Mechanical Ventilation: Respiratory Physiology and Conventional Ventilation

2018 ◽  
Author(s):  
Adrian A. Maung ◽  
Lewis J Kaplan
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Distress Syndrome ◽  
Functional Unit ◽  
Respiratory Physiology ◽  
Pulmonary Physiology ◽  
Functional Understanding ◽  
Ground Ambulance ◽  
Prerequisite Knowledge ◽  
Ventilation Modes

This three-part review is intended to enable the reader to manage the fundamentals of mechanical ventilation in both the urgent and the nonurgent setting. This first chapter provides a functional understanding of basic pulmonary physiology as a prerequisite knowledge base prior to reviewing the concepts central to basic, traditional, and cyclical ventilation that is regularly employed in the air or ground ambulance, emergency department, operating room, and intensive care unit. Subsequent chapters will review advanced ventilation modes, adjuncts, and special problems encountered in patients with respiratory failure requiring mechanical ventilation. Each segment is intended to build on the preceding one and therefore establishes a functional unit with regard to mechanical ventilation, whether it is provided in an invasive or a noninvasive fashion.   This review contains 5 Figures and 10 references Key Words: acute respiratory failure, acute respiratory distress syndrome, hypercapnia/therapy, hypoxia/therapy, mechanical ventilation, pulmonary gas exchange

Mechanical Ventilation: Respiratory Physiology and Conventional Ventilation

2018 ◽  
Author(s):  
Adrian A. Maung ◽  
Lewis J Kaplan
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Distress Syndrome ◽  
Functional Unit ◽  
Respiratory Physiology ◽  
Pulmonary Physiology ◽  
Functional Understanding ◽  
Ground Ambulance ◽  
Prerequisite Knowledge ◽  
Ventilation Modes

This three-part review is intended to enable the reader to manage the fundamentals of mechanical ventilation in both the urgent and the nonurgent setting. This first chapter provides a functional understanding of basic pulmonary physiology as a prerequisite knowledge base prior to reviewing the concepts central to basic, traditional, and cyclical ventilation that is regularly employed in the air or ground ambulance, emergency department, operating room, and intensive care unit. Subsequent chapters will review advanced ventilation modes, adjuncts, and special problems encountered in patients with respiratory failure requiring mechanical ventilation. Each segment is intended to build on the preceding one and therefore establishes a functional unit with regard to mechanical ventilation, whether it is provided in an invasive or a noninvasive fashion.   This review contains 5 Figures and 10 references Key Words: acute respiratory failure, acute respiratory distress syndrome, hypercapnia/therapy, hypoxia/therapy, mechanical ventilation, pulmonary gas exchange

Surfactant therapy in combination treatment of COVID-19 related acute respiratory distress syndrome

2021 ◽  
pp. 50-56
Author(s):  
Renat R. Gubaidullin ◽  
◽  
Aleksandr P. Kuzin ◽  
Vladimir V. Kulakov ◽  
◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Standard Therapy ◽  
Distress Syndrome ◽  
Severe Pneumonia ◽  
Lung Ventilation ◽  
Surfactant Therapy

ntroduction. The COVID-19 pandemic caused an outbreak of viral lung infections with severe acute respiratory syndrome complicated with acute respiratory failure. Despite the fact that the pandemic has a lengthened run, none of the therapeutic approaches have proved to be sufficiently effective according to the evidence-based criteria. We consider the use of surfactant therapy in patients with severe viral pneumonia and acute respiratory distress syndrome (ARDS) as one of the possible methods for treating COVID-19 related pneumonia. Objective. To prove the clinical efficacy and safety of orally inhaled Surfactant-BL, an authorized drug, in the combination therapy of COVID-19 related ARDS. Materials and methods. A total of 38 patients with COVID-19 related severe pneumonia and ARDS were enrolled in the study. Of these, 20 patients received the standard therapy in accordance with the temporary guidelines for the prevention, diagnosis and treatment of the novel coronavirus infection (COVID-19) of the Ministry of Health of the Russian Federation, version 9. And 18 patients received the surfactant therapy in addition to the standard therapy. Surfactant-BL was used in accordance with the instructions on how to administer the drug for the indication – prevention of the development of acute respiratory distress syndrome. A step-by-step approach to the build-up of the respiratory therapy aggressiveness was used to manage hypoxia. We used oxygen inhalation via a face mask with an oxygen inflow of 5–15 l/min, highflow oxygen therapy via nasal cannulas using Airvo 2 devices, non-invasive lung ventilation, invasive lung ventilation in accordance with the principles of protective mechanical ventilation. Results and discussion. Significant differences in the frequency of transfers to mechanical ventilation, mortality, Intensive Care Unit (ICU) and hospitalization length of stay (p <0.05) were found between the groups. Patients receiving surfactant therapy who required a transfer to mechanical ventilation accounted for 22% of cases, and the mortality rate was 16%. In the group of patients receiving standard therapy without surfactant inhalation 45% were transferred to mechanical ventilation, and 35% died. For patients receiving surfactant therapy, the hospital stay was reduced by 20% on average, and ICU stay by 30%. Conclusion. The inclusion of surfactant therapy in the treatment of COVID-19 related severe pneumonia and ARDS can reduce the progression of respiratory failure, avoid the use of mechanical ventilation, shorten the ICU and hospitalization length of stay, and improve the survival rate of this patient cohort.

Pulmonary Edema in Pregnancy

2019 ◽  
Author(s):  
Sarah Rae Easter ◽  
Nicole A. Smith
Keyword(s):  
Mechanical Ventilation ◽  
Pulmonary Edema ◽  
Distress Syndrome ◽  
Respiratory Alkalosis ◽  
Pulmonary Physiology ◽  
Circulatory Overload ◽  
Physiology In Pregnancy ◽  
Important Branch ◽  
Maternal Status ◽  
In Pregnancy

Pulmonary edema is characterized by the movement of excess fluid into the alveoli of the lungs.  Although the alterations of cardiovascular and pulmonary physiology in pregnancy may predispose patients to pulmonary edema, it is never normal and constitutes severe maternal morbidity.  The etiologies of pulmonary edema are diverse, ranging from disease processes independent of pregnancy to pathophysiology unique to the gravid state.  The causes of pulmonary edema can be broadly classified as either cardiogenic or noncardiogenic, which constitutes the first important branch point in the diagnosis and management of the disease.  The treatment of pulmonary edema in pregnancy parallels that in the nonpregnant population with an emphasis on maintaining the physiologic alterations of pregnancy through supportive care, including mechanical ventilation if needed.  In all cases of pulmonary edema, the decision to proceed with delivery to improve the maternal status should be considered within the context of the etiology and anticipated disease course, the gestational age, and the goals of care. This review contains  3 figures, 4 tables, and 60 references. Key Words:  Pulmonary edema, respiratory alkalosis, acute respiratory distress syndrome (ARDS), cardiogenic pulmonary edema, transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), mechanical ventilation, extra corporeal membrane oxygenation (ECMO).

Mechanical Ventilation: Approaches and Special Considerations

2018 ◽  
Author(s):  
Adrian A. Maung ◽  
Lewis J Kaplan
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Key Words ◽  
Spontaneous Breathing ◽  
Functional Unit ◽  
Spontaneous Breathing Trial

In this chapter, we complete the discussion of mechanical ventilation by examining approaches to mechanical ventilation for different patient populations and how to assess whether a patient is ready for liberation from mechanical ventilation. Each of the three chapters is intended to build on the preceding one and therefore establishes a functional unit with regard to mechanical ventilation, whether it is provided in an invasive or a noninvasive fashion.  This review contains 1 Figure, 1 Table and 31 references Key Words: acute respiratory failure, ARDS, mechanical ventilation liberation, spontaneous breathing trial, tracheostomy 

Outcome of Acute Hypoxaemic Respiratory Failure. Insights from the Lung Safe Study

2020 ◽  
pp. 2003317
Author(s):  
Tài Pham ◽  
Antonio Pesenti ◽  
Giacomo Bellani ◽  
Gordon Rubenfeld ◽  
Eddy Fan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Distress Syndrome ◽  
Pulmonary Involvement ◽  
Positive End Expiratory Pressure ◽  
Factors Associated ◽  
Risk Of Death ◽  
Increased Risk ◽  
Current Incidence

BackgroundThe current incidence and outcome of patients with acute hypoxaemic respiratory failure requiring mechanical ventilation in intensive care unit are unknown, especially for patients not meeting criteria for acute respiratory distress syndrome (ARDS).MethodsAn international, multicentre, prospective cohort study of patients presenting with hypoxemia early in the course of mechanical ventilation, conducted during four consecutive weeks in the winter of 2014 in 459 ICUs from 50 countries (LUNG SAFE). Patients were enrolled with PaO2/FiO2 ≤300 mmHg, new pulmonary infiltrates and need for mechanical ventilation with a positive end-expiratory pressure (PEEP) of at least 5 cm H2O. ICU prevalence, causes of hypoxemia, hospital survival, factors associated with hospital mortality were measured. Patients with unilateral versus bilateral opacities were compared.Findings12 906 critically ill patients received mechanical ventilation and 34.9% with hypoxaemia and new infiltrates were enrolled, separated into ARDS (69.0%), unilateral infiltrate (22.7%) and congestive heart failure (8.2%, CHF). The global hospital mortality was 38.6%. CHF patients had a mortality comparable to ARDS (44.1%versus 40.4%). Patients with unilateral-infiltrate had lower unadjusted mortality but similar adjusted mortality than ARDS. The number of quadrants on chest imaging was associated with an increased risk of death. There was no difference in mortality comparing patients with unilateral-infiltrate and ARDS with only 2 quadrants involved.InterpretationMore than one third of the patients receiving mechanical ventilation have hypoxaemia and new infiltrates with an hospital mortality of 38.6%. Survival is dependent on the degree of pulmonary involvement whether or not ARDS criteria are reached.

scholarly journals MANAGEMENT OF ACUTE RESPIRATORY DISTRESS SYNDROME IN A CHILD WITH ADENOVIRUS PNEUMONIA: CASE REPORT AND LITERATURE REVIEW

2020 ◽  
Vol 38 ◽  
Author(s):  
Felipe Rezende Caino de Oliveira ◽  
Krisna de Medeiros Macias ◽  
Patricia Andrea Rolli ◽  
José Colleti Junior ◽  
Werther Brunow de Carvalho
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
High Frequency Ventilation ◽  
Upper Respiratory Tract ◽  
Refractory Hypoxemia ◽  
Adenovirus Pneumonia

ABSTRACT Objective: To report the case of a child who developed acute respiratory distress syndrome (ARDS) from a pulmonary infection by adenovirus. Case description: A female patient aged 2 years and 6 months, weighting 10,295 grams developed fever, productive cough and vomiting, later on progressing to ARDS despite initial therapy in accordance with the institutional protocol for ARDS treatment. The child evolved to refractory hypoxemia and hypercapnia, requiring high parameters of mechanical pulmonary ventilation and use of vasoactive agents. In the treatment escalation, the patient received steroids, inhaled nitric oxide (iNO), was submitted to the prone position, started oscillatory high-frequency ventilation (HFOV) and extracorporeal membrane oxygenation (ECMO) was indicated due to severe refractory hypoxemia. During this time, the patient’s clinical response was favorable to HFOV, improving oxygenation index and hypercapnia, allowing the reduction of vasoactive medications and mechanical ventilation parameters, and then the indication of ECMO was suspended. The patient was discharged after 26 days of hospital stay without respiratory or neurological sequelae. Comments: Adenovirus infections occur mainly in infants and children under 5 years of age and represent 2 to 5% of respiratory diseases among pediatric patients. Although most children with adenovirus develop a mild upper respiratory tract disease, more severe cases can occur. ARDS is a serious pulmonary inflammatory process with alveolar damage and hypoxemic respiratory failure; Adenovirus pneumonia in children may manifest as severe pulmonary morbidity and respiratory failure that may require prolonged mechanical ventilation. Exclusive pulmonary recruitment and HFOV are advantageous therapeutic options.

scholarly journals Mechanical ventilation in patients with severe traumatic brain injury: modern guidelines review

2021 ◽  
Vol 17 (6) ◽  
pp. 28-34
Author(s):  
D.A. Krishtafor ◽  
O.M. Klygunenko ◽  
O.V. Kravets ◽  
V.V. Yekhalov ◽  
O.V. Liashchenko
Keyword(s):  
Traumatic Brain Injury ◽  
Mechanical Ventilation ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Distress Syndrome ◽  
Extubation Failure ◽  
Neurological Patients ◽  
Ventilation Modes ◽  
Common Group ◽  
Ventilation Strategies

Traumatic brain injury is the most common group of injuries among victims admitted to the emergency departments. Up to 20 % of individuals with brain damage require endotracheal intubation and mechanical ventilation, the duration of which is significantly longer than in non-neurological patients. Such patients have a higher incidence of acute respiratory distress syndrome and ventilator-associated pneumonia, and weaning and extubation are associated with significant difficulties. However, patients with traumatic brain injury are often excluded from randomized trials, and international guidelines for the treatment of severe traumatic brain injury do not provide clear ventilation strategies. Analysis of the literature allowed us to identify modern principles of respiratory support in severe traumatic brain injury, which include: tracheal intubation in Glasgow coma scale score of ≤ 8 points; early mechanical ventilation; PaO2 in the range of 80–120 mm Hg (SaO2 ≥ 95 %), PaCO2 — 35–45 mm Hg; tidal volume ≤ 8 ml/kg; respiratory rate ≈ 20/min; PEEP ≥ 5 cm H2O; head elevation by 30°; sedation in poor synchronization with the respirator; weaning from the respirator through the use of support ventilation modes; extubation when reaching 3 points on the VISAGE scale; early (up to 4 days) tracheostomy in predicted extubation failure.

Weaning from mechanical ventilation: patterns in young children recovering from acute hypoxemic respiratory failure

1998 ◽  
Vol 7 (5) ◽  
pp. 335-345 ◽  
Author(s):  
MA Curley ◽  
JC Fackler
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Young Children ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Weaning From Mechanical Ventilation ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

OBJECTIVE: The purpose of the study was to describe the patterns of weaning from mechanical ventilation in young children recovering from acute hypoxemic respiratory failure. METHODS: Decision-making rules on progressive weaning were developed and applied to existing data on 82 patients 2 weeks to 6 years old in the Pediatric Acute Respiratory Distress Syndrome Data Set. RESULTS: Three patterns of weaning progress were detected: sprint, consistent, and inconsistent. Length of ventilation and weaning progressively increased from the sprint, to the consistent, to the inconsistent subset. Patients in the inconsistent subset were most likely to have a systemic (sepsis or shock) trigger of acute respiratory distress syndrome and to be rated as having at least moderate disability at discharge. Hypothesis-generating univariate and then multivariate logistic regression analyses indicated that patients who experienced more days of mechanical ventilation before the start of weaning and who had a higher oxygenation index during the weaning process were most likely to have an inconsistent pattern of weaning. CONCLUSION: Patterns of weaning are discernible in a population of young children and indicate a subset at risk for inconsistent weaning. Knowing the patterns of weaning may help clinicians anticipate, perhaps plot, and then modulate a patient's weaning trajectory.

Mechanical Ventilation: Advanced Ventilation and Adjuncts

2018 ◽  
Author(s):  
Adrian A. Maung ◽  
Lewis J Kaplan
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Airway Pressure ◽  
Airway Pressure Release Ventilation ◽  
High Frequency Oscillation ◽  
Non Invasive ◽  
Pressure Release ◽  
Non Invasive Ventilation ◽  
Ventilation Modes ◽  
Pressure Release Ventilation

In this chapter, we continue the discussion of mechanical ventilation by reviewing advanced ventilation modes such as airway pressure release ventilation and high-frequency oscillation as well as adjuncts that can be used in patients with respiratory failure. Each segment is intended to build on the preceding one and therefore establishes a functional unit with regard to mechanical ventilation, whether it is provided in an invasive or a noninvasive fashion. This review contains 6 Figures and 69 references Key Words: acute respiratory failure, airway pressure–release ventilation, acute respiratory distress syndrome, high-flow nasal cannula, mechanical ventilation, non-invasive ventilation, prone positioning

Mechanical Ventilation: Advanced Ventilation and Adjuncts

2018 ◽  
Author(s):  
Adrian A. Maung ◽  
Lewis J Kaplan
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Airway Pressure ◽  
Airway Pressure Release Ventilation ◽  
High Frequency Oscillation ◽  
Non Invasive ◽  
Pressure Release ◽  
Non Invasive Ventilation ◽  
Ventilation Modes ◽  
Pressure Release Ventilation

In this chapter, we continue the discussion of mechanical ventilation by reviewing advanced ventilation modes such as airway pressure release ventilation and high-frequency oscillation as well as adjuncts that can be used in patients with respiratory failure. Each segment is intended to build on the preceding one and therefore establishes a functional unit with regard to mechanical ventilation, whether it is provided in an invasive or a noninvasive fashion. This review contains 6 Figures and 69 references Key Words: acute respiratory failure, airway pressure–release ventilation, acute respiratory distress syndrome, high-flow nasal cannula, mechanical ventilation, non-invasive ventilation, prone positioning

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