Continuous on-line measurements of respiratory system, lung and chest wall mechanics during mechanic ventilation

Kárason, Sigurbergur; Søndergaard, Søren; Lundin, S.; Stenqvist, O.

doi:10.1007/s001340101024

Cited by 33 publications

(24 citation statements)

References 33 publications

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“…By excluding inspiratory resistance of the endotracheal tube, measuring intratracheal pressure makes possible the accurate measurement of dynostatic PV curves in dynamic conditions. 19,20 For routine clinical use, a 2-mm intraluminal and air-filled catheter with end-hole should be positioned in the trachea, 2 cm beyond distal tip of the endotracheal tube, 18 and left in place throughout the period of measurement. Before starting automatic measurement of PEEP-induced alveolar recruitment, the clinician selects the different PEEP levels at which alveolar recruitment will be measured (a maximum of 5) according to an ascending PEEP trial, the tidal volume, and the maximal inflation pressure (up to 100 cm H 2 O).…”

Section: Automatic Methods Available On Mechanical Ventilators and Bamentioning

confidence: 99%

Measurement of Alveolar Recruitment at the Bedside: The Beginning of a New Era in Respiratory Monitoring?

et al. 2013

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Section: Automatic Methods Available On Mechanical Ventilators and Bamentioning

confidence: 99%

Measurement of Alveolar Recruitment at the Bedside: The Beginning of a New Era in Respiratory Monitoring?

et al. 2013

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“…The "dynostatic" P/V curve is obtained during a single tidal insufflation by measuring airway pressure at the distal tip of the endotracheal tube [23,24] and calculating alveolar pressure from the dynamic tracheal pressure/volume loop. This breathto-breath determination of P/V curves allows a continuous monitoring of respiratory mechanics without altering respiratory conditions by a nonphysiological manoeuvre [25]. When automatised, this continuous monitoring of "dynostatic" P/V curves appears as a remarkable tool for detecting lung overinflation resulting from increases in PEEP and/or tidal volume [25].…”

Section: Quasistatic Methods Using a Continuous Inflation At Constantmentioning

confidence: 99%

“…This breathto-breath determination of P/V curves allows a continuous monitoring of respiratory mechanics without altering respiratory conditions by a nonphysiological manoeuvre [25]. When automatised, this continuous monitoring of "dynostatic" P/V curves appears as a remarkable tool for detecting lung overinflation resulting from increases in PEEP and/or tidal volume [25].…”

Section: Quasistatic Methods Using a Continuous Inflation At Constantmentioning

confidence: 99%

Pressure/volume curves and lung computed tomography in acute respiratory distress syndrome

Rouby¹,

Lü²,

Vieira³

2003

Eur Respir J

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Pressure/volume curves and lung computed tomography in acute respiratory distress syndrome. J-J. Rouby, Q. Lu, S. Vieira. #ERS Journals Ltd 2003. ABSTRACT: Pressure/volume (P/V) curves can be measured by static methods, constant or sinusoidal flow methods and the dynostatic method that allows a breath-tobreath determination of P/V curves. Recent ventilators are equipped with specific flow generators and software aimed at obtaining P/V curves without disconnecting the patient from the ventilator.The most recent generation of computed tomography scanners allows the quantitative determination of lung aeration, lung volumes (gas and tissue), alveolar recruitment and lung overinflation of the whole lung. In the supine position, the acute respiratory distress syndrome (ARDS) lung is characterised by an increase in lung tissue that predominates in upper lobes and a massive loss of aeration that predominates in lower lobes.In a minority of ARDS patients, the loss of aeration is homogeneously distributed. The overall lung volume of upper lobes is preserved suggesting an alveolar floodinginduced loss of aeration. In contrast, the overall lung volume of lower lobes is reduced because the heart and the abdomen exert an external compression that contributes to the loss of aeration. The P/V curve is a lung recruitment curve and the chord compliance indicates the potential for recruitment. In such patients, alveolar recruitment resulting from positive end-expiratory pressure is not accompanied by lung overinflation.In a majority of acute respiratory distress syndrome patients, upper lobes remain partially or totally aerated despite a marked regional increase in lung tissue. The upper lobes9 overall lung volume is either normal or increased, suggesting that the lung does not collapse under its own weight as generally believed. In lower lobes, the overall lung volume is reduced because the heart and the abdomen exert an external compression that contributes to the loss of aeration. The pressure/volume curve is influenced by the recruitment of poorly and nonaerated lung regions and by the mechanical properties of the part of the lung remaining aerated. In such patients, alveolar recruitment resulting from positive end-expiratory pressure w10 cmH 2 O is preceded and accompanied by lung overinflation. Eur Respir J 2003; 22: Suppl. 42, 27s- Respiratory pressure/volume (P/V) curves can be easily obtained at the bedside in critically ill patients whose lungs are mechanically ventilated. Many ventilators are now equipped with flow generators and software that allow the obtention and the analysis of the P/V curve without disconnecting the patient from mechanical ventilation. Hypothesis and concepts serving for interpreting the P/V curves of patients with acute respiratory distress syndrome (ARDS) have been deeply modified during the past 15 yrs. Initially believed to reflect the mechanical properties of the "baby" lung [1], the P/V curve is now rather considered as a lung recruitment curve [2] which is markedly influenced by the regiona...

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“…Analogue outputs of ventilator monitoring systems are commonly used for clinical and research purposes [27,28] as they allow post processing and storing of data, hard copying of waveforms and loops, and calculation of further parameters, e.g. work of breathing (WOB), which are normally not presented on standard read-out displays of ventilators.…”

Section: Errors On the Estimation Of The Parameters Obtained By Ventimentioning

confidence: 99%

Experimental evaluation of errors in the measurement of respiratory parameters of the newborn performed by a continuous flow neonatal ventilator

Cappa

Sciuto

Silvestri

2006

Journal of Medical Engineering & Technology

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Pulmonary ventilators for intensive care provide information on, among many other patient respiratory parameters, patient resistance, compliance and 'work of breathing' values calculated from pressure and flow data patterns according to a widely utilized algorithm. The effects induced by the breathing circuit and analogue filtering of the ventilator measuring system are experimentally investigated during controlled ventilation. Three main phenomena are observed: (a) errors in calculation of resistance and compliance due to filtering of pressure and flow waveforms; (b) the presence of pressure oscillations at the beginning of inspiration and expiration phases; and (c) the phase shift between pressure and flow waveforms. The experimental evaluation of the measuring system of a neonatal ventilator is then conducted and: (a) a delay in pressure and flow measurement synchronization equal to 22 +/- 2 ms is evaluated; moreover, (b) a difference between the values provided by the ventilator and those measured by the reference experimental setup on respiratory parameters such as the compliance, resistance and work of breathing that lies in the range of 7-16% of reading is observed.

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Continuous on-line measurements of respiratory system, lung and chest wall mechanics during mechanic ventilation

Cited by 33 publications

References 33 publications

Measurement of Alveolar Recruitment at the Bedside: The Beginning of a New Era in Respiratory Monitoring?

Measurement of Alveolar Recruitment at the Bedside: The Beginning of a New Era in Respiratory Monitoring?

Pressure/volume curves and lung computed tomography in acute respiratory distress syndrome

Experimental evaluation of errors in the measurement of respiratory parameters of the newborn performed by a continuous flow neonatal ventilator

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