1
|
Niyatiwatchanchai N, Rattanathanya H, Thengchaisri N. Comparative study of ventilation techniques with supraglottic airway devices in cats: volume-controlled vs pressure-controlled techniques. J Feline Med Surg 2024; 26:1098612X231225353. [PMID: 38294899 PMCID: PMC10949876 DOI: 10.1177/1098612x231225353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVES This study compared the effectiveness of a new supraglottic airway device (SGAD) in cats undergoing anaesthesia using two types of mechanical ventilation: volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). METHODS A total of 13 healthy cats (five male, eight female; median age 2 years [range 1-3]) were randomly allocated to either VCV or PCV. Five tidal volumes (6, 8, 10, 12 and 14 ml/kg) and five peak inspiratory pressures (4, 5, 6, 7 and 8 cmH2O) were randomly applied with a minute ventilation of 100 ml/kg/min. Various parameters, such as blood pressure, gas leakage, end-tidal CO2 (ETCO2) and work of breathing (WOB), were measured while using VCV or PCV. RESULTS The occurrence of hypotension (mean arterial blood pressure <60 mmHg) was slightly less frequent with VCV (38 events, 65 ventilating sessions) than with PCV (40 events, 65 ventilating sessions), but this difference did not reach statistical significance (P = 0.429). The number of leakages did not differ between the VCV group (3 events, 65 ventilating sessions) and the PCV group (3 events, 65 ventilating sessions) (P = 1.000). Hypercapnia was identified when using VCV (10 events, 65 ventilating sessions) less frequently than when using PCV (17 events, 65 ventilating sessions), but this difference did not reach statistical significance (P = 0.194). The study found a significantly higher WOB in the PCV group compared with the VCV group (P <0.034). CONCLUSIONS AND RELEVANCE The present results suggested that both VCV and PCV can be used with an SGAD during anaesthesia, with VCV preferred for prolonged mechanical ventilation due to its lower workload. Adjusting tidal volume or inspiratory pressure corrects hypercapnia.
Collapse
Affiliation(s)
- Nutawan Niyatiwatchanchai
- Surgery Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Hathaipat Rattanathanya
- HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Lak Si, Bangkok, Thailand
| | - Naris Thengchaisri
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| |
Collapse
|
2
|
Dos Santos Rocha A, Habre W, Albu G. Novel ventilation techniques in children. Paediatr Anaesth 2022; 32:286-294. [PMID: 34837438 PMCID: PMC9300098 DOI: 10.1111/pan.14344] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 02/06/2023]
Abstract
Extraordinary progress has been made during the past few decades in the development of anesthesia machines and ventilation techniques. With unprecedented precision and performance, modern machines for pediatric anesthesia can deliver appropriate mechanical ventilation for children and infants of all sizes and with ongoing respiratory diseases, ensuring very small volume delivery and compensating for circuit compliance. Along with highly accurate monitoring of the delivered ventilation, modern ventilators for pediatric anesthesia also have a broad choice of ventilation modalities, including synchronized and assisted ventilation modes, which were initially conceived for ventilation weaning in the intensive care setting. Despite these technical advances, there is still room for improvement in pediatric mechanical ventilation. There is a growing effort to minimize the harm of intraoperative mechanical ventilation of children by adopting the protective ventilation strategies that were previously employed only for prolonged mechanical ventilation. More than ever, the pediatric anesthesiologist should now recognize that positive-pressure ventilation is potentially a harmful procedure, even in healthy children, as it can contribute to both ventilator-induced lung injury and ventilator-induced diaphragmatic dysfunction. Therefore, careful choice of the ventilation modality and its parameters is of paramount importance to optimize gas exchange and to protect the lungs from injury during general anesthesia. The present report reviews the novel ventilation techniques used for children, discussing the advantages and pitfalls of the ventilation modalities available in modern anesthesia machines, as well as innovative ventilation modes currently under development or research. Several innovative strategies and devices are discussed. These novel modalities are likely to become part of the armamentarium of the pediatric anesthesiologist in the near future and are particularly relevant for challenging ventilation scenarios.
Collapse
Affiliation(s)
- André Dos Santos Rocha
- Division of Anesthesiology and Unit for Anesthesiological InvestigationsDepartment of Acute MedicineUniversity Hospitals of Geneva and University of GenevaGenevaSwitzerland
| | - Walid Habre
- Division of Anesthesiology and Unit for Anesthesiological InvestigationsDepartment of Acute MedicineUniversity Hospitals of Geneva and University of GenevaGenevaSwitzerland,Pediatric Anesthesia UnitDepartment of Acute MedicineUniversity Hospitals of GenevaGenevaSwitzerland
| | - Gergely Albu
- Division of Anesthesiology and Unit for Anesthesiological InvestigationsDepartment of Acute MedicineUniversity Hospitals of Geneva and University of GenevaGenevaSwitzerland
| |
Collapse
|
3
|
Niyatiwatchanchai N, Thengchaisri N. Effects of pressure- and volume-controlled ventilation on the work of breathing in cats using a cuffed endotracheal tube. Vet World 2021; 14:2568-2573. [PMID: 34840479 PMCID: PMC8613800 DOI: 10.14202/vetworld.2021.2568-2573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background and Aim: Mechanical ventilation is essential for supporting patients’ respiratory function when they are under general anesthesia. For cats with limited lung capacity, the different effects of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) on respiratory function remain elusive. The objective of the present study was to compare the efficacy of VCV and PCV in cats under general anesthesia using a cuffed endotracheal tube (ETT). Materials and Methods: Twelve healthy cats were randomly allocated to either a VCV or PCV group. Five tidal volumes (6, 8, 10, 12, and 14 mL/kg) were randomly applied to assess the efficacy of VCV, and respiratory rates were adjusted to achieve a minute ventilation of 100 mL/kg/min. Peak inspiratory pressures (4, 5, 6, 7, and 8 mmHg) were randomly applied to assess the efficacy of PCV, and respiratory rates were adjusted to achieve a minute ventilation of 100 mL/kg/min. Blood pressure, gas leakages, and end-tidal CO2 were recorded from 60 trials for airway control during the use of VCV or PCV. Data were compared using Fisher’s exact test with a significance level of p<0.05. Results: Leakages did not differ between VCV (1/60 events) and PCV (0/60 events; p=0.500). Hypercapnia was identified when using VCV (6/60 events) less frequently than when using PCV (7/60 events; p=0.762), but did not reach statistical significance. Hypotension (mean arterial blood pressure <60 mmHg) occurred less frequently with VCV (0/60 events) than with PCV (9/60 events; p=0.003). Moreover, VCV provided a significantly lower work of breathing (151.10±65.40 cmH2O mL) compared with PCV (187.84±89.72 cmH2O mL; p<0.05). Conclusion: VCV in cats using a cuffed ETT causes less hypotension than PCV. It should be noted that VCV provides a more stable tidal volume compared with PCV, resulting in a more stable minute volume. Nonetheless, VCV should not be used in patients with an airway obstruction because higher peak airway pressure may occur and lead to lung injury.
Collapse
Affiliation(s)
- Nutawan Niyatiwatchanchai
- Surgery Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, 10900, Thailand
| | - Naris Thengchaisri
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, 10900, Thailand.,Tippimarn Veterinary Hospital, Chulabhorn Royal Academy, 906/1 Pong Ta Long Subdistrict, Pak Chong District, Nakhon Ratchasima, 30130, Thailand
| |
Collapse
|
4
|
Wang YP, Wei Y, Chen XY, Zhang LX, Zhou M, Wang J. Comparison between pressure-controlled ventilation with volume-guaranteed mode and volume-controlled mode in one-lung ventilation in infants undergoing video-assisted thoracoscopic surgery. Transl Pediatr 2021; 10:2514-2520. [PMID: 34765475 PMCID: PMC8578778 DOI: 10.21037/tp-21-421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The appropriate ventilation mode for one-lung ventilation (OLV) in infants undergoing video-assisted thoracoscopic surgery (VATS) remains controversial. Here we investigated the effect of ventilatory mode "pressure-controlled ventilation-volume guaranteed" (PCV-VG) on the airway pressures and oxygenation parameters by comparing it with volume-controlled ventilation (VCV). METHODS We retrospectively analyzed the clinical data of infants aged 2 to 12 months who underwent extratracheal bronchial blockage for OLV in our center between January 2017 and August 2020. The infants were divided into two groups according to the OLV pattern: group G (n=30, receiving PCV-VG) and group V (n=28, receiving VCV). Mean arterial pressure (MAP), heart rate (HR), maximum inspiratory pressure (Ppeak), mean airway pressure (Pmean), dynamic compliance (Cdyn), partial arterial pressure of oxygen (PaO2) was measured and compared between these two groups 10 min before OLV (T1), 30 min after the onset of OLV (T2) and 15 min after OLV (T3). The possible occurrence of hypoxemia and hypotension during OLV was monitored. RESULTS Compared to group V, group G had significantly higher PaO2and Cdyn (both P<0.05) and significantly lower Ppeak and Pmean (both P<0.05) in T2. However, all indicators did not show significant differences between these two groups at T1 and T3 (all P>0.05). The incidence of hypoxemia was significantly higher in group V than in group G (P<0.05), while the difference in the incidence of hypotension was not statistically significant (P>0.05). CONCLUSIONS Mechanical ventilation using the PCV-VG mode is possible in infants when performing OLV during VATS. Compared to VCV, PCV-VG can offer lower Ppeak and Pmean, improve lung compliance, and achieve better oxygenation.
Collapse
Affiliation(s)
- Yu-Ping Wang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Anesthesiology, Fujian Children's Hospital, Fuzhou, China
| | - Ying Wei
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Anesthesiology, Fujian Children's Hospital, Fuzhou, China
| | - Xiu-Ying Chen
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Anesthesiology, Fujian Children's Hospital, Fuzhou, China
| | - Long-Xin Zhang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Anesthesiology, Fujian Children's Hospital, Fuzhou, China
| | - Min Zhou
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Anesthesiology, Fujian Children's Hospital, Fuzhou, China
| | - Jing Wang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Anesthesiology, Fujian Children's Hospital, Fuzhou, China
| |
Collapse
|
5
|
Tyagi M, Dube SK, Pandia MP. Anaesthetic management in a case of vertebral haemangioma with Bidirectional Glenn Shunt. Indian J Anaesth 2021; 65:178-179. [PMID: 33776104 PMCID: PMC7983816 DOI: 10.4103/ija.ija_701_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/22/2020] [Accepted: 08/01/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mayank Tyagi
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Surya Kumar Dube
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Mihir Prakash Pandia
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
6
|
Abstract
Pediatric mechanical ventilation is first initiated by emergency physicians when performing active airway management in a critically ill or injured child. When initiating and adjusting mechanical ventilation, the child has unique anatomy and physiology to consider. The EP is the first to respond to ventilator alarm triggers, and the initial medical provider to resuscitate the ventilated pediatric patient who is deteriorating while in the emergency department. This article uses cases to provide a framework to initiate and troubleshoot mechanical ventilation of pediatric patients in the emergency department.
Collapse
|
7
|
Schirmer-Mikalsen K, Vik A, Skogvoll E, Moen KG, Solheim O, Klepstad P. Intracranial Pressure During Pressure Control and Pressure-Regulated Volume Control Ventilation in Patients with Traumatic Brain Injury: A Randomized Crossover trial. Neurocrit Care 2017; 24:332-41. [PMID: 26503512 DOI: 10.1007/s12028-015-0208-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Mechanical ventilation with control of partial arterial CO2 pressures (PaCO2) is used to treat or stabilize intracranial pressure (ICP) in patients with traumatic brain injury (TBI). Pressure-regulated volume control (PRVC) is a ventilator mode where inspiratory pressures are automatically adjusted to deliver the patient a pre-set stable tidal volume (TV). This may result in a more stable PaCO2 and thus a more stable ICP compared with conventional pressure control (PC) ventilation. The aim of this study was to compare PC and PRVC ventilation in TBI patients with respect to ICP and PaCO2. METHODS This is a randomized crossover trial including eleven patients with a moderate or severe TBI who were mechanically ventilated and had ICP monitoring. Each patient was administered alternating 2-h periods of PC and PRVC ventilation. The outcome variables were ICP and PaCO2. RESULTS Fifty-two (26 PC, 26 PRVC) study periods were included. Mean ICP was 10.8 mmHg with PC and 10.3 mmHg with PRVC ventilation (p = 0.38). Mean PaCO2 was 36.5 mmHg (4.87 kPa) with PC and 36.1 mmHg (4.81 kPa) with PRVC (p = 0.38). There were less fluctuations in ICP (p = 0.02) and PaCO2 (p = 0.05) with PRVC ventilation. CONCLUSIONS Mean ICP and PaCO2 were similar for PC and PRVC ventilation in TBI patients, but PRVC ventilation resulted in less fluctuation in both ICP and PaCO2. We cannot exclude that the two ventilatory modes would have impact on ICP in patients with higher ICP values; however, the similar PaCO2 observations argue against this.
Collapse
Affiliation(s)
- Kari Schirmer-Mikalsen
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, 7491, Trondheim, Norway. .,Department of Anaesthesiology and Intensive Care Medicine, St. Olav University Hospital, Pb 3250 Sluppen, 7006, Trondheim, Norway.
| | - Anne Vik
- Department of Neurosurgery, St. Olav University Hospital, Pb 3250 Sluppen, 7006, Trondheim, Norway.,Department of Neuroscience, Norwegian University of Science and Technology, 7491, Trondheim, Norway
| | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, 7491, Trondheim, Norway.,Department of Anaesthesiology and Intensive Care Medicine, St. Olav University Hospital, Pb 3250 Sluppen, 7006, Trondheim, Norway
| | - Kent Gøran Moen
- Department of Neuroscience, Norwegian University of Science and Technology, 7491, Trondheim, Norway.,Department of Medical Imaging, St. Olav University Hospital, Pb 3250 Sluppen, 7006, Trondheim, Norway
| | - Ole Solheim
- Department of Neurosurgery, St. Olav University Hospital, Pb 3250 Sluppen, 7006, Trondheim, Norway.,Department of Neuroscience, Norwegian University of Science and Technology, 7491, Trondheim, Norway
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, 7491, Trondheim, Norway.,Department of Anaesthesiology and Intensive Care Medicine, St. Olav University Hospital, Pb 3250 Sluppen, 7006, Trondheim, Norway
| |
Collapse
|
8
|
Pressure-regulated volume control vs. volume control ventilation in healthy and injured rabbit lung. Eur J Anaesthesiol 2016; 33:767-75. [DOI: 10.1097/eja.0000000000000485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
9
|
Ferrando C, Belda FJ. The Effects of Flow Waveform on Oxygenation in Pediatric Patients. Anesth Analg 2015; 121:1111. [PMID: 26378708 DOI: 10.1213/ane.0000000000000821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Carlos Ferrando
- Anesthesiology and Critical Care Department, Hospital Clinico Universitario of Valencia, Valencia, Spain Anesthesiology and Critical Care Department, Hospital Clinico Universitario of Valencia, Valencia, Spain; and, Department of Surgery, University of Valencia, Valencia, Spain,
| | | |
Collapse
|
10
|
Ferrando C, García M, Gutierrez A, Carbonell JA, Aguilar G, Soro M, Belda FJ. Effects of different flow patterns and end-inspiratory pause on oxygenation and ventilation in newborn piglets: an experimental study. BMC Anesthesiol 2014; 14:96. [PMID: 25368544 PMCID: PMC4216830 DOI: 10.1186/1471-2253-14-96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 10/17/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Historically, the elective ventilatory flow pattern for neonates has been decelerating flow (DF). Decelerating flow waveform has been suggested to improve gas exchange in the neonate when compared with square flow (SF) waveform by improving the ventilation perfusion. However, the superiority of DF compared with SF has not yet been demonstrated during ventilation in small infants. The aim of this study was to compare SF vs. DF, with or without end-inspiratory pause (EIP), in terms of oxygenation and ventilation in an experimental model of newborn piglets. METHODS The lungs of 12 newborn Landrace/LargeWhite crossbred piglets were ventilated with SF, DF, SF-EIP and DF-EIP. Tidal volume (VT), inspiratory to expiratory ratio (I/E), respiratory rate (RR), and FiO2 were keep constant during the study. In order to assure an open lung during the study while preventing alveolar collapse, a positive end-expiratory pressure (PEEP) of 6 cmH2O was applied after a single recruitment maneuver. Gas exchange, lung mechanics and hemodynamics were measured. RESULTS The inspiratory flow waveform had no effect on arterial oxygenation pressure (PaO2) (276 vs. 278 mmHg, p = 0.77), alveolar dead space to alveolar tidal volume (VDalv/VTalv) (0.21 vs. 0.19 ml, p = 0.33), mean airway pressure (Pawm) (13.1 vs. 14.0 cmH2O, p = 0.69) and compliance (Crs) (3.5 vs. 3.5 ml cmH2O(-1), p = 0.73) when comparing SF and DF. A short EIP (10%) did not produce changes in the results. CONCLUSION The present study showed that there are no differences between SF, DF, SF-EIP and DF-EIP in oxygenation, ventilation, lung mechanics, or hemodynamics in this experimental model of newborn piglets with healthy lungs.
Collapse
Affiliation(s)
- Carlos Ferrando
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario of Valencia, Av. Blasco Ibañez, 17, CP: 46010 Valencia, Spain
| | - Marisa García
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario of Valencia, Av. Blasco Ibañez, 17, CP: 46010 Valencia, Spain
| | - Andrea Gutierrez
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario of Valencia, Av. Blasco Ibañez, 17, CP: 46010 Valencia, Spain
| | - Jose A Carbonell
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario of Valencia, Av. Blasco Ibañez, 17, CP: 46010 Valencia, Spain
| | - Gerardo Aguilar
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario of Valencia, Av. Blasco Ibañez, 17, CP: 46010 Valencia, Spain
| | - Marina Soro
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario of Valencia, Av. Blasco Ibañez, 17, CP: 46010 Valencia, Spain
| | - Francisco J Belda
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario of Valencia, Av. Blasco Ibañez, 17, CP: 46010 Valencia, Spain
| |
Collapse
|
11
|
Abstract
Background: The cardiopulmonary bypass (CPB)-associated atelectasis accounted for most of the marked post-CPB increase in shunt and hypoxemia. We hypothesized that pressure-regulated volume-control (PRVC) modes having a distinct theoretical advantage over pressure-controlled ventilation (PCV) by providing the target tidal volume at the minimum available pressure may prove advantageous while ventilating these atelactic lungs. Methods: In this prospective study, 36 post-cardiac surgical patients with a PaO2/FiO2 (arterial oxygen tension/Fractional inspired oxygen) < 300 after arrival to intensive care unit (ICU), (n = 34) were randomized to receive either PRVC or PCV. Air way pressure (Paw) and arterial blood gases (ABG) were measured at four time points [T1: After induction of anesthesia, T2: after CPB (in the ICU), T3: 1 h after intervention mode, T4: 1 h after T3]. Oxygenation index (OI) = [PaO2/ {FiO2 × mean airway pressure (Pmean)}] was calculated for each set of data and used as an indirect estimation for intrapulmonary shunt. Results: There is a steady and significant improvement in OI in both the groups at first hour [PCV, 27.5(3.6) to 43.0(7.5); PRVC, 26.7(2.8) to 47.6(8.2) (P = 0.001)] and second hour [PCV, 53.8(6.4); PRVC, 65.8(7.4) (P = 0.001)] of ventilation. However, the improvement in OI was more marked in PRVC at second hour of ventilation owing to significant low mean air way pressure compared to the PCV group [PCV, 8.6(0.8); PRVC, 7.7(0.5), P = 0.001]. Conclusions: PRVC may be useful in a certain group of patients to reduce intrapulmonary shunt and improve oxygenation after cardiopulmonary bypass-induced perfusion mismatch.
Collapse
Affiliation(s)
- Aloka Samantaray
- Department of Anesthesiology and Critical Care, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | | |
Collapse
|
12
|
Turner DA, Cheifetz IM. Pediatric acute respiratory failure: areas of debate in the pediatric critical care setting. Expert Rev Respir Med 2011; 5:65-73. [PMID: 21348587 DOI: 10.1586/ers.10.93] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pediatric intensive care units across the world care for large numbers of mechanically ventilated infants and children on a daily basis, yet management of these patients is far from standardized. This lack of standardization may be a necessity in certain situations given variation between underlying disease processes, pathophysiology, response to therapy and available resources. However, there are many situations in which similar patients are managed differently across pediatric intensive care units simply because there are a shortage of available data to guide the management of these critically ill infants and children. Thus, a large fraction of pediatric critical care involves a combination of institutional preference, individual experience, opinion and extrapolation of adult data.
Collapse
Affiliation(s)
- David A Turner
- Division of Pediatric Critical Care, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
| | | |
Collapse
|
13
|
Current challenges in cardiac intensive care: optimal strategies for mechanical ventilation and timing of extubation. Cardiol Young 2008; 18 Suppl 3:72-83. [PMID: 19094381 DOI: 10.1017/s1047951108003302] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
14
|
Does Closed Loop Control of Assist Control Ventilation Reduce Ventilator-Induced Lung Injury? Clin Chest Med 2008; 29:343-50, viii. [DOI: 10.1016/j.ccm.2008.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
15
|
|
16
|
|
17
|
|
18
|
Chugh K, Sachdev A, Agarwal S. Comparision of two ventilation modes and their clinical implications in sick children. Indian J Crit Care Med 2005. [DOI: 10.4103/0972-5229.19760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
19
|
Affiliation(s)
- Nobuaki Shime
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| |
Collapse
|
20
|
Abstract
OBJECTIVES The recognition that alveolar overdistension rather than peak inspiratory airway pressure is the primary determinant of lung injury has shifted our understanding of the pathogenesis of ventilator-induced side effects. In this review, contemporary ventilatory methods, supportive treatments, and future developments relevant to pediatric critical care are reviewed. DATA SYNTHESIS A strategy combining recruitment maneuvers, low-tidal volume, and higher positive end-expiratory pressure (PEEP) decreases barotrauma and volutrauma. Given that appropriate tidal volumes are critical in determining adequate alveolar ventilation and avoiding lung injury, volume-control ventilation with high PEEP levels has been proposed as the preferable protective ventilatory mode. Pressure-related volume control ventilation and high-frequency oscillatory ventilation (HFOV) have taken on an important role as protective lung strategies. Further data are required in the treatment of children, confirming the preliminary results in specific lung pathologies. Spontaneous breathing supported artificially during inspiration (pressure support ventilation) is widely used to maintain or reactivate spontaneous breathing and to avoid hemodynamic variation. Volume support ventilation reduces the need for manual adaptation to maintain stable tidal and minute volume and can be useful in weaning. Prone positioning and permissive hypercapnia have taken on an important role in the treatment of patients undergoing artificial ventilation. Surfactant and nitric oxide have been proposed in specific lung pathologies to facilitate ventilation and gas exchange and to reduce inspired oxygen concentration. Investigation of lung ventilation using a liquid instead of gas has opened new vistas on several lung pathologies with high mortality rates. RESULTS The conviction emerges that the best ventilatory treatment may be obtained by applying a combination of types of ventilation and supportive treatments as outlined above. Early treatment is important for the overall positive final result. Lung recruitment maneuvers followed by maintaining an open lung favor rapid resolution of pathology and reduce side effects. CONCLUSIONS The methods proposed require confirmation through large controlled clinical trials that can assess the efficacy reported in pilot studies and case reports and define the optimal method(s) to treat individual pathologies in the various pediatric age groups.
Collapse
Affiliation(s)
- Giuseppe A Marraro
- Pediatric Intensive Care Unit, Fatebenefratelli and Ophthalmiatric Hospital, Milan, Italy.
| |
Collapse
|