| An optimized set-up for helmet noninvasive ventilation improves pressure support delivery and patient-ventilator interaction. | |
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MedLine Citation:
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PMID: 23011529 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVE: To test the effects on mechanical performance of helmet noninvasive ventilation (NIV) of an optimized set-up concerning the ventilator settings, the ventilator circuit and the helmet itself. SUBJECTS AND METHODS: In a bench study, helmet NIV was applied to a physical model. Pressurization and depressurization rates and minute ventilation (MV) were measured under 24 conditions including pressure support of 10 or 20 cmH(2)O, positive end expiratory pressure (PEEP) of 5 or 10 cmH(2)O, ventilator circuit with "high", "intermediate" or "low" resistance, and cushion deflated or inflated. In a clinical study pressurization and depressurization rates, MV and patient-ventilator interactions were compared in six patients with acute respiratory failure during conventional versus an "optimized" set-up (PEEP increased to 10 cmH(2)O, low resistance circuit and cushion inflated). RESULTS: In the bench study, all adjustments simultaneously applied (increased PEEP, inflated cushion and low resistance circuit) increased pressurization rate (46.7 ± 2.8 vs. 28.3 ± 0.6 %, p < 0.05), depressurization rate (82.9 ± 1.9 vs. 59.8 ± 1.1 %, p ≤ 0.05) and patient MV (8.5 ± 3.2 vs. 7.4 ± 2.8 l/min, p < 0.05), and decreased leaks (17.4 ± 6.0 vs. 33.6 ± 6.0 %, p < 0.05) compared to the basal set-up. In the clinical study, the optimized set-up increased pressurization rate (51.0 ± 3.5 vs. 30.8 ± 6.9 %, p < 0.002), depressurization rate (48.2 ± 3.3 vs. 34.2 ± 4.6 %, p < 0.0001) and total MV (27.7 ± 7.0 vs. 24.6 ± 6.9 l/min, p < 0.02), and decreased ineffective efforts (3.5 ± 5.4 vs. 20.3 ± 12.4 %, p < 0.0001) and inspiratory delay (243 ± 109 vs. 461 ± 181 ms, p < 0.005). CONCLUSIONS: An optimized set-up for helmet NIV that limits device compliance and ventilator circuit resistance as much as possible is highly effective in improving pressure support delivery and patient-ventilator interaction. |
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Authors:
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Francesco Mojoli; Giorgio A Iotti; Ilaria Currò; Marco Pozzi; Gabriele Via; Aaron Venti; Antonio Braschi |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-9-26 |
Journal Detail:
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Title: Intensive care medicine Volume: - ISSN: 1432-1238 ISO Abbreviation: Intensive Care Med Publication Date: 2012 Sep |
Date Detail:
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Created Date: 2012-9-26 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Dipartimento di Emergenza Urgenza, S.C. di Anestesia e Rianimazione I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, francesco.mojoli@unipv.it. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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