Gautham Pasupuleti, M. Mukund, Sharon A. George, Srimathi Bai KM
Background: High burden of morbidity and mortality due to respiratory illnesses was witnessed during the COVID-19 pandemic. We developed a portable automated mechanical respiratory assist device (RespirAID R20) that delivers Intermittent Positive Pressure Ventilation by mechanically compressing a Bag Valve Mask. The objective of the study is to evaluate the safety and efficacy of the RespirAID R20, a mechanical ventilation device in post-operative care patients. Method: This pilot study enrolled five subjects at Yenepoya Medical College Hospital, India. Post-operative subjects were transferred from the Mindray Synovent E3 (standard ventilator) to the RespirAID R20 for 3 hours. Ventilator and physiologic parameters were recorded and compared. Result: All patients maintained normal blood pressure, heart rate, and heart rhythm. The delivered mean tidal volume (VT) and peak inspiratory pressure (PIP) was 419.64 +/- 11 ml and 20 +/- 2 cmH2O, which remained within the initial set range of 428 +/- 12 ml and 24 +/- 2 cmH2O throughout the study duration. Arterial blood gas (ABG) parameters during RespirAID R20, except PaO2, were within the normal range. PaO2 levels were greater than 300 mm Hg during the first four hours (323 +/- 163 mmHg and 344 +/- 97 mmHg). Conclusion: The findings of this study suggests that RespirAID R20 may be an alternative device in providing respiratory assistance to sedated and intubated adult patients in the postoperative period. Additional studies are required to evaluate other possible applications of the RespirAID R20. Keywords: RespirAID R20, ABG parameters, mechanical ventilation, respiratory assist
{"title":"A pilot study to evaluate the safety and efficacy of automated mechanical respiratory aid device","authors":"Gautham Pasupuleti, M. Mukund, Sharon A. George, Srimathi Bai KM","doi":"10.53097/jmv.10064","DOIUrl":"https://doi.org/10.53097/jmv.10064","url":null,"abstract":"Background: High burden of morbidity and mortality due to respiratory illnesses was witnessed during the COVID-19 pandemic. We developed a portable automated mechanical respiratory assist device (RespirAID R20) that delivers Intermittent Positive Pressure Ventilation by mechanically compressing a Bag Valve Mask. The objective of the study is to evaluate the safety and efficacy of the RespirAID R20, a mechanical ventilation device in post-operative care patients. Method: This pilot study enrolled five subjects at Yenepoya Medical College Hospital, India. Post-operative subjects were transferred from the Mindray Synovent E3 (standard ventilator) to the RespirAID R20 for 3 hours. Ventilator and physiologic parameters were recorded and compared. Result: All patients maintained normal blood pressure, heart rate, and heart rhythm. The delivered mean tidal volume (VT) and peak inspiratory pressure (PIP) was 419.64 +/- 11 ml and 20 +/- 2 cmH2O, which remained within the initial set range of 428 +/- 12 ml and 24 +/- 2 cmH2O throughout the study duration. Arterial blood gas (ABG) parameters during RespirAID R20, except PaO2, were within the normal range. PaO2 levels were greater than 300 mm Hg during the first four hours (323 +/- 163 mmHg and 344 +/- 97 mmHg). Conclusion: The findings of this study suggests that RespirAID R20 may be an alternative device in providing respiratory assistance to sedated and intubated adult patients in the postoperative period. Additional studies are required to evaluate other possible applications of the RespirAID R20. Keywords: RespirAID R20, ABG parameters, mechanical ventilation, respiratory assist","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44240044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction SARS-CoV-2 may be associated with ARDS and the VILI. However, there are still doubts about the correlations and the interference of tidal energy in the outcomes. The objective of this study was to verify the correlations and interference of mechanical power and its components with age in the outcome in SARS-CoV-2 of subjects undergoing pressure-controlled ventilation (PCV). Method Longitudinal, prospective, observational, analytical, and quantitative study of the information collected on two parameters of the mechanical ventilator, to calculate the mechanical power by Becher formula in 163 subjects with SARS-CoV-2 and moderate ARDS between May 2021 to September 2021. Results Correlations were found between mechanical power and its components, except for compliance (P 0.234), elastance (P 0.515), resistance (P 0.570) and age (P 0.180). There was a significant impact on the outcome in the univariate analysis of age, as well as of mechanical power and its components, except for positive end expiratory pressure (PEEP) (P 0.874), minute ventilation (Ve) (P 0.437), resistive pressure (PResist) (P 0.410) and resistance (P 0.071). The multivariate analysis of mechanical power, plateau pressure (PPlateau), tidal volume (VT), driving pressure (ΔP) and elastance, showed that only mechanical power correlated to death (P 0.04) and for each additional unit in J/minute there is a 6.2% increase in the odds of death (95% IC 0.3%; 12.4%). Conclusion There are correlations between mechanical power and its components, except for compliance, elastance, resistance, and age. There is interference in the outcome in the univariate analysis of age, as well as of mechanical power and its components, except PEEP, Ve, PResist and resistance, but the multivariate analysis showed that only mechanical power correlates with the outcome in SARS-CoV-2 undergoing PCV. Keywords: SARS-CoV-2 infection; Mortality; Ventilation Induced Lung Injury; Acute Respiratory Distress Syndrome
{"title":"Correlations of mechanical power and its components with age and its interference in the outcome of SARS-CoV-2 in subjects undergoing pressure-controlled ventilation","authors":"C. Franck, Gustavo Maysonnave Franck, Ehab Daoud","doi":"10.53097/jmv.10063","DOIUrl":"https://doi.org/10.53097/jmv.10063","url":null,"abstract":"Introduction SARS-CoV-2 may be associated with ARDS and the VILI. However, there are still doubts about the correlations and the interference of tidal energy in the outcomes. The objective of this study was to verify the correlations and interference of mechanical power and its components with age in the outcome in SARS-CoV-2 of subjects undergoing pressure-controlled ventilation (PCV). Method Longitudinal, prospective, observational, analytical, and quantitative study of the information collected on two parameters of the mechanical ventilator, to calculate the mechanical power by Becher formula in 163 subjects with SARS-CoV-2 and moderate ARDS between May 2021 to September 2021. Results Correlations were found between mechanical power and its components, except for compliance (P 0.234), elastance (P 0.515), resistance (P 0.570) and age (P 0.180). There was a significant impact on the outcome in the univariate analysis of age, as well as of mechanical power and its components, except for positive end expiratory pressure (PEEP) (P 0.874), minute ventilation (Ve) (P 0.437), resistive pressure (PResist) (P 0.410) and resistance (P 0.071). The multivariate analysis of mechanical power, plateau pressure (PPlateau), tidal volume (VT), driving pressure (ΔP) and elastance, showed that only mechanical power correlated to death (P 0.04) and for each additional unit in J/minute there is a 6.2% increase in the odds of death (95% IC 0.3%; 12.4%). Conclusion There are correlations between mechanical power and its components, except for compliance, elastance, resistance, and age. There is interference in the outcome in the univariate analysis of age, as well as of mechanical power and its components, except PEEP, Ve, PResist and resistance, but the multivariate analysis showed that only mechanical power correlates with the outcome in SARS-CoV-2 undergoing PCV. Keywords: SARS-CoV-2 infection; Mortality; Ventilation Induced Lung Injury; Acute Respiratory Distress Syndrome","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42756442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present two rare cases of mechanical ventilation-associated barotrauma presenting with pneumoperitoneum and pneumoretroperitoneum separately. Pneumoperitoneum and pneumoretroperitoneum are not always associated with a hollow viscous perforation and can be seen due to barotrauma as a consequence of the Macklin effect.
{"title":"Non‐surgical pneumoperitoneum and pneumoretroperitoneum associated with mechanical ventilation","authors":"M. R. Krishna, Pramood Sood, P. Gautam","doi":"10.53097/jmv.10059","DOIUrl":"https://doi.org/10.53097/jmv.10059","url":null,"abstract":"We present two rare cases of mechanical ventilation-associated barotrauma presenting with pneumoperitoneum and pneumoretroperitoneum separately. Pneumoperitoneum and pneumoretroperitoneum are not always associated with a hollow viscous perforation and can be seen due to barotrauma as a consequence of the Macklin effect.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42044277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Yeo, Parthav Shah, M. Gozun, C. Franck, Ehab Daoud
Introduction Mechanical power has been linked to ventilator induced lung injury and mortality in acute respiratory distress syndrome (ARDS). Adaptive Ventilator Mode-2 is a closed-loop pressure-controlled mode with an optimal targeting scheme based on the inspiratory power equation that adjusts the respiratory rate and tidal volume to achieve a target minute ventilation. Conceptually, this mode should reduce the mechanical power delivered to the patients and thus reduce the incidence of ventilator induced lung injury. Methods A bench study using a lung simulator was conducted. We constructed three passive single compartment ARDS models (Mild, Moderate, Severe) with compliance of 40, 30, 20 ml/cmH2O respectively, and resistance of 10 cmH2O/L/s, with IBW 70 kg. We compared three different ventilator modes: AVM-2, Pressure Regulated Volume Control (PRVC), and Volume Controlled Ventilation (VCV) in six different scenarios: 3 levels of minute ventilation 7, 10.5, and 14 Lit/min (Experiment 1, 2, and 3 respectively), each with 3 different PEEP levels 10, 15, and 20 cmH2O (Experiment A, B, and C respectively) termed 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B, 3C respectively for a total of 81 experiments. The AVM-2 mode automatically selects the optimal tidal volume and respiratory rate per the dialed percent minute ventilation with an I:E ratio of 1:1. In the PRVC and VCV (constant flow) we selected target tidal volume 6ml/kg/IBW (420 ml) and respiratory rate adjusted to match the minute ventilation for the AVM-2 mode. I:E ratio was kept 1:2. The mechanical power delivered by the ventilator for each mode was computed and compared between the three modes in each experiment. Statistical analysis was done using Kruskal-Wallis test to analyze the difference between the three modes, post HOC Tukey test was used to analyze the difference between each mode where P < 0.05 was considered statistically significant. The Power Compliance Index was calculated and compared in each experiment. Multiple regression analysis was performed in each mode to test the correlation of the variables of mechanical power to the total calculated power. Results There were statistically significant differences (P < 0.001) between all the three modes regarding the ventilator delivered mechanical power. AVM-2 mode delivered significantly less mechanical power than VCV which in turn was less than PRVC. The Power Compliance index was also significantly lower (P < 0.01) in the AVM-2 mode compared to the other conventional modes. Multiple regression analysis indicated that in AVM-2 mode, the driving pressure (P = 0.004), tidal volume (P < 0.001), respiratory rate (P = 0.011) and PEEP (P < 0.001) were significant predictors in the model. In the VCV mode, the respiratory rate (P 0< 0.001) and PEEP (P < 0.001) were significant predictors, but the driving pressure was a non-significant predictor (P = 0.08). In PRVC mode, the respiratory rate (P < 0.001), PEEP (P < 0.001) and driving pressure (P < 0.001)
{"title":"Mechanical power in AVM-2 versus conventional ventilation modes in various ARDS lung models. Bench study","authors":"J. Yeo, Parthav Shah, M. Gozun, C. Franck, Ehab Daoud","doi":"10.53097/jmv.10056","DOIUrl":"https://doi.org/10.53097/jmv.10056","url":null,"abstract":"Introduction Mechanical power has been linked to ventilator induced lung injury and mortality in acute respiratory distress syndrome (ARDS). Adaptive Ventilator Mode-2 is a closed-loop pressure-controlled mode with an optimal targeting scheme based on the inspiratory power equation that adjusts the respiratory rate and tidal volume to achieve a target minute ventilation. Conceptually, this mode should reduce the mechanical power delivered to the patients and thus reduce the incidence of ventilator induced lung injury. Methods A bench study using a lung simulator was conducted. We constructed three passive single compartment ARDS models (Mild, Moderate, Severe) with compliance of 40, 30, 20 ml/cmH2O respectively, and resistance of 10 cmH2O/L/s, with IBW 70 kg. We compared three different ventilator modes: AVM-2, Pressure Regulated Volume Control (PRVC), and Volume Controlled Ventilation (VCV) in six different scenarios: 3 levels of minute ventilation 7, 10.5, and 14 Lit/min (Experiment 1, 2, and 3 respectively), each with 3 different PEEP levels 10, 15, and 20 cmH2O (Experiment A, B, and C respectively) termed 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B, 3C respectively for a total of 81 experiments. The AVM-2 mode automatically selects the optimal tidal volume and respiratory rate per the dialed percent minute ventilation with an I:E ratio of 1:1. In the PRVC and VCV (constant flow) we selected target tidal volume 6ml/kg/IBW (420 ml) and respiratory rate adjusted to match the minute ventilation for the AVM-2 mode. I:E ratio was kept 1:2. The mechanical power delivered by the ventilator for each mode was computed and compared between the three modes in each experiment. Statistical analysis was done using Kruskal-Wallis test to analyze the difference between the three modes, post HOC Tukey test was used to analyze the difference between each mode where P < 0.05 was considered statistically significant. The Power Compliance Index was calculated and compared in each experiment. Multiple regression analysis was performed in each mode to test the correlation of the variables of mechanical power to the total calculated power. Results There were statistically significant differences (P < 0.001) between all the three modes regarding the ventilator delivered mechanical power. AVM-2 mode delivered significantly less mechanical power than VCV which in turn was less than PRVC. The Power Compliance index was also significantly lower (P < 0.01) in the AVM-2 mode compared to the other conventional modes. Multiple regression analysis indicated that in AVM-2 mode, the driving pressure (P = 0.004), tidal volume (P < 0.001), respiratory rate (P = 0.011) and PEEP (P < 0.001) were significant predictors in the model. In the VCV mode, the respiratory rate (P 0< 0.001) and PEEP (P < 0.001) were significant predictors, but the driving pressure was a non-significant predictor (P = 0.08). In PRVC mode, the respiratory rate (P < 0.001), PEEP (P < 0.001) and driving pressure (P < 0.001) ","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46822228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It has been 60 years since Bendixen, Hedley-White, and Laver described the progressive atelectasis and resultant hypoxemia that resulted from prolonged mechanical ventilation. A proposed solution was to raise the tidal volume (VT) from those recommended by Radford’s nomogram for “proper ventilation” to 10 -15 ml/ kg. It was less than four years later that Acute Respiratory Distress Syndrome (ARDS) was first reported. Since then, clinicians and researchers have been searching for the ideal ventilation strategy to minimise the harm and optimise the outcomes from ventilatory support in the critically ill.
{"title":"The Rise of the Machines: Why the future lies with less injurious adaptive ventilation strategies","authors":"R. C Freebairn","doi":"10.53097/jmv.10055","DOIUrl":"https://doi.org/10.53097/jmv.10055","url":null,"abstract":"It has been 60 years since Bendixen, Hedley-White, and Laver described the progressive atelectasis and resultant hypoxemia that resulted from prolonged mechanical ventilation. A proposed solution was to raise the tidal volume (VT) from those recommended by Radford’s nomogram for “proper ventilation” to 10 -15 ml/ kg. It was less than four years later that Acute Respiratory Distress Syndrome (ARDS) was first reported. Since then, clinicians and researchers have been searching for the ideal ventilation strategy to minimise the harm and optimise the outcomes from ventilatory support in the critically ill.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42737504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patient-Ventilator Dyssynchrony (PVD) is often described as a patient “fighting” the ventilator. In fact, there are many forms of dyssynchrony some of which can very subtle. If unrecognized early, dyssynchrony can evoke patient discomfort, increase incidence of lung injury, lead to oversedation, and lengthen duration of mechanical ventilation. Since start of the COVID-19 pandemic, many clinicians without critical care experience have been compelled to manage patients requiring mechanical ventilation. Many academic centers, hospital systems, and physician groups have attempted to provide educational material in efforts to prepare clinicians on how to operate a ventilator. During this frenzied time, very few resources have been made available to clinicians to rapidly recognize ventilator dyssynchrony as it occurs when taking care of these patients. The figures presented in this article depict dyssynchrony in Volume Control Ventilation (VCV) with a decelerating ramp of flow and are hand drawn. While they may not perfectly represent waveforms seen on ventilators, the patterns shown and described below will be similar.
{"title":"https://www.journalmechanicalventilation.com/rapid-review-of-patient-ventilator-dyssynchrony/","authors":"D. Garner, Priyank Patel","doi":"10.53097/jmv.10058","DOIUrl":"https://doi.org/10.53097/jmv.10058","url":null,"abstract":"Patient-Ventilator Dyssynchrony (PVD) is often described as a patient “fighting” the ventilator. In fact, there are many forms of dyssynchrony some of which can very subtle. If unrecognized early, dyssynchrony can evoke patient discomfort, increase incidence of lung injury, lead to oversedation, and lengthen duration of mechanical ventilation. Since start of the COVID-19 pandemic, many clinicians without critical care experience have been compelled to manage patients requiring mechanical ventilation. Many academic centers, hospital systems, and physician groups have attempted to provide educational material in efforts to prepare clinicians on how to operate a ventilator. During this frenzied time, very few resources have been made available to clinicians to rapidly recognize ventilator dyssynchrony as it occurs when taking care of these patients. The figures presented in this article depict dyssynchrony in Volume Control Ventilation (VCV) with a decelerating ramp of flow and are hand drawn. While they may not perfectly represent waveforms seen on ventilators, the patterns shown and described below will be similar.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46251838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Unilateral lung disease (ULD) requiring mechanical ventilation is a unique challenge due to individual and interactive lung mechanics. The distribution of volume and pressure may not be even due to inequities in compliance and resistance. Independent lung ventilation (ILV) is a strategy to manage ULD but is not commonly employed. We assessed the mechanical power (MP) between single lung ventilation (SLV) and ILV in a dual lung model with different compliances. Methods A passive lung model with two different compliances (30 ml/cmH2O and 10 ml/cmH2O) and a predicted body weight of 65 kg was used to simulated ULD and ILV. In SLV the ventilator was set with the following: tidal volume (VT) 400 ml, PEEP 7, RR 20, I:E 1:2. In ILV, each lung was given a separate ventilator with equivalent settings to SLV: VT 300 ml, PEEP 7, RR 20, I:E 1:2 in the more compliant lung (MCL) and VT 100 ml, PEEP 7, RR 20, I:E 1:2 in the less compliant lung (LCL). The study was repeated with different PEEP levels and different ventilator modes, volume (VCV) and pressure control (PCV). PEEP was set according to the compliance: VT 300 ml, PEEP 8, RR 20, I:E 1:2 in the MCL and VT 100 ml, PEEP 10, RR 20, I:E 1:2 in the LCL. The MP in each study and compared SLV to the combined results from each lung in ILV. MP was indexed to the compliance in all the studies Results The MP was significantly lower in VCV compared to PCV in all studies. In VCV, the total MP in SLV was 12.61 J/min compared to 11.39 J/min in the combined lungs with the same PEEP levels (8.84 MCL and 2.55 LCL) (p = < 0.001). The total MP in SLV was also higher when comparing to ILV with different PEEP levels 12.57 J/min (9.43 MCL and 3.01LCL) (p= <0.001). In PCV, the total MP was 14.25 J/min which was higher compared to 13.22 in the combined lungs with the same PEEP levels (9.88 MCL and 3.32 LCL) (p =<0.001) however, the MP was lower compared to 14.55 in the combined lungs with different PEEP levels (10.58 MCL and 3.92 LCL) (p=<0.001).The Power Compliance Index (PCI) was significantly lower in ILV with same PEEP level (0.295 MCL and0.255 LCL, compared to 0.315 in the SLV) and similar in the different PEEP levels (0.314 MCL and , 0.314 LCL, compared to 0.315 in the SLV) in VCV. The PCI was significantly lower in the ILV with the same PEEP level (0.329 MCL, 0.332 LCL compared to 0.356 in the SLV). In the different PEEP levels, the MCL was less (0.352), and higher in the LCL (0.392) compared to the SLV (0.356) in PCV. Conclusions ILV can be achieved with lower MP in VCV using the same or higher PEEP levels than SLV, however in PCV the MP was less using the same PEEP but higher using different PEEP levels. Indexing the MP to compliance can be more meaningful in interpreting the results than the MP alone. Further studies are needed to confirm our findings.
{"title":"Mechanical power and Power Compliance Index in independent lung ventilation. New insight","authors":"Koichi Keitoku, J. Yeo, Robert Cabbat, Ehab Daoud","doi":"10.53097/jmv.10057","DOIUrl":"https://doi.org/10.53097/jmv.10057","url":null,"abstract":"Background Unilateral lung disease (ULD) requiring mechanical ventilation is a unique challenge due to individual and interactive lung mechanics. The distribution of volume and pressure may not be even due to inequities in compliance and resistance. Independent lung ventilation (ILV) is a strategy to manage ULD but is not commonly employed. We assessed the mechanical power (MP) between single lung ventilation (SLV) and ILV in a dual lung model with different compliances. Methods A passive lung model with two different compliances (30 ml/cmH2O and 10 ml/cmH2O) and a predicted body weight of 65 kg was used to simulated ULD and ILV. In SLV the ventilator was set with the following: tidal volume (VT) 400 ml, PEEP 7, RR 20, I:E 1:2. In ILV, each lung was given a separate ventilator with equivalent settings to SLV: VT 300 ml, PEEP 7, RR 20, I:E 1:2 in the more compliant lung (MCL) and VT 100 ml, PEEP 7, RR 20, I:E 1:2 in the less compliant lung (LCL). The study was repeated with different PEEP levels and different ventilator modes, volume (VCV) and pressure control (PCV). PEEP was set according to the compliance: VT 300 ml, PEEP 8, RR 20, I:E 1:2 in the MCL and VT 100 ml, PEEP 10, RR 20, I:E 1:2 in the LCL. The MP in each study and compared SLV to the combined results from each lung in ILV. MP was indexed to the compliance in all the studies Results The MP was significantly lower in VCV compared to PCV in all studies. In VCV, the total MP in SLV was 12.61 J/min compared to 11.39 J/min in the combined lungs with the same PEEP levels (8.84 MCL and 2.55 LCL) (p = < 0.001). The total MP in SLV was also higher when comparing to ILV with different PEEP levels 12.57 J/min (9.43 MCL and 3.01LCL) (p= <0.001). In PCV, the total MP was 14.25 J/min which was higher compared to 13.22 in the combined lungs with the same PEEP levels (9.88 MCL and 3.32 LCL) (p =<0.001) however, the MP was lower compared to 14.55 in the combined lungs with different PEEP levels (10.58 MCL and 3.92 LCL) (p=<0.001).The Power Compliance Index (PCI) was significantly lower in ILV with same PEEP level (0.295 MCL and0.255 LCL, compared to 0.315 in the SLV) and similar in the different PEEP levels (0.314 MCL and , 0.314 LCL, compared to 0.315 in the SLV) in VCV. The PCI was significantly lower in the ILV with the same PEEP level (0.329 MCL, 0.332 LCL compared to 0.356 in the SLV). In the different PEEP levels, the MCL was less (0.352), and higher in the LCL (0.392) compared to the SLV (0.356) in PCV. Conclusions ILV can be achieved with lower MP in VCV using the same or higher PEEP levels than SLV, however in PCV the MP was less using the same PEEP but higher using different PEEP levels. Indexing the MP to compliance can be more meaningful in interpreting the results than the MP alone. Further studies are needed to confirm our findings.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42686741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mechanical ventilation is a common issue in critically ill patients. It is a lifesaving treatment but also can cause some complications. Patient-ventilator asynchronies are frequent but are often underdiagnosed and they are a serious problem that is associated with worse clinical outcomes. Asynchrony occurs when there is a mismatch between the ventilator setting and the patient´s demand or breath delivery timing. There are a variety of asynchronies between the patient’s respiratory efforts and the programed ventilatory setting. Ineffective effort is a kind of asynchrony of the trigger variable. It occurs when the patient’s inspiratory effort fails to trigger a ventilator breath. Ineffective inspiratory efforts are a great problem in patient-ventilator interaction, and they are the most common type of asynchrony.
{"title":"Identifying asynchronies: Ineffective effort","authors":"Victor Perez, Jamille Pasco","doi":"10.53097/jmv.10060","DOIUrl":"https://doi.org/10.53097/jmv.10060","url":null,"abstract":"Mechanical ventilation is a common issue in critically ill patients. It is a lifesaving treatment but also can cause some complications. Patient-ventilator asynchronies are frequent but are often underdiagnosed and they are a serious problem that is associated with worse clinical outcomes. Asynchrony occurs when there is a mismatch between the ventilator setting and the patient´s demand or breath delivery timing. There are a variety of asynchronies between the patient’s respiratory efforts and the programed ventilatory setting. Ineffective effort is a kind of asynchrony of the trigger variable. It occurs when the patient’s inspiratory effort fails to trigger a ventilator breath. Ineffective inspiratory efforts are a great problem in patient-ventilator interaction, and they are the most common type of asynchrony.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45723893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent emphasis on energy load delivered during each ventilatory breath has opened a new insight to reduce harmful ventilatory induced lung injury, but no robust clinical evidence of patient benefit produced yet. Closed loop ventilation is a strategy to adjust respiratory support using physiological feedback data obtained for each delivered cycle of respiratory support. Dependent on the model assumption used, closed loop ventilation aims to identify the ideal combination of tidal volume size, reduced driving pressure or respiratory frequency ultimately reducing the energy loading of the lung. This review aims to discuss the current state-of-the-art ventilation concepts and their integration in closed loop ventilation.
{"title":"From state-of-the-art ventilation to closed loop ventilation","authors":"A. Schibler, M. van der Staay, Christian Remus","doi":"10.53097/jmv.10054","DOIUrl":"https://doi.org/10.53097/jmv.10054","url":null,"abstract":"Recent emphasis on energy load delivered during each ventilatory breath has opened a new insight to reduce harmful ventilatory induced lung injury, but no robust clinical evidence of patient benefit produced yet. Closed loop ventilation is a strategy to adjust respiratory support using physiological feedback data obtained for each delivered cycle of respiratory support. Dependent on the model assumption used, closed loop ventilation aims to identify the ideal combination of tidal volume size, reduced driving pressure or respiratory frequency ultimately reducing the energy loading of the lung. This review aims to discuss the current state-of-the-art ventilation concepts and their integration in closed loop ventilation.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41840409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A variety of asynchronies between the patient’s respiratory efforts and the programed ventilatory settings have been categorized. Reverse trigger is described as an inspiratory effort occurring after a ventilator-initiated breath and may represent a form of respiratory entrainment. In other words, the ventilator triggers muscular efforts. It often appears in a repetitive, stereotyped pattern. It occurs often in mechanically ventilated patients at risk of injury, might be underrecognized at the bedside and may has adverse effects on oxygenation and ventilation, as well as potentially increasing lung injury. We can phenotype these events using the Campbell diagram (pressure–volume loop) by differentiating their occurrence during inspiration and expiration. Reverse trigger with sufficient inspiratory effort and duration can result in an additional ventilator-delivered stacked breath, which can cause large tidal volumes and increased transpulmonary pressure. Keywords: Asynchrony, ventilator, reverse trigger, entrainment, lung injury, phenotype.
{"title":"Identifying asynchronies: Reverse trigger","authors":"Victor Perez, Jamille Pasco","doi":"10.53097/jmv.10052","DOIUrl":"https://doi.org/10.53097/jmv.10052","url":null,"abstract":"A variety of asynchronies between the patient’s respiratory efforts and the programed ventilatory settings have been categorized. Reverse trigger is described as an inspiratory effort occurring after a ventilator-initiated breath and may represent a form of respiratory entrainment. In other words, the ventilator triggers muscular efforts. It often appears in a repetitive, stereotyped pattern. It occurs often in mechanically ventilated patients at risk of injury, might be underrecognized at the bedside and may has adverse effects on oxygenation and ventilation, as well as potentially increasing lung injury. We can phenotype these events using the Campbell diagram (pressure–volume loop) by differentiating their occurrence during inspiration and expiration. Reverse trigger with sufficient inspiratory effort and duration can result in an additional ventilator-delivered stacked breath, which can cause large tidal volumes and increased transpulmonary pressure. Keywords: Asynchrony, ventilator, reverse trigger, entrainment, lung injury, phenotype.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41505886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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