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Care of Intubated Patients in Triage
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Shalvi Mahajan, Komal A Gandhi
Normal spontaneous negative pressure ventilation is converted into positive pressure ventilation after intubation. This will increase pressure in the central vessels and will reduce the pressure gradient. Consequently, a reduction of blood flow to the heart leads to a drop in cardiac output and lowering of blood pressures. Thus, patients may require hemodynamic support. Circulation can be maintained via fluids, vasopressor agents and blood/blood products depending on clinical parameters.
The Use of Chemical Warfare Agents during the Syrian Civil War
Published in Brian J. Lukey, James A. Romano, Salem Harry, Chemical Warfare Agents, 2019
Arik Eisenkraft, Avshalom Falk
Respiratory support may be required while the patient is still in a contaminated zone, that is, before and/or in parallel with decontamination. This requires the provision of clean air. The only available way to do this is to use a bag-valve-mask device or a portable ventilator, if available, plus suction of excessive airway secretions (Baker, 1999; Ben Abraham et al., 2002). Furthermore, positive pressure ventilation requires endotracheal intubation, which is difficult to perform by a PPE-wearing caregiver. A possible solution free of these and other hurdles of positive pressure ventilation in a contaminated environment is non-invasive, negative pressure ventilation by a biphasic extrathoracic cuirass assisted ventilator, which could be easily operated even by non-medical caregivers wearing full PPE (Gur et al., 2005). Pilot studies showed that the ventilator was superior to a bag-valve-mask device in the rescue of lethally paraoxon-poisoned pigs (Gur et al., 2015) and was safe in healthy subjects wearing protective masks (Gur et al., 2017).
Tuberculosis
Published in Keith Struthers, Clinical Microbiology, 2017
It is essential that a confirmed or suspected case of ‘open’ pulmonary TB is nursed in a single room. These rooms should have a negative-pressure ventilation system in order to reduce the organism load in the environment of the patient, and prevent spread to other patients and staff. Nursing the patient with MDR-TB or XDR-TB in a negative-pressure single room is essential.
Is positive airway pressure therapy underutilized in chronic obstructive pulmonary disease patients?
Published in Expert Review of Respiratory Medicine, 2019
Hrishikesh Kulkarni, Sairam Parthasarathy
Previous studies involving respiratory assistance effected by negative pressure ventilation were not favorable [28,29]. In 2013, a meta-analysis by Struik and colleagues found no effect of home-based NIPPV or bilevel PAP on gas exchange, 6-min walking distance, health-related quality-of-life, lung function (forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC], or maximal inspiratory pressure) and sleep efficiency [30]. Struik and colleagues at that time concluded that there was insufficient evidence to support the routine application of home-based NIPPV or bilevel PAP therapy in patients with stable COPD. Since 2013, there have been two important multicenter RCTs that suggest benefits to NIPPV therapy in patients with stable COPD and chronic respiratory failure [31,32].
Section 11: Central hypoventilation, congenital and acquired
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2018
Theo J. Moraes, Ian MacLusky, David Zielinski, Reshma Amin
There are various options available in terms of the type of support. Options include positive pressure ventilation via tracheostomy, noninvasive positive pressure ventilation (NiPPV), diaphragm pacing and negative pressure ventilation. To the authors’ knowledge, there are no comparative trials examining the relative advantages and disadvantages of these differing modes of ventilation. Thus, until definitive studies occur, treatment should be optimized for each individual in order to achieve normal ventilation and oxygenation as assessed by standard polysomnography. General recommendations can be derived from the literature and clinical experience, which are echoed by the recent ATS guidelines.1
Congenital central hypoventilation syndrome: diagnosis and management
Published in Expert Review of Respiratory Medicine, 2018
Melissa A. Maloney, Sheila S. Kun, Thomas G. Keens, Iris A. Perez
The lungs of CCHS patients are generally healthy, allowing for an array of ventilatory options. Possibilities include positive pressure ventilation (PPV) via tracheostomy, noninvasive positive pressure ventilation (NIPPV), or diaphragm pacing (DP). Although negative pressure ventilation is effective, it is less practical when compared to other portable methods and is rarely used in contemporary management of CCHS. Supplemental oxygen alone is insufficient as this therapy will improve oxygenation without addressing hypoventilation, promoting the development of cor pulmonale due to chronic hypercapnia.