Ventilators for Nonintensivists. Basic Ventilator Parameters.
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ABSTRACT:
SUBMITTER: Acho M
PROVIDER: S-EPMC8043300 | biostudies-literature | 2020 Apr
REPOSITORIES: biostudies-literature
Publications
Ventilators for Nonintensivists. Basic Ventilator Parameters.
Acho Megan M Lee Alyson C AC Lee Burton W BW
ATS scholar 20200409 2
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Project description:Mechanical ventilation is a life-support system used to maintain adequate lung function in patients who are critically ill or undergoing general anesthesia. The benefits and harms of mechanical ventilation depend not only on the operator's setting of the machine (input), but also on their interpretation of ventilator-derived parameters (outputs), which should guide ventilator strategies. Once the inputs-tidal volume (VT), positive end-expiratory pressure (PEEP), respiratory rate (RR), and inspiratory airflow (V')-have been adjusted, the following outputs should be measured: intrinsic PEEP, peak (Ppeak) and plateau (Pplat) pressures, driving pressure (ΔP), transpulmonary pressure (PL), mechanical energy, mechanical power, and intensity. During assisted mechanical ventilation, in addition to these parameters, the pressure generated 100 ms after onset of inspiratory effort (P0.1) and the pressure-time product per minute (PTP/min) should also be evaluated. The aforementioned parameters should be seen as a set of outputs, all of which need to be strictly monitored at bedside in order to develop a personalized, case-by-case approach to mechanical ventilation. Additionally, more clinical research to evaluate the safe thresholds of each parameter in injured and uninjured lungs is required.
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Project description:ContextAmid the COVID-19 pandemic, this study delves into ventilator shortages, exploring simple split ventilation (SSV), simple differential ventilation (SDV), and differential multiventilation (DMV). The knowledge gap centers on understanding their performance and safety implications.HypothesisOur hypothesis posits that SSV, SDV, and DMV offer solutions to the ventilator crisis. Rigorous testing was anticipated to unveil advantages and limitations, aiding the development of effective ventilation approaches.Methods and modelsUsing a specialized test bed, SSV, SDV, and DMV were compared. Simulated lungs in a controlled setting facilitated measurements with sensors. Statistical analysis honed in on parameters like peak inspiratory pressure (PIP) and positive end-expiratory pressure.ResultsSetting target PIP at 15 cm H2O for lung 1 and 12.5 cm H2O for lung 2, SSV revealed a PIP of 15.67 ± 0.2 cm H2O for both lungs, with tidal volume (Vt) at 152.9 ± 9 mL. In SDV, lung 1 had a PIP of 25.69 ± 0.2 cm H2O, lung 2 at 24.73 ± 0.2 cm H2O, and Vts of 464.3 ± 0.9 mL and 453.1 ± 10 mL, respectively. DMV trials showed lung 1's PIP at 13.97 ± 0.06 cm H2O, lung 2 at 12.30 ± 0.04 cm H2O, with Vts of 125.8 ± 0.004 mL and 104.4 ± 0.003 mL, respectively.Interpretation and conclusionsThis study enriches understanding of ventilator sharing strategy, emphasizing the need for careful selection. DMV, offering individualization while maintaining circuit continuity, stands out. Findings lay the foundation for robust multiplexing strategies, enhancing ventilator management in crises.
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Project description:BackgroundThe performance of high-frequency oscillatory ventilators (HFOV) differs by the waveform generation mode and circuit characteristics. Few studies have described the performance of piston-type HFOV. The present study aimed to compare the amplitude required to reach the target high-frequency tidal volume ([Formula: see text]); determine the relationship between the settings and actual pressure in amplitude or mean airway pressure ([Formula: see text]); and describe the interaction among compliance, frequency, and endotracheal tube (ETT) inner diameter in 4 HFOV models, including Humming X, Vue (a piston type ventilator commonly used in Japan), VN500 (a diaphragm type), and SLE5000 (a reverse jet type).MethodsThe oscillatory ventilators were evaluated by using a 50-mL test lung with 0.5 and 1.0 mL/cm H2O compliance, [Formula: see text] of 10 cm H2O, frequency of 12 and 15 Hz, and ETT inner diameters 2.0, 2.5, and 3.5 mm. At each permutation of compliance, frequency, and ETT, the target high-frequency [Formula: see text] was increased from 0.5 to 3.0 mL. The change in [Formula: see text] from the ventilator (ventilator [Formula: see text]) to Y-piece (Y [Formula: see text]) and alveolar pressure (alveolar [Formula: see text]) and the change in amplitude from the ventilator (ventilator amplitude) to Y-piece (Y amplitude) and alveolar pressure (alveolar amplitude) were determined at high-frequency [Formula: see text] of 1.0 and 3.0 mL.ResultsTo achieve the target high-frequency [Formula: see text], the Humming X and Vue required a higher amplitude than did the SLE5000, but the maximum amplitude in the VN500 was unable to attain a larger high-frequency [Formula: see text]. Ventilator [Formula: see text] and alveolar pressure decreased at the Y-piece with the Humming X and Vue but increased with the SLE5000. The ventilator [Formula: see text] in the VN500 decreased remarkably at a frequency of 15 Hz. The ventilator amplitude in all 4 ventilators decreased while temporarily increasing at the Y-piece in the VN500.ConclusionsThe actual measured value, such as alveolar [Formula: see text] and high-frequency [Formula: see text], varied according to the type of HFOV system and the inner diameter of the ETT, even with identical settings. Clinicians should therefore determine the setting appropriate to each HFOV model.
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Project description:ObjectivesThis study was planned to compare the prone position and non-prone position groups and to evaluate arterial blood gas results, mechanical ventilator values and ventilator-associated pneumonia (VAP) status before, during, and after patients were brought back to the non-prone position.DesignThis study is a randomized controlled trial with a parallel-group design and a 1:1 allocation ratio. A block randomisation method was used to ensure balanced allocation between two groups.SettingThe research was conducted in the 14-bed and 26-bed general ICUs of two private hospitals on the European side of Istanbul.ParticipantsThe 94 eligible participants were randomly divided into two groups. 52 participants were assigned to the prone position group, while 42 participants were assigned to the non-prone position group, which served as the control group. In the end, 40 participants were in each group.InterventionThe intervention involved placing patients in the prone position and monitoring their arterial blood gas results, mechanical ventilator values, and VAP status at multiple stages: before, during, and after returning them to the non-prone position. Each patient was followed for a minimum of 5 days.ResultsThe majority of the participants were male (51.2%) and aged 45-64 (48.8%). The comparison of experimental and control groups indicated statistically significant difference in saturation, FiO₂, inspiratory-expiratory tidal volume, and blood gas levels of the patients in the treatment group (p = 0.001; p < 0.01).ConclusionsThe change in the experimental group was greater than in the control group. In conclusion, the mechanical ventilator parameters and blood gas levels of the patients in the treatment group were better than those of the patients in the control group. It is recommended as an effective practice in patients receiving prone position mechanical ventilation (MV).Clinical trial registration number and registration dateNCT05760716/ March 6, 2023 (This trial was registered retrospectively at ClinicalTrials.gov (Registration Number: NCT05760716) after its completion due to demanded revisions. The integrity of the data and adherence to the study protocol were ensured throughout. The trial adhered to ethical standards (ethics committee approval, informed consent) even if it was not registered prospectively).
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