scholarly journals Ultrasound-guided assessment of diaphragmatic thickness as an indicator of successful extubation in mechanically ventilated cancer patients

2019 ◽  
pp. 175-185
Author(s):  
Ahmed M. Soliman ◽  
Mohga A. Samy ◽  
Ashraf M. Heikal ◽  
Mohamed A. El Ramely ◽  
Tamer A. Kotb
Keyword(s):  
Mechanical Ventilation ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Ultrasound Guided ◽  
Diaphragm Thickness ◽  
Percent Change ◽  
Rapid Shallow Breathing Index ◽  
Arterial Blood ◽  
Shallow Breathing ◽  
Successful Extubation

Objective: The study aimed to assess diaphragmatic thickness measurement by B-mode ultrasound for prediction of extubation and proper timing of weaning from mechanical ventilation in cancer patients admitted to the intensive care unit after major surgery.Methodology: A prospective, longitudinal study conducted at Surgical ICU, National Cancer Institute, Cairo University, Cairo. Fifty patients were recruited during the immediate postoperative period after major elective cancer surgery who needed mechanical ventilation (MV). Patients were enrolled when judged to be eligible for a test of weaning from MV according to clinical and arterial blood gases (ABG) criteria. The patient was assessed for weaning according to rapid shallow breathing index (RSBI) and ultrasound guided measurements of diaphragmatic thickness (tdi) during inspiration and expiration. The percent change in tdi between end-expiration and end-inspiration (Δtdi%) was calculated. The primary outcome measure was diagnostic accuracy of tdi and Δtdi% to predict weaning compared to ABG analysis (the gold standard for weaning).Results: After 48 hours, 13 patients were weaned according to ABG criteria. Kappa value (agreement) between RSBI and ABG was 0.974. Kappa between both tdi and Δtdi% and the ABG criteria was 0.891. The values differed slightly in patients tested after 72 hours. Sensitivity of a cut off level of tdi of 2 mm was 84.6% and 83.3% after 48 and 72 hours of MV, respectively. Sensitivity of Δtdi% of 20% was clearly higher after 72 hours (95.8%). Using ROC curves, Δtdi% of > 29.5% was also more sensitive after 72 hours.Conclusion: Ultrasound estimation of diaphragm function is a promising tool to help clinicians to judge weaning readiness in patients on mechanical ventilation following major cancer surgery. Diaphragm thickness and its change between end-expiration and end-inspiration showed high degree of agreement with arterial blood gases for predicting weaning readiness.Abbreviations: RSBI: Rapid shallow breathing index, MV: mechanical ventilation, tdi: diaphragm thickness, Δtdi%: percent change in tdi between end-expiration and end-inspiration, PPV: positive predictive value, NPV: negative predictive value, kappa: measure of agreement, NCI: National Cancer Institute, VIDD: ventilator-induced diaphragmatic dysfunctionCitation: Soliman AM, Samy MA, Heikal AM, El Ramely MA, Kotb TA. Ultrasoundguidedassessment of diaphragmatic thickness as an indicator of successful extubation. Anaesth pain & intensive care 2019;23(2):178-185

scholarly journals Pathophysiology and clinical consequences of arterial blood gases and pH after cardiac arrest

2020 ◽  
Vol 8 (S1) ◽  
Author(s):  
Chiara Robba ◽  
Dorota Siwicka-Gieroba ◽  
Andras Sikter ◽  
Denise Battaglini ◽  
Wojciech Dąbrowski ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Cardiac Arrest ◽  
Oxygen Demand ◽  
Blood Gases ◽  
Metabolic Energy ◽  
High Morbidity ◽  
Arterial Blood Gases ◽  
Arterial Blood ◽  
Clinical Consequences

AbstractPost cardiac arrest syndrome is associated with high morbidity and mortality, which is related not only to a poor neurological outcome but also to respiratory and cardiovascular dysfunctions. The control of gas exchange, and in particular oxygenation and carbon dioxide levels, is fundamental in mechanically ventilated patients after resuscitation, as arterial blood gases derangement might have important effects on the cerebral blood flow and systemic physiology.In particular, the pathophysiological role of carbon dioxide (CO2) levels is strongly underestimated, as its alterations quickly affect also the changes of intracellular pH, and consequently influence metabolic energy and oxygen demand. Hypo/hypercapnia, as well as mechanical ventilation during and after resuscitation, can affect CO2 levels and trigger a dangerous pathophysiological vicious circle related to the relationship between pH, cellular demand, and catecholamine levels. The developing hypocapnia can nullify the beneficial effects of the hypothermia. The aim of this review was to describe the pathophysiology and clinical consequences of arterial blood gases and pH after cardiac arrest.According to our findings, the optimal ventilator strategies in post cardiac arrest patients are not fully understood, and oxygen and carbon dioxide targets should take in consideration a complex pattern of pathophysiological factors. Further studies are warranted to define the optimal settings of mechanical ventilation in patients after cardiac arrest.

scholarly journals The Effect of Endotracheal Suctioning on Arterial Blood Gases in Patients Receiving Mechanical Ventilation: A Before-After Open Clinical Trial

2008 ◽  
Vol 6 (1) ◽  
pp. 19-26
Author(s):  
Mahmood Kohan ◽  
Ebrahim Rahimi ◽  
Hamid Mommtahan ◽  
Nahid Mohammad Taheri ◽  
Saeed Sobhanian ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Mechanical Ventilation ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Endotracheal Suctioning ◽  
Arterial Blood

Acute lung injury from mechanical ventilation at moderately high airway pressures

1990 ◽  
Vol 69 (3) ◽  
pp. 956-961 ◽  
Author(s):  
K. Tsuno ◽  
P. Prato ◽  
T. Kolobow
Keyword(s):  
Mechanical Ventilation ◽  
Peak Inspiratory Pressure ◽  
Blood Gases ◽  
Inspiratory Pressure ◽  
Control Group ◽  
Arterial Blood Gases ◽  
Lung Weight ◽  
Pulmonary Atelectasis ◽  
Arterial Pco2 ◽  
Arterial Blood

We have explored adverse pulmonary effects of mechanical ventilation at a peak inspiratory pressure of 30 cmH2O in paralyzed and anesthetized healthy sheep. A control group of eight sheep (group A) was mechanically ventilated with 40% oxygen at a tidal volume of 10 ml/kg, a frequency of 15 breaths/min, a peak inspiratory pressure less than 18 cmH2O, and a positive end-expiratory pressure of 3-5 cmH2O. During the ensuing 48 h, there were no measurable deleterious changes in lung function or arterial blood gases. Another 19 sheep were ventilated with 40% oxygen at a peak inspiratory pressure of 30 cmH2O under a different set of conditions and were randomly assigned to two groups. In group B, the respiratory rate was kept near 4 breaths/min to keep arterial PCO2 in the normal range; in group C, the frequency was kept near 15 breaths/min by including a variable dead space in the ventilator circuit to keep arterial PCO2 near baseline values. There was a progressive deterioration in total static lung compliance, functional residual capacity, and arterial blood gases. After some hours, there were abnormal chest roentgenographic changes. At time of death we found severe pulmonary atelectasis, increased wet lung weight, and an increase in the minimum surface tension of saline lung lavage fluid.

Effects of expiratory ribcage compression before endotracheal suctioning on arterial blood gases in patients receiving mechanical ventilation

2014 ◽  
Vol 19 (5) ◽  
pp. 255-261 ◽  
Author(s):  
Mahmoud Kohan ◽  
Morteza Rezaei-Adaryani ◽  
Akram Najaf-Yarandi ◽  
Fatemeh Hoseini ◽  
Nahid Mohammad-Taheri
Keyword(s):  
Mechanical Ventilation ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Endotracheal Suctioning ◽  
Arterial Blood

scholarly journals Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index

2022 ◽  
Author(s):  
Mohammad Jhahidul Alam ◽  
Simanta Roy ◽  
Mohammad Azmain Iktidar ◽  
Fahmida Khatun Padma ◽  
Khairul Islam Nipun ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Rapid Shallow Breathing Index ◽  
Shallow Breathing ◽  
Rapid Shallow Breathing ◽  
Successful Extubation

scholarly journals Rapid Onset of Specific Diaphragm Weakness in a Healthy Murine Model of Ventilator-induced Diaphragmatic Dysfunction

2012 ◽  
Vol 117 (3) ◽  
pp. 560-567 ◽  
Author(s):  
Segolene Mrozek ◽  
Boris Jung ◽  
Basil J. Petrof ◽  
Marion Pauly ◽  
Stephanie Roberge ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Blood Gases ◽  
Hemodynamic Parameters ◽  
Arterial Blood Gases ◽  
Diaphragmatic Dysfunction ◽  
Arterial Blood ◽  
Controlled Mechanical Ventilation ◽  
Mechanical Ventilation Group

Background Controlled mechanical ventilation is associated with ventilator-induced diaphragmatic dysfunction, which impedes weaning from mechanical ventilation. To design future clinical trials in humans, a better understanding of the molecular mechanisms using knockout models, which exist only in the mouse, is needed. The aims of this study were to ascertain the feasibility of developing a murine model of ventilator-induced diaphragmatic dysfunction and to determine whether atrophy, sarcolemmal injury, and the main proteolysis systems are activated under these conditions. Methods Healthy adult male C57/BL6 mice were assigned to three groups: (1) mechanical ventilation with end-expiratory positive pressure of 2-4 cm H2O for 6 h (n=6), (2) spontaneous breathing with continuous positive airway pressure of 2-4 cm H2O for 6 h (n=6), and (3) controls with no specific intervention (n=6). Airway pressure and hemodynamic parameters were monitored. Upon euthanasia, arterial blood gases and isometric contractile properties of the diaphragm and extensor digitorum longus were evaluated. Histology and immunoblotting for the main proteolysis pathways were performed. Results Hemodynamic parameters and arterial blood gases were comparable between groups and within normal physiologic ranges. Diaphragmatic but not extensor digitorum longus force production declined in the mechanical ventilation group (maximal force decreased by approximately 40%) compared with the control and continuous positive airway pressure groups. No histologic difference was found between groups. In opposition with the calpains, caspase 3 was activated in the mechanical ventilation group. Conclusion Controlled mechanical ventilation for 6 h in the mouse is associated with significant diaphragmatic but not limb muscle weakness without atrophy or sarcolemmal injury and activates proteolysis.

CPAP and Mechanical Ventilation

1991 ◽  
Vol 7 (S1) ◽  
pp. 31-40 ◽  
Author(s):  
Gunnar Sedin
Keyword(s):  
Mechanical Ventilation ◽  
Newborn Infants ◽  
Blood Gases ◽  
Hyaline Membrane Disease ◽  
Arterial Blood Gases ◽  
Intermittent Mandatory Ventilation ◽  
New Methods ◽  
Arterial Blood ◽  
Hyaline Membrane ◽  
The 1960S

Respiratory insufficiency has previously been a frequent cause of neonatal death, especially in preterm infants. As late as in 1967, Silverman and associates (66) found that in infants with hyaline membrane disease (HMD), mechanical ventilation with a body-enclosing negative pressure respirator did not improve survival. Before 1970, the mortality among infants who required respiratory therapy was high (20;46;70). At the end of the 1960s and the beginning of the 1970s, several new methods were introduced to improve ventilation of newborn infants. Kirby and coworkers (41) introduced intermittent mandatory ventilation as a way of weaning from mechanical ventilation. In a series of studies, Reynolds and coworkers evaluated the effects of different peak airway pressures, respiratory frequencies, and inspiratory:expiratory ratios on arterial blood gases and right to left shunts (32;58;59;60).

scholarly journals The role of diaphragmatic ultrasound as a predictor of successful extubation from mechanical ventilation in respiratory intensive care unit

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Randa Salah Eldin Mohamed ◽  
Abeer Salah Eldin Mahmoud ◽  
Waleed Fouad Fathalah ◽  
Mohamed Farouk Mohamed ◽  
Ahmed Aelgharib Ahmed
Keyword(s):  
Mechanical Ventilation ◽  
Diaphragm Muscle ◽  
Rapid Shallow Breathing Index ◽  
Cutoff Values ◽  
Ultrasound Evaluation ◽  
Successful Group ◽  
Residual Capacity ◽  
Shallow Breathing ◽  
Respiratory Intensive Care Unit ◽  
Successful Extubation

Abstract Background The diaphragm muscle whose dysfunction may be very common in patients undergoing mechanical ventilation (Ferrari G, De Filippi G, Elia F, Panero F, Volpicelli G, Aprà F. Crit Ultrasound J 6:8, 2014). Aim: To evaluate real-time ultrasound in the evaluation of diaphragmatic thickening, thickening fraction, and/or excursion to predict extubation outcomes. We aimed to compare these parameters with other traditional weaning measures is a fundamental. Results Out of 80 included patients, 20 (25%) have failed extubation. Diaphragmatic thickening (DT), thickening fraction (DTF), and/or excursion (DE) were significantly higher in the successful group compared to those who failed extubation (p < 0.05). Cutoff values of diaphragmatic measures associated with successful extubation (during tidal breathing) were ≥ 17 mm for DE; ≥ 2.1 cm for DT inspiration; ≥ 15.5 mm for DT expiration, functional residual capacity (FRC); and ≥ 32.82% for DTF %, giving 68%, 95%, 62%, and 90% sensitivity, respectively, and 65%, 100%, 100%, and 75% specificity, respectively. Cutoff values of diaphragmatic parameters associated with successful extubation (during deep breathing) were > 28.5 mm DT Insp, total lung capacity (TLC); >22.5mm DT Exp (RV); >37 DTF %; and > 31 mm DE, giving 100%, 73%, 97%, and 75% sensitivity and 65%, 75%, 100%, and 55% specificity, respectively. Rapid shallow breathing index (RSBI) had 47% sensitivity but 90% specificity. Conclusion Ultrasound evaluation of diaphragmatic parameters could be a good predictor of weaning in patients who passed the T-tube.

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