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Clinical practice guidelines for mechanical ventilation in adult patients with ARDS

02.10.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms, Simon Franz

Acute respiratory distress syndrome (ARDS) is characterized by an inflammatory pulmonary edema resulting in severe hypoxemia. The recent LUNG SAFE study showed that ARDS is common in the ICU, occurring in 10% of all patients admitted (1).

ARDS, VILI, guideline, mechanical ventilation, mortality, tidal volume, inspiratory pressure, prone positioning, HFOV, PEEP, recruitment maneuvers, ECMO, recruitment

Hyperoxemia in the ICU

05.07.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms, Simon Franz

Hyperoxemia can be defined as an increase in arterial oxygen partial pressure (PaO2) to a level greater than 120 mmHg (16 kPa) (1, 2). It is considered to be moderate for levels ranging between 120 and 200 mmHg, and severe if PaO2 exceeds 200 mmHg (27 kPa) (3). Hyperoxemia is caused by hyperoxia (an increase in oxygen) and occurs in 22% to 50% of mechanically ventilated patients in the ICU (1, 3-6).

hyperoxemia, hypoxia, hyperoxia, mortality, PaO2, SpO2, pulse oximetry, oxygenation, closed loop, Intellivent

Driving pressure in ARDS patients

08.05.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms

ARDS is characterized by lung collapse and consolidation leaving just a small portion of aerated lung remaining, which is at risk of ventilator-induced lung injuries (baby-lung concept).

driving pressure, lung safe, limiting driving pressure, hospital mortality, ARDS

Acute Respiratory Distress Syndrome In the Adult and Pediatric Population

03.04.2017
Author: Joe Hylton, M.A., RRT-ACCS/NPS, NRP, FAARC, FCCM, Clinical Account Manager, Hamilton Medical, Inc., Reviewer: Paul Garbarini

Acute Respiratory Distress Syndrome (ARDS) is a potentially devastating clinical disorder, affecting critically ill patients of all ages. Hypoxemic respiratory failure is a common characteristic, requiring invasive or non-invasive mechanical ventilation. Mechanical ventilation provides critical support while clinical interventions and recovery time allow potential resolution of the acute disease process. However, clinically inappropriate techniques utilizing mechanical ventilation can further precipitate lung injury and possibly delay or prevent recovery.

ALI, acute lung injury, ARDS, distress syndrome

Findings from the "Lung Safe" ARDS Epidemiology Study

03.04.2017
Author: Paul Garbarini MS, RRT, VP Product Research and Development US, Hamilton Medical, Inc., Reviewer: Mark Soucy

The Lung Safe study Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries (1) evaluated the recognition, incidence, mortality and management of ARDS in 450 ICU’s in 50 countries. The results of the study may be somewhat surprising in comparison to common perceptions.

ARDS, study, epidemiology, lung safe, criteria

Clinical practice guidelines for weaning critically ill adult patients from mechanical ventilation

03.04.2017
Author: Dr. med. Jean-Michel Arnal, Senior Intensivist, Hopital Sainte Musse, Toulon, France, Reviewer: Paul Garbarini

Due to the complications associated with mechanical ventilation, clinicians should implement strategies to liberate patients from mechanical ventilation as soon as the underlying cause for mechanical ventilation has sufficiently improved, and the patient is able to maintain spontaneous breathing unassisted.

Weaning, guidelines, liberate, liberation, recommendations, protocol, mechanical, ventilation

Bedside tip: How to set high flow oxygen therapy

15.12.2017
Author: Clinical Experts Group, Hamilton Medical , Reviewer: Paul Garbarini, David Grooms

High flow oxygen therapy combines several physiological effects: Oxygenation, PEEP, an increase in the end-expiratory lung volume (EELV), a lower respiratory rate (RR), a decrease in intrinsic PEEP and work of breathing, lower PaCO2, and improved humidification and comfort (1, 2). The optimal flow setting depends on the indications and the desired physiological effect.

high flow oxygen therapy, HFOT, settings, oxygenation, PEEP, flow

Test your IntelliVence (Vol 14 Issue 4)

02.10.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms, Simon Franz

What causes this temporary stop in breathing?

Cheyne stokes, CSR, apnea, stop breathing

Bedside tip: How to perform a recruitment maneuver

02.10.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms, Simon Franz

A recruitment maneuver (RM) is a transient increase in transpulmonary pressure applied to reaerate the collapsed lung.

recruitment, recruitment maneuver, ARDS, PEEP, sustained inflation, PV Tool

Test your IntelliVence (Vol 14 Issue 3)

05.07.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms, Simon Franz

What causes the distortions of pressure and flow during the second breath?

triggering, reverse triggering, muscle contractions, insufflation, double inspiration

Bedside tip: How to select SpO2 targets

05.07.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms, Simon Franz

In mechanically ventilated patients, SpO2 targets are selected according to the previous lung condition and the actual severity of the disease.

spo2, spo2 targets, ARDS, normal lung, hypercapnia, brain injury, PEEP

Test your IntelliVence (Vol 14 Issue 2)

09.05.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms

Why are there oscillations in the pressure and flow waveforms?

oscillations, pressure waveform, flow waveform, proximal airways, distal airways, secretions

Bedside tip: How to measure driving pressure

09.05.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms

Airway driving pressure is associated with clinical outcomes in ARDS, post-surgical, and normal-lung patients, and is a measure of the strain applied to the respiratory system and the risk of ventilator-induced lung injuries. Evidence suggests we should keep driving pressure below 14 cmH2O. But how can we measure it?

driving pressure, hold maneuver, end-expiratory, end-inspiratory, plateau pressure, PEEP, ASV

Test your IntelliVence (Vol 14 Issue 1)

05.04.2017
Author: Dr. med. Jean-Michel Arnal, Senior Intensivist, Hopital Sainte Musse, Toulon, France, Reviewer: Paul Garbarini

What does this small bump at the beginning of expiration represent?

expiration, premature, cycling, cycles, inspiratory, effort, insufflation, trigger sensitivity

Bedside tip: How to wean with ASV®

03.04.2017
Author: Dr. med. Jean-Michel Arnal, Senior Intensivist, Hopital Sainte Musse, Toulon, France, Reviewer: Paul Garbarini

The American Thoracic Society and the American College of Chest Physicians recently provided recommendations to help optimize liberation from mechanical ventilation in adult ICU patients (1). They suggest using a ventilator liberation protocol and performing spontaneous breathing trials (SBTs) with modest inspiratory pressure support (5-8 cmH2O). So how do we implement these recommendations using the Adaptive Support Ventilation (ASV) mode?

weaning, wean, ASV, recommendations, liberation, protocol, criteria, readiness-to-wean