Articles: mechanical-ventilation.
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Int J Chron Obstruct Pulmon Dis · Jan 2009
Can dead space fraction predict the length of mechanical ventilation in exacerbated COPD patients?
Chronic obstructive pulmonary disease (COPD) is a condition in which there is limited airflow during expiration (exhaling, or breathing out) that is not fully reversible and usually worsens over time. The disease is estimated to kill more than 100,000 Americans each year, and costs related to care of patients with COPD are significant. Physiologically, COPD represents a disruption in ventilation and in the exchange of gases in the lungs. Laboratory tests indicate elevated CO2 levels, gradual reduction of the levels of oxygen and pH in arterial blood, and a consequent rise in the dead space fraction (DSF) of the lungs. ⋯ Evaluation of DSF does not provide a factor in estimating the length of treatment for patients with acute respiratory failure due to COPD exacerbation.
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HSR Proc Intensive Care Cardiovasc Anesth · Jan 2009
Fluid responsiveness and right ventricular function in cardiac surgical patients. A multicenter study.
We investigated fluid responsiveness in a population of patients undergoing coronary artery revascularization, with respect to their right ventricular ejection fraction. ⋯ When right ventricular systolic function is depressed, the right ventricle inability to fill the left chambers results in a lack of the left-sided responsiveness predictors. When the right ventricular systolic function is preserved, all the classical fluid responsiveness predictors are confirmed. Right ventricular function is therefore to be always considered when addressing the problem of fluid responsiveness.
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Indian J Crit Care Med · Jan 2009
Alveolar recruitment maneuvers in acute lung injury/acute respiratory distress syndrome.
Mechanical ventilation can worsen lung damage in acute lung injury and acute respiratory distress syndrome. The use of low tidal volumes is one of the strategies that has been shown to reduce lung injury and improve outcomes in this situation. However, low tidal volumes may lead to alveolar derecruitment and worsening of hypoxia. ⋯ Although recruitment maneuvers have been shown to improve oxygenation, improved clinical outcomes have not been demonstrated. The optimal recruitment strategy and the type of patients who might benefit are also unclear. This review summarizes the impact of recruitment maneuvers on lung mechanics and physiology, techniques of application, and the clinical situations in which they may be useful.
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Unplanned extubation is quite common in intensive care unit (ICU) patients receiving mechanical ventilatory support. The present study aimed to investigate the effectiveness of noninvasive positive pressure ventilation (NPPV) in patients with unplanned extubation. ⋯ Patients with unplanned extubation before the weaning criteria are met should be intubated immediately. On the other hand, when extubation develops during the weaning period, NPPV may be an alternative. The present study was conducted with a small number of patients, and larger studies on the effectiveness of NPPV in unplanned extubation are warranted for firm conclusions.
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Pediatr Crit Care Me · Oct 2008
WITHDRAWN: Reliability of displayed tidal volume in infants and children during dual controlled ventilation.
Previous studies have shown significant difference between ventilator-measured tidal volume and actual-delivered tidal volume. However, these studies utilized external methods for measurement of compression volume. Our objective was to determine whether tidal volume could be accurately measured at the expiratory valve of a conventional ventilator using internal computer software to compensate for circuit compliance, with a dual control mode of ventilation. DESIGN:: Clinical study during an 8-month period. SETTING:: Pediatric intensive care unit. PATIENTS:: All patients admitted to the pediatric intensive care unit during the enrollment period who were mechanically ventilated using the Servo i (Maquet, Bridgewater, NJ) were eligible for this study. INTERVENTIONS:: Patients were ventilated utilizing a dual control mode of ventilatory support and either an infant or adult circuit (with and without circuit compensation). MEASUREMENTS AND MAIN ⋯ There is an underestimation of delivered tidal volume when compensating for circuit volume loss measured at the ventilator. There is no improvement in measured tidal volume utilizing circuit compensation in small infants and children.