Journal of Mechanical Ventilation最新文献

{"title":"Volume Targeted Algorithms. Are they a one-size-fits-all approach to noninvasive ventilation?","authors":"David A. Troxell","doi":"10.53097/jmv.10101","DOIUrl":"https://doi.org/10.53097/jmv.10101","url":null,"abstract":"Noninvasive ventilation (NIV) has rapidly expanded as the principle respiratory support strategy in a variety of disease states ultimately resulting in respiratory insufficiency including COPD, overlap syndrome (COPD + comingled sleep disordered breathing), obesity hypoventilation syndrome (OHS), motor neuron diseases, such as amyotrophic lateral sclerosis (ALS), as well as various muscular dystrophies to list just a few examples. In recent years, NIV technology and algorithms have experienced rapid development aimed at improving performance, reliability, comfort, portability, titration efficiency, and treatment outcomes. One specific algorithmic advancement of NIV has been the development of volume targeting algorithms and the creation of new, hybrid modes of NIV. The fundamental feature of volume targeted algorithms is the automation of the inspiratory positive airway pressure (IPAP) or pressure support (PS). In recent years, volume targeted modes have grown in popularity and often are the preferred method of implementing NIV in the home. There are important differences between manufacturer’s proprietary algorithms that should be understood by the clinician when implementing NIV or when evaluating patient response to NIV. This article will identify some of the unique characteristics of commercially available volume targeted modes and will provide an overview of recent findings in specific cohorts. Keywords: non-invasive ventilation (NIV), volume-targeted ventilation, volume assured pressure support, chronic obstructive pulmonary disease (COPD), neuromuscular disorders (NMD)","PeriodicalId":510464,"journal":{"name":"Journal of Mechanical Ventilation","volume":"83 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141337983","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}

{"title":"Pembrolizumab-induced necrotizing diaphragmatic myositis","authors":"David Rodríguez-Plaza, Carla Marco, Noemi Vidal, Enric Prats","doi":"10.53097/jmv.10103","DOIUrl":"https://doi.org/10.53097/jmv.10103","url":null,"abstract":"Pembrolizumab, an anti-PD1 antibody, is increasingly used for the treatment of non-small cell lung cancer. We report a severe and poorly described adverse effect of this therapy: necrotizing myopathy with diaphragmatic and myocardial involvement. A 77-year-old male was diagnosed with metastatic lung adenocarcinoma and started a regimen with chemotherapy along with Pembrolizumab. Two weeks after the second cycle, he was admitted to the hospital due to acute myocarditis and hypercapnic respiratory failure. Treatment with glucocorticoids and Mycophenolate improved his cardiac condition. However, hypercapnic respiratory failure persisted, as well as orthopnea and generalized muscle weakness including bulbar musculature. After comprehensive evaluation including diaphragmatic ultrasound, electromyogram, and biopsy, he was diagnosed with autoimmune necrotizing myopathy with diaphragmatic and myocardial involvement. Treatment with intravenous immunoglobulins and non-invasive mechanical ventilation was added. However, he experienced respiratory deterioration, resulting in death. This case exemplifies the importance of early recognition and intensive treatment of this serious adverse effect. Due to the increasing use of these therapies, it is expected to see a parallel increase in their adverse effects in the coming years. Keywords: Pembrolizumab, necrotizing diaphragmatic myositis","PeriodicalId":510464,"journal":{"name":"Journal of Mechanical Ventilation","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141337221","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}

{"title":"A case of large volume pneumomediastinum, extending to and surrounding the thecal sac, in a COVID-19 positive ventilated patient","authors":"Hugh Mc Guire, Ben Cantan, Richard Sweeney, Sinead Galvin","doi":"10.53097/jmv.10102","DOIUrl":"https://doi.org/10.53097/jmv.10102","url":null,"abstract":"A widespread prevalence of barotrauma among ventilated COVID-19 positive patients was observed during the pandemic. Some studies have associated COVID-19 related barotrauma with a longer length of hospitalization, longer ICU stay, and higher mortality. Pneumorrhachis is the presence of intra-spinal air, it is a rare finding and is associated with different etiologies and possible pathways of air entry into the spinal canal. Air within the spinal canal can be separated into primary and secondary pneumorrhachis, and then further classified into extra- or intradural pneumorrhachis. We present a case of severe COVID-19 infection requiring mechanical ventilation, proning, and subsequent barotrauma in the form of pneumomediastinum, and pneumorrhachis, that resolved with careful watching. This case demonstrates the ongoing challenges of mechanical ventilation and barotrauma in COVID-19 patients. Although uncommonly associated with viral pneumonia, a higher incidence of barotrauma is being observed with COVID-19 infection. Given how rare and the different causative factors are, no standardized guidelines exist for the treatment of pneumorrhachis. It is however, thought to be associated with an increased morbidity and mortality. In this case, the air appeared to be contained by the dural sac and there was no resulting pneumocephalus. Although in general, this phenomenon is usually self-limiting and without further consequences, prompt consideration of the underlying cause is of extreme importance. Keywords: Pneumorrhachis, Barotrauma, COVID-19","PeriodicalId":510464,"journal":{"name":"Journal of Mechanical Ventilation","volume":"6 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141336754","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}

{"title":"A retrospective validation of the effective and safe treatment of patients on general care wards with high velocity nasal insufflation therapy utilizing prognostic risk scores during COVID-19","authors":"Catherine Brenner, Josh Good, Heather Pavlichko, Susan McDonald, Kathy Gerich, Amy Bergeski, Matthew Pavlichko","doi":"10.53097/jmv.10100","DOIUrl":"https://doi.org/10.53097/jmv.10100","url":null,"abstract":"Background Non-invasive positive pressure ventilation (NIPPV) has been a traditional therapy for acute respiratory failure (ARF). However, the use of NIPPV during the COVID-19 pandemic was challenging, while the use of invasive mechanical ventilation produced poor outcomes. An alternative to NIPPV, high velocity nasal insufflation (HVNI) has shown promise in treating ARF effectively. Objective This study evaluated whether HVNI can be used to treat ARF safely on the general care ward (GCW) during COVID-19 pandemic surges. Methods After introducing HVNI therapy to the facility, an evidence-based scoring system, Modified Early Warning Score (MEWS), was used to risk stratify patients and assist in assigning care level. Initial settings, demographic data, patient outcomes, and health care worker (HCW) virus conversion were measured throughout the study. Treatment failure was defined as the need for invasive mechanical ventilation (IMV) or NIPPV after HVNI therapy. MEWS and ROX index were compared retrospectively using the Pearson product-moment correlation coefficient to identify trends. The Welch two sample t-test (desired power of 90% with alpha=0.05) was used for demographic and outcome analysis. Results Two hundred thirty-four patients were treated with HVNI. The GCW failure rate of 18.56% (n=31/167) was lower than the ICU failure rate of 37.31% (n=25/67) but not statistically significant (P 0.175). No elevated risk to patients or HCW was observed. Respiratory rate (GCW 24.85 vs. ICU 30.14; P <0.001), MEWS (GCW 2.34 vs. ICU 3.09; p=0.002), and ROX index (GCW 5.49 vs. ICU 4.68; P 0.002) assessments appear to be adequate predictors of HVNI failure. The Pearson product-moment coefficient comparing MEWS and ROX index identified a moderate negative correlation (-0.434; P <0.001). Discussion HVNI therapy is an effective alternative to NIPPV for treating patients with COVID-19 associated ARF. Using measures such as MEWS and/or ROX, strict patient monitoring, and HCW surveillance, HVNI can be safely utilized on the GCW. This has a direct impact when dealing with patient surges where ICU beds and resources are limited. Additional studies are needed to further delineate these concepts. Keywords: COVID-19, Non-invasive Positive Pressure Ventilation, Acute Respiratory Failure, High Flow Nasal Oxygen, High Velocity Nasal Insufflation, ICU Admission, General Care Ward, MEWS, ROX","PeriodicalId":510464,"journal":{"name":"Journal of Mechanical Ventilation","volume":"14 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141336921","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}

{"title":"Mean airway pressure - Minute ventilation product (mM): A simple and universal surrogate equation to calculate mechanical power in both volume and pressure controlled ventilation","authors":"Ehab Daoud, Philip Lee, Shane Toma, C. Franck","doi":"10.53097/jmv.10099","DOIUrl":"https://doi.org/10.53097/jmv.10099","url":null,"abstract":"Introduction Mechanical power represents the energy delivered by a mechanical ventilator onto the lungs. It incorporates all the variables participating in ventilator-induced lung injury, including driving pressure, tidal volume, positive end expiratory pressure, and respiratory rate. The pitfall of mechanical power is its mathematical complexity, as the gold standard method of calculation involves deriving the inspiratory area under the pressure-volume curve of each breath. Prior studies attempted to create simplified equations, they lack clinical utility as calculations cannot be done by solely looking at ventilator settings or they require manipulation of variables. There are also different formulas depending on the type of the mode of ventilation used. This study offers a simplified, universal equation called the mean airway pressure - Minute ventilation product (mM equation) which renders mechanical power clinical application more feasible at the bedside. Methods and Statistics Data collection used the online SIVA simulator, which simulate mechanical ventilation and calculate the geometrical area of the inspiratory limb of the pressure-volume curve. Different combinations of passive scenarios with varying compliances (10-80 ml/cmH2O) and resistances (5-30 cmH2O/L/S) in each the VCV and PCV modes were accomplished by adjusting ventilator settings with respiratory rate (5-40 BPM), tidal volume (150-700 mL), DP (5-30 cmH2O), and PEEP (0-15 cmH2O), with different inspiratory times in PCV and different flows rates in the VCV. A total of 2,000 values were collected in each mode. Range of Mechanical power measured by the simulator: 0.1 - 105 J/min and range of mM equation (mean airway pressure x Minute ventilation): 0.37 - 820 cmH2O/L/min. Pearson correlation coefficients were calculated to compare the relationship of the mM equation to the measured MP, and linear regressions were used for predicting the MP derived from the mM equation in each mode separately and when combining all data from both modes. T-test for equal variance and Bland Altmann plot were used to compare the reference MP measured (MPR) from the simulator to the one derived from the Mm formula (MPD). Results There was a statistically significant linear relationship (P < 0.001) and strong correlation of determination (R2 = 0.931), CI (0.961, 0.967) between the mM formula and the gold-standard method of calculating mechanical power for the combined two modes. For the VCV: there was a statistically significant linear relationship (P < 0.001) and strong correlation of determination (R2 = 0.936), CI (-0.963, 0.971). For the PCV: there was a statistically significant linear relationship (P < 0.001) and strong correlation of determination (R2 = 0.936), CI (-0.964, 0.970). A linear regression model predicted the MP from the mM as follows: for both modes MP = 0.13 (mM) + 3.41, for PCV MP = 0.15 (mM) + 3.79, for VCV MP = 0.13 (mM) + 2.48. The derived mechanical power from the mM was not stat","PeriodicalId":510464,"journal":{"name":"Journal of Mechanical Ventilation","volume":"4 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141337110","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}