scholarly journals Impacts in the Respiratory Mechanics of the Ventilator Hyperinsuflation in the Flow Bias Concept: a Narrative Review

2019 ◽  
Vol 21 (3) ◽  
pp. 250
Author(s):  
Jéssica Dos Santos Pereira da Rosa Gonçalves ◽  
Walkiria Shimoya-Bittencourt ◽  
Viviane Martins Santos ◽  
Michel Belmonte
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Mechanics ◽  
Ventilatory Support ◽  
Lung Compliance ◽  
Narrative Review ◽  
Mechanical Ventilator ◽  
Multiprofessional Team ◽  
Central Direction ◽  
Relevant Role ◽  
Expiratory Flow

AbstractPatients who require invasive ventilatory support are subject to the deleterious effects of this, mainly ventilator-associated pneumonia (VAP). The physiotherapist, a member of the multiprofessional team, assists the patient with the purpose of promoting the recovery and preservation of the functionality, being able to minimize / avoid secondary complications. This study aims to identify the repercussions of mechanical ventilation hyperinflation (MVH) in the flow bias concept in respiratory mechanics. This study is a narrative review. MVH is an important resource commonly used in clinical practice that involves the manipulation of mechanical ventilator configurations to provide larger pulmonary volumes, and the generated airflow gradient may play a relevant role in mucus transport, with the concept of flow bias the main factor responsible for its direction. For the mobilization of the mucus towards the cephalic direction to occur, there must be a predominant expiratory flow, guaranteeing the peak ratio of expiratory flow / inspiratory flow peak (EFP / IFP) greater than 1.11. Maintenance of mechanical ventilation assures the patient to maintain the positive end expiratory pressure (PEEP) and the oxygen inspired fraction, avoiding the deleterious effects of the mechanical ventilator disconnection. MVH is able to improve lung compliance without, however, increasing airway resistance. MVH in the cephalic flow bias concept is effective for the mucus mobilization in the central direction, being able to improve pulmonary compliance and peripheral oxygen saturation.Keywords: Respiration, Artificial. Intensive Care Units. Physical Therapy Department, Hospital.ResumoOs pacientes internados que necessitam de suporte ventilatório invasivo estão sujeitos aos efeitos deletérios deste, principalmente a pneumonia associada à ventilação mecânica (PAV). O fisioterapeuta, integrante da equipe multiprofissional, assiste o paciente com a finalidade de promover a recuperação e preservação da funcionalidade, podendo minimizar/evitar complicações secundárias. Este estudo consiste em identificar as repercussões da hiperinsuflação com ventilador mecânico (HVM) no conceito flow bias na mecânica respiratória. O presente estudo trata-se de uma revisão narrativa. A HVM é um importante recurso comumente utilizado na prática clínica que envolve a manipulação das configurações do ventilador mecânico para fornecer maiores volumes pulmonares, e o gradiente de fluxo de ar gerado pode desempenhar um papel relevante no transporte do muco, sendo o conceito de flow bias cefálico o principal fator responsável pelo direcionamento deste. Para que a mobilização do muco em direção cefálica ocorra, deve existir um fluxo expiratório predominante, garantindo a razão pico de fluxo expiratório/pico de fluxo inspiratório (PFE/PFI) maior do que 1,11. A manutenção da assistência ventilatória mecânica assegura ao paciente a manutenção da pressão positiva ao final da expiração (PEEP) e a fração inspirada de oxigênio (FiO2), evitando os efeitos deletérios da desconexão do ventilador mecânico. A HVM é capaz de melhorar a complacência pulmonar sem, no entanto, aumentar a resistência das vias aéreas. A HVM no conceito flow bias cefálico é eficaz para a mobilização do muco em direção central, sendo capaz de melhorar a complacência pulmonar e saturação periférica de oxigênio (SpO2).Palavras-chave: Respiração Artificial. Unidades de Terapia Intensiva. Serviço Hospitalar de Fisioterapia.

scholarly journals VENTILATORY SUPPORT IN SARS-VOC-2 DURING INTENSIVE THERAPY

2020 ◽  
Author(s):  
Javier Eliecer Pereira Rodriguez ◽  
Juan Camilo Quintero Gomez ◽  
Otilio Lopez Florez ◽  
Sandra Sharon Waiss Skvirsky ◽  
Ximena Velasquez Badillo
Keyword(s):  
Mechanical Ventilation ◽  
Observational Studies ◽  
Intensive Therapy ◽  
Ventilatory Support ◽  
Cochrane Collaboration ◽  
Plateau Pressure ◽  
Lung Compliance ◽  
Respiratory Support ◽  
Pulmonary Vasodilators ◽  
Critical Patients

Introduction: The SARS-CoV-2 disease outbreak has now become a pandemic. Critical patients with COVID-19 require basic and advanced respiratory support. Therefore, the objective was to describe the ventilatory support strategies in SARS-CoV-2 during intensive therapy. Materials and methods: A systematic review of observational studies of the available scientific literature was performed in accordance with the recommendations of the Cochrane collaboration and the criteria of the PRISMA Declaration. Results: Fifteen observational studies were included that gave a study population of 4,081 patients. Mechanical ventilation is the main respiratory support treatment for critically ill patients, which should be administered as soon as normal oxygenation cannot be maintained, and despite the fact that there is no current consensus on the parameters of mechanical ventilation, the evidence collected suggests the use of Fio2 on average 50%, PEEP of 14 cmH2O, lung compliance of 29-37 ml per cm of water, driving pressure between 12-14 cm of water and a plateau pressure of 22-25 cm of water. Conclusions: IL-6 is shown as a possible marker of respiratory failure and a worse prognosis as well as obesity. In addition, the use of prone position, neuromuscular blockade, pulmonary vasodilators, ECMO, and mechanical ventilation based on the clinical conditions and needs of the patient with COVID-19 are strategies that could benefit patients entering intensive therapy for SARS-CoV- 2.

scholarly journals Inhalation therapy in mechanical ventilation

2015 ◽  
Vol 41 (5) ◽  
pp. 467-472 ◽  
Author(s):  
Juçara Gasparetto Maccari ◽  
Cassiano Teixeira ◽  
Marcelo Basso Gazzana ◽  
Augusto Savi ◽  
Felippe Leopoldo Dexheimer-Neto ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Mechanics ◽  
Ventilatory Support ◽  
Drug Dose ◽  
Inhalation Therapy ◽  
Noninvasive Mechanical Ventilation ◽  
Ventilation Mode ◽  
Beta Adrenergic Agonists ◽  
Severity Of The Disease ◽  
Ventilator Synchrony

Patients with obstructive lung disease often require ventilatory support via invasive or noninvasive mechanical ventilation, depending on the severity of the exacerbation. The use of inhaled bronchodilators can significantly reduce airway resistance, contributing to the improvement of respiratory mechanics and patient-ventilator synchrony. Although various studies have been published on this topic, little is known about the effectiveness of the bronchodilators routinely prescribed for patients on mechanical ventilation or about the deposition of those drugs throughout the lungs. The inhaled bronchodilators most commonly used in ICUs are beta adrenergic agonists and anticholinergics. Various factors might influence the effect of bronchodilators, including ventilation mode, position of the spacer in the circuit, tube size, formulation, drug dose, severity of the disease, and patient-ventilator synchrony. Knowledge of the pharmacological properties of bronchodilators and the appropriate techniques for their administration is fundamental to optimizing the treatment of these patients.

scholarly journals Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
J.-L. Diehl ◽  
N. Peron ◽  
R. Chocron ◽  
B. Debuc ◽  
E. Guerot ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Dead Space ◽  
Respiratory Mechanics ◽  
Invasive Mechanical Ventilation ◽  
Endothelial Damage ◽  
Circulating Endothelial Cells ◽  
Pulmonary Mechanics ◽  
High Peep ◽  
Gas Exchanges ◽  
Physiological Dead Space

Abstract Rationale COVID-19 ARDS could differ from typical forms of the syndrome. Objective Pulmonary microvascular injury and thrombosis are increasingly reported as constitutive features of COVID-19 respiratory failure. Our aim was to study pulmonary mechanics and gas exchanges in COVID-2019 ARDS patients studied early after initiating protective invasive mechanical ventilation, seeking after corresponding pathophysiological and biological characteristics. Methods Between March 22 and March 30, 2020 respiratory mechanics, gas exchanges, circulating endothelial cells (CEC) as markers of endothelial damage, and D-dimers were studied in 22 moderate-to-severe COVID-19 ARDS patients, 1 [1–4] day after intubation (median [IQR]). Measurements and main results Thirteen moderate and 9 severe COVID-19 ARDS patients were studied after initiation of high PEEP protective mechanical ventilation. We observed moderately decreased respiratory system compliance: 39.5 [33.1–44.7] mL/cmH2O and end-expiratory lung volume: 2100 [1721–2434] mL. Gas exchanges were characterized by hypercapnia 55 [44–62] mmHg, high physiological dead-space (VD/VT): 75 [69–85.5] % and ventilatory ratio (VR): 2.9 [2.2–3.4]. VD/VT and VR were significantly correlated: r2 = 0.24, p = 0.014. No pulmonary embolism was suspected at the time of measurements. CECs and D-dimers were elevated as compared to normal values: 24 [12–46] cells per mL and 1483 [999–2217] ng/mL, respectively. Conclusions We observed early in the course of COVID-19 ARDS high VD/VT in association with biological markers of endothelial damage and thrombosis. High VD/VT can be explained by high PEEP settings and added instrumental dead space, with a possible associated role of COVID-19-triggered pulmonary microvascular endothelial damage and microthrombotic process.

scholarly journals Surgical tracheostomy in a cohort of COVID-19 patients

HNO ◽  
2021 ◽  
Author(s):  
Patrick J. Schuler ◽  
Jens Greve ◽  
Thomas K. Hoffmann ◽  
Janina Hahn ◽  
Felix Boehm ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Prolonged Mechanical Ventilation ◽  
Tertiary Care ◽  
Lung Compliance ◽  
Hypoxemic Respiratory Failure ◽  
Surgical Tracheostomy ◽  
Increased Risk ◽  
Open Surgical Tracheostomy ◽  
Sedative Drugs

Abstract Background One of the main symptoms of severe infection with the new coronavirus‑2 (SARS-CoV-2) is hypoxemic respiratory failure because of viral pneumonia with the need for mechanical ventilation. Prolonged mechanical ventilation may require a tracheostomy, but the increased risk for contamination is a matter of considerable debate. Objective Evaluation of safety and effects of surgical tracheostomy on ventilation parameters and outcome in patients with COVID-19. Study design Retrospective observational study between March 27 and May 18, 2020, in a single-center coronavirus disease-designated ICU at a tertiary care German hospital. Patients Patients with COVID-19 were treated with open surgical tracheostomy due to severe hypoxemic respiratory failure requiring mechanical ventilation. Measurements Clinical and ventilation data were obtained from medical records in a retrospective manner. Results A total of 18 patients with confirmed SARS-CoV‑2 infection and surgical tracheostomy were analyzed. The age range was 42–87 years. All patients received open tracheostomy between 2–16 days after admission. Ventilation after tracheostomy was less invasive (reduction in PEAK and positive end-expiratory pressure [PEEP]) and lung compliance increased over time after tracheostomy. Also, sedative drugs could be reduced, and patients had a reduced need of norepinephrine to maintain hemodynamic stability. Six of 18 patients died. All surgical staff were equipped with N99-masks and facial shields or with powered air-purifying respirators (PAPR). Conclusion Our data suggest that open surgical tracheostomy can be performed without severe complications in patients with COVID-19. Tracheostomy may reduce invasiveness of mechanical ventilation and the need for sedative drugs and norepinehprine. Recommendations for personal protective equipment (PPE) for surgical staff should be followed when PPE is available to avoid contamination of the personnel.

MECHANICAL VENTILATION FOR INTERSTITIAL LUNG DISEASE BY SYSTEMIC SCLEROSIS WITH CREST SYNDROME. PRESENTATION OF A CLINICAL CASE

2021 ◽  
pp. 80-81
Author(s):  
Katherine Esparza Maquilón ◽  
Antonio Miguel Ornes Rodriguez ◽  
Diana Mercedes Bombón Salazar ◽  
Daniela Macarena Mediavilla Paredes ◽  
Luis Gustavo Mediavilla Sevilla ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Systemic Sclerosis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Crest Syndrome ◽  
Positive Skin ◽  
Lung Protection ◽  
Advanced Stages

INTRODUCTION. Interstitial lung disease (ILD) with acute respiratory failure needs ventilatory support poorly documented. One of the interstitial diseases known is the Systemic sclerosis, its advanced stages develop CREST syndrome. Faverio P, et al. (2016) suggested do not close the door to these patients and open the correct protocol, criticizing the little value that the scientic community concede to invasive mechanical ventilation (IMV). CASE REPORT. 85-year-old male is internalized in critical care unit by pneumonia, the complementary evaluation shows a systemic sclerosis disease with CREST syndrome and it is conrmed by elevation of anti-centromere antibody and positive skin biopsy. Tomography highlights pneumonic consolidation plus interstitial lung involvement and echocardiography reveals pulmonary hypertension. The management is done with IMV, keeping the goal of driving pressure less than 15 as lung protection, recovering respiratory function in 3 weeks. Discussion. The evidence is too insufcient to establish the best decision on IMV to the management of ILD.

scholarly journals Adaptive Support Ventilation as a Sole Mode of Mechanical Ventilation-An Observational Study

2017 ◽  
Vol 1 (1) ◽  
pp. 8-12
Author(s):  
L.K. Rajbanshi ◽  
M. Dali ◽  
S.B. Karki ◽  
K. Khanal ◽  
B. Aryal ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Observational Study ◽  
Ventilatory Support ◽  
Control Mode ◽  
Adaptive Support Ventilation ◽  
Support Ventilation ◽  
Adaptive Support ◽  
The Mean

Introduction Adaptive support ventilation (ASV) is a close loop dual control mechanical ventilation mode. This mode can automatically change its parameters to weaning mode once the patient is actively breathing converting volume targeted pressure control mode to volume targeted pressure support mode. We aimed to observe the outcome of the patients ventilated with ASV as a sole mode in terms of duration of mechanical ventilation, duration of weaning from the ventilatory support and length of Intensive care unit (ICU) stay.Methodology We conducted a prospective observational study for the duration of six months (Sept 2015 to Feb 2016) to assess the clinical outcome of the patients ventilated by ASV as a sole mode of ventilation. The study conducted observation of 78 patients without chronic respiratory, renal, hepatic and neurological disease who were admitted in our intensive care unit for invasive ventilatory support.Results Out of the 187 patients who required invasive and noninvasive ventilation, only 78 patients fulfilled the criteria to be included in the study. It was observed that the mean duration of mechanical ventilation was 5.4 days while weaning as well as tracheal extubation was successful within 13 hours of initiation of weaning. The mean duration of ICU stay was found to be 6.3 days.Conclusion We concluded that the patient ventilated by ASV mode were effectively weaned without the need of changing the ventilator mode. However, the safety of ASV mode needs to be established by large randomized control trail in a wide spectrum of patients.Birat Journal of Health Sciences 2016 1(1): 8-12

Alternative Modes of Mechanical Ventilation

2018 ◽  
Vol 29 (4) ◽  
pp. 396-404
Author(s):  
John J. Gallagher
Keyword(s):  
Mechanical Ventilation ◽  
Closed Loop ◽  
Treatment Options ◽  
Ventilatory Support ◽  
Dual Control ◽  
Mechanical Ventilators ◽  
Lung Protection ◽  
Ventilation Modes ◽  
Volume Controlled ◽  
Pressure Controlled

Modern mechanical ventilators are more complex than those first developed in the 1950s. Newer ventilation modes can be difficult to understand and implement clinically, although they provide more treatment options than traditional modes. These newer modes, which can be considered alternative or nontraditional, generally are classified as either volume controlled or pressure controlled. Dual-control modes incorporate qualities of pressure-controlled and volume-controlled modes. Some ventilation modes provide variable ventilatory support depending on patient effort and may be classified as closed-loop ventilation modes. Alternative modes of ventilation are tools for lung protection, alveolar recruitment, and ventilator liberation. Understanding the function and application of these alternative modes prior to implementation is essential and is most beneficial for the patient.

Prevention of Methacholine-induced Changes in Respiratory Mechanics in Piglets

1997 ◽  
Vol 87 (3) ◽  
pp. 585-590 ◽  
Author(s):  
Walid Habre ◽  
Johannes H. Wildhaber ◽  
Peter D. Sly
Keyword(s):  
Respiratory Mechanics ◽  
Minimum Alveolar Concentration ◽  
Volatile Anesthetic ◽  
Lung Compliance ◽  
Control Group ◽  
Alveolar Pressure ◽  
Insufficient Information ◽  
Volatile Anesthetic Agent ◽  
Airway Opening ◽  
Induced Changes

Background Sevoflurane is a new volatile anesthetic agent that may be a useful alternative to halothane for anesthesia in children. However, there is insufficient information about its effects on respiratory mechanics, particularly in the presence of constrictor stimuli. Methods Eighteen piglets had anesthesia induced and maintained with either pentobarbital (control: n = 8), 1 minimum alveolar concentration (MAC) sevoflurane (sevo: n = 5), or 1 MAC halothane (halo: n = 5). Pressure, flow, and volume were measured at the airway opening and used to calculate lung compliance (C(L)) and resistance (R(L)). Resistance was partitioned into airway (Raw) and parenchymal (Vti) components using alveolar pressure. Methacholine was infused intravenously in a dose sufficient (15 microg x kg(-1) x h(-1)) to approximately double R(L). Results The increase in R(L) seen in the control group was almost entirely due to an increase in Vti. Sevoflurane and halothane prevented the increase in R(L) and Vti (both P < 0.02) and the decrease in C(L) (both P < 0.02). Conclusions Sevoflurane and halothane can prevent methacholine-induced changes in lung function.

scholarly journals Multiple Mechanical Ventilation: historical review and cost analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yina Faizully Quintero-Gamboa ◽  
Carlos Andrés Aguirre-Rodríguez ◽  
Aradeisy Ibarra-Picón ◽  
Edwin Rua-Ramírez ◽  
Edwin Gilberto Medina-Bejarano
Keyword(s):  
Public Health ◽  
Mechanical Ventilation ◽  
Cost Analysis ◽  
Historical Review ◽  
Medical Community ◽  
Mechanical Ventilator ◽  
Mechanical Ventilators ◽  
The Subject ◽  
Flow Division ◽  
Flow Splitter

In times of crisis in public health where the resources available in the hospital network are scarce and these must be used to the fullest, innovative ideas arise, which allow multiplying the use of existing resources, as artificial mechanical ventilators can be. These can be used in more than one patient, by attaching a device to distribute the mixture of air and oxygen from the ventilator being used simultaneously (multiple mechanical ventilation). This idea, although innovative, has generated controversy among the medical community, as many fear for the safety of their patients, because attaching such devices to the ventilator loses control over the mechanical ventilation variables of each patient and can only maintain general vigilance over the ventilator. These misgivings about the device have led several researchers to take on the task of verifying the reliability of this flow splitter connector. It is for this reason that this article presents a thorough review of the studies carried out on the subject and additionally shows an analysis of comparative costs between the acquisition of a mechanical ventilator and the flow division system.

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