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  • 1
    Electronic Resource
    Electronic Resource
    A new device to remove obstruction from endotracheal tubes during mechanical ventilation in critically ill patients (1994)
    Springer
    Intensive care medicine 20 (1994), S. 573-576 
    Details
    ISSN: 1432-1238
    Keywords: Mechanical ventilation ; Endotracheal tubes ; Obstruction ; Acute respiratory failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate the efficiency of a new device developed to remove obstructions from endotracheal tubes (ETT) in mechanically ventilated patients. Design Open study in mechanically ventilated sedated and paralyzed ICU patients. Setting General ICU and Laboratory of Respiratory Mechanics of the University of Rome “La Sapienza”. Patients 8 consecutive unselected mechanically ventilated, critically ill patients in which a partial obstruction of ETT was suspected on the basis of an increase of the peak inspiratory pressure (〉20%) plus the difficult introduction of a standard suction catheter. Interventions Obstructions to ETT were removed with an experimental “obstruction remover” (OR) Measurements “In vivo” ETT airflow resistance (0.25; 0.5; 0.75; 1l/s) was evaluated before and after use of the OR; the work of breathing necessary to overcome ETT resistance (WOBett) was also evaluated before and after OR use. Results The use of OR significantly reduced in all patients the ETT “in vivo” resistance (From 5.5±2.3 to 2.9±0.5 cmH2O/l/s at 0.25l/s,p〈0.05; from 9±2.4 to 3.8±0.8 cmH2O/l/s at 0.51l/s; from 12.2±3.5 to 5.7±1.2 cmH2O/l/s at 0.75l/s; from 16.9±6 to 9.3±3.8 cmH2O/l/s at 1l/s,p〈0.01 respectively). Also the WOBett was significantly reduced after use of the OR (from 0.66±0.19 to 0.34±0.08 J/l;p〈0.05) Conclusion This experimental device can be safely and successfully used to remove obstructions from the ETT lumen, without suspending mechanical ventilation, reducing the need for rapid ETT substitution in emergency and life-threatening situations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01705724
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  • 2
    Electronic Resource
    Electronic Resource
    Evaluation of respiratory system resistance in mechanically ventilated patients: The role of the endotracheal tube (1994)
    Springer
    Intensive care medicine 20 (1994), S. 421-424 
    Details
    ISSN: 1432-1238
    Keywords: Mechanical ventilation ; Endotracheal tube ; Respiratory system resistance ; Airway resistance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To investigate the role played by the endotracheal tube (ETT) in the correct evaluation of respiratory system mechanics with the end inflation occlusion method during constant flow controlled mechanical ventilation. Setting General ICU, university of Rome “La Sapienza”. Patients 12 consecutive patients undergoing controlled mechanical ventilation. Methods We compared the values of minimal resistance of the respiratory system (i.e. airway resistance) (RRS min) obtained: i) subtracting the theoretical value of ETT resistance from the difference between P max and P1, measured on airway pressure tracings obtained from the distal end of the ETT; ii) directly measuring airway pressure 2 cm below the ETT, thus automatically excluding ETT resistance from the data. Results The values of RRS min obtained by measuring airway pressure below the ETT were significantly lower than those obtained by measuring airway pressure at the distal end of the ETT and subtracting the theoretical ETT resistance (4.5±2.8 versus 2.5±1.6 cm H2O/l/s,p〈0.01). Conclusion When precise measurements of ohmic resistances are required in mechanically ventilated patients, the measurements must be obtained from airways pressure data obtained at tracheal level. The “in vivo” positioning of ETT significantly increases the airflow resistance of the ETT.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01710652
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  • 3
    Electronic Resource
    Electronic Resource
    Detection of leukotrienes B4, C4 and of their isomers in arterial, mixed venous blood and bronchoalveolar lavage fluid from ARDS patients (1989)
    Springer
    Intensive care medicine 15 (1989), S. 296-301 
    Details
    ISSN: 1432-1238
    Keywords: ARDS ; Leukotrienes ; Humoral mediators
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Seven patients with the adult respiratory distress syndrome (ARDS) were studied. As a control group we used 6 surgical patients who underwent minor surgical operation (inguinal hernia). For both groups the same sample collection and analysis was used. The presence of leuktorienes (LTs) B4 and C4 and of their isomers 11-trans LTC4 and Δ6-trans-12-epi LTB4 was determined in arterial, mixed venous blood and in bronchoalveolar lavage (BAL) fluid. The samples, analysed by reverse phase high performance liquid chromatography (RP-HPLC), showed a similar chromatographic picture among ARDS patients, while the control group showed no detectable amounts of LTs in BAL or blood. The distribution of these arachidonic acid metabolites in mixed venous blood, arterial blood and BAL seems to suggest pulmonary metabolism and/or inactivation. It is suggested that these mediators act as humoral factors in pathogenesis of the ARDS.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00263864
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  • 4
    Electronic Resource
    Electronic Resource
    A fibre optics system for the evaluation of airway pressure in mechanically ventilated patients (1992)
    Springer
    Intensive care medicine 18 (1992), S. 405-409 
    Details
    ISSN: 1432-1238
    Keywords: Endotracheal tube resistance ; Thoraco-pulmonary mechanics ; Fiber optic catheter ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: The present study was intended to evaluate the “in vivo” endotracheal (ET) tube resistance and respiratory mechanics in mechanically ventilated patients with respiratory failure by using fiber optic catheters.Design: Two fiber optic catheters, consisting of a thin probe with a pressure transducer on the tip, were used. The first was placed at the proximal side of the ET tube and the second was positioned distally beyond the end. A low compliant air-filled catheter connected to a traditional pressure transducer was placed close to the proximal fiber optic device to compare the pressure values obtained with both systems.Setting: The study was performed in the General Intensive Care Unit of Rome “La Sapienza”, University Hospital.Patients and participants: Seven patients admitted for the management of acute respiratory failure of different etiologies were included in the protocol. All the patients were intubated and mechanically ventilated for a least 48h prior to the investigation.Measurements and results: The endotracheal tube resistance was obtained both by the end-inspiratory occlusion method and measuring pressure proximally and distally to the ET tube. The measurement of respiratory mechanics was obtained proximally and distally to the ET tube. Different flows and tidal volume changes were performed. The results showed that the fiber optic device gives an adequate evaluation of airway pressure and the possibility for an easy detection of obstructions and/or deformations of the ET tube. The area described by inspiratory and expiratory pressure recorded at both sides of the ET tube showed a positive relationship between the surface and flows while no surface changes were shown when the tidal volumes were modified. Thoraco-pulmonary compliance measured proximally and distally to the ET tube gave rise to a small and statistically insignificant differenceConclusion: This study confirms that 48h after the positioning of ET tubes the airflow resistance is significantly higher than might be expected from the “in vitro” data. The presence of the endotracheal tube can interfere with the evaluation of thoraco-pulmonary mechanics, particularly in dynamic conditions. The fiber optic system represents an interesting and simple tool for the evaluation of ET tube resistance and pulmonary mechanics in patients undergoing mechanical ventilation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01694342
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  • 5
    Electronic Resource
    Electronic Resource
    Differential evaluation of bronchoalveolar lavage cells and leukotrienes in unilateral acture lung injury and ARDS patients (1989)
    Springer
    Intensive care medicine 15 (1989), S. 439-445 
    Details
    ISSN: 1432-1238
    Keywords: BAL ; Cells ; Leukotrienes ; Unilateral acute lung injury ; ARDS
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Patients with unilateral acute lung injury (UALI; n=6) and ARDS (n=4) were evaluated by bronchoalveolar lavage, as controls we used 5 patients suffering from cerebral hemorrhage and without pulmonary, cardiac or infectious disease who were mechanically ventilated. For each group of patients two independent bronchoalveolar lavages (BAL) were performed. The BAL fluid recovered from the two lungs was immediately analyzed for leukotrienes (LTS) by means of RP-HPLC and stained for cell counts. The BAL from the control group did not show any LTS and the percentage of neutrophils was within the normal range: 1±0.2% right lung and 1.2±0.4% left lung. The BAL fluid from UALI patients showed two different patterns, the injured lung showed high levels of LTS (39.1±8 ng ml-1 LTB4; 25±6 ng ml-1 LTD4 and 27.8±8.2 ng ml-111-trans LTC4) and an increased percentage of neutrophils (74.2±7%) compared to controls. Only 2 out of the 6 patients from the UALI group showed small amounts of LTB4 (4 ng ml-1) and LTD4 (3.2 ng ml-1). The BAL obtained from the “healthy lung” in both cases showed values of LTS almost eight fold lower than those present in the injured lung. The percentage of neutrophils from the unaffected lungs (4.3±7%) was not significantly different from controls. Lavage fluid from ARDS patients showed a similar picture to that of the affected lung from UALI patients. Evaluation of ARDS lavage fluid demonstrated the presence of the same LTS (LTB4, LTD4 and 11-trans LTC4) with concentrations similar to those found in the injured lung of UALI subjects. The amount of LTB4 (a very potent chemotatic factor) correlated directly with the percentage of neutrophils both in ARDS and the diseased lung of UALI patients. These findings suggest that LTS and neutrophils participate in the pathophysiology of UALI and ARDS, and that UALI is a localized pathologic entity similar to ARDS.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00255599
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  • 6
    Electronic Resource
    Electronic Resource
    Auto-PEEP and dynamic hyperinflation in COPD patients during controlled mechanical ventilation and high frequency jet ventilation (1990)
    Springer
    Intensive care medicine 16 (1990), S. 81-84 
    Details
    ISSN: 1432-1238
    Keywords: COPD ; High frequency jet ventilation ; Auto-PEEP
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We investigated the levels of auto-PEEP and dynamic hyperinflation during high frequency jet ventilation (HFJV) and controlled mechanical ventilation (CMV) in six patients with chronic obstructive pulmonary disease within the first 36 h of acute exacerbation. The comparative evaluation was performed at similar conditions of gas exchange in HFJV and CMV: PaO2 77.6±11 mmHg vs 80.8±12 mmHg; PaCO2 46.8±2.5 mmHg vs 47±2.8 mmHg; pH 7.38 vs 7.38. In this situation, the values of auto-PEEP and dynamic hyperinflation, expressed as Δ over the apneic functional residual capacity (FRC) did not differ: (auto-PEEPHFJV 8.9±3.8 cmH2O; auto-PEEPCMV 8.8±4.7 cmH2O; ΔFRCHFJV 0.56±0.19 l; ΔFRCCMV 0.54±0.2 l). This result suggests that, with a suitable machine setting and similar gas exchanges, HFJV produces the same level of auto-PEEP and dynamic hyperinflation as CMV in patients with chronic obstructive pulmonary disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01699850
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  • 7
    Electronic Resource
    Electronic Resource
    High frequency jet ventilation (HFJV) has no better haemodynamic tolerance than controlled mechanical ventilation (CMV) in cardiogenic shock (1988)
    Springer
    Intensive care medicine 14 (1988), S. 359-363 
    Details
    ISSN: 1432-1238
    Keywords: Cardiogenic shock ; High Frequency Jet Ventilation ; Mechanical Ventilation ; Haemodynamic effects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Six patients with acute myocardial infarction (AMI) complicated by cardiogenic shock were studied in order to compare the haemodynamic tolerance of controlled mechanical ventilation (CMV) and high frequency jet ventilation (HFJV). The comparative analysis of the two techniques was performed with the same levels of PaO2 (CMV: 101±13 mmHg; HFJV: 104.2±14 p=ns); and PaCO2 (CMV: 37±1.7; HFJV: 35.7±1.4p=ns). In this situation the values of mean airway pressure (Paw) did not differ significantly (CMV: 13±3 cm H2O; HFJV: 12.6±3.8 cm H2O) and no statistically significant difference in haemodynamic values was observed. These results demonstrate that in patients with cardiogenic shock, there is no difference between HFJV and CMV in terms of haemodynamic tolerance. Because of the more difficult clinical management of HFJV, this technique does not seem indicated as ventilatory support in patients with cardiogenic shock states.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00262889
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  • 8
    Electronic Resource
    Electronic Resource
    Effects of the heat-moisture exchangers on dynamic hyperinflation of mechanically ventilated COPD patients (1990)
    Springer
    Intensive care medicine 16 (1990), S. 441-443 
    Details
    ISSN: 1432-1238
    Keywords: Heat-moisture exchangers ; COPD ; Auto PEEP ; Controlled mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In recent years the use of devices called Heat and Moisture Exchangers (HME) has become widespread as gas conditioners for ICU patients requiring mechanical ventilation. As an important variation of the resistive properties of the HME, related to flow and duration of use, has recently been pointed out during “in vitro” studies, the use of these devices in COPD patients could increase the levels of auto PEEP and dynamic hyperinflation. In this study we have compared the levels of auto PEEP and difference in functional residual capacity (Δ FRC) in a group of COPD patients, requiring controlled mechanical ventilation (CMV), at basal conditions and after the insertion into the circuit of three HMEs (Dar Hygrobac, Pall Ultipor, Engstrom Edith) at random: the results obtained excluded a significant increase of auto PEEP and Δ (FRC) both with “new” HMEs and after 12 h of continuous use.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01711222
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