Researchers Suspect Genetic Link to COPD: “Gene variants that may be associated with chronic obstructive pulmonary disease have been identified by Boston University School of Medicine researchers.”
Browsing Posts tagged lung
Spontaneous breathing is good!?
- A combination of 18-69 hours of diaphragmatic inactivity and controlled mechanical ventilation results in 53-57% reduction of diaphragm muscle fibers!
- Asynchrony and over-assisting contribute to disappearing muscle… so tailor Ti, Insp Rise, and set rates appropriately!
Wake up and Breathe! (ABC trial)
- Paired sedation and ventilator weaning protocol consisting of daily SATs plus SBTs resulted in patients spending more time off mechanical ventilation, less time in coma, and less time in intensive care and the hospital, and the protocol improved 1-year survival compared with usual care.
The ICU patient remembers…
~20% of ICU patients suffer post-traumatic stress disorder leading to physical & mental health issues.
What they remember? (see Granja article)
1. Daily needle punctures
2. Tracheal tube aspiration
3. Nose tube
4. Bladder tube
5. Noise from conversation
6. Noise from engines and ventilators
7. Pain
8. Bedridden
9. Music in the intensive care unit
10. Comments from doctors and nurses
Lung Weight (Gattinoni lecture)
- A normal lung weighs 800-1200 grams
- An ARDS lung weighs 2000-4000 grams! At least 10-15 cm H2O PEEP to overcome the compressive forces in an ARDS lung.
Subclinical Delirium = Brain Failure?!
- Patients suffering subclinical or transient delirium are more likely to have a longer hospital stay, higher mortality rate and require increased assistance at home.
- Current debates about benzos altering the structure of the brain and increasing incidence of delirium
- Should ICUs move to Remifentanil, Propofol, Dexmedetomidine?
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Physicianbrochure
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CTV Report Video
….Respiratory support should only be delivered when the patient wants it. Traditionally, it has been a matter of supplying a ventilation support that sustains a certain level of minute ventilation, but the ventilator must take care of the lung, chest wall and abdomen, and the work of breathing increases. The patient does not receive what he needs…..
Acuity Care Technology (read more)
Dr. Christer Sinderby with a demonstration of NAVA
in operation at the Maquet Booth at the Las Vegas Conference.
High Frequency Oscillatory Ventilation (HFO) is a ventilatory strategy that employs very small tidal volumes (often less than anatomic dead space) combined with very fast rates or frequencies (where 1 Hertz or Hz = 60cycles/min).
The Sensormedics 3100B high frequency oscillator consists of a continuous positive airway pressure circuit with an integrated motor-driven piston/diaphragm for generating the oscillations. There is active inspiration as well as active expiration on the oscillator.
Gas transport during HFO is thought to be as a result of several factors: molecular diffusion, direct alveolar ventilation (bulk gas flow to the proximal alveoli), net convective transport caused by asymmetric gas-velocity profiles, improved gas mixing caused by Taylor dispersion in turbulent flow, pendelluft, and cardiogenic mixing.
In HFO, alveolar ventilation (and thus CO2 elimination) is dependent on frequency and tidal volume, but relatively independent of lung volume. Oxygenation is “uncoupled” from ventilation; that is, it is proportional to mean airway pressure and lung volume.
