17 results on '"Respiration, artificial"'
Search Results
2. Ventilation devices for neonatal resuscitation at birth: A systematic review and meta-analysis.
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Tribolet S, Hennuy N, and Rigo V
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- Infant, Newborn, Humans, Infant, Premature, Prospective Studies, Respiration, Artificial, Surface-Active Agents, Resuscitation methods, Pulmonary Surfactants
- Abstract
Initial management of inadequate adaptation to extrauterine life relies on non-invasive respiratory support. Two types of devices are available: fixed pressure devices (FPD; T-pieces or ventilators) and hand driven pressure devices (HDPD; self- or flow-inflating bags). This systematic review and meta-analysis aims to compare clinical outcomes after neonatal resuscitation according to device type., Methods: Four databases were searched from inception to 2022, January. Search strategies included Mesh/Emtree terms as well as free language without any restriction. Randomized, quasi-randomized studies and prospective cohorts comparing the use of the two types of devices in neonatal resuscitation were included., Results: Nine studies recruiting 3621 newborns were included: 5 RCTs, 2 RCTs with interventions bundles and 2 prospective cohorts. Meta-analysis of the 5 RCTs demonstrated significant reductions in bronchopulmonary dysplasia (RR0,68[0,48-0,96]-NNT 31) and other respiratory outcomes: intubation in the delivery room (RR0,72[0,58-0,88]-NNT 13,4), mechanical ventilation requirements (RR0,81[0,67-0,96]-NNT 17) and duration (MD-1,54 days[-3,03- -0,05]), need for surfactant (RR0,79[0,64-0,96]-NNT 7,3). The overall analysis found a lower mortality in the FPD group (OR0,57[0,47-0,69]-NNT 12,7) and confirmed decreases in intubation, surfactant requirement and mechanical ventilation rates (OR 0,56[0,40-0,79]- NNT7,5; OR 0,67[0,55-0,82]-NNT10,7 and OR0,58[0,42-0,80]- NNT 7,4 respectively). The risk of cystic periventricular leukomalacia (cPVL) decreased significantly with FPD (OR0.59[0.41-0.85]-NNT 27). Pneumothorax rates were similar (OR0.82[0.44-1.52])., Conclusion and Relevance: Resuscitation at birth with FPD improves respiratory transition and decreases BPD with a very low to moderate certainty of evidence. There is suggestion of decreases in mortality and cPVL. Further studies are still needed to confirm those results., Competing Interests: Conflict of Interest Statement The authors have no conflicts of interest to declare., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)
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- 2023
- Full Text
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3. The importance of measuring ventilation during resuscitation.
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Idris AH
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- Humans, Respiration, Respiration, Artificial, Cardiopulmonary Resuscitation, Resuscitation
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- 2022
- Full Text
- View/download PDF
4. Trends in neonatal resuscitation patterns in Queensland, Australia - A 10-year retrospective cohort study.
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Kapadia P, Hurst C, Harley D, Flenady V, Johnston T, Bretz P, and Liley HG
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- Australia epidemiology, Female, Humans, Infant, Newborn, Pregnancy, Queensland epidemiology, Retrospective Studies, Respiration, Artificial, Resuscitation
- Abstract
Objectives: To describe the frequency of neonatal resuscitation interventions implemented for newborn babies in the state of Queensland over a 10-year period and determine if these changes suggest adherence to changes in Australian guidelines., Study Design: A population-based retrospective cohort study utilising the Queensland Perinatal Data Collection dataset. All liveborn babies ≥23 + 0 weeks + days gestation born between 1 July 2007 and 30 June 2017 were included except those for whom resuscitation was not attempted and those babies <25 + 0 weeks for whom it was unsuccessful. Trends in resuscitation were demonstrated using Loess regression., Results: Of 618,589 eligible newborns,182,260 received any resuscitation manoeuvre (29.5%). The proportion receiving oxygen without assisted ventilation declined from 19.3% in 2007-08 to 5.6% in 2016-17. Upper airway suctioning also decreased. Assisted ventilation increased from 7.9% to 10.0% of all babies with the largest contribution from late preterm and term babies. The rate of endotracheal suctioning for meconium and the rate of narcotic antagonist use also declined. A greater proportion of babies received chest compressions (1.9-3.2 per 1000 babies) and adrenaline (epinephrine). Mortality decreased from 1.9 to 1.5 per 1000 babies in the cohort., Conclusion: Ten-year trends showed reduced use of oxygen or upper airway suctioning without assisted ventilation, reduced intubation to suction meconium, reduced use of narcotic antagonists and greater use of assisted ventilation suggesting appropriate practice change in response to Australian neonatal resuscitation guidelines. The increase in the use of chest compressions and adrenaline was unexpected and the reasons for it are unclear., (Copyright © 2020 Elsevier B.V. All rights reserved.)
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- 2020
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5. Assessment of intensive care unit-free and ventilator-free days as alternative outcomes in the pragmatic airway resuscitation trial
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Henry E. Wang, Ashish Panchal, J. Madison Hyer, Graham Nichol, Clifton W. Callaway, Tom Aufderheide, Michelle Nassal, Terry Vanden Hoek, Jing Li, Mohamud R. Daya, Matthew Hansen, Robert H. Schmicker, Ahamed Idris, and Lai Wei
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Intensive Care Units ,Critical Care ,Resuscitation ,Intubation, Intratracheal ,Emergency Medicine ,Humans ,Emergency Nursing ,Cardiology and Cardiovascular Medicine ,Respiration, Artificial - Abstract
We sought to evaluate the utility and validity of ICU-free days and ventilator-free days as candidate outcomes for OHCA trials.We conducted a secondary analysis of the Pragmatic Airway Resuscitation Trial. We determined ICU-free (days alive and out of ICU during the first 30 days) and ventilator-free days (days alive and without mechanical ventilation). We determined ICU-free and ventilator-free day distributions and correlations with Modified Rankin Scale (MRS). We tested associations with trial interventions (laryngeal tube (LT), endotracheal intubation (ETI)) using continuous (t-test), non-parametric (Wilcoxon Rank-Sum test - WRS), count (negative binomial - NB) and survival models (Cox proportional hazards (CPH) and competing risks regression (CRR)). We conducted bootstrapped simulations to estimate statistical power.ICU-free days was skewed; median 0 days (IQR 0, 0), survivors only 24 (18, 27). Ventilator-free days was skewed; median 0 (IQR 0, 0) days, survivors only 27 (IQR 23, 28). ICU-free and ventilator-free days correlated with MRS (Spearman's ρ = -0.95 and -0.97). LT was associated with higher ICU-free days using t-test (p = 0.001), WRS (p = 0.003), CPH (p = 0.02) and CRR (p = 0.04), but not NB (p = 0.13). LT was associated with higher ventilator-free days using t-test (p = 0.001), WRS (p = 0.001) and CRR (p = 0.03), but not NB (p = 0.13) or CPH (p = 0.13). Simulations suggested that t-test and WRS would have had the greatest power to detect the observed ICU- and ventilator-free days differences.ICU-free and ventilator-free days correlated with MRS and differentiated trial interventions. ICU-free and ventilator-free days may have utility in the design of OHCA trials.
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- 2022
6. The importance of measuring ventilation during resuscitation
- Author
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Ahamed H. Idris
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Respiration ,Resuscitation ,Emergency Medicine ,Humans ,Emergency Nursing ,Cardiology and Cardiovascular Medicine ,Respiration, Artificial ,Cardiopulmonary Resuscitation - Published
- 2022
7. Neonatal simulation training decreases the incidence of chest compressions in term newborns
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Eva M Schwindt, Reinhold Stockenhuber, Theresa Kainz, Nicola Stumptner, Martin Henkel, Lukas Hefler, and Jens C Schwindt
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Incidence ,Resuscitation ,Emergency Medicine ,Infant, Newborn ,Humans ,Emergency Nursing ,Cardiology and Cardiovascular Medicine ,Respiration, Artificial ,Simulation Training ,Cardiopulmonary Resuscitation ,Retrospective Studies - Abstract
To determine the effectiveness of a multidimensional neonatal simulation-based medical education training programme on direct and indirect patient outcome parameters.This was a retrospective analytical study with a historical control group in a level II neonatal care unit (1,700 births per year). A multidimensional interdisciplinary training programme on neonatal resuscitation was implemented in 2015; pre-training (2012-2014) and post-training (2015-2019) eras were compared in terms of mortality (direct outcome) and the received intervention level immediately after birth (indirect outcome). Intervention levels were defined as follows: A) short-term non-invasive ventilation, B) prolonged non-invasive ventilation (5 inflation breaths), C) chest compressions.Of 13,950 neonates born during the study period, 826 full-term newborns received one of the three intervention levels for adaptation after birth. A total of 284 (34.4%) patients received short-term non-invasive ventilation (A), 477 (57.8%) had prolonged ventilation (B), and 65 (7.9%) chest compressions (C), respectively. Comparing the pre- and post-training eras, there was no significant reduction in mortality, and no significant changes were found in groups A or B. However, the risk for chest compressions (group C) decreased significantly from 0.91% in the pre-training era to 0.20% in the post-training era (p 0.001).Although there was no significant effect on neonatal mortality, regular interdisciplinary simulation training decreased the number of administered chest compressions immediately after birth. Further studies are needed to test indirect outcome-related parameters, such as frequency of chest compressions as a measure of effectiveness and impact of medical training.
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- 2022
8. Tidal volumes and pressures delivered by the NeoPuff T-piece resuscitator during resuscitation of term newborns
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Bjorland, Peder Aleksander, Ersdal, Hege Langli, Haynes, Joanna Clare, Ushakova, Anastasia, Øymar, Knut Asbjørn Alexander, and Rettedal, Siren
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gjenoppliving ,Resuscitation ,Infant, Newborn ,nyfødtgjenoppliving ,Insufflation ,Equipment Design ,Emergency Nursing ,Respiration, Artificial ,Positive-Pressure Respiration ,Medisinske Fag: 700::Klinisk medisinske fag: 750::Pediatri: 760 [VDP] ,Emergency Medicine ,Tidal Volume ,Humans ,Cardiology and Cardiovascular Medicine - Abstract
Aim: T-piece resuscitators are commonly used for respiratory support during newborn resuscitation. This study aimed to describe delivered pressures and tidal volumes when resuscitating term newborns immediately after birth, using the NeoPuff T-piece resuscitator. Method: Observational study from June 2019 through March 2021 at Stavanger University Hospital, Norway, including term newborns ventilated with a T-piece resuscitator after birth, with consent to participate. Ventilation parameters of the first 100 inflations from each newborn were recorded by respiration monitors and divided into an early (inflation 1–20) and a late (inflation 21–100) phase. Results: Of the 7730 newborns born, 232 term newborns received positive pressure ventilation. Of these, 129 newborns were included. In the early and the late phase, the median (interquartile range) peak inflating pressure was 30 (28–31) and 30 (27–31) mbar, and tidal volume was 4.5 (1.6–7.8) and 5.7 (2.2–9.8) ml/kg, respectively. Increased inflation times were associated with an increase in volume before plateauing at an inflation time of 0.41 s in the early phase and 0.50 s in the late phase. Inflation rates exceeding 32 per minute in the early phase and 41 per minute in the late phase were associated with lower tidal volumes. Conclusion: There was a substantial variation in tidal volumes despite a relatively stable peak inflating pressure. Delivered tidal volumes were at the lower end of the recommended range. Our results indicate that an inflation time of approximately 0.5 s and rates around 30–40 per minute are associated with the highest delivered tidal volumes. publishedVersion
- Published
- 2021
9. Trends in neonatal resuscitation patterns in Queensland, Australia - A 10-year retrospective cohort study
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David Harley, Vicki Flenady, Paul Bretz, Helen G. Liley, Trisha Johnston, Priyanka Kapadia, and Cameron Hurst
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medicine.medical_specialty ,Resuscitation ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,Emergency Nursing ,03 medical and health sciences ,0302 clinical medicine ,Meconium ,Pregnancy ,Medicine ,Intubation ,Humans ,education ,Retrospective Studies ,education.field_of_study ,Narcotic antagonist ,business.industry ,Australia ,Infant, Newborn ,030208 emergency & critical care medicine ,Retrospective cohort study ,Respiration, Artificial ,Emergency medicine ,Cohort ,Emergency Medicine ,Female ,Queensland ,Cardiology and Cardiovascular Medicine ,business ,Neonatal resuscitation - Abstract
Objectives: To describe the frequency of neonatal resuscitation interventions implemented for newborn babies in the state of Queensland over a 10-year period and determine if these changes suggest adherence to changes in Australian guidelines. Study design: A population-based retrospective cohort study utilising the Queensland Perinatal Data Collection dataset. All liveborn babies ≥23 + 0 weeks + days gestation born between 1 July 2007 and 30 June 2017 were included except those for whom resuscitation was not attempted and those babies
- Published
- 2020
10. A new physiological model for studying the effect of chest compression and ventilation during cardiopulmonary resuscitation: The Thiel cadaver
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Adrien Drouet, Paul Ouellet, Laurent Brochard, Gilles Bronchti, Stéphane Delisle, Jean-Christophe M. Richard, Dominique Savary, Emmanuel Charbonney, Alain Mercat, Rigollot Marceau, Bilal Badat, Patrice Gosselin, Centre de Recherche Hôpital du Sacré-Coeur de Montréal [Canada] (HSCM), Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Interdepartmental Division of Critical Care Medicine, University of Toronto, Keenan Research Centre for Biomedical Science [Toronto, ON, Canada], Li Ka Shing Knowledge Institute [Toronto, ON, Canada]-St. Michael’s Hopsital [Toronto, ON, Canada], and Hospices Civils de Lyon (HCL)
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medicine.medical_specialty ,Resuscitation ,[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,Heart Massage ,Respiratory physiology ,Emergency Nursing ,Positive-Pressure Respiration ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Cadaver ,Intubation, Intratracheal ,Humans ,Medicine ,Lung volumes ,Cardiopulmonary resuscitation ,Airway Management ,Respiratory system ,Lung ,Positive end-expiratory pressure ,Embalming ,business.industry ,Respiration ,030208 emergency & critical care medicine ,respiratory system ,Respiration, Artificial ,Cardiopulmonary Resuscitation ,Heart Arrest ,respiratory tract diseases ,Intratracheal ,030228 respiratory system ,Artificial ,Emergency Medicine ,Cardiology ,Breathing ,Intubation ,Cardiology and Cardiovascular Medicine ,business ,Airway - Abstract
International audience; BACKGROUND: Studying ventilation and intrathoracic pressure (ITP) induced by chest compressions (CC) during Cardio Pulmonary Resuscitation is challenging and important aspects such as airway closure have been mostly ignored. We hypothesized that Thiel Embalmed Cadavers could constitute an appropriate model.METHODS: We assessed respiratory mechanics and ITP during CC in 11 cadavers, and we compared it to measurements obtained in 9 out-of-hospital cardiac arrest patients and to predicted values from a bench model. An oesophageal catheter was inserted to assess chest wall compliance, and ITP variation (ΔITP). Airway pressure variation (ΔPaw) at airway opening and ΔITP generated by CC were measured at decremental positive end expiratory pressure (PEEP) to test its impact on flow and ΔPaw. The patient's data were derived from flow and airway pressure captured via the ventilator during resuscitation.RESULTS: Resistance and Compliance of the respiratory system were comparable to those of the out-of-hospital cardiac arrest patients (C 42 ± 12 vs C 37.3 ± 10.9 mL/cmHO and Res 17.5 ± 7.5 vs Res 20.2 ± 5.3 cmHO/L/sec), and remained stable over time. During CC, ΔITP varied from 32 ± 12 cmHO to 69 ± 14 cmHO with manual and automatic CC respectively. Transmission of ΔITP at the airway opening was significantly affected by PEEP, suggesting dynamic small airway closure at low lung volumes. This phenomenon was similarly observed in patients.CONCLUSION: Respiratory mechanics and dynamic pressures during CC of cadavers behave as predicted by a theoretical model and similarly to patients. The Thiel model is a suitable to assess ITP variations induced by ventilation during CC.
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- 2018
11. Ventilation rate in adults with a tracheal tube during cardiopulmonary resuscitation: A systematic review
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Gino Vissers, Koenraad G. Monsieurs, and Jasmeet Soar
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Resuscitation ,medicine.medical_specialty ,Swine ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Emergency Nursing ,Return of spontaneous circulation ,Tracheal tube ,03 medical and health sciences ,Dogs ,0302 clinical medicine ,Respiratory Rate ,Internal medicine ,Intubation, Intratracheal ,Animals ,Humans ,Medicine ,Cardiopulmonary resuscitation ,Airway Management ,Randomized Controlled Trials as Topic ,business.industry ,030208 emergency & critical care medicine ,Respiration, Artificial ,Cardiopulmonary Resuscitation ,Heart Arrest ,Observational Studies as Topic ,Anesthesia ,Emergency Medicine ,Breathing ,Cardiology ,Observational study ,Human medicine ,Animal studies ,Cardiology and Cardiovascular Medicine ,Airway ,business - Abstract
Aim: The optimal ventilation rate during cardiopulmonary resuscitation (CPR) with a tracheal tube is unknown. We evaluated whether in adults with cardiac arrest and a secure airway (tracheal tube), a ventilation rate of 10 min(-1), compared to any other rate during CPR, improves outcomes. Methods: A systematic review up to 14 July 2016. We included both adult human and animal studies. A GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to evaluate the quality of evidence for each outcome. Results: We identified one human observational study with 67 patients and ten animal studies (234 pigs and 30 dogs). All studies carried a high risk of bias. All studies evaluated for return of spontaneous circulation (ROSC). Studies showed no improvement in ROSC with a ventilation rate of 10 min-1 compared to any other rate. The evidence for longer-term outcomes such as survival to discharge and survival with favourable neurological outcome was very limited. Conclusion: A ventilation rate recommendation of 10 min-1 during adult CPR with a tracheal tube and no pauses for chest compression is a very weak recommendation based on very low quality evidence. (C) 2017 Elsevier B.V. All rights reserved.
- Published
- 2017
12. Born not breathing: A randomised trial comparing two self-inflating bag-masks during newborn resuscitation in Tanzania
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Hussein Kidanto, Ketil Størdal, Joar Eilevstjønn, Fortunata Francis, Anita Yeconia, Hege Langli Ersdal, Jørgen E. Linde, Monica Thallinger, Estomih Mduma, and Nina Gunnes
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Male ,Resuscitation ,Pediatrics ,medicine.medical_specialty ,Birth weight ,Positive pressure ,Gestational Age ,030204 cardiovascular system & hematology ,Emergency Nursing ,Tanzania ,Laryngeal Masks ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Heart rate ,Tidal Volume ,Humans ,Medicine ,Neonatology ,Poverty ,Asphyxia ,business.industry ,Infant, Newborn ,Gestational age ,Insufflation ,Respiration, Artificial ,Cardiopulmonary Resuscitation ,Anesthesia ,Emergency Medicine ,Breathing ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Effective ventilation is crucial to save non-breathing newborns. We compared standard equipment for newborn resuscitation to a new Upright bag, in an area with high neonatal mortality. Methods Newborns requiring resuscitation at Haydom Lutheran Hospital, Tanzania, were ventilated with 230 ml standard or 320 ml Upright bag-mask by weekly non-blinded block randomisation. A Laerdal Newborn Resuscitation Monitor collected ventilation data through a flow sensor between mask and bag and heart rate with electrocardiography electrodes. Primary outcome was expiratory tidal volume per birth weight. Results Of 6110 babies born, 136 randomised to standard bag-mask and 192 to Upright, both groups had similar birth weight, gestational age, Apgar scores, gender, and mode of delivery. Compared to standard bag-mask, Upright gave higher median expiratory tidal volume (8.6 ml/kg (IQR: 3.5–13.8) vs. 10.0 ml/kg (IQR: 4.3–16.8) difference ratio 1.29, 95%CI 1.05, 1.58, p = 0.014)), increased mean airway and peak inspiratory pressures, and higher early expired CO2 (median at 20 s 4.2% vs. 3.2%, p = 0.0099). Clinical outcome 30 min post-delivery was normal in 44% with standard versus 57% with Upright (p = 0.016), but similar at 24 h. Conclusion and relevance Upright provided higher expired tidal volume, MAP, PIP and early ECO2 than the standard bag. Clinical outcome differed at 30 min, but not at 24 h. Larger volume of Upright than standard bag can be an important factor. The results are relevant for low- and high-income settings as ventilatory and heart rate parameters during resuscitation of newborns are rarely reported. Trial registered at www.ClinicalTrials.gov , NCT01869582 .
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- 2017
13. Initial arterial carbon dioxide tension is associated with neurological outcome after resuscitation from cardiac arrest
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David F. Gaieski, Molly L. Tolins, Daniel J. Henning, Alison Jaworski, Nicholas J. Johnson, and Anne V. Grossestreuer
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Adult ,Male ,medicine.medical_specialty ,Resuscitation ,Databases, Factual ,Partial Pressure ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Emergency Nursing ,Return of spontaneous circulation ,Sensitivity and Specificity ,03 medical and health sciences ,0302 clinical medicine ,Outcome Assessment, Health Care ,medicine ,Hospital discharge ,Humans ,Cardiopulmonary resuscitation ,Aged ,Retrospective Studies ,Chi-Square Distribution ,business.industry ,030208 emergency & critical care medicine ,Arterial carbon dioxide tension ,Retrospective cohort study ,Carbon Dioxide ,Middle Aged ,Respiration, Artificial ,Cardiopulmonary Resuscitation ,Heart Arrest ,Surgery ,Cerebrovascular Circulation ,Anesthesia ,Emergency Medicine ,Female ,Blood Gas Analysis ,Cardiology and Cardiovascular Medicine ,business ,Chi-squared distribution ,Respiratory minute volume - Abstract
Study objectives To determine the relationships between partial pressure of arterial carbon dioxide (PaCO 2 ), prescribed minute ventilation (MV), and neurologic outcome in patients resuscitated from cardiac arrest. Methods This was a retrospective cohort study utilizing a multicenter database of adult patients with return of spontaneous circulation (ROSC) after cardiac arrest. The primary outcome was neurologic status at hospital discharge, defined by Cerebral Performance Category (CPC) score: CPC 1–2 was favorable, CPC 3–5 was poor. We compared rates of initial normocarbia (PaCO 2 31–49mmHg) and mean sequential PaCO 2 measurements obtained over the first 24h. We also assessed the influence of MV on the PaCO 2 at initial, 6, 12, 18, and 24h after cardiac arrest using univariate linear regression. Results One hundred and fourteen patients from 3 institutions met inclusion criteria. Overall, 46/114 (40.4%, 95% CI: 31.4–49.4%) patients survived to hospital discharge, and 33/114 (28.9%, 20.6–37.2%) had CPC 1–2 at the time of discharge. A total of 38.9% (95% CI: 29.9–47.9%) of patients had initial normocarbia; 43.2% (28.6–57.8%) of these patients were discharged with CPC 1–2, compared with 20.3% (10.8–29.8%) of dyscarbic patients. By 6h, neurologic outcomes were not significantly associated with PaCO 2 . Prescribed MV was not associated with PaCO 2 at any time point with the exception of a weak correlation at hour 18. Conclusion Initial normocarbia was associated with favorable neurological outcome in patients resuscitated from cardiac arrest. This relationship was not seen at subsequent time points. There was no significant association between prescribed MV and PaCO 2 or neurologic outcome.
- Published
- 2017
14. Myocardial perfusion and oxidative stress after 21% vs. 100% oxygen ventilation and uninterrupted chest compressions in severely asphyxiated piglets
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Anne Lee Solevåg, Georg M. Schmölzer, Britt Nakstad, Megan O'Reilly, Po-Yin Cheung, Lisa K. Hornberger, Tze-Fun Lee, and Min Lu
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Male ,Cardiac output ,Resuscitation ,Swine ,medicine.medical_treatment ,Myocardial Reperfusion Injury ,Heart Massage ,030204 cardiovascular system & hematology ,Emergency Nursing ,Return of spontaneous circulation ,Asphyxia ,Random Allocation ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Animals ,Humans ,Cardiopulmonary resuscitation ,Hypoxia ,business.industry ,Hemodynamics ,Infant, Newborn ,Stroke volume ,medicine.disease ,Respiration, Artificial ,Cardiopulmonary Resuscitation ,Heart Arrest ,3. Good health ,Oxygen ,Oxidative Stress ,Blood pressure ,Echocardiography ,Anesthesia ,Pulseless electrical activity ,Emergency Medicine ,Female ,Cardiology and Cardiovascular Medicine ,business ,Neonatal resuscitation - Abstract
Aim Despite the minimal evidence, neonatal resuscitation guidelines recommend using 100% oxygen when chest compressions (CC) are needed. Uninterrupted CC in adult cardiopulmonary resuscitation (CPR) may improve CPR hemodynamics. We aimed to examine 21% oxygen (air) vs. 100% oxygen in 3:1 CC:ventilation (C:V) CPR or continuous CC with asynchronous ventilation (CCaV) in asphyxiated newborn piglets following cardiac arrest. Methods Piglets (1–3 days old) were progressively asphyxiated until cardiac arrest and randomized to 4 experimental groups ( n =8 each): air and 3:1 C:V CPR, 100% oxygen and 3:1 C:V CPR, air and CCaV, or 100% oxygen and CCaV. Time to return of spontaneous circulation (ROSC), mortality, and clinical and biochemical parameters were compared between groups. We used echocardiography to measure left ventricular (LV) stroke volume at baseline, at 30min and 4h after ROSC. Left common carotid artery blood pressure was measured continuously. Results Time to ROSC (heart rate ≥100min −1 ) ranged from 75 to 592s and mortality 50–75%, with no differences between groups. Resuscitation with air was associated with higher LV stroke volume after ROSC and less myocardial oxidative stress compared to 100% oxygen groups. CCaV was associated with lower mean arterial blood pressure after ROSC and higher myocardial lactate than those of 3:1 C:V CPR. Conclusion In neonatal asphyxia-induced cardiac arrest, using air during CC may reduce myocardial oxidative stress and improve cardiac function compared to 100% oxygen. Although overall recovery may be similar, CCaV may impair tissue perfusion compared to 3:1 C:V CPR.
- Published
- 2016
15. Automatic detection of oesophageal intubation based on ventilation pressure waveforms shows high sensitivity and specificity in patients with pulmonary disease
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Jelle Roets, Arjanne Stemerdink, Pascal Verdonck, Pieter Rombouts, Anthony Absalom, Frank Dewaele, Jan G. Zijlstra, Alain Kalmar, Koenraad G. Monsieurs, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), and Vascular Ageing Programme (VAP)
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Lung Diseases ,Male ,Emergency intubation ,PARAMEDICS ,Resuscitation ,Radiography ,030204 cardiovascular system & hematology ,Emergency Nursing ,Pulmonary compliance ,law.invention ,0302 clinical medicine ,law ,Medicine and Health Sciences ,Reliability (statistics) ,Medical Errors ,RESUSCITATION ,Oesophageal intubation ,Lung Injury ,Middle Aged ,Respiratory Function Tests ,Intensive Care Units ,medicine.anatomical_structure ,Ventilation (architecture) ,Emergency Medicine ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,Automatic detection algorithm ,Algorithms ,medicine.medical_specialty ,Lung injury ,Sensitivity and Specificity ,03 medical and health sciences ,Esophagus ,Intensive care ,Intubation, Intratracheal ,medicine ,Humans ,Aged ,business.industry ,Reproducibility of Results ,030208 emergency & critical care medicine ,Respiration, Artificial ,Surgery ,TRACHEAL TUBE PLACEMENT ,Emergency ,Human medicine ,business - Abstract
Background: Unrecognised endotracheal tube misplacement in emergency intubations has a reported incidence of up to 17%. Current detection methods have many limitations restricting their reliability and availability in these circumstances.There is therefore a clinical need for a device that is small enough to be practical in emergency situations and that can detect oesophageal intubation within seconds. In a first reported evaluation, we demonstrated an algorithm based on pressure waveform analysis, able to determine tube location with high reliability in healthy patients.The aim of this study was to validate the specificity of the algorithm in patients with abnormal pulmonary compliance, and to demonstrate the reliability of a newly developed small device that incorporates the technology.Materials and methods: Intubated patients with mild to moderate lung injury, admitted to intensive care were included in the study. The device was connected to the endotracheal tube, and three test ventilations were performed in each patient. All diagnostic data were recorded on PC for subsequent specificity/sensitivity analysis.Results and discussion: A total of 105 ventilations in 35 patients with lung injury were analysed. With the threshold D-value of 0.1, the system showed a 100% sensitivity and specificity to diagnose tube location. Conclusion: The algorithm retained its specificity in patients with decreased pulmonary compliance. We also demonstrated the feasibility to integrate sensors and diagnostic hardware in a small, portable hand-held device for convenient use in emergency situations. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.
- Published
- 2016
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16. Effect of mild hypercapnia on outcome and histological injury in a porcine post cardiac arrest model
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Daria De Giorgio, Lidia Staszewsky, Sabina Ceriani, D. De Zani, Roberto Latini, Serge Masson, A. Boccardo, Davide Pravettoni, Giuseppe Ristagno, Giovanni Babini, Marcella De Maglie, Angelo Belloli, Roberta Affatato, Markus B. Skrifvars, Eugenio Scanziani, Deborah Novelli, Department of Diagnostics and Therapeutics, University of Helsinki, Clinicum, Anestesiologian yksikkö, HUS Perioperative, Intensive Care and Pain Medicine, and HUS Emergency Medicine and Services
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Resuscitation ,ARTERIAL CARBON-DIOXIDE ,ATELECTASIS ,Survival ,IMPACT ,Swine ,medicine.medical_treatment ,Hemodynamics ,030204 cardiovascular system & hematology ,Emergency Nursing ,Hypercapnia ,0302 clinical medicine ,RESUSCITATION ,ASSOCIATION ,Neuroprotection ,ISCHEMIA ,Neurological outcome ,Emergency Medicine ,Breathing ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,CLINICAL-RELEVANCE ,Defibrillation ,METABOLISM ,03 medical and health sciences ,Internal medicine ,medicine ,Animals ,Arterial Pressure ,Cardiopulmonary resuscitation ,business.industry ,030208 emergency & critical care medicine ,Recovery of Function ,Carbon Dioxide ,medicine.disease ,3126 Surgery, anesthesiology, intensive care, radiology ,Respiration, Artificial ,Survival Analysis ,Ventilation ,Cardiopulmonary Resuscitation ,Heart Arrest ,Disease Models, Animal ,Blood pressure ,Ventricular fibrillation ,CEREBRAL-BLOOD-FLOW ,Post cardiac arrest ,Blood Gas Analysis ,business ,CARDIOPULMONARY - Abstract
Aim of the study: To evaluate in an established porcine post cardiac arrest model the effect of a mild hypercapnic ventilatory strategy on outcome. Methods: The left anterior descending coronary artery was occluded in 14 pigs and ventricular fibrillation induced and left untreated for 12 min. Cardiopulmonary resuscitation was performed for 5 min prior to defibrillation. After resuscitation, pigs were assigned to either normocapnic (end-tidal carbon dioxide (EtCO2) target: 35-40 mmHg) or hypercapnic ventilation (EtCO2 45-50 mmHg). Hemodynamics was invasively measured and EtCO2 was monitored with an infrared capnometer. Blood gas analysis, serum neuron-specific enolase (NSE) and high sensitive cardiac troponin T (hs-cTnT) were assessed. Survival and functional recovery were evaluated up to 96 h. Results: Twelve pigs were successfully resuscitated and eight survived up to 96 h, with animals in the hypercapnic group showing trend towards a longer survival. EtCO2 and arterial partial pressure of CO2 were higher in the hypercapnic group compared to the normocapnic one (p
- Published
- 2018
17. Chest compressions during ventilation in out-of-hospital cardiac arrest cause reversed airflow
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Said Hachimi-Idrissi, Christophe Duchatelet, Koenraad G. Monsieurs, Alain Kalmar, Emergency Medicine, Supporting clinical sciences, and Research Group Critical Care and Cerebral Resuscitation
- Subjects
Male ,Resuscitation ,Heart Massage/methods ,medicine.medical_treatment ,Airflow ,Respiration, Artificial/methods ,Heart Massage ,030204 cardiovascular system & hematology ,Emergency Nursing ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Intubation, Intratracheal ,Pressure ,Medicine ,Humans ,Cardiopulmonary resuscitation ,Lead (electronics) ,Tidal volume ,Airway Resistance/physiology ,Out-of-Hospital Cardiac Arrest/physiopathology ,Pulmonary Ventilation/physiology ,business.industry ,Airway Resistance ,Basic life support ,030208 emergency & critical care medicine ,Respiration, Artificial ,Cardiopulmonary Resuscitation ,Trachea/physiopathology ,Trachea ,Anesthesia ,Ventilation (architecture) ,Emergency Medicine ,Female ,Human medicine ,Cardiopulmonary Resuscitation/methods ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Ventilation ,Respiratory minute volume ,Out-of-Hospital Cardiac Arrest - Abstract
Aim During cardiopulmonary resuscitation, once the patient is intubated, compressions and ventilations are performed simultaneously. Chest compressions during the inspiratory phase of ventilation may force air out of the lungs, causing so-called “reversed airflow”, which may lead to ineffective ventilation. The purpose of this study is to determine the occurrence of this phenomenon and to quantify the volume of reversed airflow. Methods Observational study. During manual ventilation of intubated patients receiving chest compressions, the pressure gradient over the endotracheal tube was measured using two air-filled catheters connected to a custom-made portable device. Chest compression data were measured using an accelerometer on a Zoll E- series defibrillator. All data are reported as mean (standard deviation; range). Results Twenty-five patients and a total of 368 ventilations were studied, on average 15 (6; 10–30) per patient. The mean tidal volume, minute volume and ventilation rate were respectively 690 ml (160; 240–1260), 10.5 l/min (4.8; 4.4–22.1) and 18/min (6; 6–35). Reversed airflow was observed in 21/25 patients (84%) and in 65% of all ventilations, with on average two episodes per ventilation. Fifty-five percent of the chest compressions during the inspiratory phase of the ventilation generated reversed airflow. The mean volume of the reversed airflow was 96 ml per episode (52; 12–364). Conclusion Chest compressions during ventilation in intubated patients generated reversed airflow in most patients. There was wide variation in the number of episodes and volume of the reversed airflow between patients. The effect of this phenomenon on the efficacy of ventilation during resuscitation and on outcome needs further investigation.
- Published
- 2017
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