A pilot study to assess short-term physiologic outcomes of transitioning infants with severe bronchopulmonary dysplasia from ICU to two subacute ventilators

DiBlasi, Robert M; Crotwell, Dave N; Poli, Jonathan A; Hotz, Justin; Cogen, Jonathan D; Carter, Edward

doi:10.29390/cjrt-2018-001

Cited by 8 publications

(7 citation statements)

References 26 publications

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“…The intermediate ventilator is also known as the subacute ventilator. 37 With advances in ventilator technology, it is becoming increasingly difficult to clearly classify each type of device. Originally designed specifically for NIV, the bi-level ventilators now have an invasive mode of positive pressure delivery.…”

Section: Discussionmentioning

confidence: 99%

Long-term home mechanical ventilation using a noninvasive ventilator via tracheotomy in patients with myasthenia gravis: a case report and literature review

Liu

Shi

2023

Ther Adv Respir Dis

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Neuromuscular diseases (NMD) are indications for long-term home mechanical ventilation (HMV). Noninvasive ventilation is preferred to HMV. However, invasive mechanical ventilation (IMV) is more appropriate if the patient has uncontrollable airway secretions, the possibility of aspiration, failure to wean, or severe weakness of the respiratory muscles. But if the patient undergoes multiple intubation or tracheotomy, it will be more painful and unbearable. For some end-stage NMD patients who need long-term tracheostomy, HMV using noninvasive ventilator via tracheotomy may be a conservative care option. An 87-year-old male with myasthenia gravis underwent repeated IMV and failed to wean. We used a noninvasive ventilator connected to a tracheostomy tube for mechanical ventilation. One and a half years later, the patient weaned successfully. However, there was a lack of evidence-based medicine and standardized guidelines in such areas as indications, contraindications, and ventilator parameter setting. For the systematic review, a literature search was performed in PubMed, Embase, Cochrane, and CNKI (China National Knowledge Infrastructure) to identify reported cases of using noninvasive ventilator in patients undergoing tracheostomy. A total of 72 cases who performed ventilation via tracheotomy tube were identified. The main diagnoses included NMD, chronic obstructive pulmonary disease (COPD), pneumonia, and congenital central hypoventilation syndrome (CCHS). Indications included dysfunctional ventilatory weaning response (DVWR), apnea and cyanosis. Clinical outcome was as follows: 33 patients were weaned, and 24 patients underwent HMV. A total of 288 cases who performed ventilation through the mask after blocking the tracheostomy tube were identified. The primary diagnoses included COPD, NMD, thoracic restriction, spinal cord injured (SCI), and CCHS. Indications included DVWR, apnea and cyanosis, routine weaning. Clinical outcome was as follows: successful tracheostomy tube decannulations were performed in 254 patients and failed in 33 patients. So, in patients requiring HMV, selection of noninvasive ventilation (NIV) or IMV should be individualized. Tracheostomy preservation should be considered in some patients with advanced NMD if there is respiratory muscle weakness or the risk of aspiration. And attempts can be made to use a noninvasive ventilator because of its advantages of portability, ease of operation, and low cost. Noninvasive ventilators can be used in patients with tracheotomy, whether direct connection tracheotomy or mask ventilation after the tube is capped, especially in weaning and tracheostomy tube decannulation.

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Section: Discussionmentioning

confidence: 99%

Long-term home mechanical ventilation using a noninvasive ventilator via tracheotomy in patients with myasthenia gravis: a case report and literature review

Liu

Shi

2023

Ther Adv Respir Dis

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“…However, this extended range of commercially available machines makes the choice of the best device for different categories of patients more difficult. We should consider not only the patient's medical condition and ventilator needs but also any limitations of the ventilator 8–11 . The choice is also influenced by insurance, local healthcare systems, the providers' familiarity with the equipment, community nurses and respiratory therapists, and the PHVs supported in any given community.…”

Section: Planning For Transition To a Home Ventilator: Timing And Rea...mentioning

confidence: 99%

“…We should consider not only the patient's medical condition and ventilator needs but also any limitations of the ventilator. [8][9][10][11] The choice is also influenced by insurance, local healthcare systems, the providers' familiarity with the equipment, community nurses and respiratory therapists, and the PHVs supported in any given community. Several aspects of PHV setup are vital to consider when contemplating Transition: type of respiratory circuit, modes of mechanical ventilation, secondary settings (such as trigger, limit, cycling, and control variables), safety, alarms, and monitoring systems.…”

Section: Process Of Transitionmentioning

confidence: 99%

Transition from intensive care unit to a portable ventilator in children with severe bronchopulmonary dysplasia

McKinney

Agarwal

2022

Pediatric Pulmonology

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As the population of ventilator‐dependent children (VDC) with tracheostomies due to underlying severe bronchopulmonary dysplasia grows, there is an increasing need to shift the care of these children from hospital to home. Transitioning the ventilator‐dependent child from the hospital to home is a complex process that requires coordination between the medical team and the family. One crucial step in the process is transitioning from an Intensive care unit (ICU) ventilator to a portable home ventilator (PHV). The Clinical team needs to understand the nuances in transitioning to PHV, including assessing readiness to transition and choosing the optimum settings on an available home ventilator. In recent years, various ventilator modes have been available in PHV that can help achieve synchronous breathing to allow for adequate gas exchange for the infant. This review details some approaches to asses readiness to transition and the process of Transition along with commonly used modes of support available in PHV, as well as the primary and secondary settings in which we should be mindful in supporting a child with chronic respiratory failure in the home setting.

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“…Triggered breaths (%) were calculated as the total number of animal-initiated respiratory efforts to the total number of corresponding breaths triggered on the ventilator. 12 The minute ventilation calculation was based on V T , breathing frequency, and proportion of triggered efforts that resulted in ventilator-supported breaths.…”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

Physiologic Effects of 3 Different Neonatal Volume-Targeted Ventilation Modes in Surfactant-Deficient Juvenile Rabbits

et al. 2019

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BACKGROUND: Different brands of volume-targeted modes may vary the location of tidal volume (V T ) monitoring and whether peak inspiratory pressure is adjusted based on inspiratory, expiratory , or leak-compensated V T . These variables may result in different levels of support provided to patients, especially when an endotracheal tube (ETT) leak is present. We hypothesized that there would be no differences in gas exchange, triggering, or work of breathing between volume-targeted modes of 3 different brands of equipment in a surfactant-deficient, spontaneously breathing animal model with and without an ETT leak. METHODS: Twelve rabbits (mean ؎ SD 1.61 ؎ 0.20 kg) were sedated, anesthetized, intubated, lavaged with 0.9% saline solution, and randomized in a crossover design so that each animal was supported by 3 different volume-targeted modes at identical settings with and without an ETT leak. After 30 min, arterial blood gas, V T , and esophageal and airway pressure were recorded for each condition, and pressure-rate product and percentage of successfully triggered breaths were calculated. RESULTS: Gas exchange and the pressure-rate product were not different between the ventilators in the absence of an ETT leak. When an ETT leak was introduced, volume-guarantee modes allowed a higher percentage of triggered breaths and peak inspiratory pressure, which resulted in higher minute ventilation, pH, and lower P aCO 2 than the pressure-regulated volume control mode (P < .05). CONCLUSIONS: When a moderate ETT leak was present, volume-targeted modes that used proximal V T monitoring and triggering with adaptive leak compensation capabilities appeared more effective in providing ventilation support than did a ventilator that used measurements obtained from the back at the ventilator and does not have leak compensation.

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A pilot study to assess short-term physiologic outcomes of transitioning infants with severe bronchopulmonary dysplasia from ICU to two subacute ventilators

Cited by 8 publications

References 26 publications

Long-term home mechanical ventilation using a noninvasive ventilator via tracheotomy in patients with myasthenia gravis: a case report and literature review

Long-term home mechanical ventilation using a noninvasive ventilator via tracheotomy in patients with myasthenia gravis: a case report and literature review

Transition from intensive care unit to a portable ventilator in children with severe bronchopulmonary dysplasia

Physiologic Effects of 3 Different Neonatal Volume-Targeted Ventilation Modes in Surfactant-Deficient Juvenile Rabbits

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