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    946 results match your criteria Barotrauma and Mechanical Ventilation

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    [A Meta analysis of the efficacy of high-frequency oscillatory ventilation versus conventional mechanical ventilation for treating pediatric acute respiratory distress syndrome].
    Zhongguo Dang Dai Er Ke Za Zhi 2017 Apr;19(4):430-435
    Department of Pediatrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
    Objective: To systematically assess the clinical efficacy of high-frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) for treating pediatric acute respiratory distress syndrome (ARDS).

    Methods: Data from randomized controlled trials comparing HFOV and CMV in the treatment of pediatric ARDS published before July 2016 were collected from the Cochrane Library, PubMed, Medline, CNKI, and Wanfang Data. Literature screening, data extraction, and quality assessment were performed by two independent reviewers according to the inclusion and exclusion criteria. Read More

    Rationale, study design and analysis plan of the lung imaging morphology for ventilator settings in acute respiratory distress syndrome study (LIVE study): Study protocol for a randomised controlled trial.
    Anaesth Crit Care Pain Med 2017 Mar 18. Epub 2017 Mar 18.
    Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Université Clermont-Auvergne, CNRS, Inserm, GReD, 63000 Clermont-Ferrand, France. Electronic address:
    Different acute respiratory distress syndrome (ARDS) phenotypes may explain controversial results in clinical trials. Lung-morphology is one of the ARDS-phenotypes and physiological studies suggest different responses in terms of positive-end-expiratory-pressure (PEEP) and recruitment-manoeuvres (RM) according to loss of aeration. To evaluate whether tailored ventilator regimens may impact ARDS outcomes, our group has designed a randomised-clinical-trial of ventilator settings according to lung morphology in moderate-to-severe ARDS (LIVE study). Read More

    Severity of Hypoxemia and Effect of High Frequency Oscillatory Ventilation in ARDS.
    Am J Respir Crit Care Med 2017 Feb 28. Epub 2017 Feb 28.
    University of Toronto, 7938, Toronto, Ontario, Canada ;
    Rationale: High frequency oscillatory ventilation (HFOV) is theoretically beneficial for lung protection but the results of clinical trials are inconsistent, with study-level meta-analyses suggesting no significant effect on mortality.

    Objectives: The aim of this individual patient data meta-analysis was to identify ARDS patient subgroups with differential outcomes from HFOV.

    Methods: After a comprehensive search for trials, two reviewers independently identified randomized trials comparing HFOV with conventional ventilation for adults with ARDS. Read More

    The impact of a pulmonary recruitment maneuver to reduce post-laparoscopic shoulder pain: A randomized controlled trial.
    Eur J Obstet Gynecol Reprod Biol 2017 Jan 16;208:55-60. Epub 2016 Nov 16.
    Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address:
    Objective: A pulmonary recruitment maneuver (PRM) can effectively reduce post-laparoscopic shoulder pain (PLSP). However, a high-pressure PRM may cause pulmonary barotrauma. This study aimed to evaluate the efficacy and safety of a PRM using two different maximum inspiratory pressures (40 and 60cmH2O) for reducing PLSP. Read More

    Recruitment manoeuvres for adults with acute respiratory distress syndrome receiving mechanical ventilation.
    Cochrane Database Syst Rev 2016 11 17;11:CD006667. Epub 2016 Nov 17.
    Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia, 3181.
    Background: Recruitment manoeuvres involve transient elevations in airway pressure applied during mechanical ventilation to open ('recruit') collapsed lung units and increase the number of alveoli participating in tidal ventilation. Recruitment manoeuvres are often used to treat patients in intensive care who have acute respiratory distress syndrome (ARDS), but the effect of this treatment on clinical outcomes has not been well established. This systematic review is an update of a Cochrane review originally published in 2009. Read More

    Jet Ventilation during Rigid Bronchoscopy in Adults: A Focused Review.
    Biomed Res Int 2016 26;2016:4234861. Epub 2016 Oct 26.
    Department of Anesthesiology, Université catholique de Louvain, CHU UCL Namur, Avenue G. Therasse 1, 5530 Yvoir, Belgium.
    The indications for rigid bronchoscopy for interventional pulmonology have increased and include stent placements and transbronchial cryobiopsy procedures. The shared airway between anesthesiologist and pulmonologist and the open airway system, requiring specific ventilation techniques such as jet ventilation, need a good understanding of the procedure to reduce potentially harmful complications. Appropriate adjustment of the ventilator settings including pause pressure and peak inspiratory pressure reduces the risk of barotrauma. Read More

    Management of Sedation and Paralysis.
    Clin Chest Med 2016 Dec 13;37(4):723-739. Epub 2016 Oct 13.
    Duke University Medical Center, DUMC Box 3094, Durham, NC 27710, USA.
    Sedatives are administered to decrease patient discomfort and agitation during mechanical ventilation and to maintain patient-ventilator synchrony. Titration of infusions and or bolus dosing to maintain light sedation goals according to validated scales is recommended. However, it is important to consider deeper sedation for patients with refractory patient-ventilator dyssynchrony (PVD) to prevent volutrauma and barotrauma. Read More

    Ventilator-induced Lung Injury.
    Clin Chest Med 2016 Dec 14;37(4):633-646. Epub 2016 Oct 14.
    Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, Cox 201, Boston, MA 02114, USA.
    Prevention of ventilator-induced lung injury (VILI) can attenuate multiorgan failure and improve survival in at-risk patients. Clinically significant VILI occurs from volutrauma, barotrauma, atelectrauma, biotrauma, and shear strain. Differences in regional mechanics are important in VILI pathogenesis. Read More

    Emergency ventilation with the Ventrain(®) through an airway exchange catheter in a porcine model of complete upper airway obstruction.
    Can J Anaesth 2017 Jan 28;64(1):37-44. Epub 2016 Oct 28.
    Department of Anesthesiology and Pain Therapy, Maastricht University Medical Center, PO Box 5800, Maastricht, AZ, 6202, The Netherlands.
    Purpose: During difficult airway management, oxygen insufflation through airway-exchange and intubating catheters (AEC/IC) can lead to life-threatening hyperinflation. Ventrain(®) was originally designed to facilitate emergency ventilation using active expiration through short, small-bore cannulas. Herein, we studied its efficacy (oxygenation and ventilation) and safety (avoidance of hyperinflation) in a long, small-bore AEC. Read More

    Exploring alternative routes for oxygen administration.
    Intensive Care Med Exp 2016 Dec 10;4(1):34. Epub 2016 Oct 10.
    Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK.
    Background: Hypoxemia may compromise cell metabolism and organ function. Supplemental oxygen (O2) at high concentrations may prove ineffective, and issues relating to hyperoxia, barotrauma, mechanical ventilation, and extracorporeal oxygenation are well documented. Old reports suggest the potential safety and efficacy of alternative routes for O2 administration, such as intravenous or intestinal. Read More

    Venovenous Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure.
    Am Surg 2016 Sep;82(9):787-8
    Sections of Pediatric Surgery and Neonatology, Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
    Conventional treatment of respiratory failure involves positive pressure ventilation that can worsen lung damage. Extracorporeal membrane oxygenation (ECMO) is typically used when conventional therapy fails. In this study, we evaluated the use of venovenous (VV)-ECMO for the treatment of severe pediatric respiratory failure at our institution. Read More

    Prevalence and risk factors of pneumothorax among patients admitted to a Pediatric Intensive Care Unit.
    Indian J Crit Care Med 2016 Aug;20(8):453-8
    Pediatric Department, Pediatric Intensive Care Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
    Objective: Pneumothorax should be considered a medical emergency and requires a high index of suspicion and prompt recognition and intervention.

    Aims: The objective of the study was to evaluate cases developing pneumothorax following admission to a Pediatric Intensive Care Unit (PICU) over a 5-year period.

    Settings And Design: Case notes of all PICU patients (n = 1298) were reviewed, revealing that 135 cases (10. Read More

    Comparison of pressure-controlled ventilation with volume-controlled ventilation during one-lung ventilation: a systematic review and meta-analysis.
    BMC Anesthesiol 2016 Aug 31;16(1):72. Epub 2016 Aug 31.
    Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 133-792, Republic of Korea.
    Background: Not only arterial hypoxemia but acute lung injury also has become the major concerns of one-lung ventilation (OLV). The use of pressure-controlled ventilation (PCV) for OLV offers the potential advantages of lower airway pressure and intrapulmonary shunt, which result in a reduced risk of barotrauma and improved oxygenation, respectively.

    Methods: We searched Medline, Embase, the Cochrane central register of controlled trials and KoreaMedto find publications comparing the effects of PCV with those of volume-controlled ventilation (VCV) during intraoperative OLV in adults. Read More

    Transtracheal jet ventilation in the 'can't intubate can't oxygenate' emergency: a systematic review.
    Br J Anaesth 2016 Sep;117 Suppl 1:i28-i38
    Department of Anesthesia, Pharmacology and Therapeutics and Department of Medicine, Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
    Background: Transtracheal jet ventilation (TTJV) is recommended in several airway guidelines as a potentially life-saving procedure during the 'Can't Intubate Can't Oxygenate' (CICO) emergency. Some studies have questioned its effectiveness.

    Methods: Our goal was to determine the complication rates of TTJV in the CICO emergency compared with the emergency setting where CICO is not described (non-CICO emergency) or elective surgical setting. Read More

    Diaphragm Dysfunction in Mechanically Ventilated Patients.
    Arch Bronconeumol 2017 Mar 21;53(3):150-156. Epub 2016 Aug 21.
    Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar de Barcelona, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)-GREPAC, Barcelona, España; Universitat Pompeu Fabra, Barcelona, España; CIBERES, España. Electronic address:
    Muscle involvement is found in most critical patients admitted to the intensive care unit (ICU). Diaphragmatic muscle alteration, initially included in this category, has been differentiated in recent years, and a specific type of muscular dysfunction has been shown to occur in patients undergoing mechanical ventilation. We found this muscle dysfunction to appear in this subgroup of patients shortly after the start of mechanical ventilation, observing it to be mainly associated with certain control modes, and also with sepsis and/or multi-organ failure. Read More

    The role of stretch-activated ion channels in acute respiratory distress syndrome: finally a new target?
    Am J Physiol Lung Cell Mol Physiol 2016 Sep 12;311(3):L639-52. Epub 2016 Aug 12.
    University of California Los Angeles, Los Angeles, California
    Mechanical ventilation (MV) and oxygen therapy (hyperoxia; HO) comprise the cornerstones of life-saving interventions for patients with acute respiratory distress syndrome (ARDS). Unfortunately, the side effects of MV and HO include exacerbation of lung injury by barotrauma, volutrauma, and propagation of lung inflammation. Despite significant improvements in ventilator technologies and a heightened awareness of oxygen toxicity, besides low tidal volume ventilation few if any medical interventions have improved ARDS outcomes over the past two decades. Read More

    Survival Predictors for Severe ARDS Patients Treated with Extracorporeal Membrane Oxygenation: A Retrospective Study in China.
    PLoS One 2016 23;11(6):e0158061. Epub 2016 Jun 23.
    The State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China.
    Extracorporeal membrane oxygenation (ECMO) is increasingly being applied as life support for acute respiratory distress syndrome (ARDS) patients. However, the outcomes of this procedure have not yet been characterized in severe ARDS patients. The aim of this study was to evaluate the outcomes of severe ARDS patients supported with ECMO and to identify potential predictors of mortality in these patients. Read More

    Categorization in Mechanically Ventilated Pediatric Subjects: A Proposed Method to Improve Quality.
    Respir Care 2016 Sep 14;61(9):1168-78. Epub 2016 Jun 14.
    Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital and Pediatric Anesthesia, Harvard Medical School, Boston, Massachusetts.
    Background: Thousands of children require mechanical ventilation each year. Although mechanical ventilation is lifesaving, it is also associated with adverse events if not properly managed. The systematic implementation of evidence-based practice through the use of guidelines and protocols has been shown to mitigate risk, yet variation in care remains prevalent. Read More

    A comparison of synchronized intermittent mandatory ventilation and pressure-regulated volume control ventilation in elderly patients with acute exacerbations of COPD and respiratory failure.
    Int J Chron Obstruct Pulmon Dis 2016 17;11:1023-9. Epub 2016 May 17.
    Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
    Background: COPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Intensive care unit patients with acute exacerbations of COPD requiring mechanical ventilation have higher mortality rates than other hospitalized patients. Read More

    [Monitoring tidal volumes when using the Ventrain® emergency ventilator].
    Anaesthesist 2016 Jul 31;65(7):514-20. Epub 2016 May 31.
    Anästhesie-Abteilung, Universitäts-Kinderspital Zürich, Steinwiesstrasse 75, 8032, Zürich, Schweiz.
    Background: The Ventrain® emergency ventilation device allows active inspiration and expiration through transtracheal catheters or the lumen of an airway exchange catheter. This single-use handheld device is manually operated and driven by an external pressurized oxygen source. The Ventrain® may be used to ventilate patients with a complete or pending upper airway obstruction reducing the risk of barotrauma due to the possibility of active expiration. Read More

    Intrinsic positive end-expiratory pressure during ventilation through small endotracheal tubes during general anesthesia: incidence, mechanism, and predictive factors.
    J Clin Anesth 2016 Jun 16;31:124-30. Epub 2016 Apr 16.
    Anesthesia and Intensive Care, Department of Anesthesiology, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy. Electronic address:
    Study Objective: To assess the safety of mechanical ventilation and effectiveness of extrinsic positive end-expiratory pressure (PEEP) (PEEPe) in improving peripheral oxygen saturation (SpO2) during direct microlaryngeal laser surgery; to assess the incidence, amount, and nature (dynamic hyperinflation or airflow obstruction) of ensuing intrinsic PEEP (PEEPi); and to find a surrogate PEEPi indicator.

    Design: Quasiexperimental.

    Setting: S. Read More

    Performance of manual hyperinflation: consistency and modification of the technique by intensive care unit nurses during physiotherapy.
    J Clin Nurs 2016 Aug 27;25(15-16):2295-304. Epub 2016 Apr 27.
    Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
    Aims And Objectives: To assess the consistency and safety of manual hyperinflation delivery by nurses of variable clinical experience using a resuscitator bag during physiotherapy treatment.

    Background: Manual hyperinflation involves the delivery of larger than normal gas volumes to intubated patients and is routinely used by nurses in collaboration with physiotherapists for the management of retained sputum. The aim is to deliver slow deep breaths with an inspiratory hold without unsafe airway pressures, lung volumes or haemodynamic changes. Read More

    Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during laparoscopic cholecystectomy.
    Springerplus 2016 8;5:298. Epub 2016 Mar 8.
    Department of Anesthesiology and Reanimation, Bezmialem Vakif University Faculty of Medicine, Vatan Cad, 34093 Fatih, Istanbul, Turkey.
    Pressure-controlled ventilation (PCV) is less frequently employed in general anesthesia. With its high and decelerating inspiratory flow, PCV has faster tidal volume delivery and different gas distribution. The same tidal volume setting, delivered by PCV versus volume-controlled ventilation (VCV), will result in a lower peak airway pressure and reduced risk of barotrauma. Read More

    Spontaneous ventilation using Propofol TCI for microlaryngoscopy in adults: a retrospective audit.
    Anaesth Intensive Care 2016 Mar;44(2):285-93
    Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Queensland.
    We conducted a retrospective audit of 285 adult elective microlaryngoscopy cases in our institution over a three-and-a-half year period. Conventional anaesthesia with intubation and mechanical ventilation was the most common technique, used in 71% of cases. Tubeless spontaneous ventilation during total intravenous anaesthesia with a target-controlled infusion of propofol (SVTCI) was the most common alternative. Read More

    Characteristics and outcomes of patients treated with airway pressure release ventilation for acute respiratory distress syndrome: A retrospective observational study.
    J Crit Care 2016 Aug 9;34:154-9. Epub 2016 Mar 9.
    Senior Clinical Respiratory Technician, Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia.
    Background: The optimal mode of ventilation in acute respiratory distress syndrome (ARDS) remains uncertain. Airway pressure release ventilation (APRV) is a recognized treatment for mechanically-ventilated patients with severe hypoxaemia. However, contemporary data on its role as a rescue modality in ARDS is lacking. Read More

    Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data.
    Lancet Respir Med 2016 Apr 4;4(4):272-80. Epub 2016 Mar 4.
    Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
    Background: Protective mechanical ventilation strategies using low tidal volume or high levels of positive end-expiratory pressure (PEEP) improve outcomes for patients who have had surgery. The role of the driving pressure, which is the difference between the plateau pressure and the level of positive end-expiratory pressure is not known. We investigated the association of tidal volume, the level of PEEP, and driving pressure during intraoperative ventilation with the development of postoperative pulmonary complications. Read More

    The Fog of War: Delirium Prevalence in a Combat Intensive Care Unit.
    Mil Med 2016 Mar;181(3):209-12
    Department of Cardiothoracic and Vascular Surgery, UT Memorial Hermann Hospital, 6400 Fannin Street, Suite 2850, Houston, TX 77030.
    Introduction: Delirium is a fluctuating disturbance in consciousness associated with increased mortality. Injured warriors represent a unique unstudied population. We hypothesized delirium is common because of high injury severity scores and multidrug sedation regimens. Read More

    [Lung protective ventilation in elderly patients undergoing spinal operation in the prone position: a randomized controlled trial].
    Nan Fang Yi Ke Da Xue Xue Bao 2016 Feb;36(2):215-9
    Department of Anesthesiology, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China. E-mail:
    Objective: To investigate effect of lung protective ventilation on respiration and circulation in elderly patients receiving spinal operation performed in the prone position.

    Methods: Sixty patients undergoing elective spinal surgery were randomized control group [with VT of 10 mL/kg (PBW) and RR of 10-12 /min] and test group [with VT of 6 mL/kg +RMs+PEEP: 5 cmH(2)O (PBW) and RR of 12-18 /min]. Recruitment maneuver was performed once every 30 min. Read More

    Massive pulmonary hemorrhage before living donor liver transplantation in infants.
    Pediatr Transplant 2016 Feb 22;20(1):89-95. Epub 2015 Dec 22.
    Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
    A massive pulmonary hemorrhage in patients with liver cirrhosis is a life-threatening complication that may result in a contraindication of a liver transplantation because of its high mortality rate. Herein, we present two infant biliary atresia cases that successfully underwent an LDLT that was followed by intensive respiratory care for the pretransplant massive pulmonary hemorrhage. Both cases exhibited severe respiratory failure (minimum PaO2/FiO2; 46 mmHg and 39 mmHg, respectively). Read More

    Open Lung Approach for the Acute Respiratory Distress Syndrome: A Pilot, Randomized Controlled Trial.
    Crit Care Med 2016 Jan;44(1):32-42
    1Department of Respiratory Care, Massachusetts General Hospital, Boston, MA.2Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA.3CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.4Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain.5Intensive Care Unit, Hospital Universitario NS de Candelaria, Santa Cruz de Tenerife, Spain.6Department of Anesthesiology, Hospital Clinico de Valencia, Valencia, Spain.7Intensive Care Unit, Hospital Universitario Río Hortega, Valladolid, Spain.8Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.9Intensive Care Unit, Hospital Universitario Morales Meseguer, Murcia, Spain.10Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.11Intensive Care Unit, Hospital Universitario de Txagorritxu, Vitoria, Spain.12Respiratory ICU, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.13Intensive Care Unit, Hospital Universitario Fundacion Jiménez Díaz, Madrid, Spain.14Intensive Care Unit, Hospital Virgen de La Luz, Cuenca, Spain.
    Objective: The open lung approach is a mechanical ventilation strategy involving lung recruitment and a decremental positive end-expiratory pressure trial. We compared the Acute Respiratory Distress Syndrome network protocol using low levels of positive end-expiratory pressure with open lung approach resulting in moderate to high levels of positive end-expiratory pressure for the management of established moderate/severe acute respiratory distress syndrome.

    Design: A prospective, multicenter, pilot, randomized controlled trial. Read More

    Intraoperative use of low volume ventilation to decrease postoperative mortality, mechanical ventilation, lengths of stay and lung injury in patients without acute lung injury.
    Cochrane Database Syst Rev 2015 Dec 7(12):CD011151. Epub 2015 Dec 7.
    Department of Anesthesiology, Faculty of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada.
    Background: During the last decade, there has been a trend towards decreasing tidal volumes for positive pressure ventilation during surgery. It is not known whether this new trend is beneficial or harmful for patients.

    Objectives: To assess the benefit of intraoperative use of low tidal volume ventilation (< 10 mL/kg of predicted body weight) to decrease postoperative complications. Read More

    Neonatal Pneumothorax Pressures Surpass Higher Threshold in Lung Recruitment Maneuvers: An In Vivo Interventional Study.
    Respir Care 2016 Feb 10;61(2):142-8. Epub 2015 Nov 10.
    Anaesthesiology Department, La Paz University Hospital, Madrid, Spain.
    Background: Causing pneumothorax is one of the main concerns of lung recruitment maneuvers in pediatric patients, especially newborns. Therefore, these maneuvers are not performed routinely during anesthesia. Our objective was to determine the pressures that cause pneumothorax in healthy newborns by a prospective experimental study of 10 newborn piglets (<48 h old) with healthy lungs under general anesthesia. Read More

    Complications and Resource Utilization Associated With Mechanical Ventilation in a Medical Intensive Care Unit in 2013.
    J Intensive Care Med 2017 Feb 7;32(2):146-150. Epub 2016 Jul 7.
    1 Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
    Introduction: Evolving strategies for ventilator management could reduce the frequency of complications, but there is limited information about complications in contemporary intensive care units.

    Methods: We retrospectively collected information about patient demographics, chest x-ray abnormalities, complications, including pneumothoraces, ventilator-associated events, self-extubation, and resource utilization in 174 patients who required mechanical ventilation in 2013.

    Results: The mean age was 57. Read More

    [Abdominal compartment syndrome by tension pneumoperitoneum secondary to barotrauma. Presentation case].
    Cir Cir 2015 Sep-Oct;83(5):429-32. Epub 2015 Jul 6.
    Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
    Background: Pneumoperitoneum is defined as the existence of extraluminal air in the abdominal cavity. In 80-90% of cases is due to perforation of a hollow organ. However, in 10-15% of cases, it is nonsurgical pneumoperitoneum. Read More

    Neurally adjusted ventilator assist in very low birth weight infants: Current status.
    World J Methodol 2015 Jun 26;5(2):62-7. Epub 2015 Jun 26.
    Hassib Narchi, Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain PO Box 17666, United Arab Emirates.
    Continuous improvements in perinatal care have resulted in increased survival of premature infants. Their immature lungs are prone to injury with mechanical ventilation and this may develop into chronic lung disease (CLD) or bronchopulmonary dysplasia. Strategies to minimize the risk of lung injury have been developed and include improved antenatal management (education, regionalization, steroids, and antibiotics), exogenous surfactant administration and reduction of barotrauma by using exclusive or early noninvasive ventilatory support. Read More

    Transtracheal ventilation with a novel ejector-based device (Ventrain) in open, partly obstructed, or totally closed upper airways in pigs.
    Br J Anaesth 2015 Aug 25;115(2):308-16. Epub 2015 Jun 25.
    Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany.
    Background: Transtracheal access and subsequent jet ventilation are among the last options in a 'cannot intubate-cannot oxygenate' scenario. These interventions may lead to hypercapnia, barotrauma, and haemodynamic failure in the event of an obstructed upper airway. The aim of the present study was to evaluate the efficacy and the haemodynamic effects of the Ventrain, a manually operated ventilation device that provides expiratory ventilation assistance. Read More

    Portable mechanical ventilation with closed-loop control of inspired fraction of oxygen maintains oxygenation in the setting of hemorrhage and lung injury.
    J Trauma Acute Care Surg 2015 Jul;79(1):53-9; discussion 59
    From the Division of Trauma and Critical Care, Department of Surgery, Institute for Military Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
    Background: Closed-loop controllers (CLCs) embedded within portable mechanical ventilators may allow for autonomous weaning. The ability of CLCs to maintain adequate oxygenation in the setting of hemorrhage and lung injury is unknown. We hypothesized that a portable ventilator with a CLC for inspired fraction of oxygen (FIO2) could provide oxygenation in a porcine model of hemorrhage and lung injury. Read More

    Does postoperative mechanical ventilation predispose to bronchopleural fistula formation in patients undergoing pneumonectomy?
    Interact Cardiovasc Thorac Surg 2015 Sep 11;21(3):379-82. Epub 2015 Jun 11.
    Department of Thoracic Surgery, "Sotiria" General Hospital for Chest Diseases, Athens, Greece.
    A best evidence topic was written according to a structured protocol. The question addressed was whether postoperative mechanical ventilation has any effect on the incidence of development of bronchopleural fistulas (BPFs) in patients undergoing pneumonectomy. A total of 40 papers were identified using the reported search, of which 8, all retrospective, represented the best evidence to answer the clinical question. Read More

    [Massive pneumoperitoneum in a newborn with mechanical ventilation in apparent absence of barotrauma].
    Cir Pediatr 2014 Oct;27(4):201-2
    Pneumoperitoneum is usually secondary to perforation of gastrointestinal tract. Sometimes it is a barotrauma, especially in newborn infants undergoing mechanical ventilation, causing lung rupture and passage of air from airway into the peritoneum through the mediastinum. It seems less likely that the pneumoperitoneum occurs in a patient undergoing mechanical ventilation, in the absence of a demonstrable barotrauma and a bowel perforation. Read More

    Mechanical ventilation for severe asthma.
    Chest 2015 Jun;147(6):1671-1680
    Division of Pulmonary and Critical Care, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN.
    Acute exacerbations of asthma can lead to respiratory failure requiring ventilatory assistance. Noninvasive ventilation may prevent the need for endotracheal intubation in selected patients. For patients who are intubated and undergo mechanical ventilation, a strategy that prioritizes avoidance of ventilator-related complications over correction of hypercapnia was first proposed 30 years ago and has become the preferred approach. Read More

    A new technique for avoiding barotrauma-induced complications in apnea testing for brain death.
    J Clin Neurosci 2015 Jun 11;22(6):1021-4. Epub 2015 Mar 11.
    Rutgers Robert Wood Johnson Medical School, 3100 CAB, 125 Paterson Street, New Brunswick, NJ 08901, USA.
    Prompted by our experience with complications occurring with apnea testing (AT), we discuss complications reported in the literature. AT is an integral part of brain death assessment. Many complications of AT have been described, including hypoxemia, arterial hypotension, tension pneumothorax and cardiac arrest. Read More

    [The effect of mild sedation on the prognosis and inflammatory markers in critical patients with mechanical ventilation].
    Zhonghua Jie He He Hu Xi Za Zhi 2014 Nov;37(11):820-3
    The Affiliated People's Hospital of Jiangsu University, Zhenjiang 212002, China. Email:
    Objective: To compare the effect of slight and usual sedation on the prognosis and inflammatory marker levels in patients receiving mechanical ventilation in ICU.

    Methods: We enrolled 78 critically ill adult patients who were undergoing mechanical ventilation and were expected to need ventilation for more than 48 h. The patients were prospectively and randomly assigned to receive: slight sedation (Richmond Agitation Sedation Score -1 to 0, n = 38 patients) or usual sedation (Richmond Agitation Sedation Score -3 to -2, n = 40 patients). Read More

    Endobronchial occlusion with one-way endobronchial valves: a novel technique for persistent air leaks in children.
    J Pediatr Surg 2015 Jan 23;50(1):82-5. Epub 2014 Oct 23.
    Division of Pediatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA.
    Purpose: In children, persistent air leaks can result from pulmonary infection or barotrauma. Management strategies include surgery, prolonged pleural drainage, ventilator manipulation, and extracorporeal membrane oxygenation (ECMO). We report the use of endobronchial valve placement as an effective minimally invasive intervention for persistent air leaks in children. Read More

    A ventilator strategy combining low tidal volume ventilation, recruitment maneuvers, and high positive end-expiratory pressure does not increase sedative, opioid, or neuromuscular blocker use in adults with acute respiratory distress syndrome and may improve patient comfort.
    Ann Intensive Care 2014 6;4:33. Epub 2014 Nov 6.
    Interdepartmental Division of Critical Care, Hamilton Health Sciences and Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton L8S 4K1, Ontario, Canada.
    Background: The Lung Open Ventilation Study (LOV Study) compared a low tidal volume strategy with an experimental strategy combining low tidal volume, lung recruitment maneuvers, and higher plateau and positive end-expiratory pressures (PEEP) in adults with acute respiratory distress syndrome (ARDS). Herein, we compared sedative, opioid, and neuromuscular blocker (NMB) use among patients managed with the intervention and control strategies and clinicians' assessment of comfort in both groups.

    Methods: This was an observational substudy of the LOV Study, a randomized trial conducted in 30 intensive care units in Canada, Australia, and Saudi Arabia. Read More

    Pressure-controlled versus volume-controlled ventilation for acute respiratory failure due to acute lung injury (ALI) or acute respiratory distress syndrome (ARDS).
    Cochrane Database Syst Rev 2015 Jan 14;1:CD008807. Epub 2015 Jan 14.
    Medical Intensive Care Unit, Christian Medical College & Hospital, Vellore, India.
    Background: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) account for one-quarter of cases of acute respiratory failure in intensive care units (ICUs). A third to half of patients will die in the ICU, in hospital or during follow-up. Mechanical ventilation of people with ALI/ARDS allows time for the lungs to heal, but ventilation is invasive and can result in lung injury. Read More

    Macroscopic barotrauma caused by stiff and soft-tipped airway exchange catheters: an in vitro case series.
    Anesth Analg 2015 Feb;120(2):355-61
    From the *Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital Bath, Bath, United Kingdom; and †Department of Thoracic Surgery, Bristol Royal Infirmary, Bristol, United Kingdom.
    Background: Many airway management guidelines include the use of airway exchange catheters (AECs). There are reports, however, of harm from their use, from both malpositioning and in particular from the administration of oxygen via an AEC leading to barotrauma.

    Methods: We used an in vitro pig lung model to investigate the safety of administering oxygen at 4 different flow rates from a high-pressure source via 2 different AECs: a standard catheter and a soft-tipped catheter. Read More

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