Relationship between physiologic deadspace/tidal volume ratio and gas exchange in infants with acute bronchiolitis on invasive mechanical ventilation*

Almeida-Júnior, Armando A.; Silva, Marcos Tadeu Nolasco da; Almeida, Celize Cruz Bresciani; Ribeiro, José Dirceu

doi:10.1097/01.pcc.0000269389.51189.a8

Cited by 27 publications

(24 citation statements)

References 34 publications

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“…A diagnosis of bronchiolitis was confirmed if a patient met the following clinical criteria: history of cough or wheeze and presence of at least two signs of respiratory distress including nasal flaring, tachypnea, subcostal retractions, suprasternal retractions, use of auxiliary muscles, auscultation of lungs with predominance of wheezing or prolonged expiration. Chest x-ray findings were consistent with pulmonary hyperinflation and had absence of lobar consolidation [9]. Mechanical ventilation was initiated at the discretion of the attending physician for hypercapnia, respiratory acidosis, fatigue, or apnea.…”

Section: Methodsmentioning

confidence: 99%

Neurally triggered breaths reduce trigger delay and improve ventilator response times in ventilated infants with bronchiolitis

et al. 2011

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Section: Methodsmentioning

confidence: 99%

Neurally triggered breaths reduce trigger delay and improve ventilator response times in ventilated infants with bronchiolitis

et al. 2011

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“…A CV tem mostrado-se uma alternativa na avaliação de alterações funcionais dos pulmões e sua aplicação em pesquisas clínicas tem tornado-se mais acessível com o desenvolvimento de novas tecnologias. Na população pediátrica, as medidas de espaço morto pela CV vêm sendo estudadas há duas déca-das em pacientes entubados e ventilados [5][6][7][8][9][10] . Em indivíduos respirando espontaneamente, a CV pode ser utilizada na avaliação de muitas doenças, especialmente quando se tratam de pequenas vias aéreas 11 .…”

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Volumetric capnography to detect ventilation inhomogeneity in children and adolescents with controlled persistent asthma

Almeida

Almeida-Júnior²,

Ribeiro³

et al. 2011

J Pediatr (Rio J)

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Objectives: To study changes in the variables of volumetric capnography in children and adolescents with asthma compared with a control group and to investigate their changes with the use of bronchodilators and bronchial provocation test with methacholine. Methods:One hundred and three patients with controlled persistent asthma and 40 healthy volunteers participated in the study. All of them underwent volumetric capnography and spirometry. All asthmatics repeated the tests after bronchodilator use. Among 103 asthma patients, 33 underwent methacholine challenge test, and measures were recorded on three occasions: before and after methacholine and after bronchodilator use. Results:Compared with the control group, asthmatics had an increase in the slope of phase III normalized by tidal volume and decreases in tidal volume, forced expiratory volume in one second, forced vital capacity, rate of obstruction and forced expiratory flow between 25 to 75% of forced vital capacity. After bronchodilator use, there was an increase in spirometric variables, volume of anatomic dead space, and decrease in the slope of phase II normalized by tidal volume, but the slope of phase III normalized by tidal volume did not change. After methacholine, there was an increase in this variable, which decreased after bronchodilator use. Conclusions:The increase in the slope of phase III normalized by tidal volume in asthma patients suggests that these patients have ventilation inhomogeneity in the distal air spaces, which may reflect chronic structural disorders or reversible acute changes seen on the bronchial provocation test.J Pediatr (Rio J). 2011;87(2):163-168: Capnography, spirometry, pediatrics, asthma. ResumoObjetivos: Estudar alterações nas variáveis de capnografia volumétrica em crianças e adolescentes asmáticos comparados com grupocontrole e investigar suas mudanças com o uso do broncodilatador e do teste de broncoprovocação com metacolina. Métodos:Cento e três pacientes com asma persistente controlada e 40 voluntários saudáveis participaram do estudo. Todos realizaram exames de capnografia volumétrica e espirometria. Todos os asmáticos repetiram os exames após uso do broncodilatador. Dos 103 asmáticos, 33 realizaram teste de broncoprovocação com metacolina, e foram registradas as medidas em três momentos: antes e após metacolina e após broncodilatador. Resultados:Comparados ao grupo-controle, os asmáticos apresentaram aumento do slope da fase III normalizado pelo volume corrente e diminuição do volume corrente, do volume expiratório forçado no primeiro segundo, da capacidade vital forçada, do índice de obstrução e do fluxo expiratório forçado entre 25 a 75% da capacidade vital forçada. Após o broncodilatador, houve aumento das variáveis espirométricas, do volume espaço morto anatômico e diminuição do slope da fase II normalizado pelo volume corrente; porém não houve alteração do slope da fase III normalizado pelo volume corrente. Após a metacolina, houve aumento dessa variável, com diminuição após broncodilatador. Conclus...

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“…[2][3][4][5]27 Larger dead space is associated with mortality in children with acute hypoxemic respiratory failure and longer duration of mechanical ventilation in neonates with congenital heart disease. 7,28 Increased alveolar V D can be due to decreased pulmonary perfusion (microvascular thrombosis, low cardiac output, pulmonary hypertension) or alveolar overdistention.…”

Section: Discussionmentioning

confidence: 99%

“…Large dead space in mechanically ventilated children and adults is an indicator of respiratory disease severity and is associated with increased mortality, longer duration of mechanical ventilation, and higher extubation failure rates. [1][2][3][4][5][6][7][8] Optimizing mechanical ventilation settings by minimizing dead space has the potential to improve outcomes in children with respiratory failure. 9,10 Physiologic dead space is composed of both airway dead space and alveolar dead space.…”

Section: Introductionmentioning

confidence: 99%

Monitoring Dead Space in Mechanically Ventilated Children: Volumetric Capnography Versus Time-Based Capnography

et al. 2015

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Relationship between physiologic deadspace/tidal volume ratio and gas exchange in infants with acute bronchiolitis on invasive mechanical ventilation*

Cited by 27 publications

References 34 publications

Neurally triggered breaths reduce trigger delay and improve ventilator response times in ventilated infants with bronchiolitis

Neurally triggered breaths reduce trigger delay and improve ventilator response times in ventilated infants with bronchiolitis

Volumetric capnography to detect ventilation inhomogeneity in children and adolescents with controlled persistent asthma

Monitoring Dead Space in Mechanically Ventilated Children: Volumetric Capnography Versus Time-Based Capnography

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