IS KETAMINE THE RIGHT SEDATIVE FOR MECHANICALLY VENTILATED PATIENTS?

CHEST Journal ◽  
2007 ◽  
Vol 132 (4) ◽  
pp. 574A ◽  
Author(s):  
Elamin M. Elamin ◽  
Larry F. Huges ◽  
Diane Drew
Keyword(s):  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
The Right ◽  
Ventilated Patients

Haemodynamic assessments in mechanically ventilated patients

2020 ◽  
pp. 321-326
Author(s):  
Antoine Vieillard-Baron
Keyword(s):  
Pulse Pressure ◽  
Positive Pressure Ventilation ◽  
Superior Vena ◽  
Vena Cava ◽  
Positive Pressure ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Pulmonary Capillaries ◽  
The Right ◽  
Ventilated Patients

Knowledge of heart–lung interactions is key to manage haemodynamics in mechanically ventilated patients (see also Chapter 5). It allows intensivists to understand the meaning of blood and pulse pressure respiratory variations (PPV). Unlike spontaneous breathing, positive pressure ventilation increases blood pressure and pulse pressure during inspiration following by a decrease during expiration. This is called reverse pulsus paradoxus and includes a ‘d-down’ and a ‘d-up’ effect. No variation means no effect of mechanical ventilation on the heart and especially on the right heart. In case of significant PPV, tidal volume usually reduces right ventricular stroke volume by way of reducing preload where systemic venous return is decreased (fluid expansion is useful to restore haemodynamics, when impaired) or increasing afterload (obstruction of pulmonary capillaries due to alveolar inflation and, in this case, fluid expansion is useless or even sometimes deleterious). Clinical examination as well as evaluation of respiratory variations of superior vena cava by echo, helps to distinguish between these two situations. By studying the beat-by-beat changes in echo parameters induced by positive pressure ventilation heartbeat by heartbeat, echocardiography is perfectly suited to study heart–lung interactions and then to propose an appropriate optimization in case of haemodynamic impairment.

scholarly journals Supraclavicular Approach Is an Easy and Safe Method of Subclavian Vein Catheterization Even in Mechanically Ventilated Patients

2009 ◽  
Vol 111 (2) ◽  
pp. 334-339 ◽  
Author(s):  
Tomasz Czarnik ◽  
Ryszard Gawda ◽  
Tadeusz Perkowski ◽  
Rafal Weron
Keyword(s):  
Confidence Interval ◽  
Complication Rate ◽  
Central Venous Catheterization ◽  
Central Venous ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Supraclavicular Approach ◽  
Venous Catheterization ◽  
The Right ◽  
Ventilated Patients

Background Central venous catheters are commonly inserted for hemodynamic monitoring, volume monitoring, administration of medications, long-term total parenteral nutrition, access for renal replacement therapy, cardiopulmonary resuscitation, and difficult peripheral catheterization. The primary outcome of this study was to define venipuncture, catheterization and entire procedure success rates, and finally complication rate of subclavian venous catheterization via the supraclavicular approach with special focus on mechanically ventilated patients. The secondary outcome was to potentially make recommendations regarding this technique of central venous catheterization in mechanically ventilated patients. Methods The methodology of this prospective cohort study included subclavian venous catheterization via the supraclavicular approach. The technique of cannulation was the same for both the right and left sides, but the right claviculosternocleidomastoid angle was the preferred catheterization site. All procedures were performed by the first three authors, each of whom had different levels of experience. Each physician had performed at least 20 procedures before starting the study. Results In the majority of patients, venipuncture occurred during the first attempt. In 362 patients, catheterization attempts were performed, in whom 311 catheterizations (85.6%) were successful during the first attempt. The overall subclavian venous catheterization via supraclavicular approach procedure complication rate reached 1.7% (95% confidence interval 0.6-3.6%). The overall subclavian venous catheterization via the supraclavicular approach procedure success rate reached 88.9% (95% confidence interval 85.1-91.9%, n = 359). Conclusions Subclavian venous catheterization via the supraclavicular approach is an excellent method of central venous access in mechanically ventilated patients. The procedure success rate and the significant complication rate are comparable to other techniques of central venous catheterization.

scholarly journals Targeted Lateral Positioning Decreases Lung Collapse and Overdistension in COVID-19-Associated ARDS

2021 ◽  
Author(s):  
Mikuláš Mlček ◽  
Michal Otáhal ◽  
João Batista Borges ◽  
Glasiele Cristina Alcala ◽  
Dominik Hladík ◽  
...  
Keyword(s):  
Body Position ◽  
Left Lung ◽  
Lateral Position ◽  
Lung Mechanics ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Lung Aeration ◽  
The Right ◽  
Lateral Positioning ◽  
Ventilated Patients

Abstract Background Among the challenges for personalizing the management of mechanically ventilated patients with coronavirus disease (COVID-19)-associated acute respiratory distress syndrome (ARDS) are the effects of different positive end-expiratory pressure (PEEP) levels and body positions in regional lung mechanics. Right-left lung aeration asymmetry and poorly recruitable lungs with increased recruitability with alternating body position between supine and prone have been reported. However, real-time effects of changing body position and PEEP on regional overdistension and collapse, in individual patients, remain largely unknown and not timely monitored. Methods We here report a series of consecutive mechanically ventilated patients with COVID-19-associated ARDS. Aiming at to individualize PEEP and body positioning in order to reduce mechanisms of ventilator-induced lung injury, collapse and overdistension, sixteen decremental PEEP titrations were performed in the first days of mechanical ventilation (8 pairs supine vs. targeted lateral position): supine position immediately followed by 30° targeted lateral position. The choice of lateral tilt was based on X-Ray: the less aerated lung was positioned up. Maps and percentages of global and regional collapse and overdistension were measured for each PEEP level by electrical impedance tomography. Results Targeted lateral position resulted in significantly smaller amounts of overdistension and collapse when compared with the supine one: less collapse along the PEEP titration was found within the left lung in targeted lateral; and less overdistension along the PEEP titration was found within the right lung in targeted lateral. Regarding collapse within the right lung and overdistension within the left lung: no differences were found for position. Conclusions Targeted lateral positioning with bedside personalized PEEP provided a selective attenuation of overdistension and collapse in mechanically ventilated patients with COVID-19-associated ARDS and right-left lung aeration/ventilation asymmetry.

scholarly journals Targeted lateral positioning decreases lung collapse and overdistension in COVID-19-associated ARDS

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mikuláš Mlček ◽  
Michal Otáhal ◽  
João Batista Borges ◽  
Glasiele Cristina Alcala ◽  
Dominik Hladík ◽  
...  
Keyword(s):  
Body Position ◽  
Left Lung ◽  
Trial Registration ◽  
Lung Mechanics ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Lung Aeration ◽  
The Right ◽  
Lateral Positioning ◽  
Ventilated Patients

Abstract Background Among the challenges for personalizing the management of mechanically ventilated patients with coronavirus disease (COVID-19)-associated acute respiratory distress syndrome (ARDS) are the effects of different positive end-expiratory pressure (PEEP) levels and body positions in regional lung mechanics. Right-left lung aeration asymmetry and poorly recruitable lungs with increased recruitability with alternating body position between supine and prone have been reported. However, real-time effects of changing body position and PEEP on regional overdistension and collapse, in individual patients, remain largely unknown and not timely monitored. The aim of this study was to individualize PEEP and body positioning in order to reduce the mechanisms of ventilator-induced lung injury: collapse and overdistension. Methods We here report a series of five consecutive mechanically ventilated patients with COVID-19-associated ARDS in which sixteen decremental PEEP titrations were performed in the first days of mechanical ventilation (8 titration pairs: supine position immediately followed by 30° targeted lateral position). The choice of lateral tilt was based on X-Ray. This targeted lateral position strategy was defined by selecting the less aerated lung to be positioned up and the more aerated lung to be positioned down. For each PEEP level, global and regional collapse and overdistension maps and percentages were measured by electrical impedance tomography. Additionally, we present the incidence of lateral asymmetry in a cohort of forty-four patients. Results The targeted lateral position strategy resulted in significantly smaller amounts of overdistension and collapse when compared with the supine one: less collapse along the PEEP titration was found within the left lung in targeted lateral (P = 0.014); and less overdistension along the PEEP titration was found within the right lung in targeted lateral (P = 0.005). Regarding collapse within the right lung and overdistension within the left lung: no differences were found for position. In the cohort of forty-four patients, ventilation inequality of > 65/35% was observed in 15% of cases. Conclusions Targeted lateral positioning with bedside personalized PEEP provided a selective attenuation of overdistension and collapse in mechanically ventilated patients with COVID-19-associated ARDS and right-left lung aeration/ventilation asymmetry. Trial registration Trial registration number: NCT04460859

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