Removal of Bronchial Secretions by Two-Phase Gas-Liquid Transport

Benjamin, Robert; Chapman, G. A.; Kim, Chong S.; Sackner, Marvin A.

doi:10.1378/chest.95.3.658

Cited by 65 publications

(53 citation statements)

References 8 publications

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“…They found that mucus transport speed linearly increased with increasing E/I flow ratio. In an in vivo study, Benjamin et al 20 instilled mucus into the bronchi of mechanically ventilated anesthetized sheep. In this study, they compared inverse I/E time ratios (inspiratory greater than expiratory time) at 1.9/1 and 3/1 versus a conventional I/E time ratio set at 1/2.7.…”

Section: Expiratory-inspiratory Flow Ratiomentioning

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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Section: Expiratory-inspiratory Flow Ratiomentioning

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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“…Furthermore, mucus thicker than the simulated mucus used by Volpe et al would presumably require a flow of more than 17 L/min to move the mucus in either direction. Conversely, the 10% threshold proposed by Benjamin et al 7 and Kim et al 8 pertains to a broader range of simulated experimental conditions and may thus be more generalizable to clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Mucus depth has to occupy at least 10% of the airway diameter in the large airways in order for 2-phase gas/liquid flow to occur. 7,11 In the majority of patients, especially those with normal mucus production or good cough, the effect of ventilator flow bias may be clinically unimportant or negligible. However, in patients with mucus hypersecretion and inadequate airway defense mechanisms, prolonged ventilation with an inspiratory flow bias may embed mucus and cause serious respiratory complications.…”

Section: Discussionmentioning

confidence: 99%

“…Studies in animal and lung models have consistently demonstrated that inspiratory or expiratory flow bias can result in net migration of mucus in the direction of the flow bias. [7][8][9] To move mucus cephalad so that it may be easily removed by suctioning or cough, an overall expiratory flow bias must exist. By contrast, net caudad mucus migration over many consecutive hours of mechanical ventilation may result in important clinical consequences for vulnerable patients.…”

Section: Introductionmentioning

confidence: 99%

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Do Commonly Used Ventilator Settings for Mechanically Ventilated Adults Have the Potential to Embed Secretions or Promote Clearance?

2011

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“…4 Conversely, the rapid inspiratory peak flows typically selected for flow-controlled, volume-cycled ventilation, and inherent to the decelerating flow waveforms that accompany pressure control, encourage fluid migration in the opposite direction. 5,6 Patterns of high-frequency ventilation characterized by long inspiratory/expiratory ratios that produce an expiratory flow bias have been associated with mucus transfer toward the airway opening. Efficacy of percussive ventilation in clearing secretions relies on an asymmetric flow profile that favors expiration.…”

Section: Introductionmentioning

confidence: 99%

Ventilator-Associated Problems Related to Obstructive Lung DiseaseDiscussion

Marini

2013

Respir Care

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SummaryRelatively little attention has been directed toward damage inflicted upon the airway network that connects the alveoli, or toward the problems caused by invasive ventilation for patients with severe airflow obstruction. Mechanical ventilation with positive pressure can cause non-edematous barotrauma, inflict airway injury, and promote lung remodeling. Interactions between patient and ventilator, largely mediated through dynamic hyperinflation, include functional consequences for hemodynamics, respiratory muscle function, breathing work load, and patient-ventilator synchrony. Awareness of such associations not only helps to avoid complications during and after the critical phase of obstructive illness, but also opens a window to improved patient comfort and safety. The purpose of this review is to survey the range of structural damages and functional impairments that occur in an "obstructive" context.

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Removal of Bronchial Secretions by Two-Phase Gas-Liquid Transport

Cited by 65 publications

References 8 publications

Intrapulmonary Effects of Setting Parameters in Portable Intrapulmonary Percussive Ventilation Devices

Intrapulmonary Effects of Setting Parameters in Portable Intrapulmonary Percussive Ventilation Devices

Do Commonly Used Ventilator Settings for Mechanically Ventilated Adults Have the Potential to Embed Secretions or Promote Clearance?

Ventilator-Associated Problems Related to Obstructive Lung DiseaseDiscussion

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