Valor de la fracción de espacio muerto (Vd/Vt) como predictor de éxito en la extubación

González-Castro, A.; Suárez-Lopez, V.; Gómez-Marcos, V.; González-Fernández, Camilo; Iglesias-Posadilla, D.; Burón-Mediavilla, J.; Rodríguez-Borregán, J.C.; Miñambres, Eduardo; Llorca, Javier

doi:10.1016/j.medin.2011.05.016

Cited by 22 publications

(8 citation statements)

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“…Another probable cause of pulmonary impairment cited by this same author was the respiratory muscle dysfunction, in addition to the reduced lung volume, (22) which would be confirmed in our patients that presented MIP also reduced and may be exacerbated in patients transplanted by the use of immunosuppressive drugs and steroids.…”

Section: Discussionsupporting

confidence: 76%

Success or failure predictive indexes of extubation in renal transplants patients under mechanical ventilation – pilot study

et al. 2020

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Introduction: Currently, chronic kidney disease (CKD) is a major health problem and in the most severe conditions, kidney transplantation is an alternative treatment. However immunosuppression induced these patients to respiratory complications and endotracheal intubation. In order to assist the decision of the best time for weaning and extubation of these patients, there are predictive indexes that should be considered in preliminary assesment. Objective: To check the capacity of predictive indexes for weaning of mechanical ventilation, rapid shallow breathing index (RSBI), oxygenation rate (PaO 2 /FiO 2 ) and maximum inspiratory pressure (MIP) in predicting the success or extubation failure in kidney transplant patients. Methods: This study is a prospective cohort carried out with patients aged over 18, under mechanical ventilation for more than 24 hours. The patients were submitted to the Spontaneous Breathing Test, also the assessment of the Rapid Shallow Breathing Index, oxygenation index (PaO 2 /FiO 2 ), and maximum inspiratory pressure (MIP) and they were observed during 48 hours after to evaluate the success and extubation failure. Results: A total of 106 patients were eligible, and 20 of these were included with mean age of 46.9 ± 3.06 years and 14 of the subjects were male. Three patients showed extubation failure, and needed to have reintubation within the period of 48 hours as considered. Conclusion: The indices to predict weaning of mechanical ventilation, when within the expected normal values, seem to be able to predict extubation, with the exception of MIP that, even in cases of success, showed itself to be at levels lower than the predicted percentage.

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Section: Discussionsupporting

confidence: 76%

Success or failure predictive indexes of extubation in renal transplants patients under mechanical ventilation – pilot study

et al. 2020

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“…Earlier studies have found less ventilation distribution in the near-diaphragm region and more dead space in patients with chronic obstructive pulmonary disease (COPD) [3, 4]. Improving heterogeneous ventilation distribution and decreasing dead space are important during MV in AECOPD patients [3, 4]. …”

Section: Introductionmentioning

confidence: 99%

“…Patients with AECOPD also suffer from increasing dead space and decreasing ventilation efficiency [4]. Over-assistance during PSV may exacerbate this problem [6].…”

Section: Introductionmentioning

confidence: 99%

Effects of neurally adjusted ventilatory assist on air distribution and dead space in patients with acute exacerbation of chronic obstructive pulmonary disease

et al. 2017

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BackgroundNeurally adjusted ventilatory assist (NAVA) could improve patient-ventilator interaction; its effects on ventilation distribution and dead space are still unknown. The aim of this study was to evaluate the effects of varying levels of assist during NAVA and pressure support ventilation (PSV) on ventilation distribution and dead space in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsFifteen mechanically ventilated patients with AECOPD were included in the study. The initial PSV levels were set to 10 cmH2O for 10 min. Thereafter, the ventilator mode was changed to NAVA for another 10 min with the same electrical activity of the diaphragm as during PSV. Furthermore, the ventilation mode was switched between PSV and NAVA every 10 min in the following order: PSV 5 cmH2O; NAVA 50%; PSV 15 cmH2O; and NAVA 150% (relative to the initial NAVA support level). Ventilation distribution in the lung was evaluated in percentages in regions of interest (ROI) of four anteroposterior segments of equal height (ROI1 to ROI4 represents ventral, mid-ventral, mid-dorsal, and dorsal, respectively). Blood gases, ventilation distribution (electrical impedance tomography), diaphragm activity (B-mode ultrasonography), and dead space fraction (PeCO2 and PaCO2) were measured.ResultsThe trigger and cycle delays were lower during NAVA than during PSV. The work of trigger was significantly lower during NAVA compared to PSV. The diaphragm activities based on ultrasonography were higher during NAVA compared to the same support level during PSV. The ventilation distribution in ROI4 increased significantly (P < 0.05) during NAVA compared to PSV (except for a support level of 50%). Similar results were found in ROI3 + 4. NAVA reduced dead space fraction compared to the corresponding support level of PSV.ConclusionsNAVA was superior to PSV in AECOPD for increasing ventilation distribution in ROI4 and reducing dead space.Trial registrationClinicaltrials.gov, NCT02289573. Registered on 12 November 2014.

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“…A VD fraction ≤ 0.5 was associated with 96 % success of extubation. These findings were confirmed in a mixed adult population [ 54 ]. In 77.6 % of successfully extubated patients the VD fraction was <0.5.…”

Section: Others Applications Of Vcapmentioning

confidence: 53%

Volumetric capnography: lessons from the past and current clinical applications

Verscheure

Massion²,

Verschuren

et al. 2016

Crit Care

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Dead space is an important component of ventilation–perfusion abnormalities. Measurement of dead space has diagnostic, prognostic and therapeutic applications. In the intensive care unit (ICU) dead space measurement can be used to guide therapy for patients with acute respiratory distress syndrome (ARDS); in the emergency department it can guide thrombolytic therapy for pulmonary embolism; in peri-operative patients it can indicate the success of recruitment maneuvers. A newly available technique called volumetric capnography (Vcap) allows measurement of physiological and alveolar dead space on a regular basis at the bedside. We discuss the components of dead space, explain important differences between the Bohr and Enghoff approaches, discuss the clinical significance of arterial to end-tidal CO2 gradient and finally summarize potential clinical indications for Vcap measurements in the emergency room, operating room and ICU.

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Valor de la fracción de espacio muerto (Vd/Vt) como predictor de éxito en la extubación

Cited by 22 publications

References 28 publications

Success or failure predictive indexes of extubation in renal transplants patients under mechanical ventilation – pilot study

Success or failure predictive indexes of extubation in renal transplants patients under mechanical ventilation – pilot study

Effects of neurally adjusted ventilatory assist on air distribution and dead space in patients with acute exacerbation of chronic obstructive pulmonary disease

Volumetric capnography: lessons from the past and current clinical applications

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