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LoMauro A, De Luca A, Scarpazza P, Aliverti A. In Vivo Measurement of Tidal Volume During Non-invasive Respiratory Support by Continuous-Flow Helmet CPAP. Ann Biomed Eng 2024; 52:2546-2555. [PMID: 38886251 PMCID: PMC11329575 DOI: 10.1007/s10439-024-03545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/08/2024] [Indexed: 06/20/2024]
Abstract
Recently, the interest in the Helmet interface during non-invasive respiratory support (NIRS) has increased due to the COVID-19 pandemic. During NIRS, positive end-expiratory pressure (PEEP) can be given as continuous positive airway pressure (CPAP), which maintains a positive airway pressure throughout the whole respiratory cycle with Helmet as an interface (H-CPAP). The main disadvantage of the H-CPAP is the inability to measure tidal volume (VT). Opto-electronic plethysmography (OEP) is a non-invasive technique that is not sensitive to gas compression/expansion inside the helmet. OEP acquisitions were performed on 28 healthy volunteers (14 females and 14 males) at baseline and during Helmet CPAP. The effect of posture (semi-recumbent vs. prone), flow (50 vs. 60 L/min), and PEEP (0 vs. 5 vs. 10 cmH2O) on the ventilatory and thoracic-abdominal pattern and the operational volumes were investigated. Prone position limited vital capacity, abdominal expansion and chest wall recruitment. A constant flow of 60 L/min reduced the need for the subject to ventilate while having a slight recruitment effect (100 mL) in the semi-recumbent position. A progressive increasing recruitment was found with higher PEEP but limited by the prone position. It is possible to accurately measure tidal volume during H-CPAP to deliver non-invasive ventilatory support using opto-electronic plethysmography during different clinical settings.
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Affiliation(s)
- A LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, P.zza L. da Vinci, 32, 20133, Milan, Italy.
| | - A De Luca
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, P.zza L. da Vinci, 32, 20133, Milan, Italy
| | - P Scarpazza
- Pneumology Unit, Ospedale Civile, Vimercate, Milan, Italy
| | - A Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, P.zza L. da Vinci, 32, 20133, Milan, Italy
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Aljohani H, Russell D, Kim YI, Bassler J, Lowman J. The Neuromechanics of Inspiratory Muscles in Mechanical Ventilation Liberation Success and Failure. Cureus 2024; 16:e51570. [PMID: 38313921 PMCID: PMC10835747 DOI: 10.7759/cureus.51570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Assessing the neuromechanical coupling of inspiratory muscles during mechanical ventilation (MV) could reveal the physiological mechanism of MV failure. This study examined the respiratory neuromechanical characteristics between MV liberation success and failure. METHODS This is an observational prospective study that included patients during their ventilator liberation process. Assessment of surface electromyography (sEMG) of inspiratory muscles, including the diaphragm and extra-diaphragmatic (scalene, sternocleidomastoid, and parasternal) muscles, was performed 15 minutes after the initiation of spontaneous breathing trials. Neuromechanical efficiency of the diaphragm (NMEDia) and extra-diaphragmatic muscles (NMEExtra) were compared in patients who were successfully liberated from MV with those who failed MV liberation within 72 hours after extubation. RESULTS A total of 45 patients were enrolled and 28 were female (67%). The sample median age was 63 (IQR 47, 69) years old. One-third of patients failed MV liberation within 72 hours of their spontaneous breathing trials (SBTs). NMEDia was significantly lower in patients who failed MV liberation with a root mean square of (M 0.27), (IQR 0.21, 0.37) compared with (M 0.371), (IQR 0.3, 0.631) for the success group (p=0.0222). The area under the curve for NMEDia was lower in the failure group (M 0.270), (IQR 0.160, 0.370) and (M 0.485), (IQR 0.280, 0.683) for the success group (p=0.024). However, NMEExtra was not statistically different between the two groups. CONCLUSION Reduced NMEDia is a predictor of MV liberation failure. NMEExtra was not a major contributor to MV liberation outcomes. Further studies should assess the performance of inspiratory muscles NME indices to predict MV liberation outcomes.
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Affiliation(s)
- Hassan Aljohani
- Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Derek Russell
- Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Young-Il Kim
- Preventive Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - John Bassler
- Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - John Lowman
- Physical Therapy, University of Alabama at Birmingham, Birmingham, USA
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Barati P, Ghafari S, Saghaei M. Comparative Assessment of the Effects of Two Methods of Pressure Support Adjustment on Respiratory Distress in Patients under Mechanical Ventilation Admitted to Intensive Care Units. Indian J Crit Care Med 2021; 25:1026-1030. [PMID: 34963721 PMCID: PMC8664038 DOI: 10.5005/jp-journals-10071-23960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Incorrect adjustment of the respiratory parameters of the mechanical ventilator increases respiratory distress and work of breathing (WOB) in mechanically ventilated patients. The accurate adjustment of pressure support increases thepatient's comfort and decreases respiratory distress and WOB, etc.; thus, the present study was conducted to compare the effects of two pressure support adjustment methods on respiratory distress in patients under mechanical ventilation to investigate whether the rapid shallow breathing index (RSBI)method can reduce patients’ respiratory distress more and faster than the tidal volume (VT) and respiratory rate (RR) methods. Patients and methods The study was conducted in 2020 on 56 mechanically ventilated patients with respiratory distress. The patients’ respiratory distress was first measured using RSBI and the respiratory distress observation scale (RDOS). The pressuresupport was then adjusted in the patients according to the RSBI (in the trial group, n = 33)and VT and RR (in the control group, n = 23). The patients’ respiratory distress was measured again in both groups 15 and 30 minutes after the pressure support adjustment. Results The results showed no significant differences between the two groups in the mean RSBI and RDOS before (p = 0.374, p = 0.657 respectively) and 30 (p = 0.103, p = 0.218 respectively) minutes after the adjustment of the pressure support, but these mean values differed significantly (p = 0.025 for RSBI and p = 0.044 for RDOS) between the groups 15 minutes after the adjustment. Moreover, the interaction effect of the group * time for RDOS has become significant nonlinearly (p = 0.037), but none of the interaction effects of the group * time were significant for RSBI (linear: p = 0.531; nonlinear: p = 0.272). Conclusion These two methods finally reduced the patients’ respiratory distress almost equally, but RSBI method can relieve the patients’ respiratory distress faster than the VT and RR methods. How to cite this article Barati P, Ghafari S, Saghaei M. Comparative Assessment of the Effects of Two Methods of Pressure Support Adjustment on Respiratory Distress in Patients under Mechanical Ventilation Admitted to Intensive Care Units. Indian J Crit Care Med 2021;25(9):1026–1030. Key message VT, RR, and RSBI methods finally reduced the patients’ respiratory distress almost equally, but RSBI method can relieve the patients’ respiratory distress faster than the VT and RR methods.
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Affiliation(s)
- Pooneh Barati
- Critical Care Nursing, Nursingand Midwifery Care Research Center, Faculty of Nursing and Midwifery, IsfahanUniversity of Medical Sciences, Isfahan, Iran
| | - Somayeh Ghafari
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahmood Saghaei
- Department of Anesthesia, Isfahan University of Medical Sciences, Isfahan, Iran. Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Goligher EC, Costa ELV, Yarnell CJ, Brochard LJ, Stewart TE, Tomlinson G, Brower RG, Slutsky AS, Amato MPB. Effect of Lowering Vt on Mortality in Acute Respiratory Distress Syndrome Varies with Respiratory System Elastance. Am J Respir Crit Care Med 2021; 203:1378-1385. [PMID: 33439781 DOI: 10.1164/rccm.202009-3536oc] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Rationale: If the risk of ventilator-induced lung injury in acute respiratory distress syndrome (ARDS) is causally determined by driving pressure rather than by Vt, then the effect of ventilation with lower Vt on mortality would be predicted to vary according to respiratory system elastance (Ers). Objectives: To determine whether the mortality benefit of ventilation with lower Vt varies according to Ers. Methods: In a secondary analysis of patients from five randomized trials of lower- versus higher-Vt ventilation strategies in ARDS and acute hypoxemic respiratory failure, the posterior probability of an interaction between the randomized Vt strategy and Ers on 60-day mortality was computed using Bayesian multivariable logistic regression. Measurements and Main Results: Of 1,096 patients available for analysis, 416 (38%) died by Day 60. The posterior probability that the mortality benefit from lower-Vt ventilation strategies varied with Ers was 93% (posterior median interaction odds ratio, 0.80 per cm H2O/[ml/kg]; 90% credible interval, 0.63-1.02). Ers was classified as low (<2 cm H2O/[ml/kg], n = 321, 32%), intermediate (2-3 cm H2O/[ml/kg], n = 475, 46%), and high (>3 cm H2O/[ml/kg], n = 224, 22%). In these groups, the posterior probabilities of an absolute risk reduction in mortality ≥ 1% were 55%, 82%, and 92%, respectively. The posterior probabilities of an absolute risk reduction ≥ 5% were 29%, 58%, and 82%, respectively. Conclusions: The mortality benefit of ventilation with lower Vt in ARDS varies according to elastance, suggesting that lung-protective ventilation strategies should primarily target driving pressure rather than Vt.
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Affiliation(s)
- Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine.,Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, Toronto General Hospital, Toronto, Ontario, Canada
| | - Eduardo L V Costa
- Laboratório de Pneumologia LIM-09, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil.,Research and Education Institute, Hospital Sírio-Libanes, São Paulo, Brazil
| | - Christopher J Yarnell
- Interdepartmental Division of Critical Care Medicine.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| | - Laurent J Brochard
- Interdepartmental Division of Critical Care Medicine.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - George Tomlinson
- Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| | - Roy G Brower
- Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marcelo P B Amato
- Laboratório de Pneumologia LIM-09, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil
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LoMauro A, Aliverti A, Perchiazzi G, Frykholm P. Physiological changes and compensatory mechanisms by the action of respiratory muscles in a porcine model of phrenic nerve injury. J Appl Physiol (1985) 2021; 130:813-826. [PMID: 33444121 DOI: 10.1152/japplphysiol.00781.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Phrenic nerve damage may occur as a complication of specific surgical procedures, prolonged mechanical ventilation, or physical trauma. The consequent diaphragmatic paralysis or dysfunction can lead to major complications. The purpose of this study was to elucidate the role of the nondiaphragmatic respiratory muscles during partial or complete diaphragm paralysis induced by unilateral and bilateral phrenic nerve damage at different levels of ventilatory pressure support in an animal model. Ten pigs were instrumented, the phrenic nerve was exposed from the neck, and spontaneous respiration was preserved at three levels of pressure support, namely, high, low, and null, at baseline condition, after left phrenic nerve damage, and after bilateral phrenic nerve damage. Breathing pattern, thoracoabdominal volumes and asynchrony, and pressures were measured at each condition. Physiological breathing was predominantly diaphragmatic and homogeneously distributed between right and left sides. After unilateral damage, the paralyzed hemidiaphragm was passively dragged by the ipsilateral rib cage muscles and the contralateral hemidiaphragm. After bilateral damage, the drive to and the work of breathing of rib cage and abdominal muscles increased, to compensate for diaphragmatic paralysis, ensuing paradoxical thoracoabdominal breathing. Increasing level of pressure support ventilation replaces this muscle group compensation. When the diaphragm is paralyzed (unilaterally and/or bilaterally), there is a coordinated reorganization of nondiaphragmatic respiratory muscles as compensation that might be obscured by high level of pressure support ventilation. Noninvasive thoracoabdominal volume and asynchrony assessment could be useful in phrenic nerve-injured patients to estimate the extent and type of inspiratory muscle dysfunction.NEW & NOTEWORTHY This was the first (to our knowledge) implanted porcine model of phrenic nerve injury with a detailed multidimensional analysis of different degrees of diaphragmatic paralysis (unilateral and bilateral). Noninvasive thoracoabdominal volume and asynchrony assessment was shown to be useful in estimating the extent of diaphragmatic dysfunction and the consequent coordinated reorganization of nondiaphragmatic respiratory muscles. High level of pressure support ventilation was proved to obscure the interaction and compensation of respiratory muscles to deal with phrenic nerve injury.
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Affiliation(s)
- Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.,Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Gaetano Perchiazzi
- Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Frykholm
- Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Chen L, Del Sorbo L, Grieco DL, Junhasavasdikul D, Rittayamai N, Soliman I, Sklar MC, Rauseo M, Ferguson ND, Fan E, Richard JCM, Brochard L. Potential for Lung Recruitment Estimated by the Recruitment-to-Inflation Ratio in Acute Respiratory Distress Syndrome. A Clinical Trial. Am J Respir Crit Care Med 2020; 201:178-187. [DOI: 10.1164/rccm.201902-0334oc] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Lu Chen
- Keenan Research Centre and Li Ka Shing Institute, Department of Critical Care, St. Michael’s Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, and
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Lorenzo Del Sorbo
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology and Critical Care Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Domenico L. Grieco
- Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ibrahim Soliman
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Michael C. Sklar
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Michela Rauseo
- Anestesia e Rianimazione, Ospedali Riuniti di Foggia, Foggia, Italy; and
| | - Niall D. Ferguson
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology and Critical Care Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Eddy Fan
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology and Critical Care Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Laurent Brochard
- Keenan Research Centre and Li Ka Shing Institute, Department of Critical Care, St. Michael’s Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, and
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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Shi ZH, Jonkman A, de Vries H, Jansen D, Ottenheijm C, Girbes A, Spoelstra-de Man A, Zhou JX, Brochard L, Heunks L. Expiratory muscle dysfunction in critically ill patients: towards improved understanding. Intensive Care Med 2019; 45:1061-1071. [PMID: 31236639 PMCID: PMC6667683 DOI: 10.1007/s00134-019-05664-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION This narrative review summarizes current knowledge on the physiology and pathophysiology of expiratory muscle function in ICU patients, as shared by academic professionals from multidisciplinary, multinational backgrounds, who include clinicians, clinical physiologists and basic physiologists. RESULTS The expiratory muscles, which include the abdominal wall muscles and some of the rib cage muscles, are an important component of the respiratory muscle pump and are recruited in the presence of high respiratory load or low inspiratory muscle capacity. Recruitment of the expiratory muscles may have beneficial effects, including reduction in end-expiratory lung volume, reduction in transpulmonary pressure and increased inspiratory muscle capacity. However, severe weakness of the expiratory muscles may develop in ICU patients and is associated with worse outcomes, including difficult ventilator weaning and impaired airway clearance. Several techniques are available to assess expiratory muscle function in the critically ill patient, including gastric pressure and ultrasound. CONCLUSION The expiratory muscles are the "neglected component" of the respiratory muscle pump. Expiratory muscles are frequently recruited in critically ill ventilated patients, but a fundamental understanding of expiratory muscle function is still lacking in these patients.
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Affiliation(s)
- Zhong-Hua Shi
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Postbox 7057, 1007 MB,, Amsterdam, The Netherlands
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Annemijn Jonkman
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Postbox 7057, 1007 MB,, Amsterdam, The Netherlands
| | - Heder de Vries
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Postbox 7057, 1007 MB,, Amsterdam, The Netherlands
| | - Diana Jansen
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Coen Ottenheijm
- Department of Physiology, Amsterdam UMC, Location VUmc, Postbox 7057, 1007 MB, Amsterdam, The Netherlands
| | - Armand Girbes
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Postbox 7057, 1007 MB,, Amsterdam, The Netherlands
| | - Angelique Spoelstra-de Man
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Postbox 7057, 1007 MB,, Amsterdam, The Netherlands
| | - Jian-Xin Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Laurent Brochard
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Leo Heunks
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Postbox 7057, 1007 MB,, Amsterdam, The Netherlands.
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Spadaro S, Karbing DS, Dalla Corte F, Mauri T, Moro F, Gioia A, Volta CA, Rees SE. An open-loop, physiological model based decision support system can reduce pressure support while acting to preserve respiratory muscle function. J Crit Care 2018; 48:407-413. [PMID: 30317049 DOI: 10.1016/j.jcrc.2018.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess whether a clinical decision support system (CDSS) suggests PS and FIO2 maintaining appropriate breathing effort, and minimizing FIO2. MATERIALS Prospective, cross-over study in PS ventilated ICU patients. Over support (150% baseline) and under support (50% baseline) were applied by changing PS (15 patients) or PEEP (8 patients). CDSS advice was followed. Tension time index of inspiratory muscles (TTies), respiratory and metabolic variables were measured. RESULTS PS over support (median 8.0 to 12.0 cmH2O) reduced respiratory muscle activity (TTies 0.090 ± 0.028 to 0.049 ± 0.030; p < .01), and tended to increase tidal volume (VT: 8.6 ± 3.0 to 10.1 ± 2.9 ml/kg; p = .08). CDSS advice reduced PS (6.0 cmH2O, p = .005), increased TTies (0.076 ± 0.038, p < .01), and tended to reduce VT (8.9 ± 2.4 ml/kg, p = .08). PS under support (12.0 to 4.0 cmH2O) slightly increased respiratory muscle activity, (TTies to 0.120 ± 0.044; p = .007) with no significant CDSS advice. CDSS advice reduced FIO2 by 12-14% (p = .005), resulting in median SpO2 = 96% (p < .02). PEEP changes did not result in changes in physiological variables, or CDSS advice. CONCLUSION The CDSS advised on low values of PS often not prohibiting extubation, while acting to preserve respiratory muscle function and preventing passive lung inflation. CDSS advice minimized FIO2 maintaining SpO2 at safe and beneficial values.
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Affiliation(s)
- Savino Spadaro
- Department of Morphology, Experimental Medicine and Surgery, Section of Anaesthesia and Intensive Care, Arcispedale Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Dan Stieper Karbing
- Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Francesca Dalla Corte
- Department of Morphology, Experimental Medicine and Surgery, Section of Anaesthesia and Intensive Care, Arcispedale Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Moro
- Department of Morphology, Experimental Medicine and Surgery, Section of Anaesthesia and Intensive Care, Arcispedale Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Antonio Gioia
- Department of Morphology, Experimental Medicine and Surgery, Section of Anaesthesia and Intensive Care, Arcispedale Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Experimental Medicine and Surgery, Section of Anaesthesia and Intensive Care, Arcispedale Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Stephen Edward Rees
- Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
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Kostic P, LoMauro A, Larsson A, Hedenstierna G, Frykholm P, Aliverti A. Specific anesthesia-induced lung volume changes from induction to emergence: a pilot study. Acta Anaesthesiol Scand 2018; 62:282-292. [PMID: 29105056 DOI: 10.1111/aas.13026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/07/2017] [Accepted: 10/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies aimed at maintaining intraoperative lung volume to reduce post-operative pulmonary complications have been inconclusive because they mixed up the effect of general anesthesia and the surgical procedure. Our aims were to study: (1) lung volume during the entire course of anesthesia without the confounding effects of surgical procedures; (2) the combination of three interventions to maintain lung volume; and (3) the emergence phase with focus on the restored activation of the respiratory muscles. METHODS Eighteen ASA I-II patients undergoing ENT surgery under general anesthesia without muscle relaxants were randomized to an intervention group, receiving lung recruitment maneuver (LRM) after induction, 7 cmH2 O positive end-expiratory pressure (PEEP) during anesthesia and continuous positive airway pressure (CPAP) during emergence with 0.4 inspired oxygen fraction (FiO2 ) or a control group, ventilated without LRM, with 0 cmH2 O PEEP, and 1.0 FiO2 during emergence without CPAP application. End-expiratory lung volume (EELV) was continuously estimated by opto-electronic plethysmography. Inspiratory and expiratory ribcage muscles electromyography was measured in a subset of seven patients. RESULTS End-expiratory lung volume decreased after induction in both groups. It remained low in the control group and further decreased at emergence, because of active expiratory muscle contraction. In the intervention group, EELV increased after LRM and remained high after extubation. CONCLUSION A combined intervention consisting of LRM, PEEP and CPAP during emergence may effectively maintain EELV during anesthesia and even after extubation. An unexpected finding was that the activation of the expiratory muscles may contribute to EELV reduction during the emergence phase.
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Affiliation(s)
- P. Kostic
- Department of Surgical Sciences; Section of Anesthesiology and Intensive Care; Uppsala University; Uppsala Sweden
| | - A. LoMauro
- Department of Surgical Sciences; Section of Anesthesiology and Intensive Care; Uppsala University; Uppsala Sweden
- TBM Lab; Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano Italy
| | - A. Larsson
- Hedenstierna Laboratory; Department of Surgical Sciences; Section of Anesthesiology and Intensive Care; Uppsala University; Uppsala Sweden
| | - G. Hedenstierna
- Department of Medical Sciences; Section of Clinical Physiology; Uppsala University; Uppsala Sweden
| | - P. Frykholm
- Department of Surgical Sciences; Section of Anesthesiology and Intensive Care; Uppsala University; Uppsala Sweden
| | - A. Aliverti
- TBM Lab; Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano Italy
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Feitosa LADS, de Britto MCA, Aliverti A, Noronha JB, de Andrade AD. Accuracy of optoelectronic plethysmography in childhood exercise-induced asthma. J Asthma 2018; 56:61-68. [PMID: 29360392 DOI: 10.1080/02770903.2018.1424196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess the variations of end-expiratory volume of chest wall (EEVcw) measured by optoelectronic plethysmography (OEP) as a diagnostic tool in exercise-induced asthma (EIA) among asthmatic preschool children. METHODS Forty children diagnosed with asthma were included in the study. Spirometry was used as a gold standard test for comparison with OEP. A 10% decline in forced expiratory volume in 1 second was considered positive for EIA. OEP was performed with 8 cameras at a frequency of 60 Hz and 89 markers were placed on the thoraco-abdominal surface of participants. Following bronchoprovocation testing on a treadmill, series of OEP and spirometry were conducted between 5 and 30 minutes after exercise. To obtain the ideal cut-off point, a receiver operating characteristic (ROC) curve was constructed for the largest EEVcw. The highest Youden index was used as criteria to obtain the cut-off point with the best sensitivity and specificity. RESULTS Of the 40 children studied, 16 had EIA. According to the ROC curve, the cut-off point of 0.185% for EEWcw provided mean sensitivity (95% confidence interval) of 93.75% (0.69-0.99), for a specificity of 83.33% (0.63-0.95), when using the largest increase in the period of 5-30 minutes post-exercise. The low area of the ROC was 0.93 (0.85-1.00) for p < 0.001. CONCLUSION OEP can be accurately used to replace spirometry in asthmatic children unable to adequately execute the required manoeuvres.
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Affiliation(s)
| | - Murilo Carlos Amorim de Britto
- b Department of Pediatric Pulmonology , Instituto de Medicina Integral Prof. Fernando Figueira , Pernambuco, Recife , Brazil
| | - Andrea Aliverti
- c Department of Bioengineering , Politecnico di Milano , Milano , Italy
| | - Jéssica Brito Noronha
- a Department of Physiotherapy , Universidade Federal de Pernambuco , Pernambuco, Recife , Brazil
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11
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Magder S, Serri K, Verscheure S, Chauvin R, Goldberg P. Active Expiration and the Measurement of Central Venous Pressure. J Intensive Care Med 2016; 33:430-435. [PMID: 27872408 DOI: 10.1177/0885066616678578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To obtain a point prevalence estimate of alterations in central venous pressure (CVP) produced by active expiration in a consecutive series of intensive care patients. METHODS We evaluated CVP tracings taken by the nurses at their morning shift change in a consecutive series of 60 cardiac surgery and 59 noncardiac surgery patients. We also assessed change in values due to the change in transducer level. Three physicians and a nurse instructor independently reviewed the tracings and determined whether there was evidence of forced expiration and whether it was type A, defined by decreasing CVP during expiration, or type B, defined by increasing CVP during expiration. RESULTS Agreement for CVP value was 96% between a physician and a bedside nurse. Twenty-nine percent of participants had active expiration, evenly distributed between A and B types. Active expiration was not related to the type of surgery, use of bronchodilators, and the presence of chronic obstructive lung disease or abdominal distention. Active expiration was more common in nonventilated patients and patients not receiving vasopressor drugs, suggesting they were more awake. CONCLUSION Active expiration is common in critically ill patients. Failure to recognize it can result in important errors in the estimation of CVP and other hemodynamic measurements.
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Affiliation(s)
- Sheldon Magder
- 1 Division of Critical Care, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Karim Serri
- 2 Critical Care Department, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec
| | - Sara Verscheure
- 1 Division of Critical Care, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Renée Chauvin
- 1 Division of Critical Care, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Peter Goldberg
- 1 Division of Critical Care, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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12
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Abstract
Abdominal compliance (AC) is an important determinant and predictor of available workspace during laparoscopic surgery. Furthermore, critically ill patients with a reduced AC are at an increased risk of developing intra-abdominal hypertension and abdominal compartment syndrome, both of which are associated with high morbidity and mortality. Despite this, AC is a concept that has been neglected in the past.AC is defined as a measure of the ease of abdominal expansion, expressed as a change in intra-abdominal volume (IAV) per change in intra-abdominal pressure (IAP):AC = ΔIAV / ΔIAPAC is a dynamic variable dependent on baseline IAV and IAP as well as abdominal reshaping and stretching capacity. Whereas AC itself can only rarely be measured, it always needs to be considered an important component of IAP. Patients with decreased AC are prone to fulminant development of abdominal compartment syndrome when concomitant risk factors for intra-abdominal hypertension are present.This review aims to clarify the pressure-volume relationship within the abdominal cavity. It highlights how different conditions and pathologies can affect AC and which management strategies could be applied to avoid serious consequences of decreased AC.We have pooled all available human data to calculate AC values in patients acutely and chronically exposed to intra-abdominal hypertension and demonstrated an exponential abdominal pressure-volume relationship. Most importantly, patients with high level of IAP have a reduced AC. In these patients, only small reduction in IAV can significantly increase AC and reduce IAPs.A greater knowledge on AC may help in selecting a better surgical approach and in reducing complications related to intra-abdominal hypertension.
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Gregoretti C, Pisani L, Cortegiani A, Ranieri VM. Noninvasive Ventilation in Critically Ill Patients. Crit Care Clin 2015; 31:435-57. [DOI: 10.1016/j.ccc.2015.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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C M, E S, F B, A S, P S, G L, F B, S A S, S S. Development of a bio-inspired mechatronic chest wall simulator for evaluating the performances of opto-electronic plethysmography. Open Biomed Eng J 2015; 8:120-30. [PMID: 25624954 PMCID: PMC4302486 DOI: 10.2174/1874120701408010120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/29/2014] [Accepted: 10/31/2014] [Indexed: 11/22/2022] Open
Abstract
Instrumented gait analysis based on optoelectronic systems is an expensive technique used to objectively measure the human movement features and it is generally considered as the gold standard. Opto-electronic plethysmography (OEP) is a particular motion analysis system able to: (i) determine chest wall kinematic via the evaluation of marker displacements placed on the thorax and (ii) compute respiratory volumes during breathing.
The aim of this work is to describe the performances of a custom made, bio-inspired, mechatronic chest wall simulator (CWS), specifically designed to assess the metrological performances of the OEP system. The design of the simulator is based on the chest wall kinematic analysis of three healthy subjects previously determined.
Two sets of experiments were carried out: (i) to investigate the CWS dynamic response using different target displacements (1 - 12 mm), and (ii) to assess the CWS accuracy and precision in simulating quite breathing, covering the physiological range of respiratory frequency and tidal volume.
Results show that the CWS allows simulating respiratory frequency up to ~ 60 bpm. The difference between the actual displacement and the set one is always < 9 μm. The precision error, expressed as the ratio between measurement uncertainty and the actual displacement, is lower than 0.32 %.
The observed good performances permit to consider the CWS prototype feasible to be employed for assessing the performances of OEP system in periodical validation routines.
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Affiliation(s)
- Massaroni C
- Unit of Measurements and Biomedical Instrumentation, Center for Integrated Research, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Schena E
- Unit of Measurements and Biomedical Instrumentation, Center for Integrated Research, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Bastianini F
- Department of Engineering, University of ROMA TRE, Via della Vasca Navale 79/81, Roma, Italy
| | - Scorza A
- Department of Engineering, University of ROMA TRE, Via della Vasca Navale 79/81, Roma, Italy
| | - Saccomandi P
- Unit of Measurements and Biomedical Instrumentation, Center for Integrated Research, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Lupi G
- Department of Engineering, University of ROMA TRE, Via della Vasca Navale 79/81, Roma, Italy
| | - Botta F
- Department of Engineering, University of ROMA TRE, Via della Vasca Navale 79/81, Roma, Italy
| | - Sciuto S A
- Department of Engineering, University of ROMA TRE, Via della Vasca Navale 79/81, Roma, Italy
| | - Silvestri S
- Unit of Measurements and Biomedical Instrumentation, Center for Integrated Research, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
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15
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Evaristo KB, Saccomani MG, Martins MA, Cukier A, Stelmach R, Rodrigues MR, Santaella DF, Carvalho CRF. Comparison between breathing and aerobic exercise on clinical control in patients with moderate-to-severe asthma: protocol of a randomized trial. BMC Pulm Med 2014; 14:160. [PMID: 25326140 PMCID: PMC4216357 DOI: 10.1186/1471-2466-14-160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asthma is a chronic inflammatory airway disease characterized by reversible obstruction, inflammation and hyperresponsiveness to different stimulus. Aerobic and breathing exercises have been demonstrated to benefit asthmatic patients; however, there is no evidence comparing the effectiveness of these treatments. METHODS/DESIGN This is a prospective, comparative, blinded, and randomized clinical trial with 2 groups that will receive distinct interventions. Forty-eight asthmatic adults with optimized medical treatment will be randomly divided into either aerobic (AG) or breathing exercises (BG). Patients will perform breathing or aerobic exercise twice a week for 3 months, totalizing 24 sessions of 40 minutes each. Before intervention, both groups will complete an educational program consisting of 2 educational classes. Before and after interventions, the following parameters will be quantified: clinical control (main outcome), health related quality of life, levels of anxiety and depression, daily living physical activity and maximal exercise capacity (secondary outcome). Hyperventilation syndrome symptoms, autonomic nervous imbalance, thoracoabdominal kinematics, inflammatory cells in the sputum, fraction of exhaled nitric oxide (FENO) and systemic inflammatory cytokines will also be evaluated as possible mechanisms to explain the benefits of both interventions. DISCUSSION Although the benefits of breathing and aerobic exercises have been extensively studied, the comparison between both has never been investigated. Furthermore, the findings of our results will allow us to understand its application and suitability to patients that will have more benefits for every intervention optimizing its effect. TRIAL REGISTRATION Clinicaltrials.gov; Identifier: NCT02065258.
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Affiliation(s)
| | | | | | | | | | | | | | - Celso R F Carvalho
- Department of Physical Therapy, School of Medicine, University of São Paulo, Av, Dr Arnaldo 455, Rm 1210, São Paulo, SP 01246-903, Brazil.
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Pelosi P, Quintel M, Malbrain MLNG. Effect of intra-abdominal pressure on respiratory mechanics. Acta Clin Belg 2014; 62 Suppl 1:78-88. [PMID: 24881704 DOI: 10.1179/acb.2007.62.s1.011] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION There has been an exponentially increasing interest in intra-abdominal hypertension (IAH). The intra-abdominal pressure (IAP) markedly affects the function of the respiratory system. METHODS This review will focus on the available literature from the past few years. A Medline and Pubmed search was performed in order to find an answer to the question "What is the impact of increased IAP on respiratory function in the critically ill?". RESULTS In particular, increased IAP increases chest wall elastance (or decreases compliance) and promotes cranial shift of the diaphragm, with consequent reduction in lung volume and atelectasis formation. Compression of the lung parenchyma also triggers pulmonary infection. During general anaesthesia, in normal subjects, IAP does not affect the chest wall mechanics, but plays a relevant role in the caudal-cranial displacement of the abdominal content, the diaphragm and consequent changes in lung mechanics and function. In obese patients, the increased IAP is the major determinant of the reduction in lung volume, atelectasis formation and alterations in chest wall mechanics. In ARDS patients the measurement of IAP and chest wall mechanics is important for a better interpretation of respiratory mechanics, hemodynamics and appropriate setting of the ventilator. Furthermore, increased IAP promotes lung oedema, ventilator induced lung injury and reduced lymphatic flow in normal and diseased lungs. CONCLUSION Increased IAP markedly affects respiratory function in such a way that it has an impact on daily clinical practise.
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Glover G, Connolly B, Di Gangi S, Ayers L, Terblanche M, Beale R, Hart N. An observational cohort study to determine efficacy, adherence and outcome of the early initiation of pressure support ventilation during mechanical ventilation. BMJ Open Respir Res 2014; 1:e000028. [PMID: 25478179 PMCID: PMC4212705 DOI: 10.1136/bmjresp-2014-000028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/30/2014] [Accepted: 04/05/2014] [Indexed: 12/23/2022] Open
Abstract
Background Timely initiation of weaning from mechanical ventilation (MV) is important. Non-validated screening criteria may delay weaning if too prescriptive. This study observed physician-led utilisation of pressure support ventilation (PSV), referenced to four reported conventional screening criteria hypothesising that these criteria would have delayed the weaning progress. Methods A prospective observational cohort study of adult patients receiving MV in a 30-bed university hospital intensive care unit (ICU). Logistic regression analysis identified factors associated with PSV failure. Outcome is reported according to adherence to the screening criteria. Results 209 patients were included (age 62.6±15.9 years, male:female 115:94, Acute Physiology and Chronic Health Evaluation (APACHE) II 16.7±6.1). Median (IQR) time to initiate PSV was 11.0 (5.0–22.0) h, and duration of weaning to extubation was 43.0 (13.0–121.5) h. PSV weaning was initiated despite significant hypoxia (partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO2:FiO2) 35.8±15.9 kPa), moderate positive end-expiratory pressure levels (7.5±2.5 cm H2O), deep sedation (44% Richmond Agitation and Sedation Scale (RASS) ≤−3) and cardiovascular instability (48.8%). At PSV initiation, 85% of patients violated at least one screening criterion, yet 74.6% of patients remained stable for 24 h and 25.4% of patients were successfully extubated within 12 h. There was no association between individual screening criteria and PSV failure. Failure to sustain a PSV trial was associated with ventilation >7 days (RR=2.12 (1.33 to 3.38), p=0.002) and ICU mortality (RR=2.94 (1.46 to 5.94), p=0.002). Conclusions Physician-led transition to PSV and weaning was often initiated early and successfully before patients fulfilled conventional screening criteria. Failure to sustain a PSV trial could be an early indicator of prolonged MV and ICU mortality and warrants further investigation. These data support the view that current screening criteria may delay initiation of weaning.
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Affiliation(s)
- Guy Glover
- Department of Critical Care , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Bronwen Connolly
- Division of Asthma, Allergy and Lung Biology , King's College London , London , UK ; Lane Fox Respiratory Unit , Guy's and St Thomas' NHS Foundation Trust , London , UK ; Guy's and St Thomas' NHS Foundation Trust and King's College London, National Institute of Health Research Biomedical Research Centre , London , UK
| | - Stefania Di Gangi
- Department of Critical Care , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Lisa Ayers
- Department of Critical Care , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Marius Terblanche
- Department of Critical Care , Guy's and St Thomas' NHS Foundation Trust , London , UK ; Division of Health & Social Care Research, King's College London , London , UK
| | - Richard Beale
- Department of Critical Care , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Nicholas Hart
- Division of Asthma, Allergy and Lung Biology , King's College London , London , UK ; Lane Fox Respiratory Unit , Guy's and St Thomas' NHS Foundation Trust , London , UK ; Guy's and St Thomas' NHS Foundation Trust and King's College London, National Institute of Health Research Biomedical Research Centre , London , UK
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Sütterlin R, Priori R, Larsson A, LoMauro A, Frykholm P, Aliverti A. Frequency dependence of lung volume changes during superimposed high-frequency jet ventilation and high-frequency jet ventilation. Br J Anaesth 2013; 112:141-9. [PMID: 23963714 DOI: 10.1093/bja/aet260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Superimposed high-frequency jet ventilation (SHFJV) has proved to be safe and effective in clinical practice. However, it is unclear which frequency range optimizes ventilation and gas exchange. The aim of this study was to systematically compare high-frequency jet ventilation (HFJV) with HFJV by assessing chest wall volume variations (ΔEEV(CW)) and gas exchange in relation to variable high frequency. METHODS SHFJV or HFJV were used alternatively to ventilate the lungs of 10 anaesthetized pigs (21-25 kg). The low-frequency component was kept at 16 min(-1) in SHFJV. In both modes, high frequencies ranging from 100 to 1000 min(-1) were applied in random order and ventilation was maintained for 5 min in all modalities. Chest wall volume variations were obtained using opto-electronic plethysmography. Airway pressures and arterial blood gases were measured repeatedly. RESULTS SHFJV increased ΔEEV(CW) compared with HFJV; the difference ranged from 43 to 68 ml. Tidal volume (V(T)) was always >240 ml during SHFJV whereas during HFJV ranged from 92 ml at the ventilation frequency of 100 min(-1) to negligible values at frequencies >300 min(-1). We observed similar patterns for Pa(O₂) and Pa(CO₂). SHFJV provided generally higher, frequency-independent oxygenation (Pa(O₂) at least 32.0 kPa) and CO₂ removal (Pa(CO₂) ∼5.5 kPa), whereas HFJV led to hypoxia and hypercarbia at higher rates (Pa(O₂) <10 kPa and Pa(CO₂)>10 kPa at f(HF)>300 min(-1)). CONCLUSIONS In a porcine model, SHFJV was more effective in increasing end-expiratory volume than single-frequency HFJV, but both modes may provide adequate ventilation in the absence of airway obstruction and respiratory disease, except for HFJV at frequencies ≥300 min(-1).
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Affiliation(s)
- R Sütterlin
- Hedenstierna Laboratory, Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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19
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Lunardi AC, Paisani DDM, Tanaka C, Carvalho CRF. Impact of laparoscopic surgery on thoracoabdominal mechanics and inspiratory muscular activity. Respir Physiol Neurobiol 2013; 186:40-4. [DOI: 10.1016/j.resp.2012.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 12/20/2012] [Accepted: 12/28/2012] [Indexed: 10/27/2022]
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Povšič K, Fležar M, Možina J, Jezeršek M. Laser 3-D measuring system and real-time visual feedback for teaching and correcting breathing. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:036004. [PMID: 22502562 DOI: 10.1117/1.jbo.17.3.036004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present a novel method for real-time 3-D body-shape measurement during breathing based on the laser multiple-line triangulation principle. The laser projector illuminates the measured surface with a pattern of 33 equally inclined light planes. Simultaneously, the camera records the distorted light pattern from a different viewpoint. The acquired images are transferred to a personal computer, where the 3-D surface reconstruction, shape analysis, and display are performed in real time. The measured surface displacements are displayed with a color palette, which enables visual feedback to the patient while breathing is being taught. The measuring range is approximately 400×600×500 mm in width, height, and depth, respectively, and the accuracy of the calibrated apparatus is ±0.7 mm. The system was evaluated by means of its capability to distinguish between different breathing patterns. The accuracy of the measured volumes of chest-wall deformation during breathing was verified using standard methods of volume measurements. The results show that the presented 3-D measuring system with visual feedback has great potential as a diagnostic and training assistance tool when monitoring and evaluating the breathing pattern, because it offers a simple and effective method of graphical communication with the patient.
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Affiliation(s)
- Klemen Povšič
- University of Ljubljana, Faculty of Mechanical Engineering, Aškerčeva 6, 1000 Ljubljana, Slovenia.
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Leiter R, Aliverti A, Priori R, Staun P, Lo Mauro A, Larsson A, Frykholm P. Comparison of superimposed high-frequency jet ventilation with conventional jet ventilation for laryngeal surgery. Br J Anaesth 2012; 108:690-7. [PMID: 22258205 DOI: 10.1093/bja/aer460] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND New ventilators have simplified the use of supraglottic superimposed high-frequency jet ventilation (SHFJV(SG)), but it has not been systematically compared with other modes of jet ventilation (JV) in humans. We sought to investigate whether SHFJV(SG) would provide more effective ventilation compared with single-frequency JV techniques. METHODS A total of 16 patients undergoing minor laryngeal surgery under general anaesthesia were included. In each patient, four different JV techniques were applied in random order for 10-min periods: SHFJV(SG), supraglottic normal frequency (NFJV(SG)), supraglottic high frequency (HFJV(SG)), and infraglottic high-frequency jet ventilation (HFJV(IG)). Chest wall volume variations were continuously measured with opto-electronic plethysmography (OEP), intratracheal pressure was recorded and blood gases were measured. RESULTS Chest wall volumes were normalized to NFJV(SG) end-expiratory level. The increase in end-expiratory chest wall volume (EEV(CW)) was 239 (196) ml during SHFJV(SG) (P<0.05 compared with NFJV(SG)). EEV(CW) was 148 (145) and 44 (106) ml during HFJV(SG) and HFJV(IG), respectively (P<0.05 compared with SHFJV(SG)). Tidal volume (V(T)) during SHFJV(SG) was 269 (149) ml. V(T) was 229 (169) ml (P=1.00 compared with SHFJV(SG)), 145 (50) ml (P<0.05), and 110 (33) ml (P<0.01) during NFJV(SG), HFJV(SG), and HFJV(IG), respectively. Intratracheal pressures corresponded well to changes in both EEV(CW) and V(T). All JV modes resulted in adequate oxygenation. However, was lowest during HFJV(SG) [4.3 (1.3) kPa; P<0.01 compared with SHFJV(SG)]. CONCLUSION SHFJV(SG) was associated with increased EEV(CW) and V(T) compared with the three other investigated JV modes. All four modes provided adequate ventilation and oxygenation, and thus can be used for uncomplicated laryngeal surgery in healthy patients with limited airway obstruction.
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Affiliation(s)
- R Leiter
- Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Sjukhusvägen 1, Entrance 70, S-75185 Uppsala, Sweden.
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Effect of pressure support on end-expiratory lung volume and lung diffusion for carbon monoxide. Crit Care Med 2011; 39:2283-9. [DOI: 10.1097/ccm.0b013e3182227fce] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Layton AM, Garber CE, Thomashow BM, Gerardo RE, Emmert-Aronson BO, Armstrong HF, Basner RC, Jellen P, Bartels MN. Exercise ventilatory kinematics in endurance trained and untrained men and women. Respir Physiol Neurobiol 2011; 178:223-9. [PMID: 21708294 DOI: 10.1016/j.resp.2011.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 06/03/2011] [Accepted: 06/13/2011] [Indexed: 10/18/2022]
Abstract
To determine how increased ventilatory demand impacts ventilatory kinematics, we compared the total chest wall volume variations (V(CW)) of male and female endurance-trained athletes (ET) to untrained individuals (UT) during exercise. We hypothesized that training and gender would have an effect on V(CW) and kinematics at maximal exercise. Gender and training significantly influenced chest wall kinematics. Female ET did not change chest wall end-expiratory volume (V(CW,ee)) or pulmonary ribcage (V(RCp,ee)) with exercise, while female UT significantly decreased V(CW,ee) and V(RCp,ee) with exercise (p<0.05). Female ET significantly increased pulmonary ribcage end-inspiratory volume (V(RCp,ei)) with exercise (p<0.05), while female UT did not change V(RCp,ei) with exercise. Male ET significantly increased V(RCp,ei) with exercise (p<0.05); male UT did not. Men and women had significantly different variation of V(CW) (p<0.05). Women demonstrated the greatest variation of V(CW) in the pulmonary ribcage compartment (V(RCp)). Men had even volumes variation of the V(RCp) and the abdomen (V(Ab)). In conclusion, gender and training had a significant impact on ventilatory kinematics.
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Affiliation(s)
- Aimee M Layton
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 120th St., New York, NY 10027, USA.
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Aliverti A, Kostic P, Lo Mauro A, Andersson-Olerud M, Quaranta M, Pedotti A, Hedenstierna G, Frykholm P. Effects of propofol anaesthesia on thoraco-abdominal volume variations during spontaneous breathing and mechanical ventilation. Acta Anaesthesiol Scand 2011; 55:588-96. [PMID: 21385159 DOI: 10.1111/j.1399-6576.2011.02413.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anaesthesia based on inhalational agents has profound effects on chest wall configuration and breathing pattern. The effects of propofol are less well characterised. The aim of the current study was to evaluate the effects of propofol anaesthesia on chest wall motion during spontaneous breathing and positive pressure ventilation. METHODS We studied 16 subjects undergoing elective surgery requiring general anaesthesia. Chest wall volumes were continuously monitored by opto-electronic plethysmography during quiet breathing (QB) in the conscious state, induction of anaesthesia, spontaneous breathing during anaesthesia (SB), pressure support ventilation (PSV) and pressure control ventilation (PCV) after muscle paralysis. RESULTS The total chest wall volume decreased by 0.41 ± 0.08 l immediately after induction by equal reductions in the rib cage and abdominal volumes. An increase in the rib cage volume was then seen, resulting in total chest wall volumes 0.26 ± 0.09, 0.24 ± 0.10, 0.22 ± 0.10 l lower than baseline, during SB, PSV and PCV, respectively. During QB, rib cage volume displacement corresponded to 34.2 ± 5.3% of the tidal volume. During SB, PSV and PCV, this increased to 42.2 ± 4.9%, 48.2 ± 3.6% and 46.3 ± 3.2%, respectively, with a corresponding decrease in the abdominal contribution. Breathing was initiated by the rib cage muscles during SB. CONCLUSION Propofol anaesthesia decreases end-expiratory chest wall volume, with a more pronounced effect on the diaphragm than on the rib cage muscles, which initiate breathing after apnoea.
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Affiliation(s)
- A Aliverti
- TBM Lab, Dipartimento di Bioingegneria, Politecnico di Milano, Italy
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Optoelectronic Plethysmography has Improved our Knowledge of Respiratory Physiology and Pathophysiology. SENSORS 2008; 8:7951-7972. [PMID: 27873969 PMCID: PMC3791000 DOI: 10.3390/s8127951] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 11/25/2008] [Accepted: 11/27/2008] [Indexed: 11/22/2022]
Abstract
It is well known that the methods actually used to track thoraco-abdominal volume displacement have several limitations. This review evaluates the clinical usefulness of measuring chest wall kinematics by optoelectronic plethysmography [OEP]. OEP provides direct measurements (both absolute and its variations) of the volume of the chest wall and its compartments, according to the model of Ward and Macklem, without requiring calibration or subject cooperation. The system is non invasive and does not require a mouthpiece or nose-clip which may modify the pattern of breathing, making the subject aware of his breathing. Also, the precise assessment of compartmental changes in chest wall volumes, combined with pressure measurements, provides a detailed description of the action and control of the different respiratory muscle groups and assessment of chest wall dynamics in a number of physiological and clinical experimental conditions.
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Pulse and systolic pressure variation assessment in partially assisted ventilatory support. J Clin Monit Comput 2008; 22:355-9. [PMID: 18841485 DOI: 10.1007/s10877-008-9142-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 09/22/2008] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The use of pulse pressure variation (PPV) and systolic pressure variation (SPV) is possible during controlled ventilation (MV). Even in acute respiratory failure, controlled MV tends to be replaced by assisted ventilatory support. We tested if PPV and SPV during flow triggered synchronized intermittent mechanical ventilation (SIMV) could be as accurate as in controlled MV. METHODS Prospective case-controlled study. Thirty patients who met criteria of weaning from controlled MV. Twenty minutes pressure support ventilation with 3 min(-1) flow triggered SIMV breathes (10 ml kg(-1)) T1, then three consecutive breaths in controlled MV (respiratory rate 12 min(-1),10 ml kg(-1)) T2. PPV and SPV were measured in T1 and T2. Correlation and Bland-Altman analysis were used to compare respective values of PPV and SPV in the two modes of ventilation. RESULTS Significant correlations were found between dynamic indices in SIMV during pressure support ventilation and those in controlled MV mode. The mean differences between two measurements were: PPV 0.6+/-2.8% (limit of agreement: -5.0 and 6.2), SPV 0.5+/-2.3 mmHg (limit of agreement: -4.0 and 5.1). CONCLUSIONS PPV and SPV measured during SIMV fitted with the findings in controlled MV. Dynamic indexes could be accurately monitored in patients breathing with assisted respiratory assistance adding an imposed large enough SIMV breath.
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Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, Tallarini F, Cozzi P, Cressoni M, Colombo A, Marini JJ, Gattinoni L. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med 2008; 178:346-55. [PMID: 18451319 DOI: 10.1164/rccm.200710-1589oc] [Citation(s) in RCA: 470] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
RATIONALE Lung injury caused by a ventilator results from nonphysiologic lung stress (transpulmonary pressure) and strain (inflated volume to functional residual capacity ratio). OBJECTIVES To determine whether plateau pressure and tidal volume are adequate surrogates for stress and strain, and to quantify the stress to strain relationship in patients and control subjects. METHODS Nineteen postsurgical healthy patients (group 1), 11 patients with medical diseases (group 2), 26 patients with acute lung injury (group 3), and 24 patients with acute respiratory distress syndrome (group 4) underwent a positive end-expiratory pressure (PEEP) trial (5 and 15 cm H2O) with 6, 8, 10, and 12 ml/kg tidal volume. MEASUREMENTS AND MAIN RESULTS Plateau airway pressure, lung and chest wall elastances, and lung stress and strain significantly increased from groups 1 to 4 and with increasing PEEP and tidal volume. Within each group, a given applied airway pressure produced largely variable stress due to the variability of the lung elastance to respiratory system elastance ratio (range, 0.33-0.95). Analogously, for the same applied tidal volume, the strain variability within subgroups was remarkable, due to the functional residual capacity variability. Therefore, low or high tidal volume, such as 6 and 12 ml/kg, respectively, could produce similar stress and strain in a remarkable fraction of patients in each subgroup. In contrast, the stress to strain ratio-that is, specific lung elastance-was similar throughout the subgroups (13.4 +/- 3.4, 12.6 +/- 3.0, 14.4 +/- 3.6, and 13.5 +/- 4.1 cm H2O for groups 1 through 4, respectively; P = 0.58) and did not change with PEEP and tidal volume. CONCLUSIONS Plateau pressure and tidal volume are inadequate surrogates for lung stress and strain. Clinical trial registered with www.clinicaltrials.gov (NCT 00143468).
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Affiliation(s)
- Davide Chiumello
- Dipartimento di Anestesia, Rianimazione, Intensiva e Subintensivae, Terapia del Dolore, Fondazione IRCCS, Ospedale Maggiore Policlinico Mangiagalli Regina Elena di Milano, Milan, Italy.
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Vasquez D, Singh JM, Ferguson ND. Year in review 2006: Critical Care--Respirology. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:224. [PMID: 17764586 PMCID: PMC2206500 DOI: 10.1186/cc5963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present article summarises and places in context original research articles from the respirology section published in Critical Care in 2006. Twenty papers were identified and were grouped by topic into those addressing acute lung injury and ventilator-induced lung injury, those examining high-frequency oscillation, those studying pulmonary physiology and mechanics, those assessing tracheostomy, and those exploring other topics.
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Affiliation(s)
- Daniela Vasquez
- Interdepartmental Division of Critical Care Medicine, University of Toronto, and University Health Network, Toronto, Ontario, Canada
| | - Jeffrey M Singh
- Interdepartmental Division of Critical Care Medicine, University of Toronto, and University Health Network, Toronto, Ontario, Canada
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine, University of Toronto, and University Health Network, Toronto, Ontario, Canada
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Preserved spontaneous breathing in acute lung injury: show me the money? Intensive Care Med 2007; 34:397-9. [PMID: 18087690 DOI: 10.1007/s00134-007-0958-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Accepted: 11/15/2007] [Indexed: 10/22/2022]
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