Articles: mechanical-ventilation.
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Respir Physiol Neurobiol · Oct 2013
High tidal volume ventilation does not exacerbate acid-induced lung injury in infant rats.
The impact of mechanical ventilation with high V(T)-low PEEP in infant rats with preinjured lungs is unknown. After tracheal instillation of saline or acid, two week old rats were ventilated with V(T) 7 mL/kg and PEEP 5 cm H₂O or V(T) 21 mL/kg and PEEP 1cm H₂O for 4 h. Airway resistance and the coefficient of tissue elastance, measured via low-frequency forced-oscillation technique, and quasi-static pressure-volume curves deteriorated less with high V(T)-low PEEP when compared with low V(T)-high PEEP. ⋯ Moreover, differences in BALF protein concentration and histological lung injury scores were independent of applied ventilation strategies. In contrast to experimental studies with adult rats, short-term mechanical ventilation with high V(T)-low PEEP is not deleterious when compared to low V(T)-high PEEP in both healthy and pre-injured infant rat lungs. Our results call for caution when extrapolating data from adult studies and highlight the need for age-specific animal models.
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Randomized Controlled Trial
Adaptive support ventilation for complete ventilatory support in acute respiratory distress syndrome: a pilot, randomized controlled trial.
Low tidal volume ventilation has been shown to improve survival in acute respiratory distress syndrome (ARDS). Adaptive support ventilation (ASV), a closed-loop ventilatory mode, can minimize the work of breathing, and thus potentially improve the outcomes in ARDS. The aim of this pilot, randomized clinical trial was to compare the outcomes of ASV versus volume-cycled ventilation (VCV) in ARDS. ⋯ There was no significant difference in the outcomes of patients with ARDS ventilated with either VCV or ASV in this study.
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A computerized decision support system is described to predict the changes in the cerebral blood flow (CBF) of mechanically ventilated infants in response to different ventilatory settings. A CBF controller was developed and combined with a mathematical model of the infant's respiratory system to simulate the effects of ventilatory settings on the infant's CBF. ⋯ These included the results obtained under conditions of hypoventilation, hyperventilation, hypoxia, and hyperoxia. The presented decision support system has the potential to be used as an aide to the intensivist in choosing appropriate ventilation treatments for infants to prevent the untoward consequences of hazardous changes in CBF in mechanically ventilated infants such as hypoxic-ischemic brain injuries.
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Little is known about the incidence of and risk factors for adverse effects from endotracheal suctioning. We studied the incidence and risk factors, and evaluated the effect of suctioning practice guidelines. ⋯ Endotracheal suctioning frequently induces adverse effects. Technique, suctioning frequency, and higher PEEP are risk factors for complications. Their incidence can be reduced by the implementation of suctioning guidelines.