Reflections on the HIFI Trial

PEDIATRICS ◽  
1991 ◽  
Vol 87 (4) ◽  
pp. 565-567
Author(s):  
A. CHARLES BRYAN ◽  
ALISON B. FROESE
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Lung Disease ◽  
Prolonged Mechanical Ventilation ◽  
Mechanical Ventilators ◽  
History Of ◽  
Closing Pressure

Mechanical ventilators have only two functions: to provide a flux to eliminate carbon dioxide from those who will not or cannot breathe and to establish an adequate gas-exchanging volume to reduce shunting. The concept of volume recruitment to reduce shunting goes back at least to Mead and Collier in 1959,1 who showed that without periodic inflations there was a progressive fall in compliance during prolonged mechanical ventilation. Much of the subsequent history of mechanical ventilation in acute lung disease has really been the search for better methods of volume recruitment. The lung has to be inflated past the pressure at which atelectatic lung begins to open and be maintained above its closing pressure (that pressure below which alveoli and airways start to close again).

Pulmonary vascular dysfunction in preterm lambs with chronic lung disease

2003 ◽  
Vol 285 (1) ◽  
pp. L76-L85 ◽  
Author(s):  
Richard D. Bland ◽  
Con Yee Ling ◽  
Kurt H. Albertine ◽  
David P. Carlton ◽  
Amy J. MacRitchie ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Mechanical Ventilation ◽  
Smooth Muscle ◽  
Vascular Smooth Muscle ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Soluble Guanylate Cyclase ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Arteries ◽  
Human Infants

Chronic lung injury from prolonged mechanical ventilation after premature birth inhibits the normal postnatal decrease in pulmonary vascular resistance (PVR) and leads to structural abnormalities of the lung circulation in newborn sheep. Compared with normal lambs born at term, chronically ventilated preterm lambs have increased pulmonary arterial smooth muscle and elastin, fewer lung microvessels, and reduced abundance of endothelial nitric oxide synthase. These abnormalities may contribute to impaired respiratory gas exchange that often exists in infants with chronic lung disease (CLD). Nitric oxide inhalation (iNO) reduces PVR in human infants and lambs with persistent pulmonary hypertension. We wondered whether iNO might have a similar effect in lambs with CLD. We therefore studied the effect of iNO on PVR in lambs that were delivered prematurely at ∼125 days of gestation (term = 147 days) and mechanically ventilated for 3 wk. All of the lambs had chronically implanted catheters for measurement of pulmonary vascular pressures and blood flow. During week 2 of mechanical ventilation, iNO at 15 parts/million for 1 h decreased PVR by ∼20% in 12 lambs with evolving CLD. When the same study was repeated in eight lambs at the end of week 3, iNO had no significant effect on PVR. To see whether this loss of iNO effect on PVR might reflect dysfunction of lung vascular smooth muscle, we infused 8-bromo-guanosine 3′,5′-cyclic monophosphate (cGMP; 150 μg · kg-1 · min-1 iv) for 15–30 min in four of these lambs at the end of week 3. PVR consistently decreased by 30–35%. Lung immunohistochemistry and immunoblot analysis of excised pulmonary arteries from lambs with CLD, compared with control term lambs, showed decreased soluble guanylate cyclase (sGC). These results suggest that loss of pulmonary vascular responsiveness to iNO in preterm lambs with CLD results from impaired signaling, possibly related to deficient or defective activation of sGC, the intermediary enzyme through which iNO induces increased vascular smooth muscle cell cGMP and resultant vasodilation.

scholarly journals Split-ventilation for more than one patient, can it be done? Yes

2020 ◽  
Vol 1 (1) ◽  
pp. 1-7
Author(s):  
Ehab Daoud ◽  
◽  
Jewelyn Cabigan ◽  
Gary Kaneshiro ◽  
Kimiyo Yamasaki
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Limited Resources ◽  
Experimental Setup ◽  
Cross Contamination ◽  
Positive End Expiratory Pressure ◽  
Careful Monitoring ◽  
Mechanical Ventilators ◽  
Number Of Patients ◽  
History Of

Background: The COVID-19 pandemic crisis has led to an international shortage of mechanical ventilation. Due to this shortfall, the surge of increasing number of patients to limited resources of mechanical ventilators has reinvigorated the interest in the concept of split ventilation or co-ventilation (ventilating more than one patient with the same ventilator). However, major medical societies have condemned the concept in a joint statement for multiple reasons. Materials and Methods: In this paper, we will describe the history of the concept, what is trending in the literature about it and along our modification to ventilate two patients with one ventilator. We will describe how to overcome such concerns regarding cross contamination, re-breathing, safely adjusting the settings for tidal volume and positive end expiratory pressure to each patient and how to safely monitor each patient. Main results: Our experimental setup shows that we can safely ventilate two patients using one ventilator. Conclusion: The concept of ventilating more than one patient with a single ventilator is feasible especially in crisis situations. However, we caution that it has to be done under careful monitoring with expertise in mechanical ventilation. More research and investment are crucially needed in this current pandemic crisis.

Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery

2008 ◽  
Vol 109 (2) ◽  
pp. 222-227 ◽  
Author(s):  
Luciana Carrupt Machado Sogame ◽  
Milena Carlos Vidotto ◽  
José Roberto Jardim ◽  
Sonia Maria Faresin
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications ◽  
Duration Of Surgery ◽  
Level Of Consciousness ◽  
Type Of Surgery

Object It has been shown that craniotomy may lead to a decrease in lung volumes and arterial blood gas tensions as well as a change in the respiratory pattern. The purpose of this study was to determine the incidence of postoperative pulmonary complications (PPCs) and the mortality rate in patients who have undergone elective craniotomy and to evaluate the associations between preoperative and postoperative variables and PPCs in this population. Methods Two hundred thirty-six patients were followed up based on a protocol including a clinical questionnaire, physical examination and observation of clinical characteristics in the preoperative period, type of surgery performed, duration of surgery, time spent in the intensive care unit (ICU) and hospital, and the occurrence of any PPCs. Results Postoperative pulmonary complications occurred in 58 patients (24.6%) and 23 other patients (10%) died. Predicting factors for PPCs according to multivariate analyses were as follows: type of surgery performed (p < 0.0001), prolonged mechanical ventilation ≥ 48 hours (p < 0.0001), time spent in the ICU > 3 days (p < 0.0001), decrease in level of consciousness (p < 0.002), duration of surgery ≥ 300 minutes (p < 0.01), and previous chronic lung disease (p < 0.04). Conclusions The incidence from March 2003 to March 2005 of PPCs in patients who had undergone craniotomy was 25% and death occurred in 10%. Some risk factors for PPCs may be predicted such as the type of surgery performed, prolonged mechanical ventilation, a longer time in the ICU, a decreased level of consciousness, duration of surgery, and previous chronic lung disease.

scholarly journals History of Intermittent Mandatory Ventilation prior to 1972. Part one. Special Article

2021 ◽  
Vol 2 (4) ◽  
pp. 149-156
Author(s):  
Ronald Sanderson
Keyword(s):  
Mechanical Ventilation ◽  
Medical History ◽  
Mechanical Ventilators ◽  
Intermittent Mandatory Ventilation ◽  
Common Mode ◽  
Change Over Time ◽  
History Of ◽  
Over Time

Medical history is often overlooked as advances keep moving forward. Seldom is it that advances in medicine are truly new, unique ideas, but rather built on ideas that have been considered before. Even our latest developments will become history or forgotten as science and medicine advance. This history of intermittent mandatory ventilation (IMV) is a two-part article in which the first part attempts to show that the concepts and apparatus that involve the now common mode of ventilation have been considered and described for nearly 200 years, if not earlier. This older history is not brought forward to diminish what has been done in the last 50 years, but to enhance awareness of how ideas and even mechanical ventilators change over time. The second part will describe how those ideas and mechanics changed into what we now call IMV in its many forms. Keywords: Intermittent Mandatory Ventilation, IMV, History of mechanical ventilation

Prediction of Abnormal Pulmonary Follow-up in Premature Infants

PEDIATRICS ◽  
1988 ◽  
Vol 82 (4) ◽  
pp. 670-671
Author(s):  
EDUARDO BANCALARI
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Lung Disease ◽  
Premature Infants ◽  
Chronic Lung Disease ◽  
Oxygen Therapy ◽  
Prolonged Mechanical Ventilation ◽  
Respiratory Outcome ◽  
Definition Of

The article by Shennan and collaborators1 raises some interesting questions concerning the diagnosis of chronic lung disease and the predictability of respiratory outcome in early infancy. The first question addressed by the authors relates to the definition of bronchopulmonary dysplasia. This term was introduced by Northway et al2 in 1967 to describe a group of infants in whom severe chronic lung changes developed after prolonged mechanical ventilation and oxygen therapy. Most of these were infants with birth weights greater than 1000 g in whom chronic respiratory failure developed and whose chest radiographs appeared abnormal. In recent years, there has been an increase in the survival rate of infants with birth weights less than 1000 g, which has resulted in an increase in the population at risk for the development of chronic lung disease.

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