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A. Corrado - One of the best experts on this subject based on the ideXlab platform.
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Negative-Pressure Ventilation: is there still a role?
The European respiratory journal, 2002Co-Authors: A. Corrado, M. GoriniAbstract:Negative-Pressure Ventilation (NPV) was the primary mode of assisted Ventilation for patients with acute respiratory failure until the Copenhagen polio epidemic in the 1950s, when, because there was insufficient equipment, it was necessary to ventilate patients continually by hand via an endotracheal tube. Thereafter, positive-Pressure Ventilation was used routinely. Since it was also observed that patients with obstructive sleep apnoea could be treated noninvasively with positive Pressure via a nasal mask, noninvasive positive-Pressure Ventilation (NPPV) has become the most widely used noninvasive mode of Ventilation. However, NPV still has a role in the treatment of certain patients. In particular, it has been used to good effect in patients with severe respiratory acidosis or an impaired level of consciousness, patients that to date have been excluded from all prospective controlled trials of NPPV. NPV may be used in those who cannot tolerate a facial mask because of facial deformity, claustrophobia or excessive airway secretion. NPV has also been used successfully in small children, and beneficial effects on the cardiopulmonary circulation maybe a particular advantage in children undergoing complex cardiac reconstructive surgery. This review is divided into two parts: the first is concerned with the use of Negative-Pressure Ventilation in the short term, and the second with its use in the long term.
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Effect of assist Negative Pressure Ventilation by microprocessor based iron lung on breathing effort
Thorax, 2002Co-Authors: Massimo Gorini, G Villella, A. Augustynen, D. Tozzi, Roberta Ginanni, A. CorradoAbstract:Background: The lack of patient triggering capability during Negative Pressure Ventilation (NPV) may contribute to poor patient synchrony and induction of upper airway collapse. This study was undertaken to evaluate the performance of a microprocessor based iron lung capable of thermistor triggering. Methods: The effects of NPV with thermistor triggering were studied in four normal subjects and six patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) by measuring: (1) the time delay (TDtr) between the onset of inspiratory airflow and the start of assisted breathing; (2) the Pressure-time product of the diaphragm (PTPdi); and (3) non-triggering inspiratory efforts (NonTrEf). In patients the effects of Negative extrathoracic end expiratory Pressure (NEEP) added to NPV were also evaluated. Results: With increasing trigger sensitivity the mean (SE) TDtr ranged from 0.29 (0.02) s to 0.21 (0.01) s (mean difference 0.08 s, 95% CI 0.05 to 0.12) in normal subjects and from 0.30 (0.02) s to 0.21 (0.01) s (mean difference 0.09 s, 95% CI 0.06 to 0.12) in patients with COPD; NonTrEf ranged from 8.2 (1.8)% to 1.2 (0.1)% of the total breaths in normal subjects and from 11.8 (2.2)% to 2.5 (0.4)% in patients with COPD. Compared with spontaneous breathing, PTPdi decreased significantly with NPV both in normal subjects and in patients with COPD. NEEP added to NPV resulted in a significant decrease in dynamic intrinsic PEEP, diaphragm effort exerted in the pre-trigger phase, and NonTrEf. Conclusions: Microprocessor based iron lung capable of thermistor triggering was able to perform assist NPV with acceptable TDtr, significant unloading of the diaphragm, and a low rate of NonTrEf. NEEP added to NPV improved the synchrony between the patient and the ventilator.
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Negative Pressure Ventilation versus conventional mechanical Ventilation in the treatment of acute respiratory failure in copd patients
European Respiratory Journal, 1998Co-Authors: A. Corrado, M. Gorini, G Villella, Roberta Ginanni, C Pelagatti, U Buoncristiano, F Guidi, E Pagni, A Peris, E De PaolaAbstract:This case-control study was aimed to evaluate the effectiveness of Negative Pressure Ventilation (NPV) versus conventional mechanical Ventilation (CMV) for the treatment of acute respiratory failure (ARF) in patients with chronic obstructive pulmonary disease (COPD) admitted to a respiratory intermediate intensive care unit (RIICU) and four general intensive care units (ICU). Twenty-six COPD patients in ARF admitted in 1994-95 to RIICU and treated with NPV (cases) were matched according to age (+/-5 yrs), sex, causes triggering ARF, Acute Physiology and Chronic Health Evaluation (APACHE) II score (+/- 5 points), pH (+/-0.05) and arterial carbon dioxide tension (Pa,CO2) on admission with 26 patients admitted to ICU and treated with CMV (controls). The primary end points of the study were inhospital death for both groups and the need for endotracheal intubation for cases. The secondary endpoints were length and complications of mechanical Ventilation and length of hospital stay. The effectiveness of matching was 91%. Mortality rate was 23% for cases and 27% for controls (NS), five cases needed endotracheal intubation, four of whom subsequently died. The duration of Ventilation in survivors was significantly lower in cases than in controls, with a median of 16 h (range 2-111) versus 96 h (range 12-336) (P<0.02), whereas the length of hospital stay was similar in the two groups, with a median of 12 days (range 2-47) for cases vs 12 days (range 3-43) (NS) for controls. No complications were observed in cases, whereas three controls developed infective complications. These results suggest that Negative Pressure Ventilation is as efficacious as conventional mechanical Ventilation for the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease and that it is associated with a shorter duration of Ventilation and a similar length of hospital stay compared with conventional mechanical Ventilation.
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Negative Pressure Ventilation versus conventional mechanical Ventilation in the treatment of acute respiratory failure in COPD patients.
The European respiratory journal, 1998Co-Authors: A. Corrado, Massimo Gorini, G Villella, Roberta Ginanni, U Buoncristiano, F Guidi, E Pagni, A Peris, Pelagatti C, E De PaolaAbstract:This case-control study was aimed to evaluate the effectiveness of Negative Pressure Ventilation (NPV) versus conventional mechanical Ventilation (CMV) for the treatment of acute respiratory failure (ARF) in patients with chronic obstructive pulmonary disease (COPD) admitted to a respiratory intermediate intensive care unit (RIICU) and four general intensive care units (ICU). Twenty-six COPD patients in ARF admitted in 1994-95 to RIICU and treated with NPV (cases) were matched according to age (+/-5 yrs), sex, causes triggering ARF, Acute Physiology and Chronic Health Evaluation (APACHE) II score (+/- 5 points), pH (+/-0.05) and arterial carbon dioxide tension (Pa,CO2) on admission with 26 patients admitted to ICU and treated with CMV (controls). The primary end points of the study were inhospital death for both groups and the need for endotracheal intubation for cases. The secondary endpoints were length and complications of mechanical Ventilation and length of hospital stay. The effectiveness of matching was 91%. Mortality rate was 23% for cases and 27% for controls (NS), five cases needed endotracheal intubation, four of whom subsequently died. The duration of Ventilation in survivors was significantly lower in cases than in controls, with a median of 16 h (range 2-111) versus 96 h (range 12-336) (P
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Intermittent Negative Pressure Ventilation in the treatment of hypoxic hypercapnic coma in chronic respiratory insufficiency.
Thorax, 1996Co-Authors: A. Corrado, Massimo Gorini, E De Paola, D. Tozzi, Giovanni Bruscoli, Andrea Messori, Sandra Nutini, Roberta GinanniAbstract:BACKGROUND: In recent years non-invasive ventilatory techniques have been used successfully in the treatment of acute on chronic respiratory failure (ACRF), but careful selection of patients is essential and a comatose state may represent an exclusion criterion. The aim of this retrospective and uncontrolled study was to evaluate whether a non-invasive ventilatory technique such as the iron lung could also be used successfully in patients with hypoxic hypercapnic coma, thus widening the range for application of non-invasive ventilatory techniques. METHODS: A series of 150 consecutive patients with ACRF and hypoxic hypercapnic coma admitted to our respiratory intensive care unit were evaluated retrospectively. The most common underlying condition was chronic obstructive pulmonary disease (79%). On admission a severe hypoxaemia (Pao2 5.81 (3.01) kPa) and hypercapnia (Paco2 14.88 (2.78) kPa) associated with a decompensated acidosis (pH 7.13 (0.13)) were present, the Glasgow coma score ranged from 3 to 8, and the mean APACHE II score was 31.6 (5.3). All patients underwent intermittent Negative Pressure Ventilation with the iron lung. The study end point was based on a dichotomous classification of treatment failure (defined as death or need for endotracheal intubation) versus therapeutic success. RESULTS: There were 45 treatment failures (30%) and 36 deaths (24%). Nine patients (6%) required intubation because of lack of airway control. The median total duration of Ventilation was 27 hours per patient (range 2-274). The 105 successfully treated cases recovered consciousness after a median of four hours (range 1-90) of continuous ventilatory treatment and were discharged after 12.1 (9.0) days. CONCLUSIONS: These results show that, in patients with acute on chronic respiratory failure and hypoxic hypercapnic coma, the iron lung resulted in a high rate of success. As this study has the typical limitations of all retrospective and uncontrolled studies, the results need to be formally confirmed by controlled prospective studies. Confirmation of these results could widen the range of application of non-invasive ventilatory techniques.
A N Redington - One of the best experts on this subject based on the ideXlab platform.
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Negative Pressure Ventilation as haemodynamic rescue following surgery for congenital heart disease.
Intensive care medicine, 2000Co-Authors: Lara S Shekerdemian, Andrew Bush, A N Redington, Ingram Schulze-neick, Daniel J. PennyAbstract:A low cardiac output state is an important cause of morbidity and mortality following repair of tetralogy of Fallot (ToF). This is often refractory to conventional measures. The cardiac output of these patients is highly dependent on diastolic pulmonary arterial flow which is enhanced during spontaneous respiration, but much reduced by intermittent positive Pressure Ventilation (IPPV).¶We report the successful use of Negative Pressure Ventilation (NPV) as haemodynamic therapy in three children with a low output secondary to restrictive right ventricular (RV) physiology following ToF repair. NPV produced a significant haemodynamic improvement, with increases in cardiac output of greater than 100 % in two of the children. By augmenting pulmonary blood flow, and hence cardiac output, NPV has a role as adjunctive haemodynamic therapy in patients with a low output secondary to diastolic RV dysfunction, in whom early extubation is not possible.
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Cardiorespiratory responses to Negative Pressure Ventilation after tetralogy of Fallot repair: a hemodynamic tool for patients with a low-output state☆
Journal of the American College of Cardiology, 1999Co-Authors: Lara S Shekerdemian, Darryl F Shore, Andrew Bush, Christopher Lincoln, A N RedingtonAbstract:OBJECTIVES We hypothesized that a period of cuirass Negative Pressure Ventilation (NPV) would augment the cardiac output of patients in the early postoperative period after complete correction of tetralogy of Fallot (TOF). BACKGROUND Diastolic right ventricular dysfunction can lead to a low-output state in an important minority of patients after TOF repair. In these patients, the diastolic pulmonary arterial flow, which characterizes restrictive right ventricular physiology, and on which the cardiac output is so dependent, is highly sensitive to changes in intrathoracic Pressure. METHODS The effects of NPV on pulmonary blood flow were investigated in 23 intubated children who were initially ventilated using intermittent positive Pressure Ventilation after TOF repair. Eight patients had restrictive right ventricular physiology. All children received a 15-min period of NPV, and eight received a prolonged period (45 min) of NPV. RESULTS A brief period of NPV increased pulmonary blood flow by 39%, and the improvement further continued if the study period was extended, with a total increase of 67% after 45 min. Patients with restrictive physiology had a somewhat delayed response to NPV, but the ultimate increase during an extended period of NPV was greater in restrictive patients (84%) than nonrestrictive patients (50%). CONCLUSIONS By manipulating important cardiopulmonary interactions, NPV improves the cardiac output of patients after TOF repair, and has a role as a hemodynamic tool in the management of the low-output state in selected cases.
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Cardiopulmonary Interactions After Fontan Operations Augmentation of Cardiac Output Using Negative Pressure Ventilation
Circulation, 1997Co-Authors: Lara S Shekerdemian, Darryl F Shore, Andrew Bush, Christopher Lincoln, A N RedingtonAbstract:Background The low-output state is the chief cause of morbidity and mortality after Fontan operations. An alternative hemodynamic tool would be a welcome addition for these patients, who are typically resistant to conventional therapeutic measures. Methods and Results The hemodynamic effects of conversion from conventional intermittent positive Pressure Ventilation (IPPV) to cuirass Negative Pressure Ventilation (NPV) was investigated in nine acute postoperative Fontan patients on the pediatric intensive care unit and nine anesthetized patients undergoing cardiac catheterization in the convalescent phase after Fontan operations. Pulmonary blood flow was measured using the direct Fick method during IPPV and after a brief period of NPV. In one subgroup of patients, pulmonary blood flow was measured again after reinstitution of IPPV, and in a second subgroup, pulmonary blood flow was measured after an extended period of NPV. A brief period of NPV increased pulmonary blood flow from 2.4 to 3.5 L min -1 /m -2 , with a mean increase of 42%. Pulmonary blood flow continued to improve, with a total increase of 54% after an extended period of NPV. Values fell toward baseline after reinstitution of IPPV. Heart rate was unchanged during NPV, and the improvement in pulmonary blood flow was achieved by an increase in stroke volume from 25 mL/m 2 to 37 mL/m. 2 Conclusions Through improvement of the stroke volume alone, NPV brought about a marked increase in the pulmonary blood flow and, hence, cardiac output of Fontan patients. An improvement in cardiac output of this order, and by this mechanism, is currently unmatched by any therapeutic alternatives.
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Cardiopulmonary interactions in healthy children and children after simple cardiac surgery: the effects of positive and Negative Pressure Ventilation
Heart (British Cardiac Society), 1997Co-Authors: Lara S Shekerdemian, Darryl F Shore, Andrew Bush, Christopher Lincoln, Andy Petros, A N RedingtonAbstract:Objective—To investigate the effects of cuirass Negative Pressure Ventilation on the cardiac output of a group of anaesthetised children after occlusion of an asymptomatic persistent arterial duct, and a group of paediatric patients in the early postoperative period following cardiopulmonary bypass. Design—Prospective study. Setting—The paediatric intensive care unit and catheter laboratory of a tertiary care centre. Patients—16 mechanically ventilated children were studied: seven had undergone surgery for congenital heart disease, and nine cardiac catheterisation for transcatheter occlusion of an isolated asymptomatic persistent arterial duct. Interventions—Cardiac output was measured using the direct Fick method during intermittent positive Pressure Ventilation and again after a short period of Negative Pressure Ventilation. In five of the postoperative patients a third measurement was made following reinstitution of positive Pressure Ventilation. Results—Negative Pressure Ventilation was delivered without complication, with no significant change in systemic arterial oxygen and carbon dioxide tension. The mixed venous saturation increased from 74% to 75.8% in the healthy children, and from 58.9% to 62.3% in the postoperative group. Negative Pressure Ventilation increased the cardiac index from 4.0 to 4.5 l/min/m2 in the healthy children, and from 2.8 to 3.5 l/min/m2 in the surgical group. The increase was significantly higher in the postoperative patients (28.1%) than the healthy children (10.8%). Conclusions—While offering similar ventilatory efficiency to positive Pressure Ventilation, cuirass Negative Pressure Ventilation led to a modest improvement in the cardiac output of healthy children, and to a greater increase in postoperative patients. There are important cardiopulmonary interactions in normal children and in children after cardiopulmonary bypass, and by having beneficial effects on these interactions, Negative Pressure Ventilation has haemodynamic advantages over conventional positive Pressure Ventilation. Keywords: cardiopulmonary interactions; congenital heart disease; Ventilation; children
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Negative Pressure Ventilation improves cardiac output after right heart surgery
Circulation, 1996Co-Authors: Lara S Shekerdemian, Darryl F Shore, C Lincoln, Andrew Bush, A N RedingtonAbstract:Background A low cardiac output state can complicate the postoperative course of patients undergoing Fontan-type operations and tetralogy of Fallot repair. Methods and Results We investigated the effect of Negative-Pressure Ventilation on cardiac output in 11 children in the early postoperative period after right heart surgery. All patients were initially ventilated with volume-cycled intermittent positive-Pressure Ventilation, and Negative-Pressure Ventilation was delivered with the Hayek external high-frequency oscillator. Cardiac output was calculated by the direct Fick method, oxygen consumption being measured by respiratory mass spectrometry. Cardiac output was measured during intermittent positive-Pressure Ventilation and after 15 minutes of Negative-Pressure Ventilation. Negative-Pressure Ventilation improved the cardiac output by a mean of 46% (P=.005). Heart rate did not change, and stroke volume increased by a mean of 48.5% (P=.005). Mixed venous saturation increased by 4.6% (P<.02), and consequently arteriovenous oxygen content difference fell significantly (P=.01). The systemic and pulmonary vascular resistances were reduced significantly during Negative-Pressure Ventilation (P<.05 and P<.03, respectively). Conclusions Negative-Pressure Ventilation improves cardiac output in children after total cavopulmonary connection and tetralogy of Fallot repair and may prove to be an important therapeutic option in children with the low cardiac output state.
Lara S Shekerdemian - One of the best experts on this subject based on the ideXlab platform.
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Negative Pressure Ventilation as haemodynamic rescue following surgery for congenital heart disease.
Intensive care medicine, 2000Co-Authors: Lara S Shekerdemian, Andrew Bush, A N Redington, Ingram Schulze-neick, Daniel J. PennyAbstract:A low cardiac output state is an important cause of morbidity and mortality following repair of tetralogy of Fallot (ToF). This is often refractory to conventional measures. The cardiac output of these patients is highly dependent on diastolic pulmonary arterial flow which is enhanced during spontaneous respiration, but much reduced by intermittent positive Pressure Ventilation (IPPV).¶We report the successful use of Negative Pressure Ventilation (NPV) as haemodynamic therapy in three children with a low output secondary to restrictive right ventricular (RV) physiology following ToF repair. NPV produced a significant haemodynamic improvement, with increases in cardiac output of greater than 100 % in two of the children. By augmenting pulmonary blood flow, and hence cardiac output, NPV has a role as adjunctive haemodynamic therapy in patients with a low output secondary to diastolic RV dysfunction, in whom early extubation is not possible.
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Cardiorespiratory responses to Negative Pressure Ventilation after tetralogy of Fallot repair: a hemodynamic tool for patients with a low-output state☆
Journal of the American College of Cardiology, 1999Co-Authors: Lara S Shekerdemian, Darryl F Shore, Andrew Bush, Christopher Lincoln, A N RedingtonAbstract:OBJECTIVES We hypothesized that a period of cuirass Negative Pressure Ventilation (NPV) would augment the cardiac output of patients in the early postoperative period after complete correction of tetralogy of Fallot (TOF). BACKGROUND Diastolic right ventricular dysfunction can lead to a low-output state in an important minority of patients after TOF repair. In these patients, the diastolic pulmonary arterial flow, which characterizes restrictive right ventricular physiology, and on which the cardiac output is so dependent, is highly sensitive to changes in intrathoracic Pressure. METHODS The effects of NPV on pulmonary blood flow were investigated in 23 intubated children who were initially ventilated using intermittent positive Pressure Ventilation after TOF repair. Eight patients had restrictive right ventricular physiology. All children received a 15-min period of NPV, and eight received a prolonged period (45 min) of NPV. RESULTS A brief period of NPV increased pulmonary blood flow by 39%, and the improvement further continued if the study period was extended, with a total increase of 67% after 45 min. Patients with restrictive physiology had a somewhat delayed response to NPV, but the ultimate increase during an extended period of NPV was greater in restrictive patients (84%) than nonrestrictive patients (50%). CONCLUSIONS By manipulating important cardiopulmonary interactions, NPV improves the cardiac output of patients after TOF repair, and has a role as a hemodynamic tool in the management of the low-output state in selected cases.
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Cardiopulmonary Interactions After Fontan Operations Augmentation of Cardiac Output Using Negative Pressure Ventilation
Circulation, 1997Co-Authors: Lara S Shekerdemian, Darryl F Shore, Andrew Bush, Christopher Lincoln, A N RedingtonAbstract:Background The low-output state is the chief cause of morbidity and mortality after Fontan operations. An alternative hemodynamic tool would be a welcome addition for these patients, who are typically resistant to conventional therapeutic measures. Methods and Results The hemodynamic effects of conversion from conventional intermittent positive Pressure Ventilation (IPPV) to cuirass Negative Pressure Ventilation (NPV) was investigated in nine acute postoperative Fontan patients on the pediatric intensive care unit and nine anesthetized patients undergoing cardiac catheterization in the convalescent phase after Fontan operations. Pulmonary blood flow was measured using the direct Fick method during IPPV and after a brief period of NPV. In one subgroup of patients, pulmonary blood flow was measured again after reinstitution of IPPV, and in a second subgroup, pulmonary blood flow was measured after an extended period of NPV. A brief period of NPV increased pulmonary blood flow from 2.4 to 3.5 L min -1 /m -2 , with a mean increase of 42%. Pulmonary blood flow continued to improve, with a total increase of 54% after an extended period of NPV. Values fell toward baseline after reinstitution of IPPV. Heart rate was unchanged during NPV, and the improvement in pulmonary blood flow was achieved by an increase in stroke volume from 25 mL/m 2 to 37 mL/m. 2 Conclusions Through improvement of the stroke volume alone, NPV brought about a marked increase in the pulmonary blood flow and, hence, cardiac output of Fontan patients. An improvement in cardiac output of this order, and by this mechanism, is currently unmatched by any therapeutic alternatives.
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Cardiopulmonary interactions in healthy children and children after simple cardiac surgery: the effects of positive and Negative Pressure Ventilation
Heart (British Cardiac Society), 1997Co-Authors: Lara S Shekerdemian, Darryl F Shore, Andrew Bush, Christopher Lincoln, Andy Petros, A N RedingtonAbstract:Objective—To investigate the effects of cuirass Negative Pressure Ventilation on the cardiac output of a group of anaesthetised children after occlusion of an asymptomatic persistent arterial duct, and a group of paediatric patients in the early postoperative period following cardiopulmonary bypass. Design—Prospective study. Setting—The paediatric intensive care unit and catheter laboratory of a tertiary care centre. Patients—16 mechanically ventilated children were studied: seven had undergone surgery for congenital heart disease, and nine cardiac catheterisation for transcatheter occlusion of an isolated asymptomatic persistent arterial duct. Interventions—Cardiac output was measured using the direct Fick method during intermittent positive Pressure Ventilation and again after a short period of Negative Pressure Ventilation. In five of the postoperative patients a third measurement was made following reinstitution of positive Pressure Ventilation. Results—Negative Pressure Ventilation was delivered without complication, with no significant change in systemic arterial oxygen and carbon dioxide tension. The mixed venous saturation increased from 74% to 75.8% in the healthy children, and from 58.9% to 62.3% in the postoperative group. Negative Pressure Ventilation increased the cardiac index from 4.0 to 4.5 l/min/m2 in the healthy children, and from 2.8 to 3.5 l/min/m2 in the surgical group. The increase was significantly higher in the postoperative patients (28.1%) than the healthy children (10.8%). Conclusions—While offering similar ventilatory efficiency to positive Pressure Ventilation, cuirass Negative Pressure Ventilation led to a modest improvement in the cardiac output of healthy children, and to a greater increase in postoperative patients. There are important cardiopulmonary interactions in normal children and in children after cardiopulmonary bypass, and by having beneficial effects on these interactions, Negative Pressure Ventilation has haemodynamic advantages over conventional positive Pressure Ventilation. Keywords: cardiopulmonary interactions; congenital heart disease; Ventilation; children
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Negative Pressure Ventilation improves cardiac output after right heart surgery
Circulation, 1996Co-Authors: Lara S Shekerdemian, Darryl F Shore, C Lincoln, Andrew Bush, A N RedingtonAbstract:Background A low cardiac output state can complicate the postoperative course of patients undergoing Fontan-type operations and tetralogy of Fallot repair. Methods and Results We investigated the effect of Negative-Pressure Ventilation on cardiac output in 11 children in the early postoperative period after right heart surgery. All patients were initially ventilated with volume-cycled intermittent positive-Pressure Ventilation, and Negative-Pressure Ventilation was delivered with the Hayek external high-frequency oscillator. Cardiac output was calculated by the direct Fick method, oxygen consumption being measured by respiratory mass spectrometry. Cardiac output was measured during intermittent positive-Pressure Ventilation and after 15 minutes of Negative-Pressure Ventilation. Negative-Pressure Ventilation improved the cardiac output by a mean of 46% (P=.005). Heart rate did not change, and stroke volume increased by a mean of 48.5% (P=.005). Mixed venous saturation increased by 4.6% (P<.02), and consequently arteriovenous oxygen content difference fell significantly (P=.01). The systemic and pulmonary vascular resistances were reduced significantly during Negative-Pressure Ventilation (P<.05 and P<.03, respectively). Conclusions Negative-Pressure Ventilation improves cardiac output in children after total cavopulmonary connection and tetralogy of Fallot repair and may prove to be an important therapeutic option in children with the low cardiac output state.
E De Paola - One of the best experts on this subject based on the ideXlab platform.
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Negative Pressure Ventilation versus conventional mechanical Ventilation in the treatment of acute respiratory failure in copd patients
European Respiratory Journal, 1998Co-Authors: A. Corrado, M. Gorini, G Villella, Roberta Ginanni, C Pelagatti, U Buoncristiano, F Guidi, E Pagni, A Peris, E De PaolaAbstract:This case-control study was aimed to evaluate the effectiveness of Negative Pressure Ventilation (NPV) versus conventional mechanical Ventilation (CMV) for the treatment of acute respiratory failure (ARF) in patients with chronic obstructive pulmonary disease (COPD) admitted to a respiratory intermediate intensive care unit (RIICU) and four general intensive care units (ICU). Twenty-six COPD patients in ARF admitted in 1994-95 to RIICU and treated with NPV (cases) were matched according to age (+/-5 yrs), sex, causes triggering ARF, Acute Physiology and Chronic Health Evaluation (APACHE) II score (+/- 5 points), pH (+/-0.05) and arterial carbon dioxide tension (Pa,CO2) on admission with 26 patients admitted to ICU and treated with CMV (controls). The primary end points of the study were inhospital death for both groups and the need for endotracheal intubation for cases. The secondary endpoints were length and complications of mechanical Ventilation and length of hospital stay. The effectiveness of matching was 91%. Mortality rate was 23% for cases and 27% for controls (NS), five cases needed endotracheal intubation, four of whom subsequently died. The duration of Ventilation in survivors was significantly lower in cases than in controls, with a median of 16 h (range 2-111) versus 96 h (range 12-336) (P<0.02), whereas the length of hospital stay was similar in the two groups, with a median of 12 days (range 2-47) for cases vs 12 days (range 3-43) (NS) for controls. No complications were observed in cases, whereas three controls developed infective complications. These results suggest that Negative Pressure Ventilation is as efficacious as conventional mechanical Ventilation for the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease and that it is associated with a shorter duration of Ventilation and a similar length of hospital stay compared with conventional mechanical Ventilation.
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Negative Pressure Ventilation versus conventional mechanical Ventilation in the treatment of acute respiratory failure in COPD patients.
The European respiratory journal, 1998Co-Authors: A. Corrado, Massimo Gorini, G Villella, Roberta Ginanni, U Buoncristiano, F Guidi, E Pagni, A Peris, Pelagatti C, E De PaolaAbstract:This case-control study was aimed to evaluate the effectiveness of Negative Pressure Ventilation (NPV) versus conventional mechanical Ventilation (CMV) for the treatment of acute respiratory failure (ARF) in patients with chronic obstructive pulmonary disease (COPD) admitted to a respiratory intermediate intensive care unit (RIICU) and four general intensive care units (ICU). Twenty-six COPD patients in ARF admitted in 1994-95 to RIICU and treated with NPV (cases) were matched according to age (+/-5 yrs), sex, causes triggering ARF, Acute Physiology and Chronic Health Evaluation (APACHE) II score (+/- 5 points), pH (+/-0.05) and arterial carbon dioxide tension (Pa,CO2) on admission with 26 patients admitted to ICU and treated with CMV (controls). The primary end points of the study were inhospital death for both groups and the need for endotracheal intubation for cases. The secondary endpoints were length and complications of mechanical Ventilation and length of hospital stay. The effectiveness of matching was 91%. Mortality rate was 23% for cases and 27% for controls (NS), five cases needed endotracheal intubation, four of whom subsequently died. The duration of Ventilation in survivors was significantly lower in cases than in controls, with a median of 16 h (range 2-111) versus 96 h (range 12-336) (P
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Intermittent Negative Pressure Ventilation in the treatment of hypoxic hypercapnic coma in chronic respiratory insufficiency.
Thorax, 1996Co-Authors: A. Corrado, Massimo Gorini, E De Paola, D. Tozzi, Giovanni Bruscoli, Andrea Messori, Sandra Nutini, Roberta GinanniAbstract:BACKGROUND: In recent years non-invasive ventilatory techniques have been used successfully in the treatment of acute on chronic respiratory failure (ACRF), but careful selection of patients is essential and a comatose state may represent an exclusion criterion. The aim of this retrospective and uncontrolled study was to evaluate whether a non-invasive ventilatory technique such as the iron lung could also be used successfully in patients with hypoxic hypercapnic coma, thus widening the range for application of non-invasive ventilatory techniques. METHODS: A series of 150 consecutive patients with ACRF and hypoxic hypercapnic coma admitted to our respiratory intensive care unit were evaluated retrospectively. The most common underlying condition was chronic obstructive pulmonary disease (79%). On admission a severe hypoxaemia (Pao2 5.81 (3.01) kPa) and hypercapnia (Paco2 14.88 (2.78) kPa) associated with a decompensated acidosis (pH 7.13 (0.13)) were present, the Glasgow coma score ranged from 3 to 8, and the mean APACHE II score was 31.6 (5.3). All patients underwent intermittent Negative Pressure Ventilation with the iron lung. The study end point was based on a dichotomous classification of treatment failure (defined as death or need for endotracheal intubation) versus therapeutic success. RESULTS: There were 45 treatment failures (30%) and 36 deaths (24%). Nine patients (6%) required intubation because of lack of airway control. The median total duration of Ventilation was 27 hours per patient (range 2-274). The 105 successfully treated cases recovered consciousness after a median of four hours (range 1-90) of continuous ventilatory treatment and were discharged after 12.1 (9.0) days. CONCLUSIONS: These results show that, in patients with acute on chronic respiratory failure and hypoxic hypercapnic coma, the iron lung resulted in a high rate of success. As this study has the typical limitations of all retrospective and uncontrolled studies, the results need to be formally confirmed by controlled prospective studies. Confirmation of these results could widen the range of application of non-invasive ventilatory techniques.
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Negative Pressure Ventilation in the treatment of acute respiratory failure: an old noninvasive technique reconsidered
The European respiratory journal, 1996Co-Authors: A. Corrado, Massimo Gorini, G Villella, E De PaolaAbstract:Noninvasive mechanical ventilatory techniques include the use of Negative and positive Pressure ventilators. Negative Pressure ventilators, such as the "iron lung", support Ventilation by exposing the surface of the chest wall to subatmospheric Pressure during inspiration; whereas, expiration occurs when the Pressure around the chest wall increases and becomes atmospheric or greater than atmospheric. In this review, after a description of the more advanced models of tank ventilators and the physiological effects of Negative Pressure Ventilation (NPV), we summarize the recent application of this old technique in the treatment of acute respiratory failure (ARF). Several uncontrolled studies suggest that NPV may have a potential therapeutic role in the treatment of acute on chronic respiratory failure in patients with chronic obstructive pulmonary disease and restrictive thoracic disorders, reducing the need for endotracheal intubation. In the paediatric field, after substantial technical improvement, NPV has been successfully reintroduced for the treatment of ARF due to neonatal distress syndrome and bronchopulmonary dysplasia, and for the weaning from positive Pressure Ventilation in intubated patients. The positive results of these reports need to be formally confirmed by further prospective and controlled studies before recommending the generalized use of Negative Pressure Ventilation in acute respiratory failure as a standard of care.
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Respiratory muscle insufficiency in acute respiratory failure of subjects with severe COPD: treatment with intermittent Negative Pressure Ventilation.
The European respiratory journal, 1990Co-Authors: A. Corrado, E De Paola, Giovanni Bruscoli, G.f. Ciardi-dupre, A Baccini, M TaddeiAbstract:Nine subjects with severe chronic obstructive pulmonary disease (COPD) in acute respiratory failure (ARF) and with marked weakness of the respiratory muscles (Group A) underwent intermittent Negative Pressure Ventilation by means of an iron lung (8 h daily for 7 days). Seven subjects with COPD in stabilized chronic respiratory failure (Group B) were studied as controls and submitted to the same medical therapy without ventilator treatment. Functional respiratory tests were performed before and after 7 days of treatment. After ventilatory treatment, Group A showed an increase of maximum inspiratory Pressure (PImax), maximum expiratory Pressure (PEmax), vital capacity (VC), arterial oxygen tension (PaO2), pH and a decrease of residual volume (RV), total lung capacity of (TLC) and arterial carbon dioxide tension (PaCO2) (all statistically significant). No improvement was ascertained in the functional parameters of Group B. The expiratory muscles seem to play a determining role in ARF. We conclude that the iron lung is a useful therapeutic defence in removing muscular fatigue and in restoring a good level of respiratory compensation of ARF in severe COPD.
Massimo Gorini - One of the best experts on this subject based on the ideXlab platform.
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Effect of assist Negative Pressure Ventilation by microprocessor based iron lung on breathing effort
Thorax, 2002Co-Authors: Massimo Gorini, G Villella, A. Augustynen, D. Tozzi, Roberta Ginanni, A. CorradoAbstract:Background: The lack of patient triggering capability during Negative Pressure Ventilation (NPV) may contribute to poor patient synchrony and induction of upper airway collapse. This study was undertaken to evaluate the performance of a microprocessor based iron lung capable of thermistor triggering. Methods: The effects of NPV with thermistor triggering were studied in four normal subjects and six patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) by measuring: (1) the time delay (TDtr) between the onset of inspiratory airflow and the start of assisted breathing; (2) the Pressure-time product of the diaphragm (PTPdi); and (3) non-triggering inspiratory efforts (NonTrEf). In patients the effects of Negative extrathoracic end expiratory Pressure (NEEP) added to NPV were also evaluated. Results: With increasing trigger sensitivity the mean (SE) TDtr ranged from 0.29 (0.02) s to 0.21 (0.01) s (mean difference 0.08 s, 95% CI 0.05 to 0.12) in normal subjects and from 0.30 (0.02) s to 0.21 (0.01) s (mean difference 0.09 s, 95% CI 0.06 to 0.12) in patients with COPD; NonTrEf ranged from 8.2 (1.8)% to 1.2 (0.1)% of the total breaths in normal subjects and from 11.8 (2.2)% to 2.5 (0.4)% in patients with COPD. Compared with spontaneous breathing, PTPdi decreased significantly with NPV both in normal subjects and in patients with COPD. NEEP added to NPV resulted in a significant decrease in dynamic intrinsic PEEP, diaphragm effort exerted in the pre-trigger phase, and NonTrEf. Conclusions: Microprocessor based iron lung capable of thermistor triggering was able to perform assist NPV with acceptable TDtr, significant unloading of the diaphragm, and a low rate of NonTrEf. NEEP added to NPV improved the synchrony between the patient and the ventilator.
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Long-term Negative Pressure Ventilation.
Respiratory care clinics of North America, 2002Co-Authors: Antonio Corrado, Massimo GoriniAbstract:Abstract Noninvasive mechanical ventilatory techniques include the use of Negative and positive Pressure ventilators. Negative Pressure ventilators support Ventilation by exposing the surface of the chest wall to subatmospheric Pressure during inspiration, whereas expiration occurs when the Pressure around the chest wall increases and becomes equal to or greater than atmospheric Pressure. In this article, a description of Negative Pressure ventilators and the physiologic effects of Negative Pressure Ventilation (NPV) is given, and the application of this technique in the long-term treatment of chronic respiratory failure is summarized. Many studies, although uncontrolled, have shown that long-term treatment with NPV can improve respiratory muscle function, arterial blood gases, and survival in patients with neuromuscular and chest wall disorders. NPV devices, however, are more cumbersome and difficult to use than home positive Pressure ventilators (PPVs) and tend to predispose to obstructive apnoeas during sleep. In the last several decades, NPV has been supplanted by mask PPV. In experienced hands, NPV remains a second viable option in patients with neuromuscular and chest wall disorders who, for technical or other reasons, cannot be offered mask PPV. There is no evidence, however, that long-term treatment with NPV can improve respiratory muscle function, exercise endurance, quality of life, and survival in patients with severe chronic obstructive pulmonary disease.
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Physiologic Effects of Negative Pressure Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease
American journal of respiratory and critical care medicine, 2001Co-Authors: Massimo Gorini, Antonio Corrado, G Villella, Roberta Ginanni, Annike Augustynen, Donatella TozziAbstract:To assess the physiologic effects of continuous Negative extratho- racic Pressure (CNEP), Negative Pressure Ventilation (NPV), and neg- ative extrathoracic end-expiratory Pressure (NEEP) added to NPV in patients with acute exacerbation of chronic obstructive pulmo- nary disease (COPD), we measured in seven patients ventilatory pattern, arterial blood gases, respiratory mechanics, and Pressure- time product of the diaphragm (PTPdi) under four conditions: ( 1 ) spontaneous breathing (SB); ( 2 ) CNEP ( � 5 cm H 2 O); ( 3 ) NPV; ( 4 ) NPV plus NEEP. CNEP and NPV were provided by a microproces- sor-based iron lung capable of thermistor-triggering. Compared with SB, CNEP improved slightly but significantly Pa CO2 and pH, and decreased PTPdi (388 � 59 versus 302 � 43 cm H 2 Os, re- spectively, p � 0.05) and dynamic intrinsic positive end-expiratory Pressure (PEEPi) (4.6 � 0.5 versus 2.1 � 0.3 cm H 2 O, respectively, p � 0.001). NPV increased minute Ventilation ( E ), improved arterial blood gases, and decreased PTPdi to 34% of value during SB (p � 0.001). NEEP added to NPV further slightly decreased PTPdi and improved patient-ventilator interaction by reducing dynamic PEEPi and nontriggering inspiratory efforts. We conclude that CNEP and NPV, provided by microprocessor-based iron lung, are able to im- prove ventilatory pattern and arterial blood gases, and to unload inspiratory muscles in patients with acute exacerbation of COPD. Randomized controlled trials have clearly shown that, com- pared with standard medical treatment, noninvasive positive Pressure Ventilation reduces the need of endotracheal intuba- tion (1-3) and hospital mortality (1-4) in patients with acute ex- acerbation of chronic obstructive pulmonary disease (COPD). Noninvasive positive Pressure Ventilation, however, is not without its problems, and failure rates of 7 to 50% have been reported (5). Severe respiratory acidosis (6) and illness at pre- sentation (6, 7), excessive airway secretions (7), and inability to minimize the amount of air leakage (7) are major factors as- sociated with failure of noninvasive positive Pressure ventila- tion. Noninvasive mechanical Ventilation can also be provided by Negative Pressure ventilators (8), and some recent studies suggest that Negative Pressure Ventilation (NPV) provided by iron lung can be successful in patients with severe acute respi- ratory failure due to COPD (9, 10). Negative Pressure ventila- tors, however, are not widely used for several reasons (11), in- cluding the paucity of data on the physiologic effects of NPV in patients with acute exacerbations of COPD. Although many studies have investigated Ventilation, gas exchange, and respiratory muscle function during NPV in patients with sta- ble COPD (12-17), to our knowledge, data on the effects of V ·
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Negative Pressure Ventilation versus conventional mechanical Ventilation in the treatment of acute respiratory failure in COPD patients.
The European respiratory journal, 1998Co-Authors: A. Corrado, Massimo Gorini, G Villella, Roberta Ginanni, U Buoncristiano, F Guidi, E Pagni, A Peris, Pelagatti C, E De PaolaAbstract:This case-control study was aimed to evaluate the effectiveness of Negative Pressure Ventilation (NPV) versus conventional mechanical Ventilation (CMV) for the treatment of acute respiratory failure (ARF) in patients with chronic obstructive pulmonary disease (COPD) admitted to a respiratory intermediate intensive care unit (RIICU) and four general intensive care units (ICU). Twenty-six COPD patients in ARF admitted in 1994-95 to RIICU and treated with NPV (cases) were matched according to age (+/-5 yrs), sex, causes triggering ARF, Acute Physiology and Chronic Health Evaluation (APACHE) II score (+/- 5 points), pH (+/-0.05) and arterial carbon dioxide tension (Pa,CO2) on admission with 26 patients admitted to ICU and treated with CMV (controls). The primary end points of the study were inhospital death for both groups and the need for endotracheal intubation for cases. The secondary endpoints were length and complications of mechanical Ventilation and length of hospital stay. The effectiveness of matching was 91%. Mortality rate was 23% for cases and 27% for controls (NS), five cases needed endotracheal intubation, four of whom subsequently died. The duration of Ventilation in survivors was significantly lower in cases than in controls, with a median of 16 h (range 2-111) versus 96 h (range 12-336) (P
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Intermittent Negative Pressure Ventilation in the treatment of hypoxic hypercapnic coma in chronic respiratory insufficiency.
Thorax, 1996Co-Authors: A. Corrado, Massimo Gorini, E De Paola, D. Tozzi, Giovanni Bruscoli, Andrea Messori, Sandra Nutini, Roberta GinanniAbstract:BACKGROUND: In recent years non-invasive ventilatory techniques have been used successfully in the treatment of acute on chronic respiratory failure (ACRF), but careful selection of patients is essential and a comatose state may represent an exclusion criterion. The aim of this retrospective and uncontrolled study was to evaluate whether a non-invasive ventilatory technique such as the iron lung could also be used successfully in patients with hypoxic hypercapnic coma, thus widening the range for application of non-invasive ventilatory techniques. METHODS: A series of 150 consecutive patients with ACRF and hypoxic hypercapnic coma admitted to our respiratory intensive care unit were evaluated retrospectively. The most common underlying condition was chronic obstructive pulmonary disease (79%). On admission a severe hypoxaemia (Pao2 5.81 (3.01) kPa) and hypercapnia (Paco2 14.88 (2.78) kPa) associated with a decompensated acidosis (pH 7.13 (0.13)) were present, the Glasgow coma score ranged from 3 to 8, and the mean APACHE II score was 31.6 (5.3). All patients underwent intermittent Negative Pressure Ventilation with the iron lung. The study end point was based on a dichotomous classification of treatment failure (defined as death or need for endotracheal intubation) versus therapeutic success. RESULTS: There were 45 treatment failures (30%) and 36 deaths (24%). Nine patients (6%) required intubation because of lack of airway control. The median total duration of Ventilation was 27 hours per patient (range 2-274). The 105 successfully treated cases recovered consciousness after a median of four hours (range 1-90) of continuous ventilatory treatment and were discharged after 12.1 (9.0) days. CONCLUSIONS: These results show that, in patients with acute on chronic respiratory failure and hypoxic hypercapnic coma, the iron lung resulted in a high rate of success. As this study has the typical limitations of all retrospective and uncontrolled studies, the results need to be formally confirmed by controlled prospective studies. Confirmation of these results could widen the range of application of non-invasive ventilatory techniques.
