scholarly journals Control system for automated titration of positive end-expiratory pressure and tidal volume using dynamic nonlinear compliance as the setpoint

Critical Care ◽  
2009 ◽  
Vol 13 (Suppl 1) ◽  
pp. P43
Author(s):  
S Lozano-Zahonero ◽  
A Wahl ◽  
D Gottlieb ◽  
J Arntz ◽  
S Schumann ◽  
...  
Keyword(s):  
Control System ◽  
Tidal Volume ◽  
Positive End Expiratory Pressure ◽  
Automated Titration

scholarly journals Management of Intraoperative Mechanical Ventilation to Prevent Postoperative Complications after General Anesthesia: A Narrative Review

2021 ◽  
Vol 10 (12) ◽  
pp. 2656
Author(s):  
Alberto Fogagnolo ◽  
Federica Montanaro ◽  
Lou’i Al-Husinat ◽  
Cecilia Turrini ◽  
Michela Rauseo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Pulmonary Complications ◽  
Point Of View ◽  
Whole Body ◽  
Positive End Expiratory Pressure ◽  
Ventilation Strategies ◽  
Harmful Effects ◽  
Ventilation Induced Lung Injury ◽  
Different Levels

Mechanical ventilation (MV) is still necessary in many surgical procedures; nonetheless, intraoperative MV is not free from harmful effects. Protective ventilation strategies, which include the combination of low tidal volume and adequate positive end expiratory pressure (PEEP) levels, are usually adopted to minimize the ventilation-induced lung injury and to avoid post-operative pulmonary complications (PPCs). Even so, volutrauma and atelectrauma may co-exist at different levels of tidal volume and PEEP, and therefore, the physiological response to the MV settings should be monitored in each patient. A personalized perioperative approach is gaining relevance in the field of intraoperative MV; in particular, many efforts have been made to individualize PEEP, giving more emphasis on physiological and functional status to the whole body. In this review, we summarized the latest findings about the optimization of PEEP and intraoperative MV in different surgical settings. Starting from a physiological point of view, we described how to approach the individualized MV and monitor the effects of MV on lung function.

scholarly journals A Case of Paroxysmal Complete Atrioventricular Block in a COVID-19 Patient

2021 ◽  
Author(s):  
Hong Nyun Kim ◽  
Myung Hwan Bae ◽  
Bo Eun Park ◽  
Jaehee Lee
Keyword(s):  
Tidal Volume ◽  
Atrioventricular Block ◽  
Intrathoracic Pressure ◽  
Severe Hypoxia ◽  
Mechanical Ventilator ◽  
Positive End Expiratory Pressure ◽  
Complete Atrioventricular Block ◽  
Complete Atrioventricular

A patient with coronavirus disease 2019 showed complete atrioventricular block on electrocardiogram. The patient was undergoing mechanical ventilator treatment for severe hypoxia. Intrathoracic pressure was reduced by adjusting the tidal volume and the positive end-expiratory pressure of the mechanical ventilator. After that, complete atrioventricular block didn’t occur during the hospitalization.

scholarly journals Effect of tidal volume and positive end-expiratory pressure on lung hysteresis of healthy piglets

Critical Care ◽  
2014 ◽  
Vol 18 (Suppl 1) ◽  
pp. P286
Author(s):  
DT Andreis ◽  
M Milesi ◽  
P Pugni ◽  
F Nicosia ◽  
GE lapichino ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Positive End Expiratory Pressure

scholarly journals Lung ventilation injures areas with discrete alveolar flooding, in a surface tension-dependent fashion

2014 ◽  
Vol 117 (7) ◽  
pp. 788-796 ◽  
Author(s):  
You Wu (吴右) ◽  
Angana Banerjee Kharge ◽  
Carrie E. Perlman
Keyword(s):  
Surface Tension ◽  
Tidal Volume ◽  
Lung Ventilation ◽  
Transpulmonary Pressure ◽  
Exogenous Surfactant ◽  
Control Group ◽  
Positive End Expiratory Pressure ◽  
Lung Inflation ◽  
Surfactant Activity ◽  
Theoretical Considerations

With proteinaceous-liquid flooding of discrete alveoli, a model of the edema pattern in the acute respiratory distress syndrome, lung inflation over expands aerated alveoli adjacent to flooded alveoli. Theoretical considerations suggest that the overexpansion may be proportional to surface tension, T. Yet recent evidence indicates proteinaceous edema liquid may not elevate T. Thus whether the overexpansion is injurious is not known. Here, working in the isolated, perfused rat lung, we quantify fluorescence movement from the vasculature to the alveolar liquid phase as a measure of overdistension injury to the alveolar-capillary barrier. We label the perfusate with fluorescence; micropuncture a surface alveolus and instill a controlled volume of nonfluorescent liquid to obtain a micropunctured-but-aerated region (control group) or a region with discrete alveolar flooding; image the region at a constant transpulmonary pressure of 5 cmH2O; apply five ventilation cycles with a positive end-expiratory pressure of 0–20 cmH2O and tidal volume of 6 or 12 ml/kg; return the lung to a constant transpulmonary pressure of 5 cmH2O; and image for an additional 10 min. In aerated areas, ventilation is not injurious. With discrete alveolar flooding, all ventilation protocols cause sustained injury. Greater positive end-expiratory pressure or tidal volume increases injury. Furthermore, we determine T and find injury increases with T. Inclusion of either plasma proteins or Survanta in the flooding liquid does not alter T or injury. Inclusion of 2.7–10% albumin and 1% Survanta together, however, lowers T and injury. Contrary to expectation, albumin inclusion in our model facilitates exogenous surfactant activity.

Ventilation with Constant Versus Decelerating Inspiratory Flow in Experimentally Induced Acute Respiratory Failure

1996 ◽  
Vol 84 (4) ◽  
pp. 882-889. ◽  
Author(s):  
Agneta M. Markstrom ◽  
Michael Lichtwarck-Aschoff ◽  
Bjorn A. Svensson ◽  
K. Anders Nordgren ◽  
Ulf H. Sjostrand
Keyword(s):  
Carbon Dioxide ◽  
Gas Exchange ◽  
Tidal Volume ◽  
Airway Pressure ◽  
Arterial Oxygen Tension ◽  
Inspiratory Flow ◽  
Arterial Oxygen ◽  
Positive End Expiratory Pressure ◽  
Residual Capacity ◽  
Inspiratory Flow Pattern

Background Recognition of the potential for ventilator-associated lung injury has renewed the debate on the importance of the inspiratory flow pattern. The aim of this study was to determine whether a ventilatory pattern with decelerating inspiratory flow, with the major part of the tidal volume delivered early, would increase functional residual capacity at unchanged (or even reduced) inspiratory airway pressures and improve gas exchange at different positive end-expiratory pressure levels. Methods Surfactant depletion was induced by repeated bronchoalveolar lavage in 13 anesthetized piglets. Decelerating and constant inspiratory flow ventilation was applied at positive end-expiratory pressure levels of 22, 17, 13, 9, and 4 cm H(2)O. Tidal volume, inspiration-to-expiration ratio, and ventilatory frequency were kept constant. Airway pressures, gas exchange, functional residual capacity (using a wash-in/washout method with sulfurhexafluoride), central hemodynamics, and extravascular lung water (using the thermo-dye-indicator dilution technique) were measured. Results Decelerating inspiratory flow yielded a lower arterial carbon dioxide tension compared to constant flow, that is, it improved alveolar ventilation. There were no differences between the flow patterns regarding end-inspiratory occlusion airway pressure, end-inspiratory lung volume, static compliance, or arterial oxygen tension. No differences were seen in hemodynamics and oxygen delivery. Conclusions The decelerating inspiratory flow pattern increased carbon dioxide elimination, without any reduction of inspiratory airway pressure or apparent improvement in arterial oxygen tension. It remains to be established whether these differences are sufficiently pronounced to justify therapeutic consideration.

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