Inhaled bronchodilators are routinely administered to mechanically ventilated patients to relieve dyspnea and reverse bronchoconstriction. A lower percentage of the nominal dose reaches the lower respiratory tract in a mechanically ventilated patient than in a nonintubated subject, but attention to device selection, administration technique, dosing, and patient-ventilator interface can increase lower-respiratory-tract deposition in a mechanically ventilated patient. Assessing the airway response to bronchodilator by measuring airway resistance and intrinsic positive end-expiratory pressure helps guide dosing and timing of drug delivery. Selecting the optimal aerosol-generating device for a mechanically ventilated patient requires consideration of the ease, reliability, efficacy, safety, and cost of administration. With careful attention to administration technique, bronchodilator via metered-dose inhaler or nebulizer can be safe and effective with mechanically ventilated patients.. ...

Under both CMV mode and SBT, imposed expiratory WOB increased with the increase in mean expiratory flow among patients undergoing invasive mechanical ventilation. Levels of imposed expiratory WOB were affected by the ID of the ETT and ventilator mode. The main reason for the increased imposed expiratory WOB is the increase in RE imposed by the ETT and HME. Although ventilator-imposed RE was relatively low and was not clearly related to mean expiratory flow, the ventilator-imposed RE was very large for some patients under CMV mode. As mean expiratory flow increased, the end-expiratory Ptrach-PEEP setting increased under both CMV mode and SBT. Intrinsic PEEP caused by imposed RE would increase as mean expiratory flow increased.. Few studies have measured Ptrach during the expiratory phase in patients under mechanical ventilation. Stenqvist et al measured Ptrach directly in 10 patients under mechanical ventilation.18 Wrigge et al estimated Ptrach using Paw and flow signals in patients with acute ...

TY - JOUR. T1 - Effects of tracheal gas insufflation and tracheal gas exsufflation on intrinsic positive end-expiratory pressure and carbon dioxide elimination. AU - Takahashi, Toshimichi. AU - Bugedo, Guillermo. AU - Adams, Alexander B.. AU - Bliss, Peter L.. AU - Marini, John J. PY - 1999/8. Y1 - 1999/8. N2 - BACKGROUND: Tracheal gas insufflation (TGI) reduces arterial carbon dioxide tension (P(aCO2)) when used in conjunction with mechanical ventilation, but antegrade TGI flow increases intrinsic positive end- expiratory pressure (auto-PEEP) or end-expiratory lung volume (EELV). Tracheal gas exsufflation (TGE) might reduce TGI-elevated EELV while retaining the CO2 elimination effects of TGI. METHODS: An apparatus was designed to control TGI and/or TGE during selected portions of expiration. The first phase of the study examined the general effects of expiratory TGI and TGE on EELV and CO2 elimination in a mechanical test lung. In the second phase, effects on normal physiology were tested in ...

Patients under NIV for hypercapnic COPD have several reasons to develop patient-ventilatory asynchrony: delayed cycling, and insufficient expiratory time may induce progressive dynamic hyperinflation, and increase intrinsic positive end-expiratory pressure (PEEPi); too high levels of pressure support may also contribute to dynamic hyperinflation. Increase in PEEPi is associated with two respiratory events: unrewarded inspiratory efforts, and auto-triggering.. Our hypotheses are: 1/that these events occur frequently in COPD under NIV and that they are not detected by medical history or usual monitoring tools (SpO2; PtcCO2); 2/ that they can be easily detected by polysomnography; 3/ that simple adjustments of ventilator parameters aiming to reduce dynamic hyperinflation and unrewarded inspiratory efforts may improve efficacy of ventilation, quality of sleep and comfort of treatment.. The present study compares the results of two consecutive sleep studies: 1.PSG under NIV in severe stable COPD ...

Dear Editor,. Dyspnoea and exercise intolerance in patients with COPD have a wide variety of aetiologies, with dynamic hyperinflation and resultant loss in inspiratory reserve volume recognised as important mechanisms.. Baz et al1 show that dynamic laryngeal narrowing is present in patients with COPD and hypothesise that this generates intrinsic positive end-expiratory pressure (PEEPi), serving to splint open … ...

It has been shown that mechanical ventilation in patients with, or at high-risk for, the development of acute respiratory distress syndrome (ARDS) can be a double-edged sword. If the mechanical breath is improperly set, it can amplify the lung injury associated with ARDS, causing a secondary ventilator-induced lung injury (VILI). Conversely, the mechanical breath can be adjusted to minimize VILI, which can reduce ARDS mortality. The current standard of care ventilation strategy to minimize VILI attempts to reduce alveolar over-distension and recruitment-derecruitment (R/D) by lowering tidal volume (Vt) to 6 cc/kg combined with adjusting positive-end expiratory pressure (PEEP) based on a sliding scale directed by changes in oxygenation. Thus, Vt is often but not always set as a

Ventilator-dependent patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) and acute severe asthma routinely receive bronchodilators to relieve bronchoconstriction. By reducing airway resistance, bronchodilators reduce the pressure required to ventilate the lung. This reduction in pressure may protect the lung against injury and enhance patient comfort. A general population of ventilated patients in a medical intensive care unit (ICU)2,3 and patients with acute respiratory distress syndrome4,5 showed improvement in expiratory airflow and airway resistance after bronchodilators. Infants with bronchopulmonary dysplasia, and children with asthma, or bronchiolitis also receive bronchodilators on a routine basis.6-10 In ventilated patients with COPD, elevated airway resistance and intrinsic positive end-expiratory pressure are major causes for weaning failure.11 In these patients, bronchodilators may facilitate weaning.12 Therapy with bronchodilators is, therefore, ...

The ability to noninvasively assess voluntary muscle effort has wide application in physiologic studies, sports and rehabilitation medicine, as well as

36 The use of external PEEP in the setting of auto-PEEP may be conceptualized by the waterfall over a dam analogy. In this analogy, the presence of dynamic hyperinflation and 10 cmH20 of auto-PEEP is represented in the top panel by the reservoir of water trickling over the dam represented by the solid block. In the middle panel, as long as the external PEEP is less than or equal to the amount of auto-PEEP, the amount of water in the upstream reservoir, representing dynamic hyperinflation, does not increase. However, once the amount of water in the reservoir does increase (bottom panel), dynamic hyperinflation worsens. ...

Dynamic hyperinflation limits exercise duration in chronic obstructive pulmonary disease (COPD). To limit dynamic hyperinflation during exercise and thus improv...

The most common extrapulmonary problems in chronic obstructive pulmonary disease (COPD) patients are cardiovascular comorbidities, muscle weakness and dysfunction [1-3]. Indeed, the reduced peripheral muscle mass and strength increase patients symptoms during effort (fatigue and or dyspnoea) and progressively lead to disability. Furthermore, both lower and upper limb dysfunction has been shown to independently predict the long-term prognosis of COPD patients [2].. The use of arms is involved in many daily domestic tasks and activities. To date, it has been shown that daily arm activities needing elevation above the shoulders may interfere with regular breathing and are associated with dynamic hyperinflation in COPD patients [4]. The research by Meijer et al. [5], published in this issue of the European Respiratory Journal, investigated whether, and in which proportion of muscle effort, arm activities during daily life are different in COPD patients compared with matched healthy individuals. ...

Pulmonary emphysema is primarily the end-stage of lung diseases such as chronic bronchitis or COPD. Read more about symptoms, causes, and treatment.. Synonyms. Emphysema pulmonum, pulmonary emphysema, pulmonary hyperinflation, pulmonary distension. Definition. Pulmonary emphysema is a serious, progressive, and incurable disease of the lungs. Medical professionals also refer to it as pulmonary emphysema. The colloquial language is particularly familiar with the disease terms lung flatulence or lung overinflation. With pulmonary emphysema, lung function continues to decrease. This creates progressive shortness of breath. The associated lack of oxygen not only severely restricts physical performance. There are also secondary reactions that place a heavy strain on the heart, among other things. A typical consequence of emphysema is, for example, the cor pulmonale, a common form of right heart failure.. Alpha-1 Antitrypsin Deficiency. In addition to the acquired form of emphysema, there is also a ...

A mechanical and electronic apparatus which utilizes off-setting positive and negative muscle effort to provide a complete body muscle exerciser. The exerciser is constructed so that left side and right side symmetrical muscle groups are caused to work against one another, with one muscle group moving in extension providing resistance for the symmetrical muscle group to work thereagainst in contraction. A mechanical gear drive train is interposed between the opposing symmetrical muscle groups to transmit the forces exerted thereby, and to guide the users limbs so that the directions of motion are exactly opposite, and to assure that one muscle group contracts simultaneously with the extension of the other. Electrical sensors are coupled to the mechanical drive train to indicate the resistance being experienced by each muscle group; and also to indicate the position of the muscle groups, that is, the distance they have moved in their excursion. The electrical signals produced by the sensors are

EGG Protein is a powdered egg white dietary product, suitable for athletes subject to intense muscle efforts. Proteins help maintain and gain muscle mass and are a fundamental nutrient in athletes diet.

TY - PAT. T1 - Identification of dynamic hyperinflation using a combination of expiratory flow and respiratory carbon dioxide signals.. AU - Rees, Stephen E.. AU - Larraza, S. AU - Karbing, Dan S.. PY - 2017/1/5. Y1 - 2017/1/5. N2 - The present invention relates to a method for identification of an increase in the gas volume of the lung caused by the inability of a patient to expire completely, known as dynamic hyperinflation or gas trapping. The method applies analysis of a patient´s pattern of expiratory flow, along with the pattern of respiratory, e.g. expiratory, carbon dioxide level, for example the capnography signal. Analysis of these signals enables identification of dynamic hyperventilation, along with identification of change in the degree of dynamic hyperinflation indicating improvement or worsening in the patient state.. AB - The present invention relates to a method for identification of an increase in the gas volume of the lung caused by the inability of a patient to expire ...

Pulmonary hyperinflation is commonly divided into static and dynamic in patients with chronic obstructive pulmonary disease (COPD). The former can be directly attributed to the emphysema-related reduction in lung elasticity, leading to a larger volume at which lung and chest wall recoil pressures are balanced. As a consequence, both total lung capacity and functional residual capacity increase above their normal levels. Conversely, dynamic hyperinflation (DH) is caused by expiratory airflow limitation, air trapping and auto-positive end-expiratory pressure. This further increases functional residual capacity.. Extensive literature has accumulated on the objective and subjective manifestations and sequelae of pulmonary hyperinflation in COPD, including effects on respiratory muscle function, ventilation, work of breathing, exercise tolerance, cardiovascular function, dyspnoea and health status. The purpose of the articles in this issue of the European Respiratory Review is to summarise some of ...

Nawar Al-Rawas, Michael J Banner, Neil R Euliano, A Daniel Martin, Carl Tams and Andrea Gabrielli. We thank the editor for the opportunity to respond to this letter. At this time, it is unclear whether PEEPi or some critical level of PEEPi may confound determinations of Pplt, Crs, and Rtot when the τE method is used as we described [1]. A proper and scientific way to address this matter is through a carefully conducted, follow-up clinical study of patients with acute or chronic forms of respiratory failure (such as chronic obstructive pulmonary disease), in which total PEEP (including its component parts of PEEPi and applied PEEP) is correctly determined for an appropriate number of patients by using our τE method. ...

TY - JOUR. T1 - Hemodynamic benefit of positive end-expiratory pressure during acute descending aortic occlusion. AU - Johnston, William E.. AU - Conroy, Brendan P.. AU - Miller, Gregory S.. AU - Lin, Cheng Y.. AU - Deyo, Donald J.. PY - 2002/10/1. Y1 - 2002/10/1. N2 - Background: Acute aortic occlusion in vascular surgery patients abruptly increases arterial resistance and blood pressure, which, in turn, makes subsequent volume expansion during cross-clamp application difficult. The use of vasodilatory drugs or volatile anesthetic agents to attenuate this response may have persistent detrimental effects after clamp removal. Another potential therapy that produces rapid effects on myocardial loading conditions is positive end-expiratory pressure (PEEP). In a porcine model of acute aortic clamping, the hemodynamic consequences of 15 cm H2O PEEP with and without plasma volume expansion were studied. Methods: Forty anesthetized pigs underwent 30-min occlusion of the abdominal aorta 1 cm above the ...

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BACKGROUND: In spontaneously breathing patients, the differences between arterial PaCO2 and end-tidal CO2 (EtCO2) and the influence of bronchial obstruction have not clearly established.. MATERIAL/METHODS: This was a prospective observational study. Patients (n=120) were classified according to spirometric criteria into groups with normal, mild, moderate, and severe obstruction. Arterial blood gases and capnography were performed in two ways: with a tidal volume (Vt) and a non-forced maximal expiration maneuver. Pearson correlation coefficients (r) between PaCO2 and capnographic values were determined for the entire cohort and the subgroups. A concordance study was performed with Bland-Altman analysis.. RESULTS: Comparison of PaCO2 and EtCO2 measured at Vt showed a significant correlation (r=0.722, p,0.01) for the entire cohort, but with a significant mean infra-estimation: P(a-et)CO2=5.2+/-4.4 mmHg, p,0.05. Analysis of subgroups: At Vt, P(a-et)CO2 was 1.7+/-2.9 mmHg (p=ns) in patients with ...

A helpful revision guide providing a look at the Stresemann years, including his role as chancellor and the role he played in stopping hyperinflation.

Dive into the research topics of Evaluation of microleakage due to cuffs of endotracheal tubes during positive end-expiratory pressure ventilation.. Together they form a unique fingerprint. ...

Hyperinflation is the runaway and excessive rise in the prices of most goods, including necessities like food, water and fuel. Being prepared for hyperinflation is important because steep price hikes can cause starvation, homelessness, chaos and economic collapse. (h/t to SurvivalSullivan.com) Signs of hyperinflation Hyperinflation occurs for two main reasons: The amount of cash circulating in an economy increased significantly or supply chains are […]

Footnotes. This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.. Conflict of interest: Dr. Shiraishi has nothing to disclose.. Conflict of interest: Dr. Higashimoto has nothing to disclose.. Conflict of interest: Dr. Sugiya has nothing to disclose.. Conflict of interest: Dr. Mizusawa has nothing to disclose.. Conflict of interest: Dr. Takeda has nothing to disclose.. Conflict of interest: Dr. Hujita has nothing to disclose.. Conflict of interest: Dr. Nishiyama has nothing to disclose.. Conflict of interest: Dr. Kudo has nothing to disclose.. Conflict of interest: Dr. Kimura has nothing to disclose.. Conflict of interest: Dr. Chiba has nothing to ...

Why is intra-abdominal pressure monitoring important? Learn how to set up intra-abdominal pressure monitoring and how to interpret your findings.