Minerva anestesiologica
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Recent data show an alarming increasing trend in obesity around the world. Mechanical ventilation in this population requires specific ventilatory settings due to the mechanical and inflammatory alterations observed in obesity. ⋯ In order to reduce lung stress and strain, as well as minimize the risk of ventilator associated lung injury, mechanical ventilation management should be conducted with the following strategies: 1) stepwise recruitment maneuver before positive end-expiratory pressure application, which requires titration according to respiratory system dynamic compliance; and 2) tidal volume (VT) titration according to inspiratory capacity. In summary, the overall objective is to ensure an adequate setting of ventilator parameters in order to minimize the inflammatory impact already present in obese patients as well as prevent further lung damage.
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Minerva anestesiologica · Oct 2012
ReviewInterfaces for noninvasive mechanical ventilation: technical aspects and efficiency.
Noninvasive mechanical ventilation (NIV) has become a standard of care in select patients with both hypercapnic and non-hypercapnic acute respiratory failure (ARF). Consequent to the increasing use of NIV, new interfaces of different designs, shapes, sizes, and materials have been proposed for clinical use in recent years. The aim of this report is to examine the most relevant physiological aspects related to the choice of interface with particular emphasis on the problems related to dead space and air leaks that may affect the synchrony between the patient and the machine, ultimately determining the patient's compliance and therefore NIV success.
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Minerva anestesiologica · Oct 2012
Neonatal congenital diaphragmatic hernia: respiratory and blood-gas derived indices in choosing surgical timing.
Congenital diaphragmatic hernia (CDH) still has a high mortality despite advanced assistance techniques. The aim of this study is to verify the validity of five respiratory and blood-gas-derived indices in defining presurgical stabilization: the oxygenation index (OI), the alveolar-arterial O(2) gradient (A-aDO(2)), the arterial-alveolar O(2) tension ratio (a/AO(2)), the arterial pH and the PaCO(2). ⋯ The study confirms the validity of these indices as a guide to the treatment of neonates with CDH, showing a good reliability in identifying presurgical stabilization.