Covid-19 pandemic has infected more than 20 million people worldwide and claimed more than 750,000 lives so far. Given that this disease is new, the long-term lung effects for survivors especially of severe cases are unknown. Most radiographic changes compared to those commonly seen in Acute Respiratory Distress Syndrome (ARDS), manifested as groundglass opacities or diffuse interstitial/alveolar changes. We present a case of severe acute respiratory failure secondary to COVID-19 requiring prolonged mechanical ventilation and hospitalization with subsequent lung damage and unusual formation of extensive paraseptal emphysematous changes which predominantly affect the lungs apices with subsequent spontaneous pneumothorax. Currently, the long-term impacts on survivors of severe COVID-19 infections are unknown. Future long-term follow-up studies will likely confirm a significant burden and many long-lasting disabilities to the society. Keywords: COVID-19, VILI, Paraseptal Emphysema, Pulmonary fibrosis, Pneumothorax
{"title":"Unusual paraseptal emphysema as the primary changes in computerized tomography scan of a COVID-19 patient. Case report","authors":"Dan Bendsten, Takkin Lo","doi":"10.53097/JMV.10004","DOIUrl":"https://doi.org/10.53097/JMV.10004","url":null,"abstract":"Covid-19 pandemic has infected more than 20 million people worldwide and claimed more than 750,000 lives so far. Given that this disease is new, the long-term lung effects for survivors especially of severe cases are unknown. Most radiographic changes compared to those commonly seen in Acute Respiratory Distress Syndrome (ARDS), manifested as groundglass opacities or diffuse interstitial/alveolar changes. We present a case of severe acute respiratory failure secondary to COVID-19 requiring prolonged mechanical ventilation and hospitalization with subsequent lung damage and unusual formation of extensive paraseptal emphysematous changes which predominantly affect the lungs apices with subsequent spontaneous pneumothorax. Currently, the long-term impacts on survivors of severe COVID-19 infections are unknown. Future long-term follow-up studies will likely confirm a significant burden and many long-lasting disabilities to the society. Keywords: COVID-19, VILI, Paraseptal Emphysema, Pulmonary fibrosis, Pneumothorax","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47894055","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}
N. Hamahata, Ryota Sato, Kimiyo H. Yamasaki, S. Pereira, Ehab Daoud
Background: Quantification of the patient’s respiratory effort during mechanical ventilation is very important, and calculating the actual muscle pressure (Pmus) during mechanical ventilation is a cumbersome task and usually requires an esophageal balloon manometry. Airway occlusion pressure at 100 milliseconds (P0.1) can easily be obtained non-invasively. There has been no study investigating the association between Pmus and P0.1. Therefore, we aimed to investigate whether P0.1 correlates to Pmus and can be used to estimate actual Pmus Materials and Methods: A bench study using lung simulator (ASL 5000) to simulate an active breathing patient with Pmus from 1 to 30 cmH2O by increments of 1 was conducted. Twenty active breaths were measured in each Pmus. The clinical scenario was constructed as a normal lung with a fixed setting of compliances of 60 mL/cmH2O and resistances of 10 cmH2O/l/sec. All experiments were conducted using the pressure support ventilation mode (PSV) on a Hamilton-G5 ventilator (Hamilton Medical AG, Switzerland), Puritan Bennett 840TM (Covidien-Nellcor, CA) and Avea (CareFusion, CA). Main results: There was significant correlation between P 0.1 and Pmus (correlation coefficient = - 0.992, 95% CI: - 0.995 to -0.988, P-value<0.001). The equation was calculated as follows: Pmus = -2.99 x (P0.1) + 0.53 Conclusion: Estimation of Pmus using P 0.1 as a substitute is feasible, available, and reliable. Estimation of Pmus has multiple implications, especially in weaning of mechanical ventilation, adjusting ventilator support, and calculating respiratory mechanics during invasive mechanical ventilation. Keywords: P 0.1, Inspiratory occlusion pressure, WOB, Esophageal balloon, mechanical ventilators, respiratory failure Keywords: P 0.1, P mus, Inspiratory occlusion pressure, WOB, Esophageal balloon, mechanical ventilators, respiratory failure
{"title":"Estimating actual inspiratory muscle pressure from airway occlusion pressure at 100 msec","authors":"N. Hamahata, Ryota Sato, Kimiyo H. Yamasaki, S. Pereira, Ehab Daoud","doi":"10.53097/JMV.10003","DOIUrl":"https://doi.org/10.53097/JMV.10003","url":null,"abstract":"Background: Quantification of the patient’s respiratory effort during mechanical ventilation is very important, and calculating the actual muscle pressure (Pmus) during mechanical ventilation is a cumbersome task and usually requires an esophageal balloon manometry. Airway occlusion pressure at 100 milliseconds (P0.1) can easily be obtained non-invasively. There has been no study investigating the association between Pmus and P0.1. Therefore, we aimed to investigate whether P0.1 correlates to Pmus and can be used to estimate actual Pmus Materials and Methods: A bench study using lung simulator (ASL 5000) to simulate an active breathing patient with Pmus from 1 to 30 cmH2O by increments of 1 was conducted. Twenty active breaths were measured in each Pmus. The clinical scenario was constructed as a normal lung with a fixed setting of compliances of 60 mL/cmH2O and resistances of 10 cmH2O/l/sec. All experiments were conducted using the pressure support ventilation mode (PSV) on a Hamilton-G5 ventilator (Hamilton Medical AG, Switzerland), Puritan Bennett 840TM (Covidien-Nellcor, CA) and Avea (CareFusion, CA). Main results: There was significant correlation between P 0.1 and Pmus (correlation coefficient = - 0.992, 95% CI: - 0.995 to -0.988, P-value<0.001). The equation was calculated as follows: Pmus = -2.99 x (P0.1) + 0.53 Conclusion: Estimation of Pmus using P 0.1 as a substitute is feasible, available, and reliable. Estimation of Pmus has multiple implications, especially in weaning of mechanical ventilation, adjusting ventilator support, and calculating respiratory mechanics during invasive mechanical ventilation. Keywords: P 0.1, Inspiratory occlusion pressure, WOB, Esophageal balloon, mechanical ventilators, respiratory failure Keywords: P 0.1, P mus, Inspiratory occlusion pressure, WOB, Esophageal balloon, mechanical ventilators, respiratory failure","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70769122","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}
There have been confusion and contradiction on how to best manage patients with acute respiratory failure secondary to Corona virus disease-2019 (COVID-19). Recent report suggested two different phenotypes of patho-physiology (type L and type H). Type L is characterized by low elastance and low ventilation-perfusion mismatch ratio (V/Q), while type H is more consistent with the classic acute respiratory distress syndrome (ARDS) characterized by high elastance, and increased right to left shunt. The role of perfusion deficits has been clearer with the discovery of micro and macro vascular thrombi in the lung vascular endothelium. Prone position has gained interest in research and guidelines as a maneuver capable of improving ventilation and perfusion. Airway pressure release ventilation (APRV) can theoretically improve hypoxemia due to ventilation/perfusion mismatch in patients with COVID-19 compared to other conventional strategies. From this perspective, we may have to consider perfusion as the major problem in the disease process more than just ventilation. More studies are required to explore the role of perfusion and the different ventilatory strategies to best manage those patients. Key Words: airway pressure release ventilation; APRV; prone position; COVID-19; SARS-CoV-2.
{"title":"Prone position and APRV for severe hypoxemia in COVID-19 patients: The role of perfusion","authors":"R. Sato, N. Hamahata, Ehab Daoud","doi":"10.53097/JMV.10005","DOIUrl":"https://doi.org/10.53097/JMV.10005","url":null,"abstract":"There have been confusion and contradiction on how to best manage patients with acute respiratory failure secondary to Corona virus disease-2019 (COVID-19). Recent report suggested two different phenotypes of patho-physiology (type L and type H). Type L is characterized by low elastance and low ventilation-perfusion mismatch ratio (V/Q), while type H is more consistent with the classic acute respiratory distress syndrome (ARDS) characterized by high elastance, and increased right to left shunt. The role of perfusion deficits has been clearer with the discovery of micro and macro vascular thrombi in the lung vascular endothelium. Prone position has gained interest in research and guidelines as a maneuver capable of improving ventilation and perfusion. Airway pressure release ventilation (APRV) can theoretically improve hypoxemia due to ventilation/perfusion mismatch in patients with COVID-19 compared to other conventional strategies. From this perspective, we may have to consider perfusion as the major problem in the disease process more than just ventilation. More studies are required to explore the role of perfusion and the different ventilatory strategies to best manage those patients. Key Words: airway pressure release ventilation; APRV; prone position; COVID-19; SARS-CoV-2.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47194688","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}
Ehab Daoud, Jewelyn Cabigan, G. Kaneshiro, Kimiyo H. Yamasaki
Background: The COVID-19 pandemic crisis has led to an international shortage of mechanical ventilation. Due to this shortfall, the surge of increasing number of patients to limited resources of mechanical ventilators has reinvigorated the interest in the concept of split ventilation or co-ventilation (ventilating more than one patient with the same ventilator). However, major medical societies have condemned the concept in a joint statement for multiple reasons. Materials and Methods: In this paper, we will describe the history of the concept, what is trending in the literature about it and along our modification to ventilate two patients with one ventilator. We will describe how to overcome such concerns regarding cross contamination, re-breathing, safely adjusting the settings for tidal volume and positive end expiratory pressure to each patient and how to safely monitor each patient. Main results: Our experimental setup shows that we can safely ventilate two patients using one ventilator. Conclusion: The concept of ventilating more than one patient with a single ventilator is feasible especially in crisis situations. However, we caution that it has to be done under careful monitoring with expertise in mechanical ventilation. More research and investment are crucially needed in this current pandemic crisis.
{"title":"Split-ventilation for more than one patient, can it be done? Yes","authors":"Ehab Daoud, Jewelyn Cabigan, G. Kaneshiro, Kimiyo H. Yamasaki","doi":"10.53097/JMV.10002","DOIUrl":"https://doi.org/10.53097/JMV.10002","url":null,"abstract":"Background: The COVID-19 pandemic crisis has led to an international shortage of mechanical ventilation. Due to this shortfall, the surge of increasing number of patients to limited resources of mechanical ventilators has reinvigorated the interest in the concept of split ventilation or co-ventilation (ventilating more than one patient with the same ventilator). However, major medical societies have condemned the concept in a joint statement for multiple reasons. Materials and Methods: In this paper, we will describe the history of the concept, what is trending in the literature about it and along our modification to ventilate two patients with one ventilator. We will describe how to overcome such concerns regarding cross contamination, re-breathing, safely adjusting the settings for tidal volume and positive end expiratory pressure to each patient and how to safely monitor each patient. Main results: Our experimental setup shows that we can safely ventilate two patients using one ventilator. Conclusion: The concept of ventilating more than one patient with a single ventilator is feasible especially in crisis situations. However, we caution that it has to be done under careful monitoring with expertise in mechanical ventilation. More research and investment are crucially needed in this current pandemic crisis.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43319368","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}
Yellow curve: Pressure (cmH2O) on X-axis and Time (seconds) on Y-axis Pink curve: Flow (L/sec) on X-axis and Time (seconds) on Y-axis Green curve: Tidal volume (ml) on X-axis and Time (seconds) on Y-axis Two patients with respiratory failure secondary to COPD exacerbations are undergoing a spontaneous breathing trial with Pressure support ventilation 5 cmH2O and PEEP of 5 cmH2O with 25% expiratory cycle. Who is more likely to be liberated safely, who might pass, and who might fail ?
{"title":"Flow wave forms during weaning can be important","authors":"Mia Shokry, Kimiyo H. Yamasaki","doi":"10.53097/JMV.10006","DOIUrl":"https://doi.org/10.53097/JMV.10006","url":null,"abstract":"Yellow curve: Pressure (cmH2O) on X-axis and Time (seconds) on Y-axis Pink curve: Flow (L/sec) on X-axis and Time (seconds) on Y-axis Green curve: Tidal volume (ml) on X-axis and Time (seconds) on Y-axis Two patients with respiratory failure secondary to COPD exacerbations are undergoing a spontaneous breathing trial with Pressure support ventilation 5 cmH2O and PEEP of 5 cmH2O with 25% expiratory cycle. Who is more likely to be liberated safely, who might pass, and who might fail ?","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46887662","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}
Pub Date : 2008-12-31DOI: 10.1016/B978-0-7216-0186-1.50043-0
M. Niederman
{"title":"Antibiotic Use in the Mechanically Ventilated Patient","authors":"M. Niederman","doi":"10.1016/B978-0-7216-0186-1.50043-0","DOIUrl":"https://doi.org/10.1016/B978-0-7216-0186-1.50043-0","url":null,"abstract":"","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":"16 1","pages":"443 - 453"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73579077","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}
Figure 1: Pressure-Volume curve. Horizontal axis is airway pressure in cmH2O, vertical axis is resultant tidal volume in ml. LIP: Lower inflection point, HIP: high or upper inflection point, PMC: point of maximum curvature or expiratory inflection point.
{"title":"https://www.journalmechanicalventilation.com/the-pressure-volume-curve-how-to-set-peep/","authors":"Andro Youakim, Ehab Daoud","doi":"10.53097/jmv.10019","DOIUrl":"https://doi.org/10.53097/jmv.10019","url":null,"abstract":"Figure 1: Pressure-Volume curve. Horizontal axis is airway pressure in cmH2O, vertical axis is resultant tidal volume in ml. LIP: Lower inflection point, HIP: high or upper inflection point, PMC: point of maximum curvature or expiratory inflection point.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70769161","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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