scholarly journals Nebulization During Spontaneous Breathing, CPAP, and Bi-Level Positive-Pressure Ventilation: A Randomized Analysis of Pulmonary Radioaerosol Deposition

2013 ◽  
Vol 59 (4) ◽  
pp. 479-484 ◽  
Author(s):  
J. G. Maccari ◽  
C. Teixeira ◽  
A. Savi ◽  
R. P. de Oliveira ◽  
A. S. Machado ◽  
...  
Keyword(s):  
Spontaneous Breathing ◽  
Positive Pressure Ventilation ◽  
Positive Pressure

scholarly journals Respiratory pump maintains cardiac stroke volume during hypovolemia in young, healthy volunteers

2018 ◽  
Vol 124 (5) ◽  
pp. 1319-1325 ◽  
Author(s):  
Maria Skytioti ◽  
Signe Søvik ◽  
Maja Elstad
Keyword(s):  
Cardiac Output ◽  
Stroke Volume ◽  
Healthy Volunteers ◽  
Negative Pressure ◽  
Spontaneous Breathing ◽  
Positive Pressure Ventilation ◽  
Control Mode ◽  
Positive Pressure ◽  
Beneficial Effects ◽  
Cardiac Stroke Volume

Spontaneous breathing has beneficial effects on the circulation, since negative intrathoracic pressure enhances venous return and increases cardiac stroke volume. We quantified the contribution of the respiratory pump to preserve stroke volume during hypovolemia in awake, young, healthy subjects. Noninvasive stroke volume, cardiac output, heart rate, and mean arterial pressure (Finometer) were recorded in 31 volunteers (19 women), 19–30 yr old, during normovolemia and hypovolemia (approximating 450- to 500-ml reduction in central blood volume) induced by lower-body negative pressure. Control-mode noninvasive positive-pressure ventilation was employed to reduce the effect of the respiratory pump. The ventilator settings were matched to each subject’s spontaneous respiratory pattern. Stroke volume estimates during positive-pressure ventilation and spontaneous breathing were compared with Wilcoxon matched-pairs signed-rank test. Values are overall medians. During normovolemia, positive-pressure ventilation did not affect stroke volume or cardiac output. Hypovolemia resulted in an 18% decrease in stroke volume and a 9% decrease in cardiac output ( P < 0.001). Employing positive-pressure ventilation during hypovolemia decreased stroke volume further by 8% ( P < 0.001). Overall, hypovolemia and positive-pressure ventilation resulted in a reduction of 26% in stroke volume ( P < 0.001) and 13% in cardiac output ( P < 0.001) compared with baseline. Compared with the situation with control-mode positive-pressure ventilation, spontaneous breathing attenuated the reduction in stroke volume induced by moderate hypovolemia by 30% (i.e., −26 vs. −18%). In the patient who is critically ill with hypovolemia or uncontrolled hemorrhage, spontaneous breathing may contribute to hemodynamic stability, whereas controlled positive-pressure ventilation may result in circulatory decompensation. NEW & NOTEWORTHY Maintaining spontaneous respiration has beneficial effects on hemodynamic compensation, which is clinically relevant for patients in intensive care. We have quantified the contribution of the respiratory pump to cardiac stroke volume and cardiac output in healthy volunteers during normovolemia and central hypovolemia. The positive hemodynamic effect of the respiratory pump was abolished by noninvasive, low-level positive-pressure ventilation. Compared with control-mode positive-pressure ventilation, spontaneous negative-pressure ventilation attenuated the fall in stroke volume by 30%.

scholarly journals Less invasive surfactant administration (LISA): chances and limitations

2019 ◽  
Vol 104 (6) ◽  
pp. F655-F659 ◽  
Author(s):  
Egbert Herting ◽  
Christoph Härtel ◽  
Wolfgang Göpel
Keyword(s):  
Spontaneous Breathing ◽  
Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Invasive Approach ◽  
Less Invasive ◽  
Non Invasive ◽  
Adequate Dose ◽  
Open Questions ◽  
Surfactant Administration ◽  
Meta Analyses

Non-invasive ventilation and especially the application of continuous positive airway pressure (CPAP) has become standard for the treatment of premature infants with respiratory problems. However, CPAP failure may occur due to respiratory distress syndrome, that is, surfactant deficiency. Less invasive surfactant administration (LISA) aims to provide an adequate dose of surfactant while the infant is breathing spontaneously, thus avoiding positive pressure ventilation support. Using a thin catheter for surfactant application allows infants to maintain function of the glottis and continue spontaneous breathing, whereas the INtubate-SURfactant-Extubate (INSURE) procedure is connected with sedation/analgesia, regular intubation and a (brief) period of positive pressure ventilation. Individual studies and meta-analyses summarised in this review point in the direction that LISA is more effective than standard treatment or INSURE both in terms of short-term (avoidance of mechanical ventilation) and long-term (intracerebral haemorrhage and bronchopulmonary dysplasia) outcomes. Open questions include exact treatment thresholds for different gestational ages, the usefulness of devices/catheters that have recently been purpose-built for the LISA technique and especially the question of analgesia/sedation during the procedure. The current technology still demands laryngoscopy with all its unpleasant effects for infants. Therefore, studies with pharyngeal surfactant deposition immediately after delivery, the use of laryngeal airways for surfactant administration and attempts to nebulise surfactant are under way. Finally, LISA is not simply an isolated technical procedure for surfactant delivery but rather part of a comprehensive non-invasive approach supporting the concept of a gentle transition to the extrauterine world enabling preterm infants to benefit from the advantages of spontaneous breathing.

Duration of Ventricular Ejection during Spontaneous Breathing and Positive Pressure Ventilation in Newborn Infants

Neonatology ◽  
1986 ◽  
Vol 50 (3) ◽  
pp. 130-135 ◽  
Author(s):  
Mark Reller ◽  
Uma R. Kotagal ◽  
Richard A. Meyer ◽  
Samuel Kaplan
Keyword(s):  
Spontaneous Breathing ◽  
Positive Pressure Ventilation ◽  
Newborn Infants ◽  
Ventricular Ejection ◽  
Positive Pressure

scholarly journals Pulse Pressure Variation Patterns in a Swine Model of Hypovolemia under Spontaneous Breathing vs. Invasive Positive-Pressure Ventilation

2014 ◽  
Vol 1 (6) ◽  
Author(s):  
Mauricio Macário Rocha ◽  
José Marconi Almeida de Souza ◽  
Angelo Amato Vincenzo de Paola ◽  
Antônio Carlos Camargo Carvalho ◽  
Adriano Henrique Pereira Barbosa ◽  
...  
Keyword(s):  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Spontaneous Breathing ◽  
Positive Pressure Ventilation ◽  
Pressure Variation ◽  
Positive Pressure ◽  
Swine Model ◽  
Variation Patterns
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