Retention of mouth-to-mouth, mouth-to-mask and mouth-to-face shield ventilation

Background: Retention of mouth-to-mouth, mouth-to-mask and mouth-to-face shield ventilation techniques is poorly understood.Methods: A prospective randomised clinical trial was undertaken in January 2004 in 70 candidates randomly assigned to training in mouth-to-mouth, mouth-to-mask or mouth-to-face shield ventilation. Each candidate was trained for 10 min, after which tidal volume, respiratory rate, minute volume, peak airway pressure and the presence or absence of stomach inflation were measured. 58 subjects were reassessed 1 year later and study parameters were recorded again. Data were analysed with ANOVA, \textgreekq2 and McNemar tests.Results: Tidal volume, minute volume, peak airway pressure, ventilation rate and stomach inflation rate increased significantly at reassessment with all ventilation techniques compared with the initial assessment. However, at reassessment, mean (SD) tidal volume (960 (446) vs 1008 (366) vs 1402 (302) ml; p<0.05), minute volume (12 (5) vs 13 (7) vs 18 (3) l/min; p<0.05), peak airway pressure (14 (8) vs 17 (13) vs 25 (8) cm H2O; p<0.05) and stomach inflation rate (63% vs 58% vs 100%; p<0.05) were significantly lower with mouth-to-mask and mouth-to-face shield ventilation than with mouth-to-mouth ventilation. The ventilation rate at reassessment did not differ significantly between the ventilation techniques.Conclusions: One year after a single episode of ventilation training, lay persons tended to hyperventilate; however, the degree of hyperventilation and resulting stomach inflation were lower when a mouth-to-mask or a face shield device was employed. Regular training is therefore required to retain ventilation skills; retention of skills may be better with ventilation devices

Minute ventilation of cyclists, car and bus passengers: an experimental study

<p>Abstract</p> <p>Background</p> <p>Differences in minute ventilation between cyclists, pedestrians and other commuters influence inhaled doses of air pollution. This study estimates minute ventilation of cyclists, car and bus passengers, as part of a study on health effects of commuters' exposure to air pollutants.</p> <p>Methods</p> <p>Thirty-four participants performed a submaximal test on a bicycle ergometer, during which heart rate and minute ventilation were measured simultaneously at increasing cycling intensity. Individual regression equations were calculated between heart rate and the natural log of minute ventilation. Heart rates were recorded during 280 two hour trips by bicycle, bus and car and were calculated into minute ventilation levels using the individual regression coefficients.</p> <p>Results</p> <p>Minute ventilation during bicycle rides were on average 2.1 times higher than in the car (individual range from 1.3 to 5.3) and 2.0 times higher than in the bus (individual range from 1.3 to 5.1). The ratio of minute ventilation of cycling compared to travelling by bus or car was higher in women than in men. Substantial differences in regression equations were found between individuals. The use of individual regression equations instead of average regression equations resulted in substantially better predictions of individual minute ventilations.</p> <p>Conclusion</p> <p>The comparability of the gender-specific overall regression equations linking heart rate and minute ventilation with one previous American study, supports that for studies on the group level overall equations can be used. For estimating individual doses, the use of individual regression coefficients provides more precise data. Minute ventilation levels of cyclists are on average two times higher than of bus and car passengers, consistent with the ratio found in one small previous study of young adults. The study illustrates the importance of inclusion of minute ventilation data in comparing air pollution doses between different modes of transport.</p

Sustained inflation at birth did not alter lung injury from mechanical ventilation in surfactant-treated fetal lambs.

BackgroundSustained inflations (SI) are used with the initiation of ventilation at birth to rapidly recruit functional residual capacity and may decrease lung injury and the need for mechanical ventilation in preterm infants. However, a 20 second SI in surfactant-deficient preterm lambs caused an acute phase injury response without decreasing lung injury from subsequent mechanical ventilation.HypothesisA 20 second SI at birth will decrease lung injury from mechanical ventilation in surfactant-treated preterm fetal lambs.MethodsThe head and chest of fetal sheep at 126±1 day GA were exteriorized, with tracheostomy and removal of fetal lung fluid prior to treatment with surfactant (300 mg in 15 ml saline). Fetal lambs were randomized to one of four 15 minute interventions: 1) PEEP 8 cmH2O; 2) 20 sec SI at 40 cmH2O, then PEEP 8 cmH2O; 3) mechanical ventilation with 7 ml/kg tidal volume; or 4) 20 sec SI then mechanical ventilation at 7 ml/kg. Fetal lambs remained on placental support for the intervention and for 30 min after the intervention.ResultsSI recruited a mean volume of 6.8±0.8 mL/kg. SI did not alter respiratory physiology during mechanical ventilation. Heat shock protein (HSP) 70, HSP60, and total protein in lung fluid similarly increased in both ventilation groups. Modest pro-inflammatory cytokine and acute phase responses, with or without SI, were similar with ventilation. SI alone did not increase markers of injury.ConclusionIn surfactant treated fetal lambs, a 20 sec SI did not alter ventilation physiology or markers of lung injury from mechanical ventilation

Influence of oxidative stress, diaphragm fatigue, and inspiratory muscle training on the plasma cytokine response to maximum sustainable voluntary ventilation

The influence of oxidative stress, diaphragm fatigue, and inspiratory muscle training (IMT) on the cytokine response to maximum sustainable voluntary ventilation (MSVV) is unknown. Twelve healthy males were divided equally into an IMT or placebo (PLA) group, and before and after a 6-wk intervention they undertook, on separate days, 1h of (1) passive rest and (2) MSVV, whereby participants undertook volitional hyperpnea at rest that mimicked the breathing and respiratory muscle recruitment patterns commensurate with heavy cycling exercise. Plasma cytokines remained unchanged during passive rest. There was a main effect of time (P < 0.01) for plasma interleukin-1 (IL-1) and interleukin-6 (IL-6) concentrations and a strong trend (P = 0.067) for plasma interleukin-1 receptor antagonist concentration during MSVV. Plasma IL-6 concentration was reduced after IMT by 27 + 18% (main effect of intervention, P = 0.029), whereas there was no change after PLA (P = 0.753). There was no increase in a systemic marker of oxidative stress [DNA damage in peripheral blood mononuclear cells (PBMC)], and diaphragm fatigue was not related to the increases in plasma IL-1 and IL-6 concentrations. A dose-response relationship was observed between respiratory muscle work and minute ventilation and increases in plasma IL-6 concentration. In conclusion, increases in plasma IL-1 and IL-6 concentrations during MSVV were not due to diaphragm fatigue or DNA damage in PBMC. Increases in plasma IL-6 concentration during MSVV are attenuated following IMT, and the plasma IL-6 response is dependent upon the level of respiratory muscle work and minute ventilation

Evaluating single-sided natural ventilation models against full-scale idealised measurements: impact of wind direction and turbulence

Commonly single-sided natural ventilation is used in temperate climates to provide comfortable and healthy indoor environments. However, within built-up areas it is difficult to predict natural ventilation rates for buildings as they depend on many flow factors and opening type. Here, existing models are evaluated using the nine-month Refresh Cube Campaign (RCC). Pressure-based ventilation rates were determined for a small opening (1% porosity) in a cubical test building (side=6 m). The building was isolated and then sheltered in a limited staggered building array to simulate turbulent flows in dense urban areas. Internal and external flow, temperature and pressure measurements captured a wide range of scales of variability. Although the Warren and Parkins (1985, WP85) model performed best for 30-minute mean ventilation rates, all four models tested underestimated ventilation rates by a factor of 10. As wind dominated the stack effect, new coefficients were derived for the WP85 wind-driven model as a function of wind angle. Predictions were mostly improved, except for directions with complex flow patterns during the sheltered case. For the first time, the relation between ventilation rate and turbulence intensity (TI) around a full-scale building was tested. Results indicate that the wind-driven model for single-sided ventilation in highly turbulent flows (0.5<TI<4) can be improved by including TI as a multiplicative factor. Although small window openings with highly turbulent flows are common for sheltered buildings in urban areas, future model development should include a variety of configurations to assess the generality of these results

Effect of induced hypothermia on respiratory parameters in mechanically ventilated patients

Aim: Mild hypothermia is increasingly applied in the intensive care unit. Knowledge on the effects of hypothermia on respiratory parameters during mechanical ventilation is limited. In this retrospective study, we describe the effect of hypothermia on gas exchange in patients cooled for 24 h after a cardiac arrest. Methods: Respiratory parameters were derived from electronic patient files from 65 patients at the start and end of the hypothermic phase and at every centigrade increase in body temperature until normo-temperature, including tidal volume, positive end expiratory pressure (PEEP), plateau pressure, respiratory rate, exhaled CO2 concentrations (etCO(2)) and FIO2. Static compliance was calculated as V-T/P-plateau - PEEP. Dead space ventilation was calculated as (PaCO2-etCO(2))/PaCO2. Results: During hypothermia, PaCO2 decreased, at unchanged PaCO2-etCO(2) gap and minute ventilation. During rewarming, PaCO2 did not change, while etCO(2) increased at unchanged minute ventilation. Dead space ventilation did not change during hypothermia, but lowered during rewarming. During hypothermia, PaO2/FIO2 ratio increased at unchanged PEEP levels. Respiratory static compliance did not change during hypothermia, nor during rewarming. Conclusion: Hypothermia possibly improves oxygenation and ventilation in mechanically ventilated patients. Results may accord with the hypothesis that reducing metabolism with applied hypothermia may be beneficial in patients with acute lung injury, in whom low minute ventilation results in severe hypercapnia. (C) 2010 Elsevier Ireland Ltd. All rights reserve

TOLERANCE OF PHYSICAL EFFORT IN PATIENTS WITH SURGICALLY TREATED SCOLIOSIS

Fourty-eight patients were treated operatively for idiopathic scoliosis by means of CotrelDubousset technique heaving pre-operative angle values of 50°_70°. Exercise test was performed using cycle ergometer both in pre-and postoperative period. Cardiorespiratory parameters were constantly measured throughout the test to estimate ventilation threshold. Following parameters were included: heart rate, oxygen intake, lung ventilation per minute, rate and volume of ventilation, as well as power and work performed. Test was terminated when ventilation threshold was achieved. This is considered noninvasive method to calculate threshold of anaerobic metabolism. Maximal oxygen intake was indicated by means of Astrand-Ryhming nomogram. Body weight and height were also measured. Operative treatment of scoliosis using Cotrel-Dubousset method enhances physical efficiency moderately most probably due to improvement of respiratory mechanics, increase in ventilation per minute during exercise test through deepening of breaths rather than increase in ventilation rate

Influence of head rotation on ease of mask ventilation: a randomized crossover study

Background: Mask ventilation is an essential part of airway management. Head rotation increases the cross-sectional area of upper airway and improves upper airway patency. Methods: A prospective crossover study in 40 patients aged 18-69, ASA physical status I, II, III and who needed general anesthesia with tracheal intubation were selected, divided into two groups of 20 each, group I and Group II. When apnea was achieved after standard general anaesthesia, mask ventilation was performed using pressure-controlled ventilation, peak inspiratory pressure 15 cm of water, 10 breaths per minute, I:E ratio 1:2. Face mask held by two hands. Group I patients received mask ventilation with the head in a neutral position for one minute, after which the head was turned to the right for one minute and the head is returned to the neutral position for one minute. In group II patients, mask ventilation was performed from right lateral position to neutral position to right lateral position. In each position, airway pressure, compliance and expiratory tidal volume were measured. Results: There was no statistically significant difference between groups with respect to demographic data. The mean expiratory tidal volume was high in head rotation than neutral position (469.545±120.09 ml vs. 397.815±86.03 ml) p value &lt;0.05. A statistically significant (p value=0.045) seen with respect to compliance which was slightly higher in head rotation (35.83) than neutral position (29.31). Conclusions: Head rotation to the lateral position increases the expiratory tidal volume and compliance significantly as compared to head in neutral position and improves mask ventilation after induction of anaesthesia

Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation

<p>Abstract</p> <p>Background</p> <p>Suboptimal bag ventilation in cardiopulmonary resuscitation (CPR) has demonstrated detrimental physiological outcomes for cardiac arrest patients. In light of recent guideline changes for resuscitation, there is a need to identify the efficacy of bag ventilation by prehospital care providers. The objective of this study was to evaluate bag ventilation in relation to operator ability to achieve guideline consistent ventilation rate, tidal volume and minute volume when using two different capacity self-inflating bags in an undergraduate paramedic cohort.</p> <p>Methods</p> <p>An experimental study using a mechanical lung model and a simulated adult cardiac arrest to assess the ventilation ability of third year Monash University undergraduate paramedic students. Participants were instructed to ventilate using 1600 ml and 1000 ml bags for a length of two minutes at the correct rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated. Ethics approval was granted.</p> <p>Results</p> <p>Suboptimal ventilation with the use of conventional 1600 ml bag was common, with 77% and 97% of participants unable to achieve guideline consistent ventilation rates and tidal volumes respectively. Reduced levels of suboptimal ventilation arouse from the use of the smaller bag with a 27% reduction in suboptimal tidal volumes (p = 0.015) and 23% reduction in suboptimal minute volumes (p = 0.045).</p> <p>Conclusion</p> <p>Smaller self-inflating bags reduce the incidence of suboptimal tidal volumes and minute volumes and produce greater guideline consistent results for cardiac arrest patients.</p

Ventilatory Effects of Isoflurane Sedation via the Sedaconda ACD-S versus ACD-L : A Substudy of a Randomized Trial

Devices used to deliver inhaled sedation increase dead space ventilation. We therefore compared ventilatory effects among isoflurane sedation via the Sedaconda ACD-S (internal volume: 50 mL), isoflurane sedation via the Sedaconda ACD-L (100 mL), and propofol sedation with standard mechanical ventilation with heat and moisture exchangers (HME). This is a substudy of a randomized trial that compared inhaled isoflurane sedation via the ACD-S or ACD-L to intravenous propofol sedation in 301 intensive care patients. Data from the first 24 h after study inclusion were analyzed using linear mixed models. Primary outcome was minute ventilation. Secondary outcomes were tidal volume, respiratory rate, arterial carbon dioxide pressure, and isoflurane consumption. In total, 151 patients were randomized to propofol and 150 to isoflurane sedation; 64 patients received isoflurane via the ACD-S and 86 patients via the ACD-L. While use of the ACD-L was associated with higher minute ventilation (average difference (95% confidence interval): 1.3 (0.7, 1.8) L/min, p < 0.001), higher tidal volumes (44 (16, 72) mL, p = 0.002), higher respiratory rates (1.2 (0.1, 2.2) breaths/min, p = 0.025), and higher arterial carbon dioxide pressures (3.4 (1.2, 5.6) mmHg, p = 0.002), use of the ACD-S did not significantly affect ventilation compared to standard mechanical ventilation and sedation. Isoflurane consumption was slightly less with the ACD-L compared to the ACD-S (−0.7 (−1.3, 0.1) mL/h, p = 0.022). The Sedaconda ACD-S compared to the ACD-L is associated with reduced minute ventilation and does not significantly affect ventilation compared to a standard mechanical ventilation and sedation setting. The smaller ACD-S is therefore the device of choice to minimize impact on ventilation, especially in patients with a limited ability to compensate (e.g., COPD patients). Volatile anesthetic consumption is slightly higher with the ACD-S compared to the ACD-L