Feasibility of manual ventilation replacing mechanical ventilation

2021 ◽  
pp. bmjinnov-2020-000524
Author(s):  
Mark F Brady ◽  
Nicole K Weber ◽  
Richard Walker, III ◽  
Joseph E Holley ◽  
Samantha A Ni ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Peak Inspiratory Pressure ◽  
Normal Lung ◽  
Mechanical Ventilators ◽  
Manual Ventilation ◽  
Safety Device ◽  
Lung Physiology ◽  
The Mean ◽  
Output Characteristics

BackgroundDuring the COVID-19 pandemic it is anticipated that there will be a shortage of mechanical ventilators available for patients in critical condition. This has sparked many discussions about rationing resources and withholding care; however, an alternative may be to implement manual ventilation in these situations instead. Manual ventilation and a safety device were assessed for efficacy of extended use, such as may be required during this pandemic.MethodsTo evaluate physical output characteristics of extended manual ventilation and efficacy of a barotrauma mitigation device, 47 medical students, nurses and medics completed two 1-hour manual ventilation sessions using the SmartLung 2000 Lung Simulator and 5300 Series Mass Flow Meter with a SPUR II resuscitator bag and endotracheal tube, mimicking a healthy adult with normal lung physiology, both with and without the Sotair device. Providers were randomised to complete their initial session either with or without the Sotair device.FindingsCollected data show wide variability in tidal volume and peak pressure in unmitigated manual breaths despite prior training and independent exploration of the resuscitation equipment prior to testing. The mean (±SD) tidal volume with bag only was 563.9±128.8 mL and with the safety device 536.1±80.9 mL (p<0.0001). The mean peak inspiratory pressure with bag only was 17.2±6.3 cm H2O and with the safety device 14.9±2.4 cm H2O (p<0.0001).InterpretationWhile extended manual ventilation cannot replace mechanical ventilation, it is feasible with a safety device, which may reduce barotrauma, underventilation and overventilation. These results also demonstrate that withholding care and rationing resources may not be necessary.

Effects of Feedback and Education on Nurses’ Clinical Competence in Mechanical Ventilation and Accurate Tidal Volume Setting

2021 ◽  
Author(s):  
Samira Norouzrajabi ◽  
Shahrzad Ghiyasvandian ◽  
Alireza Jeddian ◽  
Ali Karimi Rozveh ◽  
Leila Sayadi
Keyword(s):  
Mechanical Ventilation ◽  
Body Weight ◽  
Tidal Volume ◽  
Clinical Competence ◽  
High Tidal Volume ◽  
Education Intervention ◽  
Predicted Body Weight ◽  
Post Test ◽  
The Mean ◽  
Effects Of Feedback

Background: Patients under mechanical ventilation are at risk of ventilator-associated complications. One of these complications is lung injury due to high tidal volume. Nurses’ competence in mechanical ventilation is critical for preventing ventilator-associated complications. This study assessed the effects of feedback and education on nurses’ clinical competence in mechanical ventilation and accurate tidal volume setting. Methods: This single arm pretest-post-test interventional study was conducted in 2019 at Shariati hospital affiliated to Tehran University of Medical Sciences. Participants were 75 conveniently selected nurses. Initially, nurses’ clinical competence in mechanical ventilation and ventilator parameters of 250 patients were assessed. A mechanical ventilation -based feedback and education intervention was implemented for nurses. Finally, mechanical ventilation clinical competence of nurses and ventilator parameters of 250 new patients were assessed. Moreover, patients’ height was estimated based on their ulna length and then, their predicted body weight was calculated using their estimated height. Accurate tidal volume was determined per predicted body weight.  Results: The mean score of nurses’ clinical competence increased from 8.27±3.09 at pretest to 10.07±3.34 at post-test (p<0.001). The mean values of both total tidal volume and tidal volume per kilogram of predicted body weight were significantly reduced respectively from 529.84±69.11 and 9.11±1.73 (ml) at pretest to 476.30±31.01 and 7.79±1.14 (ml) at post-test (p<0.001). Conclusion: The feedback and education intervention is effective in promoting nurses’ clinical competence in mechanical ventilation and reducing tidal volume. Thereby, it can reduce lung injuries associated with high tidal volume and ensure patient safety.

scholarly journals Can you calculate the total respiratory, lung, and chest wall respiratory mechanics?

2020 ◽  
Vol 1 (1) ◽  
pp. 24-26
Author(s):  
Mia Shokry ◽  
Kimiyo Yamasaki ◽  
Ehab Daoud
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Chest Wall ◽  
Airway Pressure ◽  
Respiratory Mechanics ◽  
Peak Inspiratory Pressure ◽  
Esophageal Pressure ◽  
Horizontal Line ◽  
Pulmonary Pressure ◽  
Volume Controlled

Figure: Waveforms for a patient undergoing mechanical ventilation with volume controlled mode. Tidal Volume of 500 ml, PEEP 15, Constant inspiratory flow of 45 l/min A: Airway pressure in cmH2O, B: Esophageal pressure in cmH2O, C: Trans-pulmonary pressure in cmH2O, D: Flow in l/min, E: Tidal volume in ml Red dashed horizontal line: values at end of expiratory occlusion maneuver, White solid horizontal line: values at end of inspiratory occlusion maneuver, Green dashed horizontal line: values during peak inspiratory pressure.

scholarly journals 10D: Feasibility Study of a Novel Low-cost Brazilian Emergency Mechanical Ventilator

2020 ◽  
Author(s):  
Uri Adrian Prync Flato ◽  
Patricia C. dos Santos ◽  
Fábio Manhoso ◽  
Fernanda Mesquita Serva ◽  
Jeferson Dias ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Low Cost ◽  
Pulmonary Ventilation ◽  
Animal Experiments ◽  
Mechanical Ventilator ◽  
Mechanical Ventilators ◽  
Group I ◽  
Emergency Transport ◽  
The Mean ◽  
Group Ii

Abstract Background: The current need for pulmonary mechanical ventilation related to COVID-19 exceeds the ability of health systems worldwide to acquire and produce mechanical ventilators. The major cause of mortality in patients with this disease is hypoxemia secondary to an inflammatory storm in the lungs associated with thrombotic events. A partnership was established between the university and the private engineering and industrial automation sector to concept and design novel a low-cost emergency mechanical ventilator that could be rapidly available for use in emergency, transport or low-resource health care system, and attend the urgent demand of artificial respiratory system that is need worldwide. It was evaluated the viability of oxygenation and pulmonary ventilation with an emergency mechanical ventilation device called 10D-EMV in animal experiments. A two-stage sequential adaptive study was conducted in 10 sheep, divided into group I (PEEP valve close to the device) and group II (PEEP valve distal to the device). Each animal underwent mechanical ventilation for a total of 120 minutes. Results: The mean oxygenation in group I and group II were 368 mmHg and 366 mmHg, respectively, while the mean partial pressure of carbon dioxide was 58 mmHg and 48 mmHg. Conclusion: This study demonstrates the viability of the 10D device as a novel proposed emergency mechanical ventilator, in order to attend the pandemics demand. Further clinical studies in humans are needed to assess its safety and efficacy.

scholarly journals Split-ventilation for more than one patient, can it be done? Yes

2020 ◽  
Vol 1 (1) ◽  
pp. 1-7
Author(s):  
Ehab Daoud ◽  
◽  
Jewelyn Cabigan ◽  
Gary Kaneshiro ◽  
Kimiyo Yamasaki
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Limited Resources ◽  
Experimental Setup ◽  
Cross Contamination ◽  
Positive End Expiratory Pressure ◽  
Careful Monitoring ◽  
Mechanical Ventilators ◽  
Number Of Patients ◽  
History Of

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.

scholarly journals A Higher Tidal Volume May Be Used for Athletes according to Measured FVC

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Pavlos Myrianthefs ◽  
George Baltopoulos
Keyword(s):  
Mechanical Ventilation ◽  
Body Weight ◽  
Tidal Volume ◽  
Vital Capacity ◽  
Professional Athletes ◽  
Normal Lung ◽  
Predicted Body Weight ◽  
Lung Volumes ◽  
Males And Females ◽  
The Difference

We investigated whether professional athletes may require higher tidal volume (Tv) during mechanical ventilation hypothesizing that they have significantly higher “normal” lung volumes compared to what was predicted and to nonathletes. Measured and predicted spirometric values were recorded in both athletes and nonathletes using a Spirovit SP-1 spirometer (Schiller, Switzerland). NormalTv(6 mL/kg of predicted body weight) was calculated as a percentage of measured and predicted forced vital capacity (FVC) and the difference (δ) was used to calculate the additionalTvrequired using the equation: NewTv(TvN)=Tv+(Tv×δ). Professional athletes had significantly higher FVC compared to what was predicted (by 9% in females and 10% in males) and to nonathletes. They may also require aTvof 6.6 mL/kg for males and 6.5 mL/kg for females during mechanical ventilation. Nonathletes may require aTvof 5.8 ± 0.1 mL/kg and 6.3 ± 0.1 mL/kg for males and females, respectively. Our findings show that athletes may require additionalTvof 10% (0.6/6 mL/kg) for males and 8.3% (0.5/6 mL/kg) for females during general anesthesia and critical care which needs to be further investigated and tested.

Mechanical ventilation of isolated septic rat lungs: effects on surfactant and inflammatory cytokines

2001 ◽  
Vol 91 (2) ◽  
pp. 811-820 ◽  
Author(s):  
Tomoo Nakamura ◽  
Jaret Malloy ◽  
Lynda McCaig ◽  
Li-Juan Yao ◽  
Mariamma Joseph ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Morphological Changes ◽  
Cecal Ligation ◽  
Normal Lung ◽  
Positive End Expiratory Pressure ◽  
Surfactant System ◽  
Rat Lungs ◽  
Group 2 ◽  
Factor Α

The effects of mechanical ventilation (MV) on the surfactant system and cytokine secretion were studied in isolated septic rat lungs. At 23 h after sham surgery or induction of sepsis by cecal ligation and perforation (CLP), lungs were excised and randomized to one of three groups: 1) a nonventilated group, 2) a group subjected to 1 h of noninjurious MV (tidal volume = 10 ml/kg, positive end-expiratory pressure = 3 cmH2O), or 3) a group subjected to 1 h of injurious MV (tidal volume = 20 ml/kg, positive end-expiratory pressure = 0 cmH2O). Nonventilated sham and CLP lungs had similar compliance, normal lung morphology, surfactant, and cytokine concentrations. Injurious ventilation decreased compliance, altered surfactant, increased cytokines, and induced morphological changes compared with nonventilation in sham and CLP lungs. In these lungs, the surfactant system was similar in sham and CLP lungs; however, tumor necrosis factor-α and interleukin-6 levels were significantly higher in CLP lungs. We conclude that injurious ventilation altered surfactant independent of sepsis and that the CLP lungs were predisposed to the secretion of larger amounts of cytokines because of ventilation.

scholarly journals Estimating actual inspiratory muscle pressure from airway occlusion pressure at 100 msec

2020 ◽  
Vol 1 (1) ◽  
pp. 8-13
Author(s):  
Natsumi Hamahata ◽  
Ryota Sato ◽  
Kimiyo Yamasaki ◽  
Sophie Pereira ◽  
Ehab Daoud
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Normal Lung ◽  
P Value ◽  
Occlusion Pressure ◽  
Mechanical Ventilators ◽  
Airway Occlusion ◽  
Esophageal Balloon ◽  
Airway Occlusion Pressure

Background: Quantification of the patient’s respiratory effort during mechanical ventilation is very important, and calculating the actual muscle pressure (Pmus) during mechanical ventilation is a cumbersome task and usually requires an esophageal balloon manometry. Airway occlusion pressure at 100 milliseconds (P0.1) can easily be obtained non-invasively. There has been no study investigating the association between Pmus and P0.1. Therefore, we aimed to investigate whether P0.1 correlates to Pmus and can be used to estimate actual Pmus Materials and Methods: A bench study using lung simulator (ASL 5000) to simulate an active breathing patient with Pmus from 1 to 30 cmH2O by increments of 1 was conducted. Twenty active breaths were measured in each Pmus. The clinical scenario was constructed as a normal lung with a fixed setting of compliances of 60 mL/cmH2O and resistances of 10 cmH2O/l/sec. All experiments were conducted using the pressure support ventilation mode (PSV) on a Hamilton-G5 ventilator (Hamilton Medical AG, Switzerland), Puritan Bennett 840TM (Covidien-Nellcor, CA) and Avea (CareFusion, CA). Main results: There was significant correlation between P 0.1 and Pmus (correlation coefficient = - 0.992, 95% CI: - 0.995 to -0.988, P-value<0.001). The equation was calculated as follows: Pmus = -2.99 x (P0.1) + 0.53 Conclusion: Estimation of Pmus using P 0.1 as a substitute is feasible, available, and reliable. Estimation of Pmus has multiple implications, especially in weaning of mechanical ventilation, adjusting ventilator support, and calculating respiratory mechanics during invasive mechanical ventilation. Keywords: P 0.1, Inspiratory occlusion pressure, WOB, Esophageal balloon, mechanical ventilators, respiratory failure Keywords: P 0.1, P mus, Inspiratory occlusion pressure, WOB, Esophageal balloon, mechanical ventilators, respiratory failure

scholarly journals Management of Intraoperative Mechanical Ventilation to Prevent Postoperative Complications after General Anesthesia: A Narrative Review

2021 ◽  
Vol 10 (12) ◽  
pp. 2656
Author(s):  
Alberto Fogagnolo ◽  
Federica Montanaro ◽  
Lou’i Al-Husinat ◽  
Cecilia Turrini ◽  
Michela Rauseo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Pulmonary Complications ◽  
Point Of View ◽  
Whole Body ◽  
Positive End Expiratory Pressure ◽  
Ventilation Strategies ◽  
Harmful Effects ◽  
Ventilation Induced Lung Injury ◽  
Different Levels

Mechanical ventilation (MV) is still necessary in many surgical procedures; nonetheless, intraoperative MV is not free from harmful effects. Protective ventilation strategies, which include the combination of low tidal volume and adequate positive end expiratory pressure (PEEP) levels, are usually adopted to minimize the ventilation-induced lung injury and to avoid post-operative pulmonary complications (PPCs). Even so, volutrauma and atelectrauma may co-exist at different levels of tidal volume and PEEP, and therefore, the physiological response to the MV settings should be monitored in each patient. A personalized perioperative approach is gaining relevance in the field of intraoperative MV; in particular, many efforts have been made to individualize PEEP, giving more emphasis on physiological and functional status to the whole body. In this review, we summarized the latest findings about the optimization of PEEP and intraoperative MV in different surgical settings. Starting from a physiological point of view, we described how to approach the individualized MV and monitor the effects of MV on lung function.

scholarly journals Characteristics and outcomes in acute patients receiving mechanical ventilation in a Coronary Care Unit (CCU)

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Rivadeneira Ruiz ◽  
DF Arroyo Monino ◽  
T Seoane Garcia ◽  
MP Ruiz Garcia ◽  
JC Garcia Rubira
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Coronary Care Unit ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Funding Sources ◽  
Copd Patients ◽  
The Mean ◽  
Coronary Care

Abstract Funding Acknowledgements Type of funding sources: None. Objectives Mechanical ventilation is the short-term technical support most widely used and cardiac arrest its main indication in a Coronary Care Unit (CCU). However, the knowledge about the specific moment and ventilator mode of onset to avoid the acute lung injury is still equivocal. Our objective is to determine the survival rate and the prognostic factors in patients supported by mechanical ventilation. Methods We conducted a retrospective cohort study of adult patients admitted to the CCU between January 2018 and November 2020 that received mechanical ventilation during the hospital stay. Results We collected 94 patients, 28% females with a median age of 68 ± 11,9. 43% were diabetics and almost one quarter of them had some degree of chronic obstructive pulmonary disease (COPD). Ischemic cardiopathy (33%) and heart failure (31%) were frequent pathologies as well as renal injury (29% patients a filtration rate below 45 mL/min/1,73m2). The reason for initiating mechanical ventilation was cardiac arrest in the half of the patients. Volume-controlled ventilation (73%) was the initial setting mode in most cases. The support with vasoactive drugs were highly necessary in these patients (Infection rate of 48%). In the subgroup analysis, we realized that the number of reintubations and the necessity of non-invasive ventilation were higher in the COPD group (p = 0,01), as well as tracheostomy (p = 0,03). COPD patients also needed higher maintaining PEEP, though this was not statistically significant. The mean length of stay in the intensive care unit of our cohort was 11 days (range: 1-78 days; median: 8 days) and the mean length of mechanical ventilation 6 days (range: 1-64 days; median: 3 days). The in-hospital mortality was 41,4%. Conclusions Cardiac arrest is the most common reason of mechanical ventilation support. Our study showed that COPD patients presented more complications during the weaning and the period after extubation. In-hospital mortality remains high in intubated patients.

Rest ventilator management in children on veno-venous extracorporeal membrane oxygenation

2021 ◽  
pp. 039139882199938
Author(s):  
Matthew L Friedman ◽  
Samer Abu-Sultaneh ◽  
James E Slaven ◽  
Christopher W Mastropietro
Keyword(s):  
Mechanical Ventilation ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Arterial Oxygen Saturation ◽  
Peak Inspiratory Pressure ◽  
Conventional Mechanical Ventilation ◽  
Arterial Oxygen ◽  
Multivariable Logistic Regression Analysis ◽  
Membrane Oxygenation ◽  
Ventilator Management

Background: We aimed to use the Extracorporeal Life Support Organization registry to describe the current practice of rest mechanical ventilation setting in children receiving veno-venous extracorporeal membrane oxygenation (V-V ECMO) and to determine if relationships exist between ventilator settings and mortality. Methods: Data for patients 14 days to 18 years old who received V-V ECMO from 2012-2016 were reviewed. Mechanical ventilation data available includes mode and settings at 24 h after ECMO cannulation. Multivariable logistic regression analysis was performed to determine if rest settings were associated with mortality. Results: We reviewed 1161 subjects, of which 1022 (88%) received conventional mechanical ventilation on ECMO. Rest settings, expressed as medians (25th%, 75th%), are as follows: rate 12 breaths/minute (10, 17); peak inspiratory pressure (PIP) 22 cmH2O (20,27); positive end expiratory pressure (PEEP) 10 cmH2O (8, 10); and fraction of inspired oxygen (FiO2) 0.4 (0.37, 0.60). Survival to discharge was 68%. Higher ventilator FiO2 (odds ratio:1.13 per 0.1 increase, 95% confidence interval:1.04, 1.23), independent of arterial oxygen saturation, was associated with mortality. Conclusions: Current rest ventilator management for children receiving V-V ECMO primarily relies on conventional mechanical ventilation with moderate amounts of PIP, PEEP, and FiO2. Further study on the relationship between FiO2 and mortality should be pursued.

Sign in / Sign up

Export Citation Format

Share Document