Intrinsic PEEP and the Airbag Effect

Rossi, Andrea; Khirani, Sonia

doi:10.1159/000203732

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…To deliver sufficient tidal volume (Vt) in this high-resistance system, the physician had to close the pressure relief valve of the bag. Thus, to avoid potential barotrauma from increasing intrinsic positive end expiratory pressure (iPEEP) after several cycles, as feared in any obstructive condition, the physician tried to give as much time as possible for each expiration cycle until the bag was fully re-expanded [ 5 – 7 ]. These passive expiration cycles were actively assisted by gentle manual compression on both sides of the chest.…”

Section: Case Presentationmentioning

confidence: 99%

Anterograde catheterization of severe tracheal stenosis as a difficult airway management option, followed by emergent tracheostomy (a case report)

Ziapour

2016

J Cardiothorac Surg

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BackgroundTo describe the successful management of a patient with severe dyspnea and hypoxia due to tracheal stenosis by the application of a novel bridging technique—anterograde tracheal catheterization—prior to tracheostomy.Case presentationA 55-year-old woman entered the Emergency Department with severe dyspnea, tachypnea, and stridor and a pulse oximetry reading of 60 %. An attempt at intubation failed because of tracheal stenosis discovered 3–4 cm distal to the vocal cords, which had been formed as a complication of intubation the previous month. Cricothyrotomy could not be applied for failed airway management because the stenosis had formed distal to the cricothyroid membrane. Laryngeal mask airway ventilation did not improve the oxygenation to more than an arterial oxygen saturation (SpO2) of 70 %. Thus, anterograde insertion of a 12-F double-lumen central venous catheter was attempted, which sealed the 2-mm orifice of the stricture. Bag–valve–mask ventilation with this latter mode provided 80 % saturation as a bridge to an emergent bed-side tracheostomy.Conclusions“Anterograde tracheal catheterization” appears to be a relatively effective and easy-to-perform option for oxygenation in such tracheal stenosis cases before a definite but time-consuming tracheostomy can secure the airway.

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Section: Case Presentationmentioning

confidence: 99%

Anterograde catheterization of severe tracheal stenosis as a difficult airway management option, followed by emergent tracheostomy (a case report)

Ziapour

2016

J Cardiothorac Surg

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“…A slight degree of dynamic pulmonary hyperinflation is present even at rest in patients with severe COPD 38,39. Dynamic pulmonary hyperinflation magnifies during acute exacerbation40,41 and exercise42 even in mild COPD 43. Dynamic pulmonary hyperinflation increases the elastic work of breathing while decreasing the pressure-generating capacity of the respiratory muscles due to its unfavorable geometric arrangement.…”

Section: Pathophysiologic Backgroundmentioning

confidence: 99%

Indacaterol: a comprehensive review

Rossi¹,

Polese²

2013

COPD

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At present there is no cure for chronic obstructive pulmonary disease (COPD). However, some nonpharmacologic treatments, such as rehabilitation and lung volume reduction surgery, as well as pharmacologic intervention, can relieve some of the patient’s symptoms and improve quality of life, while also reducing the rate of exacerbations and hospitalizations. There needs to be a paradigm shift away from the unjustified nihilistic approach to COPD towards considering it a preventable and treatable disease. After patients quit smoking and start to lead healthier lifestyles, long-acting bronchodilators, such as long-acting beta-adrenergic agents (LABA) and long-acting antimuscarinic agents (LAMA), are recommended as the cornerstone of treatment for COPD, either as monotherapy or in combination. COPD is characterized by a reduced maximum expiratory flow and slow forced emptying of the lungs, which progress over time and are not completely reversible. In this condition, gas gets trapped in the lungs and pulmonary hyperinflation occurs. LABA and LAMA improve airway patency and deflate the lungs. Indacaterol is the first once-daily LABA approved for treatment of COPD, and is administered by inhalation through the Breezhaler® device. The speed of bronchodilation is similar to that with salbutamol (ie, about five minutes) and longer (ie, 24 hours) than that with traditional LABA, with the same 12-hour effect as salmeterol and formoterol, both of which require twice-daily administration. This is why indacaterol has been called the “ultra-LABA”. On the one hand, the fast onset of action provides immediate relief of symptoms, and on the other, its constant 24-hour bronchodilation provides “pharmacologic stenting” which facilitates lung emptying, thereby decreasing trapped gas and pulmonary hyperinflation. Once-daily administration of a fast and long-acting bronchodilator can improve patient adherence with therapy, which is known to be a major problem for many medical treatments. Dose-finding trials have shown that 75 μg is the minimum dose needed to achieve clinically important improvement. However, indacaterol 150 μg and 300 μg achieve an even greater improvement in lung function and patient-oriented outcomes. Further, these two doses of indacaterol significantly reduce pulmonary hyperinflation, thereby improving exercise tolerance and ability to perform day-to-day activities. It is more effective on lung volumes at the 300 μg dose than formoterol, and better than salmeterol and tiotropium at the 150 μg dose, at least in the acute setting. It is noteworthy that few studies document these results in patients with COPD and moderate airflow obstruction. These are exactly the kind of patients our research should be concentrating on, in view of the accelerated decay in forced expiratory volume in one second at this stage of the disease. Finally, all the relevant studies show that indacaterol is consistently well tolerated by patients with COPD at every stage, and that it has a high safety profile.

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Intrinsic PEEP and the Airbag Effect

Cited by 2 publications

References 9 publications

Anterograde catheterization of severe tracheal stenosis as a difficult airway management option, followed by emergent tracheostomy (a case report)

Anterograde catheterization of severe tracheal stenosis as a difficult airway management option, followed by emergent tracheostomy (a case report)

Indacaterol: a comprehensive review

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