ventilator settings
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2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Liselotte Hol ◽  
Sunny G. L. H. Nijbroek ◽  
Ary Serpa Neto ◽  
Sabrine N. T. Hemmes ◽  
Goran Hedenstierna ◽  
...  

Abstract Background The aim of this analysis is to determine geo–economic variations in epidemiology, ventilator settings and outcome in patients receiving general anesthesia for surgery. Methods Posthoc analysis of a worldwide study in 29 countries. Lower and upper middle–income countries (LMIC and UMIC), and high–income countries (HIC) were compared. The coprimary endpoint was the risk for and incidence of postoperative pulmonary complications (PPC); secondary endpoints were intraoperative ventilator settings, intraoperative complications, hospital stay and mortality. Results Of 9864 patients, 4% originated from LMIC, 11% from UMIC and 85% from HIC. The ARISCAT score was 17.5 [15.0–26.0] in LMIC, 16.0 [3.0–27.0] in UMIC and 15.0 [3.0–26.0] in HIC (P = .003). The incidence of PPC was 9.0% in LMIC, 3.2% in UMIC and 2.5% in HIC (P < .001). Median tidal volume in ml kg− 1 predicted bodyweight (PBW) was 8.6 [7.7–9.7] in LMIC, 8.4 [7.6–9.5] in UMIC and 8.1 [7.2–9.1] in HIC (P < .001). Median positive end–expiratory pressure in cmH2O was 3.3 [2.0–5.0]) in LMIC, 4.0 [3.0–5.0] in UMIC and 5.0 [3.0–5.0] in HIC (P < .001). Median driving pressure in cmH2O was 14.0 [11.5–18.0] in LMIC, 13.5 [11.0–16.0] in UMIC and 12.0 [10.0–15.0] in HIC (P < .001). Median fraction of inspired oxygen in % was 75 [50–80] in LMIC, 50 [50–63] in UMIC and 53 [45–70] in HIC (P < .001). Intraoperative complications occurred in 25.9% in LMIC, in 18.7% in UMIC and in 37.1% in HIC (P < .001). Hospital mortality was 0.0% in LMIC, 1.3% in UMIC and 0.6% in HIC (P = .009). Conclusion The risk for and incidence of PPC is higher in LMIC than in UMIC and HIC. Ventilation management could be improved in LMIC and UMIC. Trial registration Clinicaltrials.gov, identifier: NCT01601223.


Author(s):  
Michael John Parkes ◽  
Stuart Green ◽  
Jason Cashmore ◽  
Qamar Ghafoor ◽  
Thomas Clutton-Brock

Objective: Single prolonged breath-holds of >5 min can be obtained in cancer patients. Currently, however, the preparation time in each radiotherapy session is a practical limitation for clinical adoption of this new technique. Here, we show by how much our original preparation time can be shortened without unduly compromising breath-hold duration. Methods: 44 healthy subjects performed single prolonged breath-holds from 60% O2 and mechanically induced hypocapnia. We tested the effect on breath-hold duration of shortening preparation time (the durations of acclimatization, hyperventilation and hypocapnia) by changing these durations and or ventilator settings. Results: Mean original breath-hold duration was 6.5 ± 0.2 (standard error) min. The total original preparation time (from connecting the facemask to the start of the breath-hold) was 26 ± 1 min. After shortening the hypocapnia duration from 16 to 5 min, mean breath-hold duration was still 6.1 ± 0.2 min (ns vs the original). After abolishing the acclimatization and shortening the hypocapnia to 1 min (a total preparation time now of 9 ± 1 min), a mean breath-hold duration of >5 min was still possible (now significantly shortened to 5.2 ± 0.6 min, p < 0.001). After shorter and more vigorous hyperventilation (lasting 2.7 ± 0.3 min) and shorter hypocapnia (lasting 43 ± 4 s), a mean breath-hold duration of >5 min (5.3 ± 0.2 min, p < 0.05) was still possible. Here, the final total preparation time was 3.5 ± 0.3 min. Conclusions: These improvements may facilitate adoption of the single prolonged breath-hold for a range of thoracic and abdominal radiotherapies especially involving hypofractionation. Advances in knowledge: Multiple short breath-holds improve radiotherapy for thoracic and abdominal cancers. Further improvement may occur by adopting the single prolonged breath-hold of >5 min. One limitation to clinical adoption is its long preparation time. We show here how to reduce the mean preparation time from 26 to 3.5 min without compromising breath-hold duration


2021 ◽  
Author(s):  
Cassie Montoya ◽  
Robin Steinhorn ◽  
John Berger ◽  
Harutyun Haroyan ◽  
Mariam Said ◽  
...  

Abstract ObjectiveTracheobronchomalacia (TBM) is common in neonates with bronchopulmonary dysplasia (BPD) and is associated with higher morbidity. This study evaluates the value of a CT protocol to assess the degree of TBM and gauge the adequacy of prescribed PEEP. Study DesignFour infants with severe BPD on invasive mechanical ventilation underwent a chest CT protocol, including limited reduced- dose expiratory scans with varying PEEP levels. ResultsBaseline PEEP was adjusted in all subjects after performing the Dynamic PEEP CT. In two infants, the PEEP was increased due to significant TBM, and in the other, two without signs of TBM PEEP was decreased. The clinical course improved in all patients after adjusting PEEP. ConclusionA "Dynamic PEEP" study is a highly reliable and non-invasive imaging modality for the evaluation of adequate ventilator settings in infants with severe BPD who are not optimal candidates for bronchoscopy.


2021 ◽  
Author(s):  
Kai M. Förster ◽  
Christian J. Roth ◽  
Anne Hilgendorff ◽  
Birgit Ertl‐Wagner ◽  
Andreas W. Flemmer ◽  
...  

2021 ◽  
Author(s):  
Lauren F. Goodman

Palliative or compassionate withdrawal of mechanical ventilator support at the end of life aims to optimize comfort, alleviate suffering, and allow a natural death in patients for whom life supports are not achieving desired goals. Palliative withdrawal is a medical procedure and must be treated as such. Appropriate planning and preparations are required to optimize patient comfort, which is the goal of the procedure. Many institutions have a “one size fits all” approach to this process, but individual patient factors require consideration to meet the patient’s needs. Some of these factors include patient pathophysiology (airway edema, airway trauma, hemoptysis, secretions), current treatment modalities (ventilator settings, medications including sedatives, vasopressors, inotropes, inhaled agents, neuromuscular blockade agents), and patient and family values and preferences. This chapter will discuss the implications of each of these factors and propose methods for successful transitions to comfort-focused care. Case vignettes will demonstrate the thought processes involved and model optimal management. Common ethical considerations and questions regarding palliative withdrawal of life support will also be discussed.


BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047100
Author(s):  
Chiara Robba ◽  
Giuseppe Citerio ◽  
Fabio S Taccone ◽  
Stefania Galimberti ◽  
Paola Rebora ◽  
...  

IntroductionMechanical ventilatory is a crucial element of acute brain injured patients’ management. The ventilatory goals to ensure lung protection during acute respiratory failure may not be adequate in case of concomitant brain injury. Therefore, there are limited data from which physicians can draw conclusions regarding optimal ventilator management in this setting.Methods and analysisThis is an international multicentre prospective observational cohort study. The aim of the ‘multicentre observational study on practice of ventilation in brain injured patients’—the VENTIBRAIN study—is to describe the current practice of ventilator settings and mechanical ventilation in acute brain injured patients. Secondary objectives include the description of ventilator settings among different countries, and their association with outcomes. Inclusion criteria will be adult patients admitted to the intensive care unit (ICU) with a diagnosis of traumatic brain injury or cerebrovascular diseases (intracranial haemorrhage, subarachnoid haemorrhage, ischaemic stroke), requiring intubation and mechanical ventilation and admission to the ICU. Exclusion criteria will be the following: patients aged <18 years; pregnant patients; patients not intubated or not mechanically ventilated or receiving only non-invasive ventilation. Data related to clinical examination, neuromonitoring if available, ventilator settings and arterial blood gases will be recorded at admission and daily for the first 7 days and then at day 10 and 14. The Glasgow Outcome Scale Extended on mortality and neurological outcome will be collected at discharge from ICU, hospital and at 6 months follow-up.Ethics and disseminationThe study has been approved by the Ethic committee of Brianza at the Azienda Socio Sanitaria Territoriale-Monza. Data will be disseminated to the scientific community by abstracts submitted to the European Society of Intensive Care Medicine annual conference and by original articles submitted to peer-reviewed journals.Trial registration numberNCT04459884.


2021 ◽  
Vol 18 (3) ◽  
pp. 36-45
Author(s):  
А. А. Eremenko ◽  
R. D. Komnov ◽  
P. А. Titov ◽  
S. А. Gerasimenko ◽  
D. А. Chakal

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.


2021 ◽  
Vol 10 (13) ◽  
pp. 2969
Author(s):  
Elizabeth M. Parker ◽  
Edward A. Bittner ◽  
Lorenzo Berra ◽  
Richard M. Pino

Hypoxemia of the acute respiratory distress syndrome can be reduced by turning patients prone. Prone positioning (PP) is labor intensive, risks unplanned tracheal extubation, and can result in facial tissue injury. We retrospectively examined prolonged, repeated, and early versus later PP for 20 patients with COVID-19 respiratory failure. Blood gases and ventilator settings were collected before PP, at 1, 7, 12, 24, 32, and 39 h after PP, and 7 h after completion of PP. Analysis of variance was used for comparisons with baseline values at supine positions before turning prone. PP for >39 h maintained PaO2/FiO2 (P/F) ratios when turned supine; the P/F decrease at 7 h was not significant from the initial values when turned supine. Patients turned prone a second time, when again turned supine at 7 h, had significant decreased P/F. When PP started for an initial P/F ≤ 150 versus P/F > 150, the P/F increased throughout the PP and upon return to supine. Our results show that a single turn prone for >39 h is efficacious and saves the burden of multiple prone turns, and there is no significant advantage to initiating PP when P/F > 150 compared to P/F ≤ 150.


2021 ◽  
Vol 8 ◽  
Author(s):  
Balazs P. Vagvolgyi ◽  
Mikhail Khrenov ◽  
Jonathan Cope ◽  
Anton Deguet ◽  
Peter Kazanzides ◽  
...  

Since the first reports of a novel coronavirus (SARS-CoV-2) in December 2019, over 33 million people have been infected worldwide and approximately 1 million people worldwide have died from the disease caused by this virus, COVID-19. In the United States alone, there have been approximately 7 million cases and over 200,000 deaths. This outbreak has placed an enormous strain on healthcare systems and workers. Severe cases require hospital care, and 8.5% of patients require mechanical ventilation in an intensive care unit (ICU). One major challenge is the necessity for clinical care personnel to don and doff cumbersome personal protective equipment (PPE) in order to enter an ICU unit to make simple adjustments to ventilator settings. Although future ventilators and other ICU equipment may be controllable remotely through computer networks, the enormous installed base of existing ventilators do not have this capability. This paper reports the development of a simple, low cost telerobotic system that permits adjustment of ventilator settings from outside the ICU. The system consists of a small Cartesian robot capable of operating a ventilator touch screen with camera vision control via a wirelessly connected tablet master device located outside the room. Engineering system tests demonstrated that the open-loop mechanical repeatability of the device was 7.5 mm, and that the average positioning error of the robotic finger under visual servoing control was 5.94 mm. Successful usability tests in a simulated ICU environment were carried out and are reported. In addition to enabling a significant reduction in PPE consumption, the prototype system has been shown in a preliminary evaluation to significantly reduce the total time required for a respiratory therapist to perform typical setting adjustments on a commercial ventilator, including donning and doffing PPE, from 271 to 109 s.


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