Respiratory care
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The ventilatory mechanics of patients with COPD and obesity-hypoventilation syndrome (OHS) are changed when there is air trapping and auto-PEEP, which increase respiratory effort. P0.1 measures the ventilatory drive and, indirectly, respiratory effort. The aim of the study was to measure P0.1 in subjects with COPD or OHS on treatment with positive pressure and to analyze their changes in P0.1 after treatment. ⋯ COPD and air trapping were associated with greater P0.1 as a marker of respiratory effort. A decrease in P0.1 indicates lower respiratory effort after treatment.
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High-frequency oscillatory ventilation (HFOV) is widely used in neonatal critical care, and several modern ventilators using different technologies are available to provide HFOV. These devices have different technical characteristics that might interact with patient lung mechanics to influence the effectiveness of ventilation. To verify this, we studied the oscillation transmission of 5 neonatal oscillators in a lung model mimicking the mechanical patterns commonly observed in neonatal practice. ⋯ In an experimental setting mimicking typical neonatal lung disorders, the oscillation transmission was more dependent on the ventilator model than on the mechanical lung conditions at equal HFOV parameters. Fabian HFO and VN500 provided better oscillation transmission overall, and when increasing amplitude, Fabian HFO delivered oscillations with the lowest variability.
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Review Meta Analysis
Neurally adjusted ventilatory assist (NAVA) versus pressure support ventilation (PSV) during non-invasive ventilation (NIV): systematic review and meta-analysis.
Noninvasive ventilation (NIV) is increasingly used during ventilatory support. Neurally-adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that can improve patient-ventilator interaction. We conducted a meta-analysis to compare patient-ventilator interaction and clinical outcomes between NAVA and pressure support ventilation (PSV) in adult subjects during NIV. ⋯ NAVA has advantages in ventilator-patient interaction compared to PSV in NIV. Further research is needed in order to estimate effects on clinical outcomes.
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Central venous blood gas (cVBG) values are correlated with arterial blood gas (ABG) values. However, the substitution of cVBG values for ABG values in critically ill patients remains uninvestigated. Thus, we investigated the reliability between cVBG and ABG values and sought to define the conditions that could improve the reliability of cVBG values as a substitute. ⋯ ABG and cVBG values showed clinically acceptable agreements and improved reliability in mechanically ventilated subjects with ScvO2 ≥ 70%. cVBG analysis may be a substitute for ABG analysis in mechanically ventilated patients once tissue perfusion is restored.