropy (FA, 30 direction DTI was performed. Regions of interests encompassed the thalamus, internal capsule, periventricular white matter and the cerebellar vermis. MRS was performed using a localized single-voxel (15×15×20 mm3, echo time 270 ms encompassing suptratentorial deep nuclear grey matter and central white matter. Peak-area ratios for lactate (Lac relative to N-acetylaspartate (NAA, choline (Cho and creatine (Cr were calculated. Groups were compared using 2-way RM-ANOVA, Mann-Whitney U-test and Spearman's correlations. RESULTS: No cerebral injury was seen on structural MR images. Lambs in the INJ group had higher mean FA and lower mean RD in the thalamus compared to PROT lambs, but not in the other regions of interest. Peak-area lactate ratios >1.0 was only seen in INJ lambs. A trend of higher mean peak-area ratios for Lac/Cr and Lac/Cho was seen, which correlated with lower pH in both groups. CONCLUSION: Acute changes in brain diffusion measures and metabolite peak-area ratios were observed after injurious ventilation. Early MRS/DTI is

  14. How do different brands of size 1 laryngeal mask airway compare with face mask ventilation in a dedicated laryngeal mask airway teaching manikin?

    Science.gov (United States)

    Tracy, Mark Brian; Priyadarshi, Archana; Goel, Dimple; Lowe, Krista; Huvanandana, Jacqueline; Hinder, Murray

    2018-05-01

    International neonatal resuscitation guidelines recommend the use of laryngeal mask airway (LMA) with newborn infants (≥34 weeks' gestation or >2 kg weight) when bag-mask ventilation (BMV) or tracheal intubation is unsuccessful. Previous publications do not allow broad LMA device comparison. To compare delivered ventilation of seven brands of size 1 LMA devices with two brands of face mask using self-inflating bag (SIB). 40 experienced neonatal staff provided inflation cycles using SIB with positive end expiratory pressure (PEEP) (5 cmH 2 O) to a specialised newborn/infant training manikin randomised for each LMA and face mask. All subjects received prior education in LMA insertion and BMV. 12 415 recorded inflations for LMAs and face masks were analysed. Leak detected was lowest with i-gel brand, with a mean of 5.7% compared with face mask (triangular 42.7, round 35.7) and other LMAs (45.5-65.4) (p<0.001). Peak inspiratory pressure was higher with i-gel, with a mean of 28.9 cmH 2 O compared with face mask (triangular 22.8, round 25.8) and other LMAs (14.3-22.0) (p<0.001). PEEP was higher with i-gel, with a mean of 5.1 cmH 2 O compared with face mask (triangular 3.0, round 3.6) and other LMAs (0.6-2.6) (p<0.001). In contrast to other LMAs examined, i-gel had no insertion failures and all users found i-gel easy to use. This study has shown dramatic performance differences in delivered ventilation, mask leak and ease of use among seven different brands of LMA tested in a manikin model. This coupled with no partial or complete insertion failures and ease of use suggests i-gel LMA may have an expanded role with newborn resuscitation as a primary resuscitation device. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Performance of current intensive care unit ventilators during pressure and volume ventilation.

    Science.gov (United States)

    Marchese, Andrew D; Sulemanji, Demet; Chipman, Daniel; Villar, Jesús; Kacmarek, Robert M

    2011-07-01

    Intensive-care mechanical ventilators regularly enter the market, but the gas-delivery capabilities of many have never been assessed. We evaluated 6 intensive-care ventilators in the pressure support (PS), pressure assist/control (PA/C), and volume assist/control (VA/C) modes, with lung-model mechanics combinations of compliance and resistance of 60 mL/cm H(2)O and 10 cm H(2)O/L/s, 60 mL/cm H(2)O and 5 cm H(2)O/L/s, and 30 mL/cm H(2)O and 10 cm H(2)O/L/s, and inspiratory muscle effort of 5 and 10 cm H(2)O. PS and PA/C were set to 15 cm H(2)O, and PEEP to 5 and 15 cm H(2)O in all modes. During VA/C, tidal volume was set at 500 mL and inspiratory time was set at 0.8 second. Rise time and termination criteria were set at the manufacturers' defaults, and to an optimal level during PS and PA/C. There were marked differences in ventilator performance in all 3 modes. VA/C had the greatest difficulty meeting lung model demand and the greatest variability across all tested scenarios and ventilators. From high to low inspiratory muscle effort, pressure-to-trigger, time for pressure to return to baseline, and triggering pressure-time product decreased in all modes. With increasing resistance and decreasing compliance, tidal volume, pressure-to-trigger, time-to-trigger, time for pressure to return to baseline, time to 90% of peak pressure, and pressure-time product decreased. There were large differences between the default and optimal settings for all the variables in PS and PA/C. Performance was not affected by PEEP. Most of the tested ventilators performed at an acceptable level during the majority of evaluations, but some ventilators performed inadequately during specific settings. Bedside clinical evaluation is needed.

  16. Time Course of Changes in Extravascular Water of the Lung After Pneumonectomy According to the Data of Transpulmonal Thermodilution

    Directory of Open Access Journals (Sweden)

    V. V. Kuzkov

    2006-01-01

    Full Text Available Objective: to study the accuracy of pulmonary extravascular water (PEVW measurement by thermochromodilution (TCD and isolated thermodilution (ITD on a model of pneumonectomy and subsequent ventilator-induced lung lesion (VILL in sheep.Materials and methods: the study was conducted at the Research Laboratory of University of Tromse. The experiment included 12 sheep weighing 35.6±4.6 kg. Thoracotomy and right-sided pneumonectomy were performed in the animals under general anesthesia and controlled artificial ventilation. After measurement of the parameters of systemic hemodynamics and PEVW, the animals were divided into 2 groups: 1 1 those undergoing protective ventilation (PV, n=6 with a tidal volume (TV of 6 ml/kg and a positive end-expiratory pressure (PEEP of 2 cm H2O and 2 those with VILL (n=6 with a TV of 12 ml/kg and a PEEP of 0 cm H2O. TCD and ITD (Cold Z-021 and PiCCOplus monitors, respectively (Pulsion, Germany were used to measure volumetric parameters and PEVW. The parameters of pulmonary hemodynamics, respiratory mechanics, and blood gas composition were recorded. After euthanasia of the animals, their lungs were taken to determine the control value of PEVW by postmortem gravimetry (PG.Results: in the VILL group, significant pulmonary alveolar edema developed, which was followed by hyperthermia, elevated pulmonary pressure, and increased intrapulmonary shunting. Analysis of the data indicated a close correlation between the PEVW values obtained by TCD and ITD with PG (r=0.95 and r=0.81, respectively; p<0.01; n=12. The PG deviation was 0.57±2.05 and 2.68±3.61 ml/kg for TCD and ITD, respectively (M±2d, p<0.05.Conclusion: both used techniques have an acceptable accuracy and adequately reflect both a reduction in PEVW after pneumectomy and its increase in the presence of VILL. Volumotrauma may be the key factor that provokes the development of postpneumectomic edema of the lung. 

  17. Live Webcast from CERN - Mission Impossible 3?

    CERN Document Server

    2000-01-01

    It is a beautiful sunny autumn day, 21 November 2000. The place is CERN's Microcosm exhibition where around 50 pupils from the International School in Geneva and the Collège du Leman have gathered to dive into the mystery of antimatter production and take part in CERN's second Live Webcast of the series 'The Antimatter Factory'. The first was broadcast on 18 November. The webcast is played in the mood of Mission Impossible with music and teasers from this famous television and cinema series. The mission here is not to save the planet but to understand how and why antimatter is produced at CERN. In the Webcast studio, Paola Catapano, Rolf Landua and Mick Storr answer questions posed by students in Italy and Finland thanks to video-conferencing. Paola Catapano, Visit and Exhibitions group leader, dressed like a Bond girl Rolf Landua, spokesman of the ATHENA experiment and Mick Storr Head of Technical Training lead the show. The place starts buzzing and we peep into the antimatter factory (AD) and a...

  18. Viewing angle switching of patterned vertical alignment liquid crystal display

    International Nuclear Information System (INIS)

    Lim, Young Jin; Jeong, Eun; Chin, Mi Hyung; Lee, Seung Hee; Ji, Seunghoon; Lee, Gi-Dong

    2008-01-01

    Viewing angle control of a patterned vertical alignment (PVA) liquid crystal display using only one panel is investigated. In conventional PVA modes, a vertically aligned liquid crystal (LC) director tilts down in four directions making 45 deg. with respect to crossed polarizers to exhibit a wide viewing angle. In the viewing angle control device, one pixel was divided into two sub-pixels such that the LC director in the main pixel is controlled to be tilted down in multiple directions making an angle with the polarizer, playing the role of main display with the wide viewing angle, while the LC director in the sub-pixel is controlled to be tilted down to the polarizer axis, playing the role of sub-pixel to the viewing angle control for the narrow viewing angle. Using sub-pixel control, light leakage or any type of information such as characters and image can be generated in oblique viewing directions without distorting the image quality in the normal direction, which will prevent others from peeping at the displayed image by overlapping the displayed image with the made image

  19. Sequential Oxygenation Index and Organ Dysfunction Assessment within the First 3 Days of Mechanical Ventilation Predict the Outcome of Adult Patients with Severe Acute Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Hsu-Ching Kao

    2013-01-01

    Full Text Available Objective. To determine early predictors of outcomes of adult patients with severe acute respiratory failure. Method. 100 consecutive adult patients with severe acute respiratory failure were evaluated in this retrospective study. Data including comorbidities, Sequential Organ Failure Assessment (SOFA score, Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II score, PaO2, FiO2, PaO2/FiO2, PEEP, mean airway pressure (mPaw, and oxygenation index (OI on the 1st and the 3rd day of mechanical ventilation, and change in OI within 3 days were recorded. Primary outcome was hospital mortality; secondary outcome measure was ventilator weaning failure. Results. 38 out of 100 (38% patients died within the study period. 48 patients (48% failed to wean from ventilator. Multivariate analysis showed day 3 OI ( and SOFA ( score were independent predictors of hospital mortality. Preexisting cerebrovascular accident (CVA ( was the predictor of weaning failure. Results from Kaplan-Meier method demonstrated that higher day 3 OI was associated with shorter survival time (log-Rank test, . Conclusion. Early OI (within 3 days and SOFA score were predictors of mortality in severe acute respiratory failure. In the future, prospective studies measuring serial OIs in a larger scale of study cohort is required to further consolidate our findings.

  20. Altitudinal distribution and advertisement call of Colostethus latinasus (Amphibia: Dendrobatidae), endemic species from eastern Panama and type species of Colostethus , with a molecular assessment of similar sympatric species.

    Science.gov (United States)

    Ibáñez, Roberto D; Griffith, Edgardo J; Lips, Karen R; Crawford, Andrew J

    2017-04-12

    We conducted a molecular assessment of Colostethus-like frogs along an elevational gradient in the Serranía de Pirre, above Santa Cruz de Cana, eastern Panama, aiming to establish their species identity and to determine the altitudinal distribution of C. latinasus. Our findings confirm the view of C. latinasus as an endemic species restricted to the highlands of this mountain range, i.e., 1350-1475 m.a.s.l., considered to be type locality of this species. We described the advertisement call of C. latinasus that consists of a series of 4-18 single, short and relatively loud "peep"-like notes given in rapid succession, and its spectral and temporal features were compared with calls of congeneric species. For the first time, DNA sequences from C. latinasus were obtained, since previously reported sequences were based on misidentified specimens. This is particularly important because C. latinasus is the type species of Colostethus, a genus considered paraphyletic according to recent phylogenetic analyses based on molecular data.

  1. Effect of lung resection on pleuro-pulmonary mechanics and fluid balance.

    Science.gov (United States)

    Salito, C; Bovio, D; Orsetti, G; Salati, M; Brunelli, A; Aliverti, A; Miserocchi, G

    2016-01-15

    The aim of the study was to determine in human patients the effect of lung resection on lung compliance and on pleuro-pulmonary fluid balance. Pre and post-operative values of compliance were measured in anesthetized patients undergoing resection for lung cancer (N=11) through double-lumen bronchial intubation. Lung compliance was measured for 10-12 cm H2O increase in alveolar pressure from 5 cm H2O PEEP in control and repeated after resection. No air leak was assessed and pleural fluid was collected during hospital stay. A significant negative correlation (r(2)=0.68) was found between compliance at 10 min and resected mass. Based on the pre-operative estimated lung weight, the decrease in compliance following lung resection exceeded by 10-15% that expected from resected mass. Significant negative relationships were found by relating pleural fluid drainage flow to the remaining lung mass and to post-operative lung compliance. Following lung re-expansion, data suggest a causative relationship between the decrease in compliance and the perturbation in pleuro-pulmonary fluid balance. Copyright © 2015 Elsevier B.V. All rights reserved.

  2. Mild hypothermia attenuates changes in respiratory system mechanics and modifies cytokine concentration in bronchoalveolar lavage fluid during low lung volume ventilation.

    Science.gov (United States)

    Dostál, P; Senkeřík, M; Pařízková, R; Bareš, D; Zivný, P; Zivná, H; Cerný, V

    2010-01-01

    Hypothermia was shown to attenuate ventilator-induced lung injury due to large tidal volumes. It is unclear if the protective effect of hypothermia is maintained under less injurious mechanical ventilation in animals without previous lung injury. Tracheostomized rats were randomly allocated to non-ventilated group (group C) or ventilated groups of normothermia (group N) and mild hypothermia (group H). After two hours of mechanical ventilation with inspiratory fraction of oxygen 1.0, respiratory rate 60 min(-1), tidal volume 10 ml x kg(-1), positive end-expiratory pressure (PEEP) 2 cm H2O or immediately after tracheostomy in non-ventilated animals inspiratory pressures were recorded, rats were sacrificed, pressure-volume (PV) curve of respiratory system constructed, bronchoalveolar lavage (BAL) fluid and aortic blood samples obtained. Group N animals exhibited a higher rise in peak inspiratory pressures in comparison to group H animals. Shift of the PV curve to right, higher total protein and interleukin-6 levels in BAL fluid were observed in normothermia animals in comparison with hypothermia animals and non-ventilated controls. Tumor necrosis factor-alpha was lower in the hypothermia group in comparison with normothermia and non-ventilated groups. Mild hypothermia attenuated changes in respiratory system mechanics and modified cytokine concentration in bronchoalveolar lavage fluid during low lung volume ventilation in animals without previous lung injury.

  3. Traditsiooniliselt ja pluralistlikult / Epp Annus

    Index Scriptorium Estoniae

    Annus, Epp, 1969-

    1996-01-01

    Nüpli kevadkool (seminari 'Traditsioon ja pluralism' järg põhirõhuga kirjandusloole), korraldajateks Underi ja Tuglase Kirjanduskeskus, Eesti Kirjandusmuuseum ja Tartu Ülikooli eesti kirjandusloo uurimisgrupp. Ettekanded: Loone Ots. Kuninganna jalad ehk Non sciunt, se scient. Eesti kirjandust välistudengitele; Kristi Metste. Tubli pioneer Kampmaa; Peep Ehasalu. 'Kiired' ja soomlased; Sirje Olesk. Kodu- ja väliseesti kahekõne 1950.-1960. aastatel; Marin Laak. Kriitikateos kirjandusloos : näide 1924. aastast (Valmar Adamsi arvustus Jaan Kärneri romaani 'Bianka ja Ruth' puhul); Ene-Reet Soovik. Koed, põimed ja takerdused : Ants Orase tõlkekriitikast ja -praktikast; Epp Annus. Anakroonilised võitlused romaanis 'Tõde ja õigus'; Luule Epner. Kahe 'Libahundi' vahel : draama ja teater 1960.-70ndate vahetusel, põikega proosasse; Toomas Liivamägi. Mõned vulgariseeringud (20. sajandi modernism energia jäävuse seadusest lähtudes); Toomas Muru. Paabeli torn ja Gooti katedraal; Aare Pilv. Kirjandusloolisus kui hoiak; Indrek Särg - Sven Kivisildnik. Eesti gayluule järjekordne algus; Rutt Hinrikus. Reed Morn, andekas parasiit; Kajar Pruul. Ühe kunstiteose analüüs (Sven Kivisildniku luuletus 'Eesti Nõukogude Kirjanike Liit'); Ele Süvalep. Modernist Jaan Oks

  4. Mechanical ventilation in abdominal surgery.

    Science.gov (United States)

    Futier, E; Godet, T; Millot, A; Constantin, J-M; Jaber, S

    2014-01-01

    One of the key challenges in perioperative care is to reduce postoperative morbidity and mortality. Patients who develop postoperative morbidity but survive to leave hospital have often reduced functional independence and long-term survival. Mechanical ventilation provides a specific example that may help us to shift thinking from treatment to prevention of postoperative complications. Mechanical ventilation in patients undergoing surgery has long been considered only as a modality to ensure gas exchange while allowing maintenance of anesthesia with delivery of inhaled anesthetics. Evidence is accumulating, however, suggesting an association between intraoperative mechanical ventilation strategy and postoperative pulmonary function and clinical outcome in patients undergoing abdominal surgery. Non-protective ventilator settings, especially high tidal volume (VT) (>10-12mL/kg) and the use of very low level of positive end-expiratory pressure (PEEP) (PEEPventilator-associated lung injury in patients with healthy lungs. Stimulated by previous findings in patients with acute respiratory distress syndrome, the use of lower tidal volume ventilation is becoming increasingly more common in the operating room. However, lowering tidal volume, though important, is only part of the overall multifaceted approach of lung protective mechanical ventilation. In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of mechanical ventilation in patients undergoing abdominal surgery. Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  5. ARDS: challenges in patient care and frontiers in research

    Directory of Open Access Journals (Sweden)

    Lieuwe D. Bos

    2018-01-01

    Full Text Available This review discusses the clinical challenges associated with ventilatory support and pharmacological interventions in patients with acute respiratory distress syndrome (ARDS. In addition, it discusses current scientific challenges facing researchers when planning and performing trials of ventilatory support or pharmacological interventions in these patients. Noninvasive mechanical ventilation is used in some patients with ARDS. When intubated and mechanically ventilated, ARDS patients should be ventilated with low tidal volumes. A plateau pressure <30 cmH2O is recommended in all patients. It is suggested that a plateau pressure <15 cmH2O should be considered safe. Patient with moderate and severe ARDS should receive higher levels of positive end-expiratory pressure (PEEP. Rescue therapies include prone position and neuromuscular blocking agents. Extracorporeal support for decapneisation and oxygenation should only be considered when lung-protective ventilation is no longer possible, or in cases of refractory hypoxaemia, respectively. Tracheotomy is only recommended when prolonged mechanical ventilation is expected. Of all tested pharmacological interventions for ARDS, only treatment with steroids is considered to have benefit. Proper identification of phenotypes, known to respond differently to specific interventions, is increasingly considered important for clinical trials of interventions for ARDS. Such phenotypes could be defined based on clinical parameters, such as the arterial oxygen tension/inspiratory oxygen fraction ratio, but biological marker profiles could be more promising.

  6. Protective mechanical ventilation, why use it?

    Science.gov (United States)

    Seiberlich, Emerson; Santana, Jonas Alves; Chaves, Renata de Andrade; Seiberlich, Raquel Carvalho

    2011-01-01

    Mechanical ventilation (MV) strategies have been modified over the last decades with a tendency for increasingly lower tidal volumes (VT). However, in patients without acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) the use of high VTs is still very common. Retrospective studies suggest that this practice can be related to mechanical ventilation-associated ALI. The objective of this review is to search for evidence to guide protective MV in patients with healthy lungs and to suggest strategies to properly ventilate lungs with ALI/ARDS. A review based on the main articles that focus on the use of strategies of mechanical ventilation was performed. Consistent studies to determine which would be the best way to ventilate a patient with healthy lungs are lacking. Expert recommendations and current evidence presented in this article indicate that the use of a VT lower than 10 mL.kg(-1), associated with positive end-expiratory pressure (PEEP) ≥ 5 cmH(2)O without exceeding a pressure plateau of 15 to 20 cmH(2)O could minimize alveolar stretching at the end of inspiration and avoid possible inflammation or alveolar collapse. Copyright © 2011 Elsevier Editora Ltda. All rights reserved.

  7. Ventilation and gas exchange management after cardiac arrest.

    Science.gov (United States)

    Sutherasan, Yuda; Raimondo, Pasquale; Pelosi, Paolo

    2015-12-01

    For several decades, physicians had integrated several interventions aiming to improve the outcomes in post-cardiac arrest patients. However, the mortality rate after cardiac arrest is still as high as 50%. Post-cardiac arrest syndrome is associated with high morbidity and mortality due to not only poor neurological outcome and cardiovascular failure but also respiratory dysfunction. To minimize ventilator-associated lung injury, protective mechanical ventilation by using low tidal volume ventilation and driving pressure may decrease pulmonary complications and improve survival. Low level of positive end-expiratory pressure (PEEP) can be initiated and titrated with careful cardiac output and respiratory mechanics monitoring. Furthermore, optimizing gas exchange by avoiding hypoxia and hyperoxia as well as maintaining normocarbia may improve neurological and survival outcome. Early multidisciplinary cardiac rehabilitation intervention is recommended. Minimally invasive monitoring techniques, that is, echocardiography, transpulmonary thermodilution method measuring extravascular lung water, as well as transcranial Doppler ultrasound, might be useful to improve appropriate management of post-cardiac arrest patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Flow-controlled expiration: a novel ventilation mode to attenuate experimental porcine lung injury.

    Science.gov (United States)

    Goebel, U; Haberstroh, J; Foerster, K; Dassow, C; Priebe, H-J; Guttmann, J; Schumann, S

    2014-09-01

    Whereas the effects of various inspiratory ventilatory modifications in lung injury have extensively been studied, those of expiratory ventilatory modifications are less well known. We hypothesized that the newly developed flow-controlled expiration (FLEX) mode provides a means of attenuating experimental lung injury. Experimental acute respiratory distress syndrome was induced by i.v. injection of oleic acid in 15 anaesthetized and mechanically ventilated pigs. After established lung injury ([Formula: see text]ratio ventilation (VCV) or a treatment group receiving VCV with additional FLEX (VCV+FLEX). At predefined times, lung mechanics and oxygenation were assessed. At the end of the experiment, the pigs were killed, and bronchoalveolar fluid and lung biopsies were taken. Expression of inflammatory cytokines was analysed in lung tissue and bronchoalveolar fluid. Lung injury score was determined on the basis of stained tissue samples. Compared with the control group (VCV; n=8), the VCV+FLEX group (n=7) demonstrated greater dynamic lung compliance and required less PEEP at comparable [Formula: see text] (both Pprotective ventilation. © The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  9. Synthesis of highly fluorescent hydrophobic carbon dots by hot injection method using Paraplast as precursor

    International Nuclear Information System (INIS)

    Talib, Abou; Pandey, Sunil; Thakur, Mukeshchand; Wu, Hui-Fen

    2015-01-01

    We have reported synthesis of bright blue colored hydrophobic carbon dots (hC-dots) using highly pure blend of polymers called Paraplast. We developed a hot injection method for making nearly monodispersed hC-dots with a diameter in a range: 5–30 nm as confirmed by high resolution transmission electron microscopy (HRTEM). The involvement of various functional groups was confirmed by Fourier transform infra-red (FTIR) spectroscopy. These hC-dots were incubated with breast cancer stem cells in order to check the entry as well as biological imaging. The cells were analyzed using epifluorescent microscopy. hC-dots showed concentration dependent cytotoxicity (LD 50 : 50 mg/ml) and could be used for bioimaging even at lower concentration (0.5 mg/ml). hC-dots were found to be versatile agents for peeping inside the cells which could also be used for delivery of water insoluble chemotherapeutic agents to variety of solid tumors. - Highlights: • Synthesis of hydrophobic carbon dots from polymer based Paraplast • Deep blue color under the influence of UV light • Typical optical properties used for biological imaging • Biological imaging of breast cancer stem cells revealing potential of carbon dots

  10. How does the presence of a conspecific individual change the behavioral game that a predator plays with its prey?

    Science.gov (United States)

    Vardi, Reut; Abramsky, Zvika; Kotler, Burt P; Altstein, Ofir; Rosenzweig, Michael L

    2017-07-01

    Behavioral games predators play among themselves may have profound effects on behavioral games predators play with their prey. We studied the behavioral game between predators and prey within the framework of social foraging among predators. We tested how conspecific interactions among predators (little egret) change the predator-prey behavioral game and foraging success. To do so, we examined foraging behavior of egrets alone and in pairs (male and female) in a specially designed aviary consisting of three equally spaced pools with identical initial prey (comet goldfish) densities. Each pool was comprised of a risky microhabitat, rich with food, and a safe microhabitat with no food, forcing the fish to trade off food and safety. When faced with two versus one egret, we found that fish significantly reduced activity in the risky habitat. Egrets in pairs suffered reduced foraging success (negative intraspecific density dependence) and responded to fish behavior and to their conspecific by changing their visiting regime at the different pools-having shorter, more frequent visits. The time egret spent on each visit allowed them to match their long-term capture success rate across the environment to their capture success rate in the pool, which satisfies one aspect of optimality. Overall, egrets in pairs allocated more time for foraging and changed their foraging tactics to focus more on fish under cover and fish 'peeping' out from their shelter. These results suggest that both prey and predator show behavioral flexibility and can adjust to changing conditions as needed in this foraging game.

  11. Fas-deficient mice have impaired alveolar neutrophil recruitment and decreased expression of anti-KC autoantibody:KC complexes in a model of acute lung injury

    Directory of Open Access Journals (Sweden)

    Gil Sucheol

    2012-10-01

    Full Text Available Abstract Background Exposure to mechanical ventilation enhances lung injury in response to various stimuli, such as bacterial endotoxin (LPS. The Fas/FasL system is a receptor ligand system that has dual pro-apoptotic and pro-inflammatory functions and has been implicated in the pathogenesis of lung injury. In this study we test the hypothesis that a functioning Fas/FasL system is required for the development of lung injury in mechanically ventilated mice. Methods C57BL/6 (B6 and Fas-deficient lpr mice were exposed to either intra-tracheal PBS followed by spontaneous breathing or intra-tracheal LPS followed by four hours mechanical ventilation with tidal volumes of 10 mL/kg, respiratory rate of 150 breaths per minute, inspired oxygen 0.21 and positive end expiratory pressure (PEEP of 3 cm of water. Results Compared with the B6 mice, the lpr mice showed attenuation of the neutrophilic response as measured by decreased numbers of BAL neutrophils and lung myeloperoxidase activity. Interestingly, the B6 and lpr mice had similar concentrations of pro-inflammatory cytokines, including CXCL1 (KC, and similar measurements of permeability and apoptosis. However, the B6 mice showed greater deposition of anti-KC:KC immune complexes in the lungs, as compared with the lpr mice. Conclusions We conclude that a functioning Fas/FasL system is required for full neutrophilic response to LPS in mechanically ventilated mice.

  12. The vocal repertoire of the African Penguin (Spheniscus demersus): structure and function of calls.

    Science.gov (United States)

    Favaro, Livio; Ozella, Laura; Pessani, Daniela

    2014-01-01

    The African Penguin (Spheniscus demersus) is a highly social and vocal seabird. However, currently available descriptions of the vocal repertoire of African Penguin are mostly limited to basic descriptions of calls. Here we provide, for the first time, a detailed description of the vocal behaviour of this species by collecting audio and video recordings from a large captive colony. We combine visual examinations of spectrograms with spectral and temporal acoustic analyses to determine vocal categories. Moreover, we used a principal component analysis, followed by signal classification with a discriminant function analysis, for statistical validation of the vocalisation types. In addition, we identified the behavioural contexts in which calls were uttered. The results show that four basic vocalisations can be found in the vocal repertoire of adult African Penguin, namely a contact call emitted by isolated birds, an agonistic call used in aggressive interactions, an ecstatic display song uttered by single birds, and a mutual display song vocalised by pairs, at their nests. Moreover, we identified two distinct vocalisations interpreted as begging calls by nesting chicks (begging peep) and unweaned juveniles (begging moan). Finally, we discussed the importance of specific acoustic parameters in classifying calls and the possible use of the source-filter theory of vocal production to study penguin vocalisations.

  13. Gamma-variate modeling of indicator dilution curves in electrical impedance tomography.

    Science.gov (United States)

    Hentze, Benjamin; Muders, Thomas; Luepschen, Henning; Leonhardt, Steffen; Putensen, Christian; Walter, Marian

    2017-07-01

    Electrical impedance tomography (EIT) is a non-invasive imaging technique, that can be used to monitor regional lung ventilation (V̇) in intensive care units (ICU) at bedside. This work introduces a method to extract regional lung perfusion (Q̇) from EIT image streams in order to quantify regional gas exchange in the lungs. EIT data from a single porcine animal trial, recorded during injection of a contrast agent (NaCl 10%) into a central venous catheter (CVC), are used for evaluation. Using semi-negative matrix factorization (Semi-NMF) a set of source signals is extracted from the data. A subsequent non-linear fit of a gamma-variate model to the source signals results in model signals, describing contrast agent flow through the cardio-pulmonary system. A linear fit of the model signals to the EIT image stream then yields functional images ofQ̇. Additionally, a pulmonary transit function (PTF) and parameters, such as mean transit time (MTT), time to peak (TTP) and area under curve (AUC) are derived. In result, EIT was used to track changes of regional lung ventilation to perfusion ratio (V̇/Q̇) during changes of positive end-expiratory pressure (PEEP). Furthermore, correlations of MTT and AUC with cardiac output (CO) indicate that CO measurement by EIT might be possible.

  14. Pulmonar recruitment in acute respiratory distress syndrome. What is the best strategy?

    Directory of Open Access Journals (Sweden)

    Cíntia Lourenço Santos

    Full Text Available Supporting patients with acute respiratory distress syndrome (ARDS, using a protective mechanical ventilation strategy characterized by low tidal volume and limitation of positive end-expiratory pressure (PEEP is a standard practice in the intensive care unit. However, these strategies can promote lung de-recruitment, leading to the cyclic closing and reopening of collapsed alveoli and small airways. Recruitment maneuvers (RM can be used to augment other methods, like positive end-expiratory pressure and positioning, to improve aerated lung volume. Clinical practice varies widely, and the optimal method and patient selection for recruitment maneuvers have not been determined, considerable uncertainty remaining regarding the appropriateness of RM. This review aims to discuss recent findings about the available types of RM, and compare the effectiveness, indications and adverse effects among them, as well as their impact on morbidity and mortality in ARDS patients. Recent developments include experimental and clinical evidence that a stepwise extended recruitment maneuver may cause an improvement in aerated lung volume and decrease the biological impact seen with the traditionally used sustained inflation, with less adverse effects. Prone positioning can reduce mortality in severe ARDS patients and may be an useful adjunct to recruitment maneuvers and advanced ventilatory strategies, such noisy ventilation and BIVENT, which have been useful in providing lung recruitment.

  15. Magistritööde kaitsmine : [Maria-Magdalena Jürvetson jt.

    Index Scriptorium Estoniae

    1999-01-01

    14. juunil '99 kaitsevad TPÜ filoloogiateaduskonna magistritööde kaitsmisnõukogu koosolekul Maria-Magdalena Jürvetson magistritöö "Soome keele ja rahvuskultuuri areng 19. sajandil" ja Hilve Rebase magistritöö "Norra ja Soome kirjanike loomingust ja retseptsioonist Eestis"; 15. juunil kaitsevad TPÜ infoteaduste osakonna magistritööde kaitsmisnõukogu koosolekul Aivi Sepp magistritöö "Raamatukogu- ja infoteaduslik haridus 20. sajandi teisel poolel" ja Marianne Paimre magistritöö "Narkotemaatika Eesti loetavamates päevalehtedes aastatel 1993-1995 : bibliomeetriline aspekt"; 17. juunil kaitsevad TPÜ geoökoloogia magistritööde kaitsmisnõukogu koosolekul Raimo Pajula magistritöö "Raba mikromaastike seosed rabalaama morfomeetria ja veerežiimiga Männik-järve raba näitel", Kristjan Kruusement magistritöö "Fosfori jaotus järvesetetes" ja Peep-Aarne Sirge magistritöö "Eesti endiste sõjakoolide kogemuste rakendamise võimalusi kaitsejõudude tänapäevases väljaõppes"; 21. juunil kaitsevad TPÜ kasvatusteaduste ja pedagoogika magistritööde kaitsmisnõukogu koosolekul Krista Loogma magistritöö "Stsenaariumi meetodi rakendamine hariduse tuleviku uurimisel ja haridusstrateegia arendamisel" ja Tarmo Salumaa magistritöö "Eesmärgistatud organisatsiooniliste muutuste mõju inimeste töökeskkonna tunnetamisele koolis"

  16. 矿井预掘回撤通道顶板支护技术研究及应用%Mine pre-dug channel retracement of the roof support technology research and application

    Institute of Scientific and Technical Information of China (English)

    郭玉峰

    2015-01-01

    Oblique coal mine 23101 working face for the ifrst time with pre-dug retracement passage through to peep around the rock structure and surrounding rock strength tests, the extent of damage the tunnel roof are mainly located in shallow 2.4m, with the help of the Ministry of coal within the range 0~1.3m to determine the scientiifc support designed to strengthen the rock pressure observation to ensure that the rapid closure of the mine safety purposes.%斜沟煤矿23101工作面首次采用预掘回撤通道,通过围对岩结构窥视和围岩强度的测试,得出巷道顶板的破坏范围主要位于浅部2.4 m,煤帮部0~1.3 m范围内,确定了科学的支护设计,加强矿压观测,确保了矿井安全快速收尾的目的。

  17. Definition and epidemiology of acute respiratory distress syndrome.

    Science.gov (United States)

    Rezoagli, Emanuele; Fumagalli, Roberto; Bellani, Giacomo

    2017-07-01

    Fifty years ago, Ashbaugh and colleagues defined for the first time the acute respiratory distress syndrome (ARDS), one among the most challenging clinical condition of the critical care medicine. The scientific community worked over the years to generate a unified definition of ARDS, which saw its revisited version in the Berlin definition, in 2014. Epidemiologic information about ARDS is limited in the era of the new Berlin definition, and wide differences are reported among countries all over the world. Despite decades of study in the field of lung injury, ARDS is still so far under-recognized, with 2 out of 5 cases missed by clinicians. Furthermore, although advances of ventilator strategies in the management of ARDS associated with outcome improvements-such as protective mechanical ventilation, lower driving pressure, higher PEEP levels and prone positioning-ARDS appears to be undertreated and mortality remains elevated up to 40%. In this review, we cover the history that led to the current worldwide accepted Berlin definition of ARDS and we summarize the recent data regarding ARDS epidemiology.

  18. [High-Flow Nasal Cannulae (HFNC) in Neonates: A Survey of Current Practice in Level 1 Perinatal Centres in the German State of North Rhine-Westphalia].

    Science.gov (United States)

    Hepping, N; Garbe, W; Schneider, K

    2015-12-01

    High-flow nasal cannulae (HFNC) is a kind of non-invasive respiratory support. In recent years, its application has gained increasing popularity for treating neonates with respiratory failure. Within this study, neonatologists employed at high level perinatal centres within the region of North Rhine-Westphalia, Germany were interviewed. We evaluated their personal experience as well as the underlying indication for using HFNC. We undertook an online survey. 93% of the interviewed participants use HFNC systems in their NICU. The most prominent indications were CPAP-weaning, nasal trauma, and apnoea of prematurity. Both initial flow and maximum and minimum flow rates varied widely. The primary benefit of HFNC vs. conventional CPAP was the improved neonate tolerance, less nasal traumata and ease of application and care. A common disadvantage was the inability to conduct PEEP measurements. The application of the HFNC system is increasing for specific neonatal indications, thereby increasing the data for the evaluation of effectivity and safety. Nevertheless, detailed investigations of the appropriate flow rate settings are still lacking. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Clinical factors affecting inspired gas humidification and oral dryness during noninvasive ventilation.

    Science.gov (United States)

    Oto, Jun; Imanaka, Hideaki; Nishimura, Masaji

    2011-10-01

    Oral dryness is a common complication during noninvasive ventilation (NIV). We measured the oral dryness of patients and performed a bench study to investigate factors related to humidification during NIV. Patients were randomly assigned into 2 groups: medium (Med group) and maximum (Max group) heated humidifier (HH) settings. Oral moistness was measured using an oral moisture-checking device, and the feeling of oral dryness was evaluated using a 0 to 10 numerical rating scale (NRS) at 0, 12, and 24 hours from the beginning of NIV and at 12 and 24 hours after NIV was discontinued. A bench study was performed to assess the effects of positive end-expiratory pressure (PEEP), the fraction of inspired oxygen (F(I)O(2)), and air leaks on absolute humidity. We evaluated 3 HH settings: no HH, HH at the medium setting, and HH at the maximum setting. The temperature in the outlet chamber was 31°C to 32°C for the medium HH setting and 38°C to 41°C for the maximum HH setting. In the clinical study, 12 patients were assigned to the Med group and 11 to the Max group. In the Med group, oral moistness decreased and NRS increased at 12 and 24 hours compared with 0 hours (P humidification and oral dryness during NIV. Copyright © 2011 Elsevier Inc. All rights reserved.

  20. Incidence and Risk Factors for Delirium among Mechanically Ventilated Patients in an African Intensive Care Setting: An Observational Multicenter Study

    Directory of Open Access Journals (Sweden)

    Arthur Kwizera

    2015-01-01

    Full Text Available Aim. Delirium is common among mechanically ventilated patients in the intensive care unit (ICU. There are little data regarding delirium among mechanically ventilated patients in Africa. We sought to determine the burden of delirium and associated factors in Uganda. Methods. We conducted a multicenter prospective study among mechanically ventilated patients in Uganda. Eligible patients were screened daily for delirium using the confusional assessment method (CAM-ICU. Comparisons were made using t-test, chi-squares, and Fisher’s exact test. Predictors were assessed using logistic regression. The level of statistical significance was set at P<0.05. Results. Of 160 patients, 81 (51% had delirium. Median time to onset of delirium was 3.7 days. At bivariate analysis, history of mental illness, sedation, multiorgan dysfunction, neurosurgery, tachypnea, low mean arterial pressure, oliguria, fevers, metabolic acidosis, respiratory acidosis, anaemia, physical restraints, marital status, and endotracheal tube use were significant predictors. At multivariable analysis, having a history of mental illness, sedation, respiratory acidosis, higher PEEP, endotracheal tubes, and anaemia predicted delirium. Conclusion. The prevalence of delirium in a young African population is lower than expected considering the high mortality. A history of mental illness, anaemia, sedation, endotracheal tube use, and respiratory acidosis were factors associated with delirium.

  1. Comparing the effects of rise time and inspiratory cycling criteria on 6 different mechanical ventilators.

    Science.gov (United States)

    Gonzales, Joshua F; Russian, Christopher J; Gregg Marshall, S; Collins, Kevin P

    2013-03-01

    Inspiratory rise time and cycling criteria are important settings in pressure support ventilation. The purpose of this study was to investigate the impact of minimum and maximum rise time and inspiratory cycling criteria settings on 6 new generation ventilators. Our hypothesis was there would be a difference in the exhaled tidal volume, inspiratory time, and peak flow among 6 different ventilators, based, on change in rise time and cycling criteria. The research utilized a breathing simulator and 4 different ventilator models. All mechanical ventilators were set to a spontaneous mode of ventilation with settings of pressure support 8 cm H2O and PEEP of 5 cm H2O. A minimum and maximum setting for rise time and cycling criteria were examined. Exhaled tidal volume, inspiratory time, and peak flow measurements were recorded for each simulation. Significant (P ventilator. Significant differences in exhaled tidal volume, inspiratory time, and peak flow were observed by adjusting rise time and cycling criteria. This research demonstrates that during pressure support ventilation strategy, adjustments in rise time and/or cycling criteria can produce changes in inspiratory parameters. Obviously, this finding has important implications for practitioners who utilize a similar pressure support strategy when conducting a ventilator wean. Additionally, this study outlines major differences among ventilator manufacturers when considering inspiratory rise time and cycling criteria.

  2. Mechanical ventilators in the hot zone: effects of a CBRN filter on patient protection and battery life.

    Science.gov (United States)

    Blakeman, Thomas C; Toth, Peter; Rodriquez, Dario; Branson, Richard D

    2010-09-01

    In a contaminated environment, respiratory protection for ventilator dependent patients can be achieved by attaching a chemical, biological, radiological, or nuclear (CBRN) filter to the air intake port of a portable ventilator. We evaluated the effect of the filter on battery performance of four portable ventilators in a laboratory setting. Each ventilator was attached to a test lung. Ventilator settings were: assist control (AC) mode, respiratory rate 35 bpm, tidal volume 450 ml, positive end-expiratory pressure (PEEP) 10 cm H(2)O, inspiratory time 0.8 s, and FIO(2) 0.21. Ventilators were operated until the battery was fully discharged. We also evaluated the ventilators' ability to deliver all the gas through the CBRN filter and analyzed the pressures required to breathe through the anti-asphyxiation valve of a failed device. The range of battery life varied widely across different ventilator models (99.8-562.6 min). There was no significant difference in battery life (pventilator dependent patients when environmental contamination is present, although conditions exist where all gas does not pass through the filter with some ventilators under normal operating conditions. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  3. Recurrent Spontaneous Pneumothorax during the Recovery Phase of ARDS Due to H1N1 Infection

    Directory of Open Access Journals (Sweden)

    Canan Bor

    2013-03-01

    Full Text Available The pregnant patients are prone to influenza A (H1N1 virus infection, which may rapidly progress to lower respiratory tract infection and subsequent respiratory failure and acute respiratory distress syndrome (ARDS. Pneumothorax might develop in ARDS under mechanical ventilation. But post-ARDS pneumothorax in spontaneously breathing patient has not been reported in the literature. We report a 31-year old pregnant woman infected with influenza A (H1N1 virus and progressed to ARDS. Mechanical ventilation with high PEEP improved patient's gas exchange parameters within 3 weeks. However spontaneous pneumothorax was developed one week after she weaned off the ventilator. After successful drainage therapy, the patient was discharged. However she re-admitted to the hospital because of a recurrent pneumothorax one week later. She was discharged in good health after being treated with negative continuous pleural aspiration for 10 days. Influenza might cause severe pulmonary infection and death. In addition to diffuse alveolar damage, sub-pleural and intrapulmonary air cysts might occur in influenza-related ARDS and may lead to spontaneous pneumothorax. This complication should always be considered during the recovery period of ARDS and a long-term close follow-up is necessary.

  4. Eesti Vabariigi põhiseadus : kommenteeritud väljaanne / toimetuskolleegium: Eerik-Juhan Truuväli, Oliver Kask, Lasse Lehis, Heiki Lindpere, Uno Lõhmus, Ülle Madise, Kalle Merusk, Raul Narits, Vallo Olle, Jüri Põld, Heinrich Schneider

    Index Scriptorium Estoniae

    2002-01-01

    Kommentaaride autorid ja sisu: Sissejuhatus / Raul Narits, Heinrich Schneider, Lauri Madise. [Preambul] / Heinrich Schneider. I ptk. / Kalle Merusk, Taavi Annus, Madis Ernits, Heiki Lindpere, Lauri Madise. II ptk. / Uno Lõhmus, Taavi Annus, Madis Ernits, Oliver Kask, Eerik Kergandberg, Rait Maruste, Peeter Roosma. III ptk. / Oliver Kask. IV ptk. / Jüri Põld, Lauri Madise, Aaro Mõttus. V ptk. / Eerik-Juhan Truuväli, Ülle Madise, Jüri Põld, Urmas Reinsalu. VI ptk. / Kalle Merusk, Jüri Põld. VII ptk. / Eerik-Juhan Truuväli, Jüri Põld. VIII ptk. / Lasse Lehis. IX ptk. / Heiki Lindpere, Kristi Land, Lauri Madise, Heiki Pisuke. X ptk. / Oliver Kask, Enn Markvart, Jüri Põld. XI ptk. / Heinrich Schneider. XII ptk. / Raul Narits, Aare Reenumägi, Peeter Roosma, Enn Markvart. XIII ptk. / Uno Lõhmus, Madis Ernits, Jüri Põld. XIV ptk. / Vallo Olle, Arno Almann, Ülle Madise, Jüri Liventaal. XV ptk. / Eerik-Juhan Truuväli, Aaro Mõttus. Eesti Vabariigi põhiseaduse rakendamise seadus / Raul Narits, Peeter Roosma, Oliver Kask. Märksõnastik / koost. Ülle Madise, Peep Pruks. Kasutatud õigusaktide lühendid / koost. Virgo Saarmets. Eesti Vabariigi põhiseadus 1990-2002 : bibliograafia / koost. Maia Ruttu

  5. June 2015 Phoenix critical care journal club: interventions in ARDS

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2015-06-01

    Full Text Available No abstract available. Article truncated at 150 words. Mortality has been declining in the adult respiratory distress syndrome (ARDS (1. However, the cause of the decline in mortality is unclear. The only intervention shown to improve survival has been low tidal volume ventilation but the mortality was improving before this intervention was widely used (2. Nevertheless, it was suggested that we look at system performance regarding ARDS management from a critical appraisal standpoint. This journal club was hoped to help as a starting point in that regard. Four potential beneficial interventions were discussed: 1. Conservative fluid management; 2. Optimal PEEP as determined by esophageal pressure; 3. Prone positioning; and 4. Mechanical ventilation driving pressure. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Comparison of two fluid-management strategies in acute lung injury. N Engl ...

  6. Telemedicine Versus Face-to-Face Evaluations by Respiratory Therapists of Mechanically Ventilated Neonates and Children: A Pilot Study.

    Science.gov (United States)

    Bell, Rebecca C; Yager, Phoebe H; Clark, Maureen E; Roumiantsev, Serguei; Venancio, Heather L; Chipman, Daniel W; Kacmarek, Robert M; Noviski, Natan N

    2016-02-01

    Mechanical ventilation is one of the most important therapeutic interventions in neonatal and pediatric ICUs. Telemedicine has been shown to reliably extend pediatric intensivist expertise to facilities where expertise is limited. If reliable, telemedicine may extend the reach of pediatric respiratory therapists (RTs) to facilities where expertise does not exist or free up existing RT resources for important face-to-face activities in facilities where expertise is limited. The aim of this study was to determine how well respiratory assessments for ventilated neonates and children correlated when performed simultaneously by 2 RTs face-to-face and via telemedicine. We conducted a pilot study including 40 assessments by 16 RTs on 11 subjects (5 neonatal ICU; 6 pediatric ICU). Anonymously completed intake forms by 2 different RTs concurrently assessing 14 ventilator-derived and patient-based respiratory variables were used to determine correlations. Forty paired assessments were performed. Median telemedicine assessment time was 8 min. The Pearson correlation coefficient (r) was used to determine agreement between continuous data, and the Cohen kappa statistics were used for binary variables. Pressure control, PEEP, breathing frequency, and FIO2 perfectly correlated (r = 1, all P Telemedicine technology was acceptable to RTs. Telemedicine evaluations highly correlated with face-to-face for 10 of 14 aspects of standard bedside respiratory assessment. Poor correlation was noted for more complex, patient-generated parameters, highlighting the importance of further investigation incorporating a virtual stethoscope. Copyright © 2016 by Daedalus Enterprises.

  7. Right ventricular function during one-lung ventilation: effects of pressure-controlled and volume-controlled ventilation.

    Science.gov (United States)

    Al Shehri, Abdullah M; El-Tahan, Mohamed R; Al Metwally, Roshdi; Qutub, Hatem; El Ghoneimy, Yasser F; Regal, Mohamed A; Zien, Haytham

    2014-08-01

    To test the effects of pressure-controlled (PCV) and volume-controlled (VCV) ventilation during one-lung ventilation (OLV) for thoracic surgery on right ventricular (RV) function. A prospective, randomized, double-blind, controlled, crossover study. A single university hospital. Fourteen pairs of consecutive patients scheduled for elective thoracotomy. Patients were assigned randomly to ventilate the dependent lung with PCV or VCV mode, each in a randomized crossover order using tidal volume of 6 mL/kg, I: E ratio 1: 2.5, positive end-expiratory pressure (PEEP) of 5 cm H2O and respiratory rate adjusted to maintain normocapnia. Intraoperative changes in RV function (systolic and early diastolic tricuspid annular velocity (TAV), end-systolic volume (ESV), end-diastolic volume (EDV) and fractional area changes (FAC)), airway pressures, compliance and oxygenation index were recorded. The use of PCV during OLV resulted in faster systolic (10.1±2.39 vs. 5.8±1.67 cm/s, respectively), diastolic TAV (9.2±1.99 vs. 4.6±1.42 cm/s, respectively) (prights reserved.

  8. PORTRAIT DE L’ARTISTE EN SINOLOGUE CAMILO PESSANHA (1867–1926 ET LA CHINE

    Directory of Open Access Journals (Sweden)

    Gérard М. М. Siary

    2016-12-01

    Full Text Available This essay analyzes the image of China in the work of the Portuguese poet C. Pessanha. Not only it focuses on Pessanha’s place in the history of Portuguese literature but also analyzes such comparativist aspect as the image of East Asia in the Western culture and European orientalism. The image of China in Pessanha’s work is ambivalent and was developed under the influence of the “myths” invented by Studia Litterarum. Vol. 1, no 3–4 Gérard М. М. Siary 175 the turn-of-the-century decadent writers, essayists, and orientalists whose insights peeped into the hitherto impenetrable and closed Chinese culture. Pessanha does not like and even despises China but is fascinated by the vital energy of this country and its people. He pays special attention to Macau that becomes for him the symbol of Portuguese Empire. Through the image of Macau, he talks about the past, the present, and the future of Portugal, a country that he believed could be reborn if regained its energy.

  9. Synthesis of highly fluorescent hydrophobic carbon dots by hot injection method using Paraplast as precursor

    Energy Technology Data Exchange (ETDEWEB)

    Talib, Abou [Doctoral Degree Program in Marine Biotechnology, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan (China); Pandey, Sunil [Department of Chemistry, National Sun Yat-Sen University, 70, Lien-Hai Road, Kaohsiung 80424, Taiwan (China); Center for Nanoscience and Nanotechnology, National Sun Yat-Sen University, 70, Lien-Hai Road, Kaohsiung 80424, Taiwan (China); Thakur, Mukeshchand [Department of Chemistry, National Sun Yat-Sen University, 70, Lien-Hai Road, Kaohsiung 80424, Taiwan (China); Wu, Hui-Fen, E-mail: hui@faculty.nsysu.edu.tw [Department of Chemistry, National Sun Yat-Sen University, 70, Lien-Hai Road, Kaohsiung 80424, Taiwan (China); Center for Nanoscience and Nanotechnology, National Sun Yat-Sen University, 70, Lien-Hai Road, Kaohsiung 80424, Taiwan (China); Doctoral Degree Program in Marine Biotechnology, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan (China); School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung 800, Taiwan (China); Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, 80424, Taiwan (China)

    2015-03-01

    We have reported synthesis of bright blue colored hydrophobic carbon dots (hC-dots) using highly pure blend of polymers called Paraplast. We developed a hot injection method for making nearly monodispersed hC-dots with a diameter in a range: 5–30 nm as confirmed by high resolution transmission electron microscopy (HRTEM). The involvement of various functional groups was confirmed by Fourier transform infra-red (FTIR) spectroscopy. These hC-dots were incubated with breast cancer stem cells in order to check the entry as well as biological imaging. The cells were analyzed using epifluorescent microscopy. hC-dots showed concentration dependent cytotoxicity (LD{sub 50}: 50 mg/ml) and could be used for bioimaging even at lower concentration (0.5 mg/ml). hC-dots were found to be versatile agents for peeping inside the cells which could also be used for delivery of water insoluble chemotherapeutic agents to variety of solid tumors. - Highlights: • Synthesis of hydrophobic carbon dots from polymer based Paraplast • Deep blue color under the influence of UV light • Typical optical properties used for biological imaging • Biological imaging of breast cancer stem cells revealing potential of carbon dots.

  10. CDC releases ventilator-associated events criteria

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-01-01

    Full Text Available No abstract available. Article truncated at 150 words. A new term has been coined by the CDC, ventilator-associated events (VAEs (1. In 2011, the CDC convened a working group composed of members of several stakeholder organizations to address the limitations of the definition of ventilator-associated pneumonia (VAP definition (2. The organizations represented in the Working Group include: the Critical Care Societies Collaborative (the American Association of Critical-Care Nurses, the American College of Chest Physicians, the American Thoracic Society, and the Society for Critical Care Medicine; the American Association for Respiratory Care; the Association of Professionals in Infection Control and Epidemiology; the Council of State and Territorial Epidemiologists; the Healthcare Infection Control Practices Advisory Committee’s Surveillance Working Group; the Infectious Diseases Society of America; and the Society for Healthcare Epidemiology of America. VAEs are defined by an increase oxygen (>0.2 in FiO2 or positive end-expiratory pressure (PEEP (≥3 cm H2O, after a previous stable baseline of at least 2 …

  11. Electrical impedance tomography

    Science.gov (United States)

    Lobo, Beatriz; Hermosa, Cecilia; Abella, Ana

    2018-01-01

    Continuous assessment of respiratory status is one of the cornerstones of modern intensive care unit (ICU) monitoring systems. Electrical impedance tomography (EIT), although with some constraints, may play the lead as a new diagnostic and guiding tool for an adequate optimization of mechanical ventilation in critically ill patients. EIT may assist in defining mechanical ventilation settings, assess distribution of tidal volume and of end-expiratory lung volume (EELV) and contribute to titrate positive end-expiratory pressure (PEEP)/tidal volume combinations. It may also quantify gains (recruitment) and losses (overdistention or derecruitment), granting a more realistic evaluation of different ventilator modes or recruitment maneuvers, and helping in the identification of responders and non-responders to such maneuvers. Moreover, EIT also contributes to the management of life-threatening lung diseases such as pneumothorax, and aids in guiding fluid management in the critical care setting. Lastly, assessment of cardiac function and lung perfusion through electrical impedance is on the way. PMID:29430443

  12. Ventilation distribution measured with EIT at varying levels of pressure support and Neurally Adjusted Ventilatory Assist in patients with ALI.

    Science.gov (United States)

    Blankman, Paul; Hasan, Djo; van Mourik, Martijn S; Gommers, Diederik

    2013-06-01

    The purpose of this study was to compare the effect of varying levels of assist during pressure support (PSV) and Neurally Adjusted Ventilatory Assist (NAVA) on the aeration of the dependent and non-dependent lung regions by means of Electrical Impedance Tomography (EIT). We studied ten mechanically ventilated patients with Acute Lung Injury (ALI). Positive-End Expiratory Pressure (PEEP) and PSV levels were both 10 cm H₂O during the initial PSV step. Thereafter, we changed the inspiratory pressure to 15 and 5 cm H₂O during PSV. The electrical activity of the diaphragm (EAdi) during pressure support ten was used to define the initial NAVA gain (100 %). Thereafter, we changed NAVA gain to 150 and 50 %, respectively. After each step the assist level was switched back to PSV 10 cm H₂O or NAVA 100 % to get a new baseline. The EIT registration was performed continuously. Tidal impedance variation significantly decreased during descending PSV levels within patients, whereas not during NAVA. The dorsal-to-ventral impedance distribution, expressed according to the center of gravity index, was lower during PSV compared to NAVA. Ventilation contribution of the dependent lung region was equally in balance with the non-dependent lung region during PSV 5 cm H₂O, NAVA 50 and 100 %. Neurally Adjusted Ventilatory Assist ventilation had a beneficial effect on the ventilation of the dependent lung region and showed less over-assistance compared to PSV in patients with ALI.

  13. Non-pharmacological strategies for blood conservation in cardiac surgery.

    Science.gov (United States)

    Ruel, M A; Rubens, F D

    2001-04-01

    Of all surgical specialties, cardiac operations are most often associated with coagulopathy, blood loss, and the need for transfusions. This not only represents a major burden on blood procurement and banking organizations at all levels, but also constitutes a risk for each patient receiving allogeneic blood products. This paper reviews current non-pharmacological strategies aimed at decreasing blood use in patients undergoing cardiac surgery. The literature pertaining to each blood conservation strategy was searched, reviewed, and appraised. Meta- analyses were also consulted and their results complemented with subsequent reports when available. Preoperative autologous donation programs are effective in decreasing allogeneic transfusions, but are costly and applicable to elective patients only. Off-pump revascularization strategies also appear to decrease transfusion requirements in suitable patients. The effectiveness of acute normovolemic hemodilution, retrograde autologous priming, small volume cardiopulmonary bypass circuits, platelet-rich plasmapheresis, alternative heparin strategies, and postoperative cell salvage are more difficult to appraise as a high proportion of available studies suffer from lack of transfusion guidelines or the absence of blinding. Biological glues, surgical adhesives, and postoperative increases in positive end-expiratory pressure (PEEP) have no demonstrated efficacy. The applicability or effectiveness of many of these modalities remains controversial and more studies are needed before they may be employed routinely in cardiac surgical patients. The judicious use of rational transfusion guidelines may still be the simplest and most cost-effective means of blood conservation today.

  14. An object-oriented computational model to study cardiopulmonary hemodynamic interactions in humans.

    Science.gov (United States)

    Ngo, Chuong; Dahlmanns, Stephan; Vollmer, Thomas; Misgeld, Berno; Leonhardt, Steffen

    2018-06-01

    This work introduces an object-oriented computational model to study cardiopulmonary interactions in humans. Modeling was performed in object-oriented programing language Matlab Simscape, where model components are connected with each other through physical connections. Constitutive and phenomenological equations of model elements are implemented based on their non-linear pressure-volume or pressure-flow relationship. The model includes more than 30 physiological compartments, which belong either to the cardiovascular or respiratory system. The model considers non-linear behaviors of veins, pulmonary capillaries, collapsible airways, alveoli, and the chest wall. Model parameters were derisved based on literature values. Model validation was performed by comparing simulation results with clinical and animal data reported in literature. The model is able to provide quantitative values of alveolar, pleural, interstitial, aortic and ventricular pressures, as well as heart and lung volumes during spontaneous breathing and mechanical ventilation. Results of baseline simulation demonstrate the consistency of the assigned parameters. Simulation results during mechanical ventilation with PEEP trials can be directly compared with animal and clinical data given in literature. Object-oriented programming languages can be used to model interconnected systems including model non-linearities. The model provides a useful tool to investigate cardiopulmonary activity during spontaneous breathing and mechanical ventilation. Copyright © 2018 Elsevier B.V. All rights reserved.

  15. Effect of driving pressure on mortality in ARDS patients during lung protective mechanical ventilation in two randomized controlled trials.

    Science.gov (United States)

    Guérin, Claude; Papazian, Laurent; Reignier, Jean; Ayzac, Louis; Loundou, Anderson; Forel, Jean-Marie

    2016-11-29

    Driving pressure (ΔPrs) across the respiratory system is suggested as the strongest predictor of hospital mortality in patients with acute respiratory distress syndrome (ARDS). We wonder whether this result is related to the range of tidal volume (V T ). Therefore, we investigated ΔPrs in two trials in which strict lung-protective mechanical ventilation was applied in ARDS. Our working hypothesis was that ΔPrs is a risk factor for mortality just like compliance (Crs) or plateau pressure (Pplat,rs) of the respiratory system. We performed secondary analysis of data from 787 ARDS patients enrolled in two independent randomized controlled trials evaluating distinct adjunctive techniques while they were ventilated as in the low V T arm of the ARDSnet trial. For this study, we used V T , positive end-expiratory pressure (PEEP), Pplat,rs, Crs, ΔPrs, and respiratory rate recorded 24 hours after randomization, and compared them between survivors and nonsurvivors at day 90. Patients were followed for 90 days after inclusion. Cox proportional hazard modeling was used for mortality at day 90. If colinearity between ΔPrs, Crs, and Pplat,rs was verified, specific Cox models were used for each of them. Both trials enrolled 805 patients of whom 787 had day-1 data available, and 533 of these survived. In the univariate analysis, ΔPrs averaged 13.7 ± 3.7 and 12.8 ± 3.7 cmH 2 O (P = 0.002) in nonsurvivors and survivors, respectively. Colinearity between ΔPrs, Crs and Pplat,rs, which was expected as these variables are mathematically coupled, was statistically significant. Hazard ratios from the Cox models for day-90 mortality were 1.05 (1.02-1.08) (P = 0.005), 1.05 (1.01-1.08) (P = 0.008) and 0.985 (0.972-0.985) (P = 0.029) for ΔPrs, Pplat,rs and Crs, respectively. PEEP and V T were not associated with death in any model. When ventilating patients with low V T , ΔPrs is a risk factor for death in ARDS patients, as is Pplat,rs or Crs. As our data

  16. Síndrome do desconforto respiratório agudo pulmonar e extrapulmonar: existem diferenças? Pulmonary and extrapulmonary acute respiratory distress syndrome: are they different?

    Directory of Open Access Journals (Sweden)

    Cristiane S. N. Baez Garcia

    2008-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A patogênese da síndrome do desconforto respiratório agudo (SDRA tem sido explicada pela presença de uma agressão direta (SDRA pulmonar e/ou indireta (SDRA extrapulmonar ao parênquima pulmonar. Evidências indicam que a fisiopatologia da doença pode diferir com o tipo de lesão. O objetivo deste estudo foi apresentar breve revisão das diferenças entre a SDRA pulmonar e a SDRA extrapulmonar e discutir as interações entre os aspectos morfofuncionais e a resposta aos diferentes tratamentos. CONTEÚDO: Esta revisão bibliográfica baseou-se em uma pesquisa sistemática de artigos experimentais e clínicos sobre SDRA incluídos nas bases de dados MedLine e SciElo nos últimos 20 anos. Muitos pesquisadores concordam, com base em estudos experimentais, que a SDRA pulmonar e a SDRA extrapulmonar não são idênticas no que diz respeito aos aspectos morfofuncionais, a resposta à pressão positiva ao final da expiração (PEEP, manobra de recrutamento alveolar, posição prona e outras terapias farmacológicas. Entretanto, os estudos clínicos têm descrito resultados contraditórios, os quais podem ser atribuídos à dificuldade de se classificar a SDRA em uma ou outra etiologia, e de se precisar o início, a fase e a gravidade da SDRA nos pacientes. CONCLUSÕES: Pacientes com SDRA de etiologias distintas perduram sendo considerados como pertencendo a uma mesma síndrome e, assim, são tratados da mesma forma. Logo, é fundamental entender as diferenças fisiopatológicas entre a SDRA pulmonar e extrapulmonar para que a terapia seja mais bem direcionada.BACKGROUND AND OBJECTIVES: The pathogenesis of acute respiratory distress syndrome (ARDS has been described by the presence of direct (pulmonary and/or indirect (extrapulmonary insult to the lung parenchyma. Evidence indicates that the pathophysiology of ARDS may differ according to the type of primary insult. This article presents a brief overview of differences

  17. Comparação entre três métodos de obtenção do índice de respiração rápida e superficial em pacientes submetidos ao desmame da ventilação mecânica Comparison among three methods to measure the rapid shallow breathing index in patients submitted to weaning from mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Lorena de Oliveira Santos

    2007-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Esta pesquisa justifica-se na necessidade de maior conhecimento a respeito das técnicas de desmame ventilatório utilizadas em pacientes sob ventilação mecânica prolongada. O objetivo deste estudo foi comparar a obtenção do índice de respiração rápida e superficial (IRRS nas modalidades PSV de 10 cmH2O e PEEP de 5 cmH2O (PSV10; CPAP de 5 cmH2O (CPAP5 e em ventilação espontânea (ESP, correlacionando com sucesso ou insucesso na retirada da ventilação mecânica (VM. MÉTODO: Estudo prospectivo incluindo 54 pacientes em VM há mais de 48 horas, submetidos ao IRRS em três modos ventilatórios: PSV10, CPAP5 e ESP nos momentos pré e pós-nebulização, utilizando tubo-T. Os pacientes foram retirados da VM quando o IRRS era BACKGROUND AND OBJECTIVES: To compare the attainment of the rapid shallow breathing index (IRRS in modalities PSV 10 cmH2O and PEEP 5 cmH2O (PSV10, CPAP 5 cmH2O (CPAP5 and spontaneous breathing (SB, correlating them with success on failure in the withdrawal of mechanical ventilation (MV. METHODS: Prospective study including 54 patients in MV > 48 hours, submitted to the IRRS in three ventilatory modalities: PSV10, CPAP5 and SB at the moments before and after T-tube spontaneous breathing. The patients were removed from MV when IRRS was < 105. RESULTS: There wasn't statistically significant difference between IRRS values at the moments before and after T-tube SB. There was statistically significant difference IRRS value between the modalities CPAP5 and PSV10 (p = 0.008, and between the modalities SB and PSV10 (p = 0.01 at the moment before T-Tube SB and of IRRS value, gotten between CPAP5 and PSV10 (p = 0.01 at the moment after T-tube SB. CONCLUSIONS: From this sample, it can be observed that IRRS values are overestimated when gotten in modality PSV10. It was also evidenced that there is no need of a 30 min T-tube SB before extubation, when the weaning is performed with the technique of

  18. Actual performance of mechanical ventilators in ICU: a multicentric quality control study

    Directory of Open Access Journals (Sweden)

    Govoni L

    2012-12-01

    Full Text Available Leonardo Govoni,1 Raffaele L Dellaca,1 Oscar Peñuelas,2,3 Giacomo Bellani,4,5 Antonio Artigas,3,6 Miquel Ferrer,3,7 Daniel Navajas,3,8,9 Antonio Pedotti,1 Ramon Farré3,81TBM-Lab, Dipartimento di Bioingegneria, Politecnico di Milano University, Milano, Italy; 2Hospital Universitario de Getafe – CIBERES, Madrid, Spain; 3CIBER de Enfermedades Respiratorias, Bunyola, Spain; 4Department of Experimental Medicine, University of Milan, Bicocca, Italy; 5Department of Perioperative Medicine and Intensive Care, San Gerardo Hospital, Monza (MI, Italy; 6Critical Care Center, Sabadell Hospital, Corporació Sanitaria Universitaria Parc Tauli, Universitat Autonoma de Barcelona, CIBERES, Spain; 7Department of Pneumology, Hospital Clinic, IDIBAPS, Barcelona, Spain; 8Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universidad de Barcelona-IDIBAPS, Barcelona, Spain; 9Institut de Bioenginyeria de Catalunya, Barcelona, SpainAbstract: Even if the performance of a given ventilator has been evaluated in the laboratory under very well controlled conditions, inappropriate maintenance and lack of long-term stability and accuracy of the ventilator sensors may lead to ventilation errors in actual clinical practice. The aim of this study was to evaluate the actual performances of ventilators during clinical routines. A resistance (7.69 cmH2O/L/s – elastance (100 mL/cmH2O test lung equipped with pressure, flow, and oxygen concentration sensors was connected to the Y-piece of all the mechanical ventilators available for patients in four intensive care units (ICUs; n = 66. Ventilators were set to volume-controlled ventilation with tidal volume = 600 mL, respiratory rate = 20 breaths/minute, positive end-expiratory pressure (PEEP = 8 cmH2O, and oxygen fraction = 0.5. The signals from the sensors were recorded to compute the ventilation parameters. The average ± standard deviation and range (min–max of the ventilatory parameters were the following: inspired

  19. Effects of lung protective mechanical ventilation associated with permissive respiratory acidosis on regional extra-pulmonary blood flow in experimental ARDS.

    Science.gov (United States)

    Hering, Rudolf; Kreyer, Stefan; Putensen, Christian

    2017-10-27

    Lung protective mechanical ventilation with limited peak inspiratory pressure has been shown to affect cardiac output in patients with ARDS. However, little is known about the impact of lung protective mechanical ventilation on regional perfusion, especially when associated with moderate permissive respiratory acidosis. We hypothesized that lung protective mechanical ventilation with limited peak inspiratory pressure and moderate respiratory acidosis results in an increased cardiac output but unequal distribution of blood flow to the different organs of pigs with oleic-acid induced ARDS. Twelve pigs were enrolled, 3 died during instrumentation and induction of lung injury. Thus, 9 animals received pressure controlled mechanical ventilation with a PEEP of 5 cmH 2 O and limited peak inspiratory pressure (17 ± 4 cmH 2 O) versus increased peak inspiratory pressure (23 ± 6 cmH 2 O) in a crossover-randomized design and were analyzed. The sequence of limited versus increased peak inspiratory pressure was randomized using sealed envelopes. Systemic and regional hemodynamics were determined by double indicator dilution technique and colored microspheres, respectively. The paired student t-test and the Wilcoxon test were used to compare normally and not normally distributed data, respectively. Mechanical ventilation with limited inspiratory pressure resulted in moderate hypercapnia and respiratory acidosis (PaCO 2 71 ± 12 vs. 46 ± 9 mmHg, and pH 7.27 ± 0.05 vs. 7.38 ± 0.04, p respiratory acidosis was associated with an increase in cardiac output. However, the better systemic blood flow was not uniformly directed to the different organs. This observation may be of clinical interest in patients, e.g. with cardiac, renal and cerebral pathologies.

  20. Successful conservative management of a rare complication of tracheostomy; extensive posterior tracheal false pouch.

    Science.gov (United States)

    Ha, Jennifer F; Ostwani, Waseem; Green, Glenn

    2016-11-01

    With the advent of improved neonatal and pediatric intensive care management, tracheostomy is increasingly performed in children requiring prolonged ventilation. Even though tracheostomy is generally a safe procedure, there remains mortality and morbidity associated with it. We report a rare complication of a tracheostomy tube resulting in extensive erosion and posterior tracheal false pouch secondary to a large tracheostomy tube and high positive end expiratory pressure in a 12-month-old infant. This was managed successfully with conservative treatment. A former 34-week premature infant was transferred to our pediatrics intensive care unit (PICU) with recurrent episodes of cardiopulmonary arrests due to suspected severe tracheobronchomalacia. The patient has bronchopulomonary dysplasia, severe restrictive lung disease and thoracic insufficiency from skeletal dysplasia requiring tracheostomy tube (TT) at two-month-old and mechanical ventilation. The 3.5 NEO TT was gradually upsized to a 5. The PEEP setting at transfer was 18cmH2O. The direct laryngoscopy and bronchoscopy showed moderate tracheomalacia at the innominate artery with a false pouch in the posterior tracheal wall that was 1.1cm below the tracheostomy stoma. A multi-disciplinary discussion including otolaryngology, PICU, Pulmonary Medicine, and Pediatric Surgery decided on conservative management. The false pouch healed and she was transferred back to referring PICU after a 46-day. Tracheal wall erosion resulting in a pouch formation is a rare complication, but it should be considered in patients with long term tracheostomy with difficulty ventilation and oxygenation with positional change. DLB is a useful tool in its diagnosis and conservative management can be successful. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Defensive behaviors and prosencephalic neurogenesis in pigeons (Columba livia) are affected by environmental enrichment in adulthood.

    Science.gov (United States)

    Melleu, F F; Pinheiro, M V; Lino-de-Oliveira, C; Marino-Neto, J

    2016-05-01

    Neurogenesis in the adult brain appears to be phylogenetically conserved across the animal kingdom. In pigeons and other adult non-oscine birds, immature neurons are observed in several prosencephalic areas, suggesting that neurogenesis may participate in the control of different behaviors. The mechanisms controlling neurogenesis and its relevance to defensive behaviors in non-oscine birds remain elusive. Herein, the contribution of the environment to behavior and neurogenesis of pigeons was investigated. Adult pigeons (Columba livia, n = 6/group), housed in standard (SE) or enriched environment (EE) for 42 days, were exposed to an unfamiliar environment (UE) followed by presentation to a novel object (NO). Video recordings of UE+NO tests were analyzed and scored for latency, duration and frequency of angular head movements, peeping, grooming, immobility and locomotion. Twenty-four hours later, pigeons were submitted to the tonic immobility test (TI) and number of trials for TI and TI duration were scored, followed by euthanasia 2 h later. Brains were immunohistochemically processed to reveal doublecortin (DCX), a marker for newborn neurons. Compared to those housed in SE, the pigeons housed in EE responded to a NO with more immobility. In addition, the pigeons housed in EE presented longer TI, more DCX-immunoreactive (DCX-ir) cells in the hippocampus and fewer DCX-ir cells in the lateral striatum than those housed in SE. There was no correlation between the number of DCX-ir cells and the scores of immobility in behavioral tests. Together, these data suggest that enrichment favored behavioral inhibition and neurogenesis in the adult pigeons through different, parallel mechanisms.

  2. Histologic and biochemical alterations predict pulmonary mechanical dysfunction in aging mice with chronic lung inflammation.

    Science.gov (United States)

    Massa, Christopher B; Groves, Angela M; Jaggernauth, Smita U; Laskin, Debra L; Gow, Andrew J

    2017-08-01

    airway opening, to a greater extent than overt acinar wall destruction. Model-predicted deficits in PEEP-dependent lung recruitment correlate with altered lung lining fluid composition independent of age or genotype.

  3. ProSeal laryngeal mask airway improves oxygenation when used as a conduit prior to laryngoscope guided intubation in bariatric patients

    Directory of Open Access Journals (Sweden)

    Aparna Sinha

    2013-01-01

    Full Text Available Background: The primary objective of this study was to compare the effect of ventilation using the ProSeal TM laryngeal mask airway (PLMA with facemask and oropharyngeal airway (FM, prior to laryngoscopy, on arterial oxygenation in morbidly obese patients undergoing bariatric surgery. Methods: Forty morbidly obese patients were randomly recruited to either PLMA or FM. After pre-oxygenation (FiO 2 1.0 in the ramp position with continuous positive airway pressure of 10 cm H 2 O for 5 min, anaesthesia was induced. Following loss of jaw thrust oropharyngeal airway, the FM and PLMA were inserted. On achieving paralysis, volume control ventilation with PEEP (5 cm H 2 O was initiated. The difficulty in mask ventilation (DMV in FM, number of attempts at PLMA and laryngoscopy were graded (Cormack and Lehane in all patients. Time from onset of laryngoscopy to endotracheal tube confirmation was recorded. Hypoxia was defined as mild (SpO 2 ≤95%, moderate (SpO 2 ≤90% and severe (SpO 2 ≤85%. Results: Significant rise in pO 2 was observed within both groups ( P=0.001, and this was significantly higher in the PLMA ( P=0.0001 when compared between the groups. SpO 2 ≥ 90% ( P=0.018 was seen in 19/20 (95% patients in PLMA and 13/20 (65% in FM at confirmation of tracheal tube. A strong association was found between DMV and Cormack Lehane in the FM group and with number of attempts in the PLMA group. No adverse events were observed. Conclusion: ProSeal TM laryngeal mask airway as conduit prior to laryngoscopy in morbidly obese patients seems effective in increasing oxygen reserves, and can be suggested as a routine airway management technique when managing the airway in the morbidly obese.

  4. Effect of different seated positions on lung volume and oxygenation in acute respiratory distress syndrome.

    Science.gov (United States)

    Dellamonica, J; Lerolle, N; Sargentini, C; Hubert, S; Beduneau, G; Di Marco, F; Mercat, A; Diehl, J L; Richard, J C M; Bernardin, G; Brochard, L

    2013-06-01

    Lung volume available for ventilation is markedly decreased during acute respiratory distress syndrome. Body positioning may contribute to increase lung volume and partial verticalization is simple to perform. This study evaluated whether verticalization had parallel effects on oxygenation and end expiratory lung volume (EELV). Prospective multicenter study in 40 mechanically ventilated patients with ALI/ARDS in five university hospital MICUs. We evaluated four 45-min successive trunk position epochs (supine slightly elevated at 15°; semi recumbent with trunk elevated at 45°; seated with trunk elevated at 60° and legs down at 45°; back to supine). Arterial blood gases, EELV measured using the nitrogen washin/washout, and static compliance were measured. Responders were defined by a PaO₂/FiO₂ increase >20 % between supine and seated position. Results are median [25th-75th percentiles]. With median PEEP = 10 cmH₂O, verticalization increased lung volume but only responders (13 patients, 32 %) had a significant increase in EELV/PBW (predicted body weight) compared to baseline. This increase persisted at least partially when patients were positioned back to supine. Responders had a lower EELV/PBW supine [14 mL/kg (13-15) vs. 18 mL/kg (15-27) (p = 0.005)] and a lower compliance [30 mL/cmH₂O (22-38) vs. 42 (30-46) (p = 0.01)] than non-responders. Strain decreased with verticalization for responders. EELV/PBW increase and PaO₂/FiO₂ increase were not correlated. Verticalization is easily achieved and improves oxygenation in approximately 32 % of the patients together with an increase in EELV. Nonetheless, effect of verticalization on EELV/PBW is not predictable by PaO₂/FiO₂ increase, its monitoring may be helpful for strain optimization.

  5. Variability in usual care mechanical ventilation for pediatric acute lung injury: the potential benefit of a lung protective computer protocol.

    Science.gov (United States)

    Khemani, Robinder G; Sward, Katherine; Morris, Alan; Dean, J Michael; Newth, Christopher J L

    2011-11-01

    Although pediatric intensivists claim to embrace lung protective ventilation for acute lung injury (ALI), ventilator management is variable. We describe ventilator changes clinicians made for children with hypoxemic respiratory failure, and evaluate the potential acceptability of a pediatric ventilation protocol. This was a retrospective cohort study performed in a tertiary care pediatric intensive care unit (PICU). The study period was from January 2000 to July 2007. We included mechanically ventilated children with PaO(2)/FiO(2) (P/F) ratio less than 300. We assessed variability in ventilator management by evaluating actual changes to ventilator settings after an arterial blood gas (ABG). We evaluated the potential acceptability of a pediatric mechanical ventilation protocol we adapted from National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI) Acute Respiratory Distress Syndrome (ARDS) Network protocols by comparing actual practice changes in ventilator settings to changes that would have been recommended by the protocol. A total of 2,719 ABGs from 402 patients were associated with 6,017 ventilator settings. Clinicians infrequently decreased FiO(2), even when the PaO(2) was high (>68 mmHg). The protocol would have recommended more positive end expiratory pressure (PEEP) than was used in actual practice 42% of the time in the mid PaO(2) range (55-68 mmHg) and 67% of the time in the low PaO(2) range (ventilator rate (VR) when the protocol would have recommended a change, even when the pH was greater than 7.45 with PIP at least 35 cmH(2)O. There may be lost opportunities to minimize potentially injurious ventilator settings for children with ALI. A reproducible pediatric mechanical ventilation protocol could prompt clinicians to make ventilator changes that are consistent with lung protective ventilation.

  6. Variable versus conventional lung protective mechanical ventilation during open abdominal surgery (PROVAR): a randomised controlled trial.

    Science.gov (United States)

    Spieth, P M; Güldner, A; Uhlig, C; Bluth, T; Kiss, T; Conrad, C; Bischlager, K; Braune, A; Huhle, R; Insorsi, A; Tarantino, F; Ball, L; Schultz, M J; Abolmaali, N; Koch, T; Pelosi, P; Gama de Abreu, M

    2018-03-01

    Experimental studies showed that controlled variable ventilation (CVV) yielded better pulmonary function compared to non-variable ventilation (CNV) in injured lungs. We hypothesized that CVV improves intraoperative and postoperative respiratory function in patients undergoing open abdominal surgery. Fifty patients planned for open abdominal surgery lasting >3 h were randomly assigned to receive either CVV or CNV. Mean tidal volumes and PEEP were set at 8 ml kg -1 (predicted body weight) and 5 cm H 2 O, respectively. In CVV, tidal volumes varied randomly, following a normal distribution, on a breath-by-breath basis. The primary endpoint was the forced vital capacity (FVC) on postoperative Day 1. Secondary endpoints were oxygenation, non-aerated lung volume, distribution of ventilation, and pulmonary and extrapulmonary complications until postoperative Day 5. FVC did not differ significantly between CVV and CNV on postoperative Day 1, 61.5 (standard deviation 22.1) % vs 61.9 (23.6) %, respectively; mean [95% confidence interval (CI)] difference, -0.4 (-13.2-14.0), P=0.95. Intraoperatively, CVV did not result in improved respiratory function, haemodynamics, or redistribution of ventilation compared to CNV. Postoperatively, FVC, forced expiratory volume at the first second (FEV 1 ), and FEV 1 /FVC deteriorated, while atelectasis volume and plasma levels of interleukin-6 and interleukin-8 increased, but values did not differ between groups. The incidence of postoperative pulmonary and extrapulmonary complications was comparable in CVV and CNV. In patients undergoing open abdominal surgery, CVV did not improve intraoperative and postoperative respiratory function compared with CNV. NCT 01683578. Copyright © 2017 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

  7. Mild hypothermia increases pulmonary anti-inflammatory response during protective mechanical ventilation in a piglet model of acute lung injury.

    Science.gov (United States)

    Cruces, Pablo; Erranz, Benjamín; Donoso, Alejandro; Carvajal, Cristóbal; Salomón, Tatiana; Torres, María Fernanda; Díaz, Franco

    2013-11-01

    The effects of mild hypothermia (HT) on acute lung injury (ALI) are unknown in species with metabolic rate similar to that of humans, receiving protective mechanical ventilation (MV). We hypothesized that mild hypothermia would attenuate pulmonary and systemic inflammatory responses in piglets with ALI managed with a protective MV. Acute lung injury (ALI) was induced with surfactant deactivation in 38 piglets. The animals were then ventilated with low tidal volume, moderate positive end-expiratory pressure (PEEP), and permissive hypercapnia throughout the experiment. Subjects were randomized to HT (33.5°C) or normothermia (37°C) groups over 4 h. Plasma and tissue cytokines, tissue apoptosis, lung mechanics, pulmonary vascular permeability, hemodynamic, and coagulation were evaluated. Lung interleukin-10 concentrations were higher in subjects that underwent HT after ALI induction than in those that maintained normothermia. No difference was found in other systemic and tissue cytokines. HT did not induce lung or kidney tissue apoptosis or influence lung mechanics or markers of pulmonary vascular permeability. Heart rate, cardiac output, oxygen uptake, and delivery were significantly lower in subjects that underwent HT, but no difference in arterial lactate, central venous oxygen saturation, and coagulation test was observed. Mild hypothermia induced a local anti-inflammatory response in the lungs, without affecting lung function or coagulation, in this piglet model of ALI. The HT group had lower cardiac output without signs of global dysoxia, suggesting an adaptation to the decrease in oxygen uptake and delivery. Studies are needed to determine the therapeutic role of HT in ALI. © 2013 John Wiley & Sons Ltd.

  8. Perioperative lung protective ventilation in obese patients.

    Science.gov (United States)

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F; Repine, John E

    2015-05-06

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increasing, and facing these challenges is common in the operating rooms and critical care units worldwide. In this review we summarize the existing literature which supports the following recommendations for the perioperative ventilation in obese patients: (1) the use of protective ventilation with low tidal volumes (approximately 8 mL/kg, calculated based on predicted -not actual- body weight) to avoid volutrauma; (2) a focus on lung recruitment by utilizing PEEP (8-15 cmH2O) in addition to recruitment maneuvers during the intraoperative period, as well as incentivized deep breathing and noninvasive ventilation early in the postoperative period, to avoid atelectasis, hypoxemia and atelectrauma; and (3) a judicious oxygen use (ideally less than 0.8) to avoid hypoxemia but also possible reabsorption atelectasis. Obesity poses an additional challenge for achieving adequate protective ventilation during one-lung ventilation, but different lung isolation techniques have been adequately performed in obese patients by experienced providers. Postoperative efforts should be directed to avoid hypoventilation, atelectasis and hypoxemia. Further studies are needed to better define optimum protective ventilation strategies and analyze their impact on the perioperative outcomes of surgical patients with obesity.

  9. Comparisons of different mean airway pressure settings during high-frequency oscillation in inflammatory response to oleic acid-induced lung injury in rabbits

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    Koichi Ono

    2009-03-01

    Full Text Available Koichi Ono1, Tomonobu Koizumi2, Rikimaru Nakagawa1, Sumiko Yoshikawa2, Tetsutarou Otagiri11Department of Anesthesiology and Resuscitation; 2First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, JapanPurpose: The present study was designed to examine effects of different mean airway pressure (MAP settings during high-frequency oscillation (HFO on oxygenation and inflammatory responses to acute lung injury (ALI in rabbits.Methods: Anesthetized rabbits were mechanically ventilated with a conventional mechanical ventilation (CMV mode (tidal volume 6 ml/kg, inspired oxygen fraction [FIo2] of 1.0, respiratory rate [RR] of 30/min, positive end-expiratory pressure [PEEP] of 5 cmH2O. ALI was induced by intravenous administration of oleic acid (0.08 ml/kg and the animals were randomly allocated to the following three experimental groups; animals (n = 6 ventilated using the same mode of CMV, or animals ventilated with standard MAP (MAP 10 cmH2O, n = 7, and high MAP (15 cmH2O, n = 6 settings of HFO (Hz 15. The MAP settings were calculated by the inflation limb of the pressure-volume curve during CMV.Results: HFO with a high MAP setting significantly improved the deteriorated oxygenation during oleic acid-induced ALI and reduced wet/dry ratios, neutrophil counts and interleukin-8 concentration in bronchoalveolar lavage fluid, compared to those parameters in CMV and standard MAP-HFO.Conclusions: These findings suggest that only high MAP setting during HFO could contribute to decreased lung inflammation as well as improved oxygenation during the development of ALI.Keywords: lung protective ventilation, open lung ventilation, IL-8, neutrophil

  10. Predictive value of pulse pressure variation for fluid responsiveness in septic patients using lung-protective ventilation strategies.

    Science.gov (United States)

    Freitas, F G R; Bafi, A T; Nascente, A P M; Assunção, M; Mazza, B; Azevedo, L C P; Machado, F R

    2013-03-01

    The applicability of pulse pressure variation (ΔPP) to predict fluid responsiveness using lung-protective ventilation strategies is uncertain in clinical practice. We designed this study to evaluate the accuracy of this parameter in predicting the fluid responsiveness of septic patients ventilated with low tidal volumes (TV) (6 ml kg(-1)). Forty patients after the resuscitation phase of severe sepsis and septic shock who were mechanically ventilated with 6 ml kg(-1) were included. The ΔPP was obtained automatically at baseline and after a standardized fluid challenge (7 ml kg(-1)). Patients whose cardiac output increased by more than 15% were considered fluid responders. The predictive values of ΔPP and static variables [right atrial pressure (RAP) and pulmonary artery occlusion pressure (PAOP)] were evaluated through a receiver operating characteristic (ROC) curve analysis. Thirty-four patients had characteristics consistent with acute lung injury or acute respiratory distress syndrome and were ventilated with high levels of PEEP [median (inter-quartile range) 10.0 (10.0-13.5)]. Nineteen patients were considered fluid responders. The RAP and PAOP significantly increased, and ΔPP significantly decreased after volume expansion. The ΔPP performance [ROC curve area: 0.91 (0.82-1.0)] was better than that of the RAP [ROC curve area: 0.73 (0.59-0.90)] and pulmonary artery occlusion pressure [ROC curve area: 0.58 (0.40-0.76)]. The ROC curve analysis revealed that the best cut-off for ΔPP was 6.5%, with a sensitivity of 0.89, specificity of 0.90, positive predictive value of 0.89, and negative predictive value of 0.90. Automatized ΔPP accurately predicted fluid responsiveness in septic patients ventilated with low TV.

  11. High-frequency percussive ventilation attenuates lung injury in a rabbit model of gastric juice aspiration.

    Science.gov (United States)

    Allardet-Servent, Jérôme; Bregeon, Fabienne; Delpierre, Stéphane; Steinberg, Jean-Guillaume; Payan, Marie-José; Ravailhe, Sylvie; Papazian, Laurent

    2008-01-01

    To test the effects of high-frequency percussive ventilation (HFPV) compared with high-frequency oscillatory ventilation (HFOV) and low-volume conventional mechanical ventilation (LVCMV), on lung injury course in a gastric juice aspiration model. Prospective, randomized, controlled, in-vivo animal study. University animal research laboratory. Forty-three New Zealand rabbits. Lung injury was induced by intratracheal instillation of human gastric juice in order to achieve profound hypoxaemia (PaO2/FIO2ventilated for 4h after randomization in one of the following four groups: HFPV (median pressure 15cmH2O); LVCMV (VT 6mlkg(-1) and PEEP set to reach 15cmH2O plateau pressure); HFOV (mean pressure 15cmH2O); and a high-volume control group HVCMV (VT 12ml kg(-1) and ZEEP). Static respiratory compliance increased after the ventilation period in the HFPV, LVMCV and HFOV groups, in contrast with the HVCMV group. PaO2/FIO2 improved similarly in the HFPV, LVCMV and HFOV groups, and remained lower in the HVCMV group than in the three others. Lung oedema, myeloperoxidase and histological lung injury score were higher in the HVCMV group, but not different among all others. Arterial lactate markedly increased after 4h of ventilation in the HVCMV group, while lower but similar levels were observed in the three other groups. HFPV, like HFOV and protective CMV, improves respiratory mechanics and oxygenation, and attenuates lung damage. The HFPV provides attractive lung protection, but further studies should confirm these results before introducing HFPV into the clinical arena.

  12. Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus 'conventional' protective ventilation (6 ml/kg) in severe ARDS: the prospective randomized Xtravent-study.

    Science.gov (United States)

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

    2013-05-01

    Acute respiratory distress syndrome is characterized by damage to the lung caused by various insults, including ventilation itself, and tidal hyperinflation can lead to ventilator induced lung injury (VILI). We investigated the effects of a low tidal volume (V(T)) strategy (V(T) ≈ 3 ml/kg/predicted body weight [PBW]) using pumpless extracorporeal lung assist in established ARDS. Seventy-nine patients were enrolled after a 'stabilization period' (24 h with optimized therapy and high PEEP). They were randomly assigned to receive a low V(T) ventilation (≈3 ml/kg) combined with extracorporeal CO2 elimination, or to a ARDSNet strategy (≈6 ml/kg) without the extracorporeal device. The primary outcome was the 28-days and 60-days ventilator-free days (VFD). Secondary outcome parameters were respiratory mechanics, gas exchange, analgesic/sedation use, complications and hospital mortality. Ventilation with very low V(T)'s was easy to implement with extracorporeal CO2-removal. VFD's within 60 days were not different between the study group (33.2 ± 20) and the control group (29.2 ± 21, p = 0.469), but in more hypoxemic patients (PaO2/FIO2 ≤150) a post hoc analysis demonstrated significant improved VFD-60 in study patients (40.9 ± 12.8) compared to control (28.2 ± 16.4, p = 0.033). The mortality rate was low (16.5%) and did not differ between groups. The use of very low V(T) combined with extracorporeal CO2 removal has the potential to further reduce VILI compared with a 'normal' lung protective management. Whether this strategy will improve survival in ARDS patients remains to be determined (Clinical trials NCT 00538928).

  13. Effect of tidal volume on extravascular lung water content during one-lung ventilation for video-assisted thoracoscopic surgery: a randomised, controlled trial.

    Science.gov (United States)

    Qutub, Hatem; El-Tahan, Mohamed R; Mowafi, Hany A; El Ghoneimy, Yasser F; Regal, Mohamed A; Al Saflan, AbdulHadi A

    2014-09-01

    The use of low tidal volume during one-lung ventilation (OLV) has been shown to attenuate the incidence of acute lung injury after thoracic surgery. To test the effect of tidal volume during OLV for video-assisted thoracoscopic surgery on the extravascular lung water content index (EVLWI). A randomised, double-blind, controlled study. Single university hospital. Thirty-nine patients scheduled for elective video-assisted thoracoscopic surgery. Patients were randomly assigned to one of three groups (n = 13 per group) to ventilate the dependent lung with a tidal volume of 4, 6 or 8 ml  kg(-1) predicted body weight with I:E ratio of 1:2.5 and PEEP of 5 cm H2O. The primary outcomes were perioperative changes in EVLWI and EVLWI to intrathoracic blood volume index (ITBVI) ratio. Secondary outcomes included haemodynamics, oxygenation indices, incidences of postoperative acute lung injury, atelectasis, pneumonia, morbidity and 30-day mortality. A tidal volume of 4 compared with 6 and 8 ml  kg(-1) after 45 min of OLV resulted in an EVLWI of 4.1 [95% confidence interval (CI) 3.5 to 4.7] compared with 7.7 (95% CI 6.7 to 8.6) and 8.6 (95% CI 7.5 to 9.7) ml  kg(-1), respectively (P tidal volume of 4 ml kg during OLV was associated with less lung water content than with larger tidal volumes of 6 to 8 ml kg(-1), although no patient developed acute lung injury. Further studies are required to address the usefulness of EVLWI as a marker for the development of postoperative acute lung injury after the use of a low tidal volume during OLV in patients undergoing pulmonary resection. Clinicaltrials.gov identifier: NCT01762709.

  14. Histologic and biochemical alterations predict pulmonary mechanical dysfunction in aging mice with chronic lung inflammation.

    Directory of Open Access Journals (Sweden)

    Christopher B Massa

    2017-08-01

    alteration at airway opening, to a greater extent than overt acinar wall destruction. Model-predicted deficits in PEEP-dependent lung recruitment correlate with altered lung lining fluid composition independent of age or genotype.

  15. Thomas L Petty's lessons for the respiratory care clinician of today.

    Science.gov (United States)

    Pierson, David J

    2014-08-01

    Because of the importance of his original contributions and their practical relevance today, Thomas L Petty (1932-2009) was arguably the most important physician in the history of respiratory care. As much as any single individual, he was responsible for the concept of intensive and multidisciplinary respiratory care. In the 1960s and 1970s, he made key observations and introduced pioneering therapies in the ICU and in the home. He was the first to describe and name ARDS and to show how to use PEEP to treat life-threatening hypoxemia. He was one of the first anywhere to organize a pulmonary rehabilitation program and to show the beneficial effects of long-term oxygen therapy in COPD. Dr Petty emphasized the importance of practical, hands-on respiratory care education for both physicians and non-physicians using a collaborative team approach. He targeted educational activities and practical resources specifically to patients, and he showed how researchers and clinicians could interact responsibly with innovators in industry to the benefit of both. His life and career provide 6 important lessons for respiratory clinicians today and in the future: (1) whatever their roles, RTs and other clinicians in this field need to be experts in its core areas, such as mechanical ventilation, ARDS, and COPD; (2) respiratory care is a team activity: every member is important, and all the members need to communicate well and work together; (3) education needs to be targeted to those in the best position to benefit the patient, including primary care providers and family members; (4) everyone in the field needs to understand the important role of the respiratory care industry and to deal with it responsibly; (5) it must never be forgotten that it is all about the patient; and (6) respiratory care should be exciting and fun. Copyright © 2014 by Daedalus Enterprises.

  16. Pulmonary and chest wall mechanics in the control of respiration in the newborn.

    Science.gov (United States)

    Davis, G M; Bureau, M A

    1987-09-01

    Although the respiratory system is not fully developed at birth, the human newborn infant has flexible strategies to sustain breathing and defend blood gas homeostasis in both health and disease conditions. Initially the thresholds for chemoreceptor response to PO2 and PCO2 closely mimic those of the fetus, but the threshold resets to sustain ventilation adequate for blood gas homeostasis appropriate to the extrauterine milieu. The muscles of respiration have been "trained" in utero and effectively assume the function of the respiratory pump, despite their marginal reserve against fatigue. The pliable chest wall is functionally stabilized by the tonic activity of the intercostal muscles, thereby allowing effective ventilation. Finally, expiration is prolonged by the postinspiratory activity of the diaphragm and laryngeal braking as a means of maintaining an elevated lung volume and augmenting FRC. The ventilatory response of the newborn to respiratory disease is limited. The magnitude of the VE response is smaller than that of the adult, and is characterized by an increase in the respiratory rate and a limited increase in the VT. The poor effort reserve of the muscles, especially the diaphragm, predisposes the newborn to muscle fatigue and ventilatory failure. To avoid fatigue, recruitment of accessory muscles occurs, along with laryngeal braking of expiration, thereby decreasing the work of the diaphragm, recruiting new alveoli by an auto-PEEP effect, increasing the FRC volume, and improving gas exchange by an increase in the pulmonary surface area. These mechanisms help to avoid muscle exhaustion and facilitate adequate gas exchange in the presence of lung disease. We do not know precisely the postconceptual age at which the newborn is sufficiently developed to adopt these various defensive strategies of breathing, but the presence of tachypnea and grunting in 28-week-old premature infants suggests that long before term the human infant is capable of remarkable

  17. [FRC measurement in intensive care patients. A definition of standards].

    Science.gov (United States)

    Wauer, H J; Lorenz, B A; Kox, W J

    1998-10-01

    Determination of Functional Residual Capacity (FRC) can be performed through washout methods, indicator gas dilution or bodyplethysmography. Some of these techniques have been adapted for use in intensive care patients whilst being mechanically ventilated. However, most measurement setups are bulky, cumbersome to use and their running costs are high. Hence FRC measurement has not become a routine method in intensive care although it offers considerable advantages in the management of ventilated patients such as the determination of "best PEEP", the detection of progressive alveolar collapse in the course of acute lung injury and during weaning from mechanical ventilation. Up to now most efforts to improve and simplify FRC measurement were made at the expense of accuracy. An ideal method ought to be accurate, easy to handle and cost-effective. It should supply not only FRC data but also information about intrapulmonary gas distribution and dead space. These demands can be met using modern data acquisition software. The pros and cons of all methods available for FRC measurement are discussed in view of their suitability for intensive care patients. A conventional nitrogen washout using emission spectroscopy for measurement of nitrogen concentration gives satisfying exact values for the determination of the parameters mentioned above. The measurement error can be lowered under 5% by special corrections for flow and nitrogen signal (delay and rise times, changes of gas viscosity). For flow measurement a normal pneumotachograph can be used. Using a laptop computer for data acquisition the bed-side monitor fulfills most of the demands in intensive care. It is then also possible to measure indices of intrapulmonary gas distribution such as Alveolar Mixing Efficiency and Lung Clearance Index.

  18. Uso do suporte ventilatório com pressão positiva contínua em vias aéreas (CPAP por meio de máscara nasofacial no tratamento da insuficiência respiratória aguda

    Directory of Open Access Journals (Sweden)

    Scarpinella-Bueno M.A.

    1997-01-01

    Full Text Available OBJETIVO. O objetivo dos autores foi avaliar o efeito da ventilação com CPAP oferecida por meio de máscara nasofacial como método de suporte ventilatório em pacientes com insuficiência respiratória aguda com critérios de indicação para intubação traqueal. CASUÍSTICA E MÉTODO. Foram estudados 11 pacientes com idade média de 41,3 anos em insuficiência respiratória aguda internados na Unidade Respiratória do Hospital São Paulo - Escola Paulista de Medicina. À admissão, era colhida gasometria arterial em ar ambiente e monitorizava-se freqüência respiratória (f, freqüência cardíaca (FC e pressão arterial (PA. Os mesmos parâmetros eram avaliados após oxigenoterapia via máscara facial aberta e com máscara facial de CPAP usando PEEP de 5cm H2O. RESULTADOS. Com o uso de CPAP através de máscara nasofacial, houve melhora significativa dos níveis de PaO2 e diminuição da freqüência respiratória (p<0,05, quando comparados aos valores em ar ambiente e com máscara facial aberta. CONCLUSÃO. Este trabalho permitiu concluir que a máscara facial de CPAP com 5cm H2O foi eficiente em melhorar a oxigenação arterial e diminuir a freqüência respiratória dos pacientes com insuficiência respiratória aguda, proporcionando-lhes maior conforto, constituindo uma medida terapêutica capaz de evitar o suporte ventilatório invasivo.

  19. The use of continuous positive airway pressure in preterm babies with respiratory distress syndrome: a report from Baghdad, Iraq.

    Science.gov (United States)

    Hameed, Numan Nafie; Abdul Jaleel, Ra'id Khalil; Saugstad, Ola Didrik

    2014-04-01

    To study maternal and neonatal risk factors related to outcome of preterm babies with respiratory distress syndrome (RDS) on Continuous Positive Airway Pressure (CPAP) in a tertiary Iraqi NICU. A prospective case study carried out from January 5, 2011 to January 5, 2012, on 70 preterm neonates with RDS who were started on CPAP. Maternal and infant variables of preterm babies with successful or failed CPAP therapy were compared. Seventy neonates, 44 (63%) males and 26 (37%) females were included. Mean (SD) gestation was 32.8 (2.8) weeks and mean (SD) birth weight was 1860 (656) g. Thirty-seven (52.9%) babies failed CPAP, of them 29 (78.3%) were started on mechanical ventilation. The variables associated with failure of CPAP were: Birth weight ≤1500 g, gestational age ≤30 weeks, white out on the chest X-ray, FiO2 ≥50% at 20 min of CPAP, PEEP ≥5.5 cm H2O. Mortality rates were 94.6% in CPAP failures versus 5.4% in CPAP successes (p = 0.001). In infants surviving till discharge, duration of hospital stay was longer in babies who were CPAP successes (9.6 ± 3.7 versus 3.0 ± 2.7 days, p = 0.001). Gestational age, birth weight, whiteout chest X-ray, and FiO2 are important predictive values for success of CPAP therapy. A larger prospective multicenter controlled trial is needed to determine the benefits and risks of CPAP and predictors of its failure in our setting. Our results may be useful for others practicing in similar settings as us.

  20. Humidification performance of two high-flow nasal cannula devices: a bench study.

    Science.gov (United States)

    Chikata, Yusuke; Izawa, Masayo; Okuda, Nao; Itagaki, Taiga; Nakataki, Emiko; Onodera, Mutsuo; Imanaka, Hideaki; Nishimura, Masaji

    2014-08-01

    Delivering heated and humidified medical gas at 20-60 L/min, high-flow nasal cannula (HFNC) creates low levels of PEEP and ameliorates respiratory mechanics. It has become a common therapy for patients with respiratory failure. However, independent measurement of heat and humidity during HFNC and comparison of HFNC devices are lacking. We evaluated 2 HFNC (Airvo 2 and Optiflow system) devices. Each HFNC was connected to simulated external nares using the manufacturer's standard circuit. The Airvo 2 outlet-chamber temperature was set at 37°C. The Optiflow system incorporated an O2/air blender and a heated humidifier, which was set at 40°C/3. For both systems, HFNC flow was tested at 20, 40, and 50 L/min. Simulating spontaneous breathing using a mechanical ventilator and TTL test lung, we tested tidal volumes (VT) of 300, 500, and 700 mL, and breathing frequencies of 10 and 20 breaths/min. The TTL was connected to the simulated external nares with a standard ventilator circuit. To prevent condensation, the circuit was placed in an incubator maintained at 37°C. Small, medium, and large nasal prongs were tested. Absolute humidity (AH) of inspired gas was measured at the simulated external nares. At 20, 40, and 50 L/min of flow, respective AH values for the Airvo 2 were 35.3 ± 2.0, 37.1 ± 2.2, and 37.6 ± 2.1 mg/L, and for the Optiflow system, 33.1 ± 1.5, 35.9 ± 1.7, and 36.2 ± 1.8 mg/L. AH was lower at 20 L/min of HFNC flow than at 40 and 50 L/min (P 30 mg/L.

  1. Prevention of disorders of behavioral reactions in rats using nootropics with sodium valproate

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    Ivanov A.V.

    2013-06-01

    Full Text Available Using of anticonvulsants can trigger a number of side effects, such as possible changes in behavior and emotional state of people with epilepsy, risk of unwarranted aggression, nervousness, discoordination, sleepiness, encephalopathies. However, the epilepsy itself as a chronic neurological pathology causes cognitive and "epileptic" deficiency, in patients general retardation, sluggishness of mental activity, decreased cognitive abilities de¬velop. Therefore it is advisable to combine anticonvulsants with nootropics with their ability to protect the brain and increase body's resistance to extreme stress, reduce neurological deficits, restore damaged mnestic and mental functions. The author considered the use of nootropics on the background of anticonvulsant sodium valproate (80 mg/kg. Behavioral reactions of white rats in the test "Open field" and muscle tone of white mice in the test "muscle relaxation" were performed on the day 4 nootropics introduction in 1 hour after a single sodium valproate application. It’s shown experimentally that sodium valproate provided systemic depriming action on orientation and exploratory activity of rats: locomotor activity reduced in the number of squares strolled by 62.8% and in the number of vertical uprights by 80%, the amount of peeping into the burrows decreased by 58.7% as compared with the control. In the test "muscle relaxation" sodium valproate reduced muscle strength of mice by 38.6%. Against the background of anticonvulsant application piracetam (500 mg/kg had no effect on the behavioral responses of rats and muscle tone of mice. Citicoline (500 mg/kg increased locomotor activity in the number of squares crossed by 29.7%, in the number of vertical racks – by 20%, and the endurance of mice by 18.6%. Memantine (10 mg/kg in combination with sodium valproate insignificantly decreased (by 8.4% locomotor activity of rats, but increased exploratory activity by 30.5%; withholding of mice on the wire

  2. Minute Ventilation Limitations of Two Field Transport Ventilators.

    Science.gov (United States)

    Szpisjak, Dale F; Horn, Gregory; Shalov, Samuel; Abes, Alvin Angelo; Van Decar, Lauren

    2017-01-01

    Knowledge of transport ventilator performance impacts patient safety. This study compared minute ventilation (V E ) of the MOVES and Uni-Vent 731 when ventilating the VentAid Training Test Lung with compliance (C) ranging from 0.02 to 0.10 L/cm H 2 O and three different airway resistances (R) (none, Rp5, or Rp20). Tidal volume (V T ) was 800 ± 25 mL. Respiratory rate was increased to ventilator's maximum or until auto-PEEP > 5 cm H 2 O. Respiratory parameters were recorded with the RSS 100HR Research Pneumotach. Data were reported as median (interquartile range). Peak inspiratory pressure (PIP) of the Uni-Vent and MOVES ranged from 22.3 (22.2-22.5) to 82.6 (82.2-83.2) and 20.8 (20.6-20.9) to 50.6 (50.2-50.9) cm H 2 O, respectively. V E of the Uni-Vent and MOVES ranged from 17.7 (17.7-17.7) to 31.5 (31.5-31.5) and 11.3 (10.5-11.3) to 20.2 (19.7-20.5) L/min, respectively. Linear regression demonstrated strong, negative correlation of V E with PIP for the MOVES (V E [L/min] = 26 - 0.31 × PIP [cm H 2 O], r = -0.97) but weak, positive correlation for the Uni-Vent (r = 0.05). Uni-Vent V E exceeded MOVES V E under each test condition (p = 0.0002). If patient V E requirements exceed those predicted by the MOVES regression equation, then using the Uni-Vent should be considered. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

  3. A comparison of leak compensation in acute care ventilators during noninvasive and invasive ventilation: a lung model study.

    Science.gov (United States)

    Oto, Jun; Chenelle, Christopher T; Marchese, Andrew D; Kacmarek, Robert M

    2013-12-01

    Although leak compensation has been widely introduced to acute care ventilators to improve patient-ventilator synchronization in the presence of system leaks, there are no data on these ventilators' ability to prevent triggering and cycling asynchrony. The goal of this study was to evaluate the ability of leak compensation in acute care ventilators during invasive and noninvasive ventilation (NIV). Using a lung simulator, the impact of system leaks was compared on 7 ICU ventilators and 1 dedicated NIV ventilator during triggering and cycling at 2 respiratory mechanics (COPD and ARDS models) settings, various modes of ventilation (NIV mode [pressure support ventilation], and invasive mode [pressure support and continuous mandatory ventilation]), and 2 PEEP levels (5 and 10 cm H(2)O). Leak levels used were up to 35-36 L/min in NIV mode and 26-27 L/min in invasive mode. Although all of the ventilators were able to synchronize with the simulator at baseline, only 4 of the 8 ventilators synchronized to all leaks in NIV mode, and 2 of the 8 ventilators in invasive mode. The number of breaths to synchronization was higher during increasing than during decreasing leak. In the COPD model, miss-triggering occurred more frequently and required a longer time to stabilize tidal volume than in the ARDS model. The PB840 required fewer breaths to synchronize in both invasive and noninvasive modes, compared with the other ventilators (P ventilators. The PB840 and the V60 were the only ventilators to acclimate to all leaks, but there were differences in performance between these 2 ventilators. It is not clear if these differences have clinical importance.

  4. An attempt to validate the modification of the American-European consensus definition of acute lung injury/acute respiratory distress syndrome by the Berlin definition in a university hospital.

    Science.gov (United States)

    Hernu, R; Wallet, F; Thiollière, F; Martin, O; Richard, J C; Schmitt, Z; Wallon, G; Delannoy, B; Rimmelé, T; Démaret, C; Magnin, C; Vallin, H; Lepape, A; Baboi, L; Argaud, L; Piriou, V; Allaouchiche, B; Aubrun, F; Bastien, O; Lehot, J J; Ayzac, L; Guérin, C

    2013-12-01

    The Berlin definition for acute respiratory distress syndrome (ARDS) is a new proposal for changing the American-European consensus definition but has not been assessed prospectively as yet. In the present study, we aimed to determine (1) the prevalence and incidence of ARDS with both definitions, and (2) the initial characteristics of patients with ARDS and 28-day mortality with the Berlin definition. We performed a 6-month prospective observational study in the ten adult ICUs affiliated to the Public University Hospital in Lyon, France, from March to September 2012. Patients under invasive or noninvasive mechanical ventilation, with PaO2/FiO2 Conference and the Berlin definition criteria. The complete data set was measured at the time of inclusion. Patient outcome was measured at day 28 after inclusion. During the study period 3,504 patients were admitted and 278 fulfilled the American-European Consensus Conference criteria. Among them, 18 (6.5 %) did not comply with the Berlin criterion PEEP ≥ 5 cmH2O and 20 (7.2 %) had PaO2/FiO2 ratio ≤200 while on noninvasive ventilation. By using the Berlin definition in the remaining 240 patients (n = 42 mild, n = 123 moderate, n = 75 severe), the overall prevalence was 6.85 % and it was 1.20, 3.51, and 2.14 % for mild, moderate, and severe ARDS, respectively (P > 0.05 between the three groups). The incidence of ARDS amounted to 32 per 100,000 population per year, with values for mild, moderate, and severe ARDS of 5.6, 16.3, and 10 per 100,000 population per year, respectively (P Berlin definition of ARDS. Neither the stratification by severity nor the PaO2/FiO2 at study entry was independently associated with mortality.

  5. Trauma cranioencefálico e síndrome do desconforto respiratório agudo: como ventilar? Avaliação da prática clínica Traumatic brain injury and acute respiratory distress syndrome: how to ventilate? Evaluation of clinical practice

    Directory of Open Access Journals (Sweden)

    Lucas Montano Paternostro Saback

    2007-03-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O trauma cranioencefálico (TCE constitui um problema de saúde mundial, muito destes pacientes evoluem com insuficiência respiratória necessitando de intubação traqueal e suporte ventilatório artificial, apresentando como complicações freqüentes a síndrome do desconforto respiratório agudo (SDRA. Dessa forma, este estudo teve o objetivo de descrever a prática clínica diária sobre o manuseio ventilatório destes pacientes. MÉTODO: Foram avaliados quais os modos e os parâmetros ventilatórios utilizados para ventilar os pacientes com TCE e SDRA por uma amostra de fisioterapeutas da cidade de Salvador, BA, a partir de um estudo descritivo, por meio de entrevistas face-a-face no período de outubro de 2005 a março de 2006. Para tanto foi elaborado um questionário semi-estruturado contendo variáveis sócio-demográficas, o perfil do hospital e a estratégia ventilatória aplicada em pacientes com TCE que viessem desenvolver a SDRA. RESULTADOS: A amostra foi composta por 70 fisioterapeutas, 41 (58,6% eram do sexo feminino, com média de idade de 31,2 ± 6,4 (24-49 anos e tempo de formado 7,7 ± 6,4 (1-27 anos, dos quais 37 (52,9% trabalham em hospital público; 67 (95,7% têm alguma especialização. Sessenta e quatro fisioterapeutas afirmam utilizar o modo pressão controlada (PCV. A pressão de pico e a pressão platô desejada para ventilar os pacientes com TCE e SDRA foram em média, de 35,6 ± 5,3 (25-50 e 28,4 ± 5,8 (15-35 cmH2O, respectivamente. Quarenta e oito entrevistados (68,6% afirmaram desejar ventilar os pacientes com TCE e SDRA com a PaCO2 entre 30 e 35 mmHg. Trinta e um (44,3% dos entrevistados afirmaram encontrar a PEEP ideal através da PEEP que ofertasse melhor SpO2 com menor FiO2. CONCLUSÔES: É incontestável que a estratégia ventilatória de paciente com TCE grave que venha a desenvolver LPA ou SDRA constitua um autêntico desafio; observa-se uma predileção pelo modo PCV devido

  6. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012.

    Science.gov (United States)

    Dellinger, R P; Levy, Mitchell M; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M; Sevransky, Jonathan E; Sprung, Charles L; Douglas, Ivor S; Jaeschke, Roman; Osborn, Tiffany M; Nunnally, Mark E; Townsend, Sean R; Reinhart, Konrad; Kleinpell, Ruth M; Angus, Derek C; Deutschman, Clifford S; Machado, Flavia R; Rubenfeld, Gordon D; Webb, Steven; Beale, Richard J; Vincent, Jean-Louis; Moreno, Rui

    2013-02-01

    positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO (2)/FiO (2) ratio of ≤100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 h) for patients with early ARDS and a PaO (2)/FI O (2) management commencing insulin dosing when two consecutive blood glucose levels are >180 mg/dL, targeting an upper blood glucose ≤180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 h after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 h of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical

  7. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.

    Science.gov (United States)

    Dellinger, R Phillip; Levy, Mitchell M; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M; Sevransky, Jonathan E; Sprung, Charles L; Douglas, Ivor S; Jaeschke, Roman; Osborn, Tiffany M; Nunnally, Mark E; Townsend, Sean R; Reinhart, Konrad; Kleinpell, Ruth M; Angus, Derek C; Deutschman, Clifford S; Machado, Flavia R; Rubenfeld, Gordon D; Webb, Steven A; Beale, Richard J; Vincent, Jean-Louis; Moreno, Rui

    2013-02-01

    at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO2/FIO2 ratio of ≤ 100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 hrs) for patients with early ARDS and a Pao2/Fio2 management commencing insulin dosing when two consecutive blood glucose levels are > 180 mg/dL, targeting an upper blood glucose ≤ 180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 hrs after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 hrs of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and

  8. Practice of mechanical ventilation in cardiac arrest patients and effects of targeted temperature management: A substudy of the targeted temperature management trial.

    Science.gov (United States)

    Harmon, Matthew B A; van Meenen, David M P; van der Veen, Annelou L I P; Binnekade, Jan M; Dankiewicz, Josef; Ebner, Florian; Nielsen, Niklas; Pelosi, Paolo; Schultz, Marcus J; Horn, Janneke; Friberg, Hans; Juffermans, Nicole P

    2018-05-12

    Mechanical ventilation practices in patients with cardiac arrest are not well described. Also, the effect of temperature on mechanical ventilation settings is not known. The aims of this study were 1) to describe practice of mechanical ventilation and its relation with outcome 2) to determine effects of different target temperatures strategies (33 °C versus 36 °C) on mechanical ventilation settings. This is a substudy of the TTM-trial in which unconscious survivors of a cardiac arrest due to a cardiac cause were randomized to two TTM strategies, 33 °C (TTM33) and 36 °C (TTM36). Mechanical ventilation data were obtained at three time points: 1) before TTM; 2) at the end of TTM (before rewarming) and 3) after rewarming. Logistic regression was used to determine an association between mechanical ventilation variables and outcome. Repeated-measures mixed modelling was performed to determine the effect of TTM on ventilation settings. Mechanical ventilation data was available for 567 of the 950 TTM patients. Of these, 81% was male with a mean (SD) age of 64 (12) years. At the end of TTM median tidal volume was 7.7 ml/kg predicted body weight (PBW)(6.4-8.7) and 60% of patients were ventilated with a tidal volume ≤ 8 ml/kg PBW. Median PEEP was 7.7cmH 2 O (6.4-8.7) and mean driving pressure was 14.6 cmH 2 O (±4.3). The median FiO 2 fraction was 0.35 (0.30-0.45). Multivariate analysis showed an independent relationship between increased respiratory rate and 28-day mortality. TTM33 resulted in lower end-tidal CO 2 (Pgroup = 0.0003) and higher alveolar dead space fraction (Pgroup = 0.003) compared to TTM36, while PCO 2 levels and respiratory minute volume were similar between groups. In the majority of the cardiac arrest patients, protective ventilation settings are applied, including low tidal volumes and driving pressures. High respiratory rate was associated with mortality. TTM33 results in lower end-tidal CO 2 levels and a higher alveolar dead

  9. Effects of methacholine infusion on desflurane pharmacokinetics in piglets☆

    Science.gov (United States)

    Kozian, Alf; Kretzschmar, Moritz; Baumgardner, James E.; Schreiber, Jens; Hedenstierna, Göran; Larsson, Anders; Hachenberg, Thomas; Schilling, Thomas

    2015-01-01

    The data of a corresponding animal experiment demonstrates that nebulized methacholine (MCh) induced severe bronchoconstriction and significant inhomogeneous ventilation and pulmonary perfusion (V̇A/Q̇) distribution in pigs, which is similar to findings in human asthma. The inhalation of MCh induced bronchoconstriction and delayed both uptake and elimination of desflurane (Kretzschmar et al., 2015) [1]. The objective of the present data is to determine V̇A/Q̇ matching by Multiple Inert Gas Elimination Technique (MIGET) in piglets before and during methacholine- (MCh-) induced bronchoconstriction, induced by MCh infusion, and to assess the blood concentration profiles for desflurane (DES) by Micropore Membrane Inlet Mass Spectrometry (MMIMS). Healthy piglets (n=4) under general anesthesia were instrumented with arterial, central venous, and pulmonary artery lines. The airway was secured via median tracheostomy with an endotracheal tube, and animals were mechanically ventilated with intermittent positive pressure ventilation (IPPV) with a FiO2 of 0.4, tidal volume (VT)=10 ml/kg and PEEP of 5cmH2O using an open system. The determination of V.A/Q. was done by MIGET: before desflurane application and at plateau in both healthy state and during MCh infusion. Arterial blood was sampled at 0, 1, 2, 5, 10, 20, and 30 min during wash-in and washout, respectively. Bronchoconstriction was established by MCH infusion aiming at doubling the peak airway pressure, after which wash-in and washout of the anesthetic gas was repeated. Anesthesia gas concentrations were measured by MMIMS. Data were analyzed by ANOVA, paired t-test, and by nonparametric Friedman׳s test and Wilcoxon׳s matched pairs test. We measured airway pressures, pulmonary resistance, and mean paO2 as well as hemodynamic variables in all pigs before desflurane application and at plateau in both healthy state and during methacholine administration by infusion. By MIGET, fractional alveolar ventilation and

  10. [Predictive values of different critical scoring systems for mortality in patients with severe acute respiratory failure supported by extracorporeal membrane oxygenation].

    Science.gov (United States)

    Wang, R; Sun, B; Li, X Y; He, H Y; Tang, X; Zhan, Q Y; Tong, Z H

    2016-09-01

    To investigate the predictive values of different critical scoring systems for mortality in patients with severe acute respiratory failure (ARF) supported by venovenous extracorporeal membrane oxygenation (VV-ECMO). Forty-two patients with severe ARF supported by VV-ECMO were enrolled from November 2009 to July 2015.There were 25 males and 17 females. The mean age was (44±18) years (rang 18-69 years). Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ, Ⅲ, Ⅳ, Simplified Acute Physiology Score Ⅱ (SAPS) Ⅱ, Sequential Organ Failure Assessment (SOFA), ECMO net, PRedicting dEath for SEvere ARDS on VVECMO (PRESERVE), and Respiratory ECMO Survival Prediction (RESP) scores were collected within 6 hours before VV-ECMO support. The patients were divided into the survivors group (n=17) and the nonsurvivors group (n=25) by survival at 180 d after receiving VV-ECMO. The patient clinical characteristics and aforementioned scoring systems were compared between groups. Scoring systems for predicting prognosis were assessed using the area under the receiver-operating characteristic (ROC) curve. The Kaplan-Meier method was used to draw the surviving curve, and the survival of the patients was analyzed by the Log-rank test. The risk factors were assessed for prognosis by multiple logistic regression analysis. (1) Positive end expiratory pressure (PEEP) 6 hours prior to VV-ECMO support in the survivors group [(9.7±5.0)cmH2O, (1 cmH2O=0.098 kPa)] was lower than that in the nonsurvivors group [(13.2±5.4)cmH2O, t=-2.134, P=0.039]. VV-ECMO combination with continuous renal replacement therapy(CRRT) in the nonsurvivors group (32%) was used more than in the survivors group (6%, χ(2)=4.100, P=0.043). Duration of VV-ECMO support in the nonsurvivors group [(15±13) d] was longer than that in the survivors group [(12±11)d, t=-2.123, P=0.041]. APACHE Ⅱ, APACHE Ⅲ, APACHE Ⅳ, ECMO net, PRESERVE, and RESP scores in the survivors group were superior to the nonsurvivors

  11. Mortality in patients with respiratory distress syndrome.

    Science.gov (United States)

    Lopez Saubidet, I; Maskin, L P; Rodríguez, P O; Bonelli, I; Setten, M; Valentini, R

    2016-01-01

    Mortality in Acute Respiratory Distress Syndrome (ARDS) is decreasing, although its prognosis after hospital discharge and the prognostic accuracy of Berlin's new ARDS stratification are uncertain. We did a restrospective analysis of hospital and 6 month mortality of patients with ARDS admitted to the Intensive Care Unit of a Univeristy Hospital in Buenos Aires, between January 2008 and June 2011. ARDS was defined by PaO2/FiO2 lower than 200 mmHg under ventilation with at least 10 cm H2O of PEEP and a FiO2 higher or equal than 0.5. and the presence of bilateral infiltrates in chest radiography, in the absence of cardiogenic acute pulmonary edema, during the first 72 hs of mechanical ventilation. Mortality associated risk factors, the use of rescue therapies and Berlin's stratification for moderate and severe ARDS patients were considered. Ninety eight patients were included; mean age was 59±19 years old, 42,9% had mayor co-morbidities; APACHE II at admission was 22±7; SOFA at day 1 was 8±3. Prone position ventilation was applied in 20,4% and rescue measures in 12,2% (12 patients with nitric oxide and 1 with extracorporeal membrane oxygenation). Hospital and 6 months mortality were 37.7 and 43.8% respectively. After logistic regression analysis, only age, the presence of septic shock at admission, Ppl >30 cmH2O, and major co-morbidities were independently associated with hospital outcome. There was no difference between moderate and severe groups (41,2 and 36,8% respectively; p=0,25). In this cohort, including patients with severe hypoxemia and high percentage of mayor co-morbidities, ARDS associated mortality was lower than some previous studies. There was no increase in mortality after hospital discharge. There was no difference in mortality between moderate and severe groups according to Berlin's definition. Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  12. Sustained inflation and incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation in a large porcine model of acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Wunder Christian

    2006-06-01

    Full Text Available Abstract Background To compare the effect of a sustained inflation followed by an incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation on oxygenation and hemodynamics in a large porcine model of early acute respiratory distress syndrome. Methods Severe lung injury (Ali was induced in 18 healthy pigs (55.3 ± 3.9 kg, mean ± SD by repeated saline lung lavage until PaO2 decreased to less than 60 mmHg. After a stabilisation period of 60 minutes, the animals were randomly assigned to two groups: Group 1 (Pressure controlled ventilation; PCV: FIO2 = 1.0, PEEP = 5 cmH2O, VT = 6 ml/kg, respiratory rate = 30/min, I:E = 1:1; group 2 (High-frequency oscillatory ventilation; HFOV: FIO2 = 1.0, Bias flow = 30 l/min, Amplitude = 60 cmH2O, Frequency = 6 Hz, I:E = 1:1. A sustained inflation (SI; 50 cmH2O for 60s followed by an incremental mean airway pressure (mPaw trial (steps of 3 cmH2O every 15 minutes were performed in both groups until PaO2 no longer increased. This was regarded as full lung inflation. The mPaw was decreased by 3 cmH2O and the animals reached the end of the study protocol. Gas exchange and hemodynamic data were collected at each step. Results The SI led to a significant improvement of the PaO2/FiO2-Index (HFOV: 200 ± 100 vs. PCV: 58 ± 15 and TAli: 57 ± 12; p 2-reduction (HFOV: 42 ± 5 vs. PCV: 62 ± 13 and TAli: 55 ± 9; p Ali: 6.1 ± 1 vs. T75: 3.4 ± 0.4; PCV: TAli: 6.7 ± 2.4 vs. T75: 4 ± 0.5; p Conclusion A sustained inflation followed by an incremental mean airway pressure trial in HFOV improved oxygenation at a lower mPaw than during conventional lung protective ventilation. HFOV but not PCV resulted in normocapnia, suggesting that during HFOV there are alternatives to tidal ventilation to achieve CO2-elimination in an "open lung" approach.

  13. Initial Egyptian ECMO experience

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    Akram Abdelbary

    2016-04-01

    Results: A total of twelve patients received ECMO between January 2014 and June 2015. The mean age was 35.9 years. (range 13–65 years, 8 males, with VV ECMO in 10 patients, and VA ECMO in 2 patients. Out of ten patients of VV ECMO, one had H1N1 pneumonia, one had advanced vasculitic lung, four had bacterial pneumonia, two traumatic lung contusions and one with organophosphorus poisoning, and one undiagnosed etiology leading to severe ARDS. Lung injury score range was 3–3.8, PaO2/FiO2 (20–76 mechanical ventilation duration before ECMO 1–14 days, Femoro-jugular cannulation in 7 patients and femoro-femoral in 2 patients and femoro-subclavian in 1 patient; all patients were initially sedated and paralyzed for (2–4 days and ventilated on pressure controlled ventilation with Pmax of 25 cm H2O and PEEP of 10 cm H2O. In VA ECMO patients were cannulated percutaneously using femoro-femoral approach. One patient showed no neurologic recovery and died after 24 h, the other had CABG on ECMO however the heart didn’t recover and died after 9 days. Heparin intravenous infusion was used initially in all patients and changed to Bivalirudin in 2 patients due to possible HIT. Pump flow ranged from 2.6 to 6.5 L/min. Average support time was 12 days (range 2–24 days. Seven patients (63.3% were successfully separated from ECMO and survived to hospital discharge. Hospital length of stay ranged from 3 to 42 days, tracheostomy was done percutaneously in 5 patients and surgically in 3. Gastrointestinal bleeding occurred in 6 patients, VAP in 7 patients, neurologic complications in 1 patient with complete recovery, cardiac arrhythmias in 3 patients, pneumothorax in 9 patients, and deep venous thrombosis in 2 patients.

  14. Variable Ventilation Improved Respiratory System Mechanics and Ameliorated Pulmonary Damage in a Rat Model of Lung Ischemia-Reperfusion.

    Science.gov (United States)

    Soluri-Martins, André; Moraes, Lillian; Santos, Raquel S; Santos, Cintia L; Huhle, Robert; Capelozzi, Vera L; Pelosi, Paolo; Silva, Pedro L; de Abreu, Marcelo Gama; Rocco, Patricia R M

    2017-01-01

    Lung ischemia-reperfusion injury remains a major complication after lung transplantation. Variable ventilation (VV) has been shown to improve respiratory function and reduce pulmonary histological damage compared to protective volume-controlled ventilation (VCV) in different models of lung injury induced by endotoxin, surfactant depletion by saline lavage, and hydrochloric acid. However, no study has compared the biological impact of VV vs. VCV in lung ischemia-reperfusion injury, which has a complex pathophysiology different from that of other experimental models. Thirty-six animals were randomly assigned to one of two groups: (1) ischemia-reperfusion (IR), in which the left pulmonary hilum was completely occluded and released after 30 min; and (2) Sham, in which animals underwent the same surgical manipulation but without hilar clamping. Immediately after surgery, the left (IR-injured) and right (contralateral) lungs from 6 animals per group were removed, and served as non-ventilated group (NV) for molecular biology analysis. IR and Sham groups were further randomized to one of two ventilation strategies: VCV ( n = 6/group) [tidal volume (V T ) = 6 mL/kg, positive end-expiratory pressure (PEEP) = 2 cmH 2 O, fraction of inspired oxygen (FiO 2 ) = 0.4]; or VV, which was applied on a breath-to-breath basis as a sequence of randomly generated V T values ( n = 1200; mean V T = 6 mL/kg), with a 30% coefficient of variation. After 5 min of ventilation and at the end of a 2-h period (Final), respiratory system mechanics and arterial blood gases were measured. At Final, lungs were removed for histological and molecular biology analyses. Respiratory system elastance and alveolar collapse were lower in VCV than VV (mean ± SD, VCV 3.6 ± 1.3 cmH 2 0/ml and 2.0 ± 0.8 cmH 2 0/ml, p = 0.005; median [interquartile range], VCV 20.4% [7.9-33.1] and VV 5.4% [3.1-8.8], p = 0.04, respectively). In left lungs of IR animals, VCV increased the expression of interleukin-6 and

  15. Variable Ventilation Improved Respiratory System Mechanics and Ameliorated Pulmonary Damage in a Rat Model of Lung Ischemia-Reperfusion

    Directory of Open Access Journals (Sweden)

    Patricia R. M. Rocco

    2017-05-01

    Full Text Available Lung ischemia-reperfusion injury remains a major complication after lung transplantation. Variable ventilation (VV has been shown to improve respiratory function and reduce pulmonary histological damage compared to protective volume-controlled ventilation (VCV in different models of lung injury induced by endotoxin, surfactant depletion by saline lavage, and hydrochloric acid. However, no study has compared the biological impact of VV vs. VCV in lung ischemia-reperfusion injury, which has a complex pathophysiology different from that of other experimental models. Thirty-six animals were randomly assigned to one of two groups: (1 ischemia-reperfusion (IR, in which the left pulmonary hilum was completely occluded and released after 30 min; and (2 Sham, in which animals underwent the same surgical manipulation but without hilar clamping. Immediately after surgery, the left (IR-injured and right (contralateral lungs from 6 animals per group were removed, and served as non-ventilated group (NV for molecular biology analysis. IR and Sham groups were further randomized to one of two ventilation strategies: VCV (n = 6/group [tidal volume (VT = 6 mL/kg, positive end-expiratory pressure (PEEP = 2 cmH2O, fraction of inspired oxygen (FiO2 = 0.4]; or VV, which was applied on a breath-to-breath basis as a sequence of randomly generated VT values (n = 1200; mean VT = 6 mL/kg, with a 30% coefficient of variation. After 5 min of ventilation and at the end of a 2-h period (Final, respiratory system mechanics and arterial blood gases were measured. At Final, lungs were removed for histological and molecular biology analyses. Respiratory system elastance and alveolar collapse were lower in VCV than VV (mean ± SD, VCV 3.6 ± 1.3 cmH20/ml and 2.0 ± 0.8 cmH20/ml, p = 0.005; median [interquartile range], VCV 20.4% [7.9–33.1] and VV 5.4% [3.1–8.8], p = 0.04, respectively. In left lungs of IR animals, VCV increased the expression of interleukin-6 and intercellular

  16. Inhibitor of neuronal nitric oxide synthase improves gas exchange in ventilator-induced lung injury after pneumonectomy

    Directory of Open Access Journals (Sweden)

    Suborov Evgeny V

    2012-06-01

    Full Text Available Abstract Background Mechanical ventilation with high tidal volumes may cause ventilator-induced lung injury (VILI and enhanced generation of nitric oxide (NO. We demonstrated in sheep that pneumonectomy followed by injurious ventilation promotes pulmonary edema. We wished both to test the hypothesis that neuronal NOS (nNOS, which is distributed in airway epithelial and neuronal tissues, could be involved in the pathogenesis of VILI and we also aimed at investigating the influence of an inhibitor of nNOS on the course of VILI after pneumonectomy. Methods Anesthetized sheep underwent right pneumonectomy, mechanical ventilation with tidal volumes (VT of 6 mL/kg and FiO2 0.5, and were subsequently randomized to a protectively ventilated group (PROTV; n = 8 keeping VT and FiO2 unchanged, respiratory rate (RR 25 inflations/min and PEEP 4 cm H2O for the following 8 hrs; an injuriously ventilated group with VT of 12 mL/kg, zero end-expiratory pressure, and FiO2 and RR unchanged (INJV; n = 8 and a group, which additionally received the inhibitor of nNOS, 7-nitroindazole (NI 1.0 mg/kg/h intravenously from 2 hours after the commencement of injurious ventilation (INJV + NI; n = 8. We assessed respiratory, hemodynamic and volumetric variables, including both the extravascular lung water index (EVLWI and the pulmonary vascular permeability index (PVPI. We measured plasma nitrite/nitrate (NOx levels and examined lung biopsies for lung injury score (LIS. Results Both the injuriously ventilated groups demonstrated a 2–3-fold rise in EVLWI and PVPI, with no significant effects of NI. In the INJV group, gas exchange deteriorated in parallel with emerging respiratory acidosis, but administration of NI antagonized the derangement of oxygenation and the respiratory acidosis significantly. NOx displayed no significant changes and NI exerted no significant effect on LIS in the INJV group. Conclusion Inhibition of nNOS improved gas exchange

  17. Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: a Prospective Pilot Study

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    Agnese Ozolina

    2016-11-01

    Full Text Available Introduction: Coagulation and fibrinolysis remain sparsely addressed with regards to acute respiratory distress syndrome (ARDS. We hypothesized that ARDS development might be associated with changes in plasma coagulation and fibrinolysis. Our aim was to investigate the relationships between ARDS diagnosis and plasma concentrations of tissue factor (TF, tissue plasminogen activator (t-PA and plasminogen activator inhibitor-1 (PAI-1 in mechanically ventilated patients at increased risk of developing ARDS. Materials and Methods: We performed an ethically approved prospective observational pilot study. Inclusion criteria: patients with PaO2/FiO2 < 300 mmHg admitted to the intensive care unit (ICU for mechanical ventilation for 24 hours, or more, because of one or more disease conditions associated with increased risk of developing ARDS. Exclusion criteria: age below 18 years; cardiac disease. We sampled plasma prospectively and compared patients who developed ARDS with those who did not using descriptive statistics and chi-square analysis of baseline demographical and clinical data. We also analyzed plasma concentrations of TF, t-PA and PAI-1 at inclusion (T0 and on third (T3 and seventh day (T7 of the ICU stay with non-parametric statistics inclusive their sensitivity and specificity associated with the development of ARDS using receiver operating characteristic (ROC curve analysis. Statistical significance: p < 0.05.Results: Of 24 patients at risk, six developed mild ARDS and four of each moderate or severe ARDS, respectively, 3 ± 2 (Mean ± SD days after inclusion. Median plasma concentrations of TF and PAI-1 were significantly higher at T7 in patients with ARDS, as compared to non-ARDS. Simultaneously, we found moderate correlations between plasma concentrations of TF and PAI-1, TF and PaO2/FiO2 and PEEP and TF. TF plasma concentration was associated with ARDS with 71% sensitivity and 100% specificity, a cut off level of 145 pg/ml and AUC 0

  18. Subject-specific cardiovascular system model-based identification and diagnosis of septic shock with a minimally invasive data set: animal experiments and proof of concept

    International Nuclear Information System (INIS)

    Geoffrey Chase, J; Starfinger, Christina; Hann, Christopher E; Lambermont, Bernard; Ghuysen, Alexandre; Kolh, Philippe; Dauby, Pierre C; Desaive, Thomas; Shaw, Geoffrey M

    2011-01-01

    A cardiovascular system (CVS) model and parameter identification method have previously been validated for identifying different cardiac and circulatory dysfunctions in simulation and using porcine models of pulmonary embolism, hypovolemia with PEEP titrations and induced endotoxic shock. However, these studies required both left and right heart catheters to collect the data required for subject-specific monitoring and diagnosis—a maximally invasive data set in a critical care setting although it does occur in practice. Hence, use of this model-based diagnostic would require significant additional invasive sensors for some subjects, which is unacceptable in some, if not all, cases. The main goal of this study is to prove the concept of using only measurements from one side of the heart (right) in a 'minimal' data set to identify an effective patient-specific model that can capture key clinical trends in endotoxic shock. This research extends existing methods to a reduced and minimal data set requiring only a single catheter and reducing the risk of infection and other complications—a very common, typical situation in critical care patients, particularly after cardiac surgery. The extended methods and assumptions that found it are developed and presented in a case study for the patient-specific parameter identification of pig-specific parameters in an animal model of induced endotoxic shock. This case study is used to define the impact of this minimal data set on the quality and accuracy of the model application for monitoring, detecting and diagnosing septic shock. Six anesthetized healthy pigs weighing 20–30 kg received a 0.5 mg kg −1 endotoxin infusion over a period of 30 min from T0 to T30. For this research, only right heart measurements were obtained. Errors for the identified model are within 8% when the model is identified from data, re-simulated and then compared to the experimentally measured data, including measurements not used in the

  19. [Acute care of critically ill children in general hospitals: organisation and training].

    Science.gov (United States)

    van Sambeeck, S J L; Janssen, E J M; Hundscheid, T; Martens, S J L; Vos, G D

    2013-01-01

    To gain insight into how the acute care of critically ill children at general hospitals is organised, whether staff is sufficiently trained and whether the necessary materials and medications are present. Questionnaire combined with a site visit. Questionnaires were sent to all primarily involved specialists (emergency room specialists and paediatricians), and to the auxiliary anaesthetists and intensivists involved, at the nine general hospitals in Southeast Netherlands. Two researchers performed standardised interviews with the lead paediatricians on site and checked for materials and medication present in the emergency and paediatric departments. Of the 195 questionnaires sent, 97 (49.7%) were deemed suitable for analysis. The response from the primary specialists involved (77.6%) was more than twice that of the auxiliary specialists (31.9%). At 7 hospitals, verbal agreements on the organisation of acute care were maintained, 1 hospital had a written protocol, and 2 hospitals had a task force addressing this topic. One out of 5 respondents was unaware of the verbal agreements and 1 out of 3 mistakenly assumed that a protocol existed. Two out of 3 primary specialists involved were certified for Advanced Paediatric Life Support (APLS); 1 out of 13 of the auxiliary specialists had such a certificate. Scenario training was being conducted at 8 hospitals. A paediatric resuscitation cart was available at both the emergency and paediatric departments of 8 hospitals, 3 of which were fully stocked at both departments. Laryngeal mask airways and PEEP-valves (Positive End Expiratory Pressure) were lacking at 6 of the 9 hospitals. The medication stock was complete at all the hospitals. The organisation of and training for the acute care of critically ill children and presence of materials - the aspects we investigated - need attention at all general hospitals evaluated. It appeared that many specialists are not APLS certified and written protocols concerning organisation

  20. Clinical effect of alprostadil in patients with septic shock associated with acute respiratory distress syndrome

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    Li-ping LIU

    2017-10-01

    Full Text Available Objective To evaluate the clinical efficacy of alprostadil in patients with septic shock associated with acute respiratory distress syndrome (ARDS, and to explore its possible mechanism. Methods From January 2015 to June 2016, patients with septic shock associated with ARDS and meeting the inclusion criteria were involved in the study in department of critical care medicine in First Hospital of Lanzhou University and randomly divided into the control group and alprostadil group. The standard treatment was given in control group, alprostadil 10μg 2/d was given in alprostadil group on base of standard treatment. Monitoring indexes were recorded in 1, 3 and 6 days after enrollment. General condition of patients, APACHE Ⅱ score, ventilator conditions (PO2, PCO2, RR, PEEP, FiO2, oxygenation index, airway resistance, lung compliance, mechanical ventilation time, ICU stay time, hospital follow-up, 28-day follow-up, immune index (CD4+/CD8+, inflammatory markers (CRP, PCT, IL-6 were monitored. Results Sixty-five patients were included in this study, 32 in control group and 33 in alprostadil group. At 3 and 6 days after the treatment, APACHE Ⅱ score, respiratory rate (RR, the inspired oxygen concentration (FiO2, airway resistance, and C reactive protein (CRP, procalcitonin (PCT -6 and interleukin (IL-6 levels significantly decreased, compared with pretreatment and 1 day posttreatment, in the two groups and lower in alprostadil group than in the control group on the 6th day (P<0.05; at the same time, these indexes such as arterial partial pressure of oxygen (PaO2, lung compliance, oxygenation index, CD4+/CD8+ significantly increased 3 and 6 days after the treatment compared with pretreatment and 1 day posttreatment in the two groups, and on the 6th day, significantly higher in the alprostadil group than in the control group (P<0.05. Time of mechanical ventilation, ICU stay and hospital stay in the alprostadil group was respectively lower than that in