Estimation of Mortality Risk in Chronically Ventilated Infants With Bronchopulmonary Dysplasia

PEDIATRICS ◽  
1991 ◽  
Vol 88 (6) ◽  
pp. 1153-1160 ◽  
Author(s):  
Debora W. Overstreet ◽  
J. Craig Jackson ◽  
Gerald van Belle ◽  
William E. Truog
Keyword(s):  
Mechanical Ventilation ◽  
Bronchopulmonary Dysplasia ◽  
Airway Pressure ◽  
Life Support ◽  
Water Pressure ◽  
Accurate Estimation ◽  
Regression Equations ◽  
Bacterial Sepsis ◽  
Mean Airway Pressure ◽  
Predictors Of Mortality

Bronchopulmonary dysplasia is a chronic, sometimes fatal lung disease, which primarily affects premature infants and often leads to a dependence on mechanical ventilation lasting many months. To identify prognostic factors of mortality at 1 and 2 months of age, the authors reviewed the medical records of the 144 neonates admitted to two neonatal intensive care units in Seattle from January 1, 1986, through December 31, 1988, who required mechanical ventilation throughout the first month of life. Likely predictors of mortality were tested by logistic regression analysis. The calculated mean airway pressure at 30 days of age (MAP30) and the diagnosis of bacterial sepsis at any time during the first month of life (Bact0-30) were statistically significant predictors of mortality (P < .001 and P = .018, respectively) and had the lowest deviance in the regression model. The probability of mortality was estimated by 1/(1 + e-x, where x = -6.510 + 0.4588 (MAP30) + 1.475 (Bact0-30), and where MAP30 is expressed as centimeters of water pressure (1 cm H2O = 0.0978 kPa) and the presence or absence of bacteremia is 1 and 0, respectively. The records of the 57 infants who still required mechanical ventilation at 60 days of age were reanalyzed with clinical data available during the first 2 months of life. Mean airway pressure (MAP60) and the fraction of inspired oxygen (F60) at 60 days of age combined to form the best predictors of mortality, where x = -7.668 + 0.2940 (MAP60) + 5.935 (F60). The occurrence of bacterial sepsis during the first 2 months of life, the degree of hypochloremia, and the duration of chronic sedative use were also significant predictors of survival, even controlling of MAP60 and F60. These regression equations allow more accurate estimation of the likelihood of survival for chronically ventilated infants and may facilitate decisions regarding withdrawal or continuation of life support.

scholarly journals Dynamic Characteristics of Mechanical Ventilation System of Double Lungs with Bi-Level Positive Airway Pressure Model

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Dongkai Shen ◽  
Qian Zhang ◽  
Yan Shi
Keyword(s):  
Mathematical Model ◽  
Mechanical Ventilation ◽  
Dynamic Characteristics ◽  
Airway Pressure ◽  
Life Support ◽  
Positive Airway Pressure ◽  
Coupling Effect ◽  
Ventilation System ◽  
System A ◽  
Set Up

In recent studies on the dynamic characteristics of ventilation system, it was considered that human had only one lung, and the coupling effect of double lungs on the air flow can not be illustrated, which has been in regard to be vital to life support of patients. In this article, to illustrate coupling effect of double lungs on flow dynamics of mechanical ventilation system, a mathematical model of a mechanical ventilation system, which consists of double lungs and a bi-level positive airway pressure (BIPAP) controlled ventilator, was proposed. To verify the mathematical model, a prototype of BIPAP system with a double-lung simulators and a BIPAP ventilator was set up for experimental study. Lastly, the study on the influences of key parameters of BIPAP system on dynamic characteristics was carried out. The study can be referred to in the development of research on BIPAP ventilation treatment and real respiratory diagnostics.

Mechanical Ventilation: Basic Modes

2019 ◽  
pp. 10-16
Author(s):  
Amelia A. Lowell
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Respiratory Rate ◽  
Airway Pressure ◽  
Minute Ventilation ◽  
Respiratory Muscles ◽  
Supplemental Oxygen ◽  
Alveolar Ventilation ◽  
Arterial Oxygenation ◽  
Mean Airway Pressure

The main goal of mechanical ventilation is to unload the respiratory muscles to facilitate oxygenation and ventilation. This is accomplished by providing a minute ventilation (VE) (respiratory rate × tidal volume [VT]) that will result in adequate alveolar ventilation coupled with supplemental oxygen and a mean airway pressure that will result in adequate arterial oxygenation.

scholarly journals Heart-Protective Mechanical Ventilation in Postoperative Cardiosurgical Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Vadim Mazurok ◽  
Igor Kasherininov ◽  
Andrey Bautin ◽  
Olga Kulemina ◽  
Ryta Rzheutskaya
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Airway Pressure ◽  
Artery Bypass ◽  
Intervention Group ◽  
High Peep ◽  
Mean Airway Pressure ◽  
Negative Effects ◽  
Hemodynamic Profile ◽  
Peep Ventilation

Background. This study compared the hemodynamic effects and gas exchange under several different ventilator settings—with regard to tidal volume, respiratory rate, and end-expiratory pressure—in patients after coronary artery bypass grafting (CABG). Methods. Prospective interventional cohort study with a controlled group in a single cardiosurgical ICU involving 119 patients following on-pump CABG surgery. During the 1st postoperative hour, the intervention group patients were ventilated with Vt 10 ml × kg−1, RR 14/min, PEEP 5 cmH2O (“conventional ventilation”). During the 2nd hour, RR was reduced to 8/min (“reduced RR ventilation”). At 3 hrs, Vt was decreased to 6 ml × kg−1, RR returned to 14/min, and PEEP increased to 10 cmH2O (“low Vt-high PEEP ventilation”). Results. Patients in the “low Vt-high PEEP” ventilation period showed significantly lower alveolar ventilation and thoraco-pulmonary compliance than during “reduced RR” ventilation. Mean airway pressure and Vds/Vt peaked during low Vt-high PEEP ventilation; however, driving pressure was lower. Vt decrease and PEEP increase did not lead to oxygenation improvement and worsened CO2 elimination. Hemodynamically, the study revealed significant cardiac output decrease during low Vt-high PEEP ventilation. In 23.2% of patients, catecholamine therapy was initiated. Conclusions. In postoperative cardiosurgical patients, MV with Vt 6 ml × kg−1 and PEEP 10 cm H2O is characterized by worsened oxygenation and elimination of CO2 and a less favorable hemodynamic profile than ventilation with Vt 10 ml × kg−1 and PEEP 5 cmH2O. New and Noteworthy. (i) Patients after CABG may be especially sensitive to low tidal volume and increased PEEP as it negatively affects hemodynamic profile by means of the right heart preload decrease and afterload increase. (ii) Mechanical ventilation settings aiming to minimize mean airway pressure reduce the negative effects of positive inspiratory pressure and are favorable for hemodynamics.

Mean airway pressure vs. positive end-expiratory pressure during mechanical ventilation

1985 ◽  
Vol 13 (1) ◽  
pp. 34-37 ◽  
Author(s):  
ANTONIO PESENTI ◽  
ROBERTO MARCOLIN ◽  
PAOLO PRATO ◽  
MASSIMO BORELLI ◽  
ANNA RIBONI ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Airway Pressure ◽  
Positive End Expiratory Pressure ◽  
Mean Airway Pressure
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