Open access spreadsheet application for learning spontaneous breathing mechanics and mechanical ventilation

Objective Clinicians cannot precisely determine the time for withdrawal of ventilation. We aimed to evaluate the performance of driving pressure (DP)×respiratory rate (RR) to predict the outcome of weaning. Methods Plateau pressure (Pplat) and total positive end-expiratory pressure (PEEPtot) were measured during mechanical ventilation with brief deep sedation and on volume-controlled mechanical ventilation with a tidal volume of 6 mL/kg and a PEEP of 0 cmH2O. Pplat and PEEPtot were measured by patients holding their breath for 2 s after inhalation and exhalation, respectively. DP was determined as Pplat minus PEEPtot. The rapid shallow breathing index was measured from the ventilator. The highest RR was recorded within 3 minutes during a spontaneous breathing trial. Patients who tolerated a spontaneous breathing trial for 1 hour were extubated. Results Among the 105 patients studied, 44 failed weaning. During ventilation withdrawal, DP×RR was 136.7±35.2 cmH2O breaths/minute in the success group and 230.2±52.2 cmH2O breaths/minute in the failure group. A DP×RR index >170.8 cmH2O breaths/minute had a sensitivity of 93.2% and specificity of 88.5% to predict failure of weaning. Conclusions Measurement of DP×RR during withdrawal of ventilation may help predict the weaning outcome. A high DP×RR increases the likelihood of weaning failure. Statement: This manuscript was previously posted as a preprint on Research Square with the following link: https://www.researchsquare.com/article/rs-15065/v3 and DOI: 10.21203/rs.2.24506/v3

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Spontaneous breathing during mechanical ventilation*

Critical Care Medicine ◽

10.1097/01.ccm.0000163227.70097.05 ◽

2005 ◽

Vol 33 (5) ◽

pp. 1170-1171 ◽

Cited By ~ 2

Author(s):

Davide Chiumello

Keyword(s):

Mechanical Ventilation ◽

Spontaneous Breathing

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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 ◽

10.1371/journal.pone.0247360 ◽

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.

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The Association between D-dimer Levels and Thromboembolism, Worsening Severity, and Mortality among Hospitalized Adults with COVID-19

Acta Medica Philippina ◽

10.47895/amp.vi0.4153 ◽

2021 ◽

Author(s):

Patricia Pauline M. Remalante-Rayco ◽

Evelyn O. Salido ◽

Joey A. Tabula ◽

Maria Teresa S. Tolosa

Keyword(s):

Mechanical Ventilation ◽

Critical Illness ◽

Open Access ◽

Clinical Outcomes ◽

Observational Studies ◽

Prognostic Indicator ◽

Cochrane Library ◽

Increased Risk ◽

D Dimer

Objective. To assess the association between D-dimer and clinical outcomes in adults with COVID-19. Methods. We reviewed published articles and preprints from MEDLINE, Cochrane Library, Cornell Open Access Publication (COAP), MedRxiv, and BioRxiv databases. We included cohort studies on the association between D-dimer and the outcomes of thromboembolism, mortality, and worsening severity among hospitalized adults with COVID-19. Results. We found 25 observational studies on the association between D-dimer and the outcomes of thromboembolism, mortality, or worsening severity. There was an increased risk of thromboembolism (OR 5.61 [95% CI 3.97, 7.94]) with higher D-dimer levels across different COVID-19 severities. D-dimer levels are associated with higher in-hospital mortality (OR 5.57 [95% CI 2.74, 11.31]) and worsening severity manifesting as critical illness (OR 1.91 [95% CI 1.05, 3.48] to 2.58 [95% CI 1.57, 4.24]), disease progression (HR 2.846 [95% CI 2.10, 3.85]), or need for mechanical ventilation (HR 3.28 [95% CI 1.07, 10.10]). However, some methodological flaws, such as incomplete laboratory or follow-up data and concern on varied D-dimer cut-offs and definitions of worsening disease, raise some uncertainty in the widespread use of D-dimer as a prognostic marker. Conclusion. A higher D-dimer value is associated with worse clinical outcomes among hospitalized adults with COVID-19 and may be a useful prognostic indicator.

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The Use of Ventilatory Modes allowing Spontaneous Breathing during Mechanical Ventilation

Yearbook of Intensive Care and Emergency Medicine 2002 ◽

10.1007/978-3-642-56011-8_22 ◽

2002 ◽

pp. 243-252

Author(s):

R. Kuhlen ◽

C. Putensen ◽

R. Rossaint

Keyword(s):

Mechanical Ventilation ◽

Spontaneous Breathing

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Mechanical Ventilation: Approaches and Special Considerations

10.2310/7ccsp.2396 ◽

2018 ◽

Author(s):

Adrian A. Maung ◽

Lewis J Kaplan

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Key Words ◽

Spontaneous Breathing ◽

Functional Unit ◽

Spontaneous Breathing Trial

In this chapter, we complete the discussion of mechanical ventilation by examining approaches to mechanical ventilation for different patient populations and how to assess whether a patient is ready for liberation from mechanical ventilation. Each of the three chapters is intended to build on the preceding one and therefore establishes a functional unit with regard to mechanical ventilation, whether it is provided in an invasive or a noninvasive fashion. This review contains 1 Figure, 1 Table and 31 references Key Words: acute respiratory failure, ARDS, mechanical ventilation liberation, spontaneous breathing trial, tracheostomy

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Patients on Weaning Trials Classified with Neural Networks and Features Selection

Encyclopedia of Healthcare Information Systems ◽

10.4018/978-1-59904-889-5.ch132 ◽

2008 ◽

pp. 1061-1067

Author(s):

B. Giraldo ◽

A. Garde ◽

C. Arizmendi ◽

R. Jane ◽

I. Diaz ◽

...

Keyword(s):

Neural Network ◽

Neural Networks ◽

Mechanical Ventilation ◽

Intensive Care ◽

Spontaneous Breathing ◽

Selection Procedure ◽

Respiratory Pattern ◽

Features Selection ◽

Weaning From Mechanical Ventilation ◽

Pattern Variability

One of the challenges in intensive care is the process of weaning from mechanical ventilation. We studied the differences in respiratory pattern variability between patients capable of maintaining spontaneous breathing during weaning trials, and patients that fail to maintain spontaneous breathing. In this work, neural networks were applied to study these differences. 64 patients from mechanical ventilation are studied: Group S with 32 patients with Successful trials, and Group F with 32 patients that Failed to maintain spontaneous breathing and were reconnected. A performance of 64.56% of well classified patients was obtained using a neural network trained with the whole set of 35 features. After the application of a feature selection procedure (backward selection) 84.25% was obtained using only eight of the 35 features.

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