scholarly journals "Airway Pressure Release Ventilation" a step up care in ARDS

2014 ◽  
Vol 2 (1) ◽  
pp. 35-37
Author(s):  
M Motiul Islam ◽  
Raihan Rabbani ◽  
M Mofizul Islam Polash ◽  
Ahmad Mursel Anam
Keyword(s):  
Spontaneous Breathing ◽  
Protective Effects ◽  
Mechanical Ventilator ◽  
Ongoing Trial ◽  
Intermittent Mandatory Ventilation ◽  
Safe Alternative ◽  
Open Lung ◽  
Pressure Release Ventilation ◽  
Pressure Controlled ◽  
Open Lung Approach

APRV is a mode of mechanical ventilator which uses the principal of open lung approach. It is thought to be an effective & safe alternative for difficult to oxygenate patients like ARDS. It is inverse ratio, pressure controlled, intermittent mandatory ventilation with unrestricted spontaneous breathing. APRV has many purported advantages over conventional ventilation including alveolar recruitment, improved oxygenation, preservation of spontaneous breathing, improved hemodynamics and potential lung-protective effects. It has many claimed disadvantages related to risks of volumtrauma and increased energy expenditure related to spontaneous breathing. Though it was first described more than 20 years ago still it has not gained popularity till date as it is yet to prove its mortality benefits over other conventional modes. Currently there is a lot of ongoing trial globally on it. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19955 Bangladesh Crit Care J March 2014; 2 (1): 35-37

scholarly journals Pressure-Controlled Ventilation-Volume Guaranteed Mode Combined with an Open-Lung Approach Improves Lung Mechanics, Oxygenation Parameters, and the Inflammatory Response during One-Lung Ventilation: A Randomized Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Jianli Li ◽  
Baogui Cai ◽  
Dongdong Yu ◽  
Meinv Liu ◽  
Xiaoqian Wu ◽  
...  
Keyword(s):  
Lung Ventilation ◽  
Protective Ventilation ◽  
Lung Mechanics ◽  
Lung Protective Ventilation ◽  
One Lung Ventilation ◽  
Controlled Ventilation ◽  
Open Lung ◽  
Pressure Controlled Ventilation ◽  
Pressure Controlled ◽  
Open Lung Approach

We evaluated the effectiveness of pressure-controlled ventilation-volume guaranteed (PCV-VG) mode combined with open-lung approach (OLA) in patients during one-lung ventilation (OLV). First, 176 patients undergoing thoracoscopic surgery were allocated randomly to four groups: PCV+OLA (45 cases, PCV-VG mode plus OLA involving application of individualized positive end-expiratory pressure (PEEP) after a recruitment maneuver), PCV (44 cases, PCV-VG mode plus standard lung-protective ventilation with fixed PEEP of 5 cmH2O), VCV+OLA (45 cases, volume-controlled ventilation (VCV) plus OLA), and VCV (42 cases, VCV plus standard lung-protective ventilation). Mean airway pressure (Pmean), dynamic compliance (Cdyn), PaO2/FiO2 ratio, intrapulmonary shunt ratio (Qs/Qt), dead space fraction (VD/VT), and plasma concentration of neutrophil elastase were obtained to assess the effects of four lung-protective ventilation strategies. At 45 min after OLV, the median (interquartile range (IQR)) Pmean was higher in the PCV+OLA group (13.00 (12.00, 13.00) cmH2O) and the VCV+OLA group (12.00 (12.00, 14.00) cmH2O) than in the PCV group (11.00 (10.00, 12.00) cmH2O) and the VCV group (11.00 (10.00, 12.00) cmH2O) (P<0.05); the median (IQR) Cdyn was higher in the PCV+OLA group (27.00 (24.00, 32.00) mL/cmH2O) and the VCV+OLA group (27.00 (22.00, 30.00) mL/cmH2O) than in the PCV group (23.00 (21.00, 25.00) mL/cmH2O) and the VCV group (20.00 (18.75, 21.00) mL/cmH2O) (P<0.05); the median (IQR) Qs/Qt in the PCV+OLA group (0.17 (0.16, 0.19)) was significantly lower than that in the PCV group (0.19 (0.18, 0.20)) and the VCV group (0.19 (0.17, 0.20)) (P<0.05); VD/VT was lower in the PCV+OLA group (0.18±0.05) and the VCV+OLA group (0.19±0.07) than in the PCV group (0.21±0.07) and the VCV group (0.22±0.06) (P<0.05). The concentration of neutrophil elastase was lower in the PCV+OLA group than in the PCV, VCV+OLA, and VCV groups at total-lung ventilation 10 min after OLV (162.47±25.71, 198.58±41.99, 200.84±22.17, and 286.95±21.10 ng/mL, resp.) (P<0.05). In conclusion, PCV-VG mode combined with an OLA strategy leads to favorable effects upon lung mechanics, oxygenation parameters, and the inflammatory response during OLV.

Respiratory phase locking during mechanical ventilation in anesthetized human subjects

1986 ◽  
Vol 250 (5) ◽  
pp. R902-R909 ◽  
Author(s):  
C. Graves ◽  
L. Glass ◽  
D. Laporta ◽  
R. Meloche ◽  
A. Grassino
Keyword(s):  
Spontaneous Breathing ◽  
Breathing Pattern ◽  
Human Subjects ◽  
Phase Locking ◽  
Phase Relationship ◽  
Mechanical Ventilator ◽  
Lung Inflation ◽  
Fixed Phase ◽  
Simple Phase ◽  
Ventilator Settings

The coupling patterns between the rhythm of a mechanical ventilator and the rhythm of spontaneous breathing were studied in enflurane-anesthetized adult human subjects. The spontaneous breathing pattern was altered in response to different frequencies and amplitudes of forced lung inflations. A 1:1 phase locking (the frequency of the mechanical ventilator is matched by the frequency of spontaneous breathing with a fixed phase between the 2 rhythms) was observed in a range of up to +/- 40% of some of the subject's spontaneous breathing frequencies. During 1:1 phase locking, there were marked changes in the expiratory duration as measured from the electromyogram of the diaphragm. The phase relationship between onset of inflation and onset of inspiration depended on the frequency and amplitude of mechanical inflation. At ventilator settings that did not give 1:1 phase locking, other simple phase-locked patterns, such as 1:2 and 2:1, or irregular non-phase-locked patterns were observed. Reflexes arising from lung inflation, which may underlie the entrainment, are discussed in the context of these results.

Open lung approach ventilation abolishes the negative effects of respiratory rate in experimental lung injury

2016 ◽  
Vol 60 (8) ◽  
pp. 1131-1141 ◽  
Author(s):  
J. Retamal ◽  
J. B. Borges ◽  
A. Bruhn ◽  
R. Feinstein ◽  
G. Hedenstierna ◽  
...  
Keyword(s):  
Lung Injury ◽  
Respiratory Rate ◽  
Negative Effects ◽  
Open Lung ◽  
Open Lung Approach

Effects of positive end-expiratory pressure alone or an open-lung approach on recruited lung volumes and respiratory mechanics of mechanically ventilated horses

2019 ◽  
Vol 46 (6) ◽  
pp. 780-788
Author(s):  
Joaquin D. Araos ◽  
Luca Lacitignola ◽  
Tania Stripoli ◽  
Salvatore Grasso ◽  
Antonio Crovace ◽  
...  
Keyword(s):  
Respiratory Mechanics ◽  
Positive End Expiratory Pressure ◽  
Lung Volumes ◽  
Mechanically Ventilated ◽  
Open Lung ◽  
Open Lung Approach

Multimodal non-invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery

2019 ◽  
Vol 34 (5) ◽  
pp. 1015-1024
Author(s):  
Gerardo Tusman ◽  
Cecilia M. Acosta ◽  
Marcos Ochoa ◽  
Stephan H. Böhm ◽  
Emiliano Gogniat ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbidly Obese ◽  
Invasive Monitoring ◽  
Obese Patients ◽  
Non Invasive ◽  
Open Lung ◽  
Open Lung Approach

Spontaneous Breathing during General Anesthesia Prevents the Ventral Redistribution of Ventilation as Detected by Electrical Impedance Tomography

2012 ◽  
Vol 116 (6) ◽  
pp. 1227-1234 ◽  
Author(s):  
Oliver C. Radke ◽  
Thomas Schneider ◽  
Axel R. Heller ◽  
Thea Koch
Keyword(s):  
Laryngeal Mask Airway ◽  
General Anesthesia ◽  
Electrical Impedance Tomography ◽  
Pressure Support Ventilation ◽  
Spontaneous Breathing ◽  
Electrical Impedance ◽  
Pressure Support ◽  
Impedance Tomography ◽  
Support Ventilation ◽  
Pressure Controlled

Background Positive-pressure ventilation causes a ventral redistribution of ventilation. Spontaneous breathing during general anesthesia with a laryngeal mask airway could prevent this redistribution of ventilation. We hypothesize that, compared with pressure-controlled ventilation, spontaneous breathing and pressure support ventilation reduce the extent of the redistribution of ventilation as detected by electrical impedance tomography. Methods The study was a randomized, three-armed, observational, clinical trial without blinding. With approval from the local ethics committee, we enrolled 30 nonobese patients without severe cardiac or pulmonary comorbidities who were scheduled for elective orthopedic surgery. All of the procedures were performed under general anesthesia with a laryngeal mask airway and a standardized anesthetic regimen. The center of ventilation (primary outcome) was calculated before the induction of anesthesia (AWAKE), after the placement of the laryngeal mask airway (BEGIN), before the end of anesthesia (END), and after arrival in the postanesthesia care unit (PACU). Results The center of ventilation during anesthesia (BEGIN) was higher than baseline (AWAKE) in both the pressure-controlled and pressure support ventilation groups (pressure control: 55.0 vs. 48.3, pressure support: 54.7 vs. 48.8, respectively; multivariate analysis of covariance, P &lt; 0.01), whereas the values in the spontaneous breathing group remained at baseline levels (47.9 vs. 48.5). In the postanesthesia care unit, the center of ventilation had returned to the baseline values in all groups. No adverse events were recorded. Conclusions Both pressure-controlled ventilation and pressure support ventilation induce a redistribution of ventilation toward the ventral region, as detected by electrical impedance tomography. Spontaneous breathing prevents this redistribution.

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