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

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.

Mechanical Ventilation Modes

2017 ◽  
Author(s):  
Yuan Lei
Keyword(s):  
Mechanical Ventilation ◽  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Ventilation Mode ◽  
Support Ventilation ◽  
Ventilation Modes ◽  
Standardized Terminology ◽  
Signature Waveforms ◽  
Shed Light

‘Mechanical Ventilation Modes’ seeks to shed light on this hotly debated topic, one that is complicated by ventilator manufacturers’ non-standardized terminology. The chapter looks at conventional modes, adaptive modes, and biphasic modes, which it classifies based on the mechanical breath types in each mode. It includes a comparison chart of the terminology used for common modes on popular IPPV ventilators. Using their signature waveforms, the author describes the assist/control, SIMV, and pressure support ventilation or PSV modes. It defines the modes by their application of spontaneous breaths and mandatory breaths. It continues with a discussion of adaptive modes and biphasic modes. It ends by discussing how to select the appropriate ventilation mode.

Carotid body denervation eliminates apnea in response to transient hypocapnia

2003 ◽  
Vol 94 (1) ◽  
pp. 155-164 ◽  
Author(s):  
Hideaki Nakayama ◽  
Curtis A. Smith ◽  
Joshua R. Rodman ◽  
James B. Skatrud ◽  
Jerome A. Dempsey
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Eye Movement ◽  
Carotid Body ◽  
Pressure Support ◽  
Intact Animal ◽  
Periodic Breathing ◽  
Rapid Eye Movement Sleep ◽  
Peripheral Chemoreceptor ◽  
End Tidal

We determined the effects on breathing of transient ventilatory overshoots and concomitant hypocapnia, as produced by pressure support mechanical ventilation (PSV), in intact and carotid body chemoreceptor denervated (CBX) sleeping dogs. In the intact dog, PSV-induced transient increases in tidal volume and hypocapnia caused apnea within 10–11 s, followed by repetitive two-breath clusters separated by apneas, i.e., periodic breathing (PB). After CBX, significant expiratory time prolongation did not occur until after 30 s of PSV-induced hypocapnia, and PB never occurred. Average apneas of 8.4 ± 1-s duration after a ventilatory overshoot required a decrease below eupnea of end-tidal Pco 2 5.1 ± 0.4 Torr below eupnea in the intact animal and 10.1 ± 2 Torr in the CBX dog, where the former reflected peripheral and the latter central dynamic CO2 chemoresponsiveness, as tested in the absence of peripheral chemoreceptor input. Hyperoxia when the dogs were intact shortened PSV-induced apneas and reduced PB but did not mimic the effects of CBX. We conclude that, during non-rapid eye movement sleep, carotid chemoreceptors are required to produce apneas that normally occur after a transient ventilatory overshoot and for PB.

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 Management of Intraoperative Mechanical Ventilation to Prevent Postoperative Complications after General Anesthesia: A Narrative Review

2021 ◽  
Vol 10 (12) ◽  
pp. 2656
Author(s):  
Alberto Fogagnolo ◽  
Federica Montanaro ◽  
Lou’i Al-Husinat ◽  
Cecilia Turrini ◽  
Michela Rauseo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Pulmonary Complications ◽  
Point Of View ◽  
Whole Body ◽  
Positive End Expiratory Pressure ◽  
Ventilation Strategies ◽  
Harmful Effects ◽  
Ventilation Induced Lung Injury ◽  
Different Levels

Mechanical ventilation (MV) is still necessary in many surgical procedures; nonetheless, intraoperative MV is not free from harmful effects. Protective ventilation strategies, which include the combination of low tidal volume and adequate positive end expiratory pressure (PEEP) levels, are usually adopted to minimize the ventilation-induced lung injury and to avoid post-operative pulmonary complications (PPCs). Even so, volutrauma and atelectrauma may co-exist at different levels of tidal volume and PEEP, and therefore, the physiological response to the MV settings should be monitored in each patient. A personalized perioperative approach is gaining relevance in the field of intraoperative MV; in particular, many efforts have been made to individualize PEEP, giving more emphasis on physiological and functional status to the whole body. In this review, we summarized the latest findings about the optimization of PEEP and intraoperative MV in different surgical settings. Starting from a physiological point of view, we described how to approach the individualized MV and monitor the effects of MV on lung function.

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