Personalizing mechanical ventilation for acute respiratory distress syndrome

Berngard, Samuel Clark; Beitler, Jeremy R.; Malhotra, Atul

doi:10.21037/jtd.2016.02.57

Cited by 11 publications

(8 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Such a personalized approach has also been proposed by others. 22,28,29 Authors' note One of the cases in this series was presented as a poster in American Thoracic Society Conference 2014, Colorado, USA. 10…”

Section: Discussionmentioning

confidence: 99%

Ultra-protective mechanical ventilation without extra-corporeal carbon dioxide removal for acute respiratory distress syndrome

Regunath

Moulton

Woolery

et al. 2018

Journal of the Intensive Care Society

View full text Add to dashboard Cite

Background: Tidal hyperinflation can still occur with mechanical ventilation using low tidal volume (LVT) (6 mL/kg predicted body weight (PBW)) in acute respiratory distress syndrome (ARDS), despite a well-demonstrated reduction in mortality. Methods: Retrospective chart review from August 2012 to October 2014. Inclusion: Age >18years, PaO 2 /FiO 2 <200 with bilateral pulmonary infiltrates, absent heart failure, and ultra-protective mechanical ventilation (UPMV) defined as tidal volume (VT) <6 mL/kg PBW. Exclusion: UPMV use for <24 h. Demographics, admission Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, arterial blood gas, serum bicarbonate, ventilator parameters for pre-, during, and post-UPMV periods including modes, VT, peak inspiratory pressure (PIP), plateau pressure (Pplat), driving pressure, etc. were gathered. We compared lab and ventilator data for pre-, during, and post-UPMV periods. Results: Fifteen patients (male:female ¼ 7:8, age 42.13 AE 11.29 years) satisfied criteria, APACHEII 20.6 AE 7.1, mean days in intensive care unit and hospitalization were 18.5 AE 8.85 and 20.81 AE 9.78 days, 9 (60%) received paralysis and 7 (46.67%) required inotropes. Eleven patients had echocardiogram, 7 (63.64%) demonstrated right ventricular volume or pressure overload. Eleven patients (73.33%) survived. During-UPMV, VT ranged 2-5 mL/kg PBW(3.99 AE 0.73), the arterial partial pressure of carbon dioxide (PaCO 2 ) was higher than pre-UPMV values (84.81 AE 18.95 cmH 2 O vs. 69.16 AE 33.09 cmH 2 O), but pH was comparable and none received extracorporeal carbon dioxide removal (ECCO 2 -R). The positive end-expiratory pressure (14.18 AE 7.56 vs. 12.31 AE 6.84 cmH2O), PIP (38.21 AE 12.89 vs. 32.59 AE 9.88), and mean airway pressures (19.98 AE 7.61 vs. 17.48 AE 6.7 cm H 2 O) were higher during UPMV, but Pplat and PaO 2 /FiO 2 were comparable during-and pre-UPMV. Driving pressure was observed to be higher in those who died than who survived (24.18 AE 12.36 vs. 13.42 AE 3.25). Conclusion: UPMV alone may be a safe alternative option for ARDS patients in centers without ECCO 2 -R.

show abstract

Section: Discussionmentioning

confidence: 99%

Ultra-protective mechanical ventilation without extra-corporeal carbon dioxide removal for acute respiratory distress syndrome

Regunath

Moulton

Woolery

et al. 2018

Journal of the Intensive Care Society

View full text Add to dashboard Cite

show abstract

“…Their over-expression can cause local or systemic pathological damage and can be triggered by surgical procedures that damage tissues, such as lung cancer resection surgery and mechanical ventilation. Tissue damage from mechanical ventilation during lung cancer resection, especially from the use of large Vt OLV, can cause cytokine-mediated lung inflammation, known as VILI (1,2,3,19,20). Meanwhile, inflammation has been demonstrated to be associated with occurrence and progression of CHD (21).…”

Section: Discussionmentioning

confidence: 99%

Effect of lung protective ventilation on coronary heart disease patients undergoing lung cancer resection

et al. 2018

View full text Add to dashboard Cite

show abstract

“…In addition, it overcame the softening and floating chest walls, favorable for the healing of rib fractures and the stability of the chest wall, reduced the intrapulmonary shunt while decreasing the osmosis of liquid inside blood capillaries to pulmonary alveoli under pneumonedema, improved the ventilation/blood flow ratio, and significantly ameliorated the pO 2 . However, when the PEEP was extremely high, it affected the hemodynamics ( 13 ). Excessive expansion resulted in alveolar rupture and pressure trauma, including pneumothorax, and subcutaneous emphysemam.…”

Section: Discussionmentioning

confidence: 99%

Clinical study on VATS combined mechanical ventilation treatment of ARDS secondary to severe chest trauma

2016

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

The aim of the study was to investigate the clinical effects of microinvasive video-assisted thoracoscopic surgery (VATS) combined with mechanical ventilation in the treatment of acute respiratory distress syndrome (ARDS) secondary to severe chest trauma. A total of 62 patients with ARDS secondary to severe chest trauma were divided into the observation and control groups. The patients in the observation groups were treated with VATS combined with early mechanical ventilation while patients in the control group were treated using routine open thoracotomy combined with early mechanical ventilation. Compared to the controls, the survival rate of the observation group was significantly higher. The average operation time of the observation group was significantly shorter than that of the control group, and the incidence of complications in the perioperative period of the observation group was significantly lower than that of the control group (p<0.05). The average application time of the observation group was significantly shorter than that of the control group, and the incidence of ventilator-associated complications was significantly lower than that of the control group (p<0.05). In conclusion, a reasonable understanding of the indications and contraindications of VATS, combined with early mechanical treatment significantly improved the success rate of the treatment of ARDS patients secondary to severe chest trauma and reduced the complications.

show abstract

Personalizing mechanical ventilation for acute respiratory distress syndrome

Cited by 11 publications

References 15 publications

Ultra-protective mechanical ventilation without extra-corporeal carbon dioxide removal for acute respiratory distress syndrome

Ultra-protective mechanical ventilation without extra-corporeal carbon dioxide removal for acute respiratory distress syndrome

Effect of lung protective ventilation on coronary heart disease patients undergoing lung cancer resection

Clinical study on VATS combined mechanical ventilation treatment of ARDS secondary to severe chest trauma

Contact Info

Product

Resources

About