Abstract 13216: Initial Survey of Respiratory Mechanics During Prehospital Bag Ventilation

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Betty Y Yang ◽  
Jennifer E Blackwood ◽  
Jenny Shin ◽  
Sally Guan ◽  
Mengqi Gao ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Respiratory Mechanics ◽  
Predicted Body Weight ◽  
Convenience Sample ◽  
Measuring Device ◽  
Respiratory Parameters ◽  
Initial Survey ◽  
Post Intubation ◽  
End Tidal ◽  
The Relationship

Introduction: Respiratory mechanics, such as tidal volume and inspiratory pressures, affect outcome in hospitalized patients with respiratory failure. The ability to accurately measure respiratory mechanics in the prehospital setting is limited, thus the relationship between prehospital respiratory mechanics and clinical outcome is not well understood. In this feasibility study, we examined respiratory mechanics of bag-valve mask (BVM) ventilation by emergency medical services (EMS) using a novel in-line measuring device during a period when agencies switched from larger to smaller ventilation bags. Methods: This prospective cohort study included a convenience sample of adult patients who received BVM ventilation by EMS, from August 2018 to January 2020, in Bellevue, Washington. The airway monitoring device was applied by paramedics after intubation to passively record in black box mode, until termination of efforts or hospital arrival. Respiratory parameters included tidal volume, airway pressure, flow rates, end-tidal carbon dioxide, and respiratory rate. Prehospital agencies transitioned from large (1500 mL) to small (1000 mL) ventilation bags during the study period. Results: 7371 post-intubation breaths were measured in 54 patients, 32 treated for out-of-hospital cardiac arrest (OHCA) and 22 treated for non-arrest conditions, primarily respiratory etiology. EMS ventilated 19 patients with a small bag and 35 patients with a large bag. Ventilation with a smaller bag was characterized by less variability in tidal volumes and higher proportion of breaths delivered within 4-10 mL/kg of predicted body weight (Figure) (p<0.05). Conclusions: Respiratory mechanics can be measured in EMS patients receiving BVM ventilation following intubation. Ventilation with a smaller bag might reduce variation in tidal volume, but further study is needed. These data provide the first evaluation of respiratory mechanics during manual ventilation provided by EMS.

scholarly journals The relationship of tidal volume and driving pressure with mortality in hypoxic patients receiving mechanical ventilation

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255812
Author(s):  
Robert A. Raschke ◽  
Brenda Stoffer ◽  
Seth Assar ◽  
Stephanie Fountain ◽  
Kurt Olsen ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Regression Analysis ◽  
Hospital Mortality ◽  
Tidal Volume ◽  
Driving Pressure ◽  
Predicted Body Weight ◽  
Mechanically Ventilated ◽  
Referent Group ◽  
Relationship Of ◽  
The Relationship

Purpose To determine whether tidal volume/predicted body weight (TV/PBW) or driving pressure (DP) are associated with mortality in a heterogeneous population of hypoxic mechanically ventilated patients. Methods A retrospective cohort study involving 18 intensive care units included consecutive patients ≥18 years old, receiving mechanical ventilation for ≥3 days, with a PaO2/FiO2 ratio ≤300 mmHg, whether or not they met full criteria for ARDS. The main outcome was hospital mortality. Multiple logistic regression (MLR) incorporated TV/PBW, DP, and potential confounders including age, APACHE IVa® predicted hospital mortality, respiratory system compliance (CRS), and PaO2/FiO2. Predetermined strata of TV/PBW were compared using MLR. Results Our cohort comprised 5,167 patients with mean age 61.9 years, APACHE IVa® score 79.3, PaO2/FiO2 166 mmHg and CRS 40.5 ml/cm H2O. Regression analysis revealed that patients receiving DP one standard deviation above the mean or higher (≥19 cmH20) had an adjusted odds ratio for mortality (ORmort) = 1.10 (95% CI: 1.06–1.13, p = 0.009). Regression analysis showed a U-shaped relationship between strata of TV/PBW and adjusted mortality. Using TV/PBW 4–6 ml/kg as the referent group, patients receiving >10 ml/kg had similar adjusted ORmort, but those receiving 6–7, 7–8 and 8–10 ml/kg had lower adjusted ORmort (95%CI) of 0.81 (0.65–1.00), 0.78 (0.63–0.97) and 0.80 0.67–1.01) respectively. The adjusted ORmort in patients receiving 4–6 ml/kg was 1.26 (95%CI: 1.04–1.52) compared to patients receiving 6–10 ml/kg. Conclusions Driving pressures ≥19 cmH2O were associated with increased adjusted mortality. TV/PBW 4-6ml/kg were used in less than 15% of patients and associated with increased adjusted mortality compared to TV/PBW 6–10 ml/kg used in 82% of patients. Prospective clinical trials are needed to prove whether limiting DP or the use of TV/PBW 6–10 ml/kg versus 4–6 ml/kg benefits mortality.

Relationship between medication adherence and psychosocial adjustment in patients with type 2 diabetes: A cross-sectional study

2020 ◽  
Vol 40 (3) ◽  
pp. 116-122
Author(s):  
Duygu Kes ◽  
Feray Gökdoğan
Keyword(s):  
Type 2 Diabetes ◽  
Psychosocial Adjustment ◽  
Large City ◽  
Psychosocial Care ◽  
Self Report ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Adherence To Medication ◽  
The Relationship

Adherence to drug treatment is a multidimensional concept. It is affected by many factors, such as physiological, psychological, family, environmental and social conditions. However, relatively little is known about the relationship between adherence to medication and psychosocial adjustment. The aim was to explore the relationship between adherence to antidiabetic drugs and the psychosocial adjustment of patients with type 2 diabetes mellitus. This cross-sectional descriptive correlational study was conducted between March and June 2018. A convenience sample of participants was recruited from seven internal disease outpatient clinics at a public tertiary hospital, located in a large city that serves as a gateway to nearby rural and urban areas in the north-west region of Turkey. Data were collected using the Adherence to Refills and Medications Scale (ARMS-7), and the Psychosocial Adjustment to Illness Scale–Self Report (PAIS–SR). This study is reported in accordance with STROBE. Pearson’s correlation analysis found a significant weak positive correlation between all domains of the PAIS–SR and the total scores on the ARMS‐7. The participants’ scores on medication refill were found to be significantly and positively correlated with all of the PAIS–SR domain scores except the sexual relationships domain. Psychosocial care could play a crucial role in improving drug regimen adherence among patients with diabetes. Therefore, nurses should integrate psychosocial care into daily practice.

Corrosion Problems in a Refinery Diethanolamine System

CORROSION ◽  
1960 ◽  
Vol 16 (10) ◽  
pp. 503t-506t ◽  
Author(s):  
KENNETH L. MOORE
Keyword(s):  
Hydrogen Sulfide ◽  
Electrical Resistance ◽  
System Operation ◽  
Measuring Device ◽  
Acid Gas ◽  
Gas Streams ◽  
The Rich ◽  
The Relationship ◽  
Refinery Gas ◽  
Propane Butane

Abstract Various corrosion problems are described which have occurred in a large diethanolamine (DEA) system that removes hydrogen sulfide from refinery gas streams and a liquid propane-butane stream. These include reboiler corrosion, rich DEA corrosion, stress corrosion cracking, and corrosion-erosion. The effect of the problems on system operation is discussed, as well as the means of minimizing the problems. Electrical resistance measuring device data indicate the importance of keeping the solution loading below 0.34 mol of acid gas (H2S + CO2) per mol of DEA to minimize the corrosion in the rich DEA. Data from this source also show the relationship between general reboiler corrosion and solution contamination. 8.4.3

scholarly journals Cardiorespiratory Functioning in Youth with Persistent Post-Concussion Symptoms: A Pilot Study

2021 ◽  
Vol 10 (4) ◽  
pp. 561
Author(s):  
Aliyah Snyder ◽  
Christopher Sheridan ◽  
Alexandra Tanner ◽  
Kevin Bickart ◽  
Molly Sullan ◽  
...  
Keyword(s):  
Processing Speed ◽  
Mean Value ◽  
Exhaled Breath ◽  
Post Injury ◽  
The Past ◽  
Neurobehavioral Outcomes ◽  
End Tidal ◽  
Relationship Of ◽  
The Relationship ◽  
End Tidal Co2

Dysregulation of the autonomic nervous system (ANS) may play an important role in the development and maintenance of persistent post-concussive symptoms (PPCS). Post-injury breathing dysfunction, which is influenced by the ANS, has not been well-studied in youth. This study evaluated cardiorespiratory functioning at baseline in youth patients with PPCS and examined the relationship of cardiorespiratory variables with neurobehavioral outcomes. Participants were between the ages of 13–25 in two groups: (1) Patients with PPCS (concussion within the past 2–16 months; n = 13) and (2) non-injured controls (n = 12). Capnometry was used to obtain end-tidal CO2 (EtCO2), oxygen saturation (SaO2), respiration rate (RR), and pulse rate (PR) at seated rest. PPCS participants exhibited a reduced mean value of EtCO2 in exhaled breath (M = 36.3 mmHg, SD = 2.86 mmHg) and an altered inter-correlation between EtCO2 and RR compared to controls. Neurobehavioral outcomes including depression, severity of self-reported concussion symptoms, cognitive catastrophizing, and psychomotor processing speed were correlated with cardiorespiratory variables when the groups were combined. Overall, results from this study suggest that breathing dynamics may be altered in youth with PPCS and that cardiorespiratory outcomes could be related to a dimension of neurobehavioral outcomes associated with poorer recovery from concussion.

The Relationship Between Smartphone Use, Insomnia, Stress, and Anxiety Among University Students: A Cross-Sectional Study

2020 ◽  
pp. 105477382098316
Author(s):  
Nisreen Al Battashi ◽  
Omar Al Omari ◽  
Murad Sawalha ◽  
Safiya Al Maktoumi ◽  
Ahmed Alsuleitini ◽  
...  
Keyword(s):  
University Students ◽  
Severity Index ◽  
Depression Anxiety Stress Scale ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Insomnia Severity Index ◽  
Stress Scale ◽  
Smartphone Use ◽  
The Relationship ◽  
Insomnia Severity

The rapid increase in the number of smartphone users has raised concern about the negative psychosocial and physical effects of this use. A descriptive cross-sectional design was conducted to investigate the relationship between smartphone use, anxiety and insomnia among university students. A convenience sample of 404 students from one public university completed questionnaires with items from the Smartphone Addiction Scale, the Depression Anxiety Stress Scale and the Insomnia Severity Index, with some demographic data. High smartphone addition scale score was significantly associated with higher anxiety and stress scores of the Depression Anxiety Stress scale, and higher insomnia severity index score. The findings support the importance of an intervention program to promote appropriate use of smartphones and to improve sleep and psychological symptoms such as stress and anxiety among university students.

Biologically Variable Ventilation Improves Oxygenation and Respiratory Mechanics during One-lung Ventilation

2006 ◽  
Vol 105 (1) ◽  
pp. 91-97 ◽  
Author(s):  
Michael C. McMullen ◽  
Linda G. Girling ◽  
M Ruth Graham ◽  
W Alan C. Mutch
Keyword(s):  
Tidal Volume ◽  
Respiratory Mechanics ◽  
Lung Ventilation ◽  
Group Effect ◽  
Shunt Fraction ◽  
Static Compliance ◽  
One Lung Ventilation ◽  
Time Interaction ◽  
Variable Ventilation ◽  
Dead Space Ventilation

Background Hypoxemia is common during one-lung ventilation (OLV). Atelectasis contributes to the problem. Biologically variable ventilation (BVV), using microprocessors to reinstitute physiologic variability to respiratory rate and tidal volume, has been shown to be advantageous over conventional monotonous control mode ventilation (CMV) in improving oxygenation during the period of lung reinflation after OLV in an experimental model. Here, using a porcine model, the authors compared BVV with CMV during OLV to assess gas exchange and respiratory mechanics. Methods Eight pigs (25-30 kg) were studied in each of two groups. After induction of anesthesia-tidal volume 12 ml/kg with CMV and surgical intervention-tidal volume was reduced to 9 ml/kg. OLV was initiated with an endobronchial blocker, and the animals were randomly allocated to either continue CMV or switch to BVV for 90 min. After OLV, a recruitment maneuver was undertaken, and both lungs were ventilated for a further 60 min. At predetermined intervals, hemodynamics, respiratory gases (arterial, venous, and end-tidal samples) and mechanics (airway pressures, static and dynamic compliances) were measured. Derived indices (pulmonary vascular resistance, shunt fraction, and dead space ventilation) were calculated. Results By 15 min of OLV, arterial oxygen tension was greater in the BVV group (group x time interaction, P = 0.003), and shunt fraction was lower with BVV from 30 to 90 min (group effect, P = 0.0004). From 60 to 90 min, arterial carbon dioxide tension was lower with BVV (group x time interaction, P = 0.0001) and dead space ventilation was less from 60 to 90 min (group x time interaction, P = 0.0001). Static compliance was greater by 60 min of BVV and remained greater during return to ventilation of both lungs (group effect, P = 0.0001). Conclusions In this model of OLV, BVV resulted in superior gas exchange and respiratory mechanics when compared with CMV. Improved static compliance persisted with restoration of two-lung ventilation.

scholarly journals The Relationship between Resistance Exercise Performance and Ventilatory Efficiency after Beetroot Juice Intake in Well-Trained Athletes

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1094
Author(s):  
Noemí Serra-Payá ◽  
Manuel Vicente Garnacho-Castaño ◽  
Sergio Sánchez-Nuño ◽  
Lluís Albesa-Albiol ◽  
Montserrat Girabent-Farrés ◽  
...  
Keyword(s):  
Resistance Exercise ◽  
Exercise Test ◽  
Exercise Performance ◽  
Beetroot Juice ◽  
Experimental Conditions ◽  
Double Blind ◽  
Ventilatory Efficiency ◽  
End Tidal ◽  
Oxygen Uptake Efficiency Slope ◽  
The Relationship

The assessment of ventilatory efficiency is critical to understanding the matching of ventilation (VE) and perfusion in the lungs during exercise. This study aimed to establish a causal physiological relationship between ventilatory efficiency and resistance exercise performance after beetroot juice (BJ) intake. Eleven well-trained males performed a resistance exercise test after drinking 140 mL of BJ (~12.8 mmol NO3−) or a placebo (PL). Ventilatory efficiency was assessed by the VE•VCO2−1 slope, the oxygen uptake efficiency slope and the partial pressure of end-tidal carbon dioxide (PetCO2). The two experimental conditions were controlled using a randomized, double-blind crossover design. The resistance exercise test involved repeating the same routine twice, which consisted of wall ball shots plus a full squat (FS) with a 3 min rest or without a rest between the two exercises. A higher weight lifted was detected in the FS exercise after BJ intake compared with the PL during the first routine (p = 0.004). BJ improved the VE•VCO2−1 slope and the PetCO2 during the FS exercise in the first routine and at rest (p < 0.05). BJ intake improved the VE•VCO2−1 slope and the PetCO2 coinciding with the resistance exercise performance. The ergogenic effect of BJ could be induced under aerobic conditions at rest.

Respiratory mechanics in mechanically ventilated patients with respiratory failure

1985 ◽  
Vol 58 (6) ◽  
pp. 1849-1858 ◽  
Author(s):  
A. Rossi ◽  
S. B. Gottfried ◽  
B. D. Higgs ◽  
L. Zocchi ◽  
A. Grassino ◽  
...  
Keyword(s):  
Time Constant ◽  
Inflation Rate ◽  
Respiratory Mechanics ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Airway Occlusion ◽  
The Relationship ◽  
Resistance Value ◽  
Ventilated Patients

In 11 mechanically ventilated patients, respiratory mechanics were measured 1) during constant flow inflation and 2) following end-inflation airway occlusion, as proposed in model analysis (J. Appl. Physiol. 58: 1840–1848, 1985. During the latter part of inflation, the relationship between driving pressure and lung volume change was linear, allowing determination of static respiratory elastance (Ers) and resistance (RT). The latter represents in each patient the maximum resistance value that can obtain with the prevailing time constant inhomogeneity. Following occlusion, Ers and RT were also obtained along with RT (min) which represents a minimum, i.e., resistance value that would obtain in the absence of time constant inhomogeneity. A discrepancy between inflation and occlusion Ers and RT was found only in the three patients without positive end-expiratory pressure, and could be attributed to recruitment of lung units during inflation. In all instances Ers and RT were higher than normal. RT(min) was lower in all patients than the corresponding values of RT, indicating that resistance was frequency dependent due to time constant inequalities. Changes in inflation rate did not affect Ers, while RT increased with increasing flow.

Sign in / Sign up

Export Citation Format

Share Document