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Weaning from Mechanical Ventilation
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Patients who are ready to begin liberating from MV are patients for whom the underlying reasons for MV have been stabilized, are hemodynamically stable, have adequate oxygenation (e.g., PaO2/FIO2 >150, PEEP ≤8 cm H2O, FIO2 ≤0.5), are able to initiate spontaneous breaths, do not have active coronary ischemia, and do not have CO2 retention above their baseline level. If patients meet these criteria, a trial of spontaneous breathing or a gradual reduction of pressure support may be attempted. There is no definitive evidence proving superiority of one of these methods over the other. However, at the conclusion of a pressure support ventilation (PSV) wean, the patient ultimately is required to demonstrate spontaneous breathing with minimal pressure support. Patients are usually asked to maintain stable spontaneous breathing for either 30 minutes or 120 minutes to be considered successful. Trials are generally done once daily to allow adequate time for muscle recovery. Based on a modest quality of evidence, most spontaneous breathing trials are now conducted with a low, fixed level of pressure support to overcome airflow resistance within the endotracheal tube [3].
Noninvasive ventilation during exercise training
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Nicolino Ambrosino, Lara Pisani
With pressure support ventilation (PSV), each breath may be triggered and supported by the patient or by the ventilator (30). In severe COPD patients during exercise, NIV relieves dyspnoea and increases exercise tolerance, reducing the high WOB and exercise-induced lactatemia (39,40). Furthermore, during exercise noninvasive IPAP with an EPAP improved central haemodynamics and cerebral oxygenation in patients with COPD with exercise-induced desaturations (41).
Critical Care of the Trauma Patient
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Ventilatory support should be instituted earlier rather than later; select a mode of ventilation tailored to the patient's need using appropriate tidal volumes and amounts of positive end-expiratory pressure (PEEP): Pressure support ventilation (PSV) – poorly tolerated following severe injury.Lung protective ventilation (LPV) with low volume and low peak pressures is frequently not possible early in resuscitation due to severe hypoxia and low compliance, use adequate volumes despite the frequent requirement for higher pressures.High positive end-expiratory pressure PEEP (>10 up to 20–25 cm H2O may be required) to recruit alveoli.ECMO (extracorporeal membrane oxygenation) may be considered where appropriate (see also Section 17.3).Non-invasive ventilatory support in selected cases only.A safe strategy is to maintain a driving pressure (plateau pressure – PEEP) of <15 cm water while accounting for lung injury.4
Preliminary bronchodilator dose effect on aerosol-delivery through different nebulizers in noninvasively ventilated COPD patients
Published in Experimental Lung Research, 2022
Yasmin M. Madney, Hadeer S. Harb, Thierry Porée, Myriam Eckes, Marina E. Boules, Mohamed E. A. Abdelrahim
Twenty-four COPD patients were included in the study where they were admitted to the respiratory unit following disease exacerbation requiring NIV by bilevel positive airway pressure (BIPAP) to correct the existing respiratory acidosis (PaCO2 > 6.0 kPa and pH < 7.35). They all agreed to participate in the study and gave written informed consent. The study was approved by the Research Ethical Committee of the Faculty of Pharmacy, Beni-Suef University (REC-H-Ph-BSU-18001). COPD ventilated patients were set on pressure support ventilation with positive end-expiratory pressure (PEEP) = 5 cm H2O and the clinician checked the patient’s spontaneous tidal volumes. If the patients could not achieve a tidal volume (TV) of 500 ml, then the clinician titrated the inspiratory pressure support to reach the targeted TV of 500 ml. The inspiratory pressures in pressure support ventilation were between 15 and 20 cm H2O. Patients were excluded from participation in this study if they had known hypersensitivity to beclomethasone diproprionate (BPD) or salbutamol, had hypotension with systolic blood pressure below 100 mmHg, had taken part in any research study within the previous six months or had severe kidney dysfunction with creatinine clearance below 20 ml/min.
Emerging approaches in pediatric mechanical ventilation
Published in Expert Review of Respiratory Medicine, 2019
Duane C Williams, Ira M Cheifetz
In an attempt to decrease peak pressures improve carbon dioxide clearance, and improve patient-ventilator synchrony, ‘assist ventilation’ has been utilized as a modality of care. Modes such as pressure support ventilation allow the patient to control their own respiratory rate and inspiratory time. Providers set a PEEP and level of pressure support to assist the patient who triggers each breath. However, with changes in lung compliance, the generated tidal volume will vary. Therefore, with worsening airway disease the provider may need to increase the set pressure support to allow for an appropriate tidal volume and, thus, adequate minute ventilation and oxygenation. Alternative support modes, such as volume support (in which providers set a set volume for the patient), prevent loss of a desired tidal volume but may lead to elevated peak pressures in the presence of worsening lung disease.
Development challenges and opportunities in aerosol drug delivery systems in non-invasive ventilation in adults
Published in Expert Opinion on Drug Delivery, 2019
Gregory Reychler, Jean-Bernard Michotte
The influence of NIV settings was only investigated using NIPPV. Even if NIPPV-aerosol delivery combination is intuitively the most frequent, it would be interesting to explore the influence of other spontaneous modes which use different flow-time curves than NIPPV, such as proportional assist modes. Indeed, during invasive mechanical ventilation, the decelerating flow used by the pressure support ventilation was associated with a lower lung deposition of nebulized particles than the constant flow volume-controlled ventilation [63]. The different modes of NIV have different influences on the delivery of a tidal volume which is a key factor for the lung deposition. The timing of the delivery during the respiratory cycle is important to optimize drug delivery. Based on previous positive results from invasive mechanical ventilation [64–66] and healthy subjects studies [36], it seems important that further investigations focus on the synchronization of the delivery with the inspiratory part of the respiratory cycle in patients during NIV. This point is particularly important to when delivering toxic or expensive drugs by nebulization.