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Mechanical Ventilation II: Invasive Ventilation01:23

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Use of an Integrated Low-Flow Anesthetic Vaporizer, Ventilator, and Physiological Monitoring System for Rodents
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Selecting the best ventilator hyperinflation technique based on physiologic markers: A randomized controlled

Beatriz S Ribeiro1, Agnaldo J Lopes2, Sara L S Menezes3

  • 1Rehabilitation Sciences Post Graduation Program, Augusto Motta University Center, Rio de Janeiro, RJ, Brazil.

Heart & Lung : the Journal of Critical Care
|October 20, 2018
PubMed
Summary
This summary is machine-generated.

Volume-controlled ventilation (VC-CMV20) and pressure support ventilation (PSV) are effective for ventilator hyperinflation (VHI). Careful consideration of ventilator settings is crucial to avoid overdistension and patient-ventilator asynchronies.

Keywords:
Airway clearance techniquesCritical carePhysical therapy modalitiesRespiratory mechanicsRespiratory therapyVentilator hyperinflation

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Area of Science:

  • Critical Care Medicine
  • Respiratory Physiology
  • Mechanical Ventilation

Background:

  • Ventilator hyperinflation (VHI) improves respiratory mechanics, secretion clearance, and gas exchange in mechanically ventilated patients.
  • Optimal ventilator settings for performing VHI are not well-established, lacking specific recommendations.

Purpose of the Study:

  • To compare six different modes of VHI.
  • To evaluate physiological markers of efficacy and safety for selecting optimal VHI settings.

Main Methods:

  • Thirty mechanically ventilated patients participated in the study.
  • Six VHI modes were administered in a randomized order.
  • Key assessments included delivered volume, expiratory flow bias, overdistension, patient-ventilator asynchronies, and hemodynamic variables.

Main Results:

  • Volume-controlled ventilation with a 20 lpm inspiratory flow (VC-CMV20) and pressure support ventilation (PSV) demonstrated the highest effectiveness (P < 0.05).
  • A target peak pressure of 40 cmH2O was linked to significant overdistension.
  • PSV exhibited a reduced incidence of patient-ventilator asynchronies.

Conclusions:

  • VC-CMV20 and PSV emerge as the most effective modes for VHI.
  • Clinicians must carefully manage alveolar overdistension and patient-ventilator asynchronies during VHI application.