24 research outputs found
Year in review in Intensive Care Medicine, 2008: II. Experimental, acute respiratory failure and ARDS, mechanical ventilation and endotracheal intubation
SCOPUS: re.jinfo:eu-repo/semantics/publishe
0434. Simulation of late inspiratory rise in airway pressure during pressure support ventilation
Use of bronchodilators during non-invasive mechanical ventilation.
none5noneCeriana P; Navalesi P; Rampulla C; Prinianakis G; NavaCeriana, P; Navalesi, P; Rampulla, C; Prinianakis, G; Nava
Effect of varying the pressurisation rate during noninvasive pressure support ventilation
The aim of the study was to assess the effects of varying the pressurisation rate during noninvasive pressure support ventilation on patients' breathing pattern, inspiratory effort, arterial blood gases, tolerance to ventilation and amount of air leakage. A total of 15 chronic obstructive pulmonary disease patients recovering from an acute episode of hypercapnic acute respiratory failure were studied during four randomised trials with different levels of pressurisation rate. No significant changes were observed in breathing pattern and arterial blood gases between the different runs. The pressure time product of the diaphragm, an estimate of its metabolic consumption, was significantly lower with all pressurisation rates than with spontaneous breathing, but was significantly lowest with the fastest rate. However, air leak, assessed by the ratio between expired and inspired tidal volumes, increased and the patients' tolerance of ventilation, measured using a standardised scale, was significantly poorer with the fastest pressurisation rate. In chronic obstructive pulmonary disease patients recovering from an episode of acute hypercapnic respiratory failure and ventilated with noninvasive pressure support ventilation, different pressurisation rates resulted in different reductions in the pressure time product of the diaphragm; this reduction was greater with the fastest rate, but was accompanied by significant air leaks and poor tolerance
Effect of inspiratory flow rate on β2-agonist induced bronchodilation in mechanically ventilated COPD patients
Use of bronchodilators during non-invasive mechanical ventilation
Bronchodilators represent one of the most important therapeutic weapons for the treatment of airway obstructive diseases and the inhaled route of administration is very often employed due to the greater drug availability and reduced magnitude of side effects. During acute exhacerbations, it is not unfrequent that the elastic and resistive loads imposed on the ventilatory pump overcome the force sustainable by the respiratory muscles and the patient requires ventilatory assistance, in order to relieve fatigue and to optimize alveolar gas exchange. During these episodes, inhaled bronchodilators, far from being discontinued, sometime must be administered during mechanical ventilation, that, in hypercapnic ventilatory failure can be frequently applied noninvasively with a good rate of success. While in the current literature there are a lot of data about inhaled drug administration during invasive mechanical ventilation, very few data are available on the topic of aerosol therapy during noninvasive mechanical ventilation. With the present paper we want to analyze the rationale, the feasibility and the current data dealing with the administration of inhaled drugs during noninvasive mechanical ventilation
Effect of different levels of pressure support and proportional assist ventilation on breathing pattern, work of breathing and gas exchange in mechanically ventilated hypercapnic COPD patients with acute respiratory failure
Background: Proportional assist ventilation (PAV) has been shown to
maintain better patient-ventilator synchrony than pressure support
ventilation (PSV); however, its clinical advantage regarding invasive
ventilation of COPD patients has not been clarified. Objectives: To
compare the effect of PAV and PSV on respiratory parameters of
hypercapnic COPD patients with acute respiratory failure (ARF). Methods:
Nine intubated hypercapnic COPD patients were placed on the PAV or PSV
mode in random sequence. For each mode, four levels (L-1-L-4) of support
were applied. At each level, blood gases, flow, tidal volume (V-T),
airway pressure (Paw), esophageal pressure (Pes) (n = 7), patient
respiratory rate (fp), ventilator rate (fv), missing efforts (ME = fp -
fv) were measured. Results: We found increases in ME with increasing
levels of PSV but not with PAV. PO2 and V-T increased whereas PCO2
decreased significantly with increasing levels of PSV (p < 0.05). With
PAV, PCO2 decreased and V-T increased significantly only at L-4 whereas
PO2 increased from L-1 to L-4. Runaways were observed at L-3 and L-4 of
PAV. The pressure-time product (PTP) was determined for effective and
missing breaths. The mean total PTP per minute (of effective plus
missing breaths) was 160 +/- 57 cm H2O/s.min in PSV and 194 +/- 60 cm
H2O/s.min in PAV. Conclusion: We conclude that in COPD patients with
hypercapnic ARF, with increasing support, PSV causes the appearance of
ME whereas PAV develops runaway phenomena, due to the different
patient-ventilator interaction; however, these do not limit the
improvement of blood gases with the application of both methods.
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