Clinicians' Perceptions Regarding Processes of Mechanical Ventilation Management and Utilization of Lung Protective Ventilation Using an Implementation Science Approach

2019 ◽  
Author(s):  
J.M. Veith ◽  
M. Mehta ◽  
V. Madden ◽  
S. Szymanski ◽  
J. Hart ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Implementation Science ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Science Approach ◽  
Ventilation Management

Noninvasive and Invasive Ventilatory Support II

2018 ◽  
Author(s):  
Pauline K. Park ◽  
Nicole L Werner ◽  
Carl Haas
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Lung Injury ◽  
Acute Respiratory Failure ◽  
Ventilatory Support ◽  
Underlying Disease ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Pulmonary Mechanics ◽  
Ventilator Induced Lung Injury

Invasive and noninvasive ventilation are important tools in the clinician’s armamentarium for managing acute respiratory failure. Although these modalities do not treat the underlying disease, they can provide the necessary oxygenation and ventilatory support until the causal pathology resolves. Care must be taken as even appropriate application can cause harm. Knowledge of pulmonary mechanics, appreciation of the basic machine settings, and an understanding of how common and advanced modes function allows the clinician to optimally tailor support to the patient while limiting iatrogenic injury. This second chapter reviews indications for mechanical ventilation, routine management, troubleshooting, and liberation from mechanical ventilation This review contains 6 figures, 7 tables and 60 references Keywords: Mechanical ventilation, lung protective ventilation, sedation, ventilator-induced lung injury, liberation from mechanical ventilation 

scholarly journals Unsuccessful weaning from mechanical ventilation in children and ways to avoid it

2020 ◽  
pp. 82-89
Author(s):  
O. V. Filyk
Keyword(s):  
Mechanical Ventilation ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Weaning From Mechanical Ventilation ◽  
Ventilation Strategy ◽  
Group I ◽  
Protective Ventilation Strategy ◽  
Elective Tracheostomy ◽  
Group Ii ◽  
Lung Protective Ventilation Strategy

The aim of the work: to determine causes of unsuccessful weaning depending on subglottic edema markers, level of sedation and sedation-agitation, changes in neurological status and bulbar disorders in children with different types of respiratory failure. Materials and Methods. We conducted a prospective cohort single-center study at the Department of Anesthesiology and Intensive Care at Lviv Regional Children's Clinical Hospital "OHMATDYT". We included 89 patients aged 1 month – 18 years with acute respiratory failure who was mechanically ventilated for more than 3 days. They were randomly divided into 2 groups. Group I included patients who received lung-protective ventilation strategy and assessment central nervous system function and the percentage of leakage of the gas mixture near the endotracheal tube; group II – patients who received diaphragm-protective in addition to lung-protective ventilation strategy and took into account the results of central nervous system assessment and respiratory gas mixture leakage near endotracheal tube during weaning from mechanical ventilation. The primary endpoint was the frequency of reintubations, the secon­dary endpoint was the frequency of complications (tracheostomy). 82 patients were included in the data analysis. Patients were divided into age subgroups: subgroup 1 – children 1 month – 1 year; subgroup – children 1–3 years; subgroup 3 – children 3–6 years; subgroup 4 – children 6–13 years; subgroup 5 – children 13–18 years. Results and Discussion. The frequency of reintubations in patients of the age subgroup 1 was reduced in group II to 5.3 % compared with 22.7 % in group I (p = 0.02), which was accompanied by a higher frequency of elective tracheostomy (before the first attempt of weaning from mechanical ventilation) which was 11 % in comparison with 0 %, p = 0.001). The frequency of reintubations in the age subgroup 2 was reduced to 5.9 % in group II vs 20 % in group I (p = 0.04), and elective tracheostomy was performed in 18 % patients in group II vs 5 % patients in group I (p = 0.05). There were no significant differences in the frequency of reintubations among patients in the age subgroup 3 (14.2 % in group I vs 11.1 % in group II, p = 0.31); in the age subgroup 4 (13 % vs 17 %, p = 0.19); the age subgroup 5 (6 % vs 7 %, p = 0.72).

scholarly journals Patients with uninjured lungs may also benefit from lung-protective ventilator settings

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 2040 ◽  
Author(s):  
Roger Alencar ◽  
Vittorio D'Angelo ◽  
Rachel Carmona ◽  
Marcus J Schultz ◽  
Ary Serpa Neto
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Positive End Expiratory Pressure ◽  
Ventilator Induced Lung Injury ◽  
Life Saving ◽  
Indispensable Tool ◽  
Ventilator Settings

Although mechanical ventilation is a life-saving strategy in critically ill patients and an indispensable tool in patients under general anesthesia for surgery, it also acts as a double-edged sword. Indeed, ventilation is increasingly recognized as a potentially dangerous intrusion that has the potential to harm lungs, in a condition known as ‘ventilator-induced lung injury’ (VILI). So-called ‘lung-protective’ ventilator settings aiming at prevention of VILI have been shown to improve outcomes in patients with acute respiratory distress syndrome (ARDS), and, over the last few years, there has been increasing interest in possible benefit of lung-protective ventilation in patients under ventilation for reasons other than ARDS. Patients without ARDS could benefit from tidal volume reduction during mechanical ventilation. However, it is uncertain whether higher levels of positive end-expiratory pressure could benefit these patients as well. Finally, recent evidence suggests that patients without ARDS should receive low driving pressures during ventilation.

scholarly journals Closed-Loop Versus Conventional Mechanical Ventilation in COVID-19 ARDS

2021 ◽  
pp. 088506662110241
Author(s):  
Pedro David Wendel Garcia ◽  
Daniel Andrea Hofmaenner ◽  
Silvio D. Brugger ◽  
Claudio T. Acevedo ◽  
Jan Bartussek ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Odds Ratio ◽  
Closed Loop ◽  
Conventional Mechanical Ventilation ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Mechanically Ventilated ◽  
Ventilation Time ◽  
Mechanical Ventilation Time

Background: Lung-protective ventilation is key in bridging patients suffering from COVID-19 acute respiratory distress syndrome (ARDS) to recovery. However, resource and personnel limitations during pandemics complicate the implementation of lung-protective protocols. Automated ventilation modes may prove decisive in these settings enabling higher degrees of lung-protective ventilation than conventional modes. Method: Prospective study at a Swiss university hospital. Critically ill, mechanically ventilated COVID-19 ARDS patients were allocated, by study-blinded coordinating staff, to either closed-loop or conventional mechanical ventilation, based on mechanical ventilator availability. Primary outcome was the overall achieved percentage of lung-protective ventilation in closed-loop versus conventional mechanical ventilation, assessed minute-by-minute, during the initial 7 days and overall mechanical ventilation time. Lung-protective ventilation was defined as the combined target of tidal volume <8 ml per kg of ideal body weight, dynamic driving pressure <15 cmH2O, peak pressure <30 cmH2O, peripheral oxygen saturation ≥88% and dynamic mechanical power <17 J/min. Results: Forty COVID-19 ARDS patients, accounting for 1,048,630 minutes (728 days) of cumulative mechanical ventilation, allocated to either closed-loop (n = 23) or conventional ventilation (n = 17), presenting with a median paO2/ FiO2 ratio of 92 [72-147] mmHg and a static compliance of 18 [11-25] ml/cmH2O, were mechanically ventilated for 11 [4-25] days and had a 28-day mortality rate of 20%. During the initial 7 days of mechanical ventilation, patients in the closed-loop group were ventilated lung-protectively for 65% of the time versus 38% in the conventional group (Odds Ratio, 1.79; 95% CI, 1.76-1.82; P < 0.001) and for 45% versus 33% of overall mechanical ventilation time (Odds Ratio, 1.22; 95% CI, 1.21-1.23; P < 0.001). Conclusion: Among critically ill, mechanically ventilated COVID-19 ARDS patients during an early highpoint of the pandemic, mechanical ventilation using a closed-loop mode was associated with a higher degree of lung-protective ventilation than was conventional mechanical ventilation.

scholarly journals Comparative analysis of changes in the lungs of experimental animals’ induced conventional and lung protective ventilation

2018 ◽  
Vol 69 (1) ◽  
pp. 771
Author(s):  
N. VIDENOVIC ◽  
J. MLADENOVIC ◽  
V. VIDENOVIC ◽  
R. ZDRAVKOVIC
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Control Group ◽  
Histological Structure ◽  
Positive End Expiratory Pressure ◽  
Acid Base ◽  
Acid Base Status ◽  
The Impact

Mechanical ventilation has long been the leader in the treatment of critically ill and injured patients in an intensive care unit. The aim of this study was to examine the impact of the application of positive end-expiratory pressure on histopathological findings and on the parameters of ventilation, oxygenation and acid-base status. The experimental study included 42 animals (piglets), which were divided into of tree groups, each containing 14. The animals of the control group (conventional ventilation) were ventilated with the tidal volume of 10-15 mL/kg. Tidal volume of 6 mL/kg was applied in the low tidal ventilation group, whereas the ventilation strategy in the lung protective ventilation group meant the application of a tidal volume of 6 mL/kg and the 7 mbar of positive end-expiratory pressure. Mechanical ventilation in each animal lasted for 4 hours. After conducting mechanical ventilation, samples were taken from the lung tissue, which were sent for histopathological examination. The parameters of ventilation, oxygenation and acid-base status were measured after each hour’s duration of mechanical ventilation. Application of positive end-expiratory pressure 5-10 mbar during mechanical ventilation is a safe and useful method which is not followed by the occurrence of significant abnormalities in the structure of the ventilated lung. However, a low tidal volume without positive end-expiratory pressure causes significant changes in the histological structure of healthy lungs. Positive end-expiratory pressure keeps the alveoli open throughout the respiratory cycle which allows the lungs to maintain homeostasis in terms of adequate ventilation, oxygenation and acid-base status.

scholarly journals Lung-Protective Ventilation Strategies for Relief from Ventilator-Associated Lung Injury in Patients Undergoing Craniotomy: A Bicenter Randomized, Parallel, and Controlled Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Chaoliang Tang ◽  
Juan Li ◽  
Shaoqing Lei ◽  
Bo Zhao ◽  
Zhetao Zhang ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Nitric Oxide ◽  
Mechanical Ventilation ◽  
Lung Injury ◽  
Inflammatory Response ◽  
Protective Ventilation ◽  
Current Evidence ◽  
Lung Protective Ventilation ◽  
Hemodynamic Variables ◽  
And Oxidative Stress

Current evidence indicates that conventional mechanical ventilation often leads to lung inflammatory response and oxidative stress, while lung-protective ventilation (LPV) minimizes the risk of ventilator-associated lung injury (VALI). This study evaluated the effects of LPV on relief of pulmonary injury, inflammatory response, and oxidative stress among patients undergoing craniotomy. Sixty patients undergoing craniotomy received either conventional mechanical (12 mL/kg tidal volume [VT] and 0 cm H2O positive end-expiratory pressure [PEEP]; CV group) or protective lung (6 mL/kg VT and 10 cm H2O PEEP; PV group) ventilation. Hemodynamic variables, lung function indexes, and inflammatory and oxidative stress markers were assessed. The PV group exhibited greater dynamic lung compliance and lower respiratory index than the CV group during surgery (P<0.05). The PV group exhibited higher plasma interleukin- (IL-) 10 levels and lower plasma malondialdehyde and nitric oxide and bronchoalveolar lavage fluid, IL-6, IL-8, tumor necrosis factor-α, IL-10, malondialdehyde, nitric oxide, and superoxide dismutase levels (P<0.05) than the CV group. There were no significant differences in hemodynamic variables, blood loss, liquid input, urine output, or duration of mechanical ventilation between the two groups (P>0.05). Patients receiving LPV during craniotomy exhibited low perioperative inflammatory response, oxidative stress, and VALI.

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