Chest
-
To determine whether manual ventilation during intrahospital transport of mechanically ventilated critically ill patients results in blood gas and/or hemodynamic abnormalities. ⋯ Manual ventilation during intrahospital transport of critically ill mechanically ventilated patients is safe provided the person performing manual ventilation knows the inspired oxygen fraction and minute ventilation required before transport and is trained to approximate them during transport.
-
Auto-PEEP, or PEEPi, occurs when alveolar pressure fails to decrease to zero at the end of exhalation. While PEEPi can be measured in paralyzed or apneic patients by occlusion of the ventilator expiratory valve at end-exhalation (PEEPi-OC), this may not be possible in patients with spontaneous respiratory efforts. ⋯ We compared PEEPi as measured by RIP to PEEPi-OC in 20 patients receiving mechanical ventilator support. Noninvasive measurement of changes in end-expiratory TGV by RIP is a convenient alternative method to estimate PEEPi in both controlled, assisted, and spontaneously ventilating patients.
-
Airway pressure release ventilation is a recently described method of ventilatory support. It allows spontaneous ventilation with CPAP but differs from conventional ventilatory modes because, with APRV, peak inflation pressure never exceeds the level of CPAP, and airway pressure decreases, rather than increases, when tidal volume is delivered. The risk of pulmonary barotrauma and adverse hemodynamic effects associated with conventional modes of positive-pressure mechanical ventilation may be decreased because of lower peak inflation and mean airway pressures. We describe a patient in whom several risk factors for these complications were present who was treated successfully with APRV.