Minerva anestesiologica
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Adaptive Support Ventilation is a novel ventilation mode, a closed-loop control mode that may switch automatically from a PCV-like behaviour to an SIMV-like or PSV-like behaviour, according to the patient status. The operating principles are based on pressure-controlled SIMV with pressure levels and SIMV rate automatically adjusted according to measured lung mechanics at each breath. ⋯ In cardiac surgery tracheal extrubation was faster in ASV patients then in controls. In the early weaning phase of acute ventilatory insufficiency the need of resetting ventilator parameters was decreased, suggesting potential benefit for patient care.
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Initial Implementation of Mechanical Ventilation was focused on providing adequate oxygenation and relief of work of breathing. Over the last few decades it has become apparent that stretch-induced lung injury, associated with normocapnia or hypocapnia, is a real phenomenon. Attempts to reduce stretch-induced injury led to development of permissive hypercapnia in the neonatal population, and later to its acceptance as a standard of care in adult patients with ARDS. ⋯ It is now apparent that hypercapnia by itself can be protective. In addition, hypocapnia can be harmful. These observations led to the hypothesis of therapeutic hypercapnia, i.e., deliberate production of high CO2 as a goal in the care of critically ill patients.
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The scanty availability of intensive care beds in our hospital, compared with the needings of the area, led us to employ surgical department beds as post-intensive beds. The possibility of delivering non invasive ventilation by head helmet allowed, also in such settings, the ventilation of patients. This paper analyses the main capacities and problems that are faced by the nurse in the management of head helmet delivered CPAP. Main systems for gas delivery that can be used in the departments, PEEP application modalities and psychologic management of the patient are detailed.
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Automatic tube compensation (ATC) is a new option to compensate for the non-linearly flow-dependent pressure drop across an endotracheal or tracheostomy tube (ETT) during inspiration and expiration. ATC is based on a closed-loop working principle. ATC is not a true ventilatory mode but rather a new option which can be combined with all conventional ventilatory modes. ⋯ Moreover, sufficient spontaneous breathing with ATC alone, i.e. without any additional ventilatory assist, might help to predict more accurately readiness for extubation in the last phase of weaning from mechanical ventilation. Furthermore, it has been shown in patients with acute lung injury that ATC unloaded the inspiratory muscles and increased alveolar ventilation without adversely affecting cardiorespiratory function. It is the purpose of this article to describe the working principle of ATC and to give a review of the actual scientific discussion concerning ATC.
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Minerva anestesiologica · May 2002
ReviewUse and nursing of the helmet in delivering non invasive ventilation.
Continuous positive end-expiratory pressure (CPAP) and Pressure Support Ventilation (PSV) are commonly used for the therapy of several forms of respiratory failure. CPAP and PSV can be delivered both during invasive respiratory treatment, by means of an endotracheal tube or tracheostomy, and during non invasive respiratory treatment. Non Invasive Ventilation (NIV) is commonly used for the therapy of several forms of respiratory failure (COPD, Weaning period from Invasive Mechanical Ventilation, Cardiogenic Edema,.) and the helmet could be a good new device to deliver it with a better compliance instead the common facial mask without increasing the nurses' workload.