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  • 1
    Electronic Resource
    Electronic Resource
    Facial mask noninvasive mechanical ventilation reduces the incidence of nosocomial pneumonia (1997)
    Springer
    Intensive care medicine 23 (1997), S. 1024-1032 
    Details
    ISSN: 1432-1238
    Keywords: Key words Epidemiology in ICU ; Facial mask mechanical ventilation ; Logistic Regression Model ; Nosocomial pneumonia ; Ventilator-associated pneumonia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate the impact of noninvasive positive pressure mechanical ventilation (NPPV) on ventilator-associated pneumonia (VAP). Design: Prospective observational study. Setting: Medical intensive care unit (ICU) of a university teaching hospital. Patients: Cohort of 320 consecutive patients staying in the ICU more than 2 days and mechanically ventilated for ≥ 1 day. Measurements and results: VAP was diagnosed when, satisfying classical clinical and radiological criteria, fiberoptic bronchoalveolar lavage and/or protected specimen brush grew ≥ 104 and ≥ 103 CFU/ml, respectively, of at least one microorganism. Patients were classified into four subgroups according to the way in which mechanical ventilation was delivered: NPPV then tracheal intubation (TI) (n = 38), TI then NPPV (n = 23), TI only (n = 199), and NPPV only (n = 60). Occurrence of VAP was estimated by incidence rate and density of incidence. Risk factors for VAP were assessed by logistic regression analysis. Twenty-seven patients had 28 episodes of VAP. The incidence rates for patients with VAP were 18 % in NPPV-TI, 22 % in TI-NPPV, 8 % in TI, and 0 % in NPPV (p 〈 0.0001). The density of incidence of VAP was 0.85 per 100 days of TI and 0.16 per 100 days of NPPV (p = 0.04). Logistic regression showed that length of ICU stay and ventilatory support were associated with VAP. Conclusions: There is a significantly lower incidence of VAP associated with NPPV compared to tracheal intubation. This is mainly explained by differences in patient severity and risk exposure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050452
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  • 2
    Electronic Resource
    Electronic Resource
    Effect of PEEP on work of breathing in mechanically ventilated COPD patients (2000)
    Springer
    Intensive care medicine 26 (2000), S. 1207-1214 
    Details
    ISSN: 1432-1238
    Keywords: Key words Work of breathing ; Chronic obstructive pulmonary disease ; Mechanical ventilation ; Pulmonary hyperinflation ; Positive end-expiratory pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To study the effects of PEEP on the inspiratory work done per breath on the respiratory system (WI,rs) in patients with chronic obstructive pulmonary disease (COPD).¶Design: Physiological study.¶Setting: Fourteen-bed Medical ICU of a 1000-bed teaching tertiary hospital.¶Patients and participants: Ten patients with COPD intubated and mechanically ventilated for acute respiratory failure.¶Interventions: PEEP of 0 (ZEEP), ¶5, 10, and 15 cm H2O were applied randomly and measurements done at the end of a 15–20 min period.¶Measurements and results: Using the rapid airway occlusion technique during constant flow inflation, we partitioned WI,rs into its static and dynamic components. On ZEEP, the mean ± SD values of WI,rs amounted to 15.1 ± 5.7 cm H2O × l. With increasing PEEP, WI,rs was significantly reduced to 12.6 ± 5.7, 11.1 ± 4.1, and 10.4 ± 2.8 cm H2O × l at PEEP of 5, 10, and 15 cm H2O, respectively (P 〈 0.05). This reduction was entirely due to the decline of the work due to intrinsic PEEP (PEEPi) and was abolished when the applied PEEP counterbalanced PEEPi. The other components of WI,rs were not affected by PEEP. By increasing PEEP up to the level of PEEPi on ZEEP, no further increase in end-expiratory lung volume was observed.¶Conclusions: In COPD patients the application of PEEP levels close to PEEPi can substantially reduce WI,rs without promoting further dynamic pulmonary hyperinflation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051339
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    Paper (German National Licenses)
    Fulltext
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