Articles: mechanical-ventilation.
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Randomized Controlled Trial
Mechanical ventilation with ten versus twenty breaths per minute during cardio-pulmonary resuscitation for out-of-hospital cardiac arrest: A randomised controlled trial.
This study sought to assess the effects of increasing the ventilatory rate from 10 min-1 to 20 min-1 using a mechanical ventilator during cardio-pulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) on ventilation, acid-base-status, and outcomes. ⋯ gov Identifier: NCT04657393.
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Journal of critical care · Jun 2023
Randomized Controlled TrialA randomized controlled trial comparing non-invasive ventilation delivered using neurally adjusted ventilator assist (NAVA) or adaptive support ventilation (ASV) in patients with acute exacerbation of chronic obstructive pulmonary disease.
No study has compared neurally adjusted ventilator assist (NAVA) with adaptive support ventilation (ASV) during non-invasive ventilation (NIV) in subjects with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). ⋯ The use of NAVA-NIV was not superior to ASV-NIV in reducing NIV failure rates in AECOPD. Both NAVA-NIV and ASV-NIV had similar asynchrony index and 90-day mortality.
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Analysis of observational data suggests that both a T-piece and zero pressure support ventilation (PSV) and zero PEEP impose work of breathing (WOB) during a spontaneous breathing trial (SBT) similar to what a patient experiences after extubation. The aim of our study was to compare the WOB imposed by the T-piece with zero PSV and zero PEEP. We also compared the difference in WOB when using zero PSV and zero PEEP on 3 different ventilators. ⋯ Work may be imposed or reduced during spontaneous breathing on zero PSV and zero PEEP when compared to T-piece. The unpredictable nature of how zero PSV and zero PEEP behaves on different ventilators makes it an imprecise SBT modality in the context of assessing extubation readiness.
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The spontaneous breathing trial (SBT) is the final step of weaning from invasive mechanical ventilation. An SBT is aimed at predicting work of breathing (WOB) after extubation and, most importantly, a patient's eligibility for extubation. The optimal SBT modality remains debated. A high-flow oxygen (HFO) has been tested during SBT in clinical study only, which is why no definite conclusion can be drawn on its physiologic effects on the endotracheal tube. Our objective was to assess, on a bench, inspiratory tidal volume (VT), total PEEP, and WOB across 3 different SBT modalities: T-piece, 40 L/min HFO, and 60 L/min HFO. ⋯ With the same effort intensity and breathing frequency, inspiratory VT was higher in the T-piece than in the other modalities. Compared with the T-piece, WOB was significantly lower in the HFO condition and higher flow was a benefit. Based on the results of the present study, the HFO as an SBT modality would seem to require clinical testing.
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Journal of critical care · Jun 2023
Observational StudyReverse triggering neural network and rules-based automated detection in acute respiratory distress syndrome.
Dyssynchrony may cause lung injury and is associated with worse outcomes in mechanically ventilated patients. Reverse triggering (RT) is a common type of dyssynchrony presenting with several phenotypes which may directly cause lung injury and be difficult to identify. Due to these challenges, automated software to assist in identification is needed. ⋯ Automated detection of RT demonstrated good performance, with the potential application of these programs for research and clinical care.