TP55. TP055 MECHANICAL VENTILATION, ICU MANAGEMENT, AND CV最新文献

Effect of Respiratory Effort on Target Minute Ventilation During Adaptive Support Ventilation 适应性支持通气时呼吸力对目标分钟通气的影响

TP55. TP055 MECHANICAL VENTILATION, ICU MANAGEMENT, AND CV Pub Date : 2021-06-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2812

Marissa Su, Ehab Daoud

{"title":"Effect of Respiratory Effort on Target Minute Ventilation During Adaptive Support Ventilation","authors":"Marissa Su, Ehab Daoud","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2812","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2812","url":null,"abstract":"Background: Adaptive support ventilation (ASV) is an intelligent mode of mechanical ventilation protocol which uses a closed-loop control between breaths. The algorithm states that for a given level of alveolar ventilation, there is a particular respiratory rate and tidal volume which achieve a lower work of breathing. The mode allows the clinician to set a desired minute ventilation percentage (MV%) while the ventilator automatically selects the target ventilatory pattern base on these inputs and feedback from the ventilator monitoring system. The goal is to minimize the work of breathing and reduce complications by allowing the ventilator to adjust the breath delivery taking into account the patient’s respiratory mechanics (Resistance, and Compliance). In this study we examine the effect of patients’ respiratory effort on target tidal volume (VT) and Minute Ventilation (V̇e) during ASV using breathing simulator. Methods: A bench study was performed by using the ASL 5000 breathing simulator to compare the target ventilator to actual VT and V̇e value in simulated patients with various level of respiratory effort during ASV on the Hamilton G5 ventilator. The clinical scenario involves simulated adult male with IBW 70kg and normal lung mechanics: respiratory compliance of 70 mL/cm H2O, and airway resistance of 9 cm H2O/L/s. Simulated patients were subjected to five different level of muscle pressure (Pmus): 0 (Passive), -5, -10, -15, -25 (Active) cm H2O at a set respiratory rate of 10 (below targeted VT) set at three different levels of minute ventilation goals: 100%, 200%, and 300%, with a PEEP of 5 cm H2O. Fifty breaths were analyzed in every experiment. Means and standard deviations (SD) of variables were calculated. One way analysis of variants was done to compare the values. Pearson correlation coefficient test was used to calculate the correlation between the respiratory effort and the VT, V̇e, and peak inspiratory pressure (PIP). Results: The targeted VT and V̇e were not significant in the passive patient when no effort was present, however were significantly higher in the active states at all levels of Pmus on the 100%, 200% and the 300 MV%. The VT and V̇e increase correlated with the muscle effort in the 100 and 200 MV% but did not in the 300%. Conclusions: Higher inspiratory efforts resulted in significantly higher VT and V̇e than targeted ones. Estimating patients’ effort is important during setting ASV. Keywords: Mechanical ventilation, ASV, InteliVent, Pmus, tidal volume, percent minute ventilation","PeriodicalId":255004,"journal":{"name":"TP55. TP055 MECHANICAL VENTILATION, ICU MANAGEMENT, AND CV","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121705030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Volume Resuscitation Practices in End Stage Renal Disease Patients with Septic Shock 脓毒性休克终末期肾病患者的容积复苏实践

TP55. TP055 MECHANICAL VENTILATION, ICU MANAGEMENT, AND CV Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2818

G. Jaffe, M. Flynn, N. Qadir

引用次数: 0

BPAP vs AVAPS for Hypercapnic Respiratory Failure: A Retrospective Analysis BPAP与AVAPS治疗高碳酸血症性呼吸衰竭:回顾性分析

TP55. TP055 MECHANICAL VENTILATION, ICU MANAGEMENT, AND CV Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2808

H. Ahmad, H. Chaudhry, D. Oh, U.A. Mahmood, A. Gohar

引用次数: 0

Prevalence, Degree, and Drivers of Resident Burnout During MICU Rotations MICU轮岗期间住院医师职业倦怠的患病率、程度和驱动因素

TP55. TP055 MECHANICAL VENTILATION, ICU MANAGEMENT, AND CV Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2831

E. Sonntag, K. Dover, J. Banks, T. Bice, J. Cadigan, A. Davis

引用次数: 0

Resident Transitions of Care and Antimicrobial Use Among Patients in the Intensive Care Unit 重症监护病房患者护理和抗菌药物使用的住院转换

TP55. TP055 MECHANICAL VENTILATION, ICU MANAGEMENT, AND CV Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2827

B. Ademi, T. Smith, T. Rusher, T. Pham, A. Gillet, M. Moore, M. Brown, M. Flanagan, M. Mahendran, J. Mai, J. Oh, Y. Zu, J. Denson

引用次数: 0

Aiding the Recovery of ICU Survivors: Creation and Implementation of a Post-ICU Recovery Clinic 帮助ICU幸存者康复:ICU后康复诊所的创建和实施

TP55. TP055 MECHANICAL VENTILATION, ICU MANAGEMENT, AND CV Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2850

M. Biehl, K. Sarin, E. Bishop, J. Veith, M. Holztrager, K. Bash, J. O’Brien, H. Khouli

{"title":"Aiding the Recovery of ICU Survivors: Creation and Implementation of a Post-ICU Recovery Clinic","authors":"M. Biehl, K. Sarin, E. Bishop, J. Veith, M. Holztrager, K. Bash, J. O’Brien, H. Khouli","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2850","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2850","url":null,"abstract":"Introduction: Advancements in critical care medicine have led to increase in Intensive Care Unit (ICU) survival. ICU survivors often experience cognitive, mental and physical impairments as part of a condition called Post- Intensive Care Syndrome (PICS). While there are several ICU follow-up programs, there is variability in their structure and approach. We describe the creation and implementation of a Post-ICU Recovery Clinic (PIRC). Methods: A retrospective observational study was conducted and included all patients seen in a PIRC of a quaternary health system from December 2019 to September 2020. PIRC visit variables included scores on several validated questionnaires screening for mental health and cognitive disorders, 6-minute walk test, pulmonary function test, change in occupational and driving status, and referrals made during PIRC visit. Statistics reported reflect exclusion of the missing data points. Results: The criteria utilized for patient selection was circulatory shock, acute respiratory distress syndrome (ARDS), mechanical ventilation >7 days, ICU admission >7 days, delirium, cardiac arrest and COVID-19 with ICU stay >2 days. A total of 63 patients were seen in PIRC, 41% of those were ARDS survivors. Given the COVID-19 pandemic, telemedicine was shortly implemented and 62% of the visits were virtual. Median age (IQR) was 59.1 (49.2-71.6), 59% were male, with near equal Caucasian and African American distribution. All patients who had an in-person visit were seen by a critical care physician and advance practice provider, pharmacist, psychiatrist and physical therapist during the visit. 36% screened positive for anxiety or depression as identified by the Patient Health Questionnaire-4 (PHQ- 4), and 11% screened positive for post-traumatic stress disorder (PTSD) identified by the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). Of the patients seen with in-person visit, 45% had either mild or moderate cognitive impairment identified by the Montreal Cognitive Assessment (MOCA). Median 6-minute walk distance was 66% predicted. Median FEV1, FVC, and DLCO was 86, 80, and 60% predicted respectively. From the 61% of patients who were working and 91% who were driving prior to hospitalization, only 22% and 65% had returned to those activities respectively. Thirty four (56%) patients had at least one referral made, with some patients receiving up to 6 referrals. Conclusion: A high prevalence of PICS and social impairments were identified in ICU survivors at a PIRC. Incorporating an inter-disciplinary team approach and standardized surveys were imperative to recognize these impairments in order to support return to the best state of recovery possible.","PeriodicalId":255004,"journal":{"name":"TP55. TP055 MECHANICAL VENTILATION, ICU MANAGEMENT, AND CV","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125872948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Safety of Non-Invasive Ventilation in Patients with Altered Mental Status 精神状态改变患者无创通气的安全性

TP55. TP055 MECHANICAL VENTILATION, ICU MANAGEMENT, AND CV Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2810

P. Soni, V. Kumar, V. T. Gonuguntla, S. Musty, K. Gupta, K. Chawla, Y. Kupfer

引用次数: 0

Using APACHE Longitudinally in ARDS to Assess Disease Severity 在 ARDS 中纵向使用 APACHE 评估疾病严重程度

TP55. TP055 MECHANICAL VENTILATION, ICU MANAGEMENT, AND CV Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2849

A. Patel, A. Lucia Fuentes, A. Malhotra, L. C. Crotty Alexander

{"title":"Using APACHE Longitudinally in ARDS to Assess Disease Severity","authors":"A. Patel, A. Lucia Fuentes, A. Malhotra, L. C. Crotty Alexander","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2849","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2849","url":null,"abstract":"Introduction: The acute physiology, age, chronic Health Evaluation (APACHE) II score has been used to assess risk of mortality in admitted intensive care unit (ICU) patients since 1985. There are few examples of a longitudinal correlation over time. As the scores rises from 0 to 71, risk of mortality increases. For this study, other scores were also considered - SOFA (Sequential Organ Failure Assessment) was excluded due to a lack of variable diversity and small range of values. APACHE III and IV are more complex scores with additional variables, such that calculating daily scores manually was impracticable. APACHE II has consistent calibration compared to III and IV. We assessed whether APACHE III and IV scores had any additional benefit over APACHE II. Methods: APACHE II score was used to determine clinical severity daily of sixteen critically ill COVID-19 patients and compared to daily changes in cytokine levels. If any studies were unavailable for a given day, data was pulled from a maximum of 24 hours before or after the day of interest. Although GCS (Glasgow Coma Scale) is a large part of the score, and difficult to assess in an intubated patient, however it contributed to documenting sedation and intubation state. Results: APACHE II score assessed clinical severity daily in COVID-19 more effectively relative to SOFA. The wide score range allowed comparison of patients without overlap, as compared to SOFA which has a range of 0-24. With a larger range of 0-71, we believe that it increased the sensitivity for detection of small changes in clinical status. We analyzed APACHE II in context of absolute neutrophil count, plasma cytokine levels, as well as neutrophil functional studies. For our study, APACHE II, not SOFA, was helpful in demonstrating changes in severity of illness, which correlated with some of these assessments. For example, APACHE II showed a significant linear correlation with pro-inflammatory cytokine IL-8 in plasma (r2=0.47, p=0.0017;Fig 1). Conclusion: APACHE II was able to define the severity of illness in COVID-19 patients on a daily basis. APACHE II score allowed us to tie immunophenotyping to clinical disease severity over time and was helpful in broadening our approach to data comparison with clinical status. This was a pilot study to assess the ability of APACHE II to track severity of illness, but in the future, we plan to correlate APACHE II in a larger cohort of a variety of ARDS patients.","PeriodicalId":255004,"journal":{"name":"TP55. TP055 MECHANICAL VENTILATION, ICU MANAGEMENT, AND CV","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128075524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiopulmonary Bypass Effect on the Development of Postoperative Pulmonary Complications and on Short, Intermediate and Long Term Mortality in Cardiac Surgery 体外循环对心脏手术术后肺部并发症发生及短期、中期和长期死亡率的影响

TP55. TP055 MECHANICAL VENTILATION, ICU MANAGEMENT, AND CV Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2847

S. Badour, J. Abi Jaoude, T. Schwann

引用次数: 0

Fluid Management in Diabetic Ketoacidosis; Comparing Balanced Fluids to Normal saline. 糖尿病酮症酸中毒的体液管理比较平衡液体和生理盐水。

TP55. TP055 MECHANICAL VENTILATION, ICU MANAGEMENT, AND CV Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2833

D. Kumar, F. Shaikh, F. Warsha, S. Haider

引用次数: 0