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PubMed1992

Evaluation of triggering systems for patient triggered ventilation for neonates ventilator-dependent beyond 10 days of age.

The performance of two triggering systems was compared during patient triggered ventilation (PTV) of infants ventilator-dependent beyond 10 days of age. Ten infants were studied who had a median gestational age of 26.5 weeks and a postnatal age of 15.5 days. PTV was administered via the SLE ventilator and the two triggering systems, an airway pressure monitor and the MR10 respiration monitor, were used in random order each for 30 min. The airway pressure trigger had a superior performance in that, although it did not differ significantly in delivered inflation volume or sensitivity to the MR10 respiration monitor, it had a shorter trigger delay (P < 0.01). Oxygenation improved in eight of the ten infants on the airway pressure trigger, but only in three on the MR10 respiration monitor. The reduction in PaCO2 was greater during PTV with the airway pressure trigger compared with the MR10 respiration monitor (P < 0.01). We conclude that the airway pressure trigger has a superior performance compared to the MR10 respiration monitor trigger in infants who are ventilator-dependent beyond 10 days of age.

Chronic Disease↗
PubMed1990

Accuracy of end-tidal PCO2 measurements using a sidestream capnometer in infants and children ventilated with the Sechrist infant ventilator.

To determine the accuracy of end-tidal PCO2 (PETCO2) measurements analyzed with a sidestream capnometer in infants and children whose lungs were ventilated with a Sechrist infant ventilator and an Ayre's t-piece, we compared PETCO2 measurements obtained from the proximal (PETCO2-p) and distal (PETCO2-d) ends of the tracheal tube to arterial PCO2 (PaCO2) in 37 healthy infants and children between 1.3 and 24.5 kg. Both PETCO2-p and PETCO2-d accurately approximated PaCO2, however, the mean (+/- SD) arterial to end-tidal PCO2 difference (delta(a-ET)PCO2) was significantly greater with proximal (1.27 +/- 1.54 mmHg) than with distal sampling (0.64 +/- 1.64 mmHg) (P less than 0.01). In the subgroup of patients who weighted less than 12 kg, the delta(a-ET)PCO2 using proximal gas sampling (1.94 +/- 1.29 mmHg) was also significantly greater than it was using distal sampling (0.74 +/- 1.31 mmHg) (P less than 0.001). We conclude that although statistically different, both proximal and distal estimates of PETCO2 provide acceptable estimates of PaCO2 in healthy infants and children who are ventilated with a Sechrist infant ventilator and an Ayre's t-piece system.

Carbon Dioxide↗
PubMed2002

Early versus delayed surfactant administration in extremely premature neonates with respiratory distress syndrome ventilated by high-frequency oscillatory ventilation.

OBJECTIVE: To determine whether early surfactant administration is superior to selective delayed treatment in terms of improving survival and/or reducing chronic lung disease in extremely premature neonates with respiratory distress syndrome (RDS) treated by high-frequency oscillatory ventilation (HFOV). DESIGN: Prospective randomized clinical trial. SETTING: Tertiary neonatal intensive care unit (NICU) in the Perinatology Center of Prague. PATIENTS: Forty-three extremely premature infants who needed artificial ventilation within 3 h after delivery. INTERVENTIONS: Patients were randomly assigned to either early ( n=21) or delayed (n=22) administration of surfactant. All were ventilated by HFOV as the primary mode of ventilation using the high volume strategy aimed at optimizing lung volume. Curosurf at a dose of 100 mg/kg was given as a single bolus via the endotracheal tube within 1 min immediately after intubation in the early group (EARL), or during HFOV only when defined criteria were reached in the delayed (DEL) group. MEASUREMENTS AND RESULTS: No differences were noted in demographic data between the two groups. Fewer infants randomized to the EARL group required oxygen use or died at 36 weeks (combined outcome 29% vs 64%, p=0.021), and there was a lower incidence of any intraventricular hemorrhage in this group (43 vs 82%, p=0.008). CONCLUSIONS: When compared to delayed dosing, early administration of surfactant followed by HFOV facilitates and accelerates respiratory stabilization during the acute phase of severe RDS, may reduce the incidence of chronic lung disease or death and may positively influence the incidence of severe intracranial pathology in extremely premature infants with primary surfactant insufficiency.

Chronic Disease↗
PubMed2006

Comparison of conventional mandatory ventilation and high frequency oscillatory ventilation for treatment of acute lung injury induced by steam inhalation injury.

This study compared patho-physical indexes, respiratory mechanics, circulatory parameters and lung injury scores of acute lung injury (ALI) induced by steam inhalation injury in a New Zealand rabbit model with different ventilatory strategies: a control group which consisted of lower tidal volume (VT 6 ml/kg) and high positive end-expiratory pressure (PEEP) (9 cmH(2)O); treatment group which was high frequency oscillatory ventilation (HFOV). Eighteen rabbits were anaesthetized, sedated, neuromuscular-blocked and ventilated with above two modes at our animal laboratory of burn center. After induction of acute lung injury by steam inhalation, animals were randomly assigned to receive either conventional mechanical ventilation (CMV) or high frequency oscillatory ventilation and were grouped as CMV and HFOV group. As a result, HFOV attenuated the decrease in oxygenation and pulmonary compliance, alleviated lung tissue damage and inflammatory response. Therefore, HFOV may be a preferable option for treatment of acute lung injury induced by steam inhalation injury.

Animals↗
PubMed2006

Is high-frequency ventilation more beneficial than low-tidal volume conventional ventilation?

The ventilator goals of the ICU clinician faced with caring for a critically ill child who has ALI/ARDS remain relatively simple: provide adequate ventilation and oxygenation without overdistending alveoli or furthering lung injury. How one obtains these goals is much less simple. The current use of CV calls for the use of relatively low V(T)s and limiting peak inspiratory pressure and plateau pressure while accepting a certain degree of respiratory acidosis. The ICU team can also often achieve these same goals with HFOV. How, then, does one use evidenced-based medicine to pick the best mode of mechanical ventilation for a particular patient? The answer is controversial, to say the least. Does one start with a gentle, open-lung mode of CV then switch to HFOV if the child deteriorates? Or does one use HFOV from the very early stages of ALI? Animal data appear to point to advantages of HFOV when used early in the course of ALI. Most of these studies report a beneficial effect of HFOV when applied on expanded lungs in the early stages of the disease process. These beneficial effects encompass improved gas exchange, oxygenation, lung tissue morphology and pulmonary mechanics. The studies by Arnold and colleagues in the pediatric population also help to answer our questions. In their work, the early initiation of HFOV was associated with improved gas exchange and a trend toward a lower mortality. In adults, Derdak and colleagues demonstrated the superiority of HFOV in terms of gas exchange and oxygenation; however, no statistical significant difference was found for mortality. So, where is the clinician left after a review of these data? It would appear that (1) low-V(T) CV remains a cornerstone of therapy for the pediatric patient who has ALI/ARDS; (2) HFOV is a safe and well-tolerated mode of mechanical ventilation; (3) early use of HFOV (as opposed to the rescue use of this mode) may be of benefit based on animal and human data; and (4) like so many areas of pediatric critical care, clinicians must await new data and trials that will help them continue to improve the care they provide.

Animals↗
PubMed1990

High-frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in preterm infants: assessment of pulmonary function at 9 months of corrected age. HiFi Study Group.

In a comparison of the outcome of high-frequency oscillatory ventilation (HFO) and conventional mechanical ventilation (intermittent mandatory ventilation (IMV] in newborn infants, the degree of late pulmonary damage in these infants was assessed in a multicenter trial by examining their pulmonary status, including pulmonary function test results at 9 months of corrected age. A total of 432 infants were followed, 222 in the IMV group and 210 in the HFO group. Two-hundred twenty-three infants had their pulmonary mechanics measured, 118 in the IMV group and 105 in the HFO group. There were no significant differences between the two groups in conditions known to predispose infants to chronic lung disease. At 9 months of age, both groups has similar growth and a similar incidence of respiratory tract infections and hospital readmissions, and of retractions and episodes of wheezing. None of the pulmonary mechanics measurements differed. Forced expiratory flow at functional residual capacity was decreased (132 +/- 86 vs 135 +/- 92 ml/sec in the IMV and HFO groups, respectively), peak-to-peak esophageal pressure change was elevated (14.4 +/- 5.7 vs 13.5 +/- 5.7 cm H2O), dynamic compliance was in the low normal range (1.2 +/- 0.5 vs 1.3 +/- 0.6 ml/cm H2O/kg), and total pulmonary resistance was elevated (63 +/- 43 vs 57 +/- 34 cm H2O/L/sec) when the measurements were compared with normal values. The results indicate that in both groups, 30% to 40% of infants survived with chronic pulmonary changes similar to those described in infants with bronchopulmonary dysplasia. The use of high-frequency ventilation, in comparison with IMV, did not improve long-term pulmonary outcome.

Carbon Dioxide↗
PubMed1984

Quantitative ventilation-perfusion lung scans in infants and children: utility of a submicronic radiolabeled aerosol to assess ventilation.

The quantitative assessment of regional pulmonary ventilation and perfusion provides useful information regarding lung function. Its use in infants and young children, however, has been minimal because of practical and technical limitations when the distribution of ventilation is assessed by radioactive gases. In 16 infants and children we used an inexpensive commercially available nebulizer to produce a submicronic aerosol labeled with 99mtechnetium-diethylenetriamine pentacetic acid to assess ventilation quantitatively, and intravenous injections of 99mtechnetium-labeled macroaggregates of albumin to assess pulmonary perfusion quantitatively. Studies were safely completed in both ambulatory and critically ill patients, including two premature infants who had endotracheal tubes in place for ventilatory support. No sedation or patient cooperation is required. This technique enables any department of nuclear medicine to measure regional pulmonary ventilation and perfusion in infants and children.

Adolescent↗
PubMed1997

Negative-impedance ventilation and pressure support ventilation: a comparative study.

Negative impedance ventilation (NIV) is a novel mode of assisted mechanical ventilation (AMV) in which the pressure support is regulated to continuously track inspiratory flow and/or volume. In this study, we have evaluated the efficacies of NIV and inspiratory pressure support (IPS) ventilation in a model of central airway obstruction in six rabbits. For both AMV modes there was an inverse relationship between the intrinsic work of breathing and alveolar pressure. Compared to IPS, NIV was found to: (1) achieve the same degree of ventilatory unloading and similar level of pulmonary ventilation with considerably lower alveolar pressure; (2) better restore the normal tidal volume and respiratory frequency; (3) yield a shorter inspiratory duty cycle, thereby helping to rest the respiratory muscles and preclude intrinsic positive end-expiratory pressure. We conclude that NIV is more efficacious than IPS in negating airway obstruction and offers a better trade-off between the risks of respiratory muscle fatigue and pressure induced complications.

Airway Resistance↗
PubMed1998

Non-conventional respiratory support modalities applicable in the older child. High frequency ventilation and liquid ventilation.

HFV, LV, and several other novel therapies offer promise to adults and children that the mortality associated with respiratory failure may be affected. Although there are several forms of HFV, HFOV is presently gaining favor in the treatment of severe respiratory failure and has generally supplanted HFJV in pediatric critical care. HFOV has the advantage of having an active expiratory phase, which helps to minimize air trapping and better modulate mean lung volume. Ventilators with sufficient power to perform HFOV in adults are currently under investigation, although there is a growing experience in using current ventilators in larger patients. To date, however, demonstration of lowered mortality with HFOV is lacking although intermediate outcome indicators are improved. PLV also offers promise in the treatment of ARF through its drastic ability to improve oxygenation, ventilation, and compliance in many lung injury models. Human trials are presently underway, but the optimal delivery of this novel therapy still necessitates extensive investigation. TLV is likely even more removed from general clinical application given the necessity of developing a new generation of ventilators for the delivery of liquid tidal volumes. How these and other modalities may piece together to improve the condition of our patients who have respiratory failure remains to be seen, but certainly, present and future investigation will be intriguing for years to come.

Acute Disease↗
PubMed1996

[Transtracheal jet ventilation with spontaneous ventilation in neoplastic laryngeal dyspnea].

In six suffocating patients with a severe upper airway obstruction (three patients after direct laryngoscopy under general anaesthesia and three patients with cervical tumor scheduled for a difficult tracheostomy), jet-ventilation was delivered using a transtracheal catheter. The jet-ventilator insufflated oxygen only when the tracheal pressure was below a preset value, during spontaneous inspiration. During expiration, tracheal pressure increased above the preset value, the ventilator stopped the insufflation and the expiratory gases escaped through the upper airway. This method corresponds to an inspiratory support without intubation. In post-anaesthesia patients, oxygenation and alveolar ventilation were improved, allowing the avoidance of tracheostomy. In the other patients, tracheostomy was made possible with good surgical conditions under general anaesthesia. This method can be applied in conscious patients and allows oxygenation of suffocating patients.

Adult↗
PubMed1999

Flow triggering added to pressure support ventilation improves comfort and reduces work of breathing in mechanically ventilated patients.

PURPOSE: The purpose of this study was to measure the effect of flow triggering (FT), added to pressure support ventilation (PSV), during spontaneous breathing in intubated patients. MATERIALS AND METHODS: A prospective observational study was conducted at a Comprehensive Cancer Center, University Hospital. Fourteen consecutive critically ill, mechanically ventilated patients on PSV with positive end-expiratory pressure were studied. Flow triggering was added to PSV in spontaneously breathing ventilated patients. RESULTS: Respiratory rate (f), minute ventilation (Vepsilon), patient work of breathing (WOBp), respiratory drive (P0.1), rapid shallow breathing index (f/Vt), tidal volume (Vt) and a visual analog scale of breathing effort and comfort all improved. There was a large decrease in WOBp and P0.1 when flow triggering was added to PSV (P<.001). There was a moderate decrease in f/V1 during the same procedure (P<.01). Twelve patients felt subjectively better with the intervention. CONCLUSIONS: Flow triggering offers an excellent complement to PSV because it improves patient comfort and reduces the magnitude of the inspiratory effort as well as the delay time between inspiratory muscle contraction and gas flow. It augments gas exchange at no metabolic cost to the patient while reducing the work of breathing.

Adult↗
PubMed2002

Choice of ventilator types, modes, and settings for long-term ventilation.

Ventilator-associated issues are important for optimum short- and long-term outcome in patients treated with long-term mechanical ventilation, and may even influence compliance. This article discusses the individual choice of type, modeand settings ventilators, based on the efficacy of the intervention and patient-related factors, such as the patient's comfort and safety. Although this strategy may cause some overlap, from a methodological point of view it seems reasonable to deal separately with types, modes and different ventilator settings.

Chronic Disease↗
PubMed2000

A review of ventilation and the quality of ventilation air.

Ventilation is pivotal in terms of securing optimum indoor air quality. In addition, it also has a major impact on energy use in buildings. It is important, therefore, that the role and impact of ventilation is fully understood and that ventilation is employed efficiently. The purpose of this paper is to review these aspects with particular reference to recent research and developments. Key aspects are concerned with identifying the role of ventilation and reviewing this role in the context of the other measures that must be taken to secure a healthy indoor environment. References are particularly made to the development of standards and recent related research. Although good progress is being made, areas that still need to be addressed include maintaining good outdoor air quality and preventing contaminated outdoor air from entering buildings. The outcome of recent research must also be disseminated in practical ways to policy makers, building occupiers and practitioners. Good indoor climate can be achieved, not so much by introducing expensive concepts, but by developing a rationale approach to identifying needs and applying the necessary tools to deal with each need.

Air Pollution, Indoor↗
PubMed2000

Partial liquid ventilation shows dose-dependent increase in oxygenation with PEEP and decreases lung injury associated with mechanical ventilation.

PURPOSE: The purpose of this article is to evaluate the effect of positive end-expiratory pressure (PEEP) during partial liquid ventilation (PLV) and to investigate if lung damage associated with mechanical ventilation can be reduced by PLV. MATERIALS AND METHODS: Twenty-two New-Zealand white rabbits were ventilated in pressure-controlled mode maintaining constant tidal volume (10 mL/kg). Lung injury was induced by repeated saline lavage (PaO2 < 100 mm Hg). Two incremental PEEP steps maneuvers (IPSMs) from 2 to 10 cm H2O in 2 cm H2O steps were performed sequentially. The control group received the first IPSM in the supine position and were turned prone for the second IPSM. In the PLV group (n = 7), 12 mL/kg of perfluorodecalin was instilled after lung injury before the two IPSMs. The early prone group (n = 7) received both IPSMs in the prone position. Parameters of gas exchange, lung mechanics, and hemodynamics as well as pathology were examined. RESULTS: During the first IPSM, the PLV group showed a significant increase in PaO2 after instillation of perfluorodecalin (P < .05) and then showed a dose-dependent increase in PaO2 with PEER. The control and EP groups showed improvement in PaO2 only at higher PEEP, eventually showing no intergroup differences at PEEP of 10 cm H2O. During the second IPSM only the PLV group retained its ability to increase PaO2 to the level obtained during the first IPSM (P < .05 compared with control and EP groups). During the first IPSM all three groups showed increasing trend in static compliance (Cst) with PEEP peaking at PEEP of 8 cm H2O. During the second IPSM, only the PLV group showed increase in static compliance with PEEP (P < .05 compared with other groups). Lung histology revealed significantly less hyaline membrane formation in the PLV group (P < .05). CONCLUSION: PLV shows dose-dependent increase in oxygenation with PEEP and may reduce lung damage associated with mechanical ventilation.

Analysis of Variance↗
PubMed2006

[Principles and function of mechanical ventilation: classification and modes of ventilators].

A spectrum of diseases is associated with the necessity for partial or total support of pulmonary ventilation. The insight into the function of ventilators and their modes reduces the spectrum of ventilatory support to a few basic principles. The knowledge enables the pulmonary intensivist to adapt mechanical ventilation to the individual patient's needs. This overview describes the technical aspects of mechanical ventilation and summarizes the variety of specific modes implied.

Humans↗
PubMed1995

[Behavior of cerebral blood flow velocity in conventional ventilation and superimposed high frequency jet ventilation].

OBJECTIVE: Patients with increased intracranial pressure or vasospasm after subarachnoidal haemorrhage with decreased cerebral perfusion present a special problem on developing respiratory insufficiency, since kinetic therapy or extracorporal life support are contraindicated. Superimposed High Frequency Jet Ventilation (SHFJV) has been shown to be of benefit in ventilating patients with pulmonary insufficiency. The aim of this study was to evaluate if SHFJV could be safely applied in patients with critical cerebral blood flow; if so, SHFJV might be beneficial when pulmonary insufficiency occurs concomitantly. METHODS: The study was performed in 14 patients (3 with pulmonary insufficiency) applying first moderate hyperventilation (paCO2 31 to 36 mmHg) followed by increased hyperventilation (paCO2 27 to 30 mmHg) with CMV and SHFJV and measuring intracranial pressure (ICP), cerebral perfusion pressure (CPP) and blood flow velocity (BFV) of the middle cerebral artery. BFV of the middle cerebral artery which correlates closely to the cerebral blood flow, was measured continuously with transcranial Doppler ultrasound. RESULTS: CMV: Increased hyperventilation leads to a statistically significant increase in paO2 (121.3 to 147.2 mmHg, p < 0.05), SaO2 (98.5% to 99.2%, p < 0.05) and decrease in BFV (systole 115.9 to 89.6 cm/s, diastole 44.6 to 31.8 cm/s, p < 0.05). Heart rate, mean arterial blood pressure, ICP and ventilation parameters did not show any statistically significant differences. SHFJV: During SHFJV the parameters demonstrated similar patterns as during CMV. However, none of the changes were statistically significant (paO2 111.9 to 125.9 mmHg, SaO2 97.9 to 98.8, BFV systole 106 to 95 cm/s, diastole 52.7 to 42.4 cm/s, n.s.). After calculating the mean BFV according to the Markwalder formula to a standard paCO2 of 40 mmHg CMV and SHFJV were compared to one another. No statistical difference was seen between the two different ventilation techniques. CONCLUSION: In patients with increased ICP, pulmonary complications such as pneumonia or ARDS are frequently observed. Since there are indications that SHFJV is of benefit in pulmonary insufficiency, the study was conducted to demonstrate that SHFJV can be safely applied in patients with increased ICP.

Adolescent↗
PubMed1999

Comparison of one-lung ventilation and high-frequency ventilation in thoracoscopic surgery.

OBJECTIVE: To report our experience of the use of high frequency ventilation (HFV) in thoracoscopic surgery. DESIGN: Retrospective study. SETTING: University Hospital Rotterdam, The Netherlands. SUBJECTS: 31 patients (18 men and 13 women, mean age 42 years, range 26-67 years) who underwent 46 thoracoscopic procedures between January 1992 and December 1997. INTERVENTIONS: Until October 1994 patients had conventional mechanical ventilation with a double-lumen tube. Since then HFV has been used. MAIN OUTCOME MEASURES: Duration of induction, oxygen saturation, and end-tidal carbon dioxide tension. RESULTS: 25 procedures were done with a double-lumen endotracheal tube for one-lung ventilation and in 21 HFV was used. Induction of anaesthesia took significantly less time in the HFV group (median 14 minutes) compared with one-lung ventilation group (median 31 minutes) (p < 0.05). There were no significant differences between the groups in either SaO2 or end-tidal CO2. CONCLUSION: HFV is both safe and simple for use in thoracoscopic surgery.

Adult↗
PubMedDate not supplied

Acute life-threatening ventilation-perfusion inequality: an indication for independent lung ventilation.

Although reports of independent lung ventilation are found in the literature more frequently, firm criteria for its use have not yet been established. It is probable that major ventilation-perfusion inequality, especially in cases in which the blood flow is primarily diverted to the less ventilated lung, could sometimes be corrected by this technique. The present report deals with such a case and describes the angiographic studies which convinced us that differential ventilation was necessary. By this means we were able to provide successful treatment for patients who had developed preterminal hypoxemia.

Adult↗