Diaphragm antioxidant system in controlled mechanical ventilation in piglets: short term vs. prolonged mechanical ventilation response

The process of separation or weaning from mechanical ventilation can be arbitrarily separated into three categories: (1) simple weaning when patients are separated from the ventilator after the first attempt of unsupported spontaneous breathing. This usually represents slightly more than half of the patients; (2) difficult weaning when up to three attempts or 1 week is necessary to successfully separate the patient from the ventilator; (3) prolonged weaning for the remaining patients. This last group represents between 6 and 20% of the ICU population arriving at the stage of weaning and carries a considerable human and economic cost. A global approach, including measures to optimize psychological status, nutritional support, and sleep, is essential in the management of these patients, and referral to specialized weaning centres may be helpful. Muscle weakness is a very frequent finding in patients undergoing prolonged mechanical ventilation and may be worsened by excessive sedation, prolonged immobilization, and the use of controlled mechanical ventilation modes. It follows that approaches that include sedation sparing, early mobilization, and the transition to spontaneous breathing are likely to be beneficial.

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The association between airflow limitation and blood eosinophil levels with treatment outcomes in patients with chronic obstructive pulmonary disease and prolonged mechanical ventilation

Scientific Reports ◽

10.1038/s41598-019-49918-z ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Wei-Chang Huang ◽

Chen-Cheng Huang ◽

Pi-Chu Wu ◽

Chao-Jung Chen ◽

Ya-Hua Cheng ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Mechanical Ventilation ◽

Prolonged Mechanical Ventilation ◽

Adverse Outcomes ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Clinical Implications ◽

Blood Eosinophil ◽

Short Term ◽

Obstructive Pulmonary Disease

Abstract The clinical implications of airflow limitation severity and blood eosinophil level in patients with chronic obstructive pulmonary disease (COPD) and prolonged mechanical ventilation (PMV) are unknown. Thus, this study aimed to identify whether or not these two indicators were significantly associated with short-term in-respiratory care center (RCC) treatment outcomes in this population. Of all participants (n = 181) in this retrospective cross-sectional study, 41.4%, 40.9%, 8.3%, and 52.5% had prolonged RCC admission (RCC length of stay >21 days), failed weaning, death, and any adverse outcomes of interest, respectively. Compared to participants without any adverse outcomes of interest, moderate (the Global Initiative for Chronic Obstructive Lung Disease (GOLD) II) and/or severe (GOLD III) airflow limitation were significantly associated with short-term in-RCC adverse outcomes in terms of failed weaning (for III versus I, OR = 15.06, p = 0.003) and having any adverse outcomes of interest (for II versus I, OR = 17.66, p = 0.002; for III versus I, OR = 37.07, p = 0.000) though the severity of airflow limitation did not have associations with prolonged RCC admission and death after adjustment. Meanwhile, blood eosinophilia defined by various cut-off values was not associated with any adverse outcomes. The findings have significant clinical implications and are useful in the management of patients with COPD and PMV.

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Risk Factors for Prolonged Mechanical Ventilation After Pulmonary Endarterectomy: 7 Years' Experience From an Experienced Hospital in China

Frontiers in Surgery ◽

10.3389/fsurg.2021.679273 ◽

2021 ◽

Vol 8 ◽

Author(s):

Congya Zhang ◽

Lijing Yang ◽

Sheng Shi ◽

Zhongrong Fang ◽

Jun Li ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Blood Product ◽

Total Bilirubin ◽

Prolonged Mechanical Ventilation ◽

Pulmonary Endarterectomy ◽

Short Term ◽

Female Sex ◽

Product Use ◽

Independent Risk Factors

Background: Prolonged mechanical ventilation (PMV) is common after cardiothoracic surgery, whereas the mechanical ventilation strategy after pulmonary endarterectomy (PEA) has not yet been reported. We aim to identify the incidence and risk factors for PMV and the relationship between PMV and short-term outcomes.Methods: We studied a retrospective cohort of 171 who undergoing PEA surgery from 2014 to 2020. Cox regression with restricted cubic splines was performed to identify the cutoff value for PMV. The Least absolute shrinkage and selection operator regression and logistic regressions were applied to identify risk factors for PMV. The impacts of PMV on the short-term outcomes were evaluated.Results: PMV was defined as the duration of mechanical ventilation exceeding 48 h. Independent risk factors for PMV included female sex (OR 2.911; 95% CI 1.303–6.501; P = 0.009), prolonged deep hypothermic circulatory arrest (DHCA) time (OR 1.027; 95% CI 1.002–1.053; P = 0.036), increased postoperative blood product use (OR 3.542; 95% CI 1.203–10.423; P = 0.022), elevated postoperative total bilirubin levels (OR 1.021; 95% CI 1.007–1.034; P = 0.002), increased preoperative pulmonary artery pressure (PAP) (OR 1.031; 95% CI 1.014–1.048; P < 0.001) and elongated postoperative right ventricular anteroposterior dimension (RVAD) (OR 1.119; 95% CI 1.026–1.221; P = 0.011). Patients with PMV had longer intensive care unit stays, higher incidences of postoperative complications, and higher in-hospital medical expenses.Conclusions: Female sex, prolonged DHCA time, increased postoperative blood product use, elevated postoperative total bilirubin levels, increased preoperative PAP, and elongated postoperative RVAD were independent risk factors for PMV. Identification of risk factors associated with PMV in patients undergoing PEA may facilitate timely diagnosis and re-intervention for some of these modifiable factors to decrease ventilation time and improve patient outcomes.

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Mechanical ventilation results in progressive contractile dysfunction in the diaphragm

Journal of Applied Physiology ◽

10.1152/japplphysiol.00881.2001 ◽

2002 ◽

Vol 92 (5) ◽

pp. 1851-1858 ◽

Cited By ~ 193

Author(s):

Scott K. Powers ◽

R. Andrew Shanely ◽

Jeff S. Coombes ◽

Thomas J. Koesterer ◽

Michael McKenzie ◽

...

Keyword(s):

Mechanical Ventilation ◽

Spontaneous Breathing ◽

Contractile Function ◽

Control Group ◽

Contractile Dysfunction ◽

Sprague Dawley ◽

Short Term ◽

Mechanically Ventilated ◽

Sprague Dawley Rats ◽

Controlled Mechanical Ventilation

These experiments tested the hypothesis that a relatively short duration of controlled mechanical ventilation (MV) will impair diaphragmatic maximal specific force generation (specific Po) and that this force deficit will be exacerbated with increased time on the ventilator. To test this postulate, adult Sprague-Dawley rats were randomly divided into one of six experimental groups: 1) control ( n = 12); 2) 12 h of MV ( n = 4); 3) 18 h of MV ( n = 4); 4) 18 h of anesthesia and spontaneous breathing ( n = 4); 5) 24 h of MV ( n = 7); and 6) 24 h of anesthesia and spontaneous breathing ( n = 4). MV animals were anesthetized, tracheostomized, and ventilated with room air. Animals in the control group were acutely anesthetized but were not exposed to MV. Animals in two spontaneous breathing groups were anesthetized and breathed spontaneously for either 18 or 24 h. No differences ( P > 0.05) existed in diaphragmatic specific Po between control and the two spontaneous breathing groups. In contrast, compared with control, all durations of MV resulted in a reduction ( P < 0.05) in diaphragmatic specific tension at stimulation frequencies ranging from 15 to 160 Hz. Furthermore, the MV-induced decrease in diaphragmatic specific Po was time dependent, with specific Po being ∼18 and ∼46% lower ( P < 0.05) in animals mechanically ventilated for 12 and 24 h, respectively. These data support the hypothesis that relatively short-term MV impairs diaphragmatic contractile function and that the magnitude of MV-induced force deficit increases with time on the ventilator.

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