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PubMed2003

[Evaluation of oxygenation, ventilation and respiratory mechanics before and after endotracheal suction in mechanically ventilated children].

OBJECTIVES: The aim of this study was to know the effects of endotracheal suction in respiratory mechanics and oxigenation of patients with mechanical ventilation. METHODS: 13 children were studied in the pediatric intensive care unit of Hospital São Paulo, age between 47 days and 5 years old, male and female, surgical and clinic pathology, intubated by cuffed endotracheal tube, sedated and paralyzed few minutes before measurements, under previous established suction routine without preventive maneuvers, followed by a continuous monitoring of oxygenation, ventilation and respiratory mechanics under identical ventilatory sets. The parameters analyzed was Heart rate; SpO2; ph arterial; PaO2; PaCO2; SaO2; inspiratory and expiratory tidal volume; minute volume; dynamic compliance, respiratory resistance; mean airway pressure; PEEP and PEEPi., and the measurements were made immediately before suction, immediately after, ten and twenty minutes after suction RESULTS: The results showed that the technique increase the CO2 arterial pressures (PaCO2) even after 20 minutes; decrease the oxygen saturation (SpO2) immediately after the procedure with regular recuperation after 10 minutes and decrease the lung compliance (Cdin.) immediately after with lower recuperation after 10 minutes. CONCLUSION: We concluded that intratracheal suction in front of compromise of oxygenation, ventilation or respiratory mechanic, applied as minimal as possible under preventive maneuvers. We need more studies to establish the real need of intratracheal suction and a practice guideline of intervention to avoid deleterious effects of that in pediatric patients.

Child, Preschool↗
PubMed2004

Non-invasive positive pressure ventilation in acute respiratory failure. An alternative modality to invasive ventilation at a general hospital.

OBJECTIVE: Non-invasive positive pressure ventilation (NPPV) is a relatively new modality of managing acute respiratory failure (ARF). It has not been applied before in our area. The aim of this study is to verify the use of NPPV on patients with ARF at a general hospital level. METHODS: All patients admitted at the Al-Amiri Hospital, Kuwait (a secondary medical center) between 1999 and 2001 with ARF and met the inclusion criteria were included in the study. The non-invasive mode of nasal ventilation was used as the respiratory support. RESULTS: A total of 21 patients were included in the final analysis. The major cause of ARF type 2 was chronic obstructive pulmonary disease (COPD) in 71%. The overall success rate of NPPV trials was 71.4%. In the successful trials of ARF type 2, the arterial blood gas parameters of PaCo2 (p<0.005), pH (p=0.023), and PaO2 (p<0.001) showed improvement from the first hour of intervention. Analysis of variance with repeated measurement for the arterial blood gas variables showed statistical significance of changes in favor of NPPV during initial close monitoring with p<0.001. The percentage of successful trials at the general wards was 82% versus 67% for the intensive care unit cases (ICU). Surprisingly, failure of trials related mainly to the clinical status of the patients. CONCLUSION: Non-invasive positive pressure ventilation is an effective ventilatory support in ARF in a proper clinical setting. It may be used safely in the general hospital outside the ICU.

Acute Disease↗
PubMed1990

Comparison of bedside methods to assess lung mechanics in ventilated neonates: inflation pressure, amount of ventilation and optical compliance versus measured compliance.

Compliance of the respiratory system (CRS) is rarely measured in the critically ill neonate. Instead, inflation pressure (dP), amount of ventilation (dPxfr) and optical CRS are used as indirect parameters to characterize lung mechanics. In 30 randomly chosen newborns ventilated for various causes we investigated which of these bedside methods most accurately represents the compliance of the respiratory system. The correlation coefficient was much higher for the optically determined compliance (r = 0.91) than for the amount of ventilation (r = 0.67) or the inflation pressure alone (r = 0.46) versus the measured static compliance of the respiratory system.

Heart Defects, Congenital↗
PubMed1977

Idiopathic respiratory distress syndrome (IRDS): intermittent positive pressure ventilation (IPPV) versus continuous positive pressure ventilation (CPPV), a comparative study.

59 patients with IRDS treated with CPPV in 1973-1974 are compared with 59 patients treated with IPPV in 1971-1972. With CPPV there was a reduction in mortality from 40.7% to 32.2%. CPPV as compared to IPPV reduced right to left shunting from the 6th hour of life onwards. Elevated oxygen supply was needed for shorter time and time of mechanical ventilation as well as duration of intubation could be reduced. The frequency of pneumothorax during ventilation was unchanged. The frequency of bronchopulmonary dysplasia could be reduced. One third of the surviving patients had neurological symptoms at the age of one year, the frequency was lower in the CPPV group. One patient in the IPPV group was severely damaged. The results obtained are in favour of CPPV as compared to IPPV for mechanical ventilation in patients with IRDS.

Bronchial Diseases↗
PubMed1982

Oxygenation during high-frequency ventilation compared with conventional mechanical ventilation in two models of lung injury.

Oxygenation and mean lung volume were investigated during high frequency oscillation (HFO) and conventional mechanical ventilation (CMV) in two models of lung disease and related to the lung mechanics of the lesions. Oleic acid (n = 10) or lung lavage (n = 12) pulmonary injury was induced in a series of rabbits. Each animal was alternately ventilated with HFO (15 Hz sinusoidal wave form) and CMV (flow generator I:E, 1:2; f, 30 breaths/min; VT, 10 to 15 ml/kg) at matched mean airway pressure. Pao2 was measured 5 minutes after onset of ventilation. In the lung lavage model Pao2 was significantly greater during HFO than CMV (Pao2 228 +/- 116 torr vs 71 +/- 42 torr) provided that mean airway pressure was greater than the distinct opening pressure characteristic of this lesion. In the oleic acid model oxygenation was again superior during HFO (Pao2 269 +/- 116 torr vs 110 +/- 83 torr), but only if HFO was preceded by a sustained inflation. Plethysmography in a subset of six rabbits from each group revealed that the improvements in oxygenation were associated with significantly higher mean lung volumes during HFO than CMV (58 +/- 30 ml vs 29 +/- 14 ml lung lavage model, 45 +/- 15 ml vs 30.9 +/- 13 ml on the oleic acid model). The importance of a sustained inflation in rapidly optimizing gas exchange during HFO but not CMV was demonstrated. A sustained inflation resulted in immediate and sustained increases in Pao2 (from 134 +/- 102 torr to 274 +/0 124 torr in the oleic acid model; from 115 +/- 105 torr to 291 +/- 143 torr in the lung lavage model) and mean lung volume (41.8 +/- 11 to 53.8 +/- 9.7 ml in the oleic acid model, 30.9 +/- 7.7 ml to 42.8 +/- 5 ml in the lung lavage model). It is suggested that in these two particular models of lung disease, HFO, when combined with a sustained inflation (to provide opening forces), can more fully exploit the pressure volume hysteresis of unstable lung units than CMV, thereby resulting in the larger mean lung volumes and better oxygenation observed during HFO.

Animals↗
PubMed1994

[Mechanical home ventilation: indications for and application of nocturnal ventilation using nasal masks in chronic hypoventilation].

Mechanical ventilation at home has formerly been used mainly to treat respiratory failure after poliomyelitis. Nowadays this method has been refined such that insufflation is no longer necessary through a tracheostoma but via either a specially molded or a customized nose-mask. Ventilation occurs mainly at night for periodic relief of the respiratory musculature. Indications are restrictive ventilatory deficits such as kyphoscoliosis or the postthoracoplasty syndrome, slowly progressing neuromuscular diseases and sometimes traumatic tetraparesis. Evaluation and instruction of the patient take place in a pneumologic center in close cooperation with the cantonal leagues for pulmonary diseases and the family physician. Accordingly a collaboration of all social and medical institutions as well as the participation of close relatives are a prerequisite for a successful mechanical ventilation at home.

Chronic Disease↗
PubMed1994

[Experience of anesthesia during transthoracic endoscopic sympathectomy for palmar hyperhidrosis: comparison between double-lumen endobronchial tube ventilation and laryngeal mask ventilation].

In the past year we had 36 patients operated for transthoracic endoscopic sympathectomy to treat palmar hyperhidrosis. The first group composed of 17 patients receiving anesthesia with double-lumen endobronchial-tube ventilation from July-92 to April-93, and the second group composed of 19 patients receiving anesthesia with laryngeal mask ventilation from April-93 to August-93. During right lung collapse for sympathectomy, the first group patients' SaO2 (oxygen saturation) decreased from 99.65 +/- 0.62 mmHg (pre-operation) to 95.12 +/- 5.48 mmHg (at cauterization), 95.24 +/- 5.41 mmHg (5 minutes after cauterization) and resumed 99.53 +/- 0.62 mmHg after the procedure completed. During left lung collapse for left side sympathectomy, the same group patients' SaO2 decreased from 99.59 +/- 0.62 mmHg to 97.35 +/- 3.06 mmHg, 97.82 +/- 2.53 mmHg and resumed 99.65 +/- 0.49 mmHg respectively. The second group using laryngeal mask ventilation had SaO2 changes during right side sympathectomy from 99.68 +/- 0.58 mmHg (pre-cauterization) to 99.74 +/- 0.45 mmHg (when cauterization), 99.79 +/- 0.42 mmHg (5 minutes after cauterization) and resumed 99.84 +/- 0.37 mmHg after the procedure completed. During left side sympathectomy the second group patients' SaO2 changed from 99.84 +/- 0.39 mmHg to 99.42 +/- 1.50 mmHg, 99.47 +/- 1.46 mmHg and resumed 99.74 +/- 0.59 mmHg respectively. After 2-Way ANOVA with repeated measures of the SaO2 value, we could see that no matter what side operation, there were differences existed between these two groups (< 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Acute obstruction of an anesthetic gas evacuation system. Ventilation with a Servo Ventilator 900D].

During aorto-coronary bypass surgery acute expiratory airway obstruction occurred in two patients during controlled ventilation with a Servo D ventilator (Siemens Elema) in combination with a Servo EVAC 180 gas evacuation system. In this system expiratory volume passes from the ventilator to the reservoir bag. Distension of the bag will open the valve to the receiving unit by vertical dislocation of the valve spring. The mechanism relies on free mobility of the valve spring within the reservoir bag. We observed an increase in mean expiratory and inspiratory airway pressure above 40 mmHg due to blockage of the expiratory gas outlet by external lateral dislocation of the valve spring. In conclusion, while free mobility of the valve spring within the hanging Evac bag has to be ascertained at all times for safe application of the EVAC 180 system, the manufacturer should provide some appropriate mechanical shelter around the bag.

Airway Obstruction↗
PubMed1979

Ventilator modifications for intermittent mandatory ventilation.

A Loosko MK2 ventilator has been modified to provide IMV in newborns. IMV rate can be varied from 3-60/min. The minimum inspiration period can be theoretically as low as 0.1 sec. This modification in neonatal mechanical ventilation has been shown to be economically feasible.

Humans↗
PubMed1984

High-frequency jet ventilation versus intermittent positive-pressure ventilation.

Airway pressures and cardiorespiratory variables were compared for conventional ventilation (CV) and high-frequency jet ventilation (HFJV), at a similar fraction of inspired O2 (FIO2), positive end-expiratory pressure (PEEP) and PaCO2 in 11 ICU patients. For CV and HFJV, respectively, peak (PAP) and mean airway pressures (Paw) were 15.4 and 9.1 mm Hg and 4.4 and 5 mm Hg. Cardiac index (CI) was 2.54 and 2.60 L/min X m2, total systemic vascular resistance index (SVRI) 2846 and 2923 dyne X sec/cm5 X m2, PaO2 207 and 149 torr, and Qsp/Qt 7% and 11%. HFJV decreased significantly PAP and was less likely to produce pulmonary barotrauma. Cardiac indices were not different, indicating that this variable may be affected by Paw. HFJV neither increased nor decreased CI at similar PEEP and PaCO2 as compared to CV. The decrease in PaO2 and increase in Qsp/Qt may be due to small inspired gas volumes potentiating microatelectasis. On the basis of this study, we recommend initiating HFJV at FIO2 of 0.9 and PEEP of 5 cm H2O, and monitoring both PAP and Paw.

Aged↗
PubMed1987

Combined unilateral high frequency jet ventilation and contralateral intermittent positive pressure ventilation.

The anaesthetic management of a patient who required right lower lobectomy for bronchial carcinoma associated with emphysema, pneumoconiosis and a previous thoracoplasty for pulmonary tuberculosis, is described. A technique of unilateral high frequency jet ventilation plus conventional intermittent positive pressure ventilation to the contralateral lung was used.

Anesthesia, General↗
PubMed1991

High-frequency oscillatory ventilation versus intermittent mandatory ventilation: early hemodynamic effects in the premature baboon with hyaline membrane disease.

We studied the hemodynamic consequences during the first 24 h of life in premature baboons (140 d) with hyaline membrane disease that were treated with high-frequency oscillatory ventilation (HFOV) or conventional intermittent mandatory ventilation (IMV). Cardiac output and organ blood flow were measured at three time-points using the radiolabeled microsphere technique. Seven of seven HFOV and six of eight IMV animals survived the 24-h period. By design, initial mean airway pressure (Paw) was higher in the HFOV group (p less than 0.01). HFOV Paw was progressively reduced during the study period because of improving oxygenation as measured by the arterial to alveolar oxygen ratio. In contrast, it was necessary to increase Paw in the IMV animals to maintain the arterial to alveolar oxygen ratio. By 23 h, the IMV group required higher Paw than the HFOV group (p less than 0.05) and had a lower arterial to alveolar oxygen ratio (p less than 0.05). We found no significant differences in left ventricular output, effective systemic flow, organ blood flow, or central venous pressure between the two groups at 3, 8, or 23 h. The HFOV strategy used in our study resulted in significant improvement in oxygenation during the initial 24 h of treatment without adverse effect on left ventricular output, cerebral blood flow, or central venous pressure. We conclude that when appropriate changes in Paw are made during HFOV in response to improvement in arterial oxygenation and changes in lung inflation as assessed by chest radiographs HFOV can be achieved without depressing cardiovascular dynamics more than during conventional therapy with IMV.

Animals↗
PubMed1993

Intermittent positive pressure ventilation via the mouth as an alternative to tracheostomy for 257 ventilator users.

Despite wider application of the use of nocturnal intermittent positive pressure ventilation (IPPV) via nasal access for the management of nocturnal hypoventilation, there continues to be a lack of familiarity with the use of IPPV via the mouth for ventilatory support. Unlike nasal IPPV, which is generally practical only for nocturnal use, up to 24-h mouth IPPV was the key method of noninvasive ventilatory support that permitted the avoidance or elimination of tracheostomy for 257 individuals with acute or chronic ventilatory failure. Mouth IPPV was delivered via commercially available mouthpieces for daytime aid and mouthpiece with lip seal or custom orthodontic interfaces for nocturnal support. The use of mouth IPPV alone or in a regimen with other noninvasive ventilatory aids was reviewed for these 257 individuals. Mouth IPPV was used for nocturnal aid by 163 individuals, 61 of whom had little or no measurable vital capacity or significant ventilator-free breathing time, for more than 1,560 patient-years with few complications. It was also the predominant method of daytime ventilatory support for 228 individuals for more than 2,350 patient-years. We conclude that for individuals with adequate bulbar muscle function but chronic respiratory muscle insufficiency, mouth IPPV can be an effective alternative to tracheostomy. It can significantly prolong survival while optimizing convenience, safety, and communication.

Adolescent↗
PubMed1981

[Servo-ventilator 900 B with modified registration site for measuring the ventilation pressure. A possibility for reducing the inspiratory resistance during SIMV (author's transl)].

The inspiratory resistance, which a patient has to overcome while doing SIMV and CPAP with a Servoventilator 900 B, can be lowered by a simple modification of the ventilator. This modification is done by measuring the ventilation-pressure at the patients side of the humidifier. Measurements of pressure and flow demonstrated that, with a flow of 11 s-1 a 66%-reduction of the inspiratory resistance can be achieved.

Airway Resistance↗
PubMed1996

[Invasive ventilation. Classification, technique and clinical experiences with BiPAP/APRV (Biphasic Positive Airway Pressure/Airway Pressure Release Ventilation)].

BiPAP (bilevel or biphasic positive airway pressure) and APRV (airway pressure release ventilation) are new, and from a technical viewpoint closely related techniques recently introduced to the field of invasive ventilatory support. BiPAP/APRV can be described as a pressure controlled continuous high flow positive airway pressure system with a time-cycled change between a high inspiratory pressure level and a lower expiratory pressure level. Due to highly sensitive valves placed in the inspiratory and expiratory part of the system, unrestricted spontaneous breathing is possible at any moment of the mechanically supported ventilatory cycle. During invasive ventilation BiPAP offers potential advantages by allowing unrestricted spontaneous breathing thus reducing the need for sedation and facilitating weaning. APRV has primarily been investigated in conditions of moderate to severe acute lung injury and it seems that APRV is associated with less detrimental effects on the cardiopulmonary system compared to conventional ventilatory strategies. Apart from a review of the literature the article gives a classification and a technical description of the systems and focuses on the practical approach to BiPAP/APRV, e.g. the initiation and adjustment of respiratory support and the weaning from ventilatory support when applying these techniques.

Humans↗
PubMedDate not supplied

Calculation of mean airway pressure during neonatal intermittent positive pressure ventilation and high frequency positive pressure ventilation.

Because mean airway pressure (MAP) is extensively used to quantify ventilation administered during the neonatal period, the accuracy and reproducibility of the techniques currently used to define MAP were assessed. All techniques were found to compare closely with MAP measured by integration of the pressure wave form even at ventilator rates in excess of 100 breaths per minute. It was therefore concluded that all methods currently used are satisfactory for clinical use.

Humans↗
PubMed1992

High-frequency oscillatory ventilation compared with conventional mechanical ventilation in newborn lambs: effects of increasing airway pressure on intracranial pressures.

We tested the hypothesis that intracranial pressures and cerebral perfusion pressure in the newborn are more seriously affected by increasing airway pressure during high-frequency oscillatory ventilation (HFOV) than during conventional mechanical ventilation (CMV). Mean airway pressure was acutely elevated in stepwise fashion to 25 cm H2O in six anesthetized, paralyzed newborn lambs. Pressure (mean +/- SE) increased similarly during HFOV and CMV in the jugular vein (7 +/- 1 and 8 +/- 1 cm H2O, respectively), the sagittal sinus (6 +/- 1 and 7 +/- 1 cm H2O), and the cerebrospinal fluid of the lateral ventricle (4 +/- 1 and 6 +/- 1 cm H2O). Decreases in arterial blood pressure (-13 +/- 2 and -10 +/- 2 cm H2O) and cerebral perfusion pressure (-17 +/- 2 and -16 +/- 2 cm H2O) were also similar during HFOV and CMV. Intracranial pressure-volume curves were generated by incrementing cerebrospinal fluid volume in eight lambs. Curves generated during HFOV and CMV were similar, reflecting a similar intracranial compliance during the two ventilatory modes. These data indicate that intracranial compliance and the effects of increasing airway pressure upon intracranial pressures are not significantly different between HFOV and CMV.

Air Pressure↗