Weaning The Unweanable.aspx Ventilation Is A Modern Improvement Of The Iron Lung

The study shows the decrease in mechanical support can be effected by increasing periods of unassisted breathing, alternating unassisted breaths with mechanical breaths, and reduction of the support delivered

When the organs fail the only option is a transplant. With lungs there is only a 50% rate of a five year survival rate after a lung transplantation involving the end-stage respiratory disease. With such a drastic survival rate a study was completed to determine if patients could have a better outcome. This study was done to help determine effective methods to enhance lung transplants before surgery; the Doctors placed the recipients on bi-level positive airway pressure ventilation (BIPAP.) “BIPAP is a noninvasive mode of ventilation administered through a tight-fitting mask to assist spontaneously breathing patients”

ation that I will be discussing is Airway Pressure Release Ventilation (APRV). I have not had an opportunity to use this mode, so I thought I would research it for this assignment. “The degree of ventilator support with APRV is determined by the duration of the two CPAP levels and the mechanically delivered tidal volume. Depends mainly on respiratory compliance and the difference between the CPAP levels. By design, changes in ventilatory demand do not alter the level of mechanical support during APRV. When spontaneous breathing is absent, APRV is not different from conventional pressure-controlled, time-cycled mechanical ventilation”( Putensen, C. )APRV is a form of improved pressure ventilation allowing unrestricted spontaneous breath at an

From investigation in health practices, ventilator associated pneumonia caught my attention. “Ventilator Associated Pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care units. Most episodes of VAP are thought to develop from the aspiration of oropharyngeal secretions containing potentially pathogenic organisms. Aspiration of gastric secretions may also contribute, though likely a lesser degree. Tracheal intubation interrupts the body’s anatomic and physiologic defenses against aspiration, making mechanical ventilation a major risk for Ventilator Associated Pneumonia. Semi-recumbent positioning of mechanically ventilated patients may help reduce the incidence of gastroesophageal reflux and lead to a decreased incidence of VAP. The one randomized trial to date of semi- recumbent positioning shows it to be an effective method of reducing VAP. Immobility in critically ill patients leads to atelectasis and decreased clearance of bronchopulmonary secretions. The accumulation of contaminated oropharyngeal secretions above the endotracheal tube cuff may contribute to the risk of aspiration. Removing these

During mechanical ventilation, patients are at risk of injuries to their lungs caused by improper settings on ventilators. Mechanical ventilator induced lung injury (VILI) can affect the lung in several ways. Some of the ways the lung become affected is by excessive pressure, excessive volume, and not enough volume. When the lungs are affected by excessive pressure its termed pulmonary barotrauma. On the other hand, if the lungs receive too much volume it’s called volutrauma. However, when the lungs don’t receive enough volume its termed atelectrauma. This paper describes how pulmonary barotrauma, pulmonary volutrauma, and pulmonary atelectrauma affects the lungs during mechanical ventilation and ways to prevent them from happening.

Ge Li, MD, PhD; Lucy Y. Wang, MD; Jane B. Shofer, MS; Mary Lou Thompson, PhD; Elaine R. Peskind, MD; Wayne McCormick, MD, MPH; James D. Bowen, MD; Paul K. Crane, MD, MPH; Eric B. Larson, MD, MPH

The mechanical insufflator-exsufflator, commonly known as the CoughAssist, is medical device that uses positive and negative air pressure to inflate and rapidly deflate the lung, thus simulating a cough and helping to clear secretions. It is commonly used in patients with impaired or no cough response. This includes patients with neuromuscular disease and muscle weakness related to nervous system injuries. Furthermore, it can be used in children as well as adults in the management of

Fred S. Apple, PhD; MaryAnn M. Murakami, BA; Lesly A. Pearce, MS; Charles A. Herzog, MD

The medical field is very fast-paced and new technological discoveries are constantly being made. When one thinks of new medical findings, cancer cures and surgery are common thoughts. However, a very interesting and slightly controversial discovery has been made in the neonatal world. The Neurally Adjusted Ventilatory Assist (NAVA) is “a form of partial ventilator assistance in which the machine delivers assistance in proportion to the electrical activity of the diaphragm (EAdi), as assessed by means of transesophageal electromyography” (Gianmaria Cammarota et al., 2011). It is meant to lower inspiratory pressure and respiratory muscle load in preterm infants (Gianmaria Cammarota et al., 2011). In other words, it helps the patient- whether they be an infant or an adult- breathe when their lungs aren’t able to aid in that process. M. Ferrer and P. Pelosi, authors of “European Respiratory Monograph 55: New Developments in Mechanical Ventilation” say that the signal from the EAdi is used to regulate NAVA, which then causes the airways to receive pressure. “With NAVA, both timing and the magnitude ventilator delivered assistance are controlled by the EAdi” (M. Ferrer & P. Pelosi., 2012, p 116). My research proves that NAVA can work better than pressure support ventilation (PSV) and can be used not only for neonates, but patients in the ICU that are affected by lung-related injury or illness that causes them to have difficulty breathing on their own; though there are

Together, this results in a pressure/volume gradient throughout Mr Smith’s lungs, with his left lung having lower volume and intrapleural pressure.4 As relatively large increases in volume occur for small increases in pressure at the start of pressure volume curves, Mr Smith’s left lung is preferentially ventilated in the dependent position.3,

Providing anesthesia for lung transplantation (LT) is considered by many to be a major feat in cardiothoracic anesthesia. Some say it involves the most complex manipulation of cardiothoracic physiology, especially when cardiopulmonary bypass (CPB) is not used. There are many indications for end-stage pulmonary disease, from obstructive lung disease to pulmonary vascular disease. Traditionally, ventilation strategies for this population included tidal volumes of 8-12ml/kg to prevent atelectasis and zero PEEP to prevent a shunt of blood flow (Slinger, 2012). This strategy proved to cause harm during the periorperative period. Research now indicates that a reduction in tidal volume with added PEEP not only decreases atelectasis, but it also reduces pulmonary inflammatory response (Coppola, Froio, & Chuimello 2014). These patients already have a decreased respiratory reserve, therefore inducing an inflammatory mediated response with ventilation settings can be detrimental and should be avoided at all costs by the nurse anesthetist. It is imperative for the nurse anesthetist understand the necessity of lung protective ventilation strategies in LT.

Intubation and mechanical ventilation is a common life-saving intervention that is used in the hospital when the patient does not have adequate oxygenation or airway. It can be used to replace or assist a patient’s spontaneous breathing. In order to manage the ventilation settings you have to set the time, volume, flow and airway pressure. If the wrong settings are used it can cause ventilator-induced lung injury due to the over-distention of the lungs. The patient can be extubated when the physician determines that the problem has been solved and that the patient has adequate oxygenation and ventilation.

The lungs are attached at the Left atrial cannula were a slight flow of air is introduced to de-air through the pulmonary artery cannula. Once de-aired, the pulmonary artery cannula was then connected as well and a flow of around 130 mL/min of perfusate, which is essentially a solution with an enhanced colloid osmotic pressure that was created for EVLP. The ventilation of the perfusate is gradually increased. An estimation of the donor’s cardiac output is then made and around 50% of estimated cardiac output is maintained for the flow rate to perfuse both lungs. The ventilation using a tidal volume of around 6mL/kg (donors body weight) is maintained at 7 breaths per minute. The oxygenated perfusate is then deoxygenated by the use of CO2 gas and a heat exchanger and the resulting perfusate is then pumped back into the lungs to the pulmonary artery. The electrolytes, glucose, pCO2 and pH levels were maintained at physiologic levels in the perfusate to best reconstruct real ventilation. Just like the ex vivo heart perfusion machine (EVHP), the EVLP monitors just about every important aspect that the transplant patient will require to be able to maintain a healthy lung once transplantation is finished. These monitored values include the Left Atrial cannula pressure, the mechanical tidal volume ventilations based on donors ideal body weight, the

On the other hand, pressure control ventilator is set up so the end of the inspiration meets the set pressure; this mode gurantees specific amount of pressure. The advantages of this mode is offering lower work of breathing,

Although both the methods were noninvasive procedures, it lacked practicality. In case of iron lung the patient’s body would be enclosed in a tank except for head and neck. Evacuation of air from the tank would produce a negative pressure leading to expansion of chest wall and alveoli thus delivering the tidal volume which was directly related to the negative pressure gradient. It provided poor patient access and patients would be prone to tank shock with decreased cardiac output. In the Chest Cuirass only the patient’s chest was enclosed leaving the arms and lower body exposed. This resulted in better patient access and alleviation of shock associated with iron lung. However there was difficulty in maintaining an airtight seal between the shell and the patient’s chest wall. Therefore customized cuirass was needed to be made to ensure better