scholarly journals Comparing the Intellivent-ASV® Mode with Conventional Ventilation Modes during Weaning after Uncomplicated Cardiac Surgery

2021 ◽  
Vol 18 (3) ◽  
pp. 36-45
Author(s):  
А. А. Eremenko ◽  
R. D. Komnov ◽  
P. А. Titov ◽  
S. А. Gerasimenko ◽  
D. А. Chakal
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Adverse Events ◽  
Tidal Volume ◽  
Driving Pressure ◽  
Conventional Ventilation ◽  
Respiratory Support ◽  
Control Group ◽  
Ventilation Modes ◽  
Ventilator Settings

The objective: to compare efficacy and safety of Intellivent-ASV® with conventional ventilation modes during weaning in the patients after cardiac surgery.Subjects and methods. In this randomized controlled trial, 40 adult patients were ventilated with conventional ventilation modes and 40 with Intellivent-ASV after uncomplicated cardiac surgery. Eight physicians were involved in the study.Care of both groups was standardized, except for the modes of postoperative ventilation.We compared:- The physician’s workload, through accounting number of manual ventilator settings and time they spent near the ventilator in every group,- Duration of tracheal intubation in ICU,- Evaluation of ventilation safety by considering driving pressure, mechanical power, positive end expiratory pressure, and tidal volume level,- The frequency of adverse events, postoperative complications, and lethality.Results. There were significant differences in the duration of respiratory support in ICU: 226 ± 31 min (Intellivent Group) vs 271 ± 78 min (Control Group) (p = 0.0013).In Intellivent Group, the number of manual ventilator settings and time spent by physicians near the ventilator before tracheal extubation were significantly lower: 0 vs 4 (2–6), and 35 (25–53) sec vs 164 ± 69 sec respectively (p < 0.001 in both cases).Intellivent-ASV provided significantly more protective ventilation through reduction in the driving pressure, tidal volume, FiO2 and PEEP levels but no difference was noted between paO2/FiO2 ratio. ∆P and Vt were significantly lower in Intellivent Group – ∆P on mechanical ventilation was 6 (5–7) cm H2O vs 7.25 (6.5–9.5) cm H2O (p < 0.001); Vt on mechanical ventilation was 6 (5.2–7) vs 7 (6–9.5) ml/kg/PBW (p = 0.000003). PEEP and FiO2 levels were also significantly lower in Intellivent Group, PEEP on mechanical ventilation was 5 (5–7.5) cm H2O vs 7 (5–11.5) cm H2O and FiO2 level was 26 (22–30) % vs 34 (30–40) %.There were no significant differences between the groups in frequency of adverse events and duration of ICU and hospital stay.Conclusion. Application of Intellivent-ASV mode after uncomplicated cardiac surgery provides more protective mechanical ventilation and reduces the physician’s workload without compromising the quality of respiratory support and safety of patients.

scholarly journals Patient-Ventilator Synchrony and Tidal Volume Variability using NAVA and Pressure Support Mechanical Ventilation Modes

2011 ◽  
Vol 44 (1) ◽  
pp. 569-574
Author(s):  
Katherine T. Moorhead ◽  
Lise Piquilloud ◽  
Bernard Lambermont ◽  
Jean Roeseler ◽  
J. Geoffrey Chase ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Pressure Support ◽  
Ventilation Modes ◽  
Ventilator Synchrony

Stress during mechanical ventilation: benefit of having concrete objective information before cardiac surgery

1999 ◽  
Vol 8 (2) ◽  
pp. 118-126 ◽  
Author(s):  
H Kim ◽  
BJ Garvin ◽  
DK Moser
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Negative Mood ◽  
Emotional Reactions ◽  
Control Group ◽  
Nursing Interventions ◽  
Objective Information ◽  
Analgesic Medication ◽  
Quasi Experimental ◽  
Experimental Group

BACKGROUND: Negative emotional reactions and difficulty in communicating are common in patients receiving mechanical ventilation and may adversely affect recovery from cardiac surgery. OBJECTIVE: To determine the effect of providing concrete objective information about emotional stress and difficulty in communicating related to mechanical ventilation to Korean cardiac surgery patients. METHODS: A quasi-experimental 2-group design was used. The 22 subjects in the control group received the usual information; the 21 in the experimental group received concrete objective information in addition to the usual information. State anxiety, negative affect, use of sedative and analgesic medications, and difficulty communicating were compared between the 2 groups after surgery. RESULTS: Patients who received concrete objective information experienced less anxiety and negative mood during mechanical ventilation, less difficulty in communicating, and a shorter intubation time than did patients in the control group. The 2 groups did not differ in the amount of sedative or analgesic medication used per hour during mechanical ventilation. CONCLUSIONS: Nursing interventions that include concrete objective information help cardiac patients cope with the stresses associated with surgery and mechanical ventilation.

Severe Calcification of the Ascending Aorta Detected Incidentally in Patients Undergoing Cardiac Surgery

2019 ◽  
Vol 68 (04) ◽  
pp. 309-314 ◽  
Author(s):  
Mohamed Salem ◽  
Baland Mohammad ◽  
Katharina Huenges ◽  
Christine Friedrich ◽  
Bernd Panholzer ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Adverse Events ◽  
Circulatory Arrest ◽  
Ascending Aorta ◽  
Control Group ◽  
Study Group ◽  
Preoperative Risk ◽  
Preoperative Risk Factors ◽  
Significant Difference ◽  
Severe Calcification

Background Incidentally discovered severe calcified ascending aorta (CAA) is a major challenge faced by surgeons during cardiac surgery. The aim of this study was to evaluate the outcome in patients undergoing cardiac surgery in this condition with the additional replacement of the CAA. Methods A retrospective study on a cohort of 74 patients (28.4% females; mean age: 73 ± 7 years) underwent cardiac surgery and initial replacement of an incidentally discovered CAA using moderate hypothermic circulatory arrest. A control group was matched according to age, gender, and procedure. Results No significant differences were noted with regard to preoperative risk factors. Due to the additional replacement of CAA, the extracorporeal circulation and cross-clamping time were significantly longer in the study group (p < 0.001). Postoperatively, no significant differences in complications were observed between the groups. There was no significant difference in regard to incidence of neurologic adverse events (5.4 vs. 2.7%; p = 0.68) or 30-day mortality (6.7 vs. 4.1%; p = 0.72). Conclusion Our study showed that the initial replacement of incidental CAA in patients undergoing cardiac surgery was not associated with increased risks for neurologic adverse events and mortality.

scholarly journals Ultra-protective mechanical ventilation without extra-corporeal carbon dioxide removal for acute respiratory distress syndrome

2018 ◽  
Vol 20 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Hariharan Regunath ◽  
Nathanial Moulton ◽  
Daniel Woolery ◽  
Mohammed Alnijoumi ◽  
Troy Whitacre ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Tidal Volume ◽  
Distress Syndrome ◽  
Carbon Dioxide Removal ◽  
Driving Pressure ◽  
Protective Mechanical Ventilation

Background Tidal hyperinflation can still occur with mechanical ventilation using low tidal volume (LVT) (6 mL/kg predicted body weight (PBW)) in acute respiratory distress syndrome (ARDS), despite a well-demonstrated reduction in mortality. Methods Retrospective chart review from August 2012 to October 2014. Inclusion: Age >18years, PaO2/FiO2<200 with bilateral pulmonary infiltrates, absent heart failure, and ultra-protective mechanical ventilation (UPMV) defined as tidal volume (VT) <6 mL/kg PBW. Exclusion: UPMV use for <24 h. Demographics, admission Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, arterial blood gas, serum bicarbonate, ventilator parameters for pre-, during, and post-UPMV periods including modes, VT, peak inspiratory pressure (PIP), plateau pressure (Pplat), driving pressure, etc. were gathered. We compared lab and ventilator data for pre-, during, and post-UPMV periods. Results Fifteen patients (male:female = 7:8, age 42.13 ± 11.29 years) satisfied criteria, APACHEII 20.6 ± 7.1, mean days in intensive care unit and hospitalization were 18.5 ± 8.85 and 20.81 ± 9.78 days, 9 (60%) received paralysis and 7 (46.67%) required inotropes. Eleven patients had echocardiogram, 7 (63.64%) demonstrated right ventricular volume or pressure overload. Eleven patients (73.33%) survived. During-UPMV, VT ranged 2–5 mL/kg PBW(3.99 ± 0.73), the arterial partial pressure of carbon dioxide (PaCO2) was higher than pre-UPMV values (84.81 ± 18.95 cmH2O vs. 69.16 ± 33.09 cmH2O), but pH was comparable and none received extracorporeal carbon dioxide removal (ECCO2-R). The positive end-expiratory pressure (14.18 ± 7.56 vs. 12.31 ± 6.84 cmH2O), PIP (38.21 ± 12.89 vs. 32.59 ± 9.88), and mean airway pressures (19.98 ± 7.61 vs. 17.48 ± 6.7 cm H2O) were higher during UPMV, but Pplat and PaO2/FiO2 were comparable during- and pre-UPMV. Driving pressure was observed to be higher in those who died than who survived (24.18 ± 12.36 vs. 13.42 ± 3.25). Conclusion UPMV alone may be a safe alternative option for ARDS patients in centers without ECCO2-R.

scholarly journals Neurally Adjusted Ventilatory Assist in Critically Ill Postoperative Patients: A Crossover Randomized Study

2010 ◽  
Vol 113 (4) ◽  
pp. 925-935 ◽  
Author(s):  
Yannael Coisel ◽  
Gerald Chanques ◽  
Boris Jung ◽  
Jean-Michel Constantin ◽  
Xavier Capdevila ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Gas Exchange ◽  
Electrical Activity ◽  
Tidal Volume ◽  
Critically Ill ◽  
Neurally Adjusted Ventilatory Assist ◽  
Exchange Effects ◽  
Ventilatory Parameters ◽  
Ventilatory Assist ◽  
Ventilation Modes

Background Neurally adjusted ventilatory assist (NAVA) is a new mode of mechanical ventilation that delivers ventilatory assist in proportion to the electrical activity of the diaphragm. This study aimed to compare the ventilatory and gas exchange effects between NAVA and pressure support ventilation (PSV) during the weaning phase of critically ill patients who required mechanical ventilation subsequent to surgery. Methods Fifteen patients, the majority of whom underwent abdominal surgery, were enrolled. They were ventilated with PSV and NAVA for 24 h each in a randomized crossover order. The ventilatory parameters and gas exchange effects produced by the two ventilation modes were compared. The variability of the ventilatory parameters was also evaluated by the coefficient of variation (SD to mean ratio). Results Two patients failed to shift to NAVA because of postoperative bilateral diaphragmatic paralysis, and one patient interrupted the study because of worsening of his sickness. In the other 12 cases, the 48 h of the study protocol were completed, using both ventilation modes, with no signs of intolerance or complications. The Pao2/Fio2 (mean ± SD) ratio in NAVA was significantly higher than with PSV (264 ± 71 vs. 230 ± 75 mmHg, P &lt; 0.05). Paco2 did not differ significantly between the two modes. The tidal volume (median [interquartile range]) with NAVA was significantly lower than with PSV (7.0 [6.4-8.6] vs. 6.5 [6.3-7.4] ml/kg predicted body weight, P &lt; 0.05).Variability of insufflation airway pressure, tidal volume, and minute ventilation were significantly higher with NAVA than with PSV. Electrical activity of the diaphragm variability was significantly lower with NAVA than with PSV. Conclusions Compared with PSV, respiratory parameter variability was greater with NAVA, probably leading in part to the significant improvement in patient oxygenation.

scholarly journals Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: A retrospective analysis

2020 ◽  
Author(s):  
Rongyuan Zhang ◽  
Xu Wang ◽  
Shoujun Li ◽  
Jun Yan
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Acute Respiratory Distress Syndrome ◽  
Congenital Heart ◽  
Low Dose ◽  
Distress Syndrome ◽  
Exogenous Surfactant ◽  
Control Group ◽  
Ventilation Time ◽  
Mechanical Ventilation Time

Abstract Purpose: To evaluate the effect of low-dose exogenous surfactant therapy on infants suffering acute respiratory distress syndrome (ARDS) after cardiac surgery. Materials and methods: We conducted a retrospective case-control study of the archive data of infants diagnosed with ARDS after cardiac surgery and admitted to pediatric cardiac surgical intensive care unit (PICU). A case was defined as a patient that received surfactant and standard therapy; a control was defined as a patient that underwent standard therapy. Controls were identified by matching patients based on age(±30d), weight(±3kg), risk adjustment congenital heart surgery-1 (RACHS-1), and initial ratio of partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (±10). Outcome variables namely oxygenation indices (OI), ventilation index (VI), mechanical ventilation time and PICU time were compared.Results: Forty-four patients, 22 who received surfactant (surfactant group) and 22 who did not (control group) were analyzed. Surfactant group obtained a significant improvement on OI (13.9 vs 5.62; p=0.000) and VI (42.0 vs 22.4; p=0.000) in 6 hours, while control group got no improvement on OI (13.2 vs 11.5; p=0.065) and VI (40.2 vs 36.4; p=0.100). Compared with control group, surfactant group had shorter ventilation time (133.6h vs 218.4h; p=0.000) and PICU time (10.7d vs 17.5d; p=0.001). Infants in surfactant group under 3 months benefit more from OI and VI than infants over 3 months.Conclusions: In congenital heart disease infants with post-surgery ARDS, low-dose exogenous surfactant treatment could prominently improve oxygenation and reduced mechanical ventilation time and PICU time. And the improvement of oxygenation is more effective for infants under 3 months.

scholarly journals Open-label randomized controlled trial of ultra-low tidal ventilation without extracorporeal circulation in patients with COVID-19 pneumonia and moderate to severe ARDS: study protocol for the VT4COVID trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jean-Christophe Richard ◽  
Hodane Yonis ◽  
Laurent Bitker ◽  
Sylvain Roche ◽  
Florent Wallet ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Study Protocol ◽  
Extracorporeal Circulation ◽  
Controlled Trial ◽  
Invasive Mechanical Ventilation ◽  
Intervention Group ◽  
Control Group ◽  
Selective Reporting ◽  
Link Type

Abstract Background Acute respiratory distress syndrome (ARDS) is a severe complication of COVID-19 pneumonia, with a mortality rate amounting to 34–50% in moderate and severe ARDS, and is associated with prolonged duration of invasive mechanical ventilation. Such as in non-COVID ARDS, harmful mechanical ventilation settings might be associated with worse outcomes. Reducing the tidal volume down to 4 mL kg−1 of predicted body weight (PBW) to provide ultra-low tidal volume ventilation (ULTV) is an appealing technique to minimize ventilator-inducted lung injury. Furthermore, in the context of a worldwide pandemic, it does not require any additional material and consumables and may be applied in low- to middle-income countries. We hypothesized that ULTV without extracorporeal circulation is a credible option to reduce COVID-19-related ARDS mortality and duration of mechanical ventilation. Methods The VT4COVID study is a randomized, multi-centric prospective open-labeled, controlled superiority trial. Adult patients admitted in the intensive care unit with COVID-19-related mild to severe ARDS defined by a PaO2/FiO2 ratio ≤ 150 mmHg under invasive mechanical ventilation for less than 48 h, and consent to participate to the study will be eligible. Patients will be randomized into two balanced parallels groups, at a 1:1 ratio. The control group will be ventilated with protective ventilation settings (tidal volume 6 mL kg−1 PBW), and the intervention group will be ventilated with ULTV (tidal volume 4 mL kg−1 PBW). The primary outcome is a composite score based on 90-day all-cause mortality as a prioritized criterion and the number of ventilator-free days at day 60 after inclusion. The randomization list will be stratified by site of recruitment and generated using random blocks of sizes 4 and 6. Data will be analyzed using intention-to-treat principles. Discussion The purpose of this manuscript is to provide primary publication of study protocol to prevent selective reporting of outcomes, data-driven analysis, and to increase transparency. Enrollment of patients in the study is ongoing. Trial registration ClinicalTrials.govNCT04349618. Registered on April 16, 2020

scholarly journals Ventilator-Induced Diaphragm Dysfunction (Review)

2018 ◽  
Vol 14 (3) ◽  
pp. 82-103
Author(s):  
M. A. Babaev ◽  
D. B. Bykov ◽  
Т. M. Birg ◽  
M. А. Vyzhigina ◽  
A. A. Eremenko
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Contractile Function ◽  
Clinical Manifestations ◽  
Lung Ventilation ◽  
Respiratory Support ◽  
Diaphragm Dysfunction ◽  
Mechanical Lung ◽  
Mechanical Lung Ventilation ◽  
Ventilation Modes

Mechanical ventilation is associated with a number of complications that increase the cost of treatment and the hospital mortality rate. In 2004, the term «ventilator-induced diaphragm dysfunction» (VIDD) was proposed to explain one of the reasons for the failure of respiratory support. At present, this term is understood as a combination of atrophy and weakness of the contractile function of the diaphragm caused directly by a long-term mechanical lung ventilation. Oxidative stress, proteolysis, mitochondrial dysfunction, as well as passive overdistension of the diaphragm fibers contribute greatly to the pathogenesis of VIDD. Since 30—80% of patients in the ICU require mechanical respiratory support and even 6—8 hours of mechanical lung ventilation can contribute to the development of a significant weakness of the diaphragm, it can be concluded that the VIDD is an extremely urgent problem in most patients. Its typical clinical presentation is characterized by impaired breathing mechanics and unsuccessful attempts to switch the patient to the spontaneous breathing in the absence of other valid reasons for respiratory disorders. The sonography is the most informative and accessible diagnostic method, and preservation of spontaneous breathing activity and the use of the latest mechanical ventilation modes are considered a promising approach to prevention and correction of the disorders. The search for an optimal strategy for lung ventilation, development of diagnostic and physiotherapeutic methods, as well as the consolidation of the work of a multidisciplinary team of specialists (anesthesiologists and intensive care specialists, neurologists, pulmonologists, surgeons, etc.) can help in solving this serious problem. A review of 122 sources about the VIDD presented data on the background of the issue, the definition of the problem, etiology and pathogenesis, clinical manifestations, methods of diagnosis, the effect of drugs, prevention and therapy. 

scholarly journals The relationship of tidal volume and driving pressure with mortality in hypoxic patients receiving mechanical ventilation

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255812
Author(s):  
Robert A. Raschke ◽  
Brenda Stoffer ◽  
Seth Assar ◽  
Stephanie Fountain ◽  
Kurt Olsen ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Regression Analysis ◽  
Hospital Mortality ◽  
Tidal Volume ◽  
Driving Pressure ◽  
Predicted Body Weight ◽  
Mechanically Ventilated ◽  
Referent Group ◽  
Relationship Of ◽  
The Relationship

Purpose To determine whether tidal volume/predicted body weight (TV/PBW) or driving pressure (DP) are associated with mortality in a heterogeneous population of hypoxic mechanically ventilated patients. Methods A retrospective cohort study involving 18 intensive care units included consecutive patients ≥18 years old, receiving mechanical ventilation for ≥3 days, with a PaO2/FiO2 ratio ≤300 mmHg, whether or not they met full criteria for ARDS. The main outcome was hospital mortality. Multiple logistic regression (MLR) incorporated TV/PBW, DP, and potential confounders including age, APACHE IVa® predicted hospital mortality, respiratory system compliance (CRS), and PaO2/FiO2. Predetermined strata of TV/PBW were compared using MLR. Results Our cohort comprised 5,167 patients with mean age 61.9 years, APACHE IVa® score 79.3, PaO2/FiO2 166 mmHg and CRS 40.5 ml/cm H2O. Regression analysis revealed that patients receiving DP one standard deviation above the mean or higher (≥19 cmH20) had an adjusted odds ratio for mortality (ORmort) = 1.10 (95% CI: 1.06–1.13, p = 0.009). Regression analysis showed a U-shaped relationship between strata of TV/PBW and adjusted mortality. Using TV/PBW 4–6 ml/kg as the referent group, patients receiving >10 ml/kg had similar adjusted ORmort, but those receiving 6–7, 7–8 and 8–10 ml/kg had lower adjusted ORmort (95%CI) of 0.81 (0.65–1.00), 0.78 (0.63–0.97) and 0.80 0.67–1.01) respectively. The adjusted ORmort in patients receiving 4–6 ml/kg was 1.26 (95%CI: 1.04–1.52) compared to patients receiving 6–10 ml/kg. Conclusions Driving pressures ≥19 cmH2O were associated with increased adjusted mortality. TV/PBW 4-6ml/kg were used in less than 15% of patients and associated with increased adjusted mortality compared to TV/PBW 6–10 ml/kg used in 82% of patients. Prospective clinical trials are needed to prove whether limiting DP or the use of TV/PBW 6–10 ml/kg versus 4–6 ml/kg benefits mortality.

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