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1
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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McClelland, Graham, Karl Charlton, Karen Millican, Daniel Haworth, Paul Aitken-Fell, and Michael Norton. "EP10 The impact of introducing real time feedback on ventilation rate and volume by ambulance clinicians in the North East in a simulated cardiac arrest scenario: the VANZ study." Emergency Medicine Journal 38, no. 9 (August 19, 2021): A5.2—A5. http://dx.doi.org/10.1136/emermed-2021-999.10.
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BackgroundAdequate ventilation is an important aspect of cardiopulmonary resuscitation (CPR). Research suggests 80% of caregivers hyperventilate during CPR and that feedback improves compliance with ventilation guidelines. Hyperventilation is associated with increased intrathoracic pressure, impaired haemodynamics and cerebral vasoconstriction and therefore can be deleterious to survival. VANZ aimed to determine if compliance with European Resuscitation Council (ERC) ventilation guidelines could be improved using a real time ventilation feedback deviceMethodsParticipants simulated a two-minute cardiac arrest scenario using a manikin and defibrillator without ventilation feedback. Researchers demonstrated the ventilation feedback device and participants practiced using it. The two-minute scenario was then repeated with ventilation feedback. The ventilation rate, volume and CPR quality were recorded during each scenario. The primary outcome was based on achieving ≥50% compliance with ERC ventilation guidelines of ventilating at 8-12 breaths per minute and 500-600ml per breath. Following the study participants were asked to complete a short survey on the ventilation feedback deviceResultsDuring September 2020 106 participants (58% male, mean age 42, 74% paramedics) completed the study. The primary outcome showed a significant improvement from 9% of participants achieving ≥50% compliance without feedback to 91% of participants achieving ≥50% compliance with feedback (McNemars test p<0.0001). Survey data from participants was overwhelmingly positive about the ventilation feedback device.ConclusionsUse of real time ventilation feedback during CPR significantly improved participants ability to deliver ventilations compliant with ERC guidelines in a simulated scenario. The fact that this was a manikin study is a limitation but the low rate of compliance with ventilation guidelines without feedback raises questions about ventilation quality when CPR is performed on patients. Future research should examine the quality of ventilations performed on patients, the ability of feedback to improve compliance with guidelines and the impact this has on patient outcomes.
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Bhoyar, Ankit D. "Evolution and Characteristics of Bag-Valve-Mask Ventilation During Pandemic: A Review of the Literature." International Journal for Research in Applied Science and Engineering Technology 9, no. VII (July 10, 2021): 25–29. http://dx.doi.org/10.22214/ijraset.2021.36227.
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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. 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. 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. We will present, a historical view on manual ventilation’s evolution throughout the last decades. Artificial ventilation has developed progressively and research is still going on to improve the actual devices used. Throughout the past years, a brand-new generation of ventilators was developed, but little was done for manual ventilation. Manual ventilation through BVM can be replaced by automatic ventilation 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 and to the graph produced by a human subject. The use of an automatic manually operated device may improve ventilation efficiency and decrease the risk of pulmonary overdistention, while decreasing the ventilation rate.
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Vincent-Lambert, Craig, Andrew Makkink, and Fredrick Kloppers. "Keep pushing! Limiting interruptions to CPR; bag-valve mask versus i-gel® airway ventilation." Health SA Gesondheid 21 (October 11, 2016): 21–32. http://dx.doi.org/10.4102/hsag.v21i0.931.
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Background: Recent recommendations made by ILCOR have de-emphasised the role of advanced airway management such as “endotracheal intubation” (ETI) during cardiac arrest in favour of maximising the number of chest compressions performed by rescuers. Maximising time available for compressions is achieved by minimising hands-off time (HOT). This has led to first responders and paramedics performing single rescuer CPR using a bag-valve-mask (BVM) device as opposed to the historical practice of intubating and ventilating via an endotracheal tube. Bag-valve-mask ventilations, especially during single rescuer CPR, are however associated with complications potentially resulting in increased ventilation times. More time spent on ventilations in the single rescuer scenario naturally leads to an increase in HOT and less time being available for compressions. It is postulated that the use of an appropriate supraglottic airway device (SAD) may decrease the time spent on the ventilation component of CPR and result in a decrease in HOT.Objectives: This pilot study evaluated how interruptions to chest compressions or hands-off time (HOT) are affected by the placement of an i-gel® airway vs. simple BVM ventilation during single rescuer CPR.Method: 16 participants performed two, ten-minute single rescuer CPR simulations, firstly using the BVM and later the i-gel® airway for ventilation. Data pertaining to ventilations and HOT in each scenario was statistically analysed and compared.Results: The i-gel® airway demonstrated a superior ease of ventilation compared to BVM alone and resulted in a reduction of time spent on ventilations overall. The i-gel® however took a mean of 29 s, ± 10 s, to secure which contributes considerably to HOT.Conclusion: The use of the i-gel® airway resulted in a considerable decrease in the amount of time spent on ventilations and in more compressions being performed. The overall reduction in HOT was, however, offset by the time it took to secure the device. Further investigation into the use and securing of the i-gel® airway in single rescuer CPR is recommended.
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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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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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Riley, Cheryl, and Jobeth Pilcher. "Volume-Guaranteed Ventilation." Neonatal Network 22, no. 2 (January 2003): 17–21. http://dx.doi.org/10.1891/0730-0832.22.2.17.
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Pressure-limited, time-cycled ventilation has been the primary mode of ventilation for neonates for several decades. But the realization that volume rather than pressure causes ventilator-induced lung injury has led to the development of new strategies for ventilation. Volume guarantee is a mode of ventilation that automatically adjusts the inspiratory pressure to achieve a set tidal volume according to changes in lung compliance or resistance or the patient’s respiratory drive. Volume-guaranteed ventilation delivers a specific, preset volume of gas, and inspiration ends when it has been delivered. This mode of ventilation requires careful attention to the infant and to ventilator settings.
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Sanderson, Ronald, Denise Whitley, and Christopher Batacan. "Automated mechanical ventilation using Adaptive Support Ventilation versus conventional ventilation including ventilator length of stay, mortality, and professional social aspects of adoption of new technology." Journal of Mechanical Ventilation 2, no. 2 (June 1, 2021): 48–52. http://dx.doi.org/10.53097/jmv.10021.
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Background Automation of mechanical ventilation allows for reduction of variation in patient management and has the potential to provide increased patient safety by strict adherence to computer driven ventilator protocols. Methods: A retrospective, observational study compared a group of 196 of general ICU patients managed exclusively on automated mechanical ventilation, adaptive support ventilation (ASV), to another group of 684 managed by usual, non-automated mechanical ventilation (No ASV). The data was collected in a unique access database designed to collect data for assessment of mechanical ventilation outcomes in a small medical center ICU. Results: The length of ventilator stay was non-significant between both groups, (81.7 ± 35.2 hours) in the ASV group; vs. (94.1 ± 35.1 hours) in the No ASV. Percent mortality was significantly less in the ASV group, 8.6% compared to 27.3% in the No ASV. Conclusion: Automated ventilation appears to be a safe ventilator strategy; however, cause effect relationships cannot be determined without further, more sophisticated studies. Keywords: Closed loop ventilation, ASV, Ventilator length of stay, Percent minute ventilation
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Kolandaivelu, Kumaran, and Chi-Sang Poon. "A miniature mechanical ventilator for newborn mice." Journal of Applied Physiology 84, no. 2 (February 1, 1998): 733–39. http://dx.doi.org/10.1152/jappl.1998.84.2.733.
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Kolandaivelu, Kumaran, and Chi-Sang Poon.A miniature mechanical ventilator for newborn mice. J. Appl. Physiol. 84(2): 733–739, 1998.—Transgenic/knockout mice with predefined mutations have become increasingly popular in biomedical research as models of human diseases. In some instances, the resulting mutation may cause cardiorespiratory distress in the neonatal or adult animals and may necessitate resuscitation. Here we describe the design and testing of a miniature and versatile ventilator that can deliver varying ventilatory support modes, including conventional mechanical ventilation and high-frequency ventilation, to animals as small as the newborn mouse. With a double-piston body chamber design, the device circumvents the problem of air leakage and obviates the need for invasive procedures such as endotracheal intubation, which are particularly important in ventilating small animals. Preliminary tests on newborn mice as early as postnatal day 0 demonstrated satisfactory restoration of pulmonary ventilation and the prevention of respiratory failure in mutant mice that are prone to respiratory depression. This device may prove useful in the postnatal management of transgenic/knockout mice with genetically inflicted respiratory disorders.
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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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Pruitt, Bill, and Mary Catherine Hodges. "Mechanical ventilation." Nursing 54, no. 5 (April 19, 2024): 17–25. http://dx.doi.org/10.1097/01.nurse.0001009984.17145.03.
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Abstract: Mechanical ventilation is rarely a simple matter. Skill and knowledge are required to operate the ventilator modes, choose the optimal settings, and understand many monitored variables. Supporting the patient safely and effectively is the top priority in providing mechanical ventilation. This article discusses mechanical ventilation in adults.
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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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Pierce, JD, and K. Gerald. "Differences in end-tidal carbon dioxide and breathing patterns in ventilator-dependent patients using pressure support ventilation." American Journal of Critical Care 3, no. 4 (July 1, 1994): 276–81. http://dx.doi.org/10.4037/ajcc1994.3.4.276.
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BACKGROUND: Although several investigators have assessed the effects of pressure support ventilation on tidal volume and breathing patterns, none have investigated the combination of breathing patterns and end-tidal carbon dioxide in ventilator-dependent patients. OBJECTIVES: To determine the differences in end-tidal carbon dioxide and breathing patterns at varying pressure support ventilation levels in ventilator-dependent patients. METHODS: Breathing patterns were measured with a plethysmograph and a ventilator. End-tidal carbon dioxide was measured by connecting the capnography sampler to the exhalation port of intubated patients. All equipment was connected to a five-channel recorder for data collection. The respiratory rate, tidal volume, minute ventilation, end-tidal carbon dioxide concentration, and chest and abdominal movement were recorded at 10-minute intervals at four pressure support ventilation levels (0, 10, 15, and 20 cm H2O). RESULTS: As pressure support ventilation increased, the respiratory rate, end-tidal carbon dioxide concentration, and asynchronous movement of chest and abdomen decreased. Tidal volume increased with higher pressure support ventilation levels. CONCLUSIONS: Pressure support ventilation prevents asynchronous chest and abdominal movement and lowers the level of end-tidal carbon dioxide. Pressure support ventilation offers clinicians a way to lower the elevated carbon dioxide level that often occurs in critically ill patients. Increasing tidal volume and reducing the work of breathing by using pressure support ventilation may reduce diaphragm fatigue in ventilator-dependent patients.
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B Mohan, Prashanth, Pavan Kumar BC, and Kabara Abhishek. "Ventilator-induced lung injury in ARDS." MOJ Biology and Medicine 8, no. 3 (September 11, 2023): 129–31. http://dx.doi.org/10.15406/mojbm.2023.08.00197.
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Acute respiratory distress syndrome (ARDS) develops in nearly 2 to 19 patients in every 100 critically ill patients, and the incidence of ARDS demands the implementation of mechanical ventilation to support the respiratory distress in the patients. However, mechanical ventilation is the primary cause that leads to ventilator- induced lung injury. A sequence of pathophysiological mechanisms involving volutrauma/barotrauma results in ventilator-induced injury in the later stages. In other words, ventilator-induced lung injury is an outcome experienced as a result of physiological and morphological alterations of the lungs due to mechanical ventilation. Among all factors, VILI primarily occurs as a result of improper ventilation, and further continuation of improper ventilation can even result in a secondary ventilator-induced lung injury. Furthermore, ventilator-induced lung injury can result in hypoxia, pulmonary edema, and multi-organ dysfunction and can even risk the life of the patient. This makes it essential to identify some effective strategies that can act as a measure to support protective ventilation to prevent ventilation-induced lung injuries. This review explores the clinical aspects of barotrauma to gather proper information about the aspects that contribute to ventilator- induced lung injury so that the recommendations can be suggested to prevent the increasing incidences of these injuries during ventilation. To conduct this review, an extensive search of multiple databases, including PubMed, ScienceDirect, Medline, etc., was conducted with the mentioned keywords, and 15 articles were shortlisted to be reviewed within this article. The findings of this review have indicated that protective ventilation is the most effective strategy that can support the survival of patients suffering from ventilator- induced lung injury. Protective ventilation not only helps in saving lives, but was also found to be a useful measure in preventing lung injuries experienced by the patients due to mismatch between actual and required optimum ventilator settings for the patient. Further findings of the review also indicate that ventilator-induced lung injuries could be prevented by ensuring the transpulmonary pressure is within the physiological range and the position of the patient is maintained supine for the majority of the time to support homogeneity in the distribution of the transpulmonary pressure.
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Johnny, Jace D., Zachary Drury, Tracey Ly, and Janel Scholine. "Oral Care in Critically Ill Patients Requiring Noninvasive Ventilation: An Evidence-Based Review." Critical Care Nurse 41, no. 4 (August 1, 2021): 66–70. http://dx.doi.org/10.4037/ccn2021330.
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Topic Hospital-acquired pneumonia commonly develops after 48 hours of hospitalization and can be divided into non–ventilator-acquired and ventilator-acquired pneumonia. Prevention of non–ventilator-acquired pneumonia requires a multimodal approach. Implementation of oral care bundles can reduce the incidence of ventilator-acquired pneumonia, but the literature on oral care in other populations is limited. Clinical Relevance Use of noninvasive ventilation is increasing owing to positive outcomes. The incidence of non–ventilator-acquired pneumonia is higher in patients receiving noninvasive ventilation than in the general hospitalized population but remains lower than that of ventilator-acquired pneumonia. Non–ventilator-acquired pneumonia increases mortality risk and hospital length of stay. Purpose To familiarize nurses with the evidence regarding oral care in critically ill patients requiring noninvasive ventilation. Content Covered No standard of oral care exists for patients requiring noninvasive ventilation owing to variation in study findings, definitions, and methods. Oral care decreases the risk of hospital-acquired pneumonia and improves comfort. Nurses perform oral care less often for nonintubated patients, as it is perceived as primarily a comfort measure. The potential risks of oral care for patients receiving noninvasive ventilation have not been explored. Further research is warranted before this practice can be fully implemented. Conclusion Oral care is a common preventive measure for non–ventilator-acquired pneumonia and may improve comfort. Adherence to oral care is lower for patients not receiving mechanical ventilation. Further research is needed to identify a standard of care for oral hygiene for patients receiving noninvasive ventilation and assess the risk of adverse events.
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Surani, Salim, Munish Sharma, Kevin Middagh, Hector Bernal, Joseph Varon, Iqbal Ratnani, Humayun Anjum, and Alamgir Khan. "Weaning from Mechanical Ventilator in a Long-term Acute Care Hospital: A Retrospective Analysis." Open Respiratory Medicine Journal 14, no. 1 (December 18, 2020): 62–66. http://dx.doi.org/10.2174/1874306402014010062.
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Background: Prolonged Mechanical Ventilation (PMV) is associated with a higher cost of care and increased morbidity and mortality. Patients requiring PMV are referred mostly to Long-Term Acute Care (LTAC) facilities. Objective: To determine if protocol-driven weaning from mechanical ventilator by Respiratory Therapist (RT) would result in quicker weaning from mechanical ventilation, cost-effectiveness, and decreased mortality. Methods: A retrospective case-control study was conducted that utilized protocol-driven ventilator weaning by respiratory therapist (RT) as a part of the Respiratory Disease Certification Program (RDCP). Results: 51 patients on mechanical ventilation before initiation of protocol-based ventilator weaning formed the control group. 111 patients on mechanical ventilation after implementation of the protocol formed the study group. Time to wean from the mechanical ventilation before the implementation of protocol-driven weaning by RT was 16.76 +/- 18.91 days, while that after the implementation of protocol was 7.67 +/- 6.58 days (p < 0.0001). Mortality proportion in patients after implementation of protocol-based ventilator weaning was 0.21 as compared to 0.37 in the control group (p=0.0153). The daily cost of patient care for the LTAC while on mechanical ventilation was $2200/day per patient while it was $ 1400/day per patient while not on mechanical ventilation leading to significant cost savings. Conclusion: Protocol-driven liberation from mechanical ventilation in LTAC by RT can significantly decrease the duration of a mechanical ventilator, leading to decreased mortality and cost savings.
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Zmarzły, Marian, and Paweł Trzaskalik. "Comparative Analysis of Methane Concentration Near the Junction of the Longwall and Top Road." Management Systems in Production Engineering 27, no. 3 (September 1, 2019): 166–73. http://dx.doi.org/10.1515/mspe-2019-0027.
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AbstractMining of longwalls ventilated by the „U” method is willingly applied in Polish coal-mines due to low costs of workings maintenance, low costs of ventilation and a lower fire threat because of a limited flow of air through goafs. However, such a way of ventilation may pose an increased risk of methane explosion. For this reason, the “U” ventilation has been limited in longwalls with methane risk. The mining regulations in force provide that ventilation methane-bearing capacity, i.e. the intensity of methane flow into the ventilation air cannot exceed 20 m3 CH4/min. The regulations also provide that in the event the absolute methane-bearing capacity, i.e. a sum of methane released to the ventilation air and captured by the methane drainage system is higher than 25 m3 CH4/min and the “U” method of ventilation is applied, the effectiveness of methane drainage should be minimum 50% in relation to the forecast absolute methane-bearing capacity. To streamline the process of ventilation near the junction of the longwall and the gallery carrying off the used air, auxiliary ventilation means are applied, such as a ventilation partition, a ventube – which supplies air without methane or with a low concentration of methane, injectors etc. Application of these means is limited by the cross-section of the heading carrying off the air from the longwall. Deformations of the ventilating roadway, which is usually located in the one-sided vicinity of goafs, may prevent the use of a ventilation partition, which has a negative influence on the conditions of ventilating the junction of the longwall and ventilating roadway. The author of the article also refers to such conditions, presenting average values and maximum concentrations of methane concentrations recorded with four methane concentration sensors, located in the vicinity of the junction of the longwall and ventilating roadway.
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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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Buiteman-Kruizinga, Laura A., Ary Serpa Neto, Michela Botta, Stephanie S. List, Ben H. de Boer, Patricia van Velzen, Philipp Karl Bühler, et al. "Effect of automated versus conventional ventilation on mechanical power of ventilation—A randomized crossover clinical trial." PLOS ONE 19, no. 7 (July 30, 2024): e0307155. http://dx.doi.org/10.1371/journal.pone.0307155.
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Introduction Mechanical power of ventilation, a summary parameter reflecting the energy transferred from the ventilator to the respiratory system, has associations with outcomes. INTELLiVENT–Adaptive Support Ventilation is an automated ventilation mode that changes ventilator settings according to algorithms that target a low work–and force of breathing. The study aims to compare mechanical power between automated ventilation by means of INTELLiVENT–Adaptive Support Ventilation and conventional ventilation in critically ill patients. Materials and methods International, multicenter, randomized crossover clinical trial in patients that were expected to need invasive ventilation > 24 hours. Patients were randomly assigned to start with a 3–hour period of automated ventilation or conventional ventilation after which the alternate ventilation mode was selected. The primary outcome was mechanical power in passive and active patients; secondary outcomes included key ventilator settings and ventilatory parameters that affect mechanical power. Results A total of 96 patients were randomized. Median mechanical power was not different between automated and conventional ventilation (15.8 [11.5–21.0] versus 16.1 [10.9–22.6] J/min; mean difference –0.44 (95%–CI –1.17 to 0.29) J/min; P = 0.24). Subgroup analyses showed that mechanical power was lower with automated ventilation in passive patients, 16.9 [12.5–22.1] versus 19.0 [14.1–25.0] J/min; mean difference –1.76 (95%–CI –2.47 to –10.34J/min; P < 0.01), and not in active patients (14.6 [11.0–20.3] vs 14.1 [10.1–21.3] J/min; mean difference 0.81 (95%–CI –2.13 to 0.49) J/min; P = 0.23). Conclusions In this cohort of unselected critically ill invasively ventilated patients, automated ventilation by means of INTELLiVENT–Adaptive Support Ventilation did not reduce mechanical power. A reduction in mechanical power was only seen in passive patients. Study registration Clinicaltrials.gov (study identifier NCT04827927), April 1, 2021 URL of trial registry record https://clinicaltrials.gov/study/NCT04827927?term=intellipower&rank=1
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Perez, Victor, and Jamille Pasco. "Identifying asynchronies: Early cycling." Journal of Mechanical Ventilation 4, no. 1 (March 15, 2023): 57–59. http://dx.doi.org/10.53097/jmv.10073.
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Mechanical ventilation is a lifesaving treatment but can be associated with some complications such as ventilator-induced lung injury, ventilator associated pneumonia or ventilation induced diaphragm dysfunction. Although partial ventilatory support is preferred to limit some of the complications associated with controlled mechanical ventilation, there could be some problems like asynchrony between the patient and the ventilator. Asynchronies occur when the ventilator’s breath delivery does not match the patient’s ventilatory pattern or is inadequate to meet their flow demand. Asynchronies can lead to patient’s discomfort, prolong mechanical ventilation, intensive care unit stay and mortality. Early cycling occurs when the patient’s neural inspiratory time is longer than the inspiratory time imposed by the ventilator. It is a common cause of double trigger.
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Wilkinson, Dominic. "Ventilating the debate: elective ventilation revisited." Journal of Medical Ethics 39, no. 3 (February 18, 2013): 127–28. http://dx.doi.org/10.1136/medethics-2013-101382.
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Bowman, Thomas G., Richard J. Boergers, and Monica R. Lininger. "Airway Management in Athletes Wearing Lacrosse Equipment." Journal of Athletic Training 53, no. 3 (March 1, 2018): 240–48. http://dx.doi.org/10.4085/1062-6050-4-17.
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Context: Patient ventilation volume and rate have been found to be compromised due to the inability to seal a pocket mask over the chinstrap of football helmets. The effects of supraglottic airway devices such as the King LT and of lacrosse helmets on these measures have not been studied. Objective: To assess the effects of different airway management devices and helmet conditions on producing quality ventilations while performing cardiopulmonary resuscitation on simulation manikins. Design: Crossover study. Setting: Simulation laboratory. Patients or Other Participants: Thirty-six athletic trainers (12 men, 24 women) completed this study. Intervention(s): Airway-management device (pocket mask, oral pharyngeal airway, King LT airway [KA]) and helmet condition (no helmet, Cascade helmet, Schutt helmet, Warrior helmet) served as the independent variables. Participant pairs performed 2 minutes of 2-rescuer cardiopulmonary resuscitation under 12 trial conditions. Main Outcome Measure(s): Ventilation volume (mL), ventilation rate (ventilations/min), rating of perceived difficulty (RPD), and percentage of quality ventilations were the dependent variables. Results: A significant interaction was found between type of airway-management device and helmet condition on ventilation volume and rate (F12,408 = 2.902, P < .0001). In addition, a significant interaction was noted between airway-management device and helmet condition on RPD scores (F6,204 = 3.366, P = .003). The no-helmet condition produced a higher percentage of quality ventilations compared with the helmet conditions (P ≤ .003). Also, the percentage of quality ventilations differed, and the KA outperformed each of the other devices (P ≤ .029). Conclusions: The helmet chinstrap inhibited quality ventilation (rate and volume) in airway procedures that required the mask to be sealed on the face. However, the KA allowed quality ventilation in patients wearing a helmet with the chinstrap fastened. If a KA is not available, the helmet may need to be removed to provide quality ventilations.
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Mireles-Cabodevila, Eduardo, Enrique Diaz-Guzman, Alejandro C. Arroliga, and Robert L. Chatburn. "Human versus Computer Controlled Selection of Ventilator Settings: An Evaluation of Adaptive Support Ventilation and Mid-Frequency Ventilation." Critical Care Research and Practice 2012 (2012): 1–8. http://dx.doi.org/10.1155/2012/204314.
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Background. There are modes of mechanical ventilation that can select ventilator settings with computer controlled algorithms (targeting schemes). Two examples are adaptive support ventilation (ASV) and mid-frequency ventilation (MFV). We studied how different clinician-chosen ventilator settings are from these computer algorithms under different scenarios.Methods. A survey of critical care clinicians provided reference ventilator settings for a 70 kg paralyzed patient in five clinical/physiological scenarios. The survey-derived values for minute ventilation and minute alveolar ventilation were used as goals for ASV and MFV, respectively. A lung simulator programmed with each scenario’s respiratory system characteristics was ventilated using the clinician, ASV, and MFV settings.Results. Tidal volumes ranged from 6.1 to 8.3 mL/kg for the clinician, 6.7 to 11.9 mL/kg for ASV, and 3.5 to 9.9 mL/kg for MFV. Inspiratory pressures were lower for ASV and MFV. Clinician-selected tidal volumes were similar to the ASV settings for all scenarios except for asthma, in which the tidal volumes were larger for ASV and MFV. MFV delivered the same alveolar minute ventilation with higher end expiratory and lower end inspiratory volumes.Conclusions. There are differences and similarities among initial ventilator settings selected by humans and computers for various clinical scenarios. The ventilation outcomes are the result of the lung physiological characteristics and their interaction with the targeting scheme.
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Berquist, Justin, Carsen Banister, and Mathieu Pellissier. "Comparison of Heat Recovery Ventilator Frost Control Techniques in the Canadian Arctic: Preheat and Recirculation." E3S Web of Conferences 246 (2021): 11010. http://dx.doi.org/10.1051/e3sconf/202124611010.
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Air-to-air heat/energy recovery ventilators can effectively reduce the cost associated with ventilating a home. However, high indoor moisture levels, in conjunction with extreme temperature differences between the outdoor and indoor air can cause frost accumulation in the mechanical equipment, leading to performance degradation or failure. In this research, a demonstration house using a heat recovery ventilation system in Iqaluit, Nunavut, Canada was used to compare the performance of two frost control techniques: recirculation and electrical preheat. The advantages and disadvantages of each method are outlined to highlight the need to adapt southern strategies to ensure system functionality in the Arctic. The system was equipped with a heat recovery ventilator (HRV) with built-in recirculation technology to defrost the HRV, as well as two electric preheaters that can be used instead of recirculation and prevent frost formation. Between December 2018 and April 2019 the ventilation system’s performance was monitored for seven weeks while using either recirculation or electrical preheat. The experiments showed the ventilation system equipment consumed more absolute energy with electrical preheat than with recirculation as the frost control technique. However, when using recirculation, the ventilation system experienced more losses throughout the ventilation system, causing the whole building to consume more energy due to an increase in energy consumption by the home’s heating system. Moreover, the quantity of outdoor air that was restricted while using recirculation made electrical preheat the superior option for this ventilation system design. The energy use of the ventilation system with electric preheat enabled was 35% lower on a per volume of outdoor air basis. Contrary to some belief that preheating is a poor approach for frost control in heat/energy recovery ventilators, this research finds that preheating can be a more energy efficient method to provide ventilation if controlled well.
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Azcarate, Izaskun, Jose Antonio Urigüen, Mikel Leturiondo, Camilo Leonardo Sandoval, Koldo Redondo, José Julio Gutiérrez, James Knox Russell, et al. "The Role of Chest Compressions on Ventilation during Advanced Cardiopulmonary Resuscitation." Journal of Clinical Medicine 12, no. 21 (November 3, 2023): 6918. http://dx.doi.org/10.3390/jcm12216918.
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Background: There is growing interest in the quality of manual ventilation during cardiopulmonary resuscitation (CPR), but accurate assessment of ventilation parameters remains a challenge. Waveform capnography is currently the reference for monitoring ventilation rate in intubated patients, but fails to provide information on tidal volumes and inspiration–expiration timing. Moreover, the capnogram is often distorted when chest compressions (CCs) are performed during ventilation compromising its reliability during CPR. Our main purpose was to characterize manual ventilation during CPR and to assess how CCs may impact on ventilation quality. Methods: Retrospective analysis were performed of CPR recordings fromtwo databases of adult patients in cardiac arrest including capnogram, compression depth, and airway flow, pressure and volume signals. Using automated signal processing techniques followed by manual revision, individual ventilations were identified and ventilation parameters were measured. Oscillations on the capnogram plateau during CCs were characterized, and its correlation with compression depth and airway volume was assessed. Finally, we identified events of reversed airflow caused by CCs and their effect on volume and capnogram waveform. Results: Ventilation rates were higher than the recommended 10 breaths/min in 66.7% of the cases. Variability in ventilation rates correlated with the variability in tidal volumes and other ventilatory parameters. Oscillations caused by CCs on capnograms were of high amplitude (median above 74%) and were associated with low pseudo-volumes (median 26 mL). Correlation between the amplitude of those oscillations with either the CCs depth or the generated passive volumes was low, with correlation coefficients of −0.24 and 0.40, respectively. During inspiration and expiration, reversed airflow events caused opposed movement of gases in 80% of ventilations. Conclusions: Our study confirmed lack of adherence between measured ventilation rates and the guideline recommendations, and a substantial dispersion in manual ventilation parameters during CPR. Oscillations on the capnogram plateau caused by CCs did not correlate with compression depth or associated small tidal volumes. CCs caused reversed flow during inspiration, expiration and in the interval between ventilations, sufficient to generate volume changes and causing oscillations on capnogram. Further research is warranted to assess the impact of these findings on ventilation quality during CPR.
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Hess, D. R. "Patient-Ventilator Interaction During Noninvasive Ventilation." Respiratory Care 56, no. 2 (February 1, 2011): 153–67. http://dx.doi.org/10.4187/respcare.01049.
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Guy, Ella F. S., J. Geoffrey Chase, Jennifer L. Knopp, and Geoffrey M. Shaw. "Quantifying ventilator unloading in CPAP ventilation." Computers in Biology and Medicine 142 (March 2022): 105225. http://dx.doi.org/10.1016/j.compbiomed.2022.105225.
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Radke, Oliver. "Monitoring Mechanical Ventilation Using Ventilator Waveforms." Anesthesia & Analgesia 128, no. 1 (January 2019): e6. http://dx.doi.org/10.1213/ane.0000000000003896.
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Carteaux, Guillaume, Aissam Lyazidi, Ana Cordoba-Izquierdo, Laurence Vignaux, Philippe Jolliet, Arnaud W. Thille, Jean-Christophe M. Richard, and Laurent Brochard. "Patient-Ventilator Asynchrony During Noninvasive Ventilation." Chest 142, no. 2 (August 2012): 367–76. http://dx.doi.org/10.1378/chest.11-2279.
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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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Chenoweth, Carol E., Laraine L. Washer, Kumari Obeyesekera, Candace Friedman, Karolyn Brewer, Garrett E. Fugitt, and Rebecca Lark. "Ventilator-Associated Pneumonia in the Home Care Setting." Infection Control & Hospital Epidemiology 28, no. 8 (August 2007): 910–15. http://dx.doi.org/10.1086/519179.
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Objective.To describe the rate of infection, associated organisms, and potential risk factors for ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation at home.Design.Retrospective cohort study.Setting.University-affiliated home care service.Patients.Patients receiving mechanical ventilation at home from June 1995 through December 2001.Results.Fifty-seven patients underwent ventilation at home for a total of 50,762 ventilator-days (mean ± SD, 890.6 ± 644.43 days; range, 76-2,458 days). Seventy-nine episodes of VAP occurred in 27 patients (rate, 1.55 episodes per 1,000 ventilator-days). The first episode of VAP occurred after a mean (±SD) of 245 ± 318.07 ventilator-days. VAP was most common during the first 500 days of ventilation. Rates of VAP were higher among patients who required ventilation for longer daily durations, compared with those who required it for shorter daily durations. There was no association of VAP with age, sex, underlying disease, reason for ventilation, antacid therapy, or steroid use. Microorganisms isolated from 33 episodes of VAP with available culture results included Pseudomonas species (17 isolates), Staphylococcus aureus (11), Serratia species (7), and Stenotrophomonas species (5). Eight patients died during the study; no deaths were attributed to pneumonia.Conclusions.Although the organisms associated with VAP in the home setting are similar to those associated with hospital-acquired VAP, the incidence and mortality is much lower in the home care setting. Interventions to reduce the risk of VAP among patients receiving home care should be focused on patients who require ventilation for longer daily durations or who are new to receiving mechanical ventilation at home.
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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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Nugent, Kenneth, and Gilbert Berdine. "Mechanical power during mechanical ventilation." Southwest Respiratory and Critical Care Chronicles 12, no. 50 (January 29, 2024): 16–23. http://dx.doi.org/10.12746/swrccc.v12i50.1275.
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Mechanical ventilation provides lifesaving support for patients with acute respiratory failure. However, the pressures and volumes required to maintain gas exchange can cause ventilator-induced lung injury. The current approach to mechanical ventilation involves attention to both tidal volume and airway pressures, in particular plateau pressures and driving pressures. The ventilator provides energy to overcome airway resistance and to inflate alveolar structures. This energy delivered to the respiratory system per unit time equals mechanical power. Calculation of mechanical power provides a composite number that integrates pressures, volumes, and respiratory rates. Increased levels of mechanical power have been associated with tissue injury in animal models. In patients, mechanical power can predict outcomes, such as ICU mortality, when used in multivariable analyses. Increases in mechanical power during the initial phase of ventilation have been associated with worse outcomes. Mechanical power calculations can be used in patients on noninvasive ventilation, and measurements of mechanical power have been used to compare ventilator modes. Calculation of mechanical power requires measurement of the area in a hysteresis loop. Alternatively, simplified formulas have been developed to provide this calculation. However, this information is not available on most ventilators. Therefore, clinicians will need to make this calculation. In summary, calculation of mechanical power provides an estimate of the energy requirements for mechanical ventilation based on a composite of factors, including airway resistance, lung elastance, respiratory rate, and tidal volume.
Key words: mechanical ventilation, mechanical power, ventilator-induced lung injury, energy, work
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Su, Marissa, and ehab daoud. "Effect of respiratory effort on target minute ventilation during Adaptive Support Ventilation." Journal of Mechanical Ventilation 2, no. 2 (June 1, 2021): 53–58. http://dx.doi.org/10.53097/jmv.10022.
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Background: Adaptive support ventilation (ASV) is an intelligent mode of mechanical ventilation protocol which uses a closed-loop control between breaths. The algorithm states that for a given level of alveolar ventilation, there is a particular respiratory rate and tidal volume which achieve a lower work of breathing. The mode allows the clinician to set a desired minute ventilation percentage (MV%) while the ventilator automatically selects the target ventilatory pattern base on these inputs and feedback from the ventilator monitoring system. The goal is to minimize the work of breathing and reduce complications by allowing the ventilator to adjust the breath delivery taking into account the patient’s respiratory mechanics (Resistance, and Compliance). In this study we examine the effect of patients’ respiratory effort on target tidal volume (VT) and Minute Ventilation (V̇e) during ASV using breathing simulator. Methods: A bench study was performed by using the ASL 5000 breathing simulator to compare the target ventilator to actual VT and V̇e value in simulated patients with various level of respiratory effort during ASV on the Hamilton G5 ventilator. The clinical scenario involves simulated adult male with IBW 70kg and normal lung mechanics: respiratory compliance of 70 mL/cm H2O, and airway resistance of 9 cm H2O/L/s. Simulated patients were subjected to five different level of muscle pressure (Pmus): 0 (Passive), -5, -10, -15, -25 (Active) cm H2O at a set respiratory rate of 10 (below targeted VT) set at three different levels of minute ventilation goals: 100%, 200%, and 300%, with a PEEP of 5 cm H2O. Fifty breaths were analyzed in every experiment. Means and standard deviations (SD) of variables were calculated. One way analysis of variants was done to compare the values. Pearson correlation coefficient test was used to calculate the correlation between the respiratory effort and the VT, V̇e, and peak inspiratory pressure (PIP). Results: The targeted VT and V̇e were not significant in the passive patient when no effort was present, however were significantly higher in the active states at all levels of Pmus on the 100%, 200% and the 300 MV%. The VT and V̇e increase correlated with the muscle effort in the 100 and 200 MV% but did not in the 300%. Conclusions: Higher inspiratory efforts resulted in significantly higher VT and V̇e than targeted ones. Estimating patients’ effort is important during setting ASV. Keywords: Mechanical ventilation, ASV, InteliVent, Pmus, tidal volume, percent minute ventilation
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Hallgren, Filip, Martin Stenlo, Anna Niroomand, Ellen Broberg, Snejana Hyllén, Malin Malmsjö, and Sandra Lindstedt. "Particle flow rate from the airways as fingerprint diagnostics in mechanical ventilation in the intensive care unit: a randomised controlled study." ERJ Open Research 7, no. 3 (June 25, 2021): 00961–2020. http://dx.doi.org/10.1183/23120541.00961-2020.
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IntroductionMechanical ventilation can be monitored by analysing particles in exhaled air as measured by particle flow rate (PFR). This could be a potential method of detecting ventilator-induced lung injury (VILI) before changes in conventional parameters can be detected. The aim of this study was to investigate PFR during different ventilation modes in patients without lung pathology.MethodA prospective study was conducted on patients on mechanical ventilation in the cardiothoracic intensive care unit (ICU). A PExA 2.0 device was connected to the expiratory limb on the ventilator for continuous measurement of PFR in 30 patients randomised to either volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV) for 30 min including a recruitment manoeuvre. PFR measurements were continued as the patients were transitioned to pressure-regulated volume control (PRVC) and then pressure support ventilation (PSV) until extubation.ResultsPRVC resulted in significantly lower PFR, while those on PSV had the highest PFR. The distribution of particles differed significantly between the different ventilation modes.ConclusionsMeasuring PFR is safe after cardiac surgery in the ICU and may constitute a novel method of continuously monitoring the small airways in real time. A low PFR during mechanical ventilation may correlate to a gentle ventilation strategy. PFR increases as the patient transitions from controlled mechanical ventilation to autonomous breathing, which most likely occurs as recruitment by the diaphragm opens up more distal airways. Different ventilation modes resulted in unique particle patterns and could be used as a fingerprint for the different ventilation modes.
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Ankireddy, Korisipati, and Aruna Jyothi K. "A study on symptoms of children mechanically ventilated in a paediatric intensive care unit of a minimum resource setting in tertiary care centre." International Journal of Contemporary Pediatrics 6, no. 2 (February 23, 2019): 574. http://dx.doi.org/10.18203/2349-3291.ijcp20190689.
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Background: Mechanical ventilation, a lifesaving intervention in a critical care unit is under continuous evolution in modern era. Despite this, the management of children with invasive ventilation in developing countries with limited resources is challenging. The study analyses the clinical profile, indications, complications and duration of ventilator care in limited resource settings. Methods: A retrospective study of critically ill children mechanically ventilated in an intensive care unit of a tertiary care government hospital. Results: A total of 120 children required invasive ventilation during the study period of 1 year. Infants constituted the majority (70%), and males (65%) were marginally more than female children (35%). Respiratory failure was the most common indication for invasive ventilation (55%). The major underlying etiology for invasive ventilation was bronchopneumonia associated with septic shock (30%); and the same also required a prolonged duration of ventilation of >72 hours (35%). Prolonged ventilator support of >72 hours predisposed to more complications as well as a prolonged hospital stay of >2 weeks and above, which was statistically significant. Upper lobe atelectasis (50%) and ventilator associated pneumonia (25%) were the major complications. The mortality rate of present study population was 40% as opposed to the overall mortality of 10%. Conclusions: Present study highlights that critically ill children can be managed with mechanical ventilation even in limited resource settings. The child should be assessed clinically regarding the tolerance to extubation every day, to minimise the complications associated with prolonged ventilator support.
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Rocha, Gustavo, Paulo Soares, Américo Gonçalves, Ana Isabel Silva, Diana Almeida, Sara Figueiredo, Susana Pissarra, et al. "Respiratory Care for the Ventilated Neonate." Canadian Respiratory Journal 2018 (August 13, 2018): 1–12. http://dx.doi.org/10.1155/2018/7472964.
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Invasive ventilation is often necessary for the treatment of newborn infants with respiratory insufficiency. The neonatal patient has unique physiological characteristics such as small airway caliber, few collateral airways, compliant chest wall, poor airway stability, and low functional residual capacity. Pathologies affecting the newborn’s lung are also different from many others observed later in life. Several different ventilation modes and strategies are available to optimize mechanical ventilation and to prevent ventilator-induced lung injury. Important aspects to be considered in ventilating neonates include the use of correct sized endotracheal tube to minimize airway resistance and work of breathing, positioning of the patient, the nursing care, respiratory kinesiotherapy, sedation and analgesia, and infection prevention, namely, the ventilator-associated pneumonia and nosocomial infection, as well as prevention and treatment of complications such as air leaks and pulmonary hemorrhage. Aspects of ventilation in patients under ECMO (extracorporeal membrane oxygenation) and in palliative care are of increasing interest nowadays. Online pulmonary mechanics and function testing as well as capnography are becoming more commonly used. Echocardiography is now a routine in most neonatal units. Near infrared spectroscopy (NIRS) is an attractive tool potentially helping in preventing intraventricular hemorrhage and periventricular leukomalacia. Lung ultrasound is an emerging tool of diagnosis and can be of added value in helping monitoring the ventilated neonate. The aim of this scientific literature review is to address relevant aspects concerning the respiratory care and monitoring of the invasively ventilated newborn in order to help physicians to optimize the efficacy of care.
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Hao, Liming, Shuai Ren, Yan Shi, Na Wang, Yixuan Wang, Zujin Luo, Fei Xie, Meng Xu, Jian Zhang, and Maolin Cai. "A Novel Method to Evaluate Patient-Ventilator Synchrony during Mechanical Ventilation." Complexity 2020 (September 15, 2020): 1–15. http://dx.doi.org/10.1155/2020/4828420.
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The synchrony of patient-ventilator interaction affects the process of mechanical ventilation which is clinically applied for respiratory support. The occurrence of patient-ventilator asynchrony (PVA) not only increases the risk of ventilator complications but also affects the comfort of patients. To solve the problem of uncertain patient-ventilator interaction in the mechanical ventilation system, a novel method to evaluate patient-ventilator synchrony is proposed in this article. Firstly, a pneumatic model is established to simulate the mechanical ventilation system, which is verified to be accurate by the experiments. Then, the PVA phenomena are classified and detected based on the analysis of the ventilator waveforms. On this basis, a novel synchrony index SIhao is established to evaluate the patient-ventilator synchrony. It not only solves the defects of previous evaluation indexes but also can be used as the response parameter in the future research of ventilator control algorithms. The accurate evaluation of patient-ventilator synchrony can be applied to the adjustment of clinical strategies and the pathological analyses of patients. This research can also reduce the burden on clinicians and help to realize the adaptive control of the mechanical ventilation and weaning process in the future.
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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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Butt, Raheel Farooq, Neelam Khan, Sana Khan, Amna Akbar, Sarosh Khan Jadoon, and Areeba Tanveer. "A Research Study on Prompt Results and Physical Assessment of Mechanically Ventilated Children." Pakistan Journal of Medical and Health Sciences 17, no. 5 (May 30, 2023): 631–34. http://dx.doi.org/10.53350/pjmhs2023175631.
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Objective: There is alarming information on the usage of MV in PICUs from Asian nations. The goals of this research were to identify the patients' clinical profiles, traits, frequent causes of breathing problems, complications connected to ventilation problems, and ultimate outcomes. For admittance to the pediatric critical care unit, the criterion for mechanical ventilation (MV) is rigorous (ICU). It may be difficult to manage children in impoverished nations with minimal resources that need invasive ventilation. Methods: The information gathered included epidemiological trends, ventilation indications, problems, duration of use of the ventilator, and results. From January 2022 to December 2022, a retrospective analysis of kids who needed ventilator support in the Liaqaut National Hospital, Karachi was conducted. Results: The most frequent indications for ventilation in this research were impending respiratory arrest (34.6%) and a low Glasgow coma rating (17.8%). Of the 1172 patients who were brought to the PICU, 101 (8.6%) needed mechanical ventilation. 75% of the patients on mechanical ventilation were male, and 42% were newborns. We discuss the epidemiological patterns, prevalence, causes, and results of pediatric intensive care unit ventilator support cases. Planning better treatment plans in the future may assist improve outcomes, which can be achieved by analysis of this data. The average MV lasted 2.1 days. These kids had a 38.6% death rate. Conclusions: In summary, there is little MV activity in our PICU. The most frequent justification for mechanical ventilation was respiratory failure. Keywords: Respiratory Failure, Mechanically Ventilated, Pediatrics Intensive Care Unit.
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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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Thomas, Patricia. "Patient-Triggered Ventilation: How Does the Trigger Work?" Neonatal Network 23, no. 6 (November 2004): 65–67. http://dx.doi.org/10.1891/0730-0832.23.6.65.
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FOR THE VAST MAJORITY OF neonates requiring ventilation in our NICUs today, we use what is called patient-triggered ventilation (PTV)—synchronized intermittent mandatory ventilation, assist/control ventilation, or pressure support ventilation (Table 1). Also called synchronized ventilation, PTV has long been used successfully in adults. The goal of PTV is to prevent asynchronous breathing against the ventilator, which has been shown to contribute to pneumothorax in the neonate and subsequently to an increased risk of intraventricular hemorrhage in preterm infants.1,2 Other short-term benefits of PTV include improvements in oxygenation and carbon dioxide elimination, reduced variability in cerebral blood flow, and a shorter duration of mechanical ventilation.3
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Marley, Rex A., and Kaycee Simon. "Lung-Protective Ventilation." Annual Review of Nursing Research 35, no. 1 (January 2017): 37–53. http://dx.doi.org/10.1891/0739-6686.35.37.
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Historically, mechanical ventilation of the lungs utilizing relatively large tidal volumes was common practice in the operating room and intensive care unit (ICU). The rationale behind this treatment strategy was to yield better patient outcomes, that is, fewer pulmonary complications, and a reduction in morbidity and mortality. As evidence-based practice has evolved, potential harmful effects of traditional, nonphysiological mechanical ventilation (ventilation with larger tidal volumes and the tolerance of high airway pressures) even in shortterm treatment have been shown to correlate with systemic inflammation and the development of ventilator-associated lung injury. Lung-protective ventilation principles using more physiological tidal volumes, avoiding high inspiratory plateau pressures, along with appropriate levels of positive end-expiratory pressure have been shown to decrease pulmonary complications and improve outcomes in patients with acute respiratory distress syndrome requiring ongoing ventilatory support in the ICU. In addition, current research is beginning to validate the benefit of providing more physiologic ventilator support in the operating room, particularly for high-risk patients undergoing major abdominal surgery, in minimizing acute lung injury. A review of lung-protective ventilation measures including benefits and potential side effects is presented. Additional treatment modalities and therapeutic considerations are offered for inclusion in optimal patient management.
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Kunugiyama, Sujen K., and Christine S. Schulman. "High-Frequency Percussive Ventilation Using the VDR-4 Ventilator." AACN Advanced Critical Care 23, no. 4 (October 1, 2012): 370–80. http://dx.doi.org/10.4037/nci.0b013e31826e9031.
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High-frequency percussive ventilation (HFPV) has been used for patients with severe respiratory compromise refractory to conventional mechanical ventilation. It frequently results in equivalent or improved oxygenation and ventilation at lower peak pressures than conventional ventilation, thus minimizing secondary ventilator-associated lung injury. The only ventilator currently available that delivers HFPV is the volume diffusive respirator (VDR-4; Percussionaire Corp, Sandpoint, Idaho). High-frequency percussive ventilation is delivered via a pneumatically powered, pressure-limited, time-cycled, high-frequency flow interrupter and provides small tidal volumes with 300 to 700 oscillations per minute. Following transition to HFPV, respiratory status often stabilizes or improves within a few hours. The unique gas flow mobilizes significant volumes of pulmonary secretions, further facilitating gas exchange. This article reviews the operating principles of HFPV, the functional components of the VDR-4, and the special nursing care considerations to include sedation, hemodynamic assessment, skin and oral care, nutrition, and weaning from ventilation.
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Alencar, Roger, Vittorio D'Angelo, Rachel Carmona, Marcus J. Schultz, and Ary Serpa Neto. "Patients with uninjured lungs may also benefit from lung-protective ventilator settings." F1000Research 6 (November 22, 2017): 2040. http://dx.doi.org/10.12688/f1000research.12225.1.
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Although mechanical ventilation is a life-saving strategy in critically ill patients and an indispensable tool in patients under general anesthesia for surgery, it also acts as a double-edged sword. Indeed, ventilation is increasingly recognized as a potentially dangerous intrusion that has the potential to harm lungs, in a condition known as ‘ventilator-induced lung injury’ (VILI). So-called ‘lung-protective’ ventilator settings aiming at prevention of VILI have been shown to improve outcomes in patients with acute respiratory distress syndrome (ARDS), and, over the last few years, there has been increasing interest in possible benefit of lung-protective ventilation in patients under ventilation for reasons other than ARDS. Patients without ARDS could benefit from tidal volume reduction during mechanical ventilation. However, it is uncertain whether higher levels of positive end-expiratory pressure could benefit these patients as well. Finally, recent evidence suggests that patients without ARDS should receive low driving pressures during ventilation.
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Ryumin, V. E., S. V. Kinzhalova, G. N. Chistyakova, I. I. Remizova, and P. A. Kadochnikova. "Protective technologies of modern methods of respiratory support in neonatal practice." Messenger of ANESTHESIOLOGY AND RESUSCITATION 20, no. 1 (February 28, 2023): 69–80. http://dx.doi.org/10.24884/2078-5658-2023-20-1-69-80.
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The article presents an analysis of literature data on modern protective regimens for invasive respiratory support in premature newborns with respiratory distress syndrome. We have considered positive and negative aspects of the used methods of invasive ventilation of the lungs, which are currently widely used as a method of respiratory therapy in obstetric hospitals at any level, even in the category of children with extremely and very low birth weight. Modern protective mechanical ventilation provides for 2 main directions for reducing ventilator-induced lung damage: a decrease in tidal volume (Vt) and the principle of tolerable (permissive) hypercapnia. The use of the technique of permissive hypercapnia and regimens with a target volume can reduce the likelihood of ventilator-induced lung injury in newborns. Despite the limited indications for mechanical ventilation in modern neonatology and the widespread use of non-invasive ventilation, for patients who really need mechanical ventilation, the use of volume-targeted regimens offers the best chance of reducing ventilation complications.
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Sahoo, Bandya, Mukesh Kumar Jain, Bhaskar Thakur, Reshmi Mishra, and Sibabratta Patnaik. "Demographic Profile and Outcome of Mechanically Ventilated Children in a Tertiary Care Hospital of a Developing Country." Journal of Nepal Paediatric Society 38, no. 1 (November 19, 2018): 14–18. http://dx.doi.org/10.3126/jnps.v38i1.18879.
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Introduction: The need for mechanical ventilation (MV) is an absolute indication for admission to Paediatric intensive care unit (PICU). Management of children requiring invasive ventilation in resource limited developing countries is challenging. Scare data is available from Asian countries regarding use of MV in PICUs. The objectives of this study were to determine the clinical profile, characteristics, common causes for ventilation, ventilation related complications and final outcome of these patients.Material and Methods: A retrospective study of children requiring ventilator support in PICU of Kalinga Institute of Medical Sciences from January 2014 to December 2016 was done. Data collected included epidemiological trends, indications for ventilation, complications, length of stay on ventilator and outcome.Results: A total of 1172 patients were admitted to PICU, 101 (8.6%) patients required MV. 42% of the mechanically ventilated patients were infants and 75% were males. Impending respiratory failure (34.6%) and low Glasgow coma scale (17.8%) were the commonest indication for ventilation in this study. The median length of MV was 2.1 days. The mortality rate of these children was 38.6%. We report the epidemiological trends, frequency, indications and outcomes of children requiring ventilator support in PICU. Analysis of this data can be helpful in improving outcome in future by planning better treatment strategies.Conclusion: The frequency of MV in our PICU is low. Respiratory failure was the most common reason for mechanical ventilation.
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Sebrechts, Tom, Stuart G. Morrison, Tom Schepens, and Vera Saldien. "Flow-controlled ventilation with the Evone ventilator and Tritube versus volume-controlled ventilation." European Journal of Anaesthesiology 38, no. 2 (February 2021): 209–11. http://dx.doi.org/10.1097/eja.0000000000001326.
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Fogarty, Mike, Kai Kuck, Joseph Orr, and Derek Sakata. "A comparison of controlled ventilation with a noninvasive ventilator versus traditional mask ventilation." Journal of Clinical Monitoring and Computing 34, no. 4 (July 23, 2019): 771–77. http://dx.doi.org/10.1007/s10877-019-00365-1.
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Choi, Younhee, and Doosam Song. "How to quantify natural ventilation rate of single-sided ventilation with trickle ventilator?" Building and Environment 181 (August 2020): 107119. http://dx.doi.org/10.1016/j.buildenv.2020.107119.
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