Critical care medicine
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Critical care medicine · Jun 2000
Randomized Controlled Trial Comparative Study Clinical TrialPhysiologic evaluation of noninvasive mechanical ventilation delivered with three types of masks in patients with chronic hypercapnic respiratory failure.
The efficacy of noninvasive mechanical ventilation (NIMV) in improving breathing pattern and arterial blood gases (ABG) in hypercapnic patients has been well documented; however, little attention has been given to the choice of the interface and the ventilatory mode. We evaluated the effects of three types of masks and two modes of ventilation on patients' ABG, breathing pattern, and tolerance to ventilation. ⋯ In this physiologic study, we have shown that in patients with hypercapnic respiratory failure, irrespective of the underlying pathology, the type of interface affects the NIMV outcome more than the ventilatory mode.
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Critical care medicine · Jun 2000
Clinical Trial Controlled Clinical TrialRespiratory comfort and breathing pattern during volume proportional assist ventilation and pressure support ventilation: a study on volunteers with artificially reduced compliance.
To assess respiratory comfort and associated breathing pattern during volume assist (VA) as a component of proportional assist ventilation and during pressure support ventilation (PSV). ⋯ For volunteers breathing with artificially reduced respiratory system compliance, respiratory comfort is higher with VA than with PSV. This is probably caused by a better adaptation of the ventilatory support to the volunteer's need with VA.
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Critical care medicine · Jun 2000
ReviewNoninvasive positive pressure ventilation in the setting of severe, acute exacerbations of chronic obstructive pulmonary disease: more effective and less expensive.
The use of noninvasive ventilation for patients with acute respiratory failure has become increasingly popular over the last decade. Although the literature provides good evidence for the effectiveness of noninvasive ventilation in addition to standard therapy compared with standard therapy alone in patients with chronic obstructive pulmonary disease (avoiding intubation and improving hospital mortality), the associated costs have not been rigorously measured. Adding noninvasive positive pressure ventilation (NPPV) to standard therapy in the setting of a severe, acute exacerbation of chronic obstructive pulmonary disease (COPD) in patients with respiratory acidosis who are at high risk of requiring endotracheal intubation is both more effective and less expensive. ⋯ We conclude that from a hospital's perspective, NPPV and standard therapy for carefully selected patients with acute, severe exacerbations of COPD are more effective and less expensive than standard therapy alone.
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Critical care medicine · Jun 2000
Randomized Controlled Trial Clinical TrialEffect of inhaled nitric oxide on key mediators of the inflammatory response in patients with acute lung injury.
Inhaled nitric oxide is used to treat hypoxia associated with acute lung injury. Endogenous nitric oxide regulates inflammatory responses, but the effect of inhaled nitric oxide therapy is unknown. We hypothesized that inhaled nitric oxide may alter inflammatory responses and endogenous nitric oxide synthase activity. ⋯ The decrease in activity of nitric oxide synthase in patients receiving nitric oxide is likely to be the result of feedback inhibition of the enzyme. This study shows that inhaled nitric oxide has no effect on several markers of the inflammatory response system and does not lead to increased oxidant stress.
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Critical care medicine · Jun 2000
Clinical TrialDeadspace to tidal volume ratio predicts successful extubation in infants and children.
Using a modification of the Bohr equation, single-breath carbon dioxide capnography is a noninvasive technology for calculating physiologic dead space (V(D)/V(T)). The objective of this study was to identify a minimal V(D)/V(T) value for predicting successful extubation from mechanical ventilation in pediatric patients. ⋯ A V(D)/V(T) < or =0.50 reliably predicts successful extubation, whereas a V(D)/V(T) >0.65 identifies patients at risk for respiratory failure following extubation. There appears to be an intermediate V(D)/V(T) range (0.51-0.65) that is less predictive of successful extubation. Routine V(D)/V(T) monitoring of pediatric patients may permit earlier extubation and reduce unexpected extubation failures.