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7 results

  • Chapter 13 - Artificial Ventilation

  • Edited by Daniel Rodger, Kevin Henshaw, Paul Rawling, Scott Miller
  • Book:
    Fundamentals of Operating Department Practice
    Published online:
    18 August 2022
    Print publication:
    08 September 2022, pp 134-142

  • Summary

    This chapter provides an overview of artificial ventilation, an intervention that has developed from a basic resuscitation technique to highly sophisticated intensive care ventilators used today. Artificial ventilation is provided to unconscious patients, whether unconsciousness was caused by a medical problem (e.g., head injury) or by anaesthesia. Ventilation is usually provided through an endotracheal tube, via a breathing system which is attached to a ventilator. A heat and moisture exchange filter is used to warm and humidify the gases that reach the patient. The healthcare professional caring for the patient will adjust various parameters to ensure the ventilation strategy is appropriate for each patient and their specific needs. Positive-pressure ventilation is used to push gases into the airways of the patient and allow gas exchange to occur. Ventilators may have several different modes for delivering breaths to patients but usually are based around limiting tidal volume or peak inspiratory pressure. Artificial ventilation can affect many different physiological systems particularly the heart and blood vessels, the brain, and the kidneys.

  • High-PEEP Noninvasive Ventilation By Means of Mask as the Respiratory Support in COVID-19 ARDS Patients: Experience From General Hospital Slavonski Brod

  • Matija Jurjević, Ivan Mirković, Jasminka Kopić, Natalija Mrzljak Vučinić, Marcela Špehar Kokanović, Tonka Bujas Ćorluka
  • Journal:
    Disaster Medicine and Public Health Preparedness / Volume 17 / 2023
    Published online by Cambridge University Press:
    02 May 2022, e151
    • Article
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  • Objective:

    Despite widespread use of noninvasive ventilation (NIV) in some coronavirus disease 2019 (COVID-19) hypoxemic patients, its clinical application is still subject of debate.

    Methods:

    This is a retrospective, observational study with data collected from 91 consecutive patients treated in COVID intensive care unit (ICU) in our institution between October 2020 and February 2021. Outcomes were represented as ventilation hours, ICU and hospital length of stay, and ICU and hospital mortality.

    Results:

    Patients’ mean age was 66 ± 11 y and severe COVID-19 pneumonia with mean paO2/FiO2 137 ± 57 was observed in 90% of the patients. High positive end-expiratory pressure (PEEP) NIV by means of total face mask was initially applied in 58 (64%) patients, high flow oxygen therapy (HFOT) in 25 (27%) patients, whilst invasive mechanical ventilation (IMV) started at the moment of admission in 8 (9%) patients. NIV and high flow oxygen therapy (HFOT) have been kept on throughout ICU stay in 50 (55%) patients, while 41 (45%) patients were put on IMV. Overall ICU mortality was 41%, while ICU mortality of patients on NIV was 14%.

    Conclusions:

    High PEEP NIV was convenient and safe as initial respiratory support and in some COVID-19 ARDS patients remained an optimal respiratory support throughout their disease.

  • Mechanical Ventilation with Room Air is Feasible in a Moderate Acute Respiratory Distress Syndrome Pig Model – Implications for Disaster Situations and Low-Income Nations

  • Pinchas Halpern, Michael Goldvaser, Guy Yacov, Amir Rosner, Ada Wenger, Keren Bachar, Shahaf Katalan
  • Journal:
    Prehospital and Disaster Medicine / Volume 35 / Issue 6 / December 2020
    Published online by Cambridge University Press:
    27 August 2020, pp. 604-611
    Print publication:
    December 2020
  • Introduction:

    Patients with respiratory failure are usually mechanically ventilated, mostly with fraction of inspired oxygen (FiO2) > 0.21. Minimizing FiO2 is increasingly an accepted standard. In underserved nations and disasters, salvageable patients requiring mechanical ventilation may outstrip oxygen supplies.

    Study Objective:

    The hypothesis of the present study was that mechanical ventilation with FiO2 = 0.21 is feasible. This assumption was tested in an Acute Respiratory Distress Syndrome (ARDS) model in pigs.

    Methods:

    Seventeen pigs were anesthetized, intubated, and mechanically ventilated with FiO2 = 0.4 and Positive End Expiratory Pressure (PEEP) of 5cmH2O. Acute Respiratory Distress Syndrome was induced by intravenous (IV) oleic acid (OA) infusion, and FiO2 was reduced to 0.21 after 45 minutes of stable moderate ARDS. If peripheral capillary oxygen saturation (SpO2) decreased below 80%, PEEP was increased gradually until maximum 20cmH2O, then inspiratory time elevated from one second to 1.4 seconds.

    Results:

    Animals developed moderate ARDS (mean partial pressure of oxygen [PaO2]/FiO2 = 162.8, peak and mean inspiratory pressures doubled, and lung compliance decreased). The SpO2 decreased to <80% rapidly after FiO2 was decreased to 0.21. In 14/17 animals, increasing PEEP sufficed to maintain SpO2 > 80%. Only in 3/17 animals, elevation of FiO2 to 0.25 after PEEP reached 20cmH2O was needed to maintain SpO2 > 80%. Animals remained hemodynamically stable until euthanasia one hour later.

    Conclusions:

    In a pig model of moderate ARDS, mechanical ventilation with room air was feasible in 14/17 animals by elevating PEEP. These results in animal model support the potential feasibility of lowering FiO2 to 0.21 in some ARDS patients. The present study was conceived to address the ethical and practical paradigm of mechanical ventilation in disasters and underserved areas, which assumes that oxygen is mandatory in respiratory failure and is therefore a rate-limiting factor in care capacity allocation. Further studies are needed before paradigm changes are considered.

  • Inhaled Epoprostenol to Facilitate Safe Transport in Legionnaires’ Disease

  • Corrine Foster, Michael A. Frakes, Erica Puopolo, Francis McNulty, Mark S. Saia, Mike Hourihan, Margaret Flynn, Susan R. Wilcox
  • Journal:
    Prehospital and Disaster Medicine / Volume 35 / Issue 1 / February 2020
    Published online by Cambridge University Press:
    09 January 2020, pp. 109-114
    Print publication:
    February 2020

  • Hypoxemic patients often desaturate further with movement and transport. While inhaled epoprostenol does not improve mortality, improving oxygenation allows for transport of severely hypoxemic patients to tertiary care centers with a related improvement in mortality rates. Extracorporeal membrane oxygenation (ECMO) use is increasing in frequency for patients with refractory hypoxemia, and with increasing regionalization of care, safe transport of hypoxemic patients only becomes more important. In this series, four cases are presented of young patients with severe hypoxemic respiratory failure from Legionnaires’ disease transported on inhaled epoprostenol to ECMO centers for consideration of cannulation. With continued climate changes, Legionella and other pathogens are likely to be a continued threat. As such, optimizing oxygenation to allow for transport should continue to be a priority for critical care transport (CCT) services.

  • Case 92 - Pharmacologicmanagement of status epilepticus

  • from Section II - Neurocritical care
  • Edited by George A. Mashour, Ehab Farag
  • Book:
    Case Studies in Neuroanesthesia and Neurocritical Care
    Published online:
    03 May 2011
    Print publication:
    03 February 2011, pp 311-313

  • Summary

    Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a common problem faced by patients in the intensive care unit (ICU). The etiology of ALI is multifactorial and depends on the clinical situation; frequently ALI is the manifestation of bilateral pneumonia, transfusion reactions, or aspiration. This chapter presents a case study of a 26-year-old female who was admitted for confusion, continuing headache, nausea, and vomiting. There are two different etiological categories of ALI: direct lung injury and indirect lung injury. Direct lung injury tends to include pneumonia and aspiration along with inhalational injury and pulmonary contusions. Indirect injury etiology includes sepsis, trauma, blood transfusions, and pancreatitis. The use of positive end expiratory pressure (PEEP) and low tidal volume ventilation in the neurosurgical population is problematic, as a key component of ventilator management in this population is appropriate CO2 removal.

  • Case 91 - Succinylcholinein the patient with increased intracranial pressure

  • from Section II - Neurocritical care
  • Edited by George A. Mashour, Ehab Farag
  • Book:
    Case Studies in Neuroanesthesia and Neurocritical Care
    Published online:
    03 May 2011
    Print publication:
    03 February 2011, pp 309-310

  • Summary

    Mechanical ventilation is required frequently for patients with neurologic disorders for airway protection, pulmonary insufficiency, or management of intracranial pressure. Patients with neurologic disease are prone to hypoventilation, hypoxia, aspiration, atelectasis, and lung collapse. This chapter presents a case study of a 55-year-old female with sudden onset of severe headache and deterioration in her level of consciousness. Mechanical ventilation mode was switched to pressure control ventilation, and positive end expiratory pressure (PEEP) incrementally increased to 15cm H2O with improvement in both oxygenation and ventilation. Upon postintubation, both her mental status and respiratory status gradually improved. The chapter discusses the modes and complications of mechanical ventilation in patients with neurologic disorders. Patients with neurologic illness often require intubation and mechanical ventilation secondary to decreased levels of consciousness, impaired airway protection, neuromuscular weakness, or pulmonary complications. Mechanical ventilation strategies require optimizing oxygenation and ventilation with respect to the particular neurologic disorder.

  • Chapter 40 - Abnormal levels of consciousness

  • from Section III: - Organ dysfunction and management
  • Edited by Fang Gao Smith, University of Warwick
  • Edited in association with Joyce Yeung
  • Book:
    Core Topics in Critical Care Medicine
    Published online:
    06 July 2010
    Print publication:
    22 April 2010, pp 312-318

  • Summary

    This chapter describes oxygen cascade, and monitoring of gas exchange by pulse oximetry, capnography and blood gas analysis. Hypoventilation is a reduction in the volume of gas delivered to the alveoli causing hypoxia. Ventilation/perfusion mismatch is responsible for the hypoxaemia seen in pulmonary oedema, chronic obstructive pulmonary disease, pulmonary embolism and interstitial lung disease. Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) describe a spectrum of a critical illness syndrome involving severe inflammatory disease of the lung. Positive end expiratory pressure (PEEP) is used to improve oxygenation and prevent lung shear-stress injury associated with the opening and closing of collapsed alveoli. However, PEEP can also cause cardiovascular compromise and increased airway pressures and overdistension. The classification of pulmonary embolism by its clinical effects is: small pulmonary emboli, submassive pulmonary emboli, and massive pulmonary emboli. Surgical and catheter-based thrombectomy are alternative strategies in the management of massive pulmonary emboli.