mechanical ventilation Archives - Page 2 of 4 - Critical Care Science (CCS)
Abstract
Rev Bras Ter Intensiva. 2007;19(2):221-225
DOI 10.1590/S0103-507X2007000200014
BACKGROUND AND OBJECTIVES: Mechanically ventilated patients usually present larger amounts of pulmonary secretions because of impairment in mucociliary function and mucus transport. The manual resuscitator is considered a resource for pulmonary hyperinflation with the aim of preventing mucus retention and pulmonary complications, improving oxygenation and reexpanding collapsed areas. Alternatively, the hyperinflation by mechanical ventilator is a reliable and practical device to promote lung expansion and desobstruction. The objective of this study was to review the literature concerning manual and ventilator hyperinflation treatments for patients in the intensive care units (ICU) setting. CONTENTS: Literature searches were performed using the databases MedLine, CINAHL, SciElo and LILACS with appropriate keywords, including: intensive care units, manual hyperinflation, mechanical ventilator, physiotherapy, physical therapy and ventilator hyperinflation. CONCLUSIONS: Although there are few studies demonstrating the efficacy of ventilator hyperinflation as a physical therapy device, it can be a safety option to promote therapeutic hyperinflation in ICU, compared to manual hyperinflation.
Abstract
Rev Bras Ter Intensiva. 2007;19(2):221-225
DOI 10.1590/S0103-507X2007000200014
BACKGROUND AND OBJECTIVES: Mechanically ventilated patients usually present larger amounts of pulmonary secretions because of impairment in mucociliary function and mucus transport. The manual resuscitator is considered a resource for pulmonary hyperinflation with the aim of preventing mucus retention and pulmonary complications, improving oxygenation and reexpanding collapsed areas. Alternatively, the hyperinflation by mechanical ventilator is a reliable and practical device to promote lung expansion and desobstruction. The objective of this study was to review the literature concerning manual and ventilator hyperinflation treatments for patients in the intensive care units (ICU) setting. CONTENTS: Literature searches were performed using the databases MedLine, CINAHL, SciElo and LILACS with appropriate keywords, including: intensive care units, manual hyperinflation, mechanical ventilator, physiotherapy, physical therapy and ventilator hyperinflation. CONCLUSIONS: Although there are few studies demonstrating the efficacy of ventilator hyperinflation as a physical therapy device, it can be a safety option to promote therapeutic hyperinflation in ICU, compared to manual hyperinflation.
Abstract
Rev Bras Ter Intensiva. 2007;19(2):258-263
DOI 10.1590/S0103-507X2007000200020
BACKGROUND AND OBJECTIVES: The II Brazilian Consensus Conference on Mechanical Ventilation was published in 2000. Knowledge on the field of mechanical ventilation evolved rapidly since then, with the publication of numerous clinical studies with potential impact on the ventilatory management of critically ill patients. Moreover, the evolving concept of evidence - based medicine determined the grading of clinical recommendations according to the methodological value of the studies on which they are based. This explicit approach has broadened the understanding and adoption of clinical recommendations. For these reasons, AMIB - Associação de Medicina Intensiva Brasileira and SBPT - Sociedade Brasileira de Pneumologia e Tisiologia - decided to update the recommendations of the II Brazilian Consensus. Mechanical ventilation in the asthma attack has been one of the updated topics. Describe the most important topics on the mechanical ventilation during the asthma attack and suggest the main therapeutic approaches. METHODS: Systematic review of the published literature and gradation of the studies in levels of evidence, using the key words "mechanical ventilation" and "asthma". RESULTS: We present recommendations on the ventilatory modes and settings to be adopted when ventilating a patient during an asthma attack, as well as the recommended monitoring. Alternative ventilation techniques are also presented. CONCLUSIONS: Protective ventilatory strategies are recommended when ventilating a patient during a severe asthma attack.
Abstract
Rev Bras Ter Intensiva. 2007;19(2):258-263
DOI 10.1590/S0103-507X2007000200020
BACKGROUND AND OBJECTIVES: The II Brazilian Consensus Conference on Mechanical Ventilation was published in 2000. Knowledge on the field of mechanical ventilation evolved rapidly since then, with the publication of numerous clinical studies with potential impact on the ventilatory management of critically ill patients. Moreover, the evolving concept of evidence - based medicine determined the grading of clinical recommendations according to the methodological value of the studies on which they are based. This explicit approach has broadened the understanding and adoption of clinical recommendations. For these reasons, AMIB - Associação de Medicina Intensiva Brasileira and SBPT - Sociedade Brasileira de Pneumologia e Tisiologia - decided to update the recommendations of the II Brazilian Consensus. Mechanical ventilation in the asthma attack has been one of the updated topics. Describe the most important topics on the mechanical ventilation during the asthma attack and suggest the main therapeutic approaches. METHODS: Systematic review of the published literature and gradation of the studies in levels of evidence, using the key words "mechanical ventilation" and "asthma". RESULTS: We present recommendations on the ventilatory modes and settings to be adopted when ventilating a patient during an asthma attack, as well as the recommended monitoring. Alternative ventilation techniques are also presented. CONCLUSIONS: Protective ventilatory strategies are recommended when ventilating a patient during a severe asthma attack.
Abstract
Rev Bras Ter Intensiva. 2007;19(2):161-169
DOI 10.1590/S0103-507X2007000200004
BACKGROUND AND OBJECTIVES: In mechanical ventilation, invasive and noninvasive, the knowledge of respiratory mechanic physiology is indispensable to take decisions and into the efficient management of modern ventilators. Monitoring of pulmonary mechanic parameters is been recommended from all the review works and clinical research. The objective of this study was review concepts of pulmonary mechanic and the methods used to obtain measures in the bed side, preparing a rational sequence to obtain this data. METHODS: It was obtained bibliographic review through data bank LILACS, MedLine and PubMed, from the last ten years. RESULTS: This review approaches parameters of resistance, pulmonary compliance and intrinsic PEEP as primordial into comprehension of acute respiratory failure and mechanic ventilatory support, mainly in acute respiratory distress syndrome (ARDS) and in chronic obstructive pulmonary disease (COPD). CONCLUSIONS: Monitoring pulmonary mechanics in patients under mechanical ventilation in intensive care units gives relevant informations and should be implemented in a rational and systematic way.
Abstract
Rev Bras Ter Intensiva. 2007;19(2):161-169
DOI 10.1590/S0103-507X2007000200004
BACKGROUND AND OBJECTIVES: In mechanical ventilation, invasive and noninvasive, the knowledge of respiratory mechanic physiology is indispensable to take decisions and into the efficient management of modern ventilators. Monitoring of pulmonary mechanic parameters is been recommended from all the review works and clinical research. The objective of this study was review concepts of pulmonary mechanic and the methods used to obtain measures in the bed side, preparing a rational sequence to obtain this data. METHODS: It was obtained bibliographic review through data bank LILACS, MedLine and PubMed, from the last ten years. RESULTS: This review approaches parameters of resistance, pulmonary compliance and intrinsic PEEP as primordial into comprehension of acute respiratory failure and mechanic ventilatory support, mainly in acute respiratory distress syndrome (ARDS) and in chronic obstructive pulmonary disease (COPD). CONCLUSIONS: Monitoring pulmonary mechanics in patients under mechanical ventilation in intensive care units gives relevant informations and should be implemented in a rational and systematic way.
Abstract
Rev Bras Ter Intensiva. 2007;19(1):38-43
DOI 10.1590/S0103-507X2007000100005
BACKGROUND AND OBJECTIVES: Concerning the mechanical ventilation, the weaning is a usual and significant intensive care process. Identifying, describing and demonstrating the techniques used by Respiratory Therapists in weaning and also obtaining its parameters in Intensive Care Units (ICU). METHODS: A survey related to the weaning process was done with active ICU Respiratory Therapists from (FD) in the year 2005. The survey consisted of 31 subjective and objective questions, some of them allowing multiple answers. RESULTS: Eighty surveys were carried out at twenty hospitals. 90% of participants were specialized staff with a mean of three year working experience in ICU. In 98.7% of the answers, doctors and respiratory therapists were responsible for operating the ventilators. In 61.3%, doctors and respiratory therapists were responsible for their use and, in 36.3%, the responsibility was solely on the respiratory therapist professionals. It was found that only twenty-four respiratory therapists (30%) follow the weaning protocol. Among the most practiced parameters from the weaning process are: respiratory frequency (98%), tidal volume (97.5%) and periferic oxygen saturation (92.5%). The least utilized are the maximum inspiratory pressure (18.8%) and the vital capacity (13.8%). CONCLUSIONS: Great differences were observed in the weaning methods, choice of parameters and the way they were collected. These variations suggest that there is a lack of routine and the need to implement simple protocols.
Abstract
Rev Bras Ter Intensiva. 2007;19(1):38-43
DOI 10.1590/S0103-507X2007000100005
BACKGROUND AND OBJECTIVES: Concerning the mechanical ventilation, the weaning is a usual and significant intensive care process. Identifying, describing and demonstrating the techniques used by Respiratory Therapists in weaning and also obtaining its parameters in Intensive Care Units (ICU). METHODS: A survey related to the weaning process was done with active ICU Respiratory Therapists from (FD) in the year 2005. The survey consisted of 31 subjective and objective questions, some of them allowing multiple answers. RESULTS: Eighty surveys were carried out at twenty hospitals. 90% of participants were specialized staff with a mean of three year working experience in ICU. In 98.7% of the answers, doctors and respiratory therapists were responsible for operating the ventilators. In 61.3%, doctors and respiratory therapists were responsible for their use and, in 36.3%, the responsibility was solely on the respiratory therapist professionals. It was found that only twenty-four respiratory therapists (30%) follow the weaning protocol. Among the most practiced parameters from the weaning process are: respiratory frequency (98%), tidal volume (97.5%) and periferic oxygen saturation (92.5%). The least utilized are the maximum inspiratory pressure (18.8%) and the vital capacity (13.8%). CONCLUSIONS: Great differences were observed in the weaning methods, choice of parameters and the way they were collected. These variations suggest that there is a lack of routine and the need to implement simple protocols.
Abstract
Rev Bras Ter Intensiva. 2007;19(1):44-52
DOI 10.1590/S0103-507X2007000100006
BACKGROUND AND OBJECTIVES: The traumatic brain injury (TBI) is a healthy-world problem, some of his patients develop respiratory failure, requiring intubation and mechanical ventilation, and the most common complications are the acute respiratory distress syndrome (ARDS). In this way, this study has the objective describe the daily clinical practice of respiratory care in this patients submit mechanical ventilation. METHODS: The methods and ventilatories parameters used to ventilate the patients with TBI and ARDS has been evaluated by a sample of physiotherapists from the city of Salvador, BA, from a descriptive study. The data were collected by face-to-face interviews in the period of October 2005 to March 2006. For in such way a half structuralized questionnaire was elaborated contends changeable social-demographic, about the hospital profile and the applied ventilatory strategy in patients with TBI that come to develop ARDS. RESULTS: The sample was composed by 70 physiotherapists, 41 (58.6%) was female, with mean of age of 31.2 ± 6.4 (24-49) years-old and graduated time 7.7 ± 6.4 (1-27) years, which 37 (52.9%) works on public hospital; 67 (95.7%) has any specialization. Sixty four physiotherapists affirm the usage of the pressure controlled ventilation mode. The peak pressure and the plateau pressure wanted to ventilate the patients with TBI and ARDS were in mean 35.6 ± 5,3 (25-50) and 28,4 ± 5,8 (15-35) cmH2O respectively. Forty eighty (68.6%) of the interviewed wants a PaCO2 in 30-35 mmHg. Thirty one (44.3%) of the interviewed finds the ideal PEEP through the best SpO2 with minor FiO2. CONCLUSIONS: It's incontestable that the ventilatory strategy of a patient with severe TBI that become to develop ALI or ARDS is an authentic challenge; a predilection for PCV mode is observed due to the already known protective ventilation strategy.
Abstract
Rev Bras Ter Intensiva. 2007;19(1):44-52
DOI 10.1590/S0103-507X2007000100006
BACKGROUND AND OBJECTIVES: The traumatic brain injury (TBI) is a healthy-world problem, some of his patients develop respiratory failure, requiring intubation and mechanical ventilation, and the most common complications are the acute respiratory distress syndrome (ARDS). In this way, this study has the objective describe the daily clinical practice of respiratory care in this patients submit mechanical ventilation. METHODS: The methods and ventilatories parameters used to ventilate the patients with TBI and ARDS has been evaluated by a sample of physiotherapists from the city of Salvador, BA, from a descriptive study. The data were collected by face-to-face interviews in the period of October 2005 to March 2006. For in such way a half structuralized questionnaire was elaborated contends changeable social-demographic, about the hospital profile and the applied ventilatory strategy in patients with TBI that come to develop ARDS. RESULTS: The sample was composed by 70 physiotherapists, 41 (58.6%) was female, with mean of age of 31.2 ± 6.4 (24-49) years-old and graduated time 7.7 ± 6.4 (1-27) years, which 37 (52.9%) works on public hospital; 67 (95.7%) has any specialization. Sixty four physiotherapists affirm the usage of the pressure controlled ventilation mode. The peak pressure and the plateau pressure wanted to ventilate the patients with TBI and ARDS were in mean 35.6 ± 5,3 (25-50) and 28,4 ± 5,8 (15-35) cmH2O respectively. Forty eighty (68.6%) of the interviewed wants a PaCO2 in 30-35 mmHg. Thirty one (44.3%) of the interviewed finds the ideal PEEP through the best SpO2 with minor FiO2. CONCLUSIONS: It's incontestable that the ventilatory strategy of a patient with severe TBI that become to develop ALI or ARDS is an authentic challenge; a predilection for PCV mode is observed due to the already known protective ventilation strategy.
Abstract
Rev Bras Ter Intensiva. 2007;19(1):107-112
DOI 10.1590/S0103-507X2007000100014
BACKGROUND AND OBJECTIVES: Weaning patients from mechanical ventilation is still a challenge in Intensive Care Units (ICU) and is related to complications and mortality. Daily rounds at the bedside, which are part of good care, can identify patients able to undergo to spontaneous breathing trials. The authors suggest one mnemonic technique with the term "ESTRATEGIA" (strategy) considering some key aspects, as a checklist, which can be applied by any person of the multidisciplinary team, during the bedside rounds, in order to shorten the weaning time. CONTENTS: To introduce the word Strategy as a mnemonic method based on the studies related to weaning from mechanical ventilation and its applicability as a checklist in any intensive care unit by the multidisciplinary team where each letter reminds some key aspects related to the subject. CONCLUSIONS: The applicability of a mnemonic mechanism as a checklist for weaning patients from mechanical ventilation easily practiced during the daily round to identify those who are able to undergo to spontaneous breathing trials.
Abstract
Rev Bras Ter Intensiva. 2007;19(1):107-112
DOI 10.1590/S0103-507X2007000100014
BACKGROUND AND OBJECTIVES: Weaning patients from mechanical ventilation is still a challenge in Intensive Care Units (ICU) and is related to complications and mortality. Daily rounds at the bedside, which are part of good care, can identify patients able to undergo to spontaneous breathing trials. The authors suggest one mnemonic technique with the term "ESTRATEGIA" (strategy) considering some key aspects, as a checklist, which can be applied by any person of the multidisciplinary team, during the bedside rounds, in order to shorten the weaning time. CONTENTS: To introduce the word Strategy as a mnemonic method based on the studies related to weaning from mechanical ventilation and its applicability as a checklist in any intensive care unit by the multidisciplinary team where each letter reminds some key aspects related to the subject. CONCLUSIONS: The applicability of a mnemonic mechanism as a checklist for weaning patients from mechanical ventilation easily practiced during the daily round to identify those who are able to undergo to spontaneous breathing trials.
