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Biomedical subjects

Richard D Branson

Publications and source records attributed to Richard D Branson.

7 recordsLinked to original sources
PubMed2003

Endotracheal tubes and imposed work of breathing: what should we do about it, if anything?

Concerns about the work of breathing imposed by the endotracheal tube have led clinicians to routinely use pressure support to overcome this resistive component. More recently, ventilator manufacturers have introduced systems to automatically overcome endotracheal tube resistance, regardless of tube diameter or patient demand for flow. Despite the theoretical advantages, neither method appears to provide superior performance. Stepping back, the real question may be, is overcoming endotracheal tube resistance really important?

Humans↗
PubMed2003

Influence of low tidal volumes on gas exchange in acute respiratory distress syndrome and the role of recruitment maneuvers.

UNLABELLED: BACKGROUND Use of a low tidal volume (V(T)) strategy in the treatment of acute respiratory distress syndrome can lead to a decrease in oxygenation. This study evaluated the safety and efficacy of a recruitment maneuver (RM) in this setting. METHODS: Twelve patients with acute respiratory distress syndrome were studied within 48 hours of diagnosis. Baseline gas exchange, hemodynamics, and respiratory mechanics were determined and patients were placed on a V(T) of 6 mL/kg. Measurements were repeated and an RM of 30 cm H20 for 40 seconds was performed. Measurements were repeated at 30 minutes and 2 hours post-RM. RESULTS: Decreasing V(T) resulted in a decrease in arterial oxygenation (from 91 +/- 9 mm Hg to 75 +/- 9 mm Hg, p < 0.01), an increase in shunt (from 19 +/- 3.7% to 23 +/- 5%, p < 0.01), and a decrease in lung compliance (from 37 mL/cm H2O to 33 mL/cm H2O, < 0.05). At 30 minutes post-RM, oxygenation improved to 99 +/- 16 mm Hg, shunt decreased to 17 +/- 3%, and lung compliance improved to 39 mL/cm H2O (p < 0.05). Two hours later, oxygenation fell (86 +/- 12 mm Hg), shunt increased (20 +/- 3%), and compliance diminished (36 mL/cm H2O). There were no hemodynamic or barotraumatic complications. CONCLUSION: An RM transiently improves gas exchange during low V(T)ventilation. RMs are well tolerated and no hemodynamic consequences were seen.

Accidents, Traffic↗
PubMed2002

Transport ventilators.

Today there are a number of automatic resuscitators and simple and complex transport ventilators on the market. The user must consider the purpose of the device, the patient population to be ventilated and the capabilities of the individual devices before purchasing a transport ventilator.

Critical Illness↗
PubMed2002

Closed-loop mechanical ventilation.

Closed-loop mechanical ventilation encompasses a plethora of techniques, ranging from the very simple to the relatively complex. In the simplest form, closed-loop ventilation is the control of one output variable of the mechanical ventilator based on the measurement of an input variable. An example would be pressure support ventilation, in which flow (output) is constantly changing to maintain pressure (input) constant throughout inspiration. More complex forms of closed-loop ventilation involve measurement of multiple inputs (eg, compliance, oxygen saturation, respiratory rate) to control multiple outputs (eg, ventilator frequency, airway pressure, tidal volume). The latter type of control more closely mimics the ventilatory control and response of human physiology. This review discusses both currently available closed-loop ventilation techniques and those only available outside the United States, along with some cutting-edge techniques that have only limited use. The operation, theoretical advantages, and limitations of each technique are reviewed. When available, the literature supporting or refuting each technique will be reviewed, but, unfortunately, little has been published on certain techniques.

Algorithms↗
PubMed2002

Imposed work of breathing during ventilator failure.

INTRODUCTION: Ventilators possess an anti-asphyxia valve that allows spontaneous breathing of ambient air during ventilator failure. This study examined the imposed work of breathing and pressure-time product of 8 critical care and 9 portable ventilators, using a laboratory simulation of spontaneous breathing during ventilator failure. METHODS: A test lung was modified to simulate spontaneous breathing with a tidal volume of 0.5 L and peak inspiratory flow of 60 L/min. A pneumotachograph and pressure tap were placed at the proximal airway between the breathing circuit and endotracheal tube. Flow was derived from the pressure drop across the pneumotachograph. Signals were amplified, integrated, and saved to a spreadsheet program, and imposed work of breathing and pressure-time product were calculated. Also measured were the inspiratory pressure required to open the anti-asphyxia valve (cracking pressure), time to cracking pressure, maximum negative inspiratory pressure, and time to maximum negative inspiratory pressure. RESULTS: For the critical care ventilators the mean +/- SD imposed work of breathing ranged from 213.07 +/- 3.53 to 890.63 +/- 0.88 mJ/L and the pressure-time product ranged from 2.67 +/- 0.01 to 13.37 +/- 0.01 cm H(2)O x s/L. For the portable ventilators the mean +/- SD imposed work of breathing ranged from 361.37 +/- 1.22 to 969.60 +/- 22.70 mJ/L and the pressure-time product ranged from 4.52 +/- 0.01 to 16.70 +/- 0.37 cm H(2)O x s/L. CONCLUSIONS: Spontaneous breathing during ventilator failure may impose work approximating the physiologic work of breathing. This imposed work may prevent effective breathing through the anti-asphyxia valve during mechanical ventilator failure due to electrical failure. These results reinforce the need to properly monitor mechanically ventilated patients and to have in place sufficient back-up power supplies and a method of manual ventilation.

Equipment Design↗
PubMed2002

Battery duration of portable ventilators: effects of control variable, positive end-expiratory pressure, and inspired oxygen concentration.

INTRODUCTION: Portable ventilators require battery power during transport or when alternating current is unavailable. Manufacturers report battery duration at nominal ventilator settings. METHODS: We studied the effects of control variable (pressure control vs volume control), positive end-expiratory pressure (PEEP), and fraction of inspired oxygen (F(IO)(2)) on the battery duration of 8 portable ventilators: Achieva, HT50, iVent201, LTV1000, TBird Advanced Ventilator System (AVS), Avian, Uni-Vent 750, and Uni-Vent 754. Each ventilator was set to ventilate a test lung at a rate of 10 breaths/min, tidal volume of 750 mL, and inspiratory time of 1.5 s, with volume-controlled ventilation and then pressure-controlled ventilation (PCV), if available. F(IO)(2) was set at 0.21 and then 1.0. PEEP was set at 0, 10, and then 20 cm H(2)O. Test lung compliance and resistance were set at 20 mL/cm H(2)O and 5 cm H(2)O/L/s, respectively. Five trials were performed with each portable ventilator, with each combination of settings. Time to low-battery alarm, battery-empty alarm, and failure to ventilate the test lung were recorded. Portable ventilator performance during the trials was determined by continuous recording of tidal volume. RESULTS: The battery duration of pneumatically driven portable ventilators is longer than that of electrically driven portable ventilators. The battery duration of pneumatically driven portable ventilators is minimally affected by ventilator settings. The battery duration of electrically driven portable ventilators is shortened by use of PCV, increasing PEEP, and increasing F(IO)(2). Compared to zero PEEP, PEEP of 20 cm H(2)O reduced battery duration with HT50 (40%), LTV1000 (37%), TBird AVS (34%), and Achieva (15%). Compared to volume-controlled ventilation, PCV reduced battery duration with the LTV1000 (48%) and TBird AVS (18%). Compared to F(IO)(2) of 1.0, F(IO)(2) of 0.21 reduced battery duration with the Uni-Vent 754 (37%). Compared to F(IO)(2) of 0.21, F(IO)(2) of 1.0 reduced battery duration with the LTV1000 (17%) and TBird AVS (15%). The iVent201 was unable to deliver the set tidal volume with PCV and 20 cm H(2)O PEEP. Low-battery alarms functioned properly on all the ventilators. CONCLUSIONS: Battery duration differs greatly among the portable ventilators tested. Clinicians must be aware that portable ventilator battery duration is affected by control settings, lung impedance characteristics, and portable ventilator characteristics. Battery duration may be shorter than that reported in the operator's manual for each portable ventilator tested.

Electric Power Supplies↗