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Jung, Fang, Shang-Shing P. Chou, Shih-Hsing Yang, Jau-Chen Lin, and Guey-Mei Jow. "Closed Endotracheal Suctioning Impact on Ventilator-Related Parameters in Obstructive and Restrictive Respiratory Systems: A Bench Study." Applied Sciences 11, no. 11 (June 6, 2021): 5266. http://dx.doi.org/10.3390/app11115266.
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A closed suctioning system (CSS) in patients with coronavirus disease 2019 (COVID-19) prevents spraying respiratory secretions into the environment during suction. However, it is not clear whether ventilation is maintained during the suction procedure, especially in patients with compromised pulmonary mechanics. This paper determines the effects of endotracheal tube (ETT) size, suction catheter size, and two lung mechanics (resistance and compliance) on ventilator-related parameters measured during suction. Suction was performed on an adult training lung, ventilated with either volume-controlled (VC-CMV) or pressure-controlled mandatory ventilation (PC-CMV), using ETT sizes of 6.5–8.0 mm paired with suction catheter sizes of 8–14 French (Fr). Peak inspiratory pressure (PIP) increased by 50% when the ETT’s ventilation area was less than 25 mm2 in size, especially in patients with high airway resistance ventilated with VC-CMV. Positive end-expiratory pressure (PEEP) levels significantly decreased when using 14 Fr SC during VC-CMV and fewer effects during PC-CMV. Change of expiratory minute volume increased with higher outer diameter of suction catheters and decreased with severe lung compliance during PC-CMV. The change in ventilator-related parameters were intently monitored in the patient whose pulmonary mechanic was compromised through the CSS endotracheal tube suctioning procedures in clinical airway management.
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Pintavirooj, Chuchart, Areerat Maneerat, and Sarinporn Visitsattapongse. "Emergency Blower-Based Ventilator with Novel-Designed Ventilation Sensor and Actuator." Electronics 11, no. 5 (March 1, 2022): 753. http://dx.doi.org/10.3390/electronics11050753.
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The ventilator, a life-saving device for COVID-19-infected patients, especially for pneumonia patients whose lungs are infected, has overwhelmingly skyrocketed since the pandemic of COVID-19 diseases started in December 2019. As a result, many biomedical engineers have rushed to design and construct emergency ventilators, using the Ambu-bag squeezing ventilator to compensate for the insufficient ventilators supply. The Ambu-bag squeezing ventilator, however, suffers from the limitation of delivered tidal volume to the patient, the setting respiration rate and the noisy operational sound due to the movement of mechanic parts. The Ambu-bag based ventilator is, hence, not suitable for prolonged treatment of the patient. This paper presents a design and construction of a blower-based pressure-controlled ventilator for home-treatment COVID-19 patients featured with our novel-designed flow and pressure sensor, electronic peep valve and proportional controlled valve. Our proposed ventilator can be programmed with the suitable parameter setting depending upon the weight, height, gender, and blood oxygen saturation (SpO2) of the patients. This is useful in the current situation of COVID-19 pandemics, where trained medical staff is limited. The designed ventilator is also equipped with a safety mechanism, including an excessive-pressure-release valve, excessive flow rate, overpressure, and over-temperature blower to prevent any hazardous event. A home ventilator server is also set where all ventilator parameters will be acquired and broadcasted for remote access of the health provider. The designed blower-based ventilator has been calibrated and evaluated with a lung simulator and standard ventilator tester, including alarmed functions, safety mechanism, sound level, and regulated pressure. The respiration output graph is complied with the simulation. The blower-based ventilator for home-treatment COVID-19 patients is suitable for life support, commensurate with the strict requirements of the FDA for life-support ventilators, and ready to be tested with animal subjects in the next phase.
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Chacón-Lozsán, Francisco, and Péter Tamási. "Comparing lung mechanics of patients with COVID related respiratory distress syndrome versus non-COVID acute respiratory distress syndrome: a retrospective observational study." Journal of Mechanical Ventilation 3, no. 4 (December 15, 2022): 151–57. http://dx.doi.org/10.53097/jmv.10062.
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Background Most patients admitted to the intensive care unit with coronavirus disease (COVID-19) develop severe respiratory failure. Understanding lung mechanics helps to guide protective mechanical ventilation, improve oxygenation, and reduce the ventilator induce lung injury. This study aims to describe lung mechanics characteristics of patients with COVID -19 related acute respiratory distress syndrome (CARDS) and to compare them with non-COVID-19 associated ARDS. Methods We performed a retrospective observational study of lung mechanics: plateau pressure (Pplat), Driving pressure (DP), Mechanical power (MPw), Elastic (dynamic) power (EdPw), Total ventilatory power (TPw), and oxygenation parameters (ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), the ratio of arterial oxygen partial pressure to fractional inspired oxygen multiplied by PEEP [PaO2/(FiO2 x PEEP)], arterial and venous carbon dioxide partial pressure (PaCO2, PvCO2), and Ventilation dead space (VD) were measured and compared between the two groups after initiation of mechanical ventilation. Results 30 CARDS and 10 ARDS patients fulfilled the study requirements. We observed a significant higher MPw in the CARDS group (29.17 ± 8.29 J/min vs 15.78 ± 4.45 J/min, P 0.007), similarly observed with EdPw (256.7 ± 84.06 mJ/min vs 138.1 ± 39.15 mJ/min, P 0.01) and TPw (289.1 ± 84.51 mJ/min vs 161.5 ± 45.51, P 0.007). Inside the CARDS group, we found 2 subgroups, a low shunt subgroup and a higher shunt (Qs/Qt (%): 6.61 ± 2.46 for vs 40.3 ± 20.6, P 0.0009), however, between these two subgroups we didn’t find statistical differences on lung mechanic parameters but only in oxygenation parameters (PaO2/FiO2 and PaO2/FiO2*PEEP). When comparing these two subgroups with ARDS patients, we found more similarity between the low shunt CARDS and the ARDS patients on MP (R2 0.99, P 0.001), EdPw (R2 0.89, P 0.05) and TPw (R2 0.99, P 0.0009). Conclusions: Our study suggests important differences between CARDS and ARDS regarding mechanical parameters that could lead to more complicated management of CARDS patients and a higher prevalence of VILI. However due to the study limitations, a bigger study is necessary to corroborate our findings. Keywords: COVID-19, CARDS, ARDS, lung mechanics, VILI.
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Sedlak, Josef, Jiri Malasek, Martin Ondra, and Ales Polzer. "Construction of Mechanic Regulation of Turbine Ventilator using Half-Flap." Manufacturing Technology 16, no. 6 (December 1, 2016): 1364–70. http://dx.doi.org/10.21062/ujep/x.2016/a/1213-2489/mt/16/6/1364.
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Sedlak, Josef, Jiri Malasek, Martin Ondra, and Ales Polzer. "Construction of Mechanic Regulation of Turbine Ventilator using Whirling Turbine." Manufacturing Technology 17, no. 2 (April 1, 2017): 242–50. http://dx.doi.org/10.21062/ujep/x.2017/a/1213-2489/mt/17/2/242.
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Srinivasan, Shriya S., Khalil B. Ramadi, Francesco Vicario, Declan Gwynne, Alison Hayward, David Lagier, Robert Langer, Joseph J. Frassica, Rebecca M. Baron, and Giovanni Traverso. "A rapidly deployable individualized system for augmenting ventilator capacity." Science Translational Medicine 12, no. 549 (May 18, 2020): eabb9401. http://dx.doi.org/10.1126/scitranslmed.abb9401.
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Strategies to split ventilators to support multiple patients requiring ventilatory support have been proposed and used in emergency cases in which shortages of ventilators cannot otherwise be remedied by production or procurement strategies. However, the current approaches to ventilator sharing lack the ability to individualize ventilation to each patient, measure pulmonary mechanics, and accommodate rebalancing of the airflow when one patient improves or deteriorates, posing safety concerns to patients. Potential cross-contamination, lack of alarms, insufficient monitoring, and inability to adapt to sudden changes in patient status have prevented widespread acceptance of ventilator sharing. We have developed an individualized system for augmenting ventilator efficacy (iSAVE) as a rapidly deployable platform that uses a single ventilator to simultaneously and more safely support two individuals. The iSAVE enables individual-specific volume and pressure control and the rebalancing of ventilation in response to improvement or deterioration in an individual’s respiratory status. The iSAVE incorporates mechanisms to measure pulmonary mechanics, mitigate cross-contamination and backflow, and accommodate sudden flow changes due to individual interdependencies within the respiratory circuit. We demonstrate these capacities through validation using closed- and open-circuit ventilators on linear test lungs. We show that the iSAVE can temporarily ventilate two pigs on one ventilator as efficaciously as each pig on its own ventilator. By leveraging off-the-shelf medical components, the iSAVE could rapidly expand the ventilation capacity of health care facilities during emergency situations such as pandemics.
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Agustina, Mita. "Gargling with Aloe vera extract is effective to prevent the Ventilator-Associated Pneumonia (VAP)." GHMJ (Global Health Management Journal) 2, no. 3 (October 31, 2018): 70. http://dx.doi.org/10.35898/ghmj-23270.
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Background: Long-term use of a mechanic ventilator may cause Ventilator- Associated Pneumonia (VAP) infection, nosocomial pneumonia that occurs after 48 hours in patients using mechanical ventilation either through the endotracheal tube or the tracheostomy tube. To prevent the occurrence of VAP, antiseptic liquid (mouthwash) such as chlorhexidine 2% maybe recommended. However, gargling using chlorhexidine may also cause allergies, thus, Aloe vera extract could be an alternative. Aims: The purpose of this study was to determine the effectiveness of Aloe vera extract as mouthwash to prevent the occurrence of Ventilator-associated pneumonia. Methods: This research is a quasi-experiment case-control study with a pre- posttest control group design. The sample size in this study was 30 respondents who were equally distributed into two groups; intervention group was administered using Aloe vera extract, while chlorhexidine was practiced for the control group. To determine the occurrence of VAP, Clinical Pulmonary Infection Score (CPIS) for Ventilator-Associated Pneumonia was measured on the first day of intubation and the fourth day, enumerated by nurses in the emergency room. CPIS is a set of indicators comprised of temperature, leucocyte, trachea secretion, oxygenation (PaO2/FiO in mm Hg), and thorax photo. CPIS value below than five will be regarded non-VAP, while CPIS scored 6-9 will be diagnosed as VAP. Results: Oral hygiene with Aloe vera extract was able to prevent the occurrence of VAP (p-value = 0.001), but there was no significant difference between the control group and intervention in the CPIS component temperature, leukocytes, tracheal secretions, FiO2, and the thoracic component. Conclusions: Oral hygiene with Aloe vera extract effectively prevented the occurrence of V entilator-Associated Pneumonia (V AP) compared to chlorhexidine.
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Liu, Ling, Xiaoting Xu, Qin Sun, Yue Yu, Feiping Xia, Jianfeng Xie, Yi Yang, Leo Heunks, and Haibo Qiu. "Neurally Adjusted Ventilatory Assist versus Pressure Support Ventilation in Difficult Weaning." Anesthesiology 132, no. 6 (June 1, 2020): 1482–93. http://dx.doi.org/10.1097/aln.0000000000003207.
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Abstract Background Difficult weaning frequently develops in ventilated patients and is associated with poor outcome. In neurally adjusted ventilatory assist, the ventilator is controlled by diaphragm electrical activity, which has been shown to improve patient–ventilator interaction. The objective of this study was to compare neurally adjusted ventilatory assist and pressure support ventilation in patients difficult to wean from mechanical ventilation. Methods In this nonblinded randomized clinical trial, difficult-to-wean patients (n = 99) were randomly assigned to neurally adjusted ventilatory assist or pressure support ventilation mode. The primary outcome was the duration of weaning. Secondary outcomes included the proportion of successful weaning, patient–ventilator asynchrony, ventilator-free days, and mortality. Weaning duration was calculated as 28 days for patients under mechanical ventilation at day 28 or deceased before day 28 without successful weaning. Results Weaning duration in all patients was statistically significant shorter in the neurally adjusted ventilatory assist group (n = 47) compared with the pressure support ventilation group (n = 52; 3.0 [1.2 to 8.0] days vs. 7.4 [2.0 to 28.0], mean difference: −5.5 [95% CI, −9.2 to −1.4], P = 0.039). Post hoc sensitivity analysis also showed that the neurally adjusted ventilatory assist group had shorter weaning duration (hazard ratio, 0.58; 95% CI, 0.34 to 0.98). The proportion of patients with successful weaning from invasive mechanical ventilation was higher in neurally adjusted ventilatory assist (33 of 47 patients, 70%) compared with pressure support ventilation (25 of 52 patients, 48%; respiratory rate for neurally adjusted ventilatory assist: 1.46 [95% CI, 1.04 to 2.05], P = 0.026). The number of ventilator-free days at days 14 and 28 was statistically significantly higher in neurally adjusted ventilatory assist compared with pressure support ventilation. Neurally adjusted ventilatory assist improved patient ventilator interaction. Mortality and length of stay in the intensive care unit and in the hospital were similar among groups. Conclusions In patients difficult to wean, neurally adjusted ventilatory assist decreased the duration of weaning and increased ventilator-free days. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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Cheng, Shou-Hsia, I.-Shiow Jan, and Pin-Chun Liu. "The soaring mechanic ventilator utilization under a universal health insurance in Taiwan." Health Policy 86, no. 2-3 (May 2008): 288–94. http://dx.doi.org/10.1016/j.healthpol.2007.11.002.
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Shi, Yan, Shuai Ren, Maolin Cai, and Weiqing Xu. "Modelling and Simulation of Volume Controlled Mechanical Ventilation System." Mathematical Problems in Engineering 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/271053.
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Volume controlled mechanical ventilation system is a typical time-delay system, which is applied to ventilate patients who cannot breathe adequately on their own. To illustrate the influences of key parameters of the ventilator on the dynamics of the ventilated respiratory system, this paper firstly derived a new mathematical model of the ventilation system; secondly, simulation and experimental results are compared to verify the mathematical model; lastly, the influences of key parameters of ventilator on the dynamics of the ventilated respiratory system are carried out. This study can be helpful in the VCV ventilation treatment and respiratory diagnostics.
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Halpern, P. "(A176) Mechanical Ventilation in Disasters: “To Intubate or Not to Intubate – That is the Question!”." Prehospital and Disaster Medicine 26, S1 (May 2011): s49—s50. http://dx.doi.org/10.1017/s1049023x11001749.
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The provision of mechanical ventilatory support for large numbers of casualties in disasters is a complex, controversial issue. Some experts consider this modality unsuitable for large disasters and a waste of resources better devoted to eminently salvageable victims. However, the reality has usually been that rescue teams bring with them some ventilatory capability, even if only for perioperative support. Also, there are many instances when the environment, the existing and potential capacities, allow for significant numbers of victims to be saved by providing artificial ventilation, that would otherwise have likely died. It is therefore important to discuss the issue, with all its complexity, so that the disaster preparedness and relief community fully understands its implications and makes informed, locally relevant decisions before and after disasters strike. The purpose of this presentation is to describe the ethical dilemmas, the technical and clinical considerations for such an endeavor. Ethical considerations: providing the most care to the most victims is the dictum of disaster medical management. Lowered standards of care are accepted and often the norm. However, in many moderate and even major disasters, the ability exists to save lives that will certainly be lost otherwise, by providing intensive care including mechanical ventilatory support, or may be provided if the managers so determine. Is it then ethical, to allow certain victims to die when such support may be available? What is the cost-benefit ratio of such a decision? Who should receive this limited resource? The young and healthy? The very sick? The salvageable? The postoperative? For how long? Until the international team leaves? Types of ventilator-dependency in disasters: (1) Primary ventilatory failure, normal lungs, prolonged ventilator dependency, e.g. botulinum toxin; (2) Combined ventilatory and hypoxemic failure, short to medium-term ventilator dependency, e.g. Sarin gas intoxication; (3) Primary hypoxemic failure, parenchymal lung injury, prolonged ventilator dependency, e.g. Anthrax, mustard gas, ricin; (4) Perioperative and prophylactic ventilatory support, short term but unpredictable. Ventilator supply versus demand: (1) Insufficient ventilators for first few hours only, then supplies come in; (2) Insufficient ventilators for days, then national or international relief expected; (3) Insufficient ventilators and no expected supplies. Care environment: (1) ICU, minority of casualties; (2) General floors: inexperienced nursing, medical staff; (3) Insufficient monitoring devices; (4) Insufficient numbers and quality of respiratory therapists; (5) Commercial companies normally providing technical support understaffed. Basic requirements from the ventilators: allows spontaneous ventilation, incorporates some alarms (ideally disconnect and minute volume), made by a reputable and stable company (will be there when the disaster strikes), low cost, user friendly, long shelf life, quick activation from storage, low weight and volume, few spares, few or generic disposables, little and simple maintenance, independent of compressed oxygen (i.e. electric, multiple voltages, long-life battery). The system: Mechanical ventilation is a complete patient care unit comprising: Bed and space, Oxygen supply, Vacuum, Cardiorespiratory monitor, Mechanical ventilator, Nursing staff, Medical staff, Expert consultatory staff, Logistic and technical support staff. Potential mechanical ventilators: (1) BVM or bag-valve-tube; (2) Transport-type, pneumatic or electrical ventilators; (3) Intermediate capability pneumatic, electrical or electronic ventilators; (4) Full capability intensive care ventilators; (5) Single patient use ventilators.
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Mokra, D., P. Mikolka, P. Kosutova, M. Kolomaznik, M. Jurcek, P. Istona, K. Matasova, M. Zibolen, and A. Calkovska. "Effects of Conventional Mechanical Ventilation Performed by Two Neonatal Ventilators on the Lung Functions of Rabbits with Meconium-Induced Acute Lung Injury." Acta Medica Martiniana 16, no. 3 (December 1, 2016): 5–13. http://dx.doi.org/10.1515/acm-2016-0012.
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AbstractSevere meconium aspiration syndrome (MAS) in the neonates often requires a ventilatory support. As a method of choice, a conventional mechanical ventilation with small tidal volumes (VT<6 ml/kg) and appropriate ventilatory pressures is used. The purpose of this study was to assess the short-term effects of the small-volume CMV performed by two neonatal ventilators: Aura V (Chirana Stara Tura a.s., Slovakia) and SLE5000 (SLE Ltd., UK) on the lung functions of rabbits with experimentally-induced MAS and to estimate whether the newly developed neonatal version of the ventilator Aura V is suitable for ventilation of the animals with MAS.In the young rabbits, a model of MAS was induced by an intratracheal instillation of a suspension of neonatal meconium (4 ml/kg, 25 mg/ml). After creating the model of MAS, the animals were ventilated with small-volume CMV (frequency 50/min, VT<6 ml/kg, inspiration time 50 %, fraction of inspired oxygen 1.0, positive end-expiratory pressure 0.5 kPa, mean airway pressure 1.1 kPa) performed by ventilator Aura V (Aura group, n=7) or ventilator SLE5000 (SLE group, n=7) for additional 4 hours. One group of animals served as healthy non-ventilated controls (n=6). Blood gases, oxygenation indexes, ventilatory pressures, lung compliance, oxygen saturation and total and differential white blood cell (WBC) count were regularly determined. After euthanizing the animals, a left lung was saline-lavaged and total and differential counts of cells in the bronchoalveolar lavage (BAL) fluid were determined. A right lung was used for estimation of lung edema formation (expressed as a wet/dry weight ratio) and for analysis of concentrations of pro-inflammatory cytokines (IL-1β, IL-8, TNF). The cytokines were measured also in the blood plasma taken at the end of experiment.Meconium instillation seriously worsened the gas exchange and induced inflammation and lung edema formation. In the Aura group, slightly lower concentrations of cytokines were found and better gas exchange early after creating the MAS model was observed. However, there were no significant differences in the respiratory parameters between the ventilated groups at the end of experiment (P>0.05).Concluding, the newly developed neonatal version of the ventilator Aura V was found to be fully comparable to widely used neonatal ventilator SLE5000. Results provided by Aura V in CMV ventilation of rabbits with meconium-induced acute lung injury suggest its great potential also for future clinical use, i.e. for ventilation of the neonates with MAS.
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PAVLIDOU (Κ. ΠΑΥΛΙΔΟΥ), K., I. SAVVAS (Ι. ΣΑΒΒΑΣ), and T. ANAGNOSTOU (Τ. ΑΝΑΓΝΩΣΤΟΥ). "Mechanical ventilation. Part II: Basic principles and function of ventilators." Journal of the Hellenic Veterinary Medical Society 62, no. 4 (November 13, 2017): 334. http://dx.doi.org/10.12681/jhvms.14864.
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Mechanical ventilation is the process of supporting respiration by manual or mechanical means. When normal breathing is inefficient or has stopped, mechanical ventilation is life-saving and should be applied at once. The ventilator increases the patient's ventilation by inflating the lungs with oxygen or a mixture of air and oxygen. Ventilators play an important role in the anaesthetic management of patients, as well as in the treatment of patients in the ICU. However, there are differences between the anaesthetic ventilators and the ventilators in ICU. The main indication for mechanical ventilation is difficulty in ventilation and/or oxygenation of the patient because of any respiratory or other disease. The aims of mechanical ventilation are to supply adequate oxygen to patients with a limited vital capacity, to treat ventilatory failure, to reduce dyspnoea and to facilitate rest of fatigued breathing muscles. Depression of the central nervous system function is a pre-requirement for mechanical ventilation. Some times, opioids or muscle relaxants can be used in order to depress patient's breathing. Mechanical ventilation can be applied using many different modes: assisted ventilation, controlled ventilation, continuous positive pressure ventilation, intermittent positive pressure ventilation and jet ventilation. Furthermore, there are different types of automatic ventilators built to provide positive pressure ventilation in anaesthetized or heavily sedated or comatose patients: manual ventilators (Ambu-bag), volumecontrolled ventilators with pressure cycling, volume-controlled ventilators with time cycling and pressure-controlled ventilators. In veterinary practice, the ventilator should be portable, compact and easy to operate. The controls on most anaesthetic ventilators include settings for tidal volume, inspiratory time, inspiratory pressure, respiratory rate and inspiration: expiration (I:E) ratio. The initial settings should be between 10-20 ml/kg for tidal volume, 12-30 cmH2 0 for the inspiratory pressure and 8-15 breaths/min for the respiratory rate. Mechanical ventilation is a very important part of treatment in the ICU, but many problems may arise during application of mechanical ventilation in critically ill patients. All connections should be checked in advance and periodically for mechanical problems like leaks. Moreover, complications like lung injury, pneumonia, pneumothorax, myopathy and respiratory failure can occur during the course of mechanical ventilation causing difficulty in weaning.
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Be’eri, Eliezer, Simon Owen, Maurit Beeri, Scott R. Millis, and Arik Eisenkraft. "A Chemical-Biological-Radio-Nuclear (CBRN) Filter can be Added to the Air-Outflow Port of a Ventilator to Protect a Home Ventilated Patient From Inhalation of Toxic Industrial Compounds." Disaster Medicine and Public Health Preparedness 12, no. 6 (February 21, 2018): 739–43. http://dx.doi.org/10.1017/dmp.2018.3.
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AbstractObjectivesChemical-biological-radio-nuclear (CBRN) gas masks are the standard means for protecting the general population from inhalation of toxic industrial compounds (TICs), for example after industrial accidents or terrorist attacks. However, such gas masks would not protect patients on home mechanical ventilation, as ventilator airflow would bypass the CBRN filter. We therefore evaluated in vivo the safety of adding a standard-issue CBRN filter to the air-outflow port of a home ventilator, as a method for providing TIC protection to such patients.MethodsEight adult patients were included in the study. All had been on stable, chronic ventilation via a tracheostomy for at least 3 months before the study. Each patient was ventilated for a period of 1 hour with a standard-issue CBRN filter canister attached to the air-outflow port of their ventilator. Physiological and airflow measurements were made before, during, and after using the filter, and the patients reported their subjective sensation of ventilation continuously during the trial.ResultsFor all patients, and throughout the entire study, no deterioration in any of the measured physiological parameters and no changes in measured airflow parameters were detected. All patients felt no subjective difference in the sensation of ventilation with the CBRN filter canister in situ, as compared with ventilation without it. This was true even for those patients who were breathing spontaneously and thus activating the ventilator’s trigger/sensitivity function. No technical malfunctions of the ventilators occurred after addition of the CBRN filter canister to the air-outflow ports of the ventilators.ConclusionsA CBRN filter canister can be added to the air-outflow port of chronically ventilated patients, without causing an objective or subjective deterioration in the quality of the patients’ mechanical ventilation. (Disaster Med Public Health Preparedness. 2018;12:739-743)
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Gallagher, John J. "Alternative Modes of Mechanical Ventilation." AACN Advanced Critical Care 29, no. 4 (December 15, 2018): 396–404. http://dx.doi.org/10.4037/aacnacc2018372.
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Modern mechanical ventilators are more complex than those first developed in the 1950s. Newer ventilation modes can be difficult to understand and implement clinically, although they provide more treatment options than traditional modes. These newer modes, which can be considered alternative or nontraditional, generally are classified as either volume controlled or pressure controlled. Dual-control modes incorporate qualities of pressure-controlled and volume-controlled modes. Some ventilation modes provide variable ventilatory support depending on patient effort and may be classified as closed-loop ventilation modes. Alternative modes of ventilation are tools for lung protection, alveolar recruitment, and ventilator liberation. Understanding the function and application of these alternative modes prior to implementation is essential and is most beneficial for the patient.
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Daoud, Ehab, Jewelyn Cabigan, Gary Kaneshiro, and Kimiyo Yamasaki. "Split-ventilation for more than one patient, can it be done? Yes." Journal of Mechanical Ventilation 1, no. 1 (September 1, 2020): 1–7. http://dx.doi.org/10.53097/jmv.10002.
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Background: The COVID-19 pandemic crisis has led to an international shortage of mechanical ventilation. Due to this shortfall, the surge of increasing number of patients to limited resources of mechanical ventilators has reinvigorated the interest in the concept of split ventilation or co-ventilation (ventilating more than one patient with the same ventilator). However, major medical societies have condemned the concept in a joint statement for multiple reasons. Materials and Methods: In this paper, we will describe the history of the concept, what is trending in the literature about it and along our modification to ventilate two patients with one ventilator. We will describe how to overcome such concerns regarding cross contamination, re-breathing, safely adjusting the settings for tidal volume and positive end expiratory pressure to each patient and how to safely monitor each patient. Main results: Our experimental setup shows that we can safely ventilate two patients using one ventilator. Conclusion: The concept of ventilating more than one patient with a single ventilator is feasible especially in crisis situations. However, we caution that it has to be done under careful monitoring with expertise in mechanical ventilation. More research and investment are crucially needed in this current pandemic crisis.
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Lugones, Ignacio, Matías Ramos, María Fernanda Biancolini, and Roberto Orofino Giambastiani. "Combined Ventilation of Two Subjects with a Single Mechanical Ventilator Using a New Medical Device: An In Vitro Study." Anesthesiology Research and Practice 2021 (February 18, 2021): 1–7. http://dx.doi.org/10.1155/2021/6691591.
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Introduction. The SARS-CoV-2 pandemic has created a sudden lack of ventilators. DuplicARⓇ is a novel device that allows simultaneous and independent ventilation of two subjects with a single ventilator. The aims of this study are (a) to determine the efficacy of DuplicARⓇ to independently regulate the peak and positive-end expiratory pressures in each subject, both under pressure-controlled ventilation and volume-controlled ventilation and (b) to determine the ventilation mode in which DuplicARⓇ presents the best performance and safety. Materials and Methods. Two test lungs are connected to a single ventilator using DuplicARⓇ. Three experimental stages are established: (1) two identical subjects, (2) two subjects with the same weight but different lung compliance, and (3) two subjects with different weights and lung compliances. In each stage, the test lungs are ventilated in two ventilation modes. The positive-end expiratory pressure requirements are increased successively in one of the subjects. The goal is to achieve a tidal volume of 7 ml/kg for each subject in all different stages through manipulation of the ventilator and the DuplicARⓇ controllers. Results. DuplicARⓇ allows adequate ventilation of two subjects with different weights and/or lung compliances and/or PEEP requirements. This is achieved by adjusting the total tidal volume for both subjects (in volume-controlled ventilation) or the highest peak pressure needed (in pressure-controlled ventilation) along with the basal positive-end expiratory pressure on the ventilator and simultaneously manipulating the DuplicARⓇ controllers to decrease the tidal volume or the peak pressure in the subject that needs less and/or to increase the positive-end expiratory pressure in the subject that needs more. While ventilatory goals can be achieved in any of the ventilation modes, DuplicARⓇ performs better in pressure-controlled ventilation, as changes experienced in the variables of one subject do not modify the other one. Conclusions. DuplicARⓇ is an effective tool to manage the peak inspiratory pressure and the positive-end expiratory pressure independently in two subjects connected to a single ventilator. The driving pressure can be adjusted to meet the requirements of subjects with different weights and lung compliances. Pressure-controlled ventilation has advantages over volume-controlled ventilation and is therefore the recommended ventilation mode.
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Mammel, Mark C., Janice P. Ophoven, Patrick K. Lewallen, Margaret J. Gordon, Marylyn C. Sutton, and Stephen J. Boros. "High-Frequency Ventilation and Tracheal Injuries." Pediatrics 77, no. 4 (April 1, 1986): 608–13. http://dx.doi.org/10.1542/peds.77.4.608.
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Recent reports linking serious tracheal injuries to various forms of high-frequency ventilation prompted this study. We compared the tracheal histopathology seen following standard-frequency, conventional mechanical ventilation with that seen following high-frequency, conventional mechanical ventilation, and two different forms of high-frequency jet ventilation. Twenty-six adult cats were examined. Each was mechanically ventilated for 16 hours. Seven received standard-frequency, conventional mechanical ventilation at 20 breaths per minute. Seven received high-frequency, conventional mechanical ventilation at 150 breaths per minute. Six received high-frequency jet ventilation at 250 breaths per minute via the Instrument Development Corporation VS600 jet ventilator (IDC). Six received high-frequency jet ventilation at 400 breaths per minute via the Bunnell Life Pulse jet ventilator (BLP). A semiquantitative histopathologic scoring system graded tracheal tissue changes. All forms of high-frequency ventilation produced significant inflammation (erosion, necrosis, and polymorphonuclear leukocyte infiltration) in the trachea in the region of the endotracheal tube tip. Conventional mechanical ventilation produced less histopathology than any form of high-frequency ventilation. Of all of the ventilators examined, the BLP, the ventilator operating at the fastest rate, produced the greatest loss of surface cilia and depletion of intracellular mucus. IDC high-frequency jet ventilation and high-frequency, conventional mechanical ventilation produced nearly identical histologic injuries. In this study, significant tracheal damage occurred with all forms of high-frequency ventilation. The tracheal damage seen with high-frequency, conventional mechanical ventilation suggests that ventilator frequency, not delivery system, may be responsible for the injuries.
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Palibrk, Ivan, Marija Đukanović, Marija Milenković, Jelena Veličković, Maja Maksimović, and Nada Milenković. "ASSISTED MECHANICAL VENTILATION, BASICS OF SYNCHRONIZATION." Respiratio 10,11,12, no. 1,2,3 (June 3, 2022): 204–14. http://dx.doi.org/10.26601/rsp.aprs.22.8.
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Brojne komplikacije mehaničke ventilacije nastaju kao posledica loše sinhronizacije disanja bolesnika i aparata za mehaničku ventilaciju (ventilatora). Pored komplikacija evidentan je i diskomfort bolesnika. Savremeni modovi ventilacije u sebi imaju i mogućnost sinhronizacije rada ventilatora sa disajnim pokretima bolesnika. Sinhronizacija, zajedno sa asistiranom mehaničkom ventilacijom, je postala moguća zahvaljujući savremenoj tehnologiji. Sinhronizaciju vršimo trigerovanjem inspirijuma i ekspirijuma. Trigerovanje inspirijuma znači da bolesnik svojim inspiratornim naporom, započinje inspiratorni ciklus aparata za mehaničku ventilaciju. Na ventilatorima postoje dva načina trigerovanja. Trigerovanje volumenom i trigerovanje pritiskom. Posle započinjanja inspirijuma i aktivacije disajnog ciklusa na ventilatoru, aparat nastavlja inspirijum do ciljnog pritiska ili ciljnog volumena (asistirana ventilacija). Pored ovih načina započinjanja inspirijuma, koristi se i NAVA (Neurally adjusted ventilatory assist) tehnologija. Odnosno neuralno vođena ventilatorna asistencija. Elektroda koja se nalazi u nazogastrilčnoj sondi beleži aktivnost dijafragme. Kada se zabeleži ta aktivnost ona je osnova za započinjanje inspirijuma. Pored inspiratornog trigera, na ventilatorima se podešava i ekspiratorni triger. Ovo se odnosi na kontrolisani završetak inspirijuma. Njegovim podešavanjem određujemo kraj spontanog inspirijuma.On nam govori kada se zavrsava spontani inspirijum. Senzitivnost ekspiratornog trigera (ETS) predstavlja procenat od najvećeg inspiratornog protoka (peak inspiratory flow), kada inspirijum prelazi u ekspirijum. Svedoci smo da je asinhronija bolesnikovog disanja sa ventilatorom uobičajena pojava. Uspeh lečenja aparatom za mehaničku ventilaciju zavisi i od sinhronizacije. Trigerovanje je vid sinhronizacije, dostupan je na svim modelima ventilatora.
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Cawley, Michael J. "Mechanical Ventilation." Journal of Pharmacy Practice 24, no. 1 (November 30, 2010): 7–16. http://dx.doi.org/10.1177/0897190010388145.
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Mechanical ventilation is a common therapeutic modality required for the management of patients unable to maintain adequate intrinsic ventilation and oxygenation. Mechanical ventilators can be found within various hospital and nonhospital environments (ie, nursing homes, skilled nursing facilities, and patient’s home residence), but these devices generally require the skill of a multidisciplinary health care team to optimize therapeutic outcomes. Unfortunately, pharmacists have been excluded in the discussion of mechanical ventilation since this therapeutic modality may be perceived as irrelevant to drug utilization and the usual scope of practice of a hospital pharmacist. However, the pharmacist provides a crucial role as a member of the multidisciplinary team in the management of the mechanically ventilated patient by verifying accuracy of prescribed medications, providing recommendations of alternative drug selections, monitoring for drug and disease interactions, assisting in the development of institutional weaning protocols, and providing quality assessment of drug utilization. Pharmacists may be intimidated by the introduction of advanced ventilator microprocessor technology, but understanding and integrating ventilator management with the pharmacotherapeutic needs of the patient will ultimately help the pharmacist be a better qualified and respected practitioner. The goal of this article is to assist the pharmacy practitioner with a better understanding of mechanical ventilation and to apply this information to improve delivery of pharmaceutical care.
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VanKoevering, Kyle K., Pratyusha Yalamanchi, Catherine T. Haring, Anne G. Phillips, Stephen Lewis Harvey, Alvaro Rojas-Pena, David A. Zopf, and Glenn E. Green. "Delivery system can vary ventilatory parameters across multiple patients from a single source of mechanical ventilation." PLOS ONE 15, no. 12 (December 10, 2020): e0243601. http://dx.doi.org/10.1371/journal.pone.0243601.
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Background Current limitations in the supply of ventilators during the Covid19 pandemic have limited respiratory support for patients with respiratory failure. Split ventilation allows a single ventilator to be used for more than one patient but is not practicable due to requirements for matched patient settings, risks of cross-contamination, harmful interference between patients and the inability to individualize ventilator support parameters. We hypothesized that a system could be developed to circumvent these limitations. Methods and findings A novel delivery system was developed to allow individualized peak inspiratory pressure settings and PEEP using a pressure regulatory valve, developed de novo, and an inline PEEP ‘booster’. One-way valves, filters, monitoring ports and wye splitters were assembled in-line to complete the system and achieve the design targets. This system was then tested to see if previously described limitations could be addressed. The system was investigated in mechanical and animal trials (ultimately with a pig and sheep concurrently ventilated from the same ventilator). The system demonstrated the ability to provide ventilation across clinically relevant scenarios including circuit occlusion, unmatched physiology, and a surgical procedure, while allowing significantly different pressures to be safely delivered to each animal for individualized support. Conclusions In settings of limited ventilator availability, systems can be developed to allow increased delivery of ventilator support to patients. This enables more rapid deployment of ventilator capacity under constraints of time, space and financial cost. These systems can be smaller, lighter, more readily stored and more rapidly deployable than ventilators. However, optimizing ventilator support for patients with individualized ventilation parameters will still be dependent upon ease of use and the availability of medical personnel.
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Hassen, Kedir Abdureman, Micheal Alemayehu Nemera, Andualem Wubetie Aniley, Ararso Baru Olani, and Sofoniyas Getaneh Bedane. "Knowledge Regarding Mechanical Ventilation and Practice of Ventilatory Care among Nurses Working in Intensive Care Units in Selected Governmental Hospitals in Addis Ababa, Ethiopia: A Descriptive Cross-Sectional Study." Critical Care Research and Practice 2023 (February 13, 2023): 1–8. http://dx.doi.org/10.1155/2023/4977612.
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Introduction. Mechanical ventilation (MV) is a backbone and major supportive modality in intensive care units (ICUs) even though it has side effects and complications. Knowledge of nurses about mechanical ventilators and good practice of nursing care for the ventilated patient plays a crucial role in improving the effectiveness of mechanical ventilation, preventing harm, and optimizing the patient outcome. This study intended to assess the knowledge regarding MV and the practice of ventilator care among nurses working in the ICU. Method. A descriptive cross-sectional study design was conducted. All nurses working in the intensive care unit of selected governmental hospitals were included in the study. The data were collected from March 1 to 30, 2021 with structured and pretested self-administered questionnaires. The collected data were evaluated with SPSS version 26 software. The variables, which have an independent association with poor outcomes, were identified based on OR, with 95% CI and a p value less than 0.05. Results. Of 146 nurses who participated in the study, 51.4% were males. About 71.4% had a BSc in nursing and 57.5% of them had training related to MV. More than half (51.4%) of nurses had poor knowledge regarding MV and the majority (58.9%) of them had poor practice in ventilatory care. The educational level (AOR, 5.1; 95% CI, 1.190–22.002) was positively associated with knowledge. Likewise, the educational level (AOR 5.0 (1.011–24.971)) and work experience (AOR 4.543 (1.430–14.435)) were positively associated with the practice of nurses. Conclusions. Knowledge regarding mechanical ventilators and the practice of ventilatory care among nurses in the selected public hospitals was poor. The educational levels were found statistically associated with both the knowledge and practice of nurses. To improve nursing care offered for MV patients, upgrading the educational level of intensive care nurses plays a vital role.
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Rajbanshi, L. K., M. Dali, S. B. Karki, K. Khanal, B. Aryal, and K. Chapagain. "Adaptive Support Ventilation as a Sole Mode of Mechanical Ventilation-An Observational Study." Birat Journal of Health Sciences 1, no. 1 (March 31, 2017): 8–12. http://dx.doi.org/10.3126/bjhs.v1i1.17090.
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Introduction Adaptive support ventilation (ASV) is a close loop dual control mechanical ventilation mode. This mode can automatically change its parameters to weaning mode once the patient is actively breathing converting volume targeted pressure control mode to volume targeted pressure support mode. We aimed to observe the outcome of the patients ventilated with ASV as a sole mode in terms of duration of mechanical ventilation, duration of weaning from the ventilatory support and length of Intensive care unit (ICU) stay.Methodology We conducted a prospective observational study for the duration of six months (Sept 2015 to Feb 2016) to assess the clinical outcome of the patients ventilated by ASV as a sole mode of ventilation. The study conducted observation of 78 patients without chronic respiratory, renal, hepatic and neurological disease who were admitted in our intensive care unit for invasive ventilatory support.Results Out of the 187 patients who required invasive and noninvasive ventilation, only 78 patients fulfilled the criteria to be included in the study. It was observed that the mean duration of mechanical ventilation was 5.4 days while weaning as well as tracheal extubation was successful within 13 hours of initiation of weaning. The mean duration of ICU stay was found to be 6.3 days.Conclusion We concluded that the patient ventilated by ASV mode were effectively weaned without the need of changing the ventilator mode. However, the safety of ASV mode needs to be established by large randomized control trail in a wide spectrum of patients.Birat Journal of Health Sciences 2016 1(1): 8-12
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Richless, CI. "Current trends in mechanical ventilation." Critical Care Nurse 11, no. 3 (March 1, 1991): 41–53. http://dx.doi.org/10.4037/ccn1991.11.3.41.
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It is increasingly evident that there is little data available to compare the use of various modes of mechanical ventilation or to assess their application. It is difficult to compare the new modes of mechanical ventilation with the conventional modes because of a similar lack of clinical data. The challenge for future research in the area of ventilator technology is to generate controlled clinical studies to support its application. With the increased impact of financial constraints on healthcare, research will also need to examine the economic issues related to the application of newer modes of mechanical ventilation. The critical care nurse will be faced with the continued challenge of being knowledgeable regarding the current trends in ventilatory support and their potential advantages and disadvantages, while keeping in perspective those areas where clinical research is lacking. Possibilities for future nursing research related to mechanical ventilation are endless. The application and refinement of assessment parameters to evaluate the impact of nursing interventions on mechanically ventilated patients should be a key focus. The growing use of SVO2 monitoring in conjunction with other assessment parameters may prove to be useful tools to measure the impact of interventions such as suctioning, positioning, muscle reconditioning, weaning techniques, and comfort measures on mechanically ventilated patients.
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Stewart, Thomas E. "Establishing an Approach to Mechanical Ventilation." Canadian Respiratory Journal 3, no. 6 (1996): 403–8. http://dx.doi.org/10.1155/1996/596370.
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Technology in the intensive care environment has progressed at an exponential rate. This progression has particularly been noticeable in relation to mechanical ventilation where advancements have arguably surpassed improvements in patient morbidity and mortality. Ventilator-induced lung injury (VILI), which occurs secondary to lung overdistension and underinflation, may largely be responsible for this discrepancy. No matter which of the vast number of modes of mechanical ventilation are employed, simple principles can be followed that will prevent the development of VILI. A lung protective ventilatory approach incorporates the prevention of oxygen toxicity and the avoidance of lung over- and underinflation, while frequently using permissive hypercapnia. By establishing a lung protective approach early in the management of ventilated patients, the morbidity and mortality associated with respiratory failure may finally be reduced.
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Gonzales Carazas, Maryanne Melanie, Cesar Miguel Gavidia, Roberto Davila Fernandez, Juan Alberto Vargas Zuñiga, Alberto Crespo Paiva, William Bocanegra, Joan Calderon, et al. "Biological evaluation of a mechanical ventilator that operates by controlling an automated manual resuscitator. A descriptive study in swine." PLOS ONE 17, no. 3 (March 3, 2022): e0264774. http://dx.doi.org/10.1371/journal.pone.0264774.
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The Covid-19 outbreak challenged health systems around the world to design and implement cost-effective devices produced locally to meet the increased demand of mechanical ventilators worldwide. This study evaluates the physiological responses of healthy swine maintained under volume- or pressure-controlled mechanical ventilation by a mechanical ventilator implemented to bring life-support by automating a resuscitation bag and closely controlling ventilatory parameters. Physiological parameters were monitored in eight sedated animals (t0) prior to inducing deep anaesthesia, and during the next six hours of mechanical ventilation (t1-7). Hemodynamic conditions were monitored periodically using a portable gas analyser machine (i.e. BEecf, carbonate, SaO2, lactate, pH, PaO2, PaCO2) and a capnometer (i.e. ETCO2). Electrocardiogram, echocardiography and lung ultrasonography were performed to detect in vivo alterations in these vital organs and pathological findings from necropsy were reported. The mechanical ventilator properly controlled physiological levels of blood biochemistry such as oxygenation parameters (PaO2, PaCO2, SaO2, ETCO2), acid-base equilibrium (pH, carbonate, BEecf), and perfusion of tissues (lactate levels). In addition, histopathological analysis showed no evidence of acute tissue damage in lung, heart, liver, kidney, or brain. All animals were able to breathe spontaneously after undergoing mechanical ventilation. These preclinical data, supports the biological safety of the medical device to move forward to further evaluation in clinical studies.
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Cameron, P. D., and T. E. Oh. "Newer Modes of Mechanical Ventilatory Support." Anaesthesia and Intensive Care 14, no. 3 (August 1986): 258–66. http://dx.doi.org/10.1177/0310057x8601400306.
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Recent modes of ventilatory support aim to facilitate weaning and minimise the physiological disadvantages of intermittent positive pressure ventilation (IPPV). Intermittent mandatory ventilation (IMV) allows the patient to breathe spontaneously in between ventilator breaths. Mandatory minute volume ventilation (MMV) ensures that the patient always receives a preset minute volume, made up of both spontaneous and ventilator breaths. Pressure supported (assisted) respiration is augmentation of a spontaneous breath up to a preset pressure level, and is different from ‘triggering’, which is a patient-initiated ventilator breath. Other modes or refinements of IPPV include high frequency ventilation, expiratory retard, differential lung ventilation, inversed ratio ventilation, ‘sighs’, varied inspiratory flow waveforms and extracorporeal membrane oxygenation. While these techniques have useful applications in selective situations, IPPV remains the mainstay of managing respiratory failure for most patients.
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Raymond, Samuel J., Sam Baker, Yuzhe Liu, Mauricio J. Bustamante, Brett Ley, Michael J. Horzewski, David B. Camarillo, and David N. Cornfield. "A low-cost, highly functional, emergency use ventilator for the COVID-19 crisis." PLOS ONE 17, no. 3 (March 30, 2022): e0266173. http://dx.doi.org/10.1371/journal.pone.0266173.
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Respiratory failure complicates most critically ill patients with COVID-19 and is characterized by heterogeneous pulmonary parenchymal involvement, profound hypoxemia and pulmonary vascular injury. The high incidence of COVID-19 related respiratory failure has exposed critical shortages in the supply of mechanical ventilators, and providers with the necessary skills to treat. Traditional mass-produced ventilators rely on an internal compressor and mixer to moderate and control the gas mixture delivered to a patient. However, the current emergency has energized the pursuit of alternative designs, enabling greater flexibility in supply chain, manufacturing, storage, and maintenance considerations. To achieve this, we hypothesized that using the medical gasses and flow interruption strategy would allow for a high performance, low cost, functional ventilator. A low-cost ventilator designed and built-in accordance with the Emergency Use guidance from the US Food and Drug Administration (FDA) is presented wherein pressurized medical grade gases enter the ventilator and time limited flow interruption determines the ventilator rate and tidal volume. This simple strategy obviates the need for many components needed in traditional ventilators, thereby dramatically shortening the time from storage to clinical deployment, increasing reliability, while still providing life-saving ventilatory support. The overall design philosophy and its applicability in this new crisis is described, followed by both bench top and animal testing results used to confirm the precision, safety and reliability of this low cost and novel approach to mechanical ventilation. The ventilator meets and exceeds the critical requirements included in the FDA emergency use guidelines. The ventilator has received emergency use authorization from the FDA.
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Webb, Jeffrey B., Aaron Bray, Philip K. Asare, Rachel B. Clipp, Yatin B. Mehta, Sudheer Penupolu, Aalpen A. Patel, and S. Mark Poler. "Computational simulation to assess patient safety of uncompensated COVID-19 two-patient ventilator sharing using the Pulse Physiology Engine." PLOS ONE 15, no. 11 (November 25, 2020): e0242532. http://dx.doi.org/10.1371/journal.pone.0242532.
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Background The COVID-19 pandemic is stretching medical resources internationally, sometimes creating ventilator shortages that complicate clinical and ethical situations. The possibility of needing to ventilate multiple patients with a single ventilator raises patient health and safety concerns in addition to clinical conditions needing treatment. Wherever ventilators are employed, additional tubing and splitting adaptors may be available. Adjustable flow-compensating resistance for differences in lung compliance on individual limbs may not be readily implementable. By exploring a number and range of possible contributing factors using computational simulation without risk of patient harm, this paper attempts to define useful bounds for ventilation parameters when compensatory resistance in limbs of a shared breathing circuit is not possible. This desperate approach to shared ventilation support would be a last resort when alternatives have been exhausted. Methods A whole-body computational physiology model (using lumped parameters) was used to simulate each patient being ventilated. The primary model of a single patient with a dedicated ventilator was augmented to model two patients sharing a single ventilator. In addition to lung mechanics or estimation of CO2 and pH expected for set ventilation parameters (considerations of lung physiology alone), full physiological simulation provides estimates of additional values for oxyhemoglobin saturation, arterial oxygen tension, and other patient parameters. A range of ventilator settings and patient characteristics were simulated for paired patients. Findings To be useful for clinicians, attention has been directed to clinically available parameters. These simulations show patient outcome during multi-patient ventilation is most closely correlated to lung compliance, oxygenation index, oxygen saturation index, and end-tidal carbon dioxide of individual patients. The simulated patient outcome metrics were satisfactory when the lung compliance difference between two patients was less than 12 mL/cmH2O, and the oxygen saturation index difference was less than 2 mmHg. Interpretation In resource-limited regions of the world, the COVID-19 pandemic will result in equipment shortages. While single-patient ventilation is preferable, if that option is unavailable and ventilator sharing using limbs without flow resistance compensation is the only available alternative, these simulations provide a conceptual framework and guidelines for clinical patient selection.
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Maccari, Juçara Gasparetto, Cassiano Teixeira, Marcelo Basso Gazzana, Augusto Savi, Felippe Leopoldo Dexheimer-Neto, and Marli Maria Knorst. "Inhalation therapy in mechanical ventilation." Jornal Brasileiro de Pneumologia 41, no. 5 (October 2015): 467–72. http://dx.doi.org/10.1590/s1806-37132015000000035.
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Patients with obstructive lung disease often require ventilatory support via invasive or noninvasive mechanical ventilation, depending on the severity of the exacerbation. The use of inhaled bronchodilators can significantly reduce airway resistance, contributing to the improvement of respiratory mechanics and patient-ventilator synchrony. Although various studies have been published on this topic, little is known about the effectiveness of the bronchodilators routinely prescribed for patients on mechanical ventilation or about the deposition of those drugs throughout the lungs. The inhaled bronchodilators most commonly used in ICUs are beta adrenergic agonists and anticholinergics. Various factors might influence the effect of bronchodilators, including ventilation mode, position of the spacer in the circuit, tube size, formulation, drug dose, severity of the disease, and patient-ventilator synchrony. Knowledge of the pharmacological properties of bronchodilators and the appropriate techniques for their administration is fundamental to optimizing the treatment of these patients.
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Coudroy, Remi, Lu Chen, Tài Pham, Thomas Piraino, Irene Telias, and Laurent Brochard. "Acute Respiratory Distress Syndrome: Respiratory Monitoring and Pulmonary Physiology." Seminars in Respiratory and Critical Care Medicine 40, no. 01 (February 2019): 066–80. http://dx.doi.org/10.1055/s-0039-1685159.
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AbstractThe high prevalence of acute respiratory distress syndrome (ARDS), its morbidity and mortality continue to fare a huge burden in the intensive care unit. More than 40 years ago, experimental studies have highlighted that, albeit essential, mechanical ventilation could be harmful to lungs and more recently to the diaphragm. Despite life-saving advances in mechanical ventilation (such as low tidal-volume ventilation, neuromuscular blockers agents, or prone positioning), a recent international observational study reported that most ARDS patients were not appropriately monitored. The monitoring capabilities of ventilators, in particular the simple interaction of the patient and the mechanical ventilation, are very powerful but are underutilized. This lack of monitoring may contribute to the persisting poor outcome of patients with ARDS. Providing a more careful ventilation is a priority to improve patients' outcomes. To achieve this goal, it is of paramount importance to better understand the complex relationship between the patient and the ventilator: the impact of ventilator settings on lungs during passive controlled ventilation, but also of patient's breathing efforts on lungs during assisted ventilation. In this review we present available tools to monitor respiratory mechanics at the bedside aiming at optimizing and personalizing mechanical ventilation. Hopefully, this careful management can decrease mortality of patients with ARDS in the future.
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Robba, Chiara, Giuseppe Citerio, Fabio S. Taccone, Stefania Galimberti, Paola Rebora, Alessia Vargiolu, and Paolo Pelosi. "Multicentre observational study on practice of ventilation in brain injured patients: the VENTIBRAIN study protocol." BMJ Open 11, no. 8 (August 2021): e047100. http://dx.doi.org/10.1136/bmjopen-2020-047100.
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IntroductionMechanical ventilatory is a crucial element of acute brain injured patients’ management. The ventilatory goals to ensure lung protection during acute respiratory failure may not be adequate in case of concomitant brain injury. Therefore, there are limited data from which physicians can draw conclusions regarding optimal ventilator management in this setting.Methods and analysisThis is an international multicentre prospective observational cohort study. The aim of the ‘multicentre observational study on practice of ventilation in brain injured patients’—the VENTIBRAIN study—is to describe the current practice of ventilator settings and mechanical ventilation in acute brain injured patients. Secondary objectives include the description of ventilator settings among different countries, and their association with outcomes. Inclusion criteria will be adult patients admitted to the intensive care unit (ICU) with a diagnosis of traumatic brain injury or cerebrovascular diseases (intracranial haemorrhage, subarachnoid haemorrhage, ischaemic stroke), requiring intubation and mechanical ventilation and admission to the ICU. Exclusion criteria will be the following: patients aged <18 years; pregnant patients; patients not intubated or not mechanically ventilated or receiving only non-invasive ventilation. Data related to clinical examination, neuromonitoring if available, ventilator settings and arterial blood gases will be recorded at admission and daily for the first 7 days and then at day 10 and 14. The Glasgow Outcome Scale Extended on mortality and neurological outcome will be collected at discharge from ICU, hospital and at 6 months follow-up.Ethics and disseminationThe study has been approved by the Ethic committee of Brianza at the Azienda Socio Sanitaria Territoriale-Monza. Data will be disseminated to the scientific community by abstracts submitted to the European Society of Intensive Care Medicine annual conference and by original articles submitted to peer-reviewed journals.Trial registration numberNCT04459884.
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Brégeon, Fabienne, Stéphane Delpierre, Bruno Chetaille, Osamu Kajikawa, Thomas R. Martin, Amapola Autillo-Touati, Yves Jammes, and Jérôme Pugin. "Mechanical Ventilation Affects Lung Function and Cytokine Production in an Experimental Model of Endotoxemia." Anesthesiology 102, no. 2 (February 1, 2005): 331–39. http://dx.doi.org/10.1097/00000542-200502000-00015.
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Background Mechanical ventilation using tidal volumes around 10 ml/kg and zero positive end-expiratory pressure is still commonly used in anesthesia. This strategy has been shown to aggravate lung injury and inflammation in preinjured lungs but not in healthy lungs. In this study, the authors investigated whether this strategy would result in lung injury during transient endotoxemia in the lungs of healthy animals. Methods Volume-controlled ventilation with a tidal volume of 10 ml/kg and zero positive end-expiratory pressure was applied in two groups of anesthetized-paralyzed rabbits receiving either intravenous injection of 5 mug/kg Escherichia coli lipopolysaccharide (n = 10) or saline (n = 10) 2 h after the start of mechanical ventilation. The third group consisted of 10 spontaneously breathing anesthetized animals receiving lipopolysaccharide. Anesthesia was then continued for 4 h in the three groups while the ventilatory modes were maintained unchanged. Lung injury was studied using blood gases, respiratory physiologic variables, analysis of the bronchoalveolar lavage cell counts, and cytokine concentrations and lung pathologic examination. Results Significant histologic lung alterations, hypoxemia, and altered lung mechanics were observed in rabbits treated with mechanical ventilation and intravenous lipopolysaccharide but not in the mechanically ventilated animals injected with saline or in spontaneously breathing animals treated with lipopolysaccharide. Endotoxemic ventilated animals also had significantly more lung inflammation as assessed by the alveolar concentration of neutrophils, and the concentrations of the chemokines interleukin 8 and growth-related oncogen alpha. Conclusions These results showed that positive-pressure mechanical ventilation using a tidal volume of 10 ml/kg and zero positive end-expiratory pressure was harmful in the setting of endotoxemia, suggesting that the use of this ventilator strategy in the operating room may predispose to lung injury when endotoxemia occurs.
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Jaber, Samir, Mustapha Sebbane, Daniel Verzilli, Stefan Matecki, Marc Wysocki, Jean-Jacques Eledjam, and Laurent Brochard. "Adaptive Support and Pressure Support Ventilation Behavior in Response to Increased Ventilatory Demand." Anesthesiology 110, no. 3 (March 1, 2009): 620–27. http://dx.doi.org/10.1097/aln.0b013e31819793fb.
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Background Dual-control modes of ventilation adapt the pressure delivery to keep a volume target in response to changes in respiratory mechanics, but they may respond poorly to changes in ventilatory demand. Adaptive support ventilation (ASV), a complex minute volume-targeted pressure-regulated ventilation, was compared to adaptive pressure ventilation (APV), a dual-mode in which the pressure level is adjusted to deliver a preset tidal volume, and to pressure support ventilation (PSV) when facing an increase in ventilatory demand. Methods A total of 14 intensive care unit patients being weaned off mechanical ventilation were included in this randomized crossover study. The effect of adding a heat-and-moisture exchanger to augment circuit dead space was assessed with a same fixed level of ASV, PSV, and APV. Results Arterial blood gases, ventilator response, and patient respiratory effort parameters were evaluated at the end of the six periods. Adding dead space significantly increased minute ventilation and PaCO2 values with the three modes. Indexes of respiratory effort (pressure-time index of respiratory muscles and work of breathing) increased with all ventilatory modes after dead-space augmentation. This increase was significantly greater with APV than with PSV or ASV (P < 0.05). The assistance delivered during APV decreased significantly with dead-space from 12.7 +/- 2.6 to 6.7 +/- 1.4 cm H2O, whereas no change occurred with ASV and PSV. Conclusions ASV and PSV behaved differently but ended up with similar pressure level facing acute changes in ventilatory demand, by contrast to APV (a simple volume-guaranteed pressure-control mode), in which an increase in ventilatory demand results in a decrease in the pressure support provided by the ventilator.
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Aytekin, Fuat, Pınar Yildiz Gulhan, Kuddusi Teberik, Ege Gulec Balbay, Ilter Iritas, Merve Ercelik, Mehmet Fatih Elverisli, and Oner Abidin Balbay. "The effects of non‐invasive mechanic ventilator modes on intraocular pressure in COPD patients with hypercapnic respiratory failure." Clinical Respiratory Journal 14, no. 2 (December 18, 2019): 165–72. http://dx.doi.org/10.1111/crj.13117.
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Kondili, Eumorfia, Demosthenes Makris, Dimitrios Georgopoulos, Nikoletta Rovina, Anastasia Kotanidou, and Antonia Koutsoukou. "COVID-19 ARDS: Points to Be Considered in Mechanical Ventilation and Weaning." Journal of Personalized Medicine 11, no. 11 (October 28, 2021): 1109. http://dx.doi.org/10.3390/jpm11111109.
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The COVID-19 disease can cause hypoxemic respiratory failure due to ARDS, requiring invasive mechanical ventilation. Although early studies reported that COVID-19-associated ARDS has distinctive features from ARDS of other causes, recent observational studies have demonstrated that ARDS related to COVID-19 shares common clinical characteristics and respiratory system mechanics with ARDS of other origins. Therefore, mechanical ventilation in these patients should be based on strategies aiming to mitigate ventilator-induced lung injury. Assisted mechanical ventilation should be applied early in the course of mechanical ventilation by considering evaluation and minimizing factors associated with patient-inflicted lung injury. Extracorporeal membrane oxygenation should be considered in selected patients with refractory hypoxia not responding to conventional ventilation strategies. This review highlights the current and evolving practice in managing mechanically ventilated patients with ARDS related to COVID-19.
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Hamahata, Natsumi, Ryota Sato, Kimiyo Yamasaki, Sophie Pereira, and Ehab Daoud. "Estimating actual inspiratory muscle pressure from airway occlusion pressure at 100 msec." Journal of Mechanical Ventilation 1, no. 1 (September 1, 2020): 8–13. http://dx.doi.org/10.53097/jmv.10003.
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Background: Quantification of the patient’s respiratory effort during mechanical ventilation is very important, and calculating the actual muscle pressure (Pmus) during mechanical ventilation is a cumbersome task and usually requires an esophageal balloon manometry. Airway occlusion pressure at 100 milliseconds (P0.1) can easily be obtained non-invasively. There has been no study investigating the association between Pmus and P0.1. Therefore, we aimed to investigate whether P0.1 correlates to Pmus and can be used to estimate actual Pmus Materials and Methods: A bench study using lung simulator (ASL 5000) to simulate an active breathing patient with Pmus from 1 to 30 cmH2O by increments of 1 was conducted. Twenty active breaths were measured in each Pmus. The clinical scenario was constructed as a normal lung with a fixed setting of compliances of 60 mL/cmH2O and resistances of 10 cmH2O/l/sec. All experiments were conducted using the pressure support ventilation mode (PSV) on a Hamilton-G5 ventilator (Hamilton Medical AG, Switzerland), Puritan Bennett 840TM (Covidien-Nellcor, CA) and Avea (CareFusion, CA). Main results: There was significant correlation between P 0.1 and Pmus (correlation coefficient = - 0.992, 95% CI: - 0.995 to -0.988, P-value<0.001). The equation was calculated as follows: Pmus = -2.99 x (P0.1) + 0.53 Conclusion: Estimation of Pmus using P 0.1 as a substitute is feasible, available, and reliable. Estimation of Pmus has multiple implications, especially in weaning of mechanical ventilation, adjusting ventilator support, and calculating respiratory mechanics during invasive mechanical ventilation. Keywords: P 0.1, Inspiratory occlusion pressure, WOB, Esophageal balloon, mechanical ventilators, respiratory failure Keywords: P 0.1, P mus, Inspiratory occlusion pressure, WOB, Esophageal balloon, mechanical ventilators, respiratory failure
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Ouellette, Daniel R. "New Developments in Mechanical Ventilation." US Respiratory & Pulmonary Diseases 12, no. 02 (2017): 21. http://dx.doi.org/10.17925/usrpd.2017.12.02.21.
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Positive pressure ventilation was developed in the 1950s as a way to treat respiratory failure due to ventilatory insufficiency. While lifesaving, mechanical ventilation, especially when prolonged, can be associated with a host of complications. Current advances focus on strategies to liberate patients from the ventilator. New guidelines have been published to aid practitioners in this area.
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Lozano-Zahonero, Sara, Matthias Schneider, Sashko Spassov, and Stefan Schumann. "A novel mechanical ventilator providing flow-controlled expiration for small animals." Laboratory Animals 54, no. 6 (February 19, 2020): 568–75. http://dx.doi.org/10.1177/0023677220906857.
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For investigating the effects of mechanical ventilation on the respiratory system, experiments in small mammal models are used. However, conventional ventilators for small animals are usually limited to a specific ventilation mode, and in particular to passive expiration. Here, we present a computer-controlled research ventilator for small animals which provides conventional mechanical ventilation as well as new type ventilation profiles. Typical profiles of conventional mechanical ventilation, as well as flow-controlled expiration and sinusoidal ventilation profiles can be generated with our new ventilator. Flow control during expiration reduced the expiratory peak flow rate by 73% and increased the mean airway pressure by up to 1 mbar compared with conventional ventilation without increasing peak pressure and end-expiratory pressure. Our new ventilator for small animals allows for the application of various ventilation profiles. We could analyse the effects of applying conventional ventilation profiles, pressure-controlled ventilation and volume-controlled ventilation, as well as the novel flow-controlled ventilation profile. This new approach enables studying the mechanical properties of the respiratory system with an increased freedom for choosing independent ventilation parameters.
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Bhoyar, Ankit D. "Design Construction and Performance Test of a Low-Cost Pandemic Ventilator for Breathing Support." International Journal for Research in Applied Science and Engineering Technology 9, no. 8 (August 31, 2021): 2374–80. http://dx.doi.org/10.22214/ijraset.2021.37771.
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Abstract: Mass casualty incidents such as those that are being experienced during the novel coronavirus disease (COVID-19) pandemic can overwhelm local healthcare systems, where the number of casualties exceeds local resources and capabilities in a short period of time. The introduction of patients with worsening lung function as a result of COVID-19 has strained traditional ventilator supplies. Mechanical ventilator is a medical device which is usually utilized to ventilate patients who cannot breathe adequately on their own. Among many types of ventilators Bag Valve Mask (BVM) is a manual ventilator in which a bag is pressed to deliver air into the lungs of the patient. In present work, a mechanical system along with speed controller has been developed to automate the operation of BVM. The constructed prototype contains crank, powered by servo motor, supported by wooden frame. To bridge the gap during ventilator shortages and to help clinicians triage patients, manual resuscitator devices can be used to deliver respirations to a patient requiring breathing support. With principal dimensions of 0.54*0.64 m2 , bvm weighs 0.9 kg and DC power convertor for supplying power for a continuous operation, the prototype can be moved easily. The dimensions of the frame are selected as such to be compatible with the physical dimension of Ambu bag. The performance of the device was tested using Airflow meter which illustrates that the Tidal Volume vs. Time graph of the automated system is similar to the graph produced by manual operation of the BVM, but with a mean deviation of 0.182 Litres with manual operation and 0.1 Litres with prototype. For patients who require ventilatory support, manual ventilation is a vital procedure. It has to be performed by experienced healthcare providers that are regularly trained for the use of bag-valve-mask (BVM) in emergency situations. Keywords: Mechanical Ventilator, Automated BVM, BPM, COVID-19, Ventilator design, Airflow meter
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Doorduin, Jonne, Christer A. Sinderby, Jennifer Beck, Johannes G. van der Hoeven, and Leo M. A. Heunks. "Assisted Ventilation in Patients with Acute Respiratory Distress Syndrome." Anesthesiology 123, no. 1 (July 1, 2015): 181–90. http://dx.doi.org/10.1097/aln.0000000000000694.
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Abstract Background: In patients with acute respiratory distress syndrome (ARDS), the use of assisted mechanical ventilation is a subject of debate. Assisted ventilation has benefits over controlled ventilation, such as preserved diaphragm function and improved oxygenation. Therefore, higher level of “patient control” of ventilator assist may be preferable in ARDS. However, assisted modes may also increase the risk of high tidal volumes and lung-distending pressures. The current study aims to quantify how differences in freedom to control the ventilator affect lung-protective ventilation, breathing pattern variability, and patient–ventilator interaction. Methods: Twelve patients with ARDS were ventilated in a randomized order with assist pressure control ventilation (PCV), pressure support ventilation (PSV), and neurally adjusted ventilatory assist (NAVA). Transpulmonary pressure, tidal volume, diaphragm electrical activity, and patient–ventilator interaction were measured. Respiratory variability was assessed using the coefficient of variation of tidal volume. Results: During inspiration, transpulmonary pressure was slightly lower with NAVA (10.3 ± 0.7, 11.2 ± 0.7, and 9.4 ± 0.7 cm H2O for PCV, PSV, and NAVA, respectively; P < 0.01). Tidal volume was similar between modes (6.6 [5.7 to 7.0], 6.4 [5.8 to 7.0], and 6.0 [5.6 to 7.3] ml/kg for PCV, PSV, and NAVA, respectively), but respiratory variability was higher with NAVA (8.0 [6.4 to 10.0], 7.1 [5.9 to 9.0], and 17.0 [12.0 to 36.1] % for PCV, PSV, and NAVA, respectively; P < 0.001). Patient–ventilator interaction improved with NAVA (6 [5 to 8] % error) compared with PCV (29 [14 to 52] % error) and PSV (12 [9 to 27] % error); P < 0.0001. Conclusion: In patients with mild-to-moderate ARDS, increasing freedom to control the ventilator maintains lung-protective ventilation in terms of tidal volume and lung-distending pressure, but it improves patient–ventilator interaction and preserves respiratory variability.
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Imanaka, Hideaki, Dean Hess, Max Kirmse, Luca M. Bigatello, Robert M. Kacmarek, Wolfgang Steudel, and William E. Hurford. "Inaccuracies of Nitric Oxide Delivery Systems during Adult Mechanical Ventilation." Anesthesiology 86, no. 3 (March 1, 1997): 676–88. http://dx.doi.org/10.1097/00000542-199703000-00021.
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Background Various systems to administer inhaled nitric oxide (NO) have been used in patients and experimental animals. We used a lung model to evaluate five NO delivery systems during mechanical ventilation with various ventilatory patterns. Methods An adult mechanical ventilator was attached to a test lung configured to separate inspired and expired gases. Four injection systems were evaluated with NO injected either into the inspiratory circuit 90 cm proximal to the Y piece or directly at the Y piece and delivered either continuously or only during the inspiratory phase. Alternatively, NO was mixed with air using a blender and delivered to the high-pressure air inlet of the ventilator. Nitric oxide concentration was measured from the inspiratory limb of the ventilator circuit and the tracheal level using rapid- and slow-response chemiluminescence analyzers. The ventilator was set for constant-flow volume control ventilation, pressure control ventilation, pressure support ventilation, or synchronized intermittent mandatory ventilation. Tidal volumes of 0.5 l and 1 l were evaluated with inspiratory times of 1 s and 2 s. Results The system that premixed NO proximal to the ventilator was the only one that maintained constant NO delivery regardless of ventilatory pattern. The other systems delivered variable NO concentration during pressure control ventilation and spontaneous breathing modes. Systems that injected a continuous flow of NO delivered peak NO concentrations greater than the calculated dose. These variations were not apparent when a slow-response chemiluminescence analyzer was used. Conclusions NO delivery systems that inject NO at a constant rate, either continuously or during inspiration only, into the inspiratory limb of the ventilator circuit produce highly variable and unpredictable NO delivery when inspiratory flow is not constant. Such systems may deliver a very high NO concentration to the lungs, which is not accurately reflected by measurements performed with slow-response analyzers.
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Hammouda, Eman Yasser, Hanaa Hussein Ahmed, Amr A. Moawad, and Nahed Attia Kandeel. "Weaning success among COPD patients following ventilator care bundle application." Clinical Nursing Studies 10, no. 1 (March 1, 2022): 1. http://dx.doi.org/10.5430/cns.v10n1p1.
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Objective: Several studies evaluated the effectiveness of the ventilator care bundle in reducing the occurrence of ventilatorassociated pneumonia. The ventilator care bundle efficacy in early mechanical ventilation weaning has not been adequately assessed. The study aimed to investigate the weaning success among chronic obstructive pulmonary disease (COPD) patients following ventilator care bundle application.Methods: This study is quasi-experimental, recruiting 80 mechanically ventilated COPD patients (40 patients for each bundle and control group). It was conducted at the respiratory intensive care units (ICUs) at Mansoura University Hospital, Egypt. Data were collected using a mechanically ventilated patient (MVP) assessment tool, a ventilator care bundle compliance checklist, and MVP evaluation tools based on the Burns’ Wean Assessment Program (BWAP) checklist and the patient’s ventilation indicators.Results: The results revealed that almost 75% of the bundle group was successfully weaned from invasive mechanical ventilation at the first attempt of the spontaneous breathing trial compared with 32.5% of the control group. The ventilation duration and length of ICU stay were reduced in the bundle compared with the control group.Conclusions: The bundle group demonstrated higher weaning scores than the control group. Therefore, we recommend the integration of the ventilator care bundle in the weaning trial of MVPs to accelerate weaning and reduce the duration of mechanical ventilation.
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Pearson, Steven D., Jay L. Koyner, and Bhakti K. Patel. "Management of Respiratory Failure." Clinical Journal of the American Society of Nephrology 17, no. 4 (March 10, 2022): 572–80. http://dx.doi.org/10.2215/cjn.13091021.
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Mechanical ventilation is a lifesaving therapy for critically ill patients with respiratory failure, but like all treatments, it has the potential to cause harm if not administered appropriately. This review aims to give an overview of the basic principles of invasive and noninvasive mechanical ventilation. Topics covered include modes of mechanical ventilation, respiratory mechanics and ventilator waveform interpretation, strategies for initial ventilator settings, indications and contraindications for noninvasive ventilation, and the effect of the ventilator on kidney function.
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Colombo, Sebastiano Maria, Michele Battistin, Eleonora Carlesso, Luigi Vivona, Fabio Carfagna, Carlo Valsecchi, Gaetano Florio, et al. "Sharing Mechanical Ventilator: In Vitro Evaluation of Circuit Cross-Flows and Patient Interactions." Membranes 11, no. 7 (July 20, 2021): 547. http://dx.doi.org/10.3390/membranes11070547.
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During the COVID-19 pandemic, a shortage of mechanical ventilators was reported and ventilator sharing between patients was proposed as an ultimate solution. Two lung simulators were ventilated by one anesthesia machine connected through two respiratory circuits and T-pieces. Five different combinations of compliances (30–50 mL × cmH2O−1) and resistances (5–20 cmH2O × L−1 × s−1) were tested. The ventilation setting was: pressure-controlled ventilation, positive end-expiratory pressure 15 cmH2O, inspiratory pressure 10 cmH2O, respiratory rate 20 bpm. Pressures and flows from all the circuit sections have been recorded and analyzed. Simulated patients with equal compliance and resistance received similar ventilation. Compliance reduction from 50 to 30 mL × cmH2O−1 decreased the tidal volume (VT) by 32% (418 ± 49 vs. 285 ± 17 mL). The resistance increase from 5 to 20 cmH2O × L−1 × s−1 decreased VT by 22% (425 ± 69 vs. 331 ± 51 mL). The maximal alveolar pressure was lower at higher compliance and resistance values and decreased linearly with the time constant (r² = 0.80, p < 0.001). The minimum alveolar pressure ranged from 15.5 ± 0.04 to 16.57 ± 0.04 cmH2O. Cross-flows between the simulated patients have been recorded in all the tested combinations, during both the inspiratory and expiratory phases. The simultaneous ventilation of two patients with one ventilator may be unable to match individual patient’s needs and has a high risk of cross-interference.
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González-Seguel, Felipe, Agustín Camus-Molina, Anita Jasmén Sepúlveda, Rodrigo Pérez Araos, Jorge Molina Blamey, and Jerónimo Graf Santos. "Settings and monitoring of mechanical ventilation during physical therapy in adult critically ill patients: protocol for a scoping review." BMJ Open 9, no. 8 (August 2019): e030692. http://dx.doi.org/10.1136/bmjopen-2019-030692.
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IntroductionEarly mobilisation has been extensively advocated to improve functional outcomes in critically ill patients, even though consistent evidence of its benefits has remained elusive. These conflicting results could be explained by a lack of knowledge on the optimal dosage of physical therapy and a mismatch between ventilatory support and exercise-induced patient ventilatory demand. Modern mechanical ventilators provide real-time monitoring of respiratory/metabolic variables and ventilatory setting that could be used for physical therapy dosage or ventilatory support titration, allowing individualised interventions in these patients. The aim of this review is to comprehensively map and summarise current knowledge on adjustments of respiratory support and respiratory or metabolic monitoring during physical therapy in adult critically ill mechanically ventilated patients.Methods and analysisThis is a scoping review protocol based on the methodology of the Joanna-Briggs-Institute. The search strategy will be conducted from inception to 30 June 2019 as a cut-off date in PubMed, CINAHL, Rehabilitation & Sport Medicine, Scielo Citation Index, Epistemónikos, Clinical Trials, PEDro and Cochrane Library, performed by a biomedical librarian and two critical care physiotherapists. All types of articles will be selected, including conference abstracts, clinical practice guidelines and expert recommendations. Bibliometric variables, patient characteristics, physical therapy interventions, ventilator settings and respiratory or metabolic monitoring will be extracted. The identified literature will be analysed by four critical care physiotherapists and reviewed by a senior critical care physician.Ethics and disseminationEthical approval is not required. The knowledge-translation of the results will be carried out based on the End-of-Grant strategies: diffusion, dissemination and application. The results will be published in a peer-review journal, presentations will be disseminated in relevant congresses, and recommendations based on the results will be developed through training for mechanical ventilation and physical therapy stakeholders.
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Van de Louw, Andry, Claire Médigue, Yves Papelier, and François Cottin. "Breathing cardiovascular variability and baroreflex in mechanically ventilated patients." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 295, no. 6 (December 2008): R1934—R1940. http://dx.doi.org/10.1152/ajpregu.90475.2008.
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Heart rate and blood pressure variations during spontaneous ventilation are related to the negative airway pressure during inspiration. Inspiratory airway pressure is positive during mechanical ventilation, suggesting that reversal of the normal baroreflex-mediated pattern of variability may occur. We investigated heart rate and blood pressure variability and baroreflex sensitivity in 17 mechanically ventilated patients. ECG (RR intervals), invasive systolic blood pressure (SBP), and respiratory flow signals were recorded. High-frequency (HF) amplitude of RR and SBP time series and HF phase differences between RR, SBP, and ventilatory signals were continuously computed by Complex DeModulation (CDM). Cross-spectral analysis was used to assess the coherence and the gain functions between RR and SBP, yielding baroreflex sensitivity indices. The HF phase difference between SBP and ventilatory signals was nearly constant in all patients with inversion of SBP variability during the ventilator cycle compared with cycling with negative inspiratory pressure to replicate spontaneous breathing. In 12 patients ( group 1), the phase difference between RR and ventilatory signals changed over time and the HF-RR amplitude varied. In the remaining five patients ( group 2), RR-ventilatory signal phase and HF-RR amplitude showed little change; however, only one of these patients exhibited a RR-ventilatory signal phase difference mimicking the normal pattern of respiratory sinus arrhythmia. Spectral coherence between RR and SBP was lower in the group with phase difference changes. Positive pressure ventilation exerts mainly a mechanical effect on SBP, whereas its influence on HR variability seems more complex, suggesting a role for neural influences.
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Cannizzaro, Vincenzo, Zoltan Hantos, Peter D. Sly, and Graeme R. Zosky. "Linking lung function and inflammatory responses in ventilator-induced lung injury." American Journal of Physiology-Lung Cellular and Molecular Physiology 300, no. 1 (January 2011): L112—L120. http://dx.doi.org/10.1152/ajplung.00158.2010.
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Despite decades of research, the mechanisms of ventilator-induced lung injury are poorly understood. We used strain-dependent responses to mechanical ventilation in mice to identify associations between mechanical and inflammatory responses in the lung. BALB/c, C57BL/6, and 129/Sv mice were ventilated using a protective [low tidal volume and moderate positive end-expiratory pressure (PEEP) and recruitment maneuvers] or injurious (high tidal volume and zero PEEP) ventilation strategy. Lung mechanics and lung volume were monitored using the forced oscillation technique and plethysmography, respectively. Inflammation was assessed by measuring numbers of inflammatory cells, cytokine (IL-6, IL-1β, and TNF-α) levels, and protein content of the BAL. Principal components factor analysis was used to identify independent associations between lung function and inflammation. Mechanical and inflammatory responses in the lung were dependent on ventilation strategy and mouse strain. Three factors were identified linking 1) pulmonary edema, protein leak, and macrophages, 2) atelectasis, IL-6, and TNF-α, and 3) IL-1β and neutrophils, which were independent of responses in lung mechanics. This approach has allowed us to identify specific inflammatory responses that are independently associated with overstretch of the lung parenchyma and loss of lung volume. These data provide critical insight into the mechanical responses in the lung that drive local inflammation in ventilator-induced lung injury and the basis for future mechanistic studies in this field.
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Rao, Shivaram, Nitin Bhat, Adarsha Gopadi Krishna Bhat, and H. Manjunatha Hande. "Incidence, determinants and outcomes of ventilator associated pneumonia in medical intensive care unit: a prospective cohort study from South Western India." International Journal of Research in Medical Sciences 9, no. 5 (April 28, 2021): 1306. http://dx.doi.org/10.18203/2320-6012.ijrms20211429.
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Background: Ventilators are being increasingly used in developing countries as a result of which complications like ventilator associated pneumonia is also increasing. Present study is being undertaken to evaluate the impact of risk factors and their changing trends for Ventilator associated pneumonia.Methods: A prospective observational study was conducted in mechanically ventilated patients of medical intensive care unit from October 2013 to April 2015.Results: In present study 166 patients receiving mechanical ventilation in a medical ICU were observed. Incidence of VAP in present study is 43.5 for 1000 days of mechanical ventilation. The risk factors that were significant in the study are organ failure (p=0.001), emergency intubation (p=0.001), reintubation (p=0.023) and COPD (p=0.026). The common organisms responsible for VAP were Acinetobacter (30%), Klebsiella pneumoniae (27.1%) and Pseudomonas aeruginosa (20%). The mortality was higher in VAP group (31.3%) compared to the non VAP group (15.7%).Conclusions: There is high incidence of VAP in the developing countries. The risk factors that were found to be associated with VAP in the present study were the presence of COPD, reintubation, organ failure and emergency intubation. VAP is associated with significantly increased duration of hospital stay, morbidity and mortality.
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Nishimura, Masaji, Dean Hess, Robert M. Kacmarek, Ray Ritz, and William E. Hurford. "Nitrogen Dioxide Production during Mechanical Ventilation with Nitric Oxide in Adults." Anesthesiology 82, no. 5 (May 1, 1995): 1246–54. http://dx.doi.org/10.1097/00000542-199505000-00020.
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Background Inhaled nitric oxide (NO) may be useful in the treatment of adult respiratory distress syndrome and other diseases characterized by pulmonary hypertension and hypoxemia. NO is rapidly converted to nitrogen dioxide (NO2) in oxygen (O2) environments. We hypothesized that in patients whose lungs are mechanically ventilated and in those with a long residence time for NO in the lungs, a clinically important [NO2] may be present. We therefore determined the rate constants for NO conversion in adult mechanical ventilators and in a test lung simulating prolonged intrapulmonary residence of NO. Methods NO (800 ppm) was blended with nitrogen (N2), delivered to the high-pressure air inlet of a Puritan-Bennett 7200ae or Siemens Servo 900C ventilator, and used to ventilate a test lung. The ventilator settings were varied: minute ventilation (VE) from 5 to 25 l/min, inspired O2 fraction (FIO2) from 0.24 to 0.87, and [NO] from 10 to 80 ppm. The experiment was then repeated with air instead of N2 as the dilution gas. The effect of pulmonary residence time on NO2 production was examined at test lung volumes of 0.5-4.0 l, VE of 5-25 l/min, FIO2 of 0.24-0.87, and [NO] of 10-80 ppm. The inspiratory gas mixture was sampled 20 cm from the Y-piece and from within the test lung. NO and NO2 were measured by chemiluminescence. The rate constant (k) for the conversion of NO to NO2 was determined from the relation 1/[NO]t-1/[NO]o = k x [O2] x t, where t = residence time. Results No NO2 was detected during any trial with VE 20 or 25 l/min. With N2 dilution and the Puritan-Bennett 7200ae, NO2 (< or = 1 ppm) was detected only at a VE of 5 l/min with an FIO2 of 0.87 and [NO] > or = 70 ppm. In contrast, [NO2] values were greater with the Servo 900C ventilator than with the Puritan-Bennett 7200ae at similar settings. When NO was diluted with air, clinically important [NO2] values were measured with both ventilators at high [NO] and FIO2. Rate constants were 1.46 x 10(-9) ppm-2.min-1 when NO was mixed with N2, 1.17 x 10(-8) ppm-2.min-1 when NO was blended with air, and 1.44 x 10(-9) ppm-2.min-1 in the test lung. Conclusions [NO2] increased with increased FIO2 and [NO], decreased VE, blending with air, and increased lung volumes. Higher [NO2] was produced with the Servo 900C ventilator than the Puritan-Bennett 7200ae because of the greater residence time. With long intrapulmonary residence times for NO, there is a potential for NO2 production within the lungs. The rate constants determined can be used to estimate [NO2] in adult mechanical ventilation systems.