Mechanical Ventilation Parameters Research Articles

The Impact of Pneumoperitoneum on Mean Expiratory Flow Rate: Observational Insights from Patients with Healthy Lungs

Background/Objectives: Surgical pneumoperitoneum (PP) significantly impacts volume-controlled ventilation, characterized by reduced respiratory compliance, elevated peak inspiratory pressure, and an accelerated expiratory phase due to an earlier onset of the airway pressure gradient. We hypothesized that this would shorten expiratory time, potentially increasing expiratory flow rate compared to pneumoperitoneum conditions. Calculations were performed to establish correlations between respiratory parameters and the mean increase in expiratory flow rate relative to baseline. Methods: Mechanical ventilation parameters were recorded for 67 patients both pre- and post-PP. Ventilator settings were standardized with a tidal volume of 6 mL/kg, a respiratory rate of 12 breaths per minute, a PEEP of 3 cmH2O, an inspiratory time of 2 s, and an inspiratory-to-expiratory ratio of 1:1.5 (I:E). Results: The application of PP increased both peak inspiratory pressure and mean expiratory flow rate by 28% compared to baseline levels. The elevated intra-abdominal pressure of 20 cmH2O resulted in a 34% reduction in dynamic chest compliance, a 50% increase in elastance, and a 20% increase in airway resistance. The mean expiratory flow rate increments relative to baseline showed a significant negative correlation with elastance (p = 0.0119) and a positive correlation with dynamic compliance (p = 0.0028) and resistance (p = 0.0240). Conclusions: A PP of 20 cmH2O resulted in an increase in the mean expiratory flow rate in the conventional I:E ratio in the volume-ventilated mode. PP reduces lung and chest wall compliance by elevating the diaphragm, compressing the thoracic cavity, and increasing airway pressures. Consequently, the lungs and chest wall stiffen, requiring greater ventilatory effort and accelerating expiratory flow due to increased airway resistance and altered pulmonary mechanics. Prolonging the inspiratory phase through I:E ratio adjustment helps maintain peak inspiratory pressures closer to baseline levels, and this method enhances the safety and efficacy of mechanical ventilation in maintaining optimal respiratory function during laparoscopic surgery.

Predictive value of neutrophil-to-lymphocyte ratio in in-hospital mortality in sepsis patients: A cross-sectional study

Objective: To explore the predictive value of neutrophil-to-lymphocyte ratio (NLR) in in-hospital mortality in sepsis patients. Methods: A prospective observational cross-sectional study was conducted on 100 patients with septicemia. The data about the patient’s demography, medical history, general examination including pulse rate, blood pressure, etc, use of vasopressor support, need for renal replacement therapy, mechanical ventilation, outcome, and lab parameters including total lymphocyte count with neutrophil-to-lymphocyte ratio were recorded. And parameters between survivals and non-survivals were compared. Results: Out of 100 patients, 80% were from rural backgrounds. Most patients were 50 to 59 years old. 26 Patients were dead. The patients in the nonsurvivor group were older and more had a history of diabetes mellitus when compared with the survivor group. The non-survivor group had a higher NLR, APACHE II, and SOFA score. Conclusions: NLR is a readily available parameter and can be used as a good prognostic indicator for mortality in sepsis patients.

A novel, cassette-based nitric oxide delivery system with an advanced feedback control algorithm accurately delivers nitric oxide via the anesthesia machine independent of fresh gas flow rate and volatile anesthetic agent

Nitric oxide (NO), a selective pulmonary vasodilator, can be delivered via conventional ICU and anesthesia machine ventilators. Anesthesia machines are designed for rebreathing of circulating gases, reducing volatile anesthetic agent quantity used. Current cylinder- and ionizing-based NO delivery technologies use breathing circuit flow to determine NO delivery and do not account for recirculated gases; therefore, they cannot accurately dose NO at FGF below patient minute ventilation (MV). A novel, cassette-based NO delivery system (GENOSYL® DS, Vero Biotech Inc.) uses measured NO concentration in the breathing circuit as an input to an advanced feedback control algorithm, providing accurate NO delivery regardless of FGF and recirculation of gases. This study evaluated GENOSYL® DS accuracy with different anesthesia machines, ventilation parameters, FGFs, and volatile anesthetics. GENOSYL® DS was tested with GE Aisys and Dräger Fabius anesthesia machines to determine NO dose accuracy with FGF < patient MV, and with a Getinge Flow-i anesthesia machine to determine NO dose accuracy when delivering various volatile anesthetic agents. Neonatal and adult mechanical ventilation parameters and circuits were used. GENOSYL® DS maintained accurate NO delivery with all three anesthesia machines, at low FGF with recirculation of gases, and with all volatile anesthetic agents at different concentrations. Measured NO2 levels remained acceptable at ≤ 1 ppm with set NO dose ≤ 40 ppm. GENOSYL® DS, with its advanced feedback control algorithm, is the only NO delivery system capable of accurately dosing NO with anesthesia machines with rebreathing ventilation parameters (FGF < MV) regardless of anesthetic agent.

Potential risk factors of pediatric acute respiratory distress syndrome in sepsis

Background Sepsis in children is characterized by a dysregulated host response to infection and life-threatening organ dysfunction. Pediatric acute respiratory distress syndrome (PARDS) is a severe complication of sepsis. Several known risk factors of PARDS are immunodeficiency, obesity, source of infection, and genetic factors. Objective To describe the potential risk factors of PARDS in septic children at Haji Adam Malik General Hospital, Medan, North Sumatera. Methods This descriptive study using eligible medical record data from sepsis patients aged 1 month – 18 years was conducted at Haji Adam Malik General Hospital in 2020–2022. A total sampling method was used for subject selection. Patients’ demographic and clinical characteristics, mechanical ventilation modes and parameters, laboratory results, and outcomes were collected from medical records. Patients were classified as having sepsis with PARDS if Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria of ARDS was met. Results Of 112 pediatric sepsis patients, 33.9% developed PARDS. The mortality rates for PARDS was 73.7%. Of the patients with PARDS, 57.9% had immunodeficiency, 60.5% patients had an intrapulmonary infection, 39.5% had an extrapulmonary infection, and 23.7% of patients had a suspected genetic disorder. In addition, 39.5% had good nutritional status, followed by 21.1% with obese. Conclusion The majority of patients with PARDS have intrapulmonary infection and immunodeficiency. Some of patients with PARDS have suspected genetic disorders and well nourished.

Community-acquired neonatal SARS-CoV-2 infection: case report

Background and Objectives: Data collection on the incidence of COVID-19 is conducted less frequently in newborns (NB) than in adults. In view of the small number of described neonatal SARS-CoV-2 infections, in this study, we report a clinical case of community-acquired COVID-19 infection in a newborn. Methods: Clinical characteristics were collected from the medical records from April 2021 until the final outcome of the newborn in May 2021. Results: This article discusses the case of a full-term male newborn aged 38 weeks. On the 17th day of life, this newborn was admitted to the pediatric unit with fever and zone 4 jaundice, mild lower chest retraction and tachypnea. The mother was diagnosed with COVID-19. Late neonatal sepsis with pulmonary focus was detected. The newborn was hospitalized and the antigen test for COVID-19 came back positive. The condition of the neonate rapidly deteriorated and he was referred to the neonatal intensive care unit (NICU), where he was intubated and placed on pressure-controlled mechanical ventilation. During his second week in the NICU, he developed severe pulmonary hypertension with decreased peripheral oxygen saturation and tachycardia. The newborn required blood transfusion and was put into prone position during part of the treatment. Reductions in mechanical ventilation parameters were not tolerated by the NB’s organism and he developed progressive hypoxemia. The newborn died 1 month and 3 days after hospitalization. Conclusion: Our study shows a case of community-acquired COVID-19 that progressed to the severe form of the disease.

The mechanical ventilation guided by electrical impedance tomography in acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is a common and critical clinical condition characterized by diffuse damage to the lung interstitium, alveoli, and increased permeability of pulmonary blood vessels. CT can be used to assess the imaging features, severity, and prediction of ARDS, but it requires patient transportation to the CT room and is only a static examination. Electrical impedance tomography (EIT) is an increasingly widely used monitoring tool in clinical applications in recent years. It enables continuous real-time assessment of lung ventilation distribution at the bedside and has high clinical value in optimizing mechanical ventilation parameters for critically ill patients. This article introduces the basic principles of EIT and how to better utilize EIT technology to guide mechanical ventilation treatment for ARDS patients.

Consistency between safe mechanical ventilation parameters in the general ICU patient population

Consistency between safe mechanical ventilation parameters in the general ICU patient population

A multimodal stacked ensemble model for cardiac output prediction utilizing cardiorespiratory interactions during general anesthesia

This study examined the possibility of estimating cardiac output (CO) using a multimodal stacking model that utilizes cardiopulmonary interactions during general anesthesia and outlined a retrospective application of machine learning regression model to a pre-collected dataset. The data of 469 adult patients (obtained from VitalDB) with normal pulmonary function tests who underwent general anesthesia were analyzed. The hemodynamic data in this study included non-invasive blood pressure, plethysmographic heart rate, and SpO2. CO was recorded using Vigileo and EV1000 (pulse contour technique devices). Respiratory data included mechanical ventilation parameters and end-tidal CO2 levels. A generalized linear regression model was used as the metalearner for the multimodal stacking ensemble method. Random forest, generalized linear regression, gradient boosting machine, and XGBoost were used as base learners. A Bland–Altman plot revealed that the multimodal stacked ensemble model for CO prediction from 327 patients had a bias of − 0.001 L/min and − 0.271% when calculating the percentage of difference using the EV1000 device. Agreement of model CO prediction and measured Vigileo CO in 142 patients reported a bias of − 0.01 and − 0.333%. Overall, this model predicts CO compared to data obtained by the pulse contour technique CO monitors with good agreement.

Progress in the relationship between mechanical ventilation parameters and ventilator-related complications during perioperative anesthesia.

Mechanical ventilation, as an important respiratory support, plays an important role in general anesthesia and it is the cornerstone of intraoperative management of surgical patients. Different from spontaneous respiration, intraoperative mechanical ventilation can lead to postoperative lung injury, and its impact on surgical mortality cannot be ignored. Postoperative lung injury increases hospital stay and is related to preoperative conditions, anesthesia time, and intraoperative ventilation settings. Through reading literature and research reports, the relationship between perioperative input parameters and output parameters related to mechanical ventilation and ventilator-related complications was reviewed, providing reference for the subsequent setting of input parameters of mechanical ventilation and new ventilation strategies. The parameters of inspiratory pressure rise time and inspiratory time can change the gas distribution, gas flow rate and airway pressure into the lungs, but there are few clinical studies on them. It can be used as a prospective intervention to study the effect of specific protective ventilation strategies on pulmonary complications after perioperative anesthesia. There are many factors affecting lung function after perioperative mechanical ventilation. Due to the difference of human body, the ventilation parameters suitable for each patient are different, and the deviation of each ventilation parameter can lead to postoperative pulmonary complications. Inspiratory pressure rise time and inspiratory time will be used as the new ventilation strategy.

Individualized estimation of arterial carbon dioxide partial pressure using machine learning in children receiving mechanical ventilation

BackgroundMeasuring arterial partial pressure of carbon dioxide (PaCO2) is crucial for proper mechanical ventilation, but the current sampling method is invasive. End-tidal carbon dioxide (EtCO2) has been used as a surrogate, which can be measured non-invasively, but its limited accuracy is due to ventilation-perfusion mismatch. This study aimed to develop a non-invasive PaCO2 estimation model using machine learning.MethodsThis retrospective observational study included pediatric patients (< 18 years) admitted to the pediatric intensive care unit of a tertiary children’s hospital and received mechanical ventilation between January 2021 and June 2022. Clinical information, including mechanical ventilation parameters and laboratory test results, was used for machine learning. Linear regression, multilayer perceptron, and extreme gradient boosting were implemented. The dataset was divided into 7:3 ratios for training and testing. Model performance was assessed using the R2 value.ResultsWe analyzed total 2,427 measurements from 32 patients. The median (interquartile range) age was 16 (12−19.5) months, and 74.1% were female. The PaCO2 and EtCO2 were 63 (50−83) mmHg and 43 (35−54) mmHg, respectively. A significant discrepancy of 19 (12–31) mmHg existed between EtCO2 and the measured PaCO2. The R2 coefficient of determination for the developed models was 0.799 for the linear regression model, 0.851 for the multilayer perceptron model, and 0.877 for the extreme gradient boosting model. The correlations with PaCO2 were higher in all three models compared to EtCO2.ConclusionsWe developed machine learning models to non-invasively estimate PaCO2 in pediatric patients receiving mechanical ventilation, demonstrating acceptable performance. Further research is needed to improve reliability and external validation.

Development and evaluation of a mechanical ventilator-sharing system.

During the COVID-19 pandemic surge in the hospitalization of critically ill patients and the global demand for mechanical ventilators, alternative strategies for device sharing were explored. We developed and assessed the performance of a system for shared ventilation that uses clinically available components to individualize tidal volumes under a variety of clinically relevant conditions. The feasibility of remote monitoring of ventilators was also assessed. By using existing resources and off-the-shelf components, a ventilator-sharing system (VSS) that ventilates 2 patients simultaneously with a single device, and a ventilator monitoring system (VMS) that remotely monitors pulmonary mechanics were developed. The feasibility and effectiveness of VSS and VMS were evaluated in benchtop testing using 2 test lungs on a single ventilator, and then performance was assessed in translational swine models of normal and impaired lung function. In benchtop testing, VSS and VMS delivered the set individualized parameters with minimal % errors in test lungs under pressure- and volume-regulated ventilation modes, suggesting the highest precision and accuracy. In animal studies, the VSS and VMS successfully delivered the individualized mechanical ventilation parameters within clinically acceptable limits. Further, we found no statistically significant difference between the target and measured values. The VSS adequately ventilated 2 test lungs or animals with variable lung conditions. The VMS accurately displayed mechanical ventilation settings, parameters, and alarms. Both of these systems could be rapidly assembled for scaling up to ventilate several critically ill patients in a pandemic or mass casualty disaster situations by leveraging off-the-shelf and custom 3D printed components.

Association between mechanical ventilation parameters and mortality in children with respiratory failure on ECMO: a systematic review and meta-analysis.

In refractory respiratory failure (RF), extracorporeal membrane oxygenation (ECMO) is a salvage therapy that seeks to reduce lung injury induced by mechanical ventilation. The parameters of optimal mechanical ventilation in children during ECMO are not known. Pulmonary ventilatory management during this therapy may impact mortality. The objective of this study was to evaluate the association between ventilatory parameters in children during ECMO therapy and in-hospital mortality. A systematic search of PubMed/MEDLINE, Embase, Cochrane, and Google Scholar from January 2013 until May 2022 (PROSPERO 450744), including studies in children with ECMO-supported RF assessing mechanical ventilation parameters, was conducted. Risk of bias was assessed using the Newcastle-Ottawa scale; heterogeneity, with absence <25% and high >75%, was assessed using I2. Sensitivity and subgroup analyses using the Mantel-Haenszel random-effects model were performed to explore the impact of methodological quality on effect size. Six studies were included. The median age was 3.4 years (IQR: 3.2-4.2). Survival in the 28-day studies was 69%. Mechanical ventilation parameters associated with higher mortality were a very low tidal volume ventilation (<4 ml/kg; OR: 4.70; 95% CI: 2.91-7.59; p < 0.01; I2: 38%), high plateau pressure (mean Dif: -0.70 95% CI: -0.18, -0.22; p < 0.01), and high driving pressure (mean Dif: -0.96 95% CI: -1.83, -0.09: p = 0.03). The inspired fraction of oxygen (p = 0.09) and end-expiratory pressure (p = 0.69) were not associated with higher mortality. Patients who survived had less multiple organ failure (p < 0.01). The mechanical ventilation variables associated with higher mortality in children with ECMO-supported respiratory failure are high plateau pressures, high driving pressure and very low tidal volume ventilation. No association between mortality and other parameters of the mechanical ventilator, such as the inspired fraction of oxygen or end-expiratory pressure, was found. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023450744, PROSPERO 2023 (CRD42023450744).

Prolonged venous hemodiafiltration and hemoperfusion with polymixin in fulminant meningococcal disease: A case report

Fulminate meningococcal infection is one of the most formidable life-threatening conditions in children, accompanied by a high probability of complications and adverse outcomes, including disability, irreversible damage to the central nervous system, and death. The key link in the pathogenesis of this condition is the massive release of endotoxins by the pathogen and total damage to the endothelium of all vessels, which underlies the development of septic shock and all complications. The use of extracorporeal hemocorrection methods is one of the most effective methods of treating fulminate meningococcal infection; however, despite the undoubted therapeutic effect, they are not included in the recommendations of a high level of evidence and are rarely used in routine clinical practice and, in most cases, only in the terminal phase of the disease. The study presented the characteristics of the course of generalized meningococcal infection in a 7-year-old child, including intensive care measures. Particular attention was paid to assessing the severity of the condition and the effectiveness of extracorporeal hemocorrection methods. The child’s condition upon admission to the intensive care unit was 11 points according to the pSOFA scale, which indicated the presence of decompensated multiorgan dysfunction and was the basis for prolonged venovenous hemodiafiltration. Based on the results of the endotoxin activity assay (0.67 units), hemoperfusion with polymyxin was conducted. During therapy, the patient’s condition stabilized. Sixty-eight hours after admission, medical support for hemodynamics was discontinued, and the parameters of invasive mechanical ventilation were reduced. On day 7 of treatment, the patient was extubated, and the events of respiratory distress did not increase over time. On day 8 after admission, with full compensation of all vital functions following ischemic damage and deep necrosis of the tissues of the lower extremities, the patient was transferred to a multidisciplinary surgical hospital for further treatment. Early informed use of extracorporeal hemocorrection techniques contributes to the rapid regression of septic shock events and recovery of the patient, demonstrating the high efficacy of the methods used and the need for further multicenter randomized trials to routinely use these therapies in clinical practice.

Effect of tocilizumab on pulmonary gas exchange function in patients with severe COVID-19

Introduction. COVID-19 causes cytokine storm and acute respiratory distress syndrome, which can lead to severe lung damage and multiple organ dysfunction. Early use of monoclonal antibodies has shown promising results in cytokine storm therapy, but the effects on lung gas exchange function have not yet been studied.Aim. To evaluate the effect of tocilizumab on the dynamics of gas exchange parameters in patients with severe COVID-19. Material and methods. The study included 26 patients in whom gas exchange parameters (PaO2, PaCO2, P/f ratio), blood oxygen saturation (saturation), respiration rate, duration and parameters of high-flow oxygen therapy and noninvasive mechanical ventilation, length of stay in intensive care unit and total hospital length of stay were assessed.Results. Tocilizumab significantly improved oxygenation on the third day (p=0.001) from the time of drug administration.Conclusion. In the presented and analyzed cohort of patients with severe COVID-19 and cytokine storm, the normalization and significant increase of oxygenation parameters (PaO2, p=0.001; P/f ratio, p=0.001) were observed within three days after a single-dose tocilizumab administration in a complex intensive therapy. No significant dynamics in the respiratory support parameters was revealed, nor an effect of this therapy on the duration of the respiratory support or the reduction in the aggressiveness of its parameters was observed within three days after tocilizumab administration (p&gt;0.05).

Factors Associated With Successful Extubation Readiness Testing in Children With Congenital Heart Disease.

In children with congenital heart disease, extubation readiness testing (ERT) is performed to evaluate the potential for liberation from mechanical ventilation. There is a paucity of data that suggests what mechanical ventilation parameters are associated with successful ERT. We hypothesized that ERT success would be associated with certain mechanical ventilator parameters. Data on daily ERT assessments were recorded as part of a quality improvement project. In accordance with our respiratory therapist-driven ventilator protocol, patients were assessed daily for ERT eligibility and tested daily, if eligible. Mechanical ventilation parameters were categorized a priori to evaluate the differences in levels of respiratory support. The primary outcome was ERT success. A total of 780 ERTs from 320 subjects (median [interquartile range] age 2.5 [0.6-6.5] months and median weight [interquartile range] 4.2 [3.3-6.9] kg) were evaluated. A total of 528 ERTs (68%) were passed, 306 successful ERTs (58%) resulted in extubation, and 30 subjects (9.4%) were re-intubated. There were statistically significant differences in the ERT pass rate for ventilator mode, peak inspiratory pressure, Δ pressure, PEEP, mean airway pressure ([Formula: see text]), and dead-space-to-tidal-volume ratio (all P < .001) but not for [Formula: see text]. ERT success decreased with increases in peak inspiratory pressure, Δ pressure, PEEP, [Formula: see text], and dead-space-to-tidal-volume ratio. Logistic regression revealed neonates, Δ pressure ≥ 11 cm H2O, and [Formula: see text] > 10 cm H2O were associated with a decreased odds of ERT success, whereas children ages 1-5 years and an [Formula: see text] of 0.31-0.40 had increased odds of ERT success. ERT pass rates decreased as ventilator support increased; however, some subjects were able to pass ERT despite high ventilator support. We found that [Formula: see text] was associated with ERT success and that protocols should consider using [Formula: see text] instead of PEEP thresholds for ERT eligibility. Cyanotic lesions were not associated with ERT success, which suggests that patients with cyanotic heart disease can be included in ERT protocols.

Predicting long-term neurocognitive outcome after pediatric intensive care unit admission for bronchiolitis—preliminary exploration of the potential of machine learning

PurposeFor successful prevention and intervention, it is important to unravel the complex constellation of factors that affect neurocognitive functioning after pediatric intensive care unit (PICU) admission. This study aims (1) to elucidate the potential relevance of patient and PICU-related characteristics for long-term adverse neurocognitive outcome after PICU admission for bronchiolitis, and (2) to perform a preliminary exploration of the potential of machine learning as compared to linear regression to improve neurocognitive outcome prediction in a relatively small sample of children after PICU admission.MethodsThis cross-sectional observational study investigated 65 children aged 6–12 years with previous PICU admission for bronchiolitis (age ≤ 1 year). They were compared to demographically comparable healthy peers (n = 76) on neurocognitive functioning. Patient and PICU-related characteristics used for the prediction models were as follows: demographic characteristics, perinatal and disease parameters, laboratory results, and intervention characteristics, including hourly validated mechanical ventilation parameters. Neurocognitive outcome was measured by intelligence and computerized neurocognitive testing. Prediction models were developed for each of the neurocognitive outcomes using Regression Trees, k-Nearest Neighbors, and conventional linear regression analysis.ResultsThe patient group had lower intelligence than the control group (p < .001, d = −0.59) and poorer performance in neurocognitive functions, i.e., speed and attention (p = .03, d = −0.41) and verbal memory (p < .001, d = −0.60). Lower intelligence was predicted by lower birth weight and lower socioeconomic status (R2 = 25.9%). Poorer performance on the speed and attention domain was predicted by younger age at follow-up (R2 = 53.5%). Poorer verbal memory was predicted by lower birth weight, younger age at follow-up, and greater exposure to acidotic events (R2 = 50.6%). The machine learning models did not reveal added value in terms of model performance as compared to linear regression.Conclusion: The findings of this study suggest that in children with previous PICU admission for bronchiolitis, (1) lower birth weight, younger age at follow-up, and lower socioeconomic status are associated with poorer neurocognitive outcome; and (2) greater exposure to acidotic events during PICU admission is associated with poorer verbal memory outcome. The findings of this study provide no evidence for the added value of machine learning models as compared to linear regression analysis in the prediction of long-term neurocognitive outcome in a relatively small sample of children.What is Known:• Adverse neurocognitive outcomes are described in PICU survivors, which are known to interfere with development in other major domains of functioning, such as mental health, academic achievement, and socioeconomic success, highlighting neurocognition as an important outcome after PICU admission.• Machine learning is a rapidly growing field of artificial intelligence that is increasingly applied in health care settings, with great potential to capture the complexity of outcome prediction.What is New:• This study shows that lower birth weight, lower socioeconomic status, and greater exposure to acidotic events during PICU admission for bronchiolitis are associated with poorer long-term neurocognitive outcome after PICU admission. Results provide no evidence for the added value of machine learning models in a relatively small sample of children.• As bronchiolitis seldom manifests neurologically, the relation between acidotic events and neurocognitive outcome may reflect either potentially harmful effects of acidosis itself or related processes such as hypercapnia or hypoxic and/or ischemic events during PICU admission. This study further highlights the importance of structured follow-up to monitor long-term outcome of children after PICU admission.

Enhancing pulmonary function and arterial blood gas readings through immediate chest physiotherapy among extubated patients in ICU.

To examine the effect of immediate chest physiotherapy (ICPT) on pulmonary function and arterial blood gases among extubated patients. This prospective study enrolled patients aged 20-60 years who had been intubated for 48 h. They were randomly assigned to either a control or study group. The study group received ICPT by trained critical care nurses and physiotherapists, which included early mobilization, breathing exercises and airway clearance. The control group received standard nursing chest care (positioning, oral and endotracheal suctioning) without ICPT. Researchers evaluated participants using pulmonary function tests, arterial blood gas tests and mechanical ventilation parameters. The study enrolled 70 patients. There were no significant differences in the sociodemographic characteristics and medical data before intubation between the two groups except for preparatory education. After extubation, the vital capacity was significantly higher in the study group compared with the control group. There were also significant differences between the two groups in other lung function tests and arterial blood gas tests. After extubation, the total lung capacity, functional residual capacity and residual volume were significantly higher in the study group compared with the control group. The use of ICPT improved both pulmonary function and arterial blood gases.

Correlations between APACHE-II score and pressure parameters of mechanical ventilation in patients with ARDS and their value in prognostic evaluation.

To investigate the correlations between APACHE-II score and pressure parameters of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS) and their value in prognostic evaluation. This was a retrospective study. The clinical data of 79 patients with ARDS treated in Shengzhou Hospital of Traditional Chinese Medicine from April 2020 to April 2022 were analyzed retrospectively. According to whether their APACHE-II scores were higher than 15, they were divided into low score group (n= 20) and high score group (n= 59). The plateau pressure (Pplat), driving pressure(ΔP) and mean airway pressure (Pmean) were compared. The correlation between APACHE-II score and pressure parameters of mechanical ventilation was analyzed. Based on the follow-up of 28-d survival, their Pplat, ΔP, Pmean and APACHE-II scores were compared. The value of APACHE-II score and pressure parameters in the prognostic evaluation of ARDS patients was analyzed. Pplat, ΔP and Pmean in the low score group were significantly lower than those in the high score group(P<0.05). Pplat, ΔP, Pmean and APACHE-II score in the survival group were significantly lower than those in the control group(P<0.05). APACHE-II score showed significantly positive correlations with Pplat, ΔP and Pmean. The AUC of Pmean, Pplat, ΔP and APACHE-II score in predicting the prognosis and diagnosis of ARDS patients was 0.761, 0.833, 0.754 and 0.832, respectively. APACHE-II score of ARDS patients shows significantly positive correlations with pressure parameters of mechanical ventilation, and has diagnostic value for the prognosis of ARDS patients.

Clinical case of a high-frequency mechanical lung ventilation atypical using in the treatment of an infant with congenital lung disease

A small number of controlled studies have been conducted using high-frequency mechanical lung ventilation (HFMLV) in the treatment process. In the literature, complications associated with the use of HFMLV, in particular, the development of air leak syndrome, are described. This technique is usually successfully used in the treatment of homogeneous and symmetrical lung tissue lesions.Every year, the number of congenital malformations in children that can be accompanied by inhomogeneous lesions of the lungs increases, accordingly, the number of clinical cases that do not correspond to the classic picture of the disease increases, so they cannot be treated according to unified clinical protocols.The objective of the article is to help choose optimal modes of mechanical lung ventilation in non-standard situations, which will make it possible to improve the course of the disease, reduce the number of complications and prevent hypoxic-ischemic damage to the central nervous system as a consequence of chronic or acute hypoxia, which is combined with the phenomena of secondary ischemia.A baby was hospitalized in the department of the National Children’s Specialized Hospital «Ohmatdyt» with the main diagnosis of «hypoplasia, dysplasia of the lung» and concomitant «broncho-pulmonary dysplasia that occurred in the perinatal period. The ductus arteriosus is open. Pulmonary hypertension? Anemia. Seizure syndrome. Primary immunodeficiency? Complication: respiratory failure 3, mixed type». After surgical intervention in the scope of an atypical lobectomy, the child was ventilated using strict parameters of mechanical lung ventilation, which was accompanied by a gradual deterioration of the general condition and the condition of the lungs, caused not only by a congenital malformation of the lungs, but also by immunodeficiency (of unknown etiology), anemia, convulsive syndrome and the presence polyresistant strains of bacteria in bacterial cultures of sputum. Against the background of surgical (mechanical) trauma to the lung tissue and the presence of a bacterial disease of the lung parenchyma with a concomitant complication in the form of a tension pneumothorax, HFMLV was used as a «therapy of despair», despite the limited amount of scientific data on the effectiveness of treatment of inhomogeneous lung tissue lesions using HFMLV. During the treatment, a complication in the form of pneumothorax occurred as expected. The use of constant adequate monitoring of respiratory functions and timely elimination of complications made it possible to stabilize the child’s condition: the need for oxygen decreased, the condition of the lung parenchyma improved, the positive dynamics of the disease made it possible to carry out gradual weaning from artificial lung ventilation and the transition to spontaneous effective breathing with minimal oxygen support.Therefore, HFMLV can be not only a «therapy of despair». With proper and timely use, it can help reduce the frequency of complications associated with mechanical ventilation of the lungs.It can also be used as a separate technique, if the dynamics of the disease can be predicted, provided that the hospital has expert class respiratory function monitoring and experienced specialists.

Application effect analysis of lateral prone position ventilation in patients with acute respiratory distress syndrome

To investigate the effect of lateral prone position ventilation in patients with acute respiratory distress syndrome (ARDS). A prospective control study was conducted. A total of 75 patients with moderate to severe ARDS admitted to the department of critical care medicine of Jingxian Hospital in Anhui province from January 2020 to December 2022 were selected as the research objects. According to the envelope method, the patients were divided into the lateral prone position ventilation group (38 cases) and the traditional prone position ventilation (PPV) group (37 cases), using lateral prone position ventilation and traditional PPV, respectively. The mechanical ventilation parameters were set according to the ARDS treatment guidelines and lung protective ventilation requirements in both groups, and the time of prone position for the first 3 times was not less than 16 hours per day. General data of patients were recorded, including heart rate (HR), mean arterial pressure (MAP), airway resistance and lung static compliance (Cst) before prone position (T0), 1 hour (T1), 4 hours (T2), 8 hours (T3), and before the end of prone position (T4), oxygenation index (PaO2/FiO2) before the first prone position (t0) and 12 hours (t1), 24 hours (t2), 48 hours (t3), and 72 hours (t4) after the intensive care unit (ICU) admission, as well as the incidence of pressure injury (PI) and vomiting, tracheal intubation time, and mechanical ventilation time. Repeated measures analysis of variance was used to compare the effects of different prone positions on patients before and after the prone position. There were no significant differences in age, gender, body mass index (BMI), acute physiology and chronic health evaluation II (APACHE II), underlying diseases, HR, MAP, pH value, PaO2/FiO2, blood lactic acid (Lac), arterial blood pressure of carbon dioxide (PaCO2) and other general information between the two groups. The HR (intergroup effect: F = 0.845, P = 0.361; time effect: F = 1.373, P = 0.247; interaction: F = 0.245, P = 0.894), MAP (intergroup effect: F = 1.519, P = 0.222; time effect: F = 0.169, P = 0.954; interaction: F = 0.449, P = 0.773) and airway resistance (intergroup effect: F = 0.252, P = 0.617; time effect: F = 0.578, P = 0.679; interaction: F = 1.467, P = 0.212) of T0-T4 between two groups showed no significant difference. The Cst of T0-T4 between the two groups showed no significant difference in the intergroup effect (F = 0.311, P = 0.579) and the interaction (F = 0.364, P = 0.834), while the difference in the time effect was statistically significant (F = 120.546, P < 0.001). The PaO2/FiO2 of t0-t4 between the two groups showed no significant difference in the intergroup effect (F = 0.104, P = 0.748) and the interaction (F = 0.147, P = 0.964), while the difference in the time effect was statistically significant (F = 17.638, P < 0.001). The group factors and time factors were tested separately, and there were no significant differences in the HR, MAP, airway resistance, Cst, PaO2/FiO2 between the two groups at different time points (all P > 0.05). The Cst at T1-T4 and PaO2/FiO2 at t1-t4 in the two groups were significantly higher than those at T0/t0 (all P < 0.05). There were no significant differences in the tracheal intubation time [days: 6.75 (5.78, 8.33) vs. 7.00 (6.30, 8.45)] and mechanical ventilation time [days: 8.30 (6.70, 9.20) vs. 7.40 (6.80, 8.75)] between the lateral prone position ventilation group and the traditional PPV group (both P > 0.05). However, the incidences of PI [7.9% (3/38) vs. 27.0% (10/37)] and vomiting [10.5% (4/38) vs. 29.7% (11/37)] in the lateral prone position ventilation group were significantly lower than those in the traditional PPV group (both P < 0.05). Both lateral prone position ventilation and traditional PPV can improve Cst and oxygenation in patients with moderate to severe ARDS. The two types of prone position have little influence on HR, MAP and airway resistance of patients, and there is no difference in the influence on tracheal intubation time and mechanical ventilation time of patients. However, the lateral prone position ventilation mode can reduce the incidence of PI and vomiting, and is worthy of clinical promotion and application.