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We performed a point prevalence study on infants with severe BPD collecting data on type and settings of ventilatory support; 187 infants were included from 15 centers, 51% who were on invasive positive pressure ventilation. We found significant center-specific variation in ventilator modes.

Objective: To review the fundamentals of invasive positive pressure ventilation (IPPV) and the common complications and associated pharmacotherapeutic management in order to provide opportunities for pharmacists to improve patient outcomes. Data Sources: A MEDLINE literature search (1950-December 2017) was performed using the key search terms invasive positive pressure ventilation, mechanical ventilation, pharmacist, respiratory failure, ventilator associated organ dysfunction, ventilator associated pneumonia, ventilator bundles, and ventilator liberation. Additional references were identified from a review of literature citations. Study Selection and Data Extraction: All English-language original research and review reports were evaluated. Data Synthesis: IPPV is a common supportive care measure for critically ill patients. While lifesaving, IPPV is associated with significant complications including ventilator-associated pneumonia, sinusitis, organ dysfunction, and hemodynamic alterations. Optimization of pain and sedation management provides an opportunity for pharmacists to directly affect IPPV exposure. A number of pharmacotherapeutic interventions are related directly to prophylaxis against IPPV-associated adverse events or aimed at reduction of duration of IPPV. Conclusions: Enhanced knowledge of the common complications, associated pharmacotherapy, and monitoring strategies facilitate the pharmacist’s ability to provide increased pharmacotherapeutic insight in a multidisciplinary intensive care unit setting.

Subcutaneous emphysema (SE) results from air leak from lung parenchyma into the least resistance subcutaneous tissues. Mostly a self limiting condition but extensive subcutaneous emphysema (ESE) may lead to anxiety, disfigurement, discomfort, respiratory embarrassment, upper airway obstruction and systemic air embolism and requires active management. We report successful management of progressive SE in a patient on invasive positive pressure mechanical ventilation using a newer approach and also discuss the role of surgical tracheostomy as a rescue measure. Bangladesh Med J. 2017 May; 46 (2): 66-67

Patients with chronic obstructive pulmonary disease (COPD) make up a large proportion of hospital in-patients; they account for 12% of general medical admissions. Decisions to ventilate a patient with an exacerbation of COPD are partly based on the physician's prediction of future quality of life. In this systematic review, Pubmed, Medline, Embase, Biomed Central and the Cochrane library were electronically searched for observational and interventional studies of health-related quality of life (HRQoL) in patients with COPD, who were invasively ventilated, survived to hospital discharge and were followed up for HROoL measurements to be made. The results of the nine studies included showed that HROoL does deteriorate after invasive ventilation in intensive care, but is similar to that of patients who are on long-term oxygen therapy (LTOT) or in pulmonary rehabilitation programmes. Despite the high long-term mortality of patients with COPD, the HROoL in patients who do survive is reasonable. Identifying these patients remains a significant challenge.

OBJECTIVE: This study was performed to obtain the title of Master in Medicine, Nov/2012-Jul/2013. Improvement in cardiac output after fluid administration is known as fluid responsiveness. A reliable parameter for its evaluation is pulse pressure variation: it has established its utility in predicting volume responsiveness in mechanically ventilated patients. METHOD: Pulse pressure variation was analyzed in 10 anesthetized male pigs at four different stages: I) normovolemia and spontaneous breathing; II) hypovolemia and spontaneous breathing; III) hypovolemia under mechanical ventilation; and IV) after volume replacement, under mechanical ventilation. Cardiac output, pulmonary artery occlusion pressure, systolic pressure variation, mean arterial pressure, and heart rate were measured at all stages; red blood cell count was determined at stages I, II, and IV. RESULTS: Mean pulse pressure variation values during hypovolemia with spontaneous breathing (stage II) were significantly higher than at any other stage. After institution of mechanical ventilation, pulse pressure variation values returned to baseline without fluid administration. The lowest values were achieved after volume replacement. CONCLUSION: Pulse pressure variation values are higher during spontaneous breathing than during mechanical ventilation. Thus, it may be useful for assessment of fluid volume under these conditions, with baseline values as a starting point to which serial measurements should be compared after institution of specific therapy. RESUMO OBJETIVO: Este estudo foi realizado para obtenção do título de Mestre em Medicina, Novembro/2012-Julho/2013. A melhoria do débito cardíaco após a administração de fluidos é conhecida como a capacidade de resposta do fluido. Um parâmetro confiável para sua avaliação é a variação da pressão de pulso, cuja utilidade na previsão da capacidade de resposta volêmica em pacientes sob ventilação mecânica é reconhecida. MÉTODO: A variação de pressão de pulso foi analisada em 10 suínos machos, anestesiados em quatro diferentes estágios: I) normovolemia e respiração espontânea; II) hipovolemia e respiração espontânea; III) hipovolemia sob ventilação mecânica; e IV) após a reposição volêmica, sob ventilação mecânica. O débito cardíaco, a pressão de oclusão da artéria pulmonar, a variação da pressão sistólica, a pressão arterial média e frequência cardíaca foram medidos em todas as fases; a contagem de hemácias foi determinada nas fases I, II e IV. RESULTADOS: Os valores de variação de pressão de pulso durante a hipovolemia com respiração espontânea (estágio II) foram significativamente maiores do que em qualquer outra fase Após a instituição da ventilação mecânica, os valores de variação de pressão de pulso voltaram ao valor inicial, sem a administração de fluidos. Os valores mais baixos foram obtidos após a reposição. CONCLUSÃO: Os valores de variação da pressão de pulso são maiores durante a respiração espontânea do que durante a ventilação mecânica. Assim, esse parâmetro pode ser útil para a avaliação do volume de fluido sob estas condições. Os valores da linha de base devem ser tomados como ponto de partida contra o qual as medições seriadas devem ser comparadas após a instituição da terapêutica específica.

The lungs of premature infants are more vulnerable than term infants to the effects of invasive positive pressure ventilation. Published literature supporting the use of non-invasive respiratory support with CPAP, bi-level CPAP mode, such as, SiPAP and Nasal Intermittent Positive Pressure Ventilation (NIPPV), and surfactant administration strategies are discussed. This review focuses on non-invasive respiratory support strategies and selective early use of surfactant that may reduce the incidence of bronchopulmonary dysplasia.

To describe the outcome of patients with status asthmaticus (SA) treated in a medical ICU with positive pressure ventilation (PPV), and to identify those factors associated with increased length of hospital stay.Retrospective chart review.University-based hospital in Chicago, IL.All patients admitted with SA and treated with PPV over a 5-year period.The first ICU admission for each of 78 patients was analyzed. Fifty-six patients underwent endotracheal intubation (ETI) during the hospitalization, while 22 patients were treated with noninvasive PPV alone. Three patients died. The median hospital length of stay was 5.5 days. Cox regression analysis revealed the following factors to be independently associated with increased length of hospital stay: female gender (p0.01), ETI (p0.01), the administration of neuromuscular blockers for24 h (p0.01), inhaled corticosteroid use prior to ICU admission (p = 0.01), and increasing APACHE (acute physiology and chronic health evaluation) II score (p0.01).This study suggests that while the mortality associated with SA treated with contemporary methods of PPV is low, certain factors, including female gender, ETI, and the prolonged use of neuromuscular blockade, are associated with an increased length of hospital stay. The development of respiratory failure despite preadmission use of inhaled corticosteroids is also associated with prolonged hospitalization.

Non-invasive modes of ventilation may be adequate for some patients with less severe acute lung injury (ALI) but invasive positive pressure ventilation is usually required. Ventilation strategies for such patients have changed significantly in recent years, as it is has become increasingly apparent that the process of ventilation itself may contribute to lung injury.