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respiratory mechanics,ventilator-associated pneumonia and outcomes in intensive care unit

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World Journal of Critical Care Medicine 2018年第1期7卷 24-30页

作者： Kelser de Souza Kock Rosemeri Maurici Department of Physiotherapy University of South of Santa Catarina Graduate Program in Medical Sciences Federal University of Santa Catarina

AIM To evaluate the predictive capability of respiratory mechanics for the development of ventilator-associated pneumonia (VAP) and mortality in the intensive care unit(ICU) of a hospital in southern Brazil. METHODS A cohort study was conducted between, involving a sample of 120 individuals. Static measurements of compliance and resistance of the respiratory system in pressure-controlled ventilation (PCV) and volumecontrolled ventilation(VCV) modes in the 1 st and 5 th days of hospitalization were performed to monitor respiratory mechanics. The severity of the patients' illness was quantified by the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ). The diagnosis of VAP was made based on clinical, radiological and laboratory *** The significant associations found for the development of VAP were APACHE Ⅱ scores above the average(P = 0.016), duration of MV (P = 0.001) and ICU length of stay above the average(P = 0.003), male gender(P = 0.004), and worsening of respiratory resistance in PCV mode(P = 0.010). Age above the average(P < 0.001), low level of oxygenation on day 1(P = 0.003) and day 5 (P = 0.004) and low lung compliance during VCV on day 1 (P = 0.032) were associated with death as the *** The worsening of airway resistance in PCV mode indicated the possibility of early diagnosis of VAP. Low lung compliance during VCV and low oxygenation index were death-related prognostic indicators.

关键词： respiratory mechanics respiratory tract infection Ventilator-associated pneumonia

Effects of Breath Training Pattern “End-Inspir atory Pause” on respiratory mechanics and Arterial Blood Gas of Pa tients with COPD

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Chinese Journal of Integrative Medicine 2002年第4期8卷 279-283页

作者： LIANG Yong-jie(梁永杰) CAI Ying-yun(蔡映云) Pulmonary Department Eastern Hospital Shanghai(200120) Pulmonary Department Zhongshan Hospital Fudan U-niversity (200032)

Objective: In order to explore the mechanism of C hinese traditional breath training, the effects of end-inspiratory pause br eathing (EIPB) on the respiratory mechanics and arterial blood gas were studied in patients with chronic obstructive pulmo nary disease (COPD).Methods: Ten patients in steady stage participating in the stud y had a breath training of regulating the respiration rhythm as to having a pause betw een the deep and slow inspiration and the slow *** of the training was observed by visual feedback from the screen of the re spiratory inductive plethysmograph. The dynamic change of partial pressure of oxygen saturation in blood (SpO 2) was recorded with sphygmo-oximeter, the pulmonary mechanics and EIPB were determined with spirometer, and the data o f arterial blood gases in tranquilized breathing and EIPB were ***: After EIPB training, SpO 2 increased progressively, PaO 2 increased and PaCO 2 decreased, and the PaO 2 increment was greater than the PaCO 2 decrement. Furthermore, the tidal volume increased and the frequency of respira tion decreased significantly, both inspiration time and expiration time were prolonged. There was no significant change in both mean inspiration flow rate (VT/Ti) and expir ation flow rate (VT/Te). The baselines in spirogram during EIPB training had no raise. Conclusion: EIPB could decrease the ratio of the dead space and ti dal volume (VD/VT), cause increase of PaO 2 more than the decrease of PaCO 2, suggesting that this training could impro ve both the function of ventilation and gaseous exchange in the lung. EIPB training might be a breath ing training pattern for rehabilitation of patients with COPD.

关键词： breath training respiratory mechanics a rterial blood gas chronic obstructive pulmonary disease

Lung recruitment maneuver effects on respiratory mechanics and extravascular lung water index in patients with acute respiratory distress syndrome

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World Journal of Emergency Medicine 2011年第3期2卷 201-205页

作者： Jian-guo Zhan Xiao-juan Chen Fen Liu Zhen-guo Zeng Ke-jian Qian ICU People's Hospital of Linyi Linyi 276000 China ICU First Affiliated Hospital of Nanchang University Nanchang 330006 China

BACKGROUND：Animal experiments showed that recruitment maneuver （RM） and protective ventilation strategy of the lung could improve oxygenation and reduce extravascular lung water. This study was to investigate the effects of RM on respiratory mechanics and extravascular lung water index （EVLWI） in patients with acute respiratory distress syndrome （ARDS）. METHODS：Thirty patients with ARDS were randomized into a RM group and a non-RM group. In the RM group, after basic mechanical ventilation stabilized for 30 minutes, RM was performed and repeated once every 12 hours for 3 days. In the non-RM group, lung protective strategy was conducted without RM. Oxygenation index （PaO2/FiO2）, peak inspiratory pressure （PIP）, Plateau pressure （Pplat）, static pulmonary compliance （Cst） and EVLWI of patients before treatment and at 12, 24, 48, 72 hours after the treatment were measured and compared between the groups. Hemodynamic changes were observed before and after RM. One-way ANOVA, Student＇s t test and Fisher＇s exact test were used to process the data. RESULTS：The levels of PaO2/FiO2 and Cst increased after treatment in the two groups, but they were higher in the RM group than in the non-RM group （P〈0.05）. The PIP and Pplat decreased after treatment in the two groups, but they were lower in the RM group than in the non-RM group （P〈0.05）. The EVLWI in the two groups showed downward trend after treatment （P〈0.05）, and the differences were signifcant at all time points （P〈0.01）; the EVLWI in the RM group was lower than that in the non-RM group at 12, 24, 48 and 72 hours （P〈0.05 or P〈0.01）. Compared with pre-RM, hemodynamics changes during RM were significantly different （P〈0.01）; compared with pre-RM, the changes were not significantly different at 120 seconds after the end of RM （P〉0.05）. CONCLUSIONS： RM could reduce EVLWI, increase oxygenation and lung compliance. The effect of RM on hemodynamics was transient.

关键词： Lung recruitment maneuver Acute respiratory distress syndrome respiratory mechanics Extravascular lung water index Hemodynamics Lung protective ventilation Oxygenation index

Model-based Analysis of Ventilation Inhomogeneity in respiratory mechanics

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Engineering（科研） 2013年第10期5卷 363-367页

作者： Christoph Schranz Kevin Meffray Claudius Stahl Knut Moller Institute of Technical Medicine Furtwangen UniversityVillingen-SchwenningenGermany Department of Anaesthesiology and Critical Care Medicine University of Medical Center FreiburgGermany

Individualized models of respiratory mechanics help to reduce potential harmful effects of mechanical ventilation by supporting the evaluation of patient-specific lung protective ventilation strategies. Assessing ventilation inhomogeneities might be an important aspect in optimizing ventilator settings. The aim of this studyis to capture and analyze ventilation inhomogeneity by a mathematical model using clinical data. The results show that the lung physiology of mechanically ventilated patients without lung condition can be described by an inhomogeneity model revealing two alveolar compartments with median time constants of 0.4 and 3.9 s. Thus, the IHM in combination with specific ventilation maneuver might be suitable to capture lung physiology for model-based optimization of ventilator settings but requires additional image-based investigations to further support the validity of the model.

关键词： respiratory mechanics Inhomogeneity Model Parameter Identification Model-Based Therapy

Comparison of the effects of deep and moderate neuromuscular block on respiratory system compliance and surgical space conditions during robot-assisted laparoscopic radical prostatectomy: a randomized clinical study

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2020年第8期21卷 637-645页

作者： Shao-jun ZHU Xiao-lin ZHANG Qing XIE Yan-feng ZHOU Kui-rong WANG Department of Anesthesiology the First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China

Objective:Robot-assisted radical prostatectomy(RARP)requires pneumoperitoneum(Pnp)and a steep head-down position that may disturb respiratory system compliance(Crs)during *** aim was to compare the effects of different degrees of neuromuscular block(NMB)on Crs with the same Pnp pressure during ***:One hundred patients who underwent RARP were enrolled and randomly allocated to a deep or moderate NMB group with 50 patients in each *** was administered to both groups:in the moderate NMB group to maintain 1–2 responses to train-of-four(TOF)stimulation;and in the deep NMB group to maintain no response to TOF stimulation and 1–2 responses in the post-tetanic *** pressure in both groups was 10 mm Hg(1 mm Hg=133.3 Pa).Peak inspiratory pressure(Ppeak),mean pressure(Pmean),Crs,and airway resistance(Raw)were recorded after anesthesia induction and at 0,30,60,and 90 min of Pnp and *** space conditions were evaluated after the procedure on a 4-point ***:Immediately after the Pnp,Ppeak,Pmean,and Raw significantly increased,while Crs decreased and persisted during Pnp in both *** results did not significantly differ between the two groups at any of the time *** was no difference in surgical space conditions between *** movements occurred in 14 cases in the moderate NMB group and in one case in the deep NMB group,and all occurred during obturator lymphadenectomy.A significant difference between the two groups was ***:Under the same Pnp pressure in RARP,deep and moderate NMBs resulted in similar changes in Crs,and in other respiratory mechanics and surgical space ***,deep NMB significantly reduced body movements during surgery.

关键词： Robot-assisted radical prostatectomy(RARP) Deep neuromuscular block respiratory mechanics Surgical space condition

Is COVID-19 different from other causes of acute respiratory distresssyndrome?

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Journal of Intensive Medicine 2023年第3期3卷 212-219页

作者： François M.Beloncle Medical ICU University Hospital of AngersVent’LabUniversity of AngersAngers 49033France

Coronavirus disease 2019(COVID-19)pneumonia can lead to acute hypoxemic respiratory *** mechanical ventilation is needed,almost all patients with COVID-19 pneumonia meet the criteria for acute respiratorydistress syndrome(ARDS).The question of the specificities of COVID-19-associated ARDS compared to othercauses of ARDS is of utmost importance,as it may justify changes in ventilatory *** review aims todescribe the pathophysiology of COVID-19-associated ARDS and discusses whether specific ventilatory strategiesare required in these patients.

关键词： Mechanical ventilation respiratory mechanics Gas exchange Recruitability Dead space