Efficacy of dead-space washout in mechanically ventilated premature newborns.

Danan, Claude; Dassieu, Gilles; Janaud, Jean-Claude; Brochard, Laurent

doi:10.1164/ajrccm.153.5.8630604

Cited by 45 publications

(37 citation statements)

References 25 publications

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“…9 It has been suggested that acceptable PaCO 2 levels are observed during volume targeted ventilation in spite of the additional flow sensor dead space. 10 However, the findings obtained in this study and those obtained with continuous tracheal gas insufflation suggest that lower levels of support or perhaps smaller targeted volumes could be used by reducing the instrumental dead space in the smaller preterm infants.…”

Section: Discussionmentioning

confidence: 99%

Effects of instrumental dead space reduction during weaning from synchronized ventilation in preterm infants

et al. 2009

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Objective: A majority of the modalities of synchronized ventilation in preterm infants require the use of flow sensors that can increase dead space and may adversely affect ventilator weaning. The objective of this study was to assess the effects of flow sensor dead space during synchronized intermittent mandatory ventilation (SIMV) weaning in preterm infants.Study Design: Twelve preterm infants (gestational age 25±2 weeks, birth weight 705 ± 158 g, age: 31 ± 186 days, SIMV rate: 25 ± 8 breaths min -1 , peak inspiratory pressure 18±2 cm H 2 O, positive end-expiratory pressure: 5 ± 0.5 cm H 2 O, pressure support: 9 ± 3 cm H 2 O, fraction of inspired oxygen: 34 ± 6%) underwent two 2.5-h weaning periods during which SIMV rate was reduced twice by 5 breaths min -1 at 30-min intervals as tolerated, with and without reduction of flow sensor dead space, in random sequence. A 30-min baseline was obtained before each weaning period. Dead space was reduced by flushing the flow sensor with a continuous gas leak flow in the endotracheal tube connector.Result: Transcutaneous CO 2 tension during SIMV weaning periods without and with reduced dead space did not differ from baseline, whereas total minute ventilation and tidal volume were lower during the SIMV weaning period with reduced dead space. Three infants did not tolerate SIMV weaning without while one infant did not tolerate weaning with reduced dead space.Conclusion: SIMV weaning elicited a compensatory rise in spontaneous ventilation. When flow sensor dead space was reduced during SIMV weaning, gas exchange was maintained with lower minute ventilation. Instrumental dead space imposes a ventilatory burden during SIMV weaning in small preterm infants.

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Section: Discussionmentioning

confidence: 99%

Effects of instrumental dead space reduction during weaning from synchronized ventilation in preterm infants

et al. 2009

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“…Subsequently, it is mandatory to develop an automatic system able to stop the CTGI fl ow in the very beginning of a pressure modifi cation in the CTGI circuit. Such a system was described in the fi rst trial in neonates (Danan et al 1996 ), but some technological improvements allow simplifi cation of the whole system. Different solutions will be described later according to different situations.…”

Section: Security Devicesmentioning

confidence: 99%

Clinical Use of Nonconventional Modes of Ventilator Support

Arnold

Courtney

Danan

et al. 2014

Pediatric and Neonatal Mechanical Ventilation

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“…One reason may be a drop in EtCO 2 due to using one's voice, as observed in a study done on healthy subjects [116]. Another potential reason is dead-space washout in the upper airway that has been found to coincide with an increase in tidal volumes in other studies [117,118]. With our current data, we cannot categorically state, however, that tidal volumes increased for patients in this study.…”

Section: Discussionmentioning

confidence: 54%

Towards an improved understanding of the effect of a speaking valve on lung volumes and communication in the critically ill tracheostomised patient

Sutt¹

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Tracheostomised mechanically ventilated patients are often left unable to speak, which is frustrating for patients and the staff caring for them. Having no voice causes major distress and feelings of helplessness for patients. Voicelessness frequently leads to reduced information exchange between the patient and healthcare team, frequently to the detriment of patient care. An in-line speaking valve (SV) is a one-way valve that may be used in the mechanical ventilation circuit to enable verbal communication in tracheostomised patients.Limited data exist regarding the effect of SVs on respiratory mechanics. Deflation of the tracheostomy cuff is required for placement of the SV, effectively causing a "leak" in the As an experienced speech pathologist, I believe concerns over SV use to date have little evidence. The main objective, and first aim of this thesis was to investigate the effect of SV use on respiratory mechanics to determine whether SVs should be used in-line with mechanical ventilation of tracheostomised patients. The second aim was to assess the effect of introducing SVs into a cardio-thoracic ICU on patient tracheostomy specific outcomes. The third aim was to further clarify the effect of SVs on success with healthrelated communication for ICU patients. To achieve these aims, 5 studies were conducted, resulting in 5 manuscripts.For the first aim, 20 tracheostomised ICU patients using a SV that met the inclusion criteria were recruited to the study from November 2013-December 2014. Electrical Impedance iii Tomography (EIT) was used to assess the patients' end-expiratory lung impedance (EELI) and ventilation distribution continuously over 60 minutes (before, during and after SV use). For the third aim, 25 patients and 52 nursing staff were asked to fill out a custom-made questionnaire on success with health communication, firstly when the patients were voiceless, and, secondly, when they were using a SV. Chapter 7 highlights individual differences and some disparity between patient and nursing ratings of communication success. Overall, however, following SV use both the patients and nursing staff reported a significant improvement in success with health communication. Additional variables included oxygenation (SpOIn conclusion, the findings of this thesis addressed the research aims, and provide new knowledge through use of an innovative approach to assessing lung mechanics. Having iv already resulted in real clinical changes in our centre, the results indicate the potential for optimising communication, using SVs in tracheostomised cardiothoracic ICU patients undergoing weaning from mechanical ventilation.v

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Efficacy of dead-space washout in mechanically ventilated premature newborns.

Cited by 45 publications

References 25 publications

Effects of instrumental dead space reduction during weaning from synchronized ventilation in preterm infants

Effects of instrumental dead space reduction during weaning from synchronized ventilation in preterm infants

Clinical Use of Nonconventional Modes of Ventilator Support

Towards an improved understanding of the effect of a speaking valve on lung volumes and communication in the critically ill tracheostomised patient

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