scholarly journals Use of Lung Ultrasound for Assessment of Lung Recruitment Maneuvers in Patients with ARDS

2021 ◽  
Vol 9 (B) ◽  
pp. 952-963
Author(s):  
Waheed A. Radwan ◽  
Mohamed M. Khaled ◽  
Ayman G. Salman ◽  
Mohmed A. Fakher ◽  
Shady Khatab
Keyword(s):  
Lung Ultrasound ◽  
Lung Recruitment ◽  
Positive Pressure ◽  
Small Airways ◽  
Lung Collapse ◽  
Opening Pressure ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ultrasound Group ◽  
Ventilated Patients

BACKGROUND: Positive pressure mechanical ventilation is a non-physiological intervention that saves lives but is not free of important side effects. It invariably results in different degrees of collapse of small airways. Recruitment maneuver (RM) aims to resolve lung collapse by a brief and controlled increment in airway pressure while positive end-expiratory pressure (PEEP) afterward keeps the lungs open. Therefore, ideally RM and PEEP selection must be individualized and this can only be done when guided by specific monitoring tools since lung’s opening and closing pressures vary among patients with different lung conditions. AIM: The aim of this study was to explore the clinical value of ultrasonic monitoring in the assessment of pulmonary recruitment and the best PEEP. PATIENTS AND METHODS: This study was conducted on 120 patients, 30 were excluded as in whom lung collapse cannot be confirmed then the rest were 90 patients from whom another 25 patients excluded as they were hemodynamically unstable the rest 65 patients were divided into two groups: Group A: Included 50 mechanically ventilated patients with ARDS, underwent lung recruitment using lung ultrasound and Group B: Included 15 mechanically ventilated patients with ARDS, underwent lung recruitment using oxygenation index. This prospective study was held at many critical care departments around Egypt. RESULTS: We noticed that lung recruitment in both groups significantly increased Pao2/Fio2 ratio immediately after recruitment compared with basal state and also significantly increase dynamic compliance compared with basal state. The increase in PF ratio immediately was significantly more in ultrasound group than in oxygenation group. Furthermore, we noticed that that P/F ratio 12 h after recruitment decreased compared with P/F ratio immediately after recruitment but significantly increased compared with basal state before recruitment and also we found that the increase in P/F ratio 12 h after recruitment was more significantly in lung ultrasound group than in oxygenation group. Furthermore, we noticed that lung recruitment (both lung ultrasound and oxygenation group) significantly increase RV function using TAPSE compared with basal state. Both opening pressure and optimal PEEP were significantly higher in lung ultrasound group than in oxygenation group. In our study, opening pressure was 37.28 ± 1.25 in lung ultrasound group and was 36.67±0.98 in oxygenation group and optimal PEEP was 14.64 ± 1.08 in lung ultrasound group and was 13.13 ± 0.74 in oxygenation group. CONCLUSION: Lung US is an effective mean of evaluating and guiding alveolar recruitment in ARDS. Compared with the maximal oxygenation–guided method, the protocol for reaeration in US-guided lung recruitment achieved a higher opening pressure, resulted in greater improvements in lung aeration, and substantially reduced lung heterogeneity in ARDS.

Haemodynamic assessments in mechanically ventilated patients

2020 ◽  
pp. 321-326
Author(s):  
Antoine Vieillard-Baron
Keyword(s):  
Pulse Pressure ◽  
Positive Pressure Ventilation ◽  
Superior Vena ◽  
Vena Cava ◽  
Positive Pressure ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Pulmonary Capillaries ◽  
The Right ◽  
Ventilated Patients

Knowledge of heart–lung interactions is key to manage haemodynamics in mechanically ventilated patients (see also Chapter 5). It allows intensivists to understand the meaning of blood and pulse pressure respiratory variations (PPV). Unlike spontaneous breathing, positive pressure ventilation increases blood pressure and pulse pressure during inspiration following by a decrease during expiration. This is called reverse pulsus paradoxus and includes a ‘d-down’ and a ‘d-up’ effect. No variation means no effect of mechanical ventilation on the heart and especially on the right heart. In case of significant PPV, tidal volume usually reduces right ventricular stroke volume by way of reducing preload where systemic venous return is decreased (fluid expansion is useful to restore haemodynamics, when impaired) or increasing afterload (obstruction of pulmonary capillaries due to alveolar inflation and, in this case, fluid expansion is useless or even sometimes deleterious). Clinical examination as well as evaluation of respiratory variations of superior vena cava by echo, helps to distinguish between these two situations. By studying the beat-by-beat changes in echo parameters induced by positive pressure ventilation heartbeat by heartbeat, echocardiography is perfectly suited to study heart–lung interactions and then to propose an appropriate optimization in case of haemodynamic impairment.

scholarly journals Bronchoscopic Insufflation of Room Air for the Treatment of Lobar Atelectasis in Mechanically Ventilated Patients

1995 ◽  
Vol 23 (2) ◽  
pp. 175-177 ◽  
Author(s):  
P. V. Van Heerden ◽  
W. Jacob ◽  
P. D. Cameron ◽  
S. Webb
Keyword(s):  
Positive Pressure Ventilation ◽  
Chest Physiotherapy ◽  
Additional Benefit ◽  
Positive Pressure ◽  
Common Occurrence ◽  
Positive End Expiratory Pressure ◽  
Pulmonary Atelectasis ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Segmental and lobar pulmonary atelectasis is a common occurrence in mechanically ventilated patients. Standard therapy for atelectasis relies on positive pressure ventilation, positive end expiratory pressure (PEEP), tracheobronchial toilet and regular chest physiotherapy. Various adjuncts to physiotherapy such as bronchoscopic clearance of secretions have not proved to be of additional benefit. Bronchoscopic clearance of secretions followed by insufflation of room air at 30 cm H2O into the atelectatic segment was employed on ten occasions in mechanically ventilated patients. Rapid re-expansion of the collapsed segment or lobe occurred in seven out of the ten treatments.

scholarly journals Advantages of lung ultrasound in triage, diagnosis and monitoring COVID-19 patients: review

2021 ◽  
Vol 67 (2) ◽  
pp. 73-76
Author(s):  
Bianca Emilia Ciurba ◽  
Hédi Katalin Sárközi ◽  
István Adorján Szabó ◽  
Nimród László ◽  
Edith Simona Ianosi ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Cost Effective ◽  
Portable Devices ◽  
Standard Protocol ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Pleural Line ◽  
B Lines ◽  
Lung Sliding ◽  
Ventilated Patients

Abstract Over the last decades, especially during the COVID-19 pandemic period, lung ultrasound (LUS) gained interest due to multiple advantages: radiation-free, repeatable, cost-effective, portable devices with a bedside approach. These advantages can help clinicians in triage, in positive diagnostic, stratification of disease forms according to severity and prognosis, evaluation of mechanically ventilated patients from Intensive Care Units, as well as monitoring the progress of COVID-19 lesions, thus reducing the health care contamination. LUS should be performed by standard protocol examination. The characteristic lesions from COVID-19 pneumonia are the abolished lung sliding, presence of multiple and coalescent B-lines, disruption and thickening of pleural line with subpleural consolidations. LUS is a useful method for post-COVID-19 lesions evaluation, highlight the remaining fibrotic lesions in some patients with moderate or severe forms of pneumonia.

Expert Agreement in the Interpretation of Lung Ultrasound Studies Performed on Mechanically Ventilated Patients

2018 ◽  
Vol 37 (11) ◽  
pp. 2659-2665 ◽  
Author(s):  
Scott J. Millington ◽  
Robert T. Arntfield ◽  
Robert Jie Guo ◽  
Seth Koenig ◽  
Pierre Kory ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ultrasound Studies ◽  
Ventilated Patients

scholarly journals LUNG ULTRASOUND B-LINES CORRELATE WITH STATIC COMPLIANCE IN MECHANICALLY VENTILATED PATIENTS

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A584
Author(s):  
Andrew Lehr ◽  
Vikramjit Mukherjee ◽  
Deepak Pradhan ◽  
Bishoy Zakhary
Keyword(s):  
Lung Ultrasound ◽  
Static Compliance ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
B Lines ◽  
Ventilated Patients

Breathing cardiovascular variability and baroreflex in mechanically ventilated patients

2008 ◽  
Vol 295 (6) ◽  
pp. R1934-R1940 ◽  
Author(s):  
Andry Van de Louw ◽  
Claire Médigue ◽  
Yves Papelier ◽  
François Cottin
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Phase Difference ◽  
Airway Pressure ◽  
Baroreflex Sensitivity ◽  
Positive Pressure ◽  
Signal Phase ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Heart rate and blood pressure variations during spontaneous ventilation are related to the negative airway pressure during inspiration. Inspiratory airway pressure is positive during mechanical ventilation, suggesting that reversal of the normal baroreflex-mediated pattern of variability may occur. We investigated heart rate and blood pressure variability and baroreflex sensitivity in 17 mechanically ventilated patients. ECG (RR intervals), invasive systolic blood pressure (SBP), and respiratory flow signals were recorded. High-frequency (HF) amplitude of RR and SBP time series and HF phase differences between RR, SBP, and ventilatory signals were continuously computed by Complex DeModulation (CDM). Cross-spectral analysis was used to assess the coherence and the gain functions between RR and SBP, yielding baroreflex sensitivity indices. The HF phase difference between SBP and ventilatory signals was nearly constant in all patients with inversion of SBP variability during the ventilator cycle compared with cycling with negative inspiratory pressure to replicate spontaneous breathing. In 12 patients ( group 1), the phase difference between RR and ventilatory signals changed over time and the HF-RR amplitude varied. In the remaining five patients ( group 2), RR-ventilatory signal phase and HF-RR amplitude showed little change; however, only one of these patients exhibited a RR-ventilatory signal phase difference mimicking the normal pattern of respiratory sinus arrhythmia. Spectral coherence between RR and SBP was lower in the group with phase difference changes. Positive pressure ventilation exerts mainly a mechanical effect on SBP, whereas its influence on HR variability seems more complex, suggesting a role for neural influences.

Changes in Stroke Volume Induced by Lung Recruitment Maneuver Predict Fluid Responsiveness in Mechanically Ventilated Patients in the Operating Room

2017 ◽  
Vol 126 (2) ◽  
pp. 260-267 ◽  
Author(s):  
Matthieu Biais ◽  
Romain Lanchon ◽  
Musa Sesay ◽  
Lisa Le Gall ◽  
Bruno Pereira ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Pulse Pressure ◽  
Volume Expansion ◽  
Recruitment Maneuver ◽  
Lung Recruitment ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Preload Responsiveness ◽  
Lung Recruitment Maneuver ◽  
Ventilated Patients

Abstract Background Lung recruitment maneuver induces a decrease in stroke volume, which is more pronounced in hypovolemic patients. The authors hypothesized that the magnitude of stroke volume reduction through lung recruitment maneuver could predict preload responsiveness. Methods Twenty-eight mechanically ventilated patients with low tidal volume during general anesthesia were included. Heart rate, mean arterial pressure, stroke volume, and pulse pressure variations were recorded before lung recruitment maneuver (application of continuous positive airway pressure of 30 cm H2O for 30 s), during lung recruitment maneuver when stroke volume reached its minimal value, and before and after volume expansion (250 ml saline, 0.9%, infused during 10 min). Patients were considered as responders to fluid administration if stroke volume increased greater than or equal to 10%. Results Sixteen patients were responders. Lung recruitment maneuver induced a significant decrease in mean arterial pressure and stroke volume in both responders and nonresponders. Changes in stroke volume induced by lung recruitment maneuver were correlated with those induced by volume expansion (r2 = 0.56; P < 0.0001). A 30% decrease in stroke volume during lung recruitment maneuver predicted fluid responsiveness with a sensitivity of 88% (95% CI, 62 to 98) and a specificity of 92% (95% CI, 62 to 99). Pulse pressure variations more than 6% before lung recruitment maneuver discriminated responders with a sensitivity of 69% (95% CI, 41 to 89) and a specificity of 75% (95% CI, 42 to 95). The area under receiver operating curves generated for changes in stroke volume induced by lung recruitment maneuver (0.96; 95% CI, 0.81 to 0.99) was significantly higher than that for pulse pressure variations (0.72; 95% CI, 0.52 to 0.88; P < 0.05). Conclusions The authors’ study suggests that the magnitude of stroke volume decrease during lung recruitment maneuver could predict preload responsiveness in mechanically ventilated patients in the operating room.

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