Tag: PEEP

Upvote Story 14
The Advanced Ventilator Book is a companion to the best-selling The Ventilator Book and is written for clinicians who already have a solid foundation in the basics of mechanical ventilation. It goes beyond the ventilator itself to discuss strategies for severe hypoxemia and rescue maneuvers for refractory respiratory failure. Subjects covered in The Advanced Ventilator Book include: Optimal PEEP, Treatment of severe bronchospasm, Prone positioning,... Read More | Comment
Upvote Story 5
Prone position, inhaled nitric oxide, high frequency oscillation, extra corporeal life support. The mortality of severe acute respiratory distress syndrome (ARDS), defined with a PaO2/FiO2 ratio of 100 mmHg or less with at least 5 cm H2O of PEEP, still exceeds 40%. Furthermore, although it is true that more ARDS patients die from multi-organ failure than hypoxemia per se, an important subgroup of severe ARDS... Read More | Comment
Upvote Story 5
Since the description in the 1970s of external positive end-expiratory pressure for acute respiratory distress syndrome (ARDS), the optimum level of external positive end-expiratory pressure remains unresolved. In the 1990s, the lower inflection point, an inspiratory phenomenon on the low-flow pressure–volume curve, was defined as the point above which external positive end-expiratory pressure should be set to ensure full opening of the lung, e.g., open... Read More | Comment
Upvote Story 5
The use of heated and humidified high flow nasal cannula (HFNC) has become increasingly popular in the treatment of patients with acute respiratory failure through all age groups. I first started using it as a pediatric intensive care fellow, but had little knowledge of how it actually worked. I noticed a few years after using it successfully in children, mainly with severe bronchiolitis, that we... Read More | Comment
Upvote Story 6
Emergency physicians (EPs) are experts in emergent airway management and thus must be confident managing mechanical ventilation. Hospital-wide bed shortages mean that EPs will be managing admitted patients for longer periods of time, and if you work in a hospital without intensivist coverage you must be the ventilator expert. A recent study suggests implementing a ventilator protocol in the emergency department can improve mortality in... Read More | Comment
Upvote Story 4
Decompressive laparotomy has been advised as potential treatment for abdominal compartment syndrome (ACS) when medical management fails; yet, the effect on parameters of organ function differs markedly in the published literature. In this study, we sought to investigate the effect of decompressive laparotomy on intra-abdominal pressure and organ function in critically ill adult and pediatric patients with ACS, specifically focusing on hemodynamic, respiratory, and kidney... Read More | Comment
Upvote Story 7
Patients with PARDS managed with lower PEEP relative to FiO2 than recommended by the ARDSNet model had higher mortality. Clinical trials targeting PEEP management in PARDS are needed. This was a multicenter, retrospective analysis of patients with pediatric acute respiratory distress syndrome (PARDS) managed without a formal PEEP/FiO2 protocol. Four distinct datasets were combined for analysis. Read More | Comment
Upvote Story 4
Several studies nowadays prove the physiological benefits of neurally adjusted ventilatory assist, as opposed to the conventional modes of partial support. Whether these advantages translate into improvement of clinical outcomes remains to be determined. Compared with pressure support, neurally adjusted ventilatory assist has been shown to improve patient–ventilator interaction and synchrony in patients with the most challenging respiratory system mechanics, such as very low compliance... Read More | Comment
Upvote Story 5
In this post I will briefly explain and critique their mathematical approach, propose a simpler equation for estimating PEEPi in APRV [based on far fewer physiological assumptions] and finally reaffirm why, in my opinion, driving pressure is a troublesome variable, particularly in APRV. It is entirely possible that a patient with severe ARDS secondary to trauma-induced pancreatitis and a patient with equally severe ARDS from... Read More | Comment
Upvote Story 5
Timely use of NIV in the ED may decrease the need for invasive ventilation and its associated complications. The appropriate device, interface and patient selection are, therefore, key components of NIV success. Once the decision is given to apply NIV, EP should decide on the mode (either CPAP or BPAP), the interface, and the circuit that is suitable for the ventilator. Continuous positive airway pressure... Read More | Comment
Upvote Story 5
High flow nasal oxygen is a novel device that actively humidifies and heats air to make flows of up to 60 liters a minutes tolerable. These incredibly high flows are important, because in order to provide 100% fiO2 to patients in respiratory distress, we must be able to match their minute ventilation. High flow nasal oxygen also offers the theoretical benefits of low levels of... Read More | Comment
Upvote Story 10
At hospital discharge, >1/3 of Acute Respiratory Distress Syndrome (ARDS) survivors had muscle weakness. Greater strength at discharge and throughout follow-up was associated with improved 5-year survival. In patients with post-ICU weakness, both persisting and resolving trajectories, were commonly experienced and associated with worse survival during follow-up. Strength was evaluated with standardized manual muscle testing using the Medical Research Council sumscore (range: 0–60, higher is... Read More | Comment
Upvote Story 10
Determining the optimal positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome remains an area of active investigation. Most trials individualizing PEEP optimize one physiologic parameter (e.g., driving pressure) by titrating PEEP while holding other ventilator settings constant. Optimal PEEP, however, may depend on the tidal volume, and changing the tidal volume with which a best PEEP trial is performed may lead to... Read More | Comment
Upvote Story 4
Mechanical Ventilation is a modality commonly used in the critically ill, but many providers, may not have a strong understanding of the basics. Emergency Medicine and Critical Care Physicians need to have a firm grasp of the basic concepts of mechanical ventilation because without it, we can do serious harm to our patients. Airway management is not complete once the endotracheal tube is placed through... Read More | Comment
Upvote Story 11
A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study. While prone positioning (PP) has been shown to improve patient survival in moderate to severe acute respiratory distress syndrome (ARDS) patients, the rate of application of PP in clinical practice still appears low. Over the study period, 6723 patients were screened in 141 ICUs from 20... Read More | Comment