Ventilation In Postoperative Patients Research Articles

Effectiveness of adaptive support ventilation in facilitating weaning from mechanical ventilation in postoperative patients

Effectiveness of adaptive support ventilation in facilitating weaning from mechanical ventilation in postoperative patients

Comparison of Extubation Outcomes Following T-piece Trial versus Pressure Support/Continous Positive Airway Pressure in Postsurgical Patients

Background: Pressure support with continuous positive airway pressure (CPAP) and T-piece trials are the most common spontaneous breathing trial used to test readiness for extubation. Aim: We aimed to compare extubation failures defined by the need for reintubation within 48 h following T-piece trial versus extubation directly from pressure support (PS) ventilation in postoperative patients. Patients and Methods: This was a prospective cross-sectional study conducted in the postsurgical patients. Hemodynamic parameters and respiratory variables were measured before and after weaning trials. Outcomes after extubation, need for noninvasive-assist ventilation following extubation, duration of oxygen therapy, and time of shifting from the Intensive Care Unit (ICU) were also recorded. Results: Fifty patients needed mechanical ventilation postoperatively were recruited for the study. No significant differences were seen in the rate of extubation failures between PS- and T-piece groups. Rapid shallow breathing index recorded at the start of weaning was significantly higher in the T-piece group (P

Capnography monitoring in the Post Anaesthesia Care Unit (PACU)

Problem identification Capnography monitoring has been identified as a valuable monitoring tool to assist in the early detection of respiratory adverse events in post-operative patients in the PACU who are receiving supplemental oxygen. This integrated review of literature aims to identify the usefulness of implementing capnography monitoring in the PACU as standard practice to ensure safe patient outcomes. Literature search A search was undertaken of Scopus, Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Health Source: Nursing and Academic Edition, Clinical Key, PubMed and MEDLINE Complete electronic databases. Articles (n=12) were selected for this review including a randomised control trial (RCT), quality improvement projects, a prospective observation study, a prospective cross-sectional study, an evidence summary and a systematic review and meta-analysis study. Data evaluation synthesis The main indicators for the use of capnography in the PACU included patients on assisted oxygen, patients receiving opioid analgesia, patients with obstructive sleep apnoea and paediatric patients. All articles related to capnography presented complimentary findings regarding the usefulness of capnography monitoring and its implementation in the PACU. Implications for perioperative nursing practice or research Capnography is effective in identifying compromised ventilation in post-operative patients who are receiving supplemental oxygen in the PACU, compared to the use of pulse oximetry alone. The literature recommends the combined use of pulse oximetry and capnography in the post-operative period to provide clinicians with a complete assessment of a patients ventilatory status. Nursing education is indicated to improve respiratory assessments and monitoring skills of PACU nurses combined with further research to ensure the effective implementation of capnography in the PACU.

Diaphragmatic Dysfunction as a Predictor of Weaning Outcomes from Mechanical Ventilation in Postoperative Patients with Rheumatic Heart Disease Complicated with Cachexia

Background and Objective: This study aims to evaluate the predictive value of the diaphragmatic excursion for weaning from mechanical ventilation in postoperative patients with rheumatic heart disease complicated with cachexia. Methods: Eighty-four postoperative patients with rheumatic heart disease complicated with cachexia who need mechanical ventilation >72 h were enrolled for this prospective study. All patients were evaluated during the weaning process from June 2015 to March 2018. Patients received SBT for 1 h, and we performed ultrasound for the right hemidiaphragm and tested the diaphragmatic excursion. Patients who passed the SBT and no need for reintubation or non-invasive positive pressure ventilation (NIPPV) within 48 h were classified as Group A and others were classified as Group B. Results: We found that the diaphragmatic excursion of Group B (0.76 ± 0.23 cm) was significantly smaller than that of Group A (1.19 ± 0.62 cm), and the oxygen partial pressure of Group B (70.1 ± 9.2 mmHg) was significantly lower than that of Group A (98.6 ± 7.8 mmHg). Conclusion: The assessment of diaphragmatic excursion using ultrasound may be helpful to predict the outcome of weaning for postoperative patients with rheumatic heart disease complicated with cachexia.

Application of noninvasive ventilation in postoperative patients: indications and clinical strategies

Application of noninvasive ventilation in postoperative patients: indications and clinical strategies

Effects of Propofol on Respiratory Drive and Patient-ventilator Synchrony during Pressure Support Ventilation in Postoperative Patients

Background:Propofol is increasingly used during partial support mechanical ventilation such as pressure support ventilation (PSV) in postoperative patients. However, breathing pattern, respiratory drive, and patient-ventilator synchrony are affected by the sedative used and the sedation depth. The present study aimed to evaluate the physiologic effects of varying depths of propofol sedation on respiratory drive and patient-ventilator synchrony during PSV in postoperative patients.Methods:Eight postoperative patients receiving PSV for <24 h were enrolled. Propofol was administered to achieve and maintain a Ramsay score of 4, and the inspiratory pressure support was titrated to obtain a tidal volume (VT) of 6–8 ml/kg. Then, the propofol dose was reduced to achieve and maintain a Ramsay score of 3 and then 2. At each Ramsay level, the patient underwent 30-min trials of PSV. We measured the electrical activity of the diaphragm, flow, airway pressure, neuro-ventilatory efficiency (NVE), and patient-ventilator synchrony.Results:Increasing the depth of sedation reduced the peak and mean electrical activity of the diaphragm, which suggested a decrease in respiratory drive, while VT remained unchanged. The NVE increased with an increase in the depth of sedation. Minute ventilation and inspiratory duty cycle decreased with an increase in the depth of sedation, but this only achieved statistical significance between Ramsay 2 and both Ramsay 4 and 3 (P < 0.05). The ineffective triggering index increased with increasing sedation depth (9.5 ± 4.0%, 6.7 ± 2.0%, and 4.2 ± 2.1% for Ramsay 4, 3, and 2, respectively) and achieved statistical significance between each pair of depth of sedation (P < 0.05). The depth of sedation did not affect gas exchange.Conclusions:Propofol inhibits respiratory drive and deteriorates patient-ventilator synchrony to the extent that varies with the depth of sedation. Propofol has less effect on breathing pattern and has no effect on VT and gas exchange in postoperative patients with PSV.

Noninvasive Ventilation Practice in Cardiac Surgery Patients: Insights From a European Survey

Noninvasive Ventilation Practice in Cardiac Surgery Patients: Insights From a European Survey

Non-invasive ventilation in postoperative patients: a systematic review

Postoperative pulmonary complications, generally defined as any pulmonary abnormality occurring in the postoperative period, are still a significant issue in clinical practice increasing hospital length of stay, morbidity and mortality. Non-invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic pulmonary failure, is nowadays also used in perioperative settings. Investigate the application and results of preventive and therapeutic NIV in postsurgical patients. A systematic review. Medical literature databases were searched for articles about "clinical trials," "randomized controlled trials" and "meta-analyses." The keywords "cardiac surgery," "thoracic surgery," "lung surgery," "abdominal surgery," "solid organ transplantation," "thoraco-abdominal surgery" and "bariatric surgery" were combined with any of these: "non-invasive positive pressure ventilation," "continuous positive airway pressure," "bilevel ventilation," "postoperative complications," "postoperative care," "respiratory care," "acute respiratory failure," "acute lung injury" and "acute respiratory distress syndrome." Twenty-nine articles (N=2,279 patients) met the inclusion criteria. Nine studies evaluated NIV in post-abdominal surgery, three in thoracic surgery, eight in cardiac surgery, three in thoraco-abdominal surgery, four in bariatric surgery and two in post solid organ transplantation used both for prophylactic and therapeutic purposes. NIV improved arterial blood gases in 15 of the 22 prophylactic and in 4 of the 7 therapeutic studies, respectively. NIV reduced the intubation rate in 11 of the 29 studies and improved outcome in only 1. Despite these limited data and the necessity of new randomized trials, NIV could be considered as a prophylactic and therapeutic tool to improve gas exchange in postoperative patients.

Effects of deep breathing exercises and ambulation on pattern of Ventilation in post-operative patients

Deep breathing and ambulation are used by physiotherapists for patients after surgery, however the precise effects of these on ventilation have not been investigated. This study was designed to compare the effects of deep breathing and ambulation on pattern of breathing in patients after upper abdominal surgery. A similar increase was found in minute ventilation, however the pattern of breathing seen during each treatment was very different. During the deep breathing exercises patients had large, significant increases in tidal volume (mean change 488.5ml), while respiratory rate decreased non-significantly. By comparison, ambulation caused small and non-significant increases in both tidal volume (163.4ml) and respiratory rate. It appears that if one of the aims of ambulation is to increase tidal volume, patients may need to be encouraged to augment their tidal volumes.

Driving pressure and arterial carbon dioxide tension during high-frequency jet ventilation in postoperative patients.

To achieve normocarbia during conventional mechanical ventilation, ventilator settings are determined initially on the basis of body weight. The best ventilator settings for CO2 elimination during high-frequency jet ventilation (HFJV) have not been so clearly defined. A recent study has suggested that eucarbia will be obtained with HFJV when tidal volume (VT) per kg of body weight is kept within a narrow, well-defined range. In the same study, a "bench test" demonstrated that VT was directly proportional to the jet ventilator driving pressure (DP). The goal of our study was to confirm this recommended VT/kg to obtain eucarbia and to determine whether the relation observed between VT and DP in the laboratory was true clinically. We studied 14 patients admitted to the ICU for postoperative support. We determined a good correlation between DP and VT/kg (r = .811, p less than .001) for the group as a whole and a good inverse correlation between DP or VT/kg and PaCO2 for most individual patients; however, there was a poor inverse correlation between DP or VT/kg and PaCO2 for the group as a whole, due to wide patient-to-patient variation in the efficiency of jet ventilation. We conclude that there is no universal formula for setting jet ventilator DP or VT/kg to affect normocarbia in humans.