Articles: mechanical-ventilation.
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Critical care clinics · Jul 2018
ReviewDeterminants and Prevention of Ventilator-Induced Lung Injury.
Ventilator-induced lung injury develops from interactions between the lung parenchyma and applied mechanical power. In acute respiratory distress syndrome, the lung is smaller size with an inhomogeneous structure. ⋯ Volutrauma and atelectrauma harms and benefits, however, seem to be equivalent at 5 to 15 cm H2O. At values greater than 15 cm H2O, the risk of damage outweighs the benefits of major atelectrauma prevention.
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Critical care clinics · Jul 2018
ReviewAvoiding Respiratory and Peripheral Muscle Injury During Mechanical Ventilation: Diaphragm-Protective Ventilation and Early Mobilization.
Both limb muscle weakness and respiratory muscle weakness are exceedingly common in critically ill patients. Respiratory muscle weakness prolongs ventilator dependence, predisposing to nosocomial complications and death. ⋯ Major mechanisms of muscle injury include critical illness polymyoneuropathy, sepsis, pharmacologic exposures, metabolic derangements, and excessive muscle loading and unloading. The diaphragm may become weak because of excessive unloading (leading to atrophy) or because of excessive loading (either concentric or eccentric) owing to insufficient ventilator assistance.
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Lung-protective ventilation (LPV) has become the cornerstone of management in patients with ARDS. A subset of patients is unable to tolerate LPV without significant CO2 elevation. In these patients, permissive hypercapnia is used. ⋯ In this narrative review, we highlight clinically relevant end-organ effects in both animal models and clinical studies. We also explore the association between elevated CO2, acute cor pulmonale, and ICU mortality. We conclude with a brief review of alternative therapies for CO2 management currently under investigation in patients with moderate to severe ARDS.
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Critical care medicine · Jul 2018
Observational StudyAn Open-Loop, Physiologic Model-Based Decision Support System Can Provide Appropriate Ventilator Settings.
To evaluate the physiologic effects of applying advice on mechanical ventilation by an open-loop, physiologic model-based clinical decision support system. ⋯ The results indicate that during a short period, the clinical decision support system provided appropriate suggestions of mechanical ventilation in a varied ICU population, significantly reducing ventilation to levels which might be considered safe and beneficial.
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Pediatric pulmonology · Jul 2018
Accuracy of oscillatory pressure measured by mechanical ventilators during high frequency oscillatory ventilation in newborns.
Oscillatory pressure (ΔP) measurement during high frequency oscillatory ventilation (HFOV) is technically challenging and influenced by all the components of the measurement system. ⋯ The ventilator model, the breathing circuit, the flowmeter, and the patient condition severely impacts ΔP measurement accuracy during HFOV, leading to highly variable performances. This prevents the possibility of using the ΔP required to normalize gas exchange as an indicator of patients' condition, complicates comparison of ventilators performances, and adds a significant element of complexity in clinical management of HFOV.