Respiratory care clinics of North America最新文献

{"title":"Expiratory asynchrony.","authors":"Hong-Lin Du,&nbsp;Yoshitsugu Yamada","doi":"10.1016/j.rcc.2005.02.001","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.02.001","url":null,"abstract":"<p><p>Expiratory asynchrony is a universal phenomenon, and expiratory synchrony occurs only by chance. Expiratory asynchrony exists in all breath modes and has a significant impact on the patient's work of breathing and the weaning process. Advancements in ventilator designs and basic physiologic science could lead to the improvement of the expiratory asynchrony.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"11 2","pages":"265-80"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rcc.2005.02.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40947793","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":"Assessment of respiratory output in mechanically ventilated patients.","authors":"Franco Laghi","doi":"10.1016/j.rcc.2005.02.008","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.02.008","url":null,"abstract":"<p><p>Mechanically ventilated patients are subject to few pathophysiologic disturbances that have such intuitive importance as abnormal function of the respiratory output. Abnormal function of the respiratory output plays a fundamental role in all aspects of mechanical ventilation: in determining which patients require mechanical ventilation, in determining the interaction between a patient and the ventilator, and in determining when a patient can tolerate discontinuation of mechanical ventilation. Monitoring indexes such as the rate of rise in electrical activity of the diaphragm, Po.1, (dP/dt)max, and Pmus, has provided insight into the performance of the respiratory centers in critically ill patients, but these methods require considerable refinement. A large body of research on measurements of energy expenditure of the respiratory muscles, such as pressure-time product, and measurements of inspiratory effort, such as the tension-time index, is currently accumulating. Several challenges, however, lay ahead regarding these indices. First, there is the need to identify the correct level of pressure generation and respiratory muscle effort that should be attained in the day-to-day management of mechanically ventilated patients. The correct titration of ventilator setting should not cause iatrogenic muscle damage because the support is excessive or insufficient. One of the challenges in reaching this goal is that for the same patient, different underlying pathologic conditions (eg, sepsis or ventilator-associated muscle injury) may require different levels of support. Second, many of the measurements of pressure generation and effort have been confined to the research laboratory. Modifications of the technology to achieve accurate measurements in the intensive care unit-outside of the research laboratory--are needed. To facilitate individual titration of ventilator settings, the new technologies must provide easier access to quantification of drive, pressure output, and effort. Finally, more research is needed to define the effect of monitoring respiratory output on patient outcome and containment of costs.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"11 2","pages":"173-99"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rcc.2005.02.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40947789","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":"Patient-ventilator interaction: an overview.","authors":"George Prinianakis,&nbsp;Eumorfia Kondili,&nbsp;Dimitris Georgopoulos","doi":"10.1016/j.rcc.2005.02.007","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.02.007","url":null,"abstract":"<p><p>During assisted mechanical ventilation, the total pressure applied to respiratory system is the sum of ventilator and muscle pressure. As a result, the respiratory system is under the influence of two pumps, the ventilator pump (ie, Paw), which is controlled by the physician's brain and the capabilities of the ventilator, and the patient's own respiratory muscle pump (Pmus), which is controlled by the patient's brain. The patient-ventilator interaction is mainly an expression of the function of these two brains, which should be in harmony to promote patient-ventilator synchrony. The achievement of this harmony depends exclusively on the physician, who should be aware that during assisted mechanical ventilation the respiratory system is not a passive structure but reacts to pressure delivered by the ventilator via various feedback systems and, depending on several factors both to the ventilator and patient, may modify the function of the ventilator. Finally, the physician should know that the ventilator imposes significant constraints to the respiratory system, the magnitude of which depends heavily on the triggering variable, the variable that controls the gas delivery and the cycling off criterion.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"11 2","pages":"201-24"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rcc.2005.02.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40947790","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":"Patient-ventilator interaction during the triggering phase.","authors":"Fabrizio Racca,&nbsp;Vincenzo Squadrone,&nbsp;V Marco Ranieri","doi":"10.1016/j.rcc.2005.01.001","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.01.001","url":null,"abstract":"<p><p>Partial patient-controlled mechanical support mode ventilators provide positive pressure assistance whenever a patient's inspiratory effort decreases pressure or flow in the ventilator circuit below the sensitivity set by clinicians; these modes minimize disuse atrophy of the respiratory muscles, can facilitate the weaning process, and usually require lower ventilator pressures. The capability of restoring gas exchange, unloading respiratory muscles, and relieving the patient's dyspnea with partial patient-controlled mechanical support modes depends on matching between the ventilator setting and the patient's ventilatory demand (ie, patient-ventilator interactions).</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"11 2","pages":"225-45"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rcc.2005.01.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40947791","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":"Patient-ventilator interaction during noninvasive positive pressure ventilation.","authors":"Stefano Nava,&nbsp;Piero Ceriana","doi":"10.1016/j.rcc.2005.02.003","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.02.003","url":null,"abstract":"<p><p>The interaction between the patient and the ventilator is complex,especially in a \"semi-open\" system as for noninvasive ventilation(NIV). Air leaks around the mask are likely to occur, and they affect patient-ventilator synchrony. Several variables may be responsible for the mismatch between the start of the neural output and that of ventilatory aid during NIV. The most common mode of ventilation is pressure support ventilation (PSV), which may result in a number of inspiratory efforts not being followed by ventilator aid. New modes of ventilation, such as proportional assist ventilation, maybe useful in improving patient tolerance to ventilation without affecting clinical outcome. The ventilatory settings are important during PSV to determine the synchrony. The inspiratory trigger function may be influenced by the amount of leaks, whereas a better synchrony may be achieved if the termination of the inspiratory phase is time cycled instead of flow cycled. A high pressurization rate results in poor compliance. Care should be paid in the choice of the interfaces because leaks in the system are associated with a substantial breath-to-breath inspiratory variation independent from the patient effort. Last, NIV should be delivered with turbine- or piston-based ventilators that are able to compensate for air leaks. With respect to the problem of sedation, we point out the importance of optimizing the environmental conditions, avoiding excessive light and noise, assuring patient comfort, and providing reassurance. When sedation is needed, we suggest the use of low doses of analgesics and neuroleptic agents in selected cases.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"11 2","pages":"281-93"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rcc.2005.02.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40949286","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":"Potential advantages of patient-ventilator synchrony.","authors":"Kannan Ramar,&nbsp;Catherine S H Sassoon","doi":"10.1016/j.rcc.2005.02.005","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.02.005","url":null,"abstract":"<p><p>During conventional mechanical ventilation, fixed set pressure, flow, and tidal volume result in a mismatch between patient and ventilator inspiratory time and in a patient's inability to adapt to changing ventilatory demand. Synchrony between the patient and ventilator improves neuromuscular coupling and the ability to adapt to increased ventilatory demand or loading. The sensation of dyspnea prevents ineffective inspiratory efforts and attenuates periodic breathing during sleep.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"11 2","pages":"307-17"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rcc.2005.02.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40949288","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":"Modes of pressure delivery and patient-ventilator interaction.","authors":"C Bonetto,&nbsp;M N Caló,&nbsp;M O Delgado,&nbsp;J Mancebo","doi":"10.1016/j.rcc.2005.01.002","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.01.002","url":null,"abstract":"<p><p>Differences between assist-control pressure and volume ventilation are minimal provided that peak inspiratory flow delivered at early inspiration matches patient demand Ventilation at constant flow and controlled tidal volume allow instantaneous analysis of the patient-ventilator interactions and the mechanical properties of the respiratory system. The cycle-per-cycle variability of peak inspiratory flow, which is permitted in pressure-limited modes, may allow better patient comfort. We do not know if one mode (pressure controlled or volume controlled) is superior to the other in terms of outcomes.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"11 2","pages":"247-63"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rcc.2005.01.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40947792","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":"Effects of sleep on patient-ventilator interaction.","authors":"Sairam Parthasarathy","doi":"10.1016/j.rcc.2005.02.004","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.02.004","url":null,"abstract":"<p><p>Sleep influences patient-ventilator interaction. Adjustment of ventilator settings in critically ill patients may require understanding and monitoring of the influence of the sleep-wakefulness state on patient-ventilator interaction. Research studies of patient-ventilator interactions should be controlled for the confounding influence of changes in the sleep-wakefulness state.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"11 2","pages":"295-305"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rcc.2005.02.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40949287","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":"New and future developments to improve patient-ventilator interaction.","authors":"Eumorfia Kondili,&nbsp;Dimitris Georgopoulos","doi":"10.1016/j.rcc.2005.02.006","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.02.006","url":null,"abstract":"<p><p>The new and future developments to improve the patient-ventilator interaction are mainly based on the concept of the tight coupling between neural output and ventilator function. This tight coupling should be present throughout a patient's respiratory cycle, a task that is demanding from a technical point of view. By achieving a tight neuromechanical coupling, the ventilator operates as an external respiratory muscle of high capabilities controlled mainly by the patient. This task, however, necessitates knowledge of respiratory system physiology and pathophysiology and the interaction between patient and ventilator. Although currently sophisticated computer algorithms have been developed, the caregiver is the one who controls the patient-ventilator system. Without indepth knowledge of this system, the algorithms may induce harm rather than benefit.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"11 2","pages":"319-39"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rcc.2005.02.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40949289","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":"Patient–Ventilator Interaction","authors":"R. Branson, N. MacIntyre","doi":"10.1016/J.RCC.2005.02.010","DOIUrl":"https://doi.org/10.1016/J.RCC.2005.02.010","url":null,"abstract":"","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86365389","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}