Articles: mechanical-ventilation.
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The COVID-19 pandemic has produced critical shortages of ventilators worldwide. There is an unmet need for rapidly deployable, emergency-use ventilators with sufficient functionality to manage COVID-19 patients with severe Acute Respiratory Distress Syndrome. Here we show the development and validation of a simple, portable, and low-cost ventilator that may be rapidly manufactured with minimal susceptibility to supply chain disruptions. ⋯ Food and Drug Administration standards of safety and efficacy, an Emergency Use Authorization is in review for this system. This emergency ventilator could eliminate controversial ventilator rationing or splitting to serve multiple patients. All design and validation information is provided to facilitate ventilator production even in resource-limited settings.
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Zhonghua yi xue za zhi · Jun 2020
[Effect of different mechanical ventilation modes on patient-ventilator synchrony and diaphragm function in rabbit model of acute respiratory distress syndrome].
Objective: To observe the effect of different modes of mechanical ventilation on patient-ventilator synchrony and diaphragm function in rabbits with acute respiratory distress syndrome(ARDS). Methods: Eighteen New Zealand rabbit models of ARDS were induced by intratracheal infusion hydrochloric acid until the oxygenation index (PaO(2)/FiO(2)) was less than 200 mmHg, and then divided into three groups with random number: assisted-controlled mechanical ventilation (A/C) group, pressure support ventilation (PSV) group and neurally adjusted ventilatory assist (NAVA) group. All of them were ventilated for four hours with the targeted tidal volume (V(T)) (6 ml/kg) and the positive end-expiratory pressure (PEEP) titrated with the maximum oxygenation method. ⋯ Compared with A/C group, the concentration of MDA in the diaphragm in NAVA group was obviously lower(P<0.05). SOD and GSH level inthe diaphragm in NAVA group were both obviously higher than those in A/C group (both P<0.05). Conclusions: It is helpful to avoid eccentric contraction of diaphragm, lessen oxidative stress and alleviate ventilator-related diaphragm dysfunction by keeping spontaneous breathing as far as possible and subject-ventilator synchrony when ventilation in ARDS with NAVA.
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This article examines successful management of an anesthesia machine failure with the Draeger (or Dräger) Apollo (Draeger Inc) anesthesia workstation. Approximately 45 minutes into the case, while the patient was under general anesthesia and mechanical ventilation, the anesthesia machine failed to achieve positive pressurization following a high-pressure alarm. Despite multiple maneuvers, the issue did not resolve until the machine was manually powered off and on at the main power switch. This case report emphasizes the importance of always having a backup means of patient ventilation and anesthesia administration.
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Journal of critical care · Jun 2020
Acute respiratory failure in randomized trials of noninvasive respiratory support: A systematic review of definitions, patient characteristics, and criteria for intubation.
To examine the definitions of acute respiratory failure, the characteristics of recruited patients, and the criteria for intubation used in randomized trials. ⋯ We identified deficiencies in the design and reporting of randomized trials, some of which can be remedied by investigators. We also found that patient characteristics differ by the type of respiratory failure. This knowledge can help clinician identify patients at the right moment to benefit from the tested interventions and investigators in developing criteria for enrollment in future trials.