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Статті в журналах з теми "Ventilator dyssynchrony"

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Автор: Grafiati

Опубліковано: 10 грудня 2022

Оновлено: 29 січня 2023

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1

Garner, Daniel, and Priyank Patel. "https://www.journalmechanicalventilation.com/rapid-review-of-patient-ventilator-dyssynchrony/." Journal of Mechanical Ventilation 3, no. 3 (September 15, 2022): 133–40. http://dx.doi.org/10.53097/jmv.10058.

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Patient-Ventilator Dyssynchrony (PVD) is often described as a patient “fighting” the ventilator. In fact, there are many forms of dyssynchrony some of which can very subtle. If unrecognized early, dyssynchrony can evoke patient discomfort, increase incidence of lung injury, lead to oversedation, and lengthen duration of mechanical ventilation. Since start of the COVID-19 pandemic, many clinicians without critical care experience have been compelled to manage patients requiring mechanical ventilation. Many academic centers, hospital systems, and physician groups have attempted to provide educational material in efforts to prepare clinicians on how to operate a ventilator. During this frenzied time, very few resources have been made available to clinicians to rapidly recognize ventilator dyssynchrony as it occurs when taking care of these patients. The figures presented in this article depict dyssynchrony in Volume Control Ventilation (VCV) with a decelerating ramp of flow and are hand drawn. While they may not perfectly represent waveforms seen on ventilators, the patterns shown and described below will be similar.

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2

Grossbach, Irene, Linda Chlan, and Mary Fran Tracy. "Overview of Mechanical Ventilatory Support and Management of Patient- and Ventilator-Related Responses." Critical Care Nurse 31, no. 3 (June 1, 2011): 30–44. http://dx.doi.org/10.4037/ccn2011595.

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Nurses must be knowledgeable about the function and limitations of ventilator modes, causes of respiratory distress and dyssynchrony with the ventilator, and appropriate management in order to provide high-quality patient-centered care. Prompt recognition of problems and action by the nurse may resolve acute respiratory distress, dyspnea, and increased work of breathing and prevent adverse events. This article presents an overview of mechanical ventilation modes and the assessment and management of dyspnea and patient-ventilator dyssynchrony. Strategies to manage patients’ responses to mechanical ventilatory support and recommendations for staff education also are presented.

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3

Oto, Brandon, Janet Annesi, and Raymond J. Foley. "Patient–ventilator dyssynchrony in the intensive care unit: A practical approach to diagnosis and management." Anaesthesia and Intensive Care 49, no. 2 (March 2021): 86–97. http://dx.doi.org/10.1177/0310057x20978981.

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Patient–ventilator dyssynchrony or asynchrony occurs when, for any parameter of respiration, discordance exists between the patient’s spontaneous effort and the ventilator’s provided support. If not recognised, it may promote oversedation, prolong the duration of mechanical ventilation, create risk for lung injury, and generally confuse the clinical picture. Seven forms of dyssynchrony are common: (a) ineffective triggering; (b) autotriggering; (c) inadequate flow; (d) too much flow; (e) premature cycling; (f) delayed cycling; and (g) peak pressure apnoea. ‘Reverse triggering’ also occurs and may mimic premature cycling. Correct diagnosis of these phenomena often permits management by simple ventilator optimisation rather than by less desirable measures.

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4

Antonogiannaki, Elvira-Markela, Dimitris Georgopoulos, and Evangelia Akoumianaki. "Patient-Ventilator Dyssynchrony." Korean Journal of Critical Care Medicine 32, no. 4 (November 30, 2017): 307–22. http://dx.doi.org/10.4266/kjccm.2017.00535.

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5

De Oliveira, Bruno, Nahla Aljaberi, Ahmed Taha, Baraa Abduljawad, Fadi Hamed, Nadeem Rahman, and Jihad Mallat. "Patient–Ventilator Dyssynchrony in Critically Ill Patients." Journal of Clinical Medicine 10, no. 19 (September 30, 2021): 4550. http://dx.doi.org/10.3390/jcm10194550.

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Patient–ventilator dyssynchrony is a mismatch between the patient’s respiratory efforts and mechanical ventilator delivery. Dyssynchrony can occur at any phase throughout the respiratory cycle. There are different types of dyssynchrony with different mechanisms and different potential management: trigger dyssynchrony (ineffective efforts, autotriggering, and double triggering); flow dyssynchrony, which happens during the inspiratory phase; and cycling dyssynchrony (premature cycling and delayed cycling). Dyssynchrony has been associated with patient outcomes. Thus, it is important to recognize and address these dyssynchronies at the bedside. Patient–ventilator dyssynchrony can be detected by carefully scrutinizing the airway pressure–time and flow–time waveforms displayed on the ventilator screens along with assessing the patient’s comfort. Clinicians need to know how to depict these dyssynchronies at the bedside. This review aims to define the different types of dyssynchrony and then discuss the evidence for their relationship with patient outcomes and address their potential management.

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6

MacIntyre, Neil. "Managing Patient-Ventilator Dyssynchrony*." Critical Care Medicine 49, no. 12 (November 18, 2021): 2149–51. http://dx.doi.org/10.1097/ccm.0000000000005154.

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7

MacIntyre, Neil R., Robert McConnell, Kuo-Chen G. Cheng, and Aneysa Sane. "Patient-ventilator flow dyssynchrony." Critical Care Medicine 25, no. 10 (October 1997): 1671–77. http://dx.doi.org/10.1097/00003246-199710000-00016.

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8

Hess, Dean. "Ventilator Circuits, Humidification and Ventilator-Associated Pneumonia." Canadian Respiratory Journal 3, no. 6 (1996): 397–402. http://dx.doi.org/10.1155/1996/972402.

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Technical issues in the care of mechanically ventilated patients include those related to the ventilator circuit, humidification and ventilator-associated pneumonia. Principal issues related to ventilator circuits include leaks and compression volume. Circuit compression volume affects delivered tidal volume as well as measurements of auto-positive end-expiratory pressure and mixed expiredPCO2. Resistance through the ventilator circuit contributes to patient-ventilator dyssynchrony during assisted modes of mechanical ventilation. Adequate humidification of inspired gas is necessary to prevent heat and moisture loss. Common methods of humidification of inspired gas during mechanical ventilation include use of active heated humidifiers and passive artificial noses. Artificial noses are less effective than active humidifiers and are best suited to short term use. With active humidifiers, the circuit can be heated to avoid condensate formation. However, care must be exercised when heated circuits are used to avoid delivery of a low relative humidity and subsequent drying of secretions in the artificial airway. Although pneumonia is a complication of mechanical ventilation, these pneumonias are usually the result of aspiration of pharyngeal secretions and are seldom related to the ventilator circuit. Ventilator circuits do not need to be changed more frequently than weekly for infection control purposes, and the incidence of ventilator-associated pneumonia may be greater with more frequent circuit changes.

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9

Lydon, A. M., M. Doyle, and M. B. Donnelly. "Ventilator-Patient Dyssynchrony Induced by Change in Ventilation Mode." Anaesthesia and Intensive Care 29, no. 3 (June 2001): 273–75. http://dx.doi.org/10.1177/0310057x0102900309.

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10

Kondili, Eumorfia, Nektaria Xirouchaki, and Dimitris Georgopoulos. "Modulation and treatment of patient–ventilator dyssynchrony." Current Opinion in Critical Care 13, no. 1 (February 2007): 84–89. http://dx.doi.org/10.1097/mcc.0b013e328011278d.

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11

Sottile, Peter D., David Albers, Carrie Higgins, Jeffery Mckeehan, and Marc M. Moss. "The Association Between Ventilator Dyssynchrony, Delivered Tidal Volume, and Sedation Using a Novel Automated Ventilator Dyssynchrony Detection Algorithm*." Critical Care Medicine 46, no. 2 (February 2018): e151-e157. http://dx.doi.org/10.1097/ccm.0000000000002849.

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12

Nakanishi, Nobuto, Yoshitoyo Ueno, Hideaki Imanaka, and Masaji Nishimura. "Effect of leak on patient-ventilator dyssynchrony during noninvasive positive pressure ventilation: comparison among ventilator brand." Journal of the Japanese Society of Intensive Care Medicine 19, no. 3 (2012): 423–24. http://dx.doi.org/10.3918/jsicm.19.423.

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13

Koryakin, A. G., A. V. Vlasenko, E. P. Rodionov, and E. A. Evdokimov. "Asynchronies during respiratory support." Medical alphabet, no. 17 (September 8, 2022): 50–61. http://dx.doi.org/10.33667/2078-5631-2022-17-50-61.

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Asynchronies (desynchronies, dyssynchrony) is a disturbance of the harmonious interaction between the patient’s respiratory system and а ventilator. Asynchronies occur as a result of various reasons and with any form of respiratory support (non-invasive, assisted or fully controlled mechanical ventilation). Asynchrony is a significant cause of biomechanics and gas exchange disorders in the development of both self-injury and ventilator-induced lung injury, an increase of the respiratory support duration and mortality in patients with respiratory failure. Understanding the mechanisms of the asynchrony pathogenesis and assessment of the patient’s respiratory system condition make it possible to timely identify and resolve disturbance of the patient-ventilator interactions. The article presents a classification, the main causes of development, diagnostic and correction methods of different variants of desynchronies in patients with respiratory disorders during of respiratory support.

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14

Hess, Dean R., та B. Taylor Thompson. "Patient-ventilator dyssynchrony during lung protective ventilation: Whatʼs a clinician to do?*". Critical Care Medicine 34, № 1 (січень 2006): 231–33. http://dx.doi.org/10.1097/01.ccm.0000196083.45897.e9.

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15

Mellado Artigas, Ricard, L. Felipe Damiani, Thomas Piraino, Tai Pham, Lu Chen, Michela Rauseo, Irene Telias, et al. "Reverse Triggering Dyssynchrony 24 h after Initiation of Mechanical Ventilation." Anesthesiology 134, no. 5 (March 4, 2021): 760–69. http://dx.doi.org/10.1097/aln.0000000000003726.

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Background Reverse triggering is a delayed asynchronous contraction of the diaphragm triggered by passive insufflation by the ventilator in sedated mechanically ventilated patients. The incidence of reverse triggering is unknown. This study aimed at determining the incidence of reverse triggering in critically ill patients under controlled ventilation. Methods In this ancillary study, patients were continuously monitored with a catheter measuring the electrical activity of the diaphragm. A method for automatic detection of reverse triggering using electrical activity of the diaphragm was developed in a derivation sample and validated in a subsequent sample. The authors assessed the predictive value of the software. In 39 recently intubated patients under assist-control ventilation, a 1-h recording obtained 24 h after intubation was used to determine the primary outcome of the study. The authors also compared patients’ demographics, sedation depth, ventilation settings, and time to transition to assisted ventilation or extubation according to the median rate of reverse triggering. Results The positive and negative predictive value of the software for detecting reverse triggering were 0.74 (95% CI, 0.67 to 0.81) and 0.97 (95% CI, 0.96 to 0.98). Using a threshold of 1 μV of electrical activity to define diaphragm activation, median reverse triggering rate was 8% (range, 0.1 to 75), with 44% (17 of 39) of patients having greater than or equal to 10% of breaths with reverse triggering. Using a threshold of 3 μV, 26% (10 of 39) of patients had greater than or equal to 10% reverse triggering. Patients with more reverse triggering were more likely to progress to an assisted mode or extubation within the following 24 h (12 of 39 [68%]) vs. 7 of 20 [35%]; P = 0.039). Conclusions Reverse triggering detection based on electrical activity of the diaphragm suggests that this asynchrony is highly prevalent at 24 h after intubation under assist-control ventilation. Reverse triggering seems to occur during the transition phase between deep sedation and the onset of patient triggering. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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16

Mellott, Karen G., Mary Jo Grap, Cindy L. Munro, Curtis N. Sessler, and Paul A. Wetzel. "Patient-Ventilator Dyssynchrony: Clinical Significance and Implications for Practice." Critical Care Nurse 29, no. 6 (December 1, 2009): 41–55. http://dx.doi.org/10.4037/ccn2009612.

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17

Morales-Estrella, Jorge, and Eduardo Mireles-Cabodevila. "A Man with Pleural Effusion and Patient–Ventilator Dyssynchrony." Annals of the American Thoracic Society 15, no. 12 (December 2018): 1483–86. http://dx.doi.org/10.1513/annalsats.201807-477cc.

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18

Sottile, PeterD, David Albers, BradfordJ Smith, and MarcM Moss. "Ventilator dyssynchrony – Detection, pathophysiology, and clinical relevance: A Narrative review." Annals of Thoracic Medicine 15, no. 4 (2020): 190. http://dx.doi.org/10.4103/atm.atm_63_20.

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19

Rossi, A., and L. Appendini. "Wasted efforts and dyssynchrony: Is the patient-ventilator battle back?" Intensive Care Medicine 21, no. 11 (November 1995): 867–70. http://dx.doi.org/10.1007/bf01712326.

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20

Figueroa-Casas, Juan B., and Ricardo Montoya. "Effect of Tidal Volume Size and Its Delivery Mode on Patient–Ventilator Dyssynchrony." Annals of the American Thoracic Society 13, no. 12 (December 2016): 2207–14. http://dx.doi.org/10.1513/annalsats.201605-362oc.

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21

Zedan, Moustafa Abd El Hafez, Abdalla Soliman Ayoub, and Ameen A. Hegazy. "Study of Patient Ventilator Dyssynchrony, Causes and Effect on Weaning in Mechanically Ventilated Patient in Respiratory Intensive Care Unit, Observational Study." Egyptian Journal of Hospital Medicine 74, no. 5 (January 1, 2019): 1031–35. http://dx.doi.org/10.21608/ejhm.2019.26350.

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22

Malkoc, Aldin, Ashley Stading, Stephanie Wong, Tara Weaver, and Leslie Ghisletta. "Novel Treatment of Ventilator Dyssynchrony From Central Alveolar Hypoventilation Syndrome Utilizing Scheduled 5-Hydroxytryptamine-3 Receptor Antagonist." Journal of Medical Cases 13, no. 9 (September 2022): 443–48. http://dx.doi.org/10.14740/jmc3983.

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23

Takeuchi, Muneyuki, Hideaki Imanaka, Hiroshi Miyano, Keiji Kumon, and Masaji Nishimura. "Effect of Patient-triggered Ventilation on Respiratory Workload in Infants after Cardiac Surgery." Anesthesiology 93, no. 5 (November 1, 2000): 1238–44. http://dx.doi.org/10.1097/00000542-200011000-00017.

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Background Patient-triggered ventilation (PTV) is commonly used in adults to avoid dyssynchrony between patient and ventilator. However, few investigations have examined the effects of PTV in infants. Our objective was to determine if pressure-control PTV reduces infants' respiratory workloads in proportion to the level of pressure control. We also explored which level of pressure control provided respiratory workloads similar to those after the extubation of the trachea. Methods When seven post-cardiac surgery infants, aged 1 to 11 months, were to be weaned with the pressure-control PTV, we randomly applied five levels of pressure control: 0, 4, 8, 12, and 16 cm H2O. All patients were ventilated with assist-control mode, triggering sensitivity of 1 l/min, and positive end-expiratory pressure of 3 cm H2O. After establishing steady state conditions at each level of pressure control, arterial blood gases were analyzed and esophageal pressure (Pes), airway pressure, and airflow were measured. Inspiratory work of breathing (WOB) was calculated using a Campbell diagram. A modified pressure-time product (PTPmod) and the negative deflection of Pes were calculated from the Pes tracing below the baseline. The measurement was repeated after extubation. Results Pressure-control PTV supported every spontaneous breath. By decreasing the level of pressure control, respiratory rate increased, tidal volume decreased, and as a result, minute ventilation and arterial carbon dioxide partial pressure were maintained stable. The WOB, PTPmod, and negative deflection of Pes increased as pressure control level was decreased. The WOB and PTPmod at 4 cm H2O pressure control and 0 cm H2O pressure control and after extubation were significantly greater than those at the pressure control of 16, 12, and 8 cm H2O (P < 0.05). The WOB and PTPmod were almost equivalent after extubation and at 4 cm H2O pressure control. Conclusions Work of breathing and PTPmod were changed according to the pressure control level in post-cardiac surgery infants. PTV may be feasible in infants as well as in adults.

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24

Zein, Ahmed Ragab, Shahad Saad Albishi, Turki Nasser Alotaibi, Hidayah Dhiyaa Almanasif, Mohammad Ibraheem Qashgry, Saad Abdullah Al Holaibi, Lujain Darwish Raggam, et al. "Differences in long-term sedation agents used for the critically ill patients." International Journal Of Community Medicine And Public Health 9, no. 2 (January 28, 2022): 1023. http://dx.doi.org/10.18203/2394-6040.ijcmph20220073.

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Sedative agents are commonly prescribed for critically ill patients admitted to the intensive care unit (ICU). The literature has reported many indications for using sedation for critically ill patients. These include reducing and managing high intracranial pressure, resolution of ventilator dyssynchrony, and decreasing agitation or anxiety. Different medications were reported in the literature as good sedatives for critically ill patients. Although very efficacious (benzodiazepines, propofol, and dexmedetomidine), many adverse events (as bradycardia, respiratory and myocardial depression, and hypotension) were reported as potential complications. The present literature review has discussed the potential differences and patients’ outcomes after sedation with long-term modalities in the ICU. Overall, clinicians must critically consider balancing the harms and benefits of using sedatives for critically ill patients because of the potential complications encountered during these procedures. In addition, different sedatives were reported in the literature with variable efficacies and adverse events. For example, using dexmedetomidine and propofol has been more advantageous than using benzodiazepines, and some studies also favor dexmedetomidine. However, it should be noted that adverse events are still reported with all of these modalities. Therefore, the administration of long-term sedatives should follow a strict protocol to enhance patients’ outcomes.

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25

Gupta, Shikha, Vinay Joshi, Preetha Joshi, Shelley Monkman, Kelly Vallaincourt, and Karen Choong. "Airway Pressure Release Ventilation: A Neonatal Case Series and Review of Current Pediatric Practice." Canadian Respiratory Journal 20, no. 5 (2013): e86-e91. http://dx.doi.org/10.1155/2013/734729.

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BACKGROUND: The use of airway pressure release ventilation (APRV) in very low birth weight infants is limited.OBJECTIVE: To report the authors’ institutional experience and to review the current literature regarding the use of APRV in pediatric populations.METHODS: Neonates <1500 g ventilated using APRV from 2005 to 2006 at McMaster Children’s Hospital (Hamilton, Ontario) were retrospectively reviewed. Publications describing APRV in children from 1987 to 2011 were reviewed.RESULTS: Five infants, 24 to 28 weeks’ gestational age, were ventilated using APRV. Indications for APRV were refractory hypoxemia (n=3), ventilatory dyssynchrony (n=1) and minimizing sedatives (n=1). All infants appeared to tolerate APRV well with no recorded adverse events. Current pediatric evidence regarding APRV is primarily observational. Published experience reveals that APRV settings in pediatrics often approximate those used in adults, thus deviating from the original guidelines recommended in children. Clinical outcomes, such as oxygenation, ventilation and sedation requirements, are inconsistent.CONCLUSIONS: APRV is primarily used as a rescue ventilation mode in children. Neonatal evidence is limited; however, the present study indicates that APRV is feasible in very low birth weight infants. There are unique considerations when applying this mode in small infants. Further research is necessary to confirm whether APRV is a safe and effective ventilation strategy in this population.

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26

Damiani, L. Felipe, Doreen Engelberts, Luca Bastia, Kohei Osada, Bhushan H. Katira, Gail Otulakowski, Ewan C. Goligher, et al. "Impact of Reverse Triggering Dyssynchrony during Lung-Protective Ventilation on Diaphragm Function: An Experimental Model." American Journal of Respiratory and Critical Care Medicine 205, no. 6 (March 15, 2022): 663–73. http://dx.doi.org/10.1164/rccm.202105-1089oc.

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27

Figueroa-Casas, Juan B., and Ricardo Montoya. "Difference in inspiratory flow between volume and pressure control ventilation in patients with flow dyssynchrony." Journal of Critical Care 42 (December 2017): 264–67. http://dx.doi.org/10.1016/j.jcrc.2017.08.007.

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28

Haruki, Nobuhiko, Masaaki Takeuchi, Hidetoshi Yoshitani, Hiroshi Kuwaki, Mai Iwataki, and Yutaka Otsuji. "Adaptive Servo-Ventilation Therapy in a Patient with Medically Refractory Heart Failure and Left Ventricular Dyssynchrony." Journal of Cardiac Failure 17, no. 9 (September 2011): S177—S178. http://dx.doi.org/10.1016/j.cardfail.2011.06.623.

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29

Winter, R., A. Fazlinezhad, S. Martins Fernandes, M. Pellegrino, X. Iriart, S. Moustafa, D. Stolfo, et al. "Poster session 3The imaging examinationP646Simulator-based testing of skill in transthoracic echoP647Clinical and echocardiographic characteristics of isolated left ventricular non-compactionP648Appropriate use criteria of transthoracic echocardiography and its clinical impact in an aged populationAnatomy and physiology of the heart and great vesselsP649Prevalence and determinants of exercise oscillatory ventilation in the EUROEX trial populationAssessment of diameters, volumes and massP650Left atrial remodeling after percutaneous left atrial appendage closureP651Global atrial performance with tyrosine kinase inhibitors in metastatic renal cell carcinomaP652Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomesP653Parameters of speckle-tracking echocardiography and biomechanical values of a dilative ascending aortaAssessments of haemodynamicsP654Right atrial hemodynamics in infants and children: observations from 3-dimensional echocardiography derived right atrial volumesAssessment of systolic functionP655One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fractionP656Persistence of cardiac remodeling in adolescents with previous fetal growth restrictionP6572D speckle tracking-derived left ventricle global longitudinal strain and left ventricular dysfunction stages: a useful discriminator in moderate-to-severe aortic regurgitationP658Global longitudinal strain and strain rate in type two diabetes patients with chronic heart failure: relevance to circulating osteoprotegerinP659Analysis of left ventricular function in patients before and after surgical and interventional mitral valve therapyP660Left ventricular end-diastolic volume is complementary with global longitudinal strain for the prediction of left ventricular ejection fraction in echocardiographic daily practiceP661Left ventricular assist device, right ventricle function, and selection bias: the light side of the moonP662Assessment of right ventricular function in patients with anterior ST elevation myocardial infarction; a 2-d speckle tracking studyP663Right ventricular systolic function assessment in sickle cell anaemia using echocardiographyAssessment of diastolic functionP664Prognostic value of transthoracic cardiopulmonary ultrasound in cardiac surgery intensive care unitP665Comparative efficacy of renin-angiotensin system modulators on prognosis, right heart and left atrial parameters in patients with chronic heart failure and preserved left ventricular systolic functionP666Left atrial volume index is the most significant diastolic functional parameter of hemodynamic burden as measured by NT-proBNP in acute myocardial infarctionP667Preventive echocardiographic screening. preliminary dataP668Assessment of the atrial electromechanical delay and the mechanical functions of the left atrium in patients with diabetes mellitus type IIschemic heart diseaseP669Coronary flow velocity reserve by echocardiography as a measure of microvascular function: feasibility, reproducibility and agreement with PET in overweight patients with coronary artery diseaseP670Influence of cardiovascular risk in the occurrence of events in patients with negative stress echocardiographyP671Prevalence of transmural myocardial infarction and viable myocardium in chronic total occlusion (CTO) patientsP672The impact of the interleukin 6 receptor antagonist tocilizumab on mircovascular dysfunction after non st elevation myocardial infarction assessed by coronary flow reserve from a randomized studyP673Impact of manual thrombus aspiration on left ventricular remodeling: the echocardiographic substudy of the randomized Physiologic Assessment of Thrombus Aspirtion in patients with ST-segment ElevatioP674Acute heart failure in STEMI patients treated with primary percutaneous coronary intervention is related to transmural circumferential myocardial strainP675Long-term prognostic value of infarct size as assessed by cardiac magnetic resonance imaging after a first st-segment elevation myocardial infarctionHeart valve DiseasesP676Prognostic value of LV global longitudinal strain in aortic stenosis with preserved LV ejection fractionP677Importance of longitudinal dyssynchrony in low flow low gradient severe aortic stenosis patients undergoing dobutamine stress echocardiography. a multicenter study (on behalf of the HAVEC group)P678Predictive value of left ventricular longitudinal strain by 2D Speckle Tracking echocardiography, in asymptomatic patients with severe aortic stenosis and preserved ejection fractionP679Clinical and echocardiographic characteristics of the flow-gradient patterns in patients with severe aortic stenosis and preserved left ventricular ejection fractionP6802D and 3D speckle tracking assessment of left ventricular function in severe aortic stenosis, a step further from biplane ejection fractionP681Functional evaluation in aortic stenosis: determinant of exercise capacityP682Left ventricular mechanics: novel tools to evaluate left ventricular function in patients with primary mitral regurgitationP683Plasma B-type natriuretic peptide level in patients with isolated rheumatic mitral stenosisP684Quantitative assessment of severity in aortic regurgitation and the influence of elastic proprieties of thoracic aortaP685Characterization of chronic aortic and mitral regurgitation using cardiovascular magnetic resonanceP686Functional mitral regurgitation: a warning sign of underlying left ventricular systolic dysfunction in heart failure with preserved ejection fraction.P687Secondary mitral valve tenting in primary degenerative prolapse quantified by three-dimensional echocardiography predicts regurgitation recurrence after mitral valve repairP688Advanced heart failure with reduced ejection fraction and severe mitral insufficiency compensate with a higher oxygen peripheral extraction to a reduced cardiac output vs oxygen uptake response to maxP689Predictors of acute procedural success after percutaneous mitraclip implantation in patients with moderate-to-severe or severe mitral regurgitation and reduced ejection fractionP690The value of transvalvular gradients obtained by transthoracic echocardiography in estimation of severe paravalvular leakage in patients with mitral prosthetic valvesP691Characteristics of infective endocarditis in a non tertiary hospitalP692Infective endocarditis: predictors of severity in a 3-year retrospective analysisP693New echocardiographic predictors of early recurrent mitral functional regurgitation after mitraclip implantationP694Transesophageal echocardiography can be reliably used for the allocation of patients with severe aortic stenosis for tras-catheter aortic valve implantationP695Annular sizing for transcatheter aortic valve selection. A comparison between computed tomography and 3D echocardiographyP696Association between aortic dilatation, mitral valve prolapse and atrial septal aneurysm: first descriptive study.CardiomyopathiesP698Cardiac resynchronization therapy by multipoint pacing improves the acute response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo studyP699Long-term natural history of right ventricular function in dilated cardiomyopathy: innocent bystander or leading actor?P700Right to left ventricular interdependence at rest and during exercise assessed by the ratio between pulmonary systolic to diastolic time in heart failure reduced ejection fractionP701Exercise strain imaging demonstrates impaired right ventricular contractile reserve in patients with hypertrophic cardiomyopathyP702Prevalence of overt left ventricular dysfunction (burn-out phase) in a portuguese population of hypertrophic cardiomyopathy, a multicentre studyP703Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosisP704Multimodality imaging and genotype-phenotype associations in a cohort of patients with hypertrophic cardiomyopathy studied by next generation sequencing and cardiac magnetic resonanceP705Sudden cardiac death risk assessment in apical hypertrophic cardiomyopathy: do we need to add MRI to the equation?P706Prognostic value of left ventricular ejection fraction, proBNP, exercise capacity, and NYHA functional class in patients with left ventricular non-compaction cardiomyopathyP707The anti-hypertrophic microRNAs miR-1, miR-133a and miR-26b and their relationship to left ventricular hypertrophy in patients with essential hypertensionP708Prevalence of left ventricular systolic dysfunction in a portuguese population of left ventricular non-compaction cardiomyopathy, a multicentre studyP709Assessment of systolic and diastolic features in light chain amyloidosis: an echocardiographic and cardiac magnetic resonance studyP710Morbid obesity-associated hypertension identifies bariatric surgery best responders: Clinical and echocardiographic follow up studyP711Echocardiographic markera for overhydration in patients under haemodialysisP712Gender aspects of right ventricular size and function in clinically stable heart transplant patientsP713Evidence of cardiac stem cells from the left ventricular apical tip in patients undergone LVAD implant: a comparative strain-ultrastructural studySystemic diseases and other conditionsP714Speckle tracking assessment of right ventricular function is superior for differentiation of pressure versus volume overloaded right ventricleP715Prognostic value of pulmonary arterial pressure: analysis in a large dataset of timely matched non-invasive and invasive assessmentsP716Effect of the glucagon-like peptide-1 analogue liraglutide on left ventricular diastolic and systolic function in patients with type 2 diabetes: a randomised, single-blinded, crossover pilot studyP717Tissue doppler evaluation of left ventricular functions, left atrial mechanical functions and atrial electromechanical delay in juvenile idiopathic arthritisP718Echocardiographic detection of subclinical left ventricular dysfunction in patients with rheumatoid arthritisP719Left ventricular strain values are unaffected by intense training: a longitudinal, speckle-tracking studyP720Diastolic left ventricular function in autosomal dominant polycystic kidney disease: a matched-cohort, speckle-tracking echocardiographic studyP721Relationship between adiponectin level and left ventricular mass and functionP722Left atrial function is impaired in patients with multiple sclerosisMasses, tumors and sources of embolismP723Paradoxical embolization to the brain in patients with acute pulmonary embolism and confirmed patent foramen ovale with bidirectional shunt, results of prospective monitoringP724Following the European Society of Cardiology proposed echocardiographic algorithm in elective patients with clinical suspicion of infective endocarditis: diagnostic yield and prognostic implicationsP725Metastatic cardiac18F-FDG uptake in patients with malignancy: comparison with echocardiographic findingsDiseases of the aortaP726Echocardiographic measurements of aortic pulse wave velocity correlate well with invasive methodP727Assessment of increase in aortic and carotid intimal medial thickness in adolescent type 1 diabetic patientsStress echocardiographyP728Determinants and prognostic significance of heart rate variability in renal transplant candidates undergoing dobutamine stress echocardiographyP729Pattern of cardiac output vs O2 uptake ratio during maximal exercise in heart failure with reduced ejection fraction: pathophysiological insightsP730Prognostic value and predictive factors of cardiac events in patients with normal exercise echocardiographyP731Right ventricular mechanics during exercise echocardiography: normal values, feasibility and reproducibility of conventional and new right ventricular function parametersP732The added value of exercise-echo in heart failure patients: assessing dynamic changes in extravascular lung waterP733Applicability of appropriate use criteria of exercise stress echocardiography in real-life practice: what have we improved with new documents?Transesophageal echocardiographyP7343D-TEE guidance in percutaneous mitral valve interventions correcting mitral regurgitationContrast echocardiographyP735Pulmonary transit time by contrast enhanced ultrasound as parameter for cardiac performance: a comparison with magnetic resonance imaging and NT-ProBNPReal-time three-dimensional TEEP736Optimal parameter selection for anisotropic diffusion denoising filters applied to aortic valve 4d echocardiographsP737Left ventricle systolic function in non-alcoholic cirrhotic candidates for liver transplantation: a three-dimensional speckle-tracking echocardiography studyTissue Doppler and speckle trackingP738Optimizing speckle tracking echocardiography strain measurements in infants: an in-vitro phantom studyP739Usefulness of vascular mechanics in aortic degenerative valve disease to estimate prognosis: a two dimensional speckle tracking studyP740Vascular mechanics in aortic degenerative valve disease: a two dimensional speckle-tracking echocardiography studyP741Statins and vascular load in aortic valve disease patients, a speckle tracking echocardiography studyP742Is Left Bundle Branch Block only an electrocardiographic abnormality? Study of LV function by 2D speckle tracking in patients with normal ejection fractionP743Dominant inheritance of global longitudinal strain in a population of healthy and hypertensive twinsP744Mechanical differences of left atria in paroxysmal atrial fibrillation: A speckle-tracking study.P745Different distribution of myocardial deformation between hypertrophic cardiomyopathy and aortic stenosisP746Left atrial mechanics in patients with chronic renal failure. Incremental value for atrial fibrillation predictionP747Subclinical myocardial dysfunction in cancer patients: is there a direct effect of tumour growth?P748The abnormal global longitudinal strain predicts significant circumflex artery disease in low risk acute coronary syndromeP7493D-Speckle tracking echocardiography for assessing ventricular funcion and infarct size in young patients after acute coronary syndromeP750Evaluation of left ventricular dyssynchrony by echocardiograhy in patients with type 2 diabetes mellitus without clinically evident cardiac diseaseP751Differences in myocardial function between peritoneal dialysis and hemodialysis patients: insights from speckle tracking echoP752Appraisal of left atrium changes in hypertensive heart disease: insights from a speckle tracking studyP753Left ventricular rotational behavior in hypertensive patients: Two dimensional speckle tracking imaging studyComputed Tomography & Nuclear CardiologyP754Effectiveness of adaptive statistical iterative reconstruction of 64-slice dual-energy ct pulmonary angiography in the patients with reduced iodine load: comparison with standard ct pulmonary angiograP755Clinical prediction model to inconclusive result assessed by coronary computed tomography angiography." European Heart Journal – Cardiovascular Imaging 16, suppl 2 (December 2015): S102—S129. http://dx.doi.org/10.1093/ehjci/jev277.

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Ohshimo, Shinichiro. "Oxygen administration for patients with ARDS." Journal of Intensive Care 9, no. 1 (February 6, 2021). http://dx.doi.org/10.1186/s40560-021-00532-0.

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AbstractAcute respiratory distress syndrome (ARDS) is a fatal condition with insufficiently clarified etiology. Supportive care for severe hypoxemia remains the mainstay of essential interventions for ARDS. In recent years, adequate ventilation to prevent ventilator-induced lung injury (VILI) and patient self-inflicted lung injury (P-SILI) as well as lung-protective mechanical ventilation has an increasing attention in ARDS.Ventilation-perfusion mismatch may augment severe hypoxemia and inspiratory drive and consequently induce P-SILI. Respiratory drive and effort must also be carefully monitored to prevent P-SILI. Airway occlusion pressure (P0.1) and airway pressure deflection during an end-expiratory airway occlusion (Pocc) could be easy indicators to evaluate the respiratory drive and effort. Patient-ventilator dyssynchrony is a time mismatching between patient’s effort and ventilator drive. Although it is frequently unrecognized, dyssynchrony can be associated with poor clinical outcomes. Dyssynchrony includes trigger asynchrony, cycling asynchrony, and flow delivery mismatch. Ventilator-induced diaphragm dysfunction (VIDD) is a form of iatrogenic injury from inadequate use of mechanical ventilation. Excessive spontaneous breathing can lead to P-SILI, while excessive rest can lead to VIDD. Optimal balance between these two manifestations is probably associated with the etiology and severity of the underlying pulmonary disease.High-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NPPV) are non-invasive techniques for supporting hypoxemia. While they are beneficial as respiratory supports in mild ARDS, there can be a risk of delaying needed intubation. Mechanical ventilation and ECMO are applied for more severe ARDS. However, as with HFNC/NPPV, inappropriate assessment of breathing workload potentially has a risk of delaying the timing of shifting from ventilator to ECMO. Various methods of oxygen administration in ARDS are important. However, it is also important to evaluate whether they adequately reduce the breathing workload and help to improve ARDS.

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DeLuca, Jr, Lawrence A. "Acute Respiratory Failure And Mechanical Ventilation." DeckerMed Emergency Medicine, December 2, 2020. http://dx.doi.org/10.2310/em.4722.

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Patients with acute respiratory failure present to the emergency department (ED) on a regular basis, and emergency physicians (EPs) are expected to be skilled in endotracheal intubation. Historically, although a significant portion of emergency medicine residency training focuses on airway management, extended management of the ventilated patient has received relatively short shrift. Recent data indicate that not only is endotracheal intubation one of the most commonly performed ED procedures, but also that in the initial hours of care, it is also often the EP rather than the intensivist who provides the bulk of critical care to the patient. It is therefore critical that EPs are skilled in ongoing management of the ventilated patient in the early hours as inappropriate management of the ventilator or sedation/analgesia can have a significant impact on complications such as ventilator-induced lung injury, ventilator-associated pneumonia (VAP), ventilator weaning, and delirium. This review outlines basic strategies for the physiologic management of respiratory failure patients to reduce periintubation complications and discuss ventilation strategies, appropriate use of analgesia/sedation, and prevention of secondary complications such as VAP and delirium. Basic troubleshooting of common ventilator problems is also reviewed. Although it is not expected that the EP will replace the intensivist, the goal of this review is to optimize patient management early in the ED stay, to facilitate the transition between the ED and the intensive care unit, and to reduce preventable complications by optimizing the care of ventilated patients in the ED. This review contains 9 figures, 6 tables and 48 references. Key words: acute respiratory distress syndrome, analgesia, chronic obstructive pulmonary disease, delirium, hypercapnia, hyperventilation, hypoxia, patient-ventilator dyssynchrony, pulmonary edema, respiratory failure, sedation, ventilator-associated pneumonia

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DeLuca, Jr, Lawrence A. "Acute Respiratory Failure And Mechanical Ventilation." DeckerMed Transitional Year Weekly Curriculum™, August 19, 2018. http://dx.doi.org/10.2310/tywc.4722.

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Анотація:

Patients with acute respiratory failure present to the emergency department (ED) on a regular basis, and emergency physicians (EPs) are expected to be skilled in endotracheal intubation. Historically, although a significant portion of emergency medicine residency training focuses on airway management, extended management of the ventilated patient has received relatively short shrift. Recent data indicate that not only is endotracheal intubation one of the most commonly performed ED procedures, but also that in the initial hours of care, it is also often the EP rather than the intensivist who provides the bulk of critical care to the patient. It is therefore critical that EPs are skilled in ongoing management of the ventilated patient in the early hours as inappropriate management of the ventilator or sedation/analgesia can have a significant impact on complications such as ventilator-induced lung injury, ventilator-associated pneumonia (VAP), ventilator weaning, and delirium. This review outlines basic strategies for the physiologic management of respiratory failure patients to reduce periintubation complications and discuss ventilation strategies, appropriate use of analgesia/sedation, and prevention of secondary complications such as VAP and delirium. Basic troubleshooting of common ventilator problems is also reviewed. Although it is not expected that the EP will replace the intensivist, the goal of this review is to optimize patient management early in the ED stay, to facilitate the transition between the ED and the intensive care unit, and to reduce preventable complications by optimizing the care of ventilated patients in the ED. This review contains 9 figures, 4 tables and 46 references Key words: acute respiratory distress syndrome, analgesia, chronic obstructive pulmonary disease, delirium, hypercapnia, hyperventilation, hypoxia, patient-ventilator dyssynchrony, pulmonary edema, respiratory failure, sedation, ventilator-associated pneumonia

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Akella, Padmastuti, Louis P. Voigt, and Sanjay Chawla. "To Wean or Not to Wean: A Practical Patient Focused Guide to Ventilator Weaning." Journal of Intensive Care Medicine, July 11, 2022, 088506662210954. http://dx.doi.org/10.1177/08850666221095436.

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Since the inception of critical care medicine and artificial ventilation, literature and research on weaning has transformed daily patient care in intensive care units (ICU). As our knowledge of mechanical ventilation (MV) improved, so did the need to study patient-ventilator interactions and weaning predictors. Randomized trials have evaluated the use of protocol-based weaning (vs. usual care) to study the duration of MV in ICUs, different techniques to conduct spontaneous breathing trials (SBT), and strategies to eventually extubate a patient whose initial SBT failed. Despite considerable milestones in the management of multiple diseases contributing to reversible respiratory failure, in the application of early rehabilitative interventions to preserve muscle integrity, and in ventilator technology that mitigates against ventilator injury and dyssynchrony, major barriers to successful liberation from MV persist. This review provides a broad encompassing view of weaning classification, causes of weaning failure, and evidence behind weaning predictors and weaning modes.

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Agrawal, Deepak K., Bradford J. Smith, Peter D. Sottile, and David J. Albers. "A Damaged-Informed Lung Ventilator Model for Ventilator Waveforms." Frontiers in Physiology 12 (October 1, 2021). http://dx.doi.org/10.3389/fphys.2021.724046.

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Motivated by a desire to understand pulmonary physiology, scientists have developed physiological lung models of varying complexity. However, pathophysiology and interactions between human lungs and ventilators, e.g., ventilator-induced lung injury (VILI), present challenges for modeling efforts. This is because the real-world pressure and volume signals may be too complex for simple models to capture, and while complex models tend not to be estimable with clinical data, limiting clinical utility. To address this gap, in this manuscript we developed a new damaged-informed lung ventilator (DILV) model. This approach relies on mathematizing ventilator pressure and volume waveforms, including lung physiology, mechanical ventilation, and their interaction. The model begins with nominal waveforms and adds limited, clinically relevant, hypothesis-driven features to the waveform corresponding to pulmonary pathophysiology, patient-ventilator interaction, and ventilator settings. The DILV model parameters uniquely and reliably recapitulate these features while having enough flexibility to reproduce commonly observed variability in clinical (human) and laboratory (mouse) waveform data. We evaluate the proof-in-principle capabilities of our modeling approach by estimating 399 breaths collected for differently damaged lungs for tightly controlled measurements in mice and uncontrolled human intensive care unit data in the absence and presence of ventilator dyssynchrony. The cumulative value of mean squares error for the DILV model is, on average, ≈12 times less than the single compartment lung model for all the waveforms considered. Moreover, changes in the estimated parameters correctly correlate with known measures of lung physiology, including lung compliance as a baseline evaluation. Our long-term goal is to use the DILV model for clinical monitoring and research studies by providing high fidelity estimates of lung state and sources of VILI with an end goal of improving management of VILI and acute respiratory distress syndrome.

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Tammen, Alison J., Donald Brescia, Dan Jonas, Jeremy L. Hodges, and Philip Keith. "Fentanyl-Induced Rigid Chest Syndrome in Critically Ill Patients." Journal of Intensive Care Medicine, July 19, 2022, 088506662211156. http://dx.doi.org/10.1177/08850666221115635.

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Background Opioid induced chest wall rigidity was first described in the early 1950s during surgical anesthesia and has often been referred to as fentanyl induced rigid chest syndrome (FIRCS). It has most commonly been described in the setting of procedural sedation and bronchoscopy, characterized by pronounced abdominal and thoracic rigidity, asynchronous ventilation, and respiratory failure. FIRCS has been infrequently described in the setting of continuous analgesia in critically ill adult patients. We postulate that FIRCS can occur in this setting and is likely under recognized, leading to increased morbidity and mortality. Methods Patients admitted to the intensive care unit with suspected FIRCS were included in this retrospective analysis. The objective of this analysis is to describe the clinical presentation and treatment strategies for FIRCS. Results Forty-two patients exhibiting symptoms of FIRCS were included in this analysis. Twenty-two of the forty-two patients with descriptive documentation had evidence of thoracic or abdominal rigidity on examination (52.4%). Twelve of sixteen (75%) patients treated solely with naloxone had documented ventilator compliance following intervention, compared to six of eleven (55%) managed with cisatracurium alone. Nine of twelve patients who ultimately received naloxone after initial treatment with cisatracurium had documented ventilator compliance following naloxone administration (75%). Standard interventions, including sedation optimization and ventilator adjustments were attempted to rule out and treat other potential causes of dyssynchrony. In most cases, the administration of naloxone resulted in appropriate compliance with both ventilator and patient-initiated breaths, suggesting the ventilator dyssynchrony was due to fentanyl. Conclusions This is the largest case series to date describing FIRCS in the intensive care setting. Recognition and prompt management is necessary for improved patient outcomes. Research is needed to increase awareness and recognition, identify patient risk factors, and analyze the efficacy and safety of interventions.

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Taha, A., A. Shafie, Y. Lavoie, H. Hubert, and R. Marktanner. "Adaptive support ventilation as an acceptable mode to prevent airflow limitation, air entrapment, dynamic hyperinflation and patient-ventilator dyssynchrony." Intensive Care Medicine Experimental 3, S1 (October 1, 2015). http://dx.doi.org/10.1186/2197-425x-3-s1-a826.

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Saishu, Yumi, Takuya Yoshida, Yusuke Seino, and Takeshi Nomura. "Nivolumab-related myasthenia gravis with myositis requiring prolonged mechanical ventilation: a case report." Journal of Medical Case Reports 16, no. 1 (February 14, 2022). http://dx.doi.org/10.1186/s13256-022-03286-x.

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Abstract Background Nivolumab is an immune checkpoint inhibitor that blocks inhibitors of T-cell activation and blunts antitumor immunity and is used in the treatment of various cancers. However, immune checkpoint inhibitors have immune-related adverse effects on various organs due to promoting T-cell activity against host tissues by blocking inhibition of T-cell function. Although immune-related adverse effects including hepatitis, colitis, pneumonitis, dermatitis, nephritis, endocrinopathies, and hypophysitis are well recognized with established treatment guidelines, neuromuscular immune-related adverse effects are rare phenomena. Case presentation A 55-year-old Asian (Japanese) woman was diagnosed with nivolumab-related myasthenia gravis with myositis and myocarditis. She had a past history of thymectomy for large thymoma with a high anti-acetylcholine receptor antibody level without any symptoms. Nivolumab was administered for the treatment of malignant melanoma. Creatine kinase levels began to rise 2 weeks after the administration, and abnormal neurological findings appeared 3 weeks after the administration. Ventricular arrhythmia, wide QRS complex, and dyssynchrony of the left ventricle also appeared. Intravenous immunoglobulin and corticosteroids were administered, and plasma exchange was performed. The patient required intensive care and prolonged mechanical ventilation with tracheostomy owing to weakness of the diaphragm; she was eventually weaned from the ventilator and discharged. Diaphragm ultrasound was used for the decision-making of the weaning strategy and evaluation of the diaphragmatic function. Conclusions Nivolumab-induced severe myasthenia gravis with myositis and myocarditis required intensive care and prolonged mechanical ventilation. Although immune checkpoint inhibitor-related myasthenia gravis is a rare adverse event, appropriate and prompt treatment is required because of its severity and rapid progression. Diaphragm ultrasound was useful not only in diagnosing diaphragm dysfunction and deciding the strategy for weaning from mechanical ventilation but also in evaluating the recovery of the diaphragmatic function.

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Nasa, Prashant, Elie Azoulay, Ashish K. Khanna, Ravi Jain, Sachin Gupta, Yash Javeri, Deven Juneja, et al. "Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method." Critical Care 25, no. 1 (March 16, 2021). http://dx.doi.org/10.1186/s13054-021-03491-y.

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Abstract Background Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. Methods Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ2) test (p < 0·05 was considered as unstable). Results Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16–24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment. Conclusion Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited. Trial registration: The study was registered with Clinical trials.gov Identifier: NCT04534569.

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"VENTILATORY DYSSYNCHRONY IN MECHANICALLY VENTILATED PATIENTS: IS IT A PROBLEM?" Respirology 22 (November 2017): 58–59. http://dx.doi.org/10.1111/resp.13206_144.

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Fixsen, Louis S., Philippe C. Wouters, Richard G. P. Lopata, and Hareld M. C. Kemps. "Strain-based discoordination imaging during exercise in heart failure with reduced ejection fraction: Feasibility and reproducibility." BMC Cardiovascular Disorders 22, no. 1 (March 25, 2022). http://dx.doi.org/10.1186/s12872-022-02578-w.

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Abstract Purpose Various parameters of mechanical dyssynchrony have been proposed to improve patient selection criteria for cardiac resynchronization therapy, but sensitivity and specificity are lacking. However, echocardiographic parameters are consistently investigated at rest, whereas heart failure (HF) symptoms predominately manifest during submaximal exertion. Although strain-based predictors of response are promising, feasibility and reproducibility during exercise has yet to be demonstrated. Methods Speckle-tracking echocardiography was performed in patients with HF at two separate visits. Echocardiography was performed at rest, during various exercise intensity levels, and during recovery from exercise. Systolic rebound stretch of the septum (SRSsept), systolic shortening, and septal discoordination index (SDI) were calculated. Results Echocardiography was feasible in about 70–80% of all examinations performed during exercise. Of these acquired views, 84% of the cine-loops were suitable for analysis of strain-based mechanical dyssynchrony. Test–retest variability and intra- and inter-operator reproducibility at 30% and 60% of the ventilatory threshold (VT) were about 2.5%. SDI improved in the majority of patients at 30% and 60% of the VT, with moderate to good agreement between both intensity levels. Conclusion Although various challenges remain, exercise echocardiography with strain analysis appears to be feasible in the majority of patients with dyssynchronous heart failure. Inter- and intra-observer agreement of SRSsept and SDI up to 60% of the VT were comparable to resting values. During exercise, the extent of SDI was variable, suggesting a heterogeneous response to exercise. Further research is warranted to establish its clinical significance.

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Cornejo, Rodrigo A., Daniel H. Arellano, Pablo Ruiz-Rudolph, Dannette V. Guiñez, Caio C. A. Morais, Abraham I. J. Gajardo, Marioli T. Lazo, et al. "Inflammatory biomarkers and pendelluft magnitude in ards patients transitioning from controlled to partial support ventilation." Scientific Reports 12, no. 1 (November 23, 2022). http://dx.doi.org/10.1038/s41598-022-24412-1.

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AbstractThe transition from controlled to partial support ventilation is a challenge in acute respiratory distress syndrome (ARDS) patients due to the risks of patient-self-inflicted lung injury. The magnitude of tidal volume (VT) and intrapulmonary dyssynchrony (pendelluft) are suggested mechanisms of lung injury. We conducted a prospective, observational, physiological study in a tertiary academic intensive care unit. ARDS patients transitioning from controlled to partial support ventilation were included. On these, we evaluated the association between changes in inflammatory biomarkers and esophageal pressure swing (ΔPes), transpulmonary driving pressure (ΔPL), VT, and pendelluft. Pendelluft was defined as the percentage of the tidal volume that moves from the non-dependent to the dependent lung region during inspiration, and its frequency at different thresholds (− 15, − 20 and − 25%) was also registered. Blood concentrations of inflammatory biomarkers (IL-6, IL-8, TNF-α, ANGPT2, RAGE, IL-18, Caspase-1) were measured before (T0) and after 4-h (T4) of partial support ventilation. Pendelluft, ΔPes, ΔPL and VT were recorded. Nine out of twenty-four patients (37.5%) showed a pendelluft mean ≥ 10%. The mean values of ΔPes, ΔPL, and VT were − 8.4 [− 6.7; − 10.2] cmH2O, 15.2 [12.3–16.5] cmH2O and 8.1 [7.3–8.9] m/kg PBW, respectively. Significant associations were observed between the frequency of high-magnitude pendelluft and IL-8, IL-18, and Caspase-1 changes (T0/T4 ratio). These results suggest that the frequency of high magnitude pendelluft may be a potential determinant of inflammatory response related to inspiratory efforts in ARDS patients transitioning to partial support ventilation. Future studies are needed to confirm these results.

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Pham, Tài, Jaume Montanya, Irene Telias, Thomas Piraino, Rudys Magrans, Rémi Coudroy, L. Felipe Damiani, et al. "Automated detection and quantification of reverse triggering effort under mechanical ventilation." Critical Care 25, no. 1 (February 15, 2021). http://dx.doi.org/10.1186/s13054-020-03387-3.

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Анотація:

Abstract Background Reverse triggering (RT) is a dyssynchrony defined by a respiratory muscle contraction following a passive mechanical insufflation. It is potentially harmful for the lung and the diaphragm, but its detection is challenging. Magnitude of effort generated by RT is currently unknown. Our objective was to validate supervised methods for automatic detection of RT using only airway pressure (Paw) and flow. A secondary objective was to describe the magnitude of the efforts generated during RT. Methods We developed algorithms for detection of RT using Paw and flow waveforms. Experts having Paw, flow and esophageal pressure (Pes) assessed automatic detection accuracy by comparison against visual assessment. Muscular pressure (Pmus) was measured from Pes during RT, triggered breaths and ineffective efforts. Results Tracings from 20 hypoxemic patients were used (mean age 65 ± 12 years, 65% male, ICU survival 75%). RT was present in 24% of the breaths ranging from 0 (patients paralyzed or in pressure support ventilation) to 93.3%. Automatic detection accuracy was 95.5%: sensitivity 83.1%, specificity 99.4%, positive predictive value 97.6%, negative predictive value 95.0% and kappa index of 0.87. Pmus of RT ranged from 1.3 to 36.8 cmH20, with a median of 8.7 cmH20. RT with breath stacking had the highest levels of Pmus, and RTs with no breath stacking were of similar magnitude than pressure support breaths. Conclusion An automated detection tool using airway pressure and flow can diagnose reverse triggering with excellent accuracy. RT generates a median Pmus of 9 cmH2O with important variability between and within patients. Trial registration BEARDS, NCT03447288.

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