Initiating Mechanical Ventilation/Positive Pressure Support

2018 ◽  
pp. 112-113
Keyword(s):  
Mechanical Ventilation ◽  
Pressure Support ◽  
Positive Pressure

scholarly journals Respiratory Modalities in Preventing Reintubation in a Pediatric Intensive Care Unit

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199153
Author(s):  
Ameer Al-Hadidi ◽  
Morta Lapkus ◽  
Patrick Karabon ◽  
Begum Akay ◽  
Paras Khandhar
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Noninvasive Positive Pressure Ventilation ◽  
Pediatric Intensive Care ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Positive Pressure ◽  
P Value

Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, P-value = .0357) and hospital LOS (16.43 vs 10.20 days, P-value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.

scholarly journals Oxygen administration for patients with ARDS

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Shinichiro Ohshimo
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Positive Pressure ◽  
Respiratory Drive ◽  
Severe Hypoxemia ◽  
Airway Occlusion ◽  
Non Invasive ◽  
Oxygen Administration ◽  
Essential Interventions ◽  
Invasive Techniques

AbstractAcute respiratory distress syndrome (ARDS) is a fatal condition with insufficiently clarified etiology. Supportive care for severe hypoxemia remains the mainstay of essential interventions for ARDS. In recent years, adequate ventilation to prevent ventilator-induced lung injury (VILI) and patient self-inflicted lung injury (P-SILI) as well as lung-protective mechanical ventilation has an increasing attention in ARDS.Ventilation-perfusion mismatch may augment severe hypoxemia and inspiratory drive and consequently induce P-SILI. Respiratory drive and effort must also be carefully monitored to prevent P-SILI. Airway occlusion pressure (P0.1) and airway pressure deflection during an end-expiratory airway occlusion (Pocc) could be easy indicators to evaluate the respiratory drive and effort. Patient-ventilator dyssynchrony is a time mismatching between patient’s effort and ventilator drive. Although it is frequently unrecognized, dyssynchrony can be associated with poor clinical outcomes. Dyssynchrony includes trigger asynchrony, cycling asynchrony, and flow delivery mismatch. Ventilator-induced diaphragm dysfunction (VIDD) is a form of iatrogenic injury from inadequate use of mechanical ventilation. Excessive spontaneous breathing can lead to P-SILI, while excessive rest can lead to VIDD. Optimal balance between these two manifestations is probably associated with the etiology and severity of the underlying pulmonary disease.High-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NPPV) are non-invasive techniques for supporting hypoxemia. While they are beneficial as respiratory supports in mild ARDS, there can be a risk of delaying needed intubation. Mechanical ventilation and ECMO are applied for more severe ARDS. However, as with HFNC/NPPV, inappropriate assessment of breathing workload potentially has a risk of delaying the timing of shifting from ventilator to ECMO. Various methods of oxygen administration in ARDS are important. However, it is also important to evaluate whether they adequately reduce the breathing workload and help to improve ARDS.

scholarly journals Patient-Ventilator Synchrony and Tidal Volume Variability using NAVA and Pressure Support Mechanical Ventilation Modes

2011 ◽  
Vol 44 (1) ◽  
pp. 569-574
Author(s):  
Katherine T. Moorhead ◽  
Lise Piquilloud ◽  
Bernard Lambermont ◽  
Jean Roeseler ◽  
J. Geoffrey Chase ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Pressure Support ◽  
Ventilation Modes ◽  
Ventilator Synchrony

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed N Al Shafi'i ◽  
Doaa M. Kamal El-din ◽  
Mohammed A. Abdulnaiem Ismaiel ◽  
Hesham M Abotiba
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

Positive pressure inspiratory aid v assisted mechanical ventilation after esophageal surgery

1987 ◽  
Vol 2 (2) ◽  
pp. 101-108 ◽  
Author(s):  
J.J. Fargier ◽  
D. Robert ◽  
F. Boyer ◽  
J. Chagny ◽  
C. Kopp ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Esophageal Surgery ◽  
Positive Pressure ◽  
Assisted Mechanical Ventilation

Management of Acute Respiratory Failure Due to Pulmonary Edema With Nasal Positive Pressure Support

CHEST Journal ◽  
1994 ◽  
Vol 105 (1) ◽  
pp. 229-231 ◽  
Author(s):  
Stephen E. Lapinsky ◽  
David B. Mount ◽  
Dale Mackey ◽  
Ronald F. Grossman
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Pulmonary Edema ◽  
Pressure Support ◽  
Positive Pressure

Spectrum of Multiorgan Dysfunction in Scrub Typhus Infection

2021 ◽  
Vol 67 (4) ◽  
Author(s):  
Vidushi Mahajan ◽  
Vishal Guglani ◽  
Nidhi Singla ◽  
Jagdish Chander
Keyword(s):  
Pressure Support ◽  
Distress Syndrome ◽  
Scrub Typhus ◽  
Pediatric Emergency ◽  
University Teaching ◽  
Positive Pressure ◽  
Mortality And Morbidity ◽  
Multiorgan Dysfunction ◽  
Igm Elisa ◽  
Systemic Manifestations

Abstract Objectives We planned this study to determine the clinical spectrum and compare incidence of multiorgan dysfunction in children hospitalized with scrub typhus with other etiologies of tropical fever. Design Prospective cohort study. Setting Pediatric emergency and PICU services of a university teaching hospital situated in the sub-Himalayan region. Patient Children aged 2 months to 14 years with acute undifferentiated fever of more than 5 days. Interventions Detailed fever workup was performed in all children. We compared scrub typhus IgM positive children (cases) with remaining febrile children who were negative for scrub IgM assay (controls) for mortality and morbidity. Main results We enrolled 224 febrile children; 76 children (34%) were positive for scrub typhus IgM ELISA. Scrub typhus group had a significantly higher incidence of multiorgan dysfunction [OR 3.5 (95% CI 2.0–6.3); p < 0.001] as compared to non-scrub typhus group requiring supportive care. The incidence of altered sensorium [OR 8.8 (95% CI 3.1–24.9)], seizures [OR 3.0 (95% CI 1.1–8.3)], acute respiratory distress syndrome [OR 17.1 (95% CI 2.1–140.1)], acute renal failure (5% vs. 0%), meningitis [OR 6.2 (95% CI 1.2–31.6)], thrombocytopenia [OR 2.8 (95% CI 1.5–5.1)], transaminitis [OR 2.7 (95% CI 1.6–4.8)], requirement of oxygen [OR 17.8 (95% CI 4.0–80.3)], positive pressure support [OR 3.7 (95% CI 1.2–10.5)] and shock requiring inotropes [OR 3.0 (95% CI 1.3–6.7)] was significantly higher in scrub typhus group as compared to the non-scrub typhus group (Table 1). Conclusions Pediatric scrub typhus who were hospitalized had severe systemic manifestations when compared to other causes of fever.

Emergency Pediatric Noninvasive Ventilation and Invasive Mechanical Ventilation

2020 ◽  
pp. 51-63
Author(s):  
Garrett S. Pacheco
Keyword(s):  
Mechanical Ventilation ◽  
Emergency Physician ◽  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Supportive Treatment ◽  
Airway Clearance Therapy ◽  
Respiratory Complaints ◽  
Ventilator Settings

Respiratory complaints are common conditions for children to present to emergency departments. Typically, patients respond to simple supportive treatment, whether it is airway clearance therapy, oxygen therapy, or bronchodilators. When these patients are critically ill, they often require aggressive oxygenation/ventilation with noninvasive strategies, or even tracheal intubation. The use of noninvasive positive pressure ventilation has led to a significant reduction in the necessity for endotracheal intubation in children. The emergency physician should be familiar with the indications and appropriate application of these modalities. Furthermore, when patients require invasive mechanical ventilation, the emergency physician should have an understanding of initial ventilator settings, troubleshooting alarms, and an approach to the decompensating pediatric ventilated patient.

Hypoxia

2018 ◽  
pp. 168-171
Author(s):  
Drew Clare
Keyword(s):  
Mechanical Ventilation ◽  
Airway Obstruction ◽  
Pulmonary Embolus ◽  
Positive Pressure ◽  
Potential Development ◽  
Normal Chest Radiograph ◽  
Normal Chest ◽  
Chest X Ray ◽  
Fast Exam ◽  
Delayed Pneumothorax

The case illustrates the approach to an intubated patient on mechanical ventilation with desaturation and clinical deterioration. Included is a list of potential etiologies, including airway obstruction, pneumothorax, mucus plug/atelectasis, aspiration or infection, and pulmonary embolus as well as a description of how to systematically evaluate these patients. Various imaging modalities are reviewed, including the findings of a chest X-ray and results of a limited bedside ultrasound. The case highlights the potential development of a delayed pneumothorax or hemothorax, despite an initially normal chest radiograph, particularly with the addition of positive pressure ventilation. The case highlights the importance of the focused assessment with sonography for trauma (FAST) exam.

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