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Kock KDS, Maurici R. Respiratory mechanics, ventilator-associated pneumonia and outcomes in intensive care unit. World J Crit Care Med 2018; 7:24-30. [PMID: 29430405 PMCID: PMC5797973 DOI: 10.5492/wjccm.v7.i1.24] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/05/2017] [Accepted: 12/04/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the predictive capability of respiratory mechanics for the development of ventilator-associated pneumonia (VAP) and mortality in the intensive care unit (ICU) of a hospital in southern Brazil.
METHODS A cohort study was conducted between, involving a sample of 120 individuals. Static measurements of compliance and resistance of the respiratory system in pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) modes in the 1st and 5th days of hospitalization were performed to monitor respiratory mechanics. The severity of the patients’ illness was quantified by the Acute Physiology and Chronic Health Evaluation II (APACHE II). The diagnosis of VAP was made based on clinical, radiological and laboratory parameters.
RESULTS The significant associations found for the development of VAP were APACHE II scores above the average (P = 0.016), duration of MV (P = 0.001) and ICU length of stay above the average (P = 0.003), male gender (P = 0.004), and worsening of respiratory resistance in PCV mode (P = 0.010). Age above the average (P < 0.001), low level of oxygenation on day 1 (P = 0.003) and day 5 (P = 0.004) and low lung compliance during VCV on day 1 (P = 0.032) were associated with death as the outcome.
CONCLUSION The worsening of airway resistance in PCV mode indicated the possibility of early diagnosis of VAP. Low lung compliance during VCV and low oxygenation index were death-related prognostic indicators.
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Affiliation(s)
- Kelser de Souza Kock
- Department of Physiotherapy, University of South of Santa Catarina, Tubarão, SC 88704-001, Brazil
| | - Rosemeri Maurici
- Graduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, SC 88700-000, Brazil
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Kock KDS, Rosa BCD, Martignago N, Reis C, Maurici R. Comparison of respiratory mechanics measurements in the volume cycled ventilation (VCV) and pressure controlled ventilation (PCV). FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/0103-5150.029.002.ao02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction Monitoring respiratory mechanics may provide important information for the intensivist, assisting in the early detection of pulmonary function changes of patients hospitalized in ICU. Objective: To compare measurements of respiratory mechanics in VCV and PCV modes, and correlate them with age and oxygenation index. Materials and methods: Cross-sectional study conducted in the adult ICU of the Hospital Nossa Senhora da Conceição, in Tubarão - SC. A hundred and twenty individuals were selected between March and August 2013. The respiratory mechanics measurements were evaluated using compliance and resistance static measures of the respiratory system in PCV and VCV modes between the 1st and 5th day of hospitalization. Simultaneously, the oxygenation index PaO2/FiO2 was collected. Results: The obtained results were: compliance (VCV) = 40.9 ± 12.8 mL/cmH2O, compliance (PCV) = 35.0 ± 10.0 mL/cmH2O, resistance (VCV) = 13.2 ± 4.9 cmH2O/L/s, resistance (PCV) = 27.3 ± 16.2 cmH2O/L/s and PaO2/FiO2 = 236.0 ± 97.6 mmHg. There was statistical difference (p < 0.001) between the compliance and resistance measures in VCV and PCV modes. The correlations between the oxygenation index and compliance in VCV and PCV modes and resistance in VCV and PCV modes were, respectively, r = 0.381 (p < 0.001), r = 0.398 (p < 0.001), r = -0.188 (p = 0.040), r = -0.343 (p < 0.001). Conclusion: Despite the differences between the respiratory mechanics measurements the monitoring using VCV and PCV modes seems to show complementary aspects.
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Beda A, Güldner A, Carvalho AR, Zin WA, Carvalho NC, Huhle R, Giannella-Neto A, Koch T, de Abreu MG. Liquid- and air-filled catheters without balloon as an alternative to the air-filled balloon catheter for measurement of esophageal pressure. PLoS One 2014; 9:e103057. [PMID: 25247308 PMCID: PMC4172426 DOI: 10.1371/journal.pone.0103057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/26/2014] [Indexed: 11/25/2022] Open
Abstract
Background Measuring esophageal pressure (Pes) using an air-filled balloon catheter (BC) is the common approach to estimate pleural pressure and related parameters. However, Pes is not routinely measured in mechanically ventilated patients, partly due to technical and practical limitations and difficulties. This study aimed at comparing the conventional BC with two alternative methods for Pes measurement, liquid-filled and air-filled catheters without balloon (LFC and AFC), during mechanical ventilation with and without spontaneous breathing activity. Seven female juvenile pigs (32–42 kg) were anesthetized, orotracheally intubated, and a bundle of an AFC, LFC, and BC was inserted in the esophagus. Controlled and assisted mechanical ventilation were applied with positive end-expiratory pressures of 5 and 15 cmH2O, and driving pressures of 10 and 20 cmH2O, in supine and lateral decubitus. Main Results Cardiogenic noise in BC tracings was much larger (up to 25% of total power of Pes signal) than in AFC and LFC (<3%). Lung and chest wall elastance, pressure-time product, inspiratory work of breathing, inspiratory change and end-expiratory value of transpulmonary pressure were estimated. The three catheters allowed detecting similar changes in these parameters between different ventilation settings. However, a non-negligible and significant bias between estimates from BC and those from AFC and LFC was observed in several instances. Conclusions In anesthetized and mechanically ventilated pigs, the three catheters are equivalent when the aim is to detect changes in Pes and related parameters between different conditions, but possibly not when the absolute value of the estimated parameters is of paramount importance. Due to a better signal-to-noise ratio, and considering its practical advantages in terms of easier calibration and simpler acquisition setup, LFC may prove interesting for clinical use.
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Affiliation(s)
- Alessandro Beda
- Pulmonary Engineering Group, Clinic of Anaesthesiology and Intensive Care Therapy, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
- Department of Electronic Engineering and Postgraduate Program of Electrical Engineering, Federal University of Minas Gerais, Pampulha, Belo Horizonte, Brazil
- * E-mail:
| | - Andreas Güldner
- Pulmonary Engineering Group, Clinic of Anaesthesiology and Intensive Care Therapy, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
| | - Alysson R. Carvalho
- Laboratory of Respiration Physiology, Carlos Chagas Filho Biophysics Institute, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Biomedical Engineering Program, Alberto Luis Coimbra Program of Post-Graduation and Research in Engineering, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Walter Araujo Zin
- Laboratory of Respiration Physiology, Carlos Chagas Filho Biophysics Institute, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nadja C. Carvalho
- Pulmonary Engineering Group, Clinic of Anaesthesiology and Intensive Care Therapy, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
- Department of Electronic Engineering and Postgraduate Program of Electrical Engineering, Federal University of Minas Gerais, Pampulha, Belo Horizonte, Brazil
| | - Robert Huhle
- Pulmonary Engineering Group, Clinic of Anaesthesiology and Intensive Care Therapy, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
| | - Antonio Giannella-Neto
- Biomedical Engineering Program, Alberto Luis Coimbra Program of Post-Graduation and Research in Engineering, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thea Koch
- Pulmonary Engineering Group, Clinic of Anaesthesiology and Intensive Care Therapy, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
| | - Marcelo Gama de Abreu
- Pulmonary Engineering Group, Clinic of Anaesthesiology and Intensive Care Therapy, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
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Increase in airway pressure resulting from prone position patient placing may predict intraoperative surgical blood loss. Spine (Phila Pa 1976) 2013; 38:E678-82. [PMID: 23429680 DOI: 10.1097/brs.0b013e31828cb3e5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective study on intraoperative blood loss during lumbar spine surgery. OBJECTIVE To evaluate the relationship between airway pressure change due to the patient's prone position and intraoperative blood loss during lumbar spine surgery. SUMMARY OF BACKGROUND DATA A prone position may increase abdominal pressure. Changes in abdominal pressure may influence airway pressure and cause intraoperative blood loss as a result of epidural venous congestion. METHODS Patients undergoing lumbar spine surgery were placed in a prone position after the administration of general anesthesia. Peak airway pressure, plateau pressure, mean blood pressure, and heart rate were measured 5 minutes after anesthesia induction and 15 minutes after being placed in a prone position. Intraoperative blood loss was measured at the end of surgery. RESULTS Mean peak airway pressure was 13.7 ± 1.8 mm Hg while in a supine position and increased to 15.1 ± 2.5 mm Hg after placement in the prone position (P = 0.002). Plateau pressure was 12.6 ± 2.5 mm Hg while in a supine position and increased to 14.1 ± 1.9 mm Hg after placement in a prone position (P = 0.0002). Intraoperative blood loss was correlated with peak (R2 = 0.405) and plateau (R2 = 0.489) airway pressure changes. CONCLUSION Increase in airway pressure resulting from placement into a prone position may predict intraoperative surgical blood loss.
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Avena KDM, Duarte ACM, Cravo SLD, Sologuren MJJ, Gastaldi AC. [Effects of manually assisted coughing on respiratory mechanics in patients requiring full ventilatory support]. J Bras Pneumol 2009; 34:380-6. [PMID: 18622505 DOI: 10.1590/s1806-37132008000600008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Accepted: 08/16/2007] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Manually assisted coughing (MAC) consists of a vigorous thrust applied to the chest at the beginning of a spontaneous expiration or of the expiratory phase of mechanical ventilation. Due to routine use of MAC in intensive care units, the objective of this study was to assess the effects of MAC on respiratory system mechanics in patients requiring full ventilatory support. METHODS We assessed 16 sedated patients on full ventilatory support (no active participation in ventilation). Respiratory system mechanics and oxyhemoglobin saturation were measured before and after MAC, as well as after endotracheal aspiration. Bilateral MAC was performed ten times on each patient, with three respiratory cycle intervals between each application. RESULTS Data analysis demonstrated a decrease in resistive pressure and respiratory system resistance, together with an increase in oxyhemoglobin saturation, after MAC combined with endotracheal aspiration. No evidence of alterations in peak pressures, plateau pressures or respiratory system compliance change was observed after MAC. CONCLUSIONS The use of MAC alters respiratory system mechanics, increasing resistive forces by removing secretions. The technique is considered safe and efficacious for postoperative patients. Using MAC in conjunction with endotracheal aspiration provided benefits, achieving the proposed objective: the displacement and removal of airway secretions.
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