Articles: mechanical-ventilation.
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Soft mist inhalers (SMIs) generate aerosols with a smaller particle size than pressurized metered-dose inhalers (pMDIs). However, the whole-span particle size distribution (PSD) of SMIs and the optimal delivery method of SMIs during mechanical ventilation have not been fully investigated. This study aimed to measure the PSD of the SMI alone and the SMI coupled to an inhalation aid (eg, a spacer, a valved holding chamber), as well as the delivery efficiency of SMI in different actuation timings and circuit positions during mechanical ventilation. As a suitable comparison, the pMDI was chosen for the same measurement. ⋯ The SMI with an inhalation aid showed marginal improvement on the PSD. The inhaler type, actuation timing, and position within the circuit also played important roles in delivery efficiency during mechanical ventilation.
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J Vet Emerg Crit Care (San Antonio) · Jul 2020
High-flow nasal cannula oxygen therapy in acute hypoxemic respiratory failure in 22 dogs requiring oxygen support escalation.
To determine the effect of high-flow nasal cannula (HFNC) oxygen therapy on cardiorespiratory variables and outcome in dogs with acute hypoxemic respiratory failure. ⋯ HFNC use improved oxygenation and work of breathing relative to traditional oxygen therapies, without impairing ventilation. HFNC use appears to be a beneficial oxygen support modality to bridge the gap between standard oxygen supplementation and mechanical ventilation.
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Paediatric anaesthesia · Jul 2020
Association of Tidal Volume during Mechanical Ventilation with Postoperative Pulmonary Complications in Pediatric Patients Undergoing Major Scoliosis Surgery.
The use of lung-protective ventilation strategies with low tidal volumes may reduce the occurrence of postoperative pulmonary complications. However, evidence of the association of intraoperative tidal volume settings with pulmonary complications in pediatric patients undergoing major spinal surgery is insufficient. ⋯ In pediatric patients undergoing major spinal surgery, high tidal volume was associated with an elevated risk of postoperative pulmonary complications. However, the effect of tidal volume on pulmonary outcomes in the young subgroup (≤3 years) differed from that in the old (>3 years). Such information may help to optimize ventilation strategy for children of different ages.
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The overwhelming demand for mechanical ventilators due to COVID-19 has stimulated interest in using one ventilator for multiple patients (ie, multiplex ventilation). Despite a plethora of information on the internet, there is little supporting evidence and no human studies. The risk of multiplex ventilation is that ventilation and PEEP effects are largely uncontrollable and depend on the difference between patients' resistance and compliance. It is not clear whether volume control ventilation or pressure control ventilation is safer or more effective. We designed a simulation-based study to allow complete control over the relevant variables to determine the effects of various degrees of resistance-compliance imbalance on tidal volume (VT), end-expiratory lung volume (EELV), and imputed pH. ⋯ These experiments confirmed the potential for markedly different ventilation and oxygenation for patients with uneven respiratory system impedances during multiplex ventilation. Three critical problems must be solved to minimize risk: (1) partitioning of inspiratory flow from the ventilator individually between the 2 patients, (2) measurement of VT delivered to each patient, and (3) provision for individual PEEP. We provide suggestions for solving these problems.
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Emerging Infect. Dis. · Jul 2020
Case ReportsFatal Invasive Aspergillosis and Coronavirus Disease in an Immunocompetent Patient.
Invasive pulmonary aspergillosis is a complication in critically ill patients with acute respiratory distress syndrome, especially those with severe influenza pneumonia. We report a fatal case of invasive pulmonary aspergillosis in an immunocompetent patient in France who had severe coronavirus disease-associated pneumonia.