High-frequency percussive ventilation and low tidal volume ventilation in burns: A randomized controlled trial*

Chung, Kevin K.; Wolf, Steven E.; Renz, Evan M.; Allan, Patrick F.; Aden, James K; Merrill, Gerald A.; Shelhamer, Mehdi C.; King, Booker T.; White, Christopher E.; Bell, David; Schwacha, Martin G.; Wanek, Sandra M.; Wade, Charles E.; Holcomb, John B.; Blackbourne, Lorne H.; Cancio, Leopoldo C.

doi:10.1097/ccm.0b013e3181eb9d0b

Cited by 111 publications

(73 citation statements)

References 37 publications

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“…[41][42][43] Th eoretically, APRV should minimize the primary physiologic mechanisms of VILI by maintaining an "open lung, " resulting in homogeneous lung ventilation. In addition, APRV gradually infl ates or "nudges" the lung open, which minimizes the tissue damage associated with aggressive recruitment maneuvers.…”

Section: Airway Pressure Release Ventilationmentioning

confidence: 99%

RETRACTED: Mechanical Ventilation as a Therapeutic Tool to Reduce ARDS Incidence

Nieman

Gatto

Bates

et al. 2015

Chest

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Section: Airway Pressure Release Ventilationmentioning

confidence: 99%

RETRACTED: Mechanical Ventilation as a Therapeutic Tool to Reduce ARDS Incidence

Nieman

Gatto

Bates

et al. 2015

Chest

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“…IPV may be delivered via a face mask, a mouthpiece, an endotracheal tube, or a tracheostomy. Recent reports have suggested that IPV facilitates airway clearance and improves homogeneity of ventilation in patients with cystic fibrosis, [1][2][3][4][5] in patients with neuromuscular disorders with retention of mucus, 6,7 in patients with atelectasis, 8 -10 in burned patients with inhalation injury, [11][12][13] and in patients with COPD. 14 -17 Despite potential benefits related to the use of IPV therapy, the impact of setting parameters such as the ratio of inspiratory to expiratory time, the pressure, and the frequency on the mechanical effects produced by IPV devices is totally unknown.…”

Section: Introductionmentioning

confidence: 99%

Intrapulmonary Effects of Setting Parameters in Portable Intrapulmonary Percussive Ventilation Devices

Toussaint¹,

Guillet²,

Paternotte³

et al. 2012

Respir Care

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BACKGROUND: Despite potential benefits of intrapulmonary percussive ventilation (IPV) in various respiratory diseases, the impact of setting parameters on the mechanical effects produced by IPV in the lungs is unknown. We hypothesized that changing the parameters on IPV would modulate these effects. This in vitro study aimed at comparing the changes in intrapulmonary effects resulting from changes in parameters in 3 portable IPV devices (IMP2, Impulsator, and Pegaso). METHODS: Parameters were set in 72 combinations of frequency (90 -250 cycles/min), inspiratory to expiratory (I/E) time ratio (from 1/2 to 3/1), and pressure (10 -60 cm H 2 O). Four resulting effects were recorded on a test lung via a pneumotachometer: the expiratory to inspiratory flow ratio (E/I flow ratio), the PEEP, the ventilation, and the percussion. Percussion was assessed by the end-slope of the pressure curve. Analysis of variance was used for data analysis. RESULTS: E/I flow ratio increased with increasing I/E time ratio (P < .001). The Pegaso produced the lowest E/I flow ratio. PEEP raised 6 cm H 2 O in both IMP2 and Impulsator, and 17 cm H 2 O in the Pegaso with increasing frequency (P < .01), pressure, and I/E time ratio (P < .001). In all devices, ventilation increased with increasing pressure and decreasing frequency (P < .001). Percussion increased with increasing frequency and decreasing I/E time ratio (P < .001), and with increasing pressure when I/E time ratio was 1/1 or less. The Pegaso provided the poorest percussion. CON-CLUSIONS: This study suggests that changing the parameters considerably modulates the mechanical effects produced by portable IPV devices in the lungs. Increasing frequency increased PEEP and percussion, but decreased ventilation. Increasing I/E time increased PEEP and E/I flow ratio, and decreased percussion. Finally, increasing pressure increased PEEP and ventilation. The Pegaso produced the highest PEEP, least percussion, and smallest change in E/I flow ratio.

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“…Despite the theoretical advantages of IPV for enhanced secretion clearance, and the positive results of the aforementioned studies, another randomized trial comparing IPV to either conventional or lung-protective ventilation did not find significant differences in infectious complications, at least in patients with thermal injuries. 19 However, secretion clearance was neither monitored nor an end point in these studies.…”

Section: Intrapulmonary Percussive Ventilationmentioning

confidence: 99%

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Kallet

2013

Respir Care

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Mechanically ventilated patients in respiratory failure often require adjunct therapies to address special needs such as inhaled drug delivery to alleviate airway obstruction, treat pulmonary infection, or stabilize gas exchange, or therapies that enhance pulmonary hygiene. These therapies generally are supportive in nature rather than curative. Currently, most lack high-level evidence supporting their routine use. This overview describes the rationale and examines the evidence supporting adjunctive therapies during mechanical ventilation. Both mechanistic and clinical research suggests that intrapulmonary percussive ventilation may enhance pulmonary secretion mobilization and might reverse atelectasis. However, its impact on outcomes such ICU stay is uncertain. The most crucial issue is whether aerosolized antibiotics should be used to treat ventilatorassociated pneumonia, particularly when caused by multi-drug resistant pathogens. There is encouraging evidence from several studies supporting its use, at least in individual cases of pneumonia non-responsive to systemic antibiotic therapy. Inhaled pulmonary vasodilators provide at least short-term improvement in oxygenation and may be useful in stabilizing pulmonary gas exchange in complex management situations. Small uncontrolled studies suggest aerosolized heparin with N-acetylcysteine might break down pulmonary casts and relieve airway obstruction in patients with severe inhalation injury. Similar low-level evidence suggests that heliox is effective in reducing airway pressure and improving ventilation in various forms of lower airway obstruction. These therapies generally are supportive and may facilitate patient management. However, because they have not been shown to improve patient outcomes, it behooves clinicians to use these therapies parsimoniously and to monitor their effectiveness carefully. Key words: high-frequency percussive ventilation; intrapulmonary percussive ventilation; inhaled nitric oxide; aerosolized prostacyclin; aerosolized heparin; metered-dose inhalers; heliox.

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High-frequency percussive ventilation and low tidal volume ventilation in burns: A randomized controlled trial*

Cited by 111 publications

References 37 publications

RETRACTED: Mechanical Ventilation as a Therapeutic Tool to Reduce ARDS Incidence

RETRACTED: Mechanical Ventilation as a Therapeutic Tool to Reduce ARDS Incidence

Intrapulmonary Effects of Setting Parameters in Portable Intrapulmonary Percussive Ventilation Devices

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

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