scholarly journals Airway Pressure and Respiratory Mechanics Variability with Different Body Positions in Mechanically Ventilated Critical Care Patients: A Prospective Comparative Clinical Study

2020 ◽  
pp. 1-6
Author(s):  
Alaa Ali M. Elzohry
Keyword(s):  
Critical Care ◽  
Prone Position ◽  
Airway Pressure ◽  
Major Trauma ◽  
Respiratory Mechanics ◽  
Cuff Pressure ◽  
Mean Airway Pressure ◽  
Mechanically Ventilated ◽  
Prospective Comparative Study ◽  
Critical Care Patients

Aim: This prospective comparative study aimed to investigate the effect of various body positions on changes of respiratory parameters mostly; the TV, oxygen saturation, airway pressure, and endotracheal tube cuff pressure in mechanically ventilated critical care patients. Background: Many patients who are admitted to the critical care unit require intubation and invasive mechanical ventilation for many reasons such as major trauma, medical causes, or post-operative major surgeries. Changing a patient’s position in the critical care unit is very important for the following benefits; to break through the routine monotonic delivery of mechanical ventilation, to favor the clearance of respiratory secretions, the prevention of pressure sores and ventilator acquired pneumonia, and finally the improvement in lung volume and oxygenation. Methods: A prospective, comparative study was carried out on 210 patients of both gender, aged between 21-70 years old admitted to ICU due to many reasons. After stabilization of patient condition and connection of monitors’ cables, supine position or semi setting position was chosen and this was documented in the patient’s chart. All patients were sedated to prevent them from breathing against the machine which causes the ETT cuff pressure and mean airway pressure to rise. Fentanyl sedation drug (Loading dose: 1–2 mic/kg/hour infused gradually. Maintenance dose: 1-4 mic/kg/hour) using continuous intravenous infusion typically in combination with Midazolam sedation (0.05-0.2 mg/kg/hour). The following parameters were recorded; tidal volume, mean airway pressure, PO2 /FIO2 , and ETT cuff pressure. Results: Our results show that about (58.1%) were male and (41.9%) were female. Concerning age, their mean was between (40.6 ± 8.9) years. Regarding diagnosis (50.5%) of patients were admitted with major trauma, (31.9%) due to medical causes, and (17.6%) admitted due to major chest and abdominal surgeries. The patient’s mean heart rate was (93.6 ± 7.5) b/m and the Mean Arterial Pressure was (67.7 ± 0.6)°C. Tables the Description, SOP2, Mean airway, and ETT cuff pressure of each body position in the study with the highest SPO2 98% and cuff pressure 19.2+41 in the prone position. The position checklist is illustrated in Table and Figure. The highest TV (520 ml) and PO2 /FIO2 ratio (410) were in prone poison and the lowest was in Lower Fowler position (460 ml and 320) respectively. Regarding outcome and ICU stay which were the best in both semi setting and prone position. Conclusion: Supine position (lying flat) or lateral position do not seem beneficial for critically ill patients in terms of respiratory mechanics. The semi-sitting position (with thorax angulation=30° from the horizontal plane) is associated with improvement of PO2/FIO2 , oxygenation, and tidal volume, and the effects of prone position on respiratory mechanics are very beneficial and this reflected on patient outcome and short ICU length of stay.

Subsequent Pressure Injury Development in Mechanically Ventilated Critical Care Patients with Hospital-Acquired Pressure Injury

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jenny Alderden ◽  
Allen Cadavero ◽  
Yunchuan “Lucy” Zhao ◽  
Desiree Dougherty ◽  
Se-Hee Jung ◽  
...  
Keyword(s):  
Critical Care ◽  
Mechanically Ventilated ◽  
Pressure Injury ◽  
Hospital Acquired ◽  
Critical Care Patients

scholarly journals Psychometric validation of the behavioral indicators of pain scale for the assessment of pain in mechanically ventilated and unable to self-report critical care patients

2016 ◽  
Vol 40 (8) ◽  
pp. 463-473 ◽  
Author(s):  
I. Latorre-Marco ◽  
M. Acevedo-Nuevo ◽  
M. Solís-Muñoz ◽  
L. Hernández-Sánchez ◽  
C. López-López ◽  
...  
Keyword(s):  
Critical Care ◽  
Pain Scale ◽  
Self Report ◽  
Psychometric Validation ◽  
Mechanically Ventilated ◽  
Behavioral Indicators ◽  
Critical Care Patients

scholarly journals Association between core body temperature and mean airway pressure with endotracheal cuff pressure in intubated patients of emergency department

2019 ◽  
Vol 35 (5) ◽  
Author(s):  
Zahra Parsian ◽  
Farzad Rahmani ◽  
Ata Mahmoodpoor ◽  
Mahboob Pouraghaei ◽  
Maryam Barzegar Jalali ◽  
...  
Keyword(s):  
Emergency Department ◽  
Body Temperature ◽  
Airway Pressure ◽  
Cuff Pressure ◽  
Core Body Temperature ◽  
Time Factors ◽  
Positive Pressure ◽  
Mean Airway Pressure ◽  
Creative Commons ◽  
Core Body

Background & Objective: Endotracheal intubation is routinely performed in the critical situations. In order to prevent microaspiration and tracheal injury endotracheal cuff pressure is important to remain constant between 20 and 30 cmH2O. Positive pressure ventilation, duration of intubation, body temperature, and body movements can alter endotracheal cuff pressure. This survey was conducted to evaluate core body temperature and cuff pressure relation with airway pressure simultaneously. Methods: This was a descriptive analytic study conducted from March 2018 to July 2018 on 150 intubated patients in the emergency department. All were ventilated with SIMV mode and had Ramsi sedation level of 2‑3. Mean airway pressure was measured simultaneouly with core body temperature measurement from ventilator monitor. All these parameters were measured 10 times each hour and documented. Results: There was a statistically meaningful relation between airway pressure and cuff pressure in the primary evaluation (P=0.02, r=0.19), while none of the subsequent evaluations showed meaningful relation (P>0.05). No significant relation was found between cuff pressure and core body temperature in any of the measurements (P>0.05). Conclusion: The pressure of cuff should be checked repeatedly after intubation because of substantial variation over time. Factors other than core body temperature and airway pressure can influence cuff pressure. doi: https://doi.org/10.12669/pjms.35.5.886 How to cite this:Parsian Z, Rahmani F, Mahmoodpoor A, Pouraghaei M, Jalali MB, Esfanjani RM, et al. Association between core body temperature and mean airway pressure with endotracheal cuff pressure in intubated patients of emergency department. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.886 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Physiological Effect of Prone Positioning in Mechanically Ventilated SARS- CoV-2 Infected Patients with Severe ARDS: Preliminary Analysis of an Observational Study

2020 ◽  
Author(s):  
Avishek Roy ◽  
Srikant Behera ◽  
Aparna Pande ◽  
Anirban Bhattacharjee ◽  
Amrita Bhattacharyya ◽  
...  
Keyword(s):  
Observational Study ◽  
Prone Position ◽  
Airway Pressure ◽  
Preliminary Analysis ◽  
Prospective Observational Study ◽  
Lung Compliance ◽  
Physiological Effect ◽  
Study Data ◽  
Static Compliance ◽  
Mechanically Ventilated

Prone position ventilation has been shown to decrease mortality and improve oxygenation in ARDS patients. With best of our knowledge, no study reported physiological effect of prone position in SARS- CoV-2 infected ARDS patients. In this prospective observational study, data of n=20 consecutive laboratory confirmed SARS- CoV-2 patients with severe ARDS as per Berlin definition was included. Data of 20 patients analyzed with a median (Interquartile range, IQR) age of 56 (45.5- 67) y and median (IQR) P/F ratio of 56 (54- 66) with a median (IQR) PEEP of 12 (12- 14) before initiation of prone position. Seventy-five percentage (95% CI 53.1- 88.8) patients were prone responders at 16h prone session and 50 (95% CI 29.9- 70.1) % patients were sustained responders. There was a significant decrease in plateau airway pressure (p<0.0001), peak airway pressure (p<0.0001) and driving pressure(p<0.0001) and increase in static compliance (p=0.001), P/F ratio (p<0.0001), PaO2 (p=0.0002)and SpO2 (p=0.0004) at 4h and 16h since initiation of prone session and also after return of supine position. Prone position in SARS- CoV-2 infected severe ARDS patients is associated with improvement in lung compliance and oxygenation in two- third of the patients and persisted in half of the patients.

Optimal sedation of mechanically ventilated pediatric critical care patients

1994 ◽  
Vol 22 (1) ◽  
pp. 163-170 ◽  
Author(s):  
Celeste M. Marx ◽  
Paul G. Smith ◽  
Lia H. Lowrie ◽  
Kim W. Hamlett ◽  
Bruce Ambuel ◽  
...  
Keyword(s):  
Critical Care ◽  
Pediatric Critical Care ◽  
Mechanically Ventilated ◽  
Critical Care Patients

Effects of Prone Positioning on Transpulmonary Pressures and End-expiratory Volumes in Patients without Lung Disease

2018 ◽  
Vol 128 (6) ◽  
pp. 1187-1192 ◽  
Author(s):  
Abirami Kumaresan ◽  
Robert Gerber ◽  
Ariel Mueller ◽  
Stephen H. Loring ◽  
Daniel Talmor
Keyword(s):  
Chest Wall ◽  
Prone Position ◽  
Airway Pressure ◽  
Transpulmonary Pressure ◽  
Esophageal Pressure ◽  
Driving Pressure ◽  
Prone Positioning ◽  
Volume Increase ◽  
Mechanically Ventilated ◽  
Chest Wall Elastance

Abstract Background The effects of prone positioning on esophageal pressures have not been investigated in mechanically ventilated patients. Our objective was to characterize effects of prone positioning on esophageal pressures, transpulmonary pressure, and lung volume, thereby assessing the potential utility of esophageal pressure measurements in setting positive end-expiratory pressure (PEEP) in prone patients. Methods We studied 16 patients undergoing spine surgery during general anesthesia and neuromuscular blockade. We measured airway pressure, esophageal pressures, airflow, and volume, and calculated the expiratory reserve volume and the elastances of the lung and chest wall in supine and prone positions. Results Esophageal pressures at end expiration with 0 cm H2O PEEP decreased from supine to prone by 5.64 cm H2O (95% CI, 3.37 to 7.90; P &lt; 0.0001). Expiratory reserve volume measured at relaxation volume increased from supine to prone by 0.15 l (interquartile range, 0.25, 0.10; P = 0.003). Chest wall elastance increased from supine to prone by 7.32 (95% CI, 4.77 to 9.87) cm H2O/l at PEEP 0 (P &lt; 0.0001) and 6.66 cm H2O/l (95% CI, 3.91 to 9.41) at PEEP 7 (P = 0.0002). Median driving pressure, the change in airway pressure from end expiration to end-inspiratory plateau, increased in the prone position at PEEP 0 (3.70 cm H2O; 95% CI, 1.74 to 5.66; P = 0.001) and PEEP 7 (3.90 cm H2O; 95% CI, 2.72 to 5.09; P &lt; 0.0001). Conclusions End-expiratory esophageal pressure decreases, and end-expiratory transpulmonary pressure and expiratory reserve volume increase, when patients are moved from supine to prone position. Mean respiratory system driving pressure increases in the prone position due to increased chest wall elastance. The increase in end-expiratory transpulmonary pressure and expiratory reserve volume may be one mechanism for the observed clinical benefit with prone positioning.

Advantage of “Dynamic Screening” in Major Trauma Victims and Critical Care Patients

1990 ◽  
pp. 229-238
Author(s):  
J. Gmeinwieser ◽  
P. Gerhardt ◽  
K. Mühlbauer ◽  
M. Strotzer
Keyword(s):  
Critical Care ◽  
Major Trauma ◽  
Dynamic Screening ◽  
Trauma Victims ◽  
Critical Care Patients
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