Intermittent Ventilatory Support Research Articles

Could CPAP Devices Be Used to Ventilate Cardiac Arrest Patients? A Bench Study

Objectives To investigate the potential efficacy of a commercial continuous positive airway pressure (CPAP) ventilator to provide effective respiratory support in a simulated scenario of out-of-hospital cardiac arrest (OHCA). Methods The study was conducted on a high-fidelity manikin (SimMan 3 GTM, Laerdal, NOR) connected to the ASL 5000TM Lung Simulator (IngMar Medical, USA). To simulate OHCA, we set no spontaneous respiratory acts and physiological respiratory system resistance (13 cmH2O/L.sec) and compliance (50 mL/cmH2O). The Respironics BiPAP A40 ventilatorI (Philips, NL) was used to provide ventilatory support while operating in CPAP mode. Tests were performed at different values of positive pressure of the CPAP ventilator (PCPAP: 5, 7.5, 10, 12.5 and 15 cmH2O) and the intrapulmonary volume (tidal volume, Vt) measured via the simulator software computer interface. A trained physician performed the tests. Our primary outcome was a VT of ≈500-600 mL with an intermittent maneuver simulating cardiopulmonary resuscitation (CPR)-like ventilatory support practice according to international guideline-based target (1-sec ventilation followed by 1-sec pause). Results In intermittent ventilatory support tests, PCPAP levels of 12.5, and 15 cmH2O resulted in a VT equal to 508 ± 13 mL, and 557 ± 44 mL respectively (p = 0.04), thus approaching the VT target. Conclusions We provide preliminary evidence of the potential efficacy of CPAP ventilators designed for home use to provide effective respiratory support to a simulated respiratory arrest patient.

Abnormal Newborn Screen During a Pandemic.

Abnormal Newborn Screen During a Pandemic.

I‐Z‐I complex myopathy

A 6‐week‐old boy with mild dysmorphism, born with severe muscle weakness and requiring intermittent ventilatory support, had a muscle biopsy with unusual features. He died at 3 months of age. There was no family history of neuromuscular disease. His mother reportedly had hypothyroidism. Modified Gomori's trichrome stain of the muscle biopsy showed many round to elongated small bodies in many myofibers, interpreted as nemaline “rods.” Electron microscopy was performed and a few small nemaline bodies were found. Over half the cells had round or oval profiles of possibly mononuclear myoblasts largely or entirely filled with globoid dense bodies that had 11‐nm dense crossing filaments and thin actin‐like filaments that extended up to 1.5 μm from each side of the globoid bodies, corresponding to I‐Z‐I complexes of embryonic myoblasts and myotubes. Some myosin thick filaments were present. We found two previous cases with foci of I‐Z‐I–like complexes at polar “caps” and filling a few cells, but our case appears to be the only one with a significant number of cells filled with I‐Z‐I–like complexes as the major finding in a myopathy. All three patients are mildly dysmorphic males. A mutation affecting mononuclear myoblasts and early primary myotubes is suspected, although an acquired lesion cannot be ruled out. The findings may also have been altered by secondary events in this unique case, such as degeneration, regeneration, and stem‐cell activity.

Assistência ventilatória domiciliar em crianças: descrição de um programa

OBJETIVO: o numero de pacientes pediatricos dependentes de suporte ventilatorio vem aumentando de maneira relevante nas ultimas decadas. Essas criancas permanecem por longos periodos internadas, frequentemente em unidades de terapia intensiva. Para minimizar as hospitalizacoes, tem sido dada enfase a continuacao da terapia ventilatoria no domicilio. No presente trabalho descreve-se um programa de assistencia ventilatoria domiciliar desenvolvido na Alemanha, visando antever a possibilidade de adaptacao a nossa realidade. CASUISTICA E METODOLOGIA: avaliou-se o programa de assistencia ventilatoria domiciliar da UTI-Pediatrica do Dr. von Haunersches Kinderklinik - Ludwig-Maximilians-Universitat-Munchen (Munique, Alemanha) no periodo entre abril de 1997 e junho de 1998. RESULTADOS: o referido programa da suporte a pacientes com idades entre 1 e 21 anos, sendo 11 do sexo masculino e 15 do feminino. Dos 26 pacientes, 15 apresentavam patologias neuromusculares, oito problemas ventilatorios de causa central e tres doencas pulmonares obstrutivas. Doze criancas (46,2%) eram ventiladas atraves de tecnicas nao-invasivas e 19 (73,1%) necessitavam apenas de suporte ventilatorio intermitente. CONCLUSAO: o programa tem uma equipe multidisciplinar permanentemente responsavel pelo tratamento de intercorrencias. Os pacientes, em periodos pre-determinados, sao submetidos a reavaliacoes da evolucao da insuficiencia respiratoria. Essa organizacao do sistema faz com que paciente e familiares sintam-se seguros e e responsavel pelo exito do programa de assistencia ventilatoria no domicilio. Existe a necessidade de um grande esforco organizacional antes que possamos instituir programas semelhantes no Brasil.

Home ventilation of pediatric patients - description of a program

OBJECTIVE: To describe a German program for home ventilatory support, and to analyze the possibility of applying it in Brazil. MATERIALS AND METHODS: We assessed Dr. von Haunersches Kinderklinikacute;s Pediatric Intensive Care Unity - Ludwig-Maximilians - Universität - München (Munich, Germany) home ventilatory support program between April 1997 and June 1998. RESULTS: Patients aged between 1 and 21 years - 11 boys and 15 girls - participated in the study. Fifteen out of 26 children presented neuromuscular pathologies, 8 of them had ventilatory problems of central causes, and 3 children presented obstructive pulmonary diseases. Twelve (46.2%) were receiving noninvasive ventilatory assistance, and 19 (73.1%) only needed intermittent ventilatory support. CONCLUSION: The program relies on a permanent multidisciplinary staff to treat intercurrent diseases. Patients, at predetermined periods, are re-evaluated as to the evolution of respiratory insufficiency. The adequate system organization provides patients and their families with security, and accounts for the success of the home ventilatory support program. A great deal of organizational efforts should be consolidated before implementing similar programs in Brazil.

Time course evolution of ventilatory response to inspiratory unloading in patients

Inspiratory unloading decreases ventilatory drive and work of breathing in patients undergoing mechanical ventilation. We examined the time course of this effect in patients receiving permanent ventilatory support, provided by pressure support ventilation (PSV), or intermittent ventilatory support, provided by biphasic positive airway pressure (BIPAP).

A guide to noninvasive intermittent ventilatory support

Patients who use home-based medical technologies, such as noninvasive intermittent ventilatory support, may require hospitalization on units where the staff is unfamiliar with this type of equipment. Consequently, acute care clinicians need resources so they can provide safe care to these patients. This article provides background information about noninvasive intermittent ventilatory support, presents a case study to illustrate key aspects of each type of support, and provides quick reference tables to assist acute care clinicians in managing this technology.

Ventilatory Muscle Support in Respiratory Failure with Nasal Positive Pressure Ventilation

Long-term intermittent mechanical ventilation results in improvements in ventilatory performance and clinical status between ventilation sessions in patients with chronic respiratory failure. The application of intermittent positive pressure ventilation through a nasal mask (NPPV) is a simple, noninvasive method for the provision of chronic intermittent ventilatory support. We investigated the effects of NPPV on inspiratory muscle activity in three normal subjects and nine patients with acute or chronic ventilatory failure due to restrictive (four subjects) or obstructive (five subjects) respiratory disorders. NPPV resulted in reductions of phasic diaphragm electromyogram amplitude to 6.7 +/- 0.7 percent (mean +/- SEM) of values obtained during spontaneous breathing in the normal subjects, 6.4 +/- 3.2 percent in the restrictive group, and 8.3 +/- 5.1 percent in the obstructive group. Simultaneous decreases in activity of accessory respiratory muscles were observed. The reductions in inspiratory muscle activity were confirmed by the finding of positive intrathoracic pressure swings on inspiration in all subjects. With NPPV, oxygen saturation and PCO2 remained stable or improved as compared with values obtained during spontaneous breathing. These results indicate that NPPV can noninvasively provide ventilatory support while reducing inspiratory muscle energy expenditure in acute and chronic respiratory failure of diverse etiology. Long-term assisted ventilation with NPPV may be useful in improving ventilatory performance by resting the inspiratory muscles.