Prone Ventilation—It's Time

Tobin, Antony; Kelly, William

doi:10.1177/0310057x9902700213

Cited by 33 publications

(36 citation statements)

References 55 publications

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“…The potential of prone ventilation in limiting or preventing ventilator-induced lung injury includes reduction of oxygen toxicity and inspiratory pressures due to decreased right-to-left shunt and increased blood flow to lung areas with a normal ventilation-perfusion relationship [1]. Although prone position is generally considered a safe intervention and improved gas exchange and lung function are primary goals, its use might theoretically be associated with relevant extrapulmonary side effects.…”

Section: Introductionmentioning

confidence: 99%

Effect of prone position on hepato-splanchnic hemodynamics in acute lung injury

Matějovič

Rokyta

Radermacher³

et al. 2002

Intensive Care Med

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P2Model-based neuro-fuzzy control of FiO 2 for intensive care mechanical ventilation HF Kwok, GH Mills, M Mahfouf, DA Linkens Introduction: In our experience, very often, even with a nonrebreathing mask (NRM), high oxygen delivery to patient with the existent materials is insufficient. However, many of these patients need high oxygen therapy for a limited period of time. In this study we report our experience with a new device that serves to increase the concentration of oxygen delivered by a classical nasal cannula or catheter. It is not an oxygen mask. Aim:To demonstrate how a simple adjunctive system to classical nasal cannula or catheter improves considerably the oxygenation of patients at constant O 2 flow rate.Design: Prospective, observational study. Method:The double trunk mask (DTM) is a modified tusk mask described by Hnatiuk. It is composed by a normal aerosol mask with 22 mm of diameter lateral holes, 38 cm of long flexible tubing are inserted to each side of the mask. The DTM is just applied to the face of the patients who already receive O 2 through a nasal cannula or catheter. Forty-five consecutive patients, admitted in the ER or ICU, and needing oxygen delivery, are included in our study. The data collected are: PaO 2 , PaCO 2 , breathing rate with a mean flow rate of 3.58 l/min, at t0, t30 min prior to DTM and then 30 min after DTM application. Results:Nasal The knowledge-based approach to fuzzy logic control of mechanical ventilation on the ICU can be prone to bias in the experts' knowledge and errors resulting from poor communication during rule-base derivation. Therefore, a different approach was explored in the development of a fuzzy controller to control the inspired oxygen fraction (FiO 2 ). The performance of such a controller was compared with the performance of the clinicians.Method: (1) The development of a neuro-fuzzy controller. This was developed by training a neural network to generate an optimal change in the FiO 2 in order to achieve a target arterial oxygen tension (PaO 2 ) on a mathematical model of the gas exchange system (SOPAVent). The neural network learnt the relationship between the blood gases, FiO 2 and PEEP and other ventilator settings. This was done by exposing the neural network to the blood gas results produced by applying a range of FiO 2 and PEEP values to the SOPAVent model. This first neural network was then combined with another neural network which represented a fuzzy logic rule-base. The fuzzy rule-base consists of a set of 'If …, Then …' statements based around combinations of FiO 2 , PEEP and PaO 2 . The fuzzy rule-base was then adjusted by changing the weights of the neuro-controller (which correspond to the 'Then …' part of the fuzzy rules) during neural network training. The neuro-controller output is equivalent to the output from a fuzzy inference system of three inputs (the difference between the actual PaO 2 and the target, the PEEP level and the FiO 2 ).(2) Comparing neuro-fuzzy and clinicians' control. The scenarios were based on the data from th...

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Section: Introductionmentioning

confidence: 99%

Effect of prone position on hepato-splanchnic hemodynamics in acute lung injury

Matějovič

Rokyta

Radermacher³

et al. 2002

Intensive Care Med

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“…This, in addition to a more uniform lung perfusion [16], results in better ventilation/perfusion matching, and improved oxygenation [17,18]. In animal models of lung injury prone positioning also results in less histological damage [19].…”

Section: Discussionmentioning

confidence: 99%

“…While in some of the ICUs this may be due to inappropriate patient populations, the reasons expressed suggest some degree of reluctance by the staff. Even in clude corneal ulceration [8] or blindness due to orbital pressure, peripheral nerve injury associated with turning or poor positioning, cervical cord injury from hyperextension, and hypotension due to inferior vena cava compression [17].…”

Section: Discussionmentioning

confidence: 99%

“…There are few absolute contraindications to prone positioning, but clearly patients with unstable spinal injuries should not be turned, and those with unstable cardiac rhythm who may require cardiac compression of defibrillation should also be nursed supine [17]. Open chest or abdominal wounds, uncontrolled intracranial hypertension, advanced pregnancy, and severe facial trauma have also been listed as contraindications [17,23], and one group reports breast necrosis in a patient with silicone breast implants and suggests that particular care be taken if placing such patients prone [26].…”

Section: Discussionmentioning

confidence: 99%

“…Open chest or abdominal wounds, uncontrolled intracranial hypertension, advanced pregnancy, and severe facial trauma have also been listed as contraindications [17,23], and one group reports breast necrosis in a patient with silicone breast implants and suggests that particular care be taken if placing such patients prone [26].…”

Section: Discussionmentioning

confidence: 99%

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Prone positioning in acute respiratory failure: survey of Belgian ICU nurses

et al. 2002

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Gas Exchange Under Altered Gravitational Stress

Prisk¹

2011

Comprehensive Physiology

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Efficient gas exchange in the lung depends on the matching of ventilation and perfusion. However, the human lung is a readily deformable structure and as a result gravitational stresses generate gradients in both ventilation and perfusion. Nevertheless, the lung is capable of withstanding considerable change in the applied gravitational load before pulmonary gas exchange becomes impaired. The postural changes that are part of the everyday existence for most bipedal species are well tolerated, as is the removal of gravity (weightlessness). Increases in the applied gravitational load result only in a large impairment in pulmonary gas exchange above approximately three times that on the ground, at which point the matching of ventilation to perfusion is so impaired that efficient gas exchange is no longer possible. Much of the tolerance of the lung to alterations in gravitation stress comes from the fact that ventilation and perfusion are inextricably coupled. Deformations in the lung that alter ventilation necessarily alter perfusion, thus maintaining a degree of matching and minimizing the disruption in ventilation to perfusion ratio and thus gas exchange.

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Prone Ventilation—It's Time

Cited by 33 publications

References 55 publications

Effect of prone position on hepato-splanchnic hemodynamics in acute lung injury

Effect of prone position on hepato-splanchnic hemodynamics in acute lung injury

Prone positioning in acute respiratory failure: survey of Belgian ICU nurses

Gas Exchange Under Altered Gravitational Stress

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