A new ventilation inhomogeneity index from multiple breath indicator gas washout tests in mechanically ventilated patients

Huygen, P. E. M.; Gültuna, Ismail; İnce, Can; Zwart, A.; Bogaard, J. M.; Feenstra, B. W. A.; Bruining, H. A.

doi:10.1097/00003246-199308000-00013

Cited by 14 publications

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“…End-expiratory lung volume (VEE) was estimated with use of an open He (4-5 %) wash-in and wash-out technique [ 17]. The compliance of lungs and thorax (C~) was estimated with use of an inspiratory pause method [18].…”

Section: Lung Volume and Compliancementioning

confidence: 99%

A stable model of respiratory distress by small injections of oleic acid in pigs

et al. 1996

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Section: Lung Volume and Compliancementioning

confidence: 99%

A stable model of respiratory distress by small injections of oleic acid in pigs

et al. 1996

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“…Indeed the importance of such measurements have been demonstrated in experimental models of acute lung injury (ALI) where the effects of respiratory movements could be directly observed in exposed mice lungs using dark-field intravital microscopy [ 29 ]. Measurement of these parameters has classically required the quantitative measurement of the washout of inert indicator gases requiring the use of complex mass spectrometry [ 30 ] at the bedside [ 31 ]. More practical measurement of these parameters at the bedside is currently under investigation (e.g., [ 32 ]).…”

Section: Pillar Ii: Organ Functionmentioning

confidence: 99%

Personalized physiological medicine

İnce

2017

Crit Care

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This paper introduces the concept of personalized physiological medicine that is specifically directed at the needs of the critically ill patient. This differs from the conventional view of personalized medicine, characterized by biomarkers and gene profiling, instead focusing on time-variant changes in the pathophysiology and regulation of various organ systems and their cellular and subcellular constituents. I propose that personalized physiological medicine is composed of four pillars relevant to the critically ill patient. Pillar 1 is defined by the frailty and fitness of the patient and their physiological reserve to cope with the stress of critical illness and therapy. Pillar 2 involves monitoring of the key physiological variables of the different organ systems and their response to disease and therapy. Pillar 3 concerns the evaluation of the success of resuscitation by assessment of the hemodynamic coherence between the systemic and microcirculation and parenchyma of the organ systems. Finally, pillar 4 is defined by the integration of the physiological and clinical data into a time-learning adaptive model of the patient to provide feedback about the function of organ systems and to guide and assess the response to disease and therapy. I discuss each pillar and describe the challenges to research and development that will allow the realization of personalized physiological medicine to be practiced at the bedside for critically ill patients.

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“…Although inhomogeneity indexes are often used in pulmonary function labs and improve after application of positive end-expiratory pressure (PEEP) in paediatric anaesthesia, use in the intensive care unit (ICU) is limited by the need of specialized equipment and tracer gases [ 4 , 5 ]. Huygen et al [ 6 , 7 ] and Gültuna et al [ 8 ] worked on the development of inhomogeneity indexes and indicator gas injectors based on SF6 for critically ill patients, but implementation remained difficult due to the need of specialized equipment and gas containers at the bedside [ 6 , 7 ]. The availability of a routine method to quantify inhomogeneous alveolar ventilation at the bedside is expected to help to optimize ventilator settings in individual patients to achieve optimal gas exchange.…”

Section: Introductionmentioning

confidence: 99%

Assessment of ventilation inhomogeneity during mechanical ventilation using a rapid-response oxygen sensor-based oxygen washout method

Bikker

Holland

Specht

et al. 2014

ICMx

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PurposeVentilatory inhomogeneity indexes in critically ill mechanically ventilated patients could be of importance to optimize ventilator settings in order to reduce additional lung injury. The present study compared six inhomogeneity indexes calculated from the oxygen washout curves provided by the rapid oxygen sensor of the LUFU end-expiratory lung volume measurement system.MethodsInhomogeneity was tested in a porcine model before and after induction of acute lung injury (ALI) at four different levels of positive end-expiratory pressure (PEEP; 15, 10, 5 and 0 cm H2O). The following indexes were assessed: lung clearance index (LCI), mixing ratio, Becklake index, multiple breath alveolar mixing inefficiency, moment ratio and pulmonary clearance delay.ResultsLCI, mixing ratio, Becklake index and moment ratio were comparable with previous reported values and showed acceptable variation coefficients at baseline with and without ALI. Moment ratio had the highest precision, as calculated by the variation coefficients. LCI, Becklake index and moment ratio showed comparable increases in inhomogeneity during decremental PEEP steps before and after ALI.ConclusionsThe advantage of the method we introduce is the combined measurement of end-expiratory lung volume (EELV) and inhomogeneity of lung ventilation with the LUFU fast-response medical-grade oxygen sensor, without the need for external tracer gases. This can be combined with conventional breathing systems. The moment ratio and LCI index appeared to be the most favourable for integration with oxygen washout curves as judged by high precision and agreement with previous reported findings. Studies are under way to evaluate the indexes in critically ill patients.

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A new ventilation inhomogeneity index from multiple breath indicator gas washout tests in mechanically ventilated patients

Cited by 14 publications

References 0 publications

A stable model of respiratory distress by small injections of oleic acid in pigs

A stable model of respiratory distress by small injections of oleic acid in pigs

Personalized physiological medicine

Assessment of ventilation inhomogeneity during mechanical ventilation using a rapid-response oxygen sensor-based oxygen washout method

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