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At least 37 records · Page 2Linked to original sources
PubMed1991

Inverse ratio ventilation in ARDS. Rationale and implementation.

Conventional ventilatory support of patients with the adult respiratory distress syndrome (ARDS) consists of volume-cycled ventilation with applied positive end-expiratory pressure (PEEP). Unfortunately, recent evidence suggests that this strategy, as currently implemented, may perpetuate lung damage by overinflating and injuring distensible alveolar tissues. An alternative strategy--termed inverse ratio ventilation (IRV)--extends the inspiratory time, and, in concept, maintains or improves gas exchange at lower levels of PEEP and peak distending pressures. There are two methods to administer IRV: (1) volume-cycled ventilation with an end-inspiratory pause, or with a slow or decelerating inspiratory flow rate; or (2) pressure-controlled ventilation applied with a long inspiratory time. There are several real or theoretical problems common to both forms of IRV: excessive gas-trapping; adverse hemodynamic effects; and the need for sedation in most patients. Although there are many anecdotal reports of IRV, there are no controlled studies that compare outcome in ARDS patients treated with IRV as opposed to conventional ventilation. Nonetheless, clinicians are using IRV with increasing frequency. In the absence of well-designed clinical trials, we present interim guidelines for a ventilatory strategy in patients with ARDS based on the literature and our own clinical experience.

Humans↗
PubMed2001

A retrospective view of school mental health consultation.

General principles of mental health consultation as written about by Coleman and Maddux are enumerated. Historically, the refinement of these principles for school consultation was described in detail in the literature by Gerald Caplan and Irving Berlin. Common methods define the consultees' problems as work problems; the consultant views the consultees' difficulties as due to intrapsychic conflicts. Resolution of the consultees' difficulties requires the consultant to use methods that enhance the consultee's self-esteem and indirectly provide the consultee insight into the genesis of his or her problems. Thus, consultees are gradually better able to help the client with his or her difficulties. Training of child psychiatry residents in school consultation historically occurred in three divisions of child psychiatry. Training methods were quite similar. The history of consultation to school administrators at various levels, the issues that emerged, and methods of helping administrators to deal with these problems are elucidated. Special problems in dealing with school consultation on two American Indian reservations, especially that of gaining entrance into the school, are discussed.

Adolescent↗
PubMed2002

The outcome of early pressure-controlled inverse ratio ventilation on patients with severe acute respiratory distress syndrome in surgical intensive care unit.

BACKGROUND: Pressure-controlled inverse ratio ventilation (PC-IRV) was used in patients with acute respiratory distress syndrome (ARDS) after failed volume-cycled conventional ratio ventilation (VC-CRV). The aim of this study was to evaluate the outcome of early PC-IRV in severe ARDS. METHODS: Twenty patients with severe ARDS were switched from VC-CRV to PC-IRV if they failed to maintain SaO(2) >90% by the following criteria: peak inspiratory pressure (PIP) >35 cm H(2)O, FIO(2) = 60%, and positive end-expiratory pressure (PEEP) 10 cm H(2)O. RESULTS: The values of PIP, mean airway pressure, minute volumes, and lung injury score in VC-CRV were 43.9 +/- 8.0 cm H(2)O, 19.5 +/- 6.4 cm H(2)O, 11.0 +/- 2.1 L/min, and 2.8 +/- 0.2 respectively. In PC-IRV, the corresponding data were 31.8 +/- 5.1 cm H(2)O, 25.4 +/- 4.6 cm H(2)O, 8.3 +/- 0.9 L/min, and 2.5 +/- 0.4. All of these parameters were significantly different. Fifteen patients (75%) survived their intensive care unit stay. CONCLUSIONS: Early PC-IRV in severe ARDS improves oxygenation, facilitates tapering of high fraction of inspiratory oxygen, and decreases high PEEP or PIP, and then results in the improvement of the patient's outcome.

Adolescent↗
PubMed2000

Combination of inhaled nitric oxide therapy and inverse ratio ventilation in patients with sepsis-associated acute respiratory distress syndrome.

Inverse ratio ventilation (IRV) is a ventilatory technique that uses an inspiratory to expiratory ratio (I:E) greater than 1:1. We studied the effects of mechanical ventilation with an I:E of 1:3, 1:1, and 2:1 on arterial oxygenation in 10 patients with sepsis-associated acute respiratory distress syndrome (ARDS). At each I:E, patients received 0 and 4 ppm of inhaled nitric oxide (INO) in random order for 30 min. Respiratory and cardiovascular parameters were measured. Of the 10 patients studied, 7 responded to IRV and 3 did not. An increase in the I:E and the addition of INO significantly improved arterial oxygenation in the responders (p < 0. 0001 and p < 0.006, respectively). The combination of an increase in the I:E and INO had an additive effect on arterial oxygenation. The combined use of IRV and INO is a more effective method of avoiding hypoxemia than either INO or IRV alone.

Administration, Inhalation↗
PubMedDate not supplied

The Irving sterilization technique: a report of a failure.

The Irving sterilization technique is a very reliable method of surgical contraception, with only two prior mentions of failure in the literature. We present the third case of failure of an Irving operation. A discussion on the surgical aspects of the Irving technique is also presented.

Adult↗
PubMed1984

Collaborative evaluation of the Abbott yeast identification system.

The Abbott yeast identification system (Abbott Laboratories, Diagnostics Division, Irving, Tex.) is a 24-h, instrumental method for identifying medically important yeasts, based on matrix analysis of 19 biochemical reactions and the germ tube test. The system was evaluated in two clinical laboratories by using 179 coded isolates, which included a high percentage of the less frequently encountered species. Based upon results with these coded isolates and from previously obtained laboratory data, the system software was adjusted and accuracy of the yeast identification system was further evaluated with 378 isolates from clinical sources. Of the 378 clinical yeast isolates tested, 364 (96%) were correctly identified with the Abbott system. Isolates were deliberately selected so that germ tube-positive isolates made up less than 10% of the clinical isolates tested.

Candida↗
PubMed1998

Effect of inverse I:E ratio ventilation on pulmonary gas exchange in acute respiratory distress syndrome.

BACKGROUND: It is not known whether inverse I:E ratio ventilation (IRV) offers any real benefit over conventional mechanical ventilation with positive end-expiratory pressure (CMV-PEEP) at similar levels of end-expiratory pressure. METHODS: The effects of volume-controlled and pressure-controlled IRV (VC-IRV and PC-IRV, respectively) on VA/Q inequality were compared with those of CMV-PEEP at a similar level of end-expiratory pressure and with CMV without PEEP (CMV) in eight patients in the early stages of acute respiratory distress syndrome (ARDS). Respiratory blood gases, inert gases, lung mechanics, and hemodynamics were measured 30 min after the onset of each ventilatory mode. RESULTS: Recruitment of nonventilated, poorly ventilated (or both) but well-perfused alveoli increased the partial pressure of oxygen (PaO2) during CMV-PEEP (+13 mmHg) and IRV-VC (+10 mmHg; P < 0.05) compared with CMV. In contrast, PC-IRV did not affect PaO2 but caused a decrease in PaCO2 (-7 mmHg; P < 0.05). The latter was due to a concomitant decrease in dead space (P < 0.01) and shift to the right of VA/Q distributions. During PC-IRV, the increase in the mean of blood flow distribution (mean Q; P < 0.01) without a change in the dispersion (log SD Q) did not result in an increase in PaO2, probably because it reflected redistribution of blood flow within well-ventilated areas. CONCLUSIONS: Short-term PC-IRV improved carbon dioxide clearance, but the lung became less efficient as an oxygen exchanger. Furthermore, based on mean airway and plateau pressures, the risk of barotrauma was not reduced with this type of ventilation.

Adult↗
PubMed1985

[Artificial respiration technics].

In general there are two distinguishable methods of artificial ventilation: assisted spontaneous ventilation and controlled ventilation. Spontaneous ventilation can be supported by CPAP or PEEP, in order to improve oxygenation, and by IMV to improve CO2 elimination. Furthermore, high frequency low pressure ventilation may be used versus low frequency high pressure ventilation. Conventional IPPV may be supported by continuous endexspiratory pressure. In special cases IRV may be applied. High frequency low pressure ventilation methods may be used intra- and postoperatively as well as post-traumatically.

Humans↗
PubMed2001

Effects of inverse ratio ventilation versus positive end-expiratory pressure on gas exchange and gastric intramucosal PCO(2) and pH under constant mean airway pressure in acute respiratory distress syndrome.

BACKGROUND: In patients with acute respiratory distress syndrome, whether inverse ratio ventilation differs from high positive end-expiratory pressure (PEEP) for gas exchange under a similar mean airway pressure has not been adequately examined. The authors used arterial oxygenation, gastric intramucosal partial pressure of carbon dioxide (PiCO(2)), and pH (pHi) to assess whether pressure-controlled inverse ratio ventilation (PC-IRV) offers more benefits than pressure-controlled ventilation (PCV) with PEEP. METHODS: Seventeen acute respiratory distress syndrome patients were enrolled and underwent mechanical ventilation with a PCV inspiratory-to-expiratory ratio of 1:2, followed by PC-IRV 1:1 initially. Then, they were randomly assigned to receive PC-IRV 2:1, then 4:1 or 4:1, and then 2:1, alternately. The baseline setting of PCV 1:2 was repeated between the settings of PC-IRV 2:1 and 4:1. Mean airway pressure and tidal volume were kept constant by adjusting the levels of peak inspiratory pressure and applied PEEP. In each ventilatory mode, hemodynamics, pulmonary mechanics, arterial and mixed venous blood gas analysis, PiCO(2), and pHi were measured after a 1-h period of stabilization. RESULTS: With a constant mean airway pressure, PC-IRV 2:1 and 4:1 decreased arterial and mixed venous oxygenation as compared with baseline PCV 1:2. Neither the global oxygenation indices with oxygen delivery and uptake nor PiCO(2) and pHi were improved by PC-IRV. During PC-IRV, applied PEEP was lower, and auto-PEEP was higher. CONCLUSION: When substituting inverse ratio ventilation for applied PEEP to keep mean airway pressure constant, PC-IRV does not contribute more to better gas exchange and gastric intramucosal PiCO(2) and pHi than does PCV 1:2 for acute respiratory distress syndrome patients, regardless of the inspiratory-to-expiratory ratios.

APACHE↗
PubMed1985

Rapid, automated identification of novobiocin-resistant, coagulase-negative staphylococci.

A modified automated method that uses the MS-2 system (Abbott Laboratories, Diagnostics Div., Irving, Tex.) to verify the reaction of coagulase-negative staphylococci to novobiocin is described. This technique permits the testing of a great number of specimens in an average time of 99 min and results in a 100% match with the traditional method of culturing.

Bacteriological Techniques↗