Mechanical ventilation of the patient with severe chronic obstructive pulmonary disease

Gladwin, Mark T.; Pierson, David J.

doi:10.1007/s001340050688

Cited by 33 publications

(13 citation statements)

References 93 publications

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“…The general approach (signs of potential patient-ventilator mismatch and action) for the screen analysis driven ventilation (Optimized ventilation) was as follows [8,11,14-18]: 1. Sign: individuation of autotriggering.…”

Section: Methodsmentioning

confidence: 99%

Optimization of ventilator setting by flow and pressure waveforms analysis during noninvasive ventilation for acute exacerbations of COPD: a multicentric randomized controlled trial

et al. 2011

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IntroductionThe analysis of flow and pressure waveforms generated by ventilators can be useful in the optimization of patient-ventilator interactions, notably in chronic obstructive pulmonary disease (COPD) patients. To date, however, a real clinical benefit of this approach has not been proven.MethodsThe aim of the present randomized, multi-centric, controlled study was to compare optimized ventilation, driven by the analysis of flow and pressure waveforms, to standard ventilation (same physician, same initial ventilator setting, same time spent at the bedside while the ventilator screen was obscured with numerical data always available). The primary aim was the rate of pH normalization at two hours, while secondary aims were changes in PaCO2, respiratory rate and the patient's tolerance to ventilation (all parameters evaluated at baseline, 30, 120, 360 minutes and 24 hours after the beginning of ventilation). Seventy patients (35 for each group) with acute exacerbation of COPD were enrolled.ResultsOptimized ventilation led to a more rapid normalization of pH at two hours (51 vs. 26% of patients), to a significant improvement of the patient's tolerance to ventilation at two hours, and to a higher decrease of PaCO2 at two and six hours. Optimized ventilation induced physicians to use higher levels of external positive end-expiratory pressure, more sensitive inspiratory triggers and a faster speed of pressurization.ConclusionsThe analysis of the waveforms generated by ventilators has a significant positive effect on physiological and patient-centered outcomes during acute exacerbation of COPD. The acquisition of specific skills in this field should be encouraged.Trial registrationClinicalTrials.gov NCT01291303.

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Section: Methodsmentioning

confidence: 99%

Optimization of ventilator setting by flow and pressure waveforms analysis during noninvasive ventilation for acute exacerbations of COPD: a multicentric randomized controlled trial

et al. 2011

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“…2). 27 It can also be detected by applying successive increments of 3 cmH 2 O of extrinsic PEEP, since at the point when the plateau and peak pressures increase, extrinsic PEEP will have exceeded auto-PEEP. 7 The calculation of iPEEP in a spontaneously breathing patient is much more complex and difficult to extend to clinical practice, due to the frequent contribution of the respiratory muscles during active expiration.…”

Section: Dynamic Hyperinsufflation and Auto-peepmentioning

confidence: 99%

Invasive Mechanical Ventilation in COPD and Asthma

Vicente¹,

Almengor²,

Caballero³

et al. 2011

Medicina Intensiva (English Edition)

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“…Because of slowing of the respiratory rate and inability to maintain respiratory effort, intubation was necessary (8.0 mm endotracheal tube). Initially, a high inspiratory flow rate from 80 to 100 L/min, a minute ventilation less than 115 mL/kg, a tidal volume less than 8 mL/kg, an extrinsic positive end-expiratory pressure (extrinsic PEEP) less than 80% of the intrinsic PEEP, and a low respiratory rate from 10 to 14 breaths/min was used, allowing a inspiration/expiration ratio of 1:2 to 1:3 (6). To reduce bronchospasm, general anesthesia was induced (ketamine and sevoflurane).…”

Section: Case Reportmentioning

confidence: 99%

Pumpless Extracorporeal Lung Assist for the Treatment of Severe, Refractory Status Asthmaticus

et al. 2010

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Mechanical ventilation of the patient with severe chronic obstructive pulmonary disease

Cited by 33 publications

References 93 publications

Optimization of ventilator setting by flow and pressure waveforms analysis during noninvasive ventilation for acute exacerbations of COPD: a multicentric randomized controlled trial

Optimization of ventilator setting by flow and pressure waveforms analysis during noninvasive ventilation for acute exacerbations of COPD: a multicentric randomized controlled trial

Invasive Mechanical Ventilation in COPD and Asthma

Pumpless Extracorporeal Lung Assist for the Treatment of Severe, Refractory Status Asthmaticus

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