Dynamic PEEP Study: A Non-Invasive Diagnostic Exam to Assess for Effective PEEP in Fragile Children With Severe BPD

Abstract ObjectiveTracheobronchomalacia (TBM) is common in neonates with bronchopulmonary dysplasia (BPD) and is associated with higher morbidity. This study evaluates the value of a CT protocol to assess the degree of TBM and gauge the adequacy of prescribed PEEP. Study DesignFour infants with severe BPD on invasive mechanical ventilation underwent a chest CT protocol, including limited reduced- dose expiratory scans with varying PEEP levels. ResultsBaseline PEEP was adjusted in all subjects after performing the Dynamic PEEP CT. In two infants, the PEEP was increased due to significant TBM, and in the other, two without signs of TBM PEEP was decreased. The clinical course improved in all patients after adjusting PEEP. ConclusionA "Dynamic PEEP" study is a highly reliable and non-invasive imaging modality for the evaluation of adequate ventilator settings in infants with severe BPD who are not optimal candidates for bronchoscopy.

Download Full-text

Spectrum and Clinical Characteristics of Symptomatic and Asymptomatic Coronavirus Disease 2019 (COVID-19) With and Without Pneumonia

Frontiers in Medicine ◽

10.3389/fmed.2021.645651 ◽

2021 ◽

Vol 8 ◽

Author(s):

Huihui Zeng ◽

Yiming Ma ◽

Zhiguo Zhou ◽

Wenlong Liu ◽

Peng Huang ◽

...

Keyword(s):

Mechanical Ventilation ◽

Viral Load ◽

Clinical Characteristics ◽

Invasive Mechanical Ventilation ◽

The Other ◽

Limited Information ◽

Viral Shedding ◽

Non Invasive ◽

Radiologic Findings ◽

Global Pandemic

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has become a global pandemic. Based on symptoms, COVID-19 cases can be classified as symptomatic or asymptomatic. However, there is limited information about the differences between COVID-19 patients with and without pneumonia. Our study aimed to further discuss the spectrum and clinical characteristics of symptomatic and asymptomatic COVID-19 patients with and without pneumonia.Methods: In China, all COVID-19 cases are hospitalized in designated hospitals until two continuous negative oropharyngeal swabs obtained, which allows the professional monitoring of symptoms and clinical characteristics. We stratified all COVID-19 cases in our database and evaluated clinical characteristics in different COVID-19 subgroups (symptomatic with pneumonia, symptomatic without pneumonia, asymptomatic with pneumonia, and asymptomatic without pneumonia).Results: According to symptoms and laboratory and radiologic findings, COVID-19 cases were defined as symptomatic with pneumonia, symptomatic without pneumonia, asymptomatic with pneumonia, or asymptomatic without pneumonia. There were differences in the clinical characteristics and prognosis among the four groups. Both non-invasive mechanical ventilation (18, 4.2%) and invasive mechanical ventilation (11, 2.6%) were applied in only the symptomatic with pneumonia group. Likewise, extracorporeal membrane oxygenation and continuous renal replacement therapy were applied in only the symptomatic with pneumonia group. There were no differences in viral load, the durations of viral shedding, and hospitalization among the four groups.Conclusion: We have defined a comprehensive spectrum of COVID-19 with and without pneumonia. The symptomatic with pneumonia group consumed more medical resources than the other groups, and extra caution and monitoring should be applied in this group. The asymptomatic COVID-19 group had a similar viral load and viral shedding duration as the symptomatic COVID-19 group.

Download Full-text

Person in Need of Airway Cleaning and Use of Mechanical Insufflator-Exsufflator

Advances in Medical Diagnosis, Treatment, and Care - Noninvasive Ventilation Technologies and Healthcare for Geriatric Patients ◽

10.4018/978-1-7998-3531-8.ch012 ◽

2020 ◽

pp. 193-208

Author(s):

Ana Daniela Costa ◽

Rogério Ferrinho Ferreira ◽

Raquel Cruz Amorim ◽

João Vitor Vieira

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Muscle Strength ◽

Invasive Mechanical Ventilation ◽

The Other ◽

Review Of The Literature ◽

Non Invasive ◽

Airway Clearance ◽

Ventilation Performance ◽

Airway Permeability

Clearing of the airways in patients undergoing invasive mechanical ventilation (IMV) or non-invasive mechanical ventilation (NIMV) is a fundamental intervention that should be performed regularly, not only to avoid accumulation of secretions, but also to prevent the accumulation of secretions. One of the most relevant interventions in this type of patients is the use of the mechanical insufflator-exsufflator (MI-E), commonly known as cough assist. On the other hand, respiratory functional reeducation (RFR) involves a set of non-invasive procedures that allow the secretion to be released. The efficacy of the RFR associated with the use of MI-E presents gains resulting from this conjugation, namely when the person does not cooperate, when he/she shows a decrease in muscle strength or fails to present an effective cough. The integrative review of the literature has made evident the gains that exist for the person in intensive care, using MI-E associated with airway clearance, ventilation performance, airway permeability, decreased complications, and rate mortality.

Download Full-text