Objective To investigate the effects of continuous tracheal gas insufflation (CTGI) combined with biphasic intermittent positive airway pressure (BIPAP) ventilation on dogs with spontaneous breathing. Methods Eight ...Objective To investigate the effects of continuous tracheal gas insufflation (CTGI) combined with biphasic intermittent positive airway pressure (BIPAP) ventilation on dogs with spontaneous breathing. Methods Eight canine models with oleic acid induced lung injury and spontaneous breathing were ventilated in a random order by Evita 2 (Drager Inc., Germany) in modes of BIPAP (BIPAP group) and BIPAP with CTGI flow rate of 3, 6 and 9?L/min (T3, T6 and T9 groups), respectively. The setting parameters of BIPAP were fiction of inspired oxygen 60%, inspiratory to expiratory ratio 1∶1, respiratory rate 20 and positive end expiratory pressure 5?cm?H2O. Arterial and mixed venous blood gas, lung mechanics, systemic and pulmonary hemodynamics status were monitored at the same level of PaCO2 obtained by adjusting peak inspiratory pressure of BIPAP. Results Peak inspiratory pressure in the T6 group (14±4?cm?H2O) and in the T9 group (11±3?cm?H2O) were significantly lower than that of BIPAP (20±5?cm?H2O, P<0.01), but there was no significant difference among the T3, T6 and T9 groups or between the T3 and BIPAP groups. PaO2, mean artery blood pressure, mean pulmonary artery pressure, pulmonary artery wedge pressure, cardiac ouput, oxygen delivery and oxygen consumption all remained unchanged in four different conditions.Conclusions Using BIPAP combined with CTGI does not cause asynchrony between ventilator and spontaneous breathing, but significantly decreases airway pressure with no influence on hemodynamics and oxygenation. Therefore, BIPAP with CTGI may be a useful support technique, especially in cases where the airway pressure should be limited.展开更多
Background/Aims The study aims were to determine the role of inflammation in the pathogenesis of increased intracranial pressure (ICP) in patients with acute liver failure (ALF) and its interplay with cerebral blood f...Background/Aims The study aims were to determine the role of inflammation in the pathogenesis of increased intracranial pressure (ICP) in patients with acute liver failure (ALF) and its interplay with cerebral blood flow (CBF) and ammonia. Methods Twenty one patients with ALF were studied from the time they were ventilated for grade 4 encephalopathy until receiving specific treatment for increased ICP. Depending upon the ICP, the patients were divided into two groups; those that required specific treatment (ICP>20 mmHg, group 1: n=8, ICP: 32 (28-54) mmHg); and those that did not (ICP≤20 mmHg, group 2: n=13, ICP: 15 (10-20) mmHg). Results Inflammatory markers, arterial ammonia and CBF were significantly higher in the group 1 patients. TNF αlevels correlated with CBF (r=0.80). Four patients from group 2 developed surges of increased ICP (32 (15-112) hours from enrolment). These were associated increases in markers of inflammation and TNF α, and an increase in CBF. There was no change in these inflammatory markers, CBF or ICP in the other 9 group 2 patients. Conclusions The results of this study suggest that inflammation plays an important synergistic role in the pathogenesis of increased ICP possibly through its effects on CBF.展开更多
Objective: To compare duration of ventilation to mortality and adverse neurode velopmental outcomes among extremely low birth weight (ELBW; 501-1000 g) infant s. Study design: Retrospective analysis of prospectively c...Objective: To compare duration of ventilation to mortality and adverse neurode velopmental outcomes among extremely low birth weight (ELBW; 501-1000 g) infant s. Study design: Retrospective analysis of prospectively collected data from 536 4 infants with a birthweight of 501 to 1000 g born at National Institute of Chil d Health and Human Development (NICHD)-Neonatal Research Network centers from 1 995 to 1998. The main outcome measures were: survival, duration of mechanical ve ntilation, and neurodevelopmental outcome. Results: Overall survival was 71%. T he median duration of ventilation for survivors was 23 days; 75%were free of me chanical ventilation by 39 days, and 7%were ventilated for ≥60 days. Of those ventilated for ≥60 days, 24%survived without impairment. Of those ventilated f or ≥90 days, only 7%survived without impairment. Of those ventilated ≥120 day s, all survivors were impaired. Conclusions: The prognosis for ELBW with protrac ted ventilation remains grim. The cohort who remain intubated have diminished su rvival and high rates of impairment. Parents of these infants should be informed of changes in prognosis as the time of ventilation increases.展开更多
文摘Objective To investigate the effects of continuous tracheal gas insufflation (CTGI) combined with biphasic intermittent positive airway pressure (BIPAP) ventilation on dogs with spontaneous breathing. Methods Eight canine models with oleic acid induced lung injury and spontaneous breathing were ventilated in a random order by Evita 2 (Drager Inc., Germany) in modes of BIPAP (BIPAP group) and BIPAP with CTGI flow rate of 3, 6 and 9?L/min (T3, T6 and T9 groups), respectively. The setting parameters of BIPAP were fiction of inspired oxygen 60%, inspiratory to expiratory ratio 1∶1, respiratory rate 20 and positive end expiratory pressure 5?cm?H2O. Arterial and mixed venous blood gas, lung mechanics, systemic and pulmonary hemodynamics status were monitored at the same level of PaCO2 obtained by adjusting peak inspiratory pressure of BIPAP. Results Peak inspiratory pressure in the T6 group (14±4?cm?H2O) and in the T9 group (11±3?cm?H2O) were significantly lower than that of BIPAP (20±5?cm?H2O, P<0.01), but there was no significant difference among the T3, T6 and T9 groups or between the T3 and BIPAP groups. PaO2, mean artery blood pressure, mean pulmonary artery pressure, pulmonary artery wedge pressure, cardiac ouput, oxygen delivery and oxygen consumption all remained unchanged in four different conditions.Conclusions Using BIPAP combined with CTGI does not cause asynchrony between ventilator and spontaneous breathing, but significantly decreases airway pressure with no influence on hemodynamics and oxygenation. Therefore, BIPAP with CTGI may be a useful support technique, especially in cases where the airway pressure should be limited.
文摘Background/Aims The study aims were to determine the role of inflammation in the pathogenesis of increased intracranial pressure (ICP) in patients with acute liver failure (ALF) and its interplay with cerebral blood flow (CBF) and ammonia. Methods Twenty one patients with ALF were studied from the time they were ventilated for grade 4 encephalopathy until receiving specific treatment for increased ICP. Depending upon the ICP, the patients were divided into two groups; those that required specific treatment (ICP>20 mmHg, group 1: n=8, ICP: 32 (28-54) mmHg); and those that did not (ICP≤20 mmHg, group 2: n=13, ICP: 15 (10-20) mmHg). Results Inflammatory markers, arterial ammonia and CBF were significantly higher in the group 1 patients. TNF αlevels correlated with CBF (r=0.80). Four patients from group 2 developed surges of increased ICP (32 (15-112) hours from enrolment). These were associated increases in markers of inflammation and TNF α, and an increase in CBF. There was no change in these inflammatory markers, CBF or ICP in the other 9 group 2 patients. Conclusions The results of this study suggest that inflammation plays an important synergistic role in the pathogenesis of increased ICP possibly through its effects on CBF.
文摘Objective: To compare duration of ventilation to mortality and adverse neurode velopmental outcomes among extremely low birth weight (ELBW; 501-1000 g) infant s. Study design: Retrospective analysis of prospectively collected data from 536 4 infants with a birthweight of 501 to 1000 g born at National Institute of Chil d Health and Human Development (NICHD)-Neonatal Research Network centers from 1 995 to 1998. The main outcome measures were: survival, duration of mechanical ve ntilation, and neurodevelopmental outcome. Results: Overall survival was 71%. T he median duration of ventilation for survivors was 23 days; 75%were free of me chanical ventilation by 39 days, and 7%were ventilated for ≥60 days. Of those ventilated for ≥60 days, 24%survived without impairment. Of those ventilated f or ≥90 days, only 7%survived without impairment. Of those ventilated ≥120 day s, all survivors were impaired. Conclusions: The prognosis for ELBW with protrac ted ventilation remains grim. The cohort who remain intubated have diminished su rvival and high rates of impairment. Parents of these infants should be informed of changes in prognosis as the time of ventilation increases.
