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Intelligent Ventilation newsletter articles
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Recommendations for mechanical ventilation of critically ill children12.06.2018
Common clinical practice in pediatric mechanical ventilation is largely based on personal experience or what has been adopted from adult and neonatal studies. There is a fundamental lack of clinical evidence to support the daily practice of pediatric mechanical ventilation, due in part to the extensive variability in lung size, maturity and range of acute and chronic respiratory conditions existing in all age groups of children.
pediatrics, airway mechanics, respiratory system, oxygenation, targets, inspiratory time, frequency, pressure, tidal volume, PEEP, guideline
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Monitoring respiratory mechanics in mechanically ventilated patients30.04.2018
The term respiratory mechanics describes the mechanical properties of the respiratory system that is inflated during mechanical ventilation. Monitoring respiratory mechanics is useful for diagnosing the lung condition, assessing the evolution and severity of the lung impairment, and adjusting ventilator settings.
respiratory mechanics, monitoring, time constant, rcexp, expiratory time constant,
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Clinical practice guidelines for use of noninvasive ventilation for acute respiratory failure22.02.2018
The use of noninvasive ventilation (NIV) has increased considerably over the last two decades and is now widespread in the acute-care setting for management of acute respiratory failure (ARF). A guideline committee selected 11 questions relating to the clinical application of NIV for various etiologies of ARF based on their perceived clinical importance, and assessed the evidence currently available to develop corresponding recommendations [1].
NIV, guidelines, acute respiratory failure, ARF, noninvasive, noninvasive ventilation, weaning, asthma, post-extubation, respiratory failure, chest trauma, palliative care, post-operative, de novo ARF, immunocompromised, cardiogenic pulmonary edema, pulmonary edema, hypercapnia, hypercapnic, COPD exacerbation, respiratory acidosis
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High flow oxygen therapy after planned extubation19.12.2017
Oxygenation and ventilation impairment after planned extubation is frequent. Post-extubation respiratory management aims to decrease the risk of early acute respiratory failure and reintubation, which is associated with a poor prognosis (1).
high flow oxygen therapy, HFOT, extubation, oxygenation impairment, reintubation, post-extubation respiratory failure, high-risk patients, NIV, non invasive ventilation
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Clinical practice guidelines for mechanical ventilation in adult patients with ARDS02.10.2017
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
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Hyperoxemia in the ICU05.07.2017
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
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Driving pressure in ARDS patients08.05.2017
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
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Acute Respiratory Distress Syndrome In the Adult and Pediatric Population03.04.2017
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
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Findings from the "Lung Safe" ARDS Epidemiology Study03.04.2017
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
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Clinical practice guidelines for weaning critically ill adult patients from mechanical ventilation03.04.2017
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
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Test your IntelliVence (Vol 15 Issue 3)12.06.2018
A 6-month-old infant with combined tracheal stenosis and malacia both located in the subglottic trachea (therefore extrathoracically) is ventilated noninvasively with Heliox due to respiratory distress. In addition, abdominal distension is limited by a cast (reaching up to the abdomen). How would you explain the biphasic shape of the waveform for both the inspiratory and expiratory flow?
flow limitation, expiratory phase, inspiratory phase, biphasic shape, stenosis, malacia, trachea, extrathoracic, obstruction
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Bedside tip: Using measured airway mechanics in pediatrics12.06.2018
The expiratory time constant (RCexp) is measured breath-by-breath on all Hamilton Medical ventilators. As RCexp is the product of compliance and resistance, this single variable gives us an overview of the overall respiratory mechanics.
Rcexp, respiratory mechanics, compliance, resistance, time constant, settings, flow interruption, restriction, obstructive condition, mixed disease, pediatric
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Test your IntelliVence (Vol 15 Issue 2)25.04.2018
This patient is passive and ventilated in pressure-control mode. Why is the flow curve shaped this way?
pressure control mode, flow limitation, COPD, expiratory flow, bicompartmental expiration, choke point, brochospasm
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Bedside tip: How to use the expiratory time constant25.04.2018
The expiratory time constant (RCEXP) is a dynamic measurement of respiratory mechanics measured breath-by-breath on all Hamilton Medical ventilators.
rcexp, time constant, expiratory time constant, compliance, resistance, monitoring, respiratory mechanics
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Test your IntelliVence (Vol 15 Issue 1)20.03.2018
Why is the flow shape different for the second breath? The patient is ventilated in pressure-support mode with no backup respiratory rate (RR).
auto triggering, inspiratory effort, esophageal pressure, pressure, flow, slope, inspiratory flow, asynchrony, mechanical breath
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Bedside tip: How to set expiratory trigger sensitivity (ETS)22.02.2018
Optimal patient-ventilator synchrony is of prime importance, as asynchronies lead to increased work of breathing and patient discomfort, and are also associated with higher mortality and prolonged mechanical ventilation (1, 2, 3).
ets, expiratory trigger, inspiratory trigger, expiratory trigger sensitivity, asynchrony, delayed cycling, late cycling, trigger adjustment, double triggering, IntelliSync
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Test your IntelliVence (Vol 14 Issue 5)19.12.2017
Why is the end-expiratory flow positive (above baseline)?
NIV, noninvasive ventilation, leak compensation, end-expiratory flow, leak rate
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Bedside tip: How to set high flow oxygen therapy15.12.2017
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
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Test your IntelliVence (Vol 14 Issue 4)02.10.2017
What causes this temporary stop in breathing?
Cheyne stokes, CSR, apnea, stop breathing
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Bedside tip: How to perform a recruitment maneuver02.10.2017
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
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Test your IntelliVence (Vol 14 Issue 3)05.07.2017
What causes the distortions of pressure and flow during the second breath?
triggering, reverse triggering, muscle contractions, insufflation, double inspiration
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Bedside tip: How to select SpO2 targets05.07.2017
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
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Test your IntelliVence (Vol 14 Issue 2)09.05.2017
Why are there oscillations in the pressure and flow waveforms?
oscillations, pressure waveform, flow waveform, proximal airways, distal airways, secretions
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Bedside tip: How to measure driving pressure09.05.2017
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
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Test your IntelliVence (Vol 14 Issue 1)05.04.2017
What does this small bump at the beginning of expiration represent?
expiration, premature, cycling, cycles, inspiratory, effort, insufflation, trigger sensitivity
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Bedside tip: How to wean with ASV®03.04.2017
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
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