scholarly journals Limited predictability of maximal muscular pressure using the difference between peak airway pressure and positive end-expiratory pressure during proportional assist ventilation (PAV)

Critical Care ◽  
2016 ◽  
Vol 20 (1) ◽  
Author(s):  
Po-Lan Su ◽  
Pei-Shan Kao ◽  
Wei-Chieh Lin ◽  
Pei-Fang Su ◽  
Chang-Wen Chen
Keyword(s):  
Airway Pressure ◽  
Peak Airway Pressure ◽  
Positive End Expiratory Pressure ◽  
Proportional Assist Ventilation ◽  
The Difference

scholarly journals Excessive dynamic airway collapse during general anesthesia: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Shunichi Murakami ◽  
Shunsuke Tsuruta ◽  
Kazuyoshi Ishida ◽  
Atsuo Yamashita ◽  
Mishiya Matsumoto
Keyword(s):  
General Anesthesia ◽  
Airway Pressure ◽  
Positive End Expiratory Pressure ◽  
Computed Tomography Scan ◽  
Case Presentation ◽  
Airway Lumen ◽  
Asthma Attack ◽  
Airway Collapse ◽  
History Of ◽  
Tomography Scan

Abstract Background Excessive dynamic airway collapse (EDAC) is an uncommon cause of high airway pressure during mechanical ventilation. However, EDAC is not widely recognized by anesthesiologists, and therefore, it is often misdiagnosed as asthma. Case presentation A 70-year-old woman with a history of asthma received anesthesia with sevoflurane for a laparotomic cholecystectomy. Under general anesthesia, she developed wheezing, high inspiratory pressure, and a shark-fin waveform on capnography, which was interpreted as an asthma attack. However, treatment with a bronchodilator was ineffective. Bronchoscopy revealed the collapse of the trachea and main bronchi upon expiration. We reviewed the preoperative computed tomography scan and saw bulging of the posterior membrane into the airway lumen, leading to a diagnosis of EDAC. Conclusions Although both EDAC and bronchospasm present as similar symptoms, the treatments are different. Bronchoscopy proved useful for distinguishing between these two entities. Positive end-expiratory pressure should be applied and bronchodilators avoided in EDAC.

Lung Expansion, Airway Pressure Transmission, and Positive End-Expiratory Pressure

1980 ◽  
Vol 24 (4) ◽  
pp. 213
Author(s):  
J. C. CHAPIN ◽  
J. B. DOWNS ◽  
M. E. DOUGLAS ◽  
E. J. MURPHY ◽  
B. C. RUIZ
Keyword(s):  
Airway Pressure ◽  
Positive End Expiratory Pressure ◽  
Lung Expansion ◽  
Pressure Transmission

scholarly journals Manual hyperinflation and the role of physical therapy in intensive care and emergency units

2017 ◽  
Vol 30 (suppl 1) ◽  
pp. 241-248
Author(s):  
Rafael Vinícius Santos Cruz ◽  
Fabiana do Socorro da Silva Dias de Andrade ◽  
Pollyanna Dórea Gonzaga de Menezes ◽  
Bruno Oliveira Gonçalves ◽  
Robson da Silva Almeida ◽  
...  
Keyword(s):  
Intensive Care ◽  
Physical Therapy ◽  
Airway Pressure ◽  
Physical Therapists ◽  
High Peak ◽  
Peak Airway Pressure ◽  
Routine Practice ◽  
Perceived Benefits ◽  
Therapy Technique ◽  
Emergency Units

Abstract Introduction: Although manual hyperinflation (MHI) is a physical therapy technique commonly used in intensive care and emergency units, there is little consensus about its use. Objective: To investigate the knowledge of physical therapists working in intensive care and emergency units about manual hyperinflation. Methods: Data were collected through self-administered questionnaires on manual hyperinflation. Data collection took place between September 2014 and January 2015, in Itabuna and Ilhéus, Bahia, Brazil. Results: The study sample was composed of 32 physical therapists who had between 4 months and 10 years working experience. All respondents affirmed that they used the technique in their professional practice. However, only 34.4% reported it to be a routine practice. 90.6% stated that the most common patient position during manual hyperinflation is “supine”. Participants were almost unanimous (93.8%) in citing secretion removal and cough stimulation as perceived benefits of MHI. High peak airway pressure was identified as being a precaution to treatment with MHI by 84.4% of participants, whilst 100% of the sample agreed that an undrained pneumothorax was a contraindication to MHI. Conclusion: The most common answers to the questionnaire were: supine position during MHI; secretion removal and cough stimulation as perceived benefits; high peak airway pressure as a precaution; and an undrained pneumothorax as a contraindication.

scholarly journals Massive Subcutaneous Emphysema during Laparoscopic Cholecystectomy

1970 ◽  
Vol 21 (1) ◽  
pp. 77-79
Author(s):  
ASM Moosa ◽  
M Baharul Islam ◽  
Shahina Akther ◽  
M Latifur Rahman ◽  
Nazim Uddin Ahmed
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Cholecystectomy ◽  
Partial Pressure ◽  
Subcutaneous Emphysema ◽  
Airway Pressure ◽  
Surgical Techniques ◽  
Lung Ventilation ◽  
Peak Airway Pressure ◽  
Sudden Increase ◽  
Partial Pressure Of Oxygen

Laparoscopic surgical techniques are increasingly being applied to treat cholelithiasis and other indications of gallbladder diseases. These procedures however are not without potential morbidity. Herein we describe two patients treated with laparoscopic cholecystectomy; those cases were complicated with subcutaneous emphysema and hypercarbia per-operatively. After discontinuation of pneumoperitoneum, saturation of partial pressure of oxygen (SpO2) gradually increased with improvement of the neck subcutaneous emphysema, at the same time the lung ventilation also improved. Our findings show that we have to stop pneumoperitoneum or decrease partial pressure of end carbon dioxide level immediately, when we find a sudden increase of the peak airway pressure or decrease SpO2 with subcutaneous emphysema during laparoscopic cholecystectomy.   doi: 10.3329/taj.v21i1.3225 TAJ 2008; 21(1): 77-79

ARTIFICIAL VENTILATION IN HYALINE MEMBRANE DISEASE: THE USE OF POSITIVE END-EXPIRATORY PRESSURE AND CONTINUOUS POSITIVE AIRWAY PRESSURE

PEDIATRICS ◽  
1973 ◽  
Vol 51 (4) ◽  
pp. 629-640
Author(s):  
Niloufer Cumarasamy ◽  
Rosmarie Nüssli ◽  
Dieter Vischer ◽  
Peter H. Dangel ◽  
Gabriel V. Duc
Keyword(s):  
Mechanical Ventilation ◽  
Survival Rate ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Artificial Ventilation ◽  
Controlled Trial ◽  
Hyaline Membrane Disease ◽  
Positive End Expiratory Pressure ◽  
Hyaline Membrane

During the years 1969, 1970, and 1971, 120 infants with hyaline membrane disease were studied, of whom 71 were treated with artificial ventilation. Among other changes in 1971, positive end-expiratory pressure was applied during mechanical ventilation and continuous positive airway pressure maintained during the weaning period. The survival rate of the ventilated babies increased from 23% in the preceding two years to 70% in 1971. As this study is not a controlled trial, the observed increase in survival cannot be ascribed to the application of increased airway pressure alone. The data presented, though necessarily inconclusive, may be useful for continuing comparisons with other pediatric centers.

A Randomized Crossover Comparison of Airway Sealing with the Laryngeal Mask Airway Ambu AuraFlex at Three Intracuff Pressures in Pediatric Laparoscopic Surgery

2019 ◽  
Author(s):  
Xiang Liu ◽  
Xiaona Tan ◽  
Qi Zhang ◽  
Li Qiao ◽  
Lei Shi
Keyword(s):  
Laparoscopic Surgery ◽  
Laryngeal Mask Airway ◽  
Airway Pressure ◽  
Laryngeal Mask ◽  
Peak Airway Pressure ◽  
Supraglottic Airway ◽  
Intracuff Pressure ◽  
Leak Pressure ◽  
Oropharyngeal Leak Pressure ◽  
Mucosal Change

Abstract Objective An adequate intracuff pressure is important to ensure sufficient sealing function when using supraglottic airway devices to protect the airway from secretions and achieve adequate positive pressure ventilation. The aim of this study is to analyze a feasible and effective alternative Ambu AuraFlex intracuff pressure in child's laparoscopic surgery. Study Design Seventy-two children were included in this study. After insertion of the laryngeal mask airway AuraFlex, oropharyngeal leak pressure (OLP) was measured at intracuff pressures of 10, 30, and 60-cmH2O according to one of six sequences produced on the basis of 3 × 6 Williams crossover design. During the intraoperative period, AuraFlex was maintained using the last intracuff pressure of the allocated sequence. Oropharyngeal leak pressure, peak airway pressure, the fiberoptic view, mucosal change, and complications were assessed at three intracuff pressures. Results The OLP at the intracuff pressure of 10 cmH2O was significantly lower than that of 30 cmH2O (2# 18.1 ± 1.5 vs. 19.5 ± 1.4 cmH2O, p = 0.001; 2.5# 17.7 ± 1.2 vs. 20.2 ± 1.4, p = 0.001) and 60 cmH2O (2# 18.1 ± 1.5 vs. 20.0 ± 1.3 cmH2O, p = 0.002; 2.5# 17.7 ± 1.2 vs. 20.8 ± 1.1, p = 0.003). Compared with the peak airway pressure in pre-and postpneumoperitoneum, the OLP was significantly higher. Subgroup analysis showed no differences in mucosal change and complications. Conclusion Intracuff pressures of 30 may be sufficient for the Ambu AuraFlex in child's laparoscopic surgery, and there may be no added benefit of an intracuff pressure of 60 cmH2O, as oropharyngeal leak pressures were similar.

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