Tag: PEEP

Tidal Volume Strategies for those without ARDS

This paper justifies utilizing a higher tidal volume strategy for our patients without primary ARDS/pulmonary disease. This can be very useful. Patient comfort and patient-ventilator synchrony are extremely important. This... read more

Applied Physiology at the Bedside: Volumetric Capnography

Volumetric capnography is the graphical representation of the partial pressure of carbon dioxide (CO2) versus exhaled volume. This measurement is made noninvasively at every breath by a combination of flow and CO2 sensors,... read more

Determination of Brain Death Under Extracorporeal Life Support

The worldwide use of extracorporeal lung/life support is increasing in severe lung failure (veno-venous extracorporeal membrane oxygenation, vvECMO) or in cardiac arrest/severe circulatory failure (veno-arterial ECMO, vaECMO).... read more

Effect of Titrating PEEP with Esophageal Pressure-Guided Strategy vs Empirical High PEEP-Fio2 Strategy on Death and Days Free From Mechanical Ventilation Among Patients With ARDS

Among patients with moderate to severe Acute Respiratory Distress Syndrome (ARDS), PES-guided positive end-expiratory pressure (PEEP), compared with empirical high PEEP-Fio2, resulted in no significant difference in death... read more

The Shocked Intubation: Definitive Airway Sans Hypotension

Not many aspects of Emergency Medicine define our specialty better than resuscitation, and few concepts exemplify resuscitation better than shock and intubation. Yet few words together strike greater fear in the minds of... read more

Adjunct and Rescue Therapies for Refractory Hypoxemia

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... read more

Prone Positioning for a Morbidly Obese Patient with ARDS

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,... read more

High Flow Nasal Cannula (HFNC) – Part 1: How It Works

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... read more

Oxygenate, Ventilate, Do No Harm

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... read more

Effect of Decompressive Laparotomy on Organ Function in Patients with Abdominal Compartment Syndrome

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.... read more

Positive End-Expiratory Pressure Lower Than the ARDS Network Protocol Is Associated with Higher Pediatric ARDS Mortality

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... read more

Neurally adjusted ventilatory assist

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... read more

Non-invasive Ventilation in the ED: Whom, When, How?

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... read more

The Answer My Friend is Blowin’ in your Nose – High Flow Nasal Oxygen

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... read more

Muscle Weakness and 5-Year Survival in ARDS Survivors

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... read more

Best PEEP Trials are Dependent on Tidal Volume

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... read more

Simplifying Mechanical Ventilation

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... read more

Prone Positioning of ARDS Patients

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... read more

Variation of Poorly Ventilated Lung Units Measured by EIT to Dynamically Assess Recruitment

Assessing alveolar recruitment at different positive end-expiratory pressure (PEEP) levels is a major clinical and research interest because protective ventilation implies opening the lung without inducing overdistention.... read more

Mechanical Ventilation Strategies for the Surgical Patient

The understanding on the protective roles of tidal volume and PEEP settings against PPCs has rapidly expanded. During intraoperative ventilation, low tidal volumes are protective, the protective role of high levels of PEEP... read more

Effect of Lung Recruitment and Titrated PEEP vs Low PEEP on Mortality in Patients with ARDS

In patients with moderate to severe Acute Respiratory Distress Syndrome (ARDS), a strategy with lung recruitment and titrated Positive End-Expiratory Pressure (PEEP) compared with low PEEP increased 28-day all-cause mortality.... read more

The Future of Mechanical Ventilation

The adverse effects of mechanical ventilation in acute respiratory distress syndrome (ARDS) arise from two main causes: unphysiological increases of transpulmonary pressure and unphysiological increases/decreases of pleural... read more