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Patient effort at a glance 耐心的努力一目了然
Pub Date : 2021-12-15 DOI: 10.53097/jmv.10038
Mia Shokry, Kimiyo H. Yamasaki
A: Patient with little effort. Top: Volume Controlled Ventilation: airway pressure in cmH2O in yellow, constant flow in L/min in pink. Middle: Pressure controlled ventilation: airway pressure in cmH2O in yellow, decelerating flow in L/min in pink. Bottom: Esophageal pressure in cmH2O. B: Patient with high effort. Top: Volume Controlled Ventilation: airway pressure with convex negative deflection during trigger and first half of inspiration (blue arrow). Middle: Pressure controlled ventilation: airway pressure with negative deflection during the trigger (yellow arrow) and slight convex deflection (green arrow), concave deflection in the flow (orange arrow). Bottom: Convex deflection in esophageal pressure (grey arrow).
A:耐心一点。上图:容积控制通气:黄色为cmH2O表示的气道压力,粉色为L/min表示的恒定流量。中间:压控通气:黄色为cmH2O表示气道压力,粉色为L/min表示减速流量。下图:cmH2O中食道压力。B:耐心,努力。上图:容积控制通气:触发和吸气前半段气道压力呈凸型负偏转(蓝色箭头)。中间:压控通气:触发时气道压力有负偏转(黄色箭头)和轻微凸偏转(绿色箭头),气流中有凹偏转(橙色箭头)。下:食道压凸偏(灰色箭头)。
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引用次数: 0
Alveolar air leak and paraseptal emphysema in severe COVID-19 disease 重症COVID-19患者肺泡漏气和膈旁肺气肿
Pub Date : 2021-12-15 DOI: 10.53097/jmv.10034
A. Najafi, F. Fallahian, A. Ahmadi, K. Bakhtavar
Background Corona virus 2019 (COVID-19) pandemic spread in the world as a great medical crisis. Its pathophysiology, manifestations, complications, and management are not completely defined, yet. In this study frequency of alveolar air leak in critically ill COVID-19 subjects is explored. Methods A total of 820 critically ill COVID-19 subjects who admitted with respiratory insufficiency to ICUs of Sina University Hospital from March 2020 to June 2021 were included. All their chest x ray (CXR) and Computed tomography (CT) of chest were reviewed. All alveolar air leak episodes (pneumothorax, pneumomediastinum, pneumopericardium, subcutaneous emphysema) suspected films reviewed by attending intensivist and radiologist. Results Of the 820 ill COVID-19 subjects in ICUs, 492(60%) were male, and 328 (40%) were female. The Mean age of 820 subjects was 60.84 + 16.82. 584 (71.22%) of subjects were non-intubated, and 236 (28.78%) were intubated. Alveolar air leak occurred in 98 (11.95%) of subjects. Alveolar air leak episodes include pneumothorax in 26 (3.17%), subcutaneous emphysema in 72 (8.78%), pneumomediastinum in 9 (1.10%), and pneumopericardium in 1 (0.12%) of subjects. The mean age in non-intubated subjects was 59.65 + 16.84, and for intubated subjects was 63 + 16.42. There was a significant difference in age between the groups who get intubated, versus not intubated P 0.001. Of the 584 non-intubated subjects, 31 (5.31%) had subcutaneous emphysema, of the 236 intubated subjects, 41 (17.37%) had subcutaneous emphysema. Difference between groups was statistically significant, P <0.001. When we compared intubated and non-intubated patients in case of total numbers of alveolar air leak episodes, the difference was statistically significant P <0.001. Conclusion According to this study, intubation was implemented more in older patients. Also, invasive ventilation was significantly associated with subcutaneous emphysema and total number of alveolar air leak episodes. In every patient with exaggeration of hypoxia, dyspnea or chest pain, pneumothorax should be kept in mind as a differential diagnosis. Keywords: COVID-19; Respiratory failure; Alveolar air leak; Paraseptal emphysema
2019冠状病毒(COVID-19)大流行在世界范围内蔓延,成为一场巨大的医疗危机。其病理生理、表现、并发症和治疗尚未完全明确。本研究探讨重症COVID-19患者肺泡漏气频率。方法收集2020年3月至2021年6月新浪大学医院重症监护病房收治的新冠肺炎危重患者820例。回顾了所有患者的胸部x线片(CXR)和CT (CT)。所有肺泡漏气发作(气胸、纵隔气肿、心包气肿、皮下肺气肿)的可疑片均由主治医师和放射科医生复查。结果820例icu病例中,男性492例(60%),女性328例(40%)。820例受试者平均年龄60.84 + 16.82岁。未插管584例(71.22%),插管236例(28.78%)。98例(11.95%)发生肺泡漏气。肺泡漏气事件包括气胸26例(3.17%),皮下肺气肿72例(8.78%),纵隔气肿9例(1.10%),心包气肿1例(0.12%)。非插管组平均年龄59.65 + 16.84岁,插管组平均年龄63 + 16.42岁。插管组与未插管组在年龄上有显著差异(P < 0.001)。584例未插管患者中有31例(5.31%)发生皮下肺气肿,236例插管患者中有41例(17.37%)发生皮下肺气肿。组间差异有统计学意义,P <0.001。当我们比较插管和非插管患者肺泡漏气发作的总次数时,差异有统计学意义P <0.001。结论根据本研究,插管在老年患者中应用较多。此外,有创通气与皮下肺气肿和肺泡漏气发作次数显著相关。对于每一位有严重缺氧、呼吸困难或胸痛的患者,应将气胸作为鉴别诊断。关键词:COVID-19;呼吸衰竭;肺泡漏气;Paraseptal肺气肿
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引用次数: 0
A review of hospital based ventilator malfunctions reported to the FDA in 2021 对2021年向FDA报告的医院呼吸机故障的审查
Pub Date : 2021-12-15 DOI: 10.53097/jmv.10037
Stephen Tunnell
Ventilator care is synonymous with Intensive care. These devices are electromechanical and as such can fail. Most failures are without patient incident, injury, and harm. The FDA requires manufacturers who learn of malfunction, injury or death while operating their product to report to the agency via the Manufacturer and User Facility Device Experience database. I reviewed 500 recent events reported to the FDA and found an increasing trend from 2020 to 2021 in hospital ventilator malfunction reports. Examination of these reports is critical to assuring quality ventilator care. The author concluded that intensive training on the device characteristics and feature and a more rigorous examination of ventilator performance between patients may assist in reducing device malfunctions. Keywords: Mechanical ventilation, Ventilator malfunction, FDA
呼吸机护理是重症监护的代名词。这些设备是机电的,因此可能会发生故障。大多数失败都没有患者事故、伤害和伤害。美国食品药品监督管理局要求在操作产品时得知故障、受伤或死亡的制造商通过制造商和用户设备体验数据库向该机构报告。我回顾了最近向美国食品药品监督管理局报告的500起事件,发现从2020年到2021年,医院呼吸机故障报告呈上升趋势。检查这些报告对于确保呼吸机护理质量至关重要。作者得出结论,对设备特性和特点进行强化培训,并对患者之间的呼吸机性能进行更严格的检查,可能有助于减少设备故障。关键词:机械通气,呼吸机故障,美国食品药品监督管理局
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引用次数: 0
Calming the Storm: A review of corticosteroid use in severely ill COVID-19 patients on mechanical ventilation 平息风暴:新冠肺炎重症患者在机械通气中使用皮质类固醇的回顾
Pub Date : 2021-12-15 DOI: 10.53097/jmv.10036
T. Dinh, Cherie Chu
The importance of corticosteroids in the therapy of COVID-19 has been controversial. However, as the world develops a better understanding regarding the pathophysiology of COVID-19, we are realizing that suppressing the host immune response may reduce lung inflammation preventing further complications. In addition, more high-quality randomized controlled trials, meta-analysis, and review articles are being published discussing the role of corticosteroids. Majority of these studies concluded that corticosteroids are beneficial for hospitalized severely ill COVID-19 patients requiring supplemental oxygen. To date, therapeutic guidelines for COVID-19 patients recommend dexamethasone or other alternative corticosteroids, including methylprednisolone, hydrocortisone, or prednisone, as a treatment choice for severely ill COVID-19 patients. This review will discuss the pharmacology, mechanism of action, pharmacodynamics, pharmacokinetics, and benefits of corticosteroids in COVID-19 patients, and review current published clinical evidence on corticosteroids. Keywords: Corticosteroids, COVID-19, ARDS
皮质类固醇在新冠肺炎治疗中的重要性一直存在争议。然而,随着世界对新冠肺炎的病理生理学有了更好的了解,我们意识到抑制宿主免疫反应可以减少肺部炎症,防止进一步的并发症。此外,更多高质量的随机对照试验、荟萃分析和综述文章正在发表,讨论皮质类固醇的作用。这些研究中的大多数得出结论,皮质类固醇对需要补充氧气的住院重症新冠肺炎患者有益。迄今为止,新冠肺炎患者的治疗指南建议将地塞米松或其他替代皮质类固醇,包括甲基强的松龙、氢化可的松或泼尼松,作为严重新冠肺炎患者的治疗选择。这篇综述将讨论皮质类固醇在新冠肺炎患者中的药理学、作用机制、药效学、药代动力学和益处,并回顾目前已发表的皮质类固醇临床证据。关键词:皮质类固醇、新冠肺炎、ARDS
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引用次数: 0
Glossary and definitions of terms used in mechanical ventilation 机械通风术语的词汇和定义
Pub Date : 2021-09-15 DOI: 10.53097/jmv.10030
R. Chatburn
Review of the most common terms used in mechanical ventilation and their definitions.
回顾机械通风中最常用的术语及其定义。
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引用次数: 0
Volumetric Capnometry, more than end-tidal carbon dioxide 体积二氧化碳测量,超过潮汐末二氧化碳
Pub Date : 2021-09-15 DOI: 10.53097/jmv.10032
Mia Shokry, Kimiyo H. Yamasaki
Monitoring the exhaled caron dioxide pressure, known as end-tidal CO2 (ETCO2) has become the standard of care during anesthesia, intensive care units, and during cardiac arrest resuscitation. However, volumetric capnometry provides much more useful information other than the ETCO2.
监测呼出的二氧化碳压力,即潮汐末二氧化碳(ETCO2)已成为麻醉、重症监护病房和心脏骤停复苏期间的护理标准。然而,体积热容测定法提供了比ETCO2更有用的信息。
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引用次数: 0
Guidelines on setting the target minute ventilation in Adaptive Support Ventilation 自适应支持通气中设定目标分钟通气量的指南
Pub Date : 2021-09-15 DOI: 10.53097/jmv.10029
J. Arnal, Ehab Daoud
Adaptive Support Ventilation (ASV) is a fully closed loop ventilation where the operator input the desired PEEP, FiO2 and the target minute ventilation (MV) expressed as a percentage according to ideal body weight. The ventilator selects the target respiratory pattern (tidal volume, respiratory rate, and inspiratory time) based on the observed respiratory mechanics. However, there are no published guidelines on settings and adjusting the target MV in different disease states during ASV ventilation. INTELLiVENT-ASV, is the new generation modified algorithm of ASV, has made this issue much easier and simpler as the operator inputs a desired range of the end tidal exhaled carbon dioxide, and oxygen saturation and the algorithm will adjust the minute ventilation percentage as well as PEEP and FiO2 automatically to stay within that range. In this article we describe some evidence-based guidelines on how to set and adjust the target MV in various clinical conditions. Keywords: ASV, INTELLiVENT-ASV, Closed loop ventilation, End tidal CO2, ARDS, COPD, Respiratory failure
自适应支持通气(ASV)是一种全闭环通气,操作员根据理想体重输入所需的PEEP、FiO2和目标分钟通气(MV),以百分比表示。呼吸机根据观察到的呼吸力学选择目标呼吸模式(潮气量、呼吸频率和吸气时间)。然而,目前还没有关于ASV通气期间不同疾病状态下目标MV的设置和调整的公开指南。INTELLiVENT ASV是ASV的新一代改进算法,由于操作员输入了所需的潮气末呼出二氧化碳和氧饱和度范围,该算法将自动调整分钟通气百分比以及PEEP和FiO2,使其保持在该范围内,因此该问题变得更加容易和简单。在这篇文章中,我们描述了一些循证指南,介绍如何在各种临床条件下设置和调整目标MV。关键词:ASV,INTELLiVENT ASV,闭环通气,呼气末二氧化碳浓度,ARDS,COPD,呼吸衰竭
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引用次数: 0
Four Truths of Mechanical Ventilation and the Ten-Fold Path to Enlightenment 机械通风的四个真理与十重启蒙之路
Pub Date : 2021-09-15 DOI: 10.53097/jmv.10028
R. Chatburn
The Four Truths 1. The truth of confusion 2. The truth of the origin of confusion 3. The truth of the cessation of confusion 4. The truth of the path leading to the cessation of confusion The 10-Fold Path 1. A breath is one cycle of positive flow (inspiration) and negative flow (expiration) defined in terms of the flow-time curve. 2. A breath is assisted if the ventilator does work on the patient. 3. A ventilator assists breathing using either pressure control or volume control based on the equation of motion for the respiratory system. 4. Breaths are classified by the criteria that trigger (start) and cycle (stop) inspiration 5. Trigger and cycle events can be initiated by the patient or the machine. 6. Breaths are classified as spontaneous or mandatory based on both the trigger and cycle events. 7. There are 3 breath sequences: Continuous mandatory ventilation (CMV), Intermittent Mandatory Ventilation (IMV), and Continuous Spontaneous Ventilation (CSV). 8. There are 5 basic ventilatory patterns: VC-CMV, VC-IMV, PC-CMV, PC-IMV, and PC-CSV: 9. Within each ventilatory pattern there are several variations that can be distinguished by their targeting scheme(s). 10. A mode of ventilation is classified according to its control variable, breath sequence, and targeting scheme(s). Keywords: Breath. Trigger, Cycle, Breath sequences, Ventilatory patterns, Mode of ventilation
四项真理困惑的真相。困惑之源的真相。停止困惑的真相。通往停止困惑之路的真相。一次呼吸是一个由正流(吸气)和负流(呼气)组成的循环,这个循环是根据流动时间曲线来定义的。2. 如果呼吸机对病人有效,则辅助呼吸。3.呼吸机通过基于呼吸系统运动方程的压力控制或体积控制来辅助呼吸。4. 呼吸是根据触发(开始)和循环(停止)吸气的标准来分类的。触发和循环事件可以由患者或机器发起。6. 根据触发和循环事件将呼吸分为自发呼吸和强制呼吸。7. 呼吸顺序有三种:连续强制通气(CMV)、间歇强制通气(IMV)和连续自发通气(CSV)。8. 有5种基本的通气模式:VC-CMV、VC-IMV、PC-CMV、PC-IMV和PC-CSV。在每一种通风模式中,有几种变化可以通过它们的目标方案来区分。10. 根据控制变量、呼吸顺序和目标方案对通气模式进行分类。关键词:呼吸。触发,循环,呼吸顺序,通气模式,通气模式
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引用次数: 1
Mechanical ventilation modes utilization. An international survey of clinicians 机械通风方式的利用。一项国际临床医生调查
Pub Date : 2021-09-15 DOI: 10.53097/jmv.10031
Ehab Daoud, Kimiyo H. Yamasaki, Ronald Sanderson, Mia Shokry
Abstract: Background There has been an exponential increase in modes of mechanical ventilation over the last couple decades. With this increase, there have been paucity of evidence of which mode is superior to others or much guidance to use a mode in different disease status causing respiratory failure. Methods: An international survey of six questions was posted on the “society of mechanical ventilation” website and advertised on social media over the period of four months. This is a descriptive study, results are presented in two different ways. First as the total modes used and secondly, per the geographical areas as the preferred mode, mode used mostly in ARDS, COPD, and Spontaneous weaning trials. Results: Conventional older modes, Volume-controlled and Pressure-controlled ventilation were used significantly more in general and in different disease states irrespective of geographical location. Four other modes were used almost equally in all disease states irrespective of geographical location. Pressure support ventilation was the most common mode used during the spontaneous breathing trial. Conclusion: There was large heterogenicity of modes used between clinicians in general, in different disease states and in between different international geographical locations. Mechanical ventilation modes utilization varies widely and remains a personal preference with no consensus between clinicians globally. Keywords: Modes of mechanical ventilation, ARDS, COPD, SBT, survey
摘要:在过去的几十年里,机械通气的模式呈指数增长。随着这种增加,缺乏证据表明哪种模式优于其他模式,也没有太多指导在不同疾病状态下使用导致呼吸衰竭的模式。方法:在“机械通气学会”网站上发布一项包含6个问题的国际调查,并在社交媒体上进行为期4个月的宣传。这是一项描述性研究,结果以两种不同的方式呈现。首先是使用的总模式,其次,根据地理区域作为首选模式,主要用于ARDS, COPD和自发断奶试验。结果:传统的老式通气方式、容量控制通气和压力控制通气在不同疾病状态下的普遍使用和不同地理位置的使用均显著增加。其他四种模式在所有疾病状态中几乎同等使用,而不考虑地理位置。在自主呼吸试验中,压力支持通气是最常用的模式。结论:临床医生之间、不同疾病状态和不同国际地理位置之间使用的模式存在很大的异质性。机械通气方式的使用差异很大,仍然是个人偏好,全球临床医生之间没有共识。关键词:机械通气方式,ARDS, COPD, SBT,调查
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引用次数: 0
Home use of Non-invasive Ventilation for chronic obstructive pulmonary disease. Literature Review and Update. 家庭使用无创通气治疗慢性阻塞性肺病。文献综述与更新。
Pub Date : 2021-06-01 DOI: 10.53097/jmv.10023
Kimiyo H. Yamasaki
Non-invasive ventilation use in acute COPD exacerbation and acute respiratory failure is very strong, however the evidence beyond home non-invasive ventilation for COPD patients is less clear. In this review we summarize the literature on the effectiveness of home non-invasive ventilation on mortality, hospital admission rates, quality of life, lung functions, gas exchange, exercise tolerance as well as mood and anxiety. Published guidelines from multiple societies mostly give weak and conditional guidelines on the use of home non-invasive ventilation. High intensity home non-invasive ventilation was recently introduced and may further improve the outcomes. New research regarding high intensity home non-invasive ventilation and new technology are needed to define the role and the benefits of home non-invasive ventilation in patients with COPD. Keywords: Home non-invasive ventilation, COPD, GOLD
无创通气在COPD急性加重和急性呼吸衰竭中的应用非常有力,但除家庭无创通气外,COPD患者的证据尚不清楚。在这篇综述中,我们总结了关于家庭无创通气对死亡率、住院率、生活质量、肺功能、气体交换、运动耐受性以及情绪和焦虑的有效性的文献。多个协会发布的指南大多对家庭无创通气的使用给出了薄弱且有条件的指南。最近引入了高强度家庭无创通气,可能会进一步改善结果。需要对高强度家庭无创通气和新技术进行新的研究,以确定家庭无创通风在COPD患者中的作用和益处。关键词:家庭无创通气、COPD、GOLD
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引用次数: 0
期刊
Journal of mechanical ventilation
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