18 research outputs found
Use of bronchodilators during non-invasive mechanical ventilation
No full textBronchodilators represent one of the most important therapeutic weapons for the treatment of airway obstructive diseases and the inhaled route of administration is very often employed due to the greater drug availability and reduced magnitude of side effects. During acute exhacerbations, it is not unfrequent that the elastic and resistive loads imposed on the ventilatory pump overcome the force sustainable by the respiratory muscles and the patient requires ventilatory assistance, in order to relieve fatigue and to optimize alveolar gas exchange. During these episodes, inhaled bronchodilators, far from being discontinued, sometime must be administered during mechanical ventilation, that, in hypercapnic ventilatory failure can be frequently applied noninvasively with a good rate of success. While in the current literature there are a lot of data about inhaled drug administration during invasive mechanical ventilation, very few data are available on the topic of aerosol therapy during noninvasive mechanical ventilation. With the present paper we want to analyze the rationale, the feasibility and the current data dealing with the administration of inhaled drugs during noninvasive mechanical ventilation
Effect of varying the pressurisation rate during noninvasive pressure support ventilation
No full textThe aim of the study was to assess the effects of varying the pressurisation rate during noninvasive pressure support ventilation on patients' breathing pattern, inspiratory effort, arterial blood gases, tolerance to ventilation and amount of air leakage. A total of 15 chronic obstructive pulmonary disease patients recovering from an acute episode of hypercapnic acute respiratory failure were studied during four randomised trials with different levels of pressurisation rate. No significant changes were observed in breathing pattern and arterial blood gases between the different runs. The pressure time product of the diaphragm, an estimate of its metabolic consumption, was significantly lower with all pressurisation rates than with spontaneous breathing, but was significantly lowest with the fastest rate. However, air leak, assessed by the ratio between expired and inspired tidal volumes, increased and the patients' tolerance of ventilation, measured using a standardised scale, was significantly poorer with the fastest pressurisation rate. In chronic obstructive pulmonary disease patients recovering from an episode of acute hypercapnic respiratory failure and ventilated with noninvasive pressure support ventilation, different pressurisation rates resulted in different reductions in the pressure time product of the diaphragm; this reduction was greater with the fastest rate, but was accompanied by significant air leaks and poor tolerance
Non-invasive ventilation in chronic obstructive pulmonary disease patients: Helmet versus facial mask.
No full textRationale: The helmet is a new interface with the potential of increasing the success rate of non-invasive ventilation by improving tolerance. Objectives: To perform a physiological comparison between the helmet and the conventional facial mask in delivering non-invasive ventilation in hypercapnic patients with chronic obstructive pulmonary disease. Methods: Prospective, controlled, randomized study with cross-over design. In 10 patients we evaluated gas exchange, inspiratory effort, patient-ventilator synchrony and patient tolerance after 30 min of non-invasive ventilation delivered either by helmet or facial mask; both trials were preceded by periods of spontaneous unassisted breathing. Measurements: Arterial blood gases, inspiratory effort, duration of diaphragm contraction and ventilator assistance, effort-to-support delays (at the beginning and at the end of inspiration), number of ineffective efforts, and patient comfort. Main results: Non-invasive ventilation improved gas exchange (p< 0.05) and inspiratory effort (p< 0.01) with both interfaces. The helmet, however, was less efficient than the mask in reducing inspiratory effort (p< 0.05) and worsened the patient-ventilator synchrony, as indicated by the longer delays to trigger on (p< 0.05) and cycle off (p< 0.05) the mechanical assistance and by the number of ineffective efforts (p< 0.005). Patient comfort was no different with the two interfaces. Conclusions: Helmet and facial mask were equally tolerated and both were effective in ameliorating gas exchange and decreasing inspiratory effort. The helmet, however, was less efficient in decreasing inspiratory effort and worsened the patient-ventilator interaction
Drifting space: the case of Athens
No full textMotivation for this project was the current refugee crisis in Europe, although it is a fact that it extents to long ignored issue of immigration in Europe. Many studies are researching the political, economic and social aspects of migration neglecting the spatial dimension. However immigrants regardless of their background or their final destination occupy space in the urban fabric. The communities of immigrants face the continuous pressure of segregation while the urban fabric changes due to their agglomeration. The latter fail to support immigrants’ needs while at the same time conflict between them and locals arise. This research, started with an international comparison between three case studies (Athens, Paris, Stockholm) and then a deeper understanding of the socio-spatial phenomena in the case of Athens. Main focus is the relationship between the urban structures and the daily systems of locals and immigrants and the mitigation of the frictions that exist between them in a local level. The final product, located in the municipality of Athens, is composed by strategic actions and flexible urban structures that can adapt to the new circumstances while providing ways for alleviating the social and structural decay. It is a localized, actor based strategy that can help in the integration of immigrants and the development of the municipality of Athens.Architecture and The Built EnvironmentUrbanis
Physiological rationale of noninvasive mechanical ventilation use in acute respiratory failure
No full textNon-invasive ventilation in chronic obstructive pulmonary disease patients:helmet versus facial mask
No full textRATIONALE: The helmet is a new interface with the potential of increasing the success rate of non-invasive ventilation by improving tolerance. OBJECTIVES: To perform a physiological comparison between the helmet and the conventional facial mask in delivering non-invasive ventilation in hypercapnic patients with chronic obstructive pulmonary disease. METHODS: Prospective, controlled, randomized study with cross-over design. In 10[Symbol: see text]patients we evaluated gas exchange, inspiratory effort, patient-ventilator synchrony and patient tolerance after 30[Symbol: see text]min of non-invasive ventilation delivered either by helmet or facial mask; both trials were preceded by periods of spontaneous unassisted breathing. MEASUREMENTS: Arterial blood gases, inspiratory effort, duration of diaphragm contraction and ventilator assistance, effort-to-support delays (at the beginning and at the end of inspiration), number of ineffective efforts, and patient comfort. MAIN RESULTS: Non-invasive ventilation improved gas exchange (p<[Symbol: see text]0.05) and inspiratory effort (p<[Symbol: see text]0.01) with both interfaces. The helmet, however, was less efficient than the mask in reducing inspiratory effort (p<[Symbol: see text]0.05) and worsened the patient-ventilator synchrony, as indicated by the longer delays to trigger on (p<[Symbol: see text]0.05) and cycle off (p<[Symbol: see text]0.05) the mechanical assistance and by the number of ineffective efforts (p<[Symbol: see text]0.005). Patient comfort was no different with the two interfaces. CONCLUSIONS: Helmet and facial mask were equally tolerated and both were effective in ameliorating gas exchange and decreasing inspiratory effort. The helmet, however, was less efficient in decreasing inspiratory effort and worsened the patient-ventilator interaction.N/
Influence of respiratory efforts on b2-agonist induced bronchodilation in mechanically ventilated COPD patients: A prospective clinical study
No full textSummaryBackgroundSeveral in vitro studies have shown that at similar tidal volume (VT), bronchodilator delivery to target sites is significantly lower during controlled mechanical ventilation (CMV) than that during simulated spontaneous breathing. However, the influence of active respiratory efforts on the magnitude of b2-agonist induced bronchodilation in mechanically ventilated patients has not been examined.ObjectiveTo examine the influence of controlled and assisted modes of ventilatory support on the bronchodilative effect induced by b2-agonists administered with a metered dose inhaler (MDI) and a spacer device in a homogeneous group of mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).MethodsProspective clinical study. Ten mechanically ventilated patients with acute exacerbation of COPD were prospectively randomized to receive 4 puffs of salbutamol (S, 100μg/puff) either with volume-controlled (VC) or pressure-support (PS) ventilation. On PS the pressure level was such that VT was comparable between ventilatory modes. After a 6-h washout period, patients were crossed-over to receive the drug by the alternative mode of ventilation. Static and dynamic airway pressures, minimum (Rint) and maximum (Rrs) inspiratory resistance, the difference between Rrs and Rint (ΔR), end-inspiratory static compliance of the respiratory system (Crs), intrinsic positive end-expiratory pressure (PEEPi) and heart rate (HR) were measured before and at 15, 30, 60, 120, 180 and 240min after S administration.ResultsS caused a significant decrease in dynamic and static airway pressures, PEEPi, Rint and Rrs. These changes were not influenced by the ventilatory mode and were evident at 15, 30, 60 and 120min after S. HR, Crs and ΔR did not change after S administration.ConclusionsConsidering the use of propofol with its presumed bronchodilative properties as a shortcoming of our study, it is concluded that the magnitude of bronchodilation induced by salbutamol delivered by an MDI and a spacer device in mechanically ventilated COPD patients is not affected by the presence or absence of active respiratory efforts
