Mechanical ventilator: Difference between revisions
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==Acute respiratory distress syndrome== | ==Acute respiratory distress syndrome== | ||
In the [[acute respiratory distress syndrome]] (ARDS), better outcomes may occur with: | In the [[acute respiratory distress syndrome]] (ARDS) ([[P/F ratio]] < 200), better outcomes may occur with: | ||
* Low [[tidal volume]]: 8 mL/kg of body weight or less | * Low [[tidal volume]]: 8 mL/kg of body weight or less | ||
* Higher positive end-expiratory pressure | * [[Positive end expiratory pressure]] (PEEP).<ref name="pmid20197533">{{cite journal| author=Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD et al.| title=Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. | journal=JAMA | year= 2010 | volume= 303 | issue= 9 | pages= 865-73 | pmid=20197533 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18270352 | doi=10.1001/jama.299.6.637 }} | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=20197533 | doi=10.1001/jama.2010.218 }}</ref> | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18270353 | doi=10.1001/jama.299.6.646 }} < | ** Higher PEEP, such as plateau pressures not exceeding 40 cm H<sub>2</sub>O (mean positive end-expiratory pressure of 15 cm H<sub>2</sub>O)<ref name="pmid18270352">{{cite journal| author=Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ et al.| title=Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. | journal=JAMA | year= 2008 | volume= 299 | issue= 6 | pages= 637-45 | pmid=18270352 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18270352 | doi=10.1001/jama.299.6.637 }}</ref> or plateau pressure of 28 to 30 cm H<sub>2</sub>O<ref name="pmid18270353">{{cite journal| author=Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL et al.| title=Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. | journal=JAMA | year= 2008 | volume= 299 | issue= 6 | pages= 646-55 | pmid=18270353 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18270353 | doi=10.1001/jama.299.6.646 }}</ref> | |||
** A [[randomized controlled trial]] has compared titrating PEEP with esophageal pressure and recommendations by the [http://www.ardsnet.org/ Acute Respiratory Distress Syndrome Network] (ARDSNet).<ref name="pmid19001507">{{cite journal |author=Talmor D, Sarge T, Malhotra A, ''et al'' |title=Mechanical ventilation guided by esophageal pressure in acute lung injury |journal=N. Engl. J. Med. |volume=359 |issue=20 |pages=2095–104 |year=2008 |month=November |pmid=19001507 |doi=10.1056/NEJMoa0708638 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19001507&promo=ONFLNS19 |issn=}}</ref> | |||
==Weaning mechanicl ventilation== | ==Weaning mechanicl ventilation== | ||
Revision as of 12:08, 6 May 2010
In medicine, a mechanical ventilators are "devices used to produce or assist pulmonary ventilation."[1] Mechanical ventilators may be used in surgery that is performed under general anesthesia or in critical care medicine for patients with respiratory insufficiency from causes such as acute respiratory distress syndrome.
Modes of mechanical ventilation include:
Acute respiratory distress syndrome
In the acute respiratory distress syndrome (ARDS) (P/F ratio < 200), better outcomes may occur with:
- Low tidal volume: 8 mL/kg of body weight or less
- Positive end expiratory pressure (PEEP).[2]
- Higher PEEP, such as plateau pressures not exceeding 40 cm H2O (mean positive end-expiratory pressure of 15 cm H2O)[3] or plateau pressure of 28 to 30 cm H2O[4]
- A randomized controlled trial has compared titrating PEEP with esophageal pressure and recommendations by the Acute Respiratory Distress Syndrome Network (ARDSNet).[5]
Weaning mechanicl ventilation
Details for weaning from mechanical ventilation are available.[6] Example criteria are if the PaO2:FIO2 ratio was greater than 150 mm Hg and FIO2 was no greater than 0.6.[4]
References
- ↑ Anonymous (2024), Mechanical ventilator (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD et al. (2010). "Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis.". JAMA 303 (9): 865-73. DOI:10.1001/jama.2010.218. PMID 20197533. Research Blogging.
- ↑ Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ et al. (2008). "Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial.". JAMA 299 (6): 637-45. DOI:10.1001/jama.299.6.637. PMID 18270352. Research Blogging.
- ↑ 4.0 4.1 Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL et al. (2008). "Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial.". JAMA 299 (6): 646-55. DOI:10.1001/jama.299.6.646. PMID 18270353. Research Blogging.
Cite error: Invalid
<ref>tag; name "pmid18270353" defined multiple times with different content - ↑ Talmor D, Sarge T, Malhotra A, et al (November 2008). "Mechanical ventilation guided by esophageal pressure in acute lung injury". N. Engl. J. Med. 359 (20): 2095–104. DOI:10.1056/NEJMoa0708638. PMID 19001507. Research Blogging.
- ↑ Cook D et al. (2000) Criteria for Weaning from Mechanical Ventilation. Agency for HealthCare Research and Quality. ISBN 1-58763-011-7