The Experts below are selected from a list of 93 Experts worldwide ranked by ideXlab platform
Louise Rose - One of the best experts on this subject based on the ideXlab platform.
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ventilator settings and monitoring parameter targets for initiation of Continuous Mandatory Ventilation a questionnaire study
Journal of Critical Care, 2014Co-Authors: Louise Rose, Lisa Kenny, Gordon Tait, Sangeeta MehtaAbstract:Abstract Purpose To inform development of educational tools, we sought to identify initial ventilator settings and monitoring targets for 3 scenarios. Method A survey was e-mailed to Canadian Society of Respiratory Therapists members with 2 reminders in March/April 2011. Results Total evaluable surveys were 363. More participants selected pressure as opposed to volume Ventilation for acute respiratory distress syndrome (ARDS; 77%) than for chronic obstructive pulmonary disease (COPD; 50%) and postoperative Ventilation (32%; P P 2 O vs 29 cm H 2 O [COPD] and 27 cm H 2 O [postoperative], P 2 O vs 7 cm H 2 O vs 5 cm H 2 O) and fraction of inspired oxygen (Fio 2 ; 1.0 vs 0.5 vs 0.3) were also higher for ARDS (both P 2 combination as recommended by ARDSnet. Values of oxygen saturation as measured by pulse oximetry of 97% (ARDS) and 94% (COPD and postoperative) were considered appropriate for Fio 2 reduction. The lowest pH was 7.28 vs 7.23 vs 7.26; the highest pH was 7.46 vs 7.44 vs 7.46 ( P Conclusion Lung protective Ventilation was favored, yet distinct differences in ventilator settings were evident. Monitoring targets suggested relatively conservative practices for Fio 2 reduction but an understanding of permissive hypercapnia.
William Marx - One of the best experts on this subject based on the ideXlab platform.
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airway pressure release Ventilation prevents ventilator induced lung injury in normal lungs
JAMA Surgery, 2013Co-Authors: Bryanna Emr, Louis A Gatto, Shreyas Roy, Joshua Satalin, Auyon J Ghosh, Kathy Snyder, Penny Andrews, N M Habashi, William MarxAbstract:Importance Up to 25% of patients with normal lungs develop acute lung injury (ALI) secondary to mechanical Ventilation, with 60% to 80% progressing to acute respiratory distress syndrome (ARDS). Once established, ARDS is treated with mechanical Ventilation that can paradoxically elevate mortality. A Ventilation strategy that reduces the incidence of ARDS could change the clinical paradigm from treatment to prevention. Objectives To demonstrate that (1) mechanical Ventilation with tidal volume (Vt) and positive end-expiratory pressure (PEEP) settings used routinely on surgery patients causes ALI/ARDS in normal rats and (2) preemptive application of airway pressure release Ventilation (APRV) blocks drivers of lung injury (ie, surfactant deactivation and alveolar edema) and prevents ARDS. Design, Setting, and Subjects Rats were anesthetized and tracheostomy was performed at State University of New York Upstate Medical University. Arterial and venous lines, a peritoneal catheter, and a rectal temperature probe were inserted. Animals were randomized into 3 groups and followed up for 6 hours: spontaneous breathing Ventilation (SBV, n = 5), Continuous Mandatory Ventilation (CMV, n = 6), and APRV (n = 5). Rats in the CMV group were ventilated with Vtof 10 cc/kg and PEEP of 0.5 cm H 2 O. Airway pressure release Ventilation was set with a P High of 15 to 20 cm H 2 O; P Low was set at 0 cm H 2 O. Time at P High (T High ) was 1.3 to 1.5 seconds and a T Low was set to terminate at 75% of the peak expiratory flow rate (0.11-0.14 seconds), creating a minimum 90% cycle time spent at P High . Bronchoalveolar lavage fluid and lungs were harvested for histopathologic analysis at necropsy. Results Acute lung injury/ARDS developed in the CMV group (mean [SE] Pao 2 /FiO 2 ratio, 242.96 [24.82]) and was prevented with preemptive APRV (mean [SE] Pao 2 /FIO 2 ratio, 478.00 [41.38]; P Conclusions and Relevance Continuous Mandatory Ventilation in normal rats for 6 hours with Vtand PEEP settings similar to those of surgery patients caused ALI. Preemptive application of APRV blocked early drivers of lung injury, preventing ARDS. Our data suggest that APRV applied early could reduce the incidence of ARDS in patients at risk.
Nuttapol Rittayamai - One of the best experts on this subject based on the ideXlab platform.
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pressure controlled vs volume controlled Ventilation in acute respiratory failure a physiology based narrative and systematic review
Chest, 2015Co-Authors: Nuttapol Rittayamai, Christina M Katsios, Francois Beloncle, Jan O Friedrich, Jordi ManceboAbstract:BACKGROUND Mechanical Ventilation is a cornerstone in the management of acute respiratory failure. Both volume-targeted and pressure-targeted Ventilations are used, the latter modes being increasingly used. We provide a narrative review of the physiologic principles of these two types of breath delivery, performed a literature search, and analyzed published comparisons between modes. METHODS We performed a systematic review and meta-analysis to determine whether pressure control-Continuous Mandatory Ventilation (PC-CMV) or pressure control-inverse ratio Ventilation (PC-IRV) has demonstrated advantages over volume control-Continuous Mandatory Ventilation (VC-CMV). The Cochrane tool for risk of bias was used for methodologic quality. We also introduced physiologic criteria as quality indicators for selecting the studies. Outcomes included compliance, gas exchange, hemodynamics, work of breathing, and clinical outcomes. Analyses were completed with RevMan5 using random effects models. RESULTS Thirty-four studies met inclusion criteria, many being at high risk of bias. Comparisons of PC-CMV/PC-IRV and VC-CMV did not show any difference for compliance or gas exchange, even when looking at PC-IRV. Calculating the oxygenation index suggested a poorer effect for PC-IRV. There was no difference between modes in terms of hemodynamics, work of breathing, or clinical outcomes. CONCLUSIONS The two modes have different working principles but clinical available data do not suggest any difference in the outcomes. We included all identified trials, enhancing generalizability, and attempted to include only sufficient quality physiologic studies. However, included trials were small and varied considerably in quality. These data should help to open the choice of Ventilation of patients with acute respiratory failure.
Sangeeta Mehta - One of the best experts on this subject based on the ideXlab platform.
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ventilator settings and monitoring parameter targets for initiation of Continuous Mandatory Ventilation a questionnaire study
Journal of Critical Care, 2014Co-Authors: Louise Rose, Lisa Kenny, Gordon Tait, Sangeeta MehtaAbstract:Abstract Purpose To inform development of educational tools, we sought to identify initial ventilator settings and monitoring targets for 3 scenarios. Method A survey was e-mailed to Canadian Society of Respiratory Therapists members with 2 reminders in March/April 2011. Results Total evaluable surveys were 363. More participants selected pressure as opposed to volume Ventilation for acute respiratory distress syndrome (ARDS; 77%) than for chronic obstructive pulmonary disease (COPD; 50%) and postoperative Ventilation (32%; P P 2 O vs 29 cm H 2 O [COPD] and 27 cm H 2 O [postoperative], P 2 O vs 7 cm H 2 O vs 5 cm H 2 O) and fraction of inspired oxygen (Fio 2 ; 1.0 vs 0.5 vs 0.3) were also higher for ARDS (both P 2 combination as recommended by ARDSnet. Values of oxygen saturation as measured by pulse oximetry of 97% (ARDS) and 94% (COPD and postoperative) were considered appropriate for Fio 2 reduction. The lowest pH was 7.28 vs 7.23 vs 7.26; the highest pH was 7.46 vs 7.44 vs 7.46 ( P Conclusion Lung protective Ventilation was favored, yet distinct differences in ventilator settings were evident. Monitoring targets suggested relatively conservative practices for Fio 2 reduction but an understanding of permissive hypercapnia.
Francois Beloncle - One of the best experts on this subject based on the ideXlab platform.
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pressure controlled vs volume controlled Ventilation in acute respiratory failure a physiology based narrative and systematic review
Chest, 2015Co-Authors: Nuttapol Rittayamai, Christina M Katsios, Francois Beloncle, Jan O Friedrich, Jordi ManceboAbstract:BACKGROUND Mechanical Ventilation is a cornerstone in the management of acute respiratory failure. Both volume-targeted and pressure-targeted Ventilations are used, the latter modes being increasingly used. We provide a narrative review of the physiologic principles of these two types of breath delivery, performed a literature search, and analyzed published comparisons between modes. METHODS We performed a systematic review and meta-analysis to determine whether pressure control-Continuous Mandatory Ventilation (PC-CMV) or pressure control-inverse ratio Ventilation (PC-IRV) has demonstrated advantages over volume control-Continuous Mandatory Ventilation (VC-CMV). The Cochrane tool for risk of bias was used for methodologic quality. We also introduced physiologic criteria as quality indicators for selecting the studies. Outcomes included compliance, gas exchange, hemodynamics, work of breathing, and clinical outcomes. Analyses were completed with RevMan5 using random effects models. RESULTS Thirty-four studies met inclusion criteria, many being at high risk of bias. Comparisons of PC-CMV/PC-IRV and VC-CMV did not show any difference for compliance or gas exchange, even when looking at PC-IRV. Calculating the oxygenation index suggested a poorer effect for PC-IRV. There was no difference between modes in terms of hemodynamics, work of breathing, or clinical outcomes. CONCLUSIONS The two modes have different working principles but clinical available data do not suggest any difference in the outcomes. We included all identified trials, enhancing generalizability, and attempted to include only sufficient quality physiologic studies. However, included trials were small and varied considerably in quality. These data should help to open the choice of Ventilation of patients with acute respiratory failure.