scholarly journals Immediate effects of manual hyperinflation on cardiorespiratory function and sputum clearance in mechanically ventilated pediatric patients: A randomized crossover trial

2021 ◽  
pp. 1-8
Author(s):  
Tawatchai Luadsri ◽  
Jaturon Boonpitak ◽  
Kultida Pongdech-Udom ◽  
Patnuch Sukpom ◽  
Weerapong Chidnok
Keyword(s):  
Blood Pressure ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Pediatric Patients ◽  
Physical Therapist ◽  
Peak Inspiratory Pressure ◽  
Lung Compliance ◽  
Post Intervention ◽  
Mechanically Ventilated ◽  
Arterial Blood

Background: In developing countries, lower respiratory tract infection is a major cause of death in children, with severely ill patients being admitted to the critical-care unit. While physical therapists commonly use the manual hyperinflation (MHI) technique for secretion mass clearance in critical-care patients, its efficacy has not been determined in pediatric patients. Objective:This study investigated the effects of MHI on secretion mass clearance and cardiorespiratory responses in pediatric patients undergoing mechanical ventilation. Methods:A total of 12 intubated and mechanically ventilated pediatric patients were included in this study. At the same time of the day, the patients received two randomly ordered physical therapy treatments (MHI with suction and suction alone) from a trained physical therapist, with a washout period of 4[Formula: see text]h provided between interventions. Results:The MHI treatment increased the tidal volume [[Formula: see text]; 1.2[Formula: see text]mL/kg (95% CI, 0.8–1.5)] and static lung compliance [[Formula: see text]; 3.7[Formula: see text]mL/cmH2O (95% CI, 2.6–4.8)] immediately post-intervention compared with the baseline ([Formula: see text]). Moreover, the MHI with suction induced higher [Formula: see text] [1.4[Formula: see text]mL/kg (95% CI, 0.8–2.1)] and [Formula: see text] [3.4[Formula: see text]mL/cmH2O (95% CI, 2.1–4.7)] compared with the suction-alone intervention. In addition, the secretion mass [0.7[Formula: see text]g (95% CI, 0.6–0.8)] was greater in MHI with suction compared with suction alone ([Formula: see text]). However, there was no difference in peak inspiratory pressure, mean airway pressure, respiratory rate, heart rate, blood pressure, mean arterial blood pressure or oxygen saturation ([Formula: see text]) between interventions. Conclusions:MHI can improve [Formula: see text], [Formula: see text] and secretion mass without inducing adverse hemodynamic effects upon the pediatric patients requiring mechanical ventilation.

scholarly journals Estimation of change in pleural pressure in assisted and unassisted spontaneous breathing pediatric patients using fluctuation of central venous pressure: A preliminary study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247360
Author(s):  
Nao Okuda ◽  
Miyako Kyogoku ◽  
Yu Inata ◽  
Kanako Isaka ◽  
Kazue Moon ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Pediatric Patients ◽  
Venous Pressure ◽  
Balloon Catheter ◽  
Pleural Pressure ◽  
Respiratory Effort ◽  
Central Venous ◽  
Mechanically Ventilated ◽  
Esophageal Balloon

Background It is important to evaluate the size of respiratory effort to prevent patient self-inflicted lung injury and ventilator-induced diaphragmatic dysfunction. Esophageal pressure (Pes) measurement is the gold standard for estimating respiratory effort, but it is complicated by technical issues. We previously reported that a change in pleural pressure (ΔPpl) could be estimated without measuring Pes using change in CVP (ΔCVP) that has been adjusted with a simple correction among mechanically ventilated, paralyzed pediatric patients. This study aimed to determine whether our method can be used to estimate ΔPpl in assisted and unassisted spontaneous breathing patients during mechanical ventilation. Methods The study included hemodynamically stable children (aged <18 years) who were mechanically ventilated, had spontaneous breathing, and had a central venous catheter and esophageal balloon catheter in place. We measured the change in Pes (ΔPes), ΔCVP, and ΔPpl that was calculated using a corrected ΔCVP (cΔCVP-derived ΔPpl) under three pressure support levels (10, 5, and 0 cmH2O). The cΔCVP-derived ΔPpl value was calculated as follows: cΔCVP-derived ΔPpl = k × ΔCVP, where k was the ratio of the change in airway pressure (ΔPaw) to the ΔCVP during airway occlusion test. Results Of the 14 patients enrolled in the study, 6 were excluded because correct positioning of the esophageal balloon could not be confirmed, leaving eight patients for analysis (mean age, 4.8 months). Three variables that reflected ΔPpl (ΔPes, ΔCVP, and cΔCVP-derived ΔPpl) were measured and yielded the following results: -6.7 ± 4.8, − -2.6 ± 1.4, and − -7.3 ± 4.5 cmH2O, respectively. The repeated measures correlation between cΔCVP-derived ΔPpl and ΔPes showed that cΔCVP-derived ΔPpl had good correlation with ΔPes (r = 0.84, p< 0.0001). Conclusions ΔPpl can be estimated reasonably accurately by ΔCVP using our method in assisted and unassisted spontaneous breathing children during mechanical ventilation.

Detection of Seizure Activity in the Paralyzed Neonate Using Continuous Monitoring

PEDIATRICS ◽  
1982 ◽  
Vol 69 (5) ◽  
pp. 583-586
Author(s):  
Ronald N. Goldberg ◽  
Steven L. Goldman ◽  
R. Eugene Ramsay ◽  
Rosalyn Feller
Keyword(s):  
Blood Pressure ◽  
Oxygen Saturation ◽  
Arterial Blood Pressure ◽  
Cardiac Arrhythmias ◽  
Seizure Activity ◽  
Vital Signs ◽  
Transcutaneous Oxygen ◽  
Mechanically Ventilated ◽  
Arterial Blood ◽  
Systolic Arterial Blood Pressure

In experimental animals neurologic damage may occur during seizure activity whether the seizure is accompanied by motor activity and hypoxemia or whether the animal is paralyzed and normoxemic. These findings suggest that it may be important to detect seizure activity in the paralyzed neonate. Nine infants who were mechanically ventilated and paralyzed with pancuronium had their condition diagnosed as seizure activity. Vital signs were continuously monitored and six infants had either oxygen saturation or transcutaneous oxygen measured during seizure activity. For the group as a whole, rhythmic fluctuations in vital signs, cardiac rhythm, and oxygenation occurred every four minutes (range one to seven minutes) and lasted two minutes (range one to four minutes). In seven patients whose seizures were not accompanied by cardiac arrhythmias the following mean increases were noted: systolic arterial blood pressure, 15 mm Hg (range 7 to 36 mm Hg); heart rate, ten beats per minute (-11 to 30/min); oxygen saturation, 12% (range 4% to 20%); and transcutaneous oxygen, 31 mm Hg (range 14 to 45 mm Hg). Seizures in the two patients with cardiac arrhythmias were accompanied by a decrease in systolic arterial blood pressure of 27 mm Hg (range 15 to 40 mm Hg) and in oxygen saturation of 24% (range 20% to 28%). The presence of rhythmic fluctuation in vital signs and oxygenation should alert the physician to the possibility of seizure activity in the paralyzed neonate.

Regional adrenal blood flow during hypoxia in anesthetized, ventilated dogs

1989 ◽  
Vol 256 (1) ◽  
pp. H94-H100 ◽  
Author(s):  
M. K. Nishijima ◽  
M. J. Breslow ◽  
H. Raff ◽  
R. J. Traystman
Keyword(s):  
Blood Pressure ◽  
Carbon Monoxide ◽  
Blood Flow ◽  
Adrenocorticotropic Hormone ◽  
Secretory Activity ◽  
Alternative Mechanism ◽  
Mechanically Ventilated ◽  
Pentobarbital Sodium ◽  
Arterial Blood ◽  
Additional Group

The effect of hypoxic hypoxia (HH) and carbon monoxide hypoxia (COH) on adrenal medullary (MQ) and cortical (CQ) blood flow (radiolabeled microsphere technique) was studied in pentobarbital sodium-anesthetized, mechanically ventilated dogs. Animals were exposed to 60 min of hypoxia (arterial O2 content 8 vol%) induced by adding either nitrogen (HH, n = 6) or carbon monoxide (COH, n = 6) to the inspired gas. Whole adrenal Q and CQ increased by 70 and 50%, respectively, with HH but were unchanged during COH. MQ, however, increased threefold during both HH and COH. HH and COH both increased arterial levels of epinephrine, corticosteroids, and adrenocorticotropic hormone (ACTH). To determine whether the increase in CQ during HH was because of HH-induced increases in mean arterial blood pressure (MAP, approximately 20 mmHg), an additional group of animals (n = 6) was exposed to HH but had MAP maintained at control levels using a pressurized-bottle system. MAP control did not alter the CQ response to HH. We conclude that MQ appears to be associated with medullary secretory activity during hypoxia and that HH and COH stimulate adrenal medullary secretion equally. In contrast, CQ increases only with HH, despite similar increases in ACTH and corticosteroid levels during HH and COH, suggesting that an alternative mechanism is responsible for increased cortical blood flow during HH.

Variations in Arterial Blood Pressure and Photoplethysmography During Mechanical Ventilation

2006 ◽  
Vol 103 (5) ◽  
pp. 1182-1188 ◽  
Author(s):  
Giuseppe Natalini ◽  
Antonio Rosano ◽  
Maria E. Franceschetti ◽  
Paola Facchetti ◽  
Achille Bernardini
Keyword(s):  
Blood Pressure ◽  
Mechanical Ventilation ◽  
Arterial Blood Pressure ◽  
Arterial Blood

scholarly journals Early Critical Care Transthoracic Echocardiography Improves the Mortality of Patients Undergoing Mechanical Ventilation: Observational Data From Two Large Databases.

2020 ◽  
Author(s):  
Xueshu Yu ◽  
Hao Jiang ◽  
Wenjing Chen ◽  
Lingling Pan ◽  
Zhendong Fang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Transthoracic Echocardiography ◽  
Favourable Effect ◽  
Research Database ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Abstract Background: Critical care transthoracic echocardiography (TTE) can quickly and accurately assess haemodynamic changes in ICU patients. However, it is not clear whether transthoracic echocardiography improves the prognosis of mechanically ventilated patients. In this study, we hypothesized that early critical care transthoracic echocardiography independently contributes to improvements in mortality in mechanically ventilated patients in the ICU.Methods: This was a retrospective study based on the Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU-CRD). Patients undergoing mechanical ventilation for more than 48 hours were selected. The exposure of interest was early TTE. The primary outcome was in-hospital mortality. We used propensity score matching to analyse the association between early TTE and in-hospital mortality and sensitivity analysis, including the inverse probability weighting model and covariate balancing propensity score model, to ensure the robustness of our findings.Results: A total of 8862 patients undergoing mechanical ventilation were enrolled. The adjusted OR showed a favourable effect between the early TTE group and in-hospital mortality [MIMIC: OR 0.77, 95% CI (0.63–0.94), (P=0.01); eICU-CRD: OR 0.78, 95% CI (0.68–0.89), (P<0.01) ]. Furthermore, TTE was also associated with 30-day mortality in the MIMIC database [OR 0.74, 95% CI (0.6-0.92), P=0.01].Conclusions: Early application of critical care transthoracic echocardiography during mechanical ventilation is beneficial for improving in-hospital mortality. Further investigation with prospectively collected data is required to validate this relationship.

scholarly journals Effects of ABCDE Bundle Implementation on Reduction of Delirium among Mechanically Ventilated Patients at Damietta Hospital, Egypt

2021 ◽  
pp. 1-14
Author(s):  
Khalil NS ◽  
El-Kady EM ◽  
Abdel-kader FA ◽  
EL-shafey MM
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Post Intervention ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Early Exercise ◽  
Abcde Bundle ◽  
Ventilated Patients

Background: One of the principal complications in intensive care unit particularly those connected to mechanical ventilation is delirium. Delirium. It is associated with increased mortality, prolonged mechanical ventilation, and prolonged hospital length of stay (LOS). The ABCDE is a bundle intervention that stands for awakening, breathing coordination, delirium monitoring/management, and early exercise/mobility bundle that has been proposed as a multi-component intervention to reduce the incidence of delirium. Aim of the study: This study aimed to evaluate the effect of implementing the ABCDE bundle on the reduction of delirium among mechanically ventilated patients at Damietta hospital. Material and Methods: A quasi-experimental pre/post-intervention design was used to conduct this study. A purposive sample of 65 adult male and female mechanically ventilated patients aged between 18 and 60 years was recruited. Sedation and Delirium instruments measures were utilized in data collection. Result: significant differences were found in delirium scores among the studied patients (x2= 52.52; p-value=0.001). So, the mechanically ventilated patients who exposed to the implementation of the ABCDE bundle were experienced fewer delirium signs than before the ABCDE bundle implementation. Conclusion: Based on the findings of the current study, it can be concluded ABCDE bundle implementation reduced the occurrence of delirium among mechanically ventilated patients. Recommendations: ABCDE bundle should be recommended on mechanically ventilated patients. Keywords: ABCDE bundle; Mechanically Ventilated Patients; Critically Ill Patients

scholarly journals The Extent of Ventilator-Induced Lung Injury in Mice Partly Depends on Duration of Mechanical Ventilation

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Maria A. Hegeman ◽  
Sabrine N. T. Hemmes ◽  
Maria T. Kuipers ◽  
Lieuwe D. J. Bos ◽  
Geartsje Jongsma ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Capillary Permeability ◽  
Statistical Significance ◽  
Lung Compliance ◽  
Alveolar Cell ◽  
Mechanically Ventilated ◽  
Ventilator Induced Lung Injury ◽  
Cell Counts ◽  
Alveolar Capillary

Background. Mechanical ventilation (MV) has the potential to initiate ventilator-induced lung injury (VILI). The pathogenesis of VILI has been primarily studied in animal models using more or less injurious ventilator settings. However, we speculate that duration of MV also influences severity and character of VILI.Methods. Sixty-four healthy C57Bl/6 mice were mechanically ventilated for 5 or 12 hours, using lower tidal volumes with positive end-expiratory pressure (PEEP) or higher tidal volumes without PEEP. Fifteen nonventilated mice served as controls.Results. All animals remained hemodynamically stable and survived MV protocols. In both MV groups, PaO2to FiO2ratios were lower and alveolar cell counts were higher after 12 hours of MV compared to 5 hours. Alveolar-capillary permeability was increased after 12 hours compared to 5 hours, although differences did not reach statistical significance. Lung levels of inflammatory mediators did not further increase over time. Only in mice ventilated with increased strain, lung compliance declined and wet to dry ratio increased after 12 hours of MV compared to 5 hours.Conclusions. Deleterious effects of MV are partly dependent on its duration. Even lower tidal volumes with PEEP may initiate aspects of VILI after 12 hours of MV.

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