Adjunctive Therapy

In nine patients with neuromuscular disease receiving mechanical ventilation through a cuffless tracheostomy, Prigent and coworkers compared the effect of assist-control ventilation and bilevel positive-pressure ventilation (pressure support and PEEP) on speech production. At rest, breathing pattern was equivalent with the two modes. Speech was accompanied by a 20% increase in inspiratory time during bilevel ventilation but not during assist-control ventilation. The volume released by the ventilator during speech was greater with bilevel ventilation than during assist-control ventilation: 172 versus 26 ml. The maximum duration of speech (as a fraction of a respiratory cycle) was greater with bilevel ventilation than with assist-control ventilation: 74 versus 39%. Speech continued into expiration with bilevel ventilation and three patients were able to speak continuously during several respiratory cycles. Comfort during speech was greater with bilevel ventilation. The authors conclude that the duration of speech during a respiratory cycle was greater during bilevel positive-pressure ventilation (pressure support and PEEP) than during assist-control ventilation. An editorial commentary by Hoit and Banzett accompanies this article.

In nine patients with acute lung injury, Maggiore and coworkers studied the fall in end-expiratory lung volume (derecruitment) during endotracheal suctioning. Suctioning performed after disconnection from the ventilator produced a decrease in lung volume of 1,466 ml. The decrease in lung volume during suctioning after disconnection from the ventilator resulted almost equally from simple disconnection (728 ml) and application of negative pressure (737 ml). The decrease in lung volume was less when suctioning was performed via a catheter introduced through the swivel adaptor of the catheter mount (733 ml) or with use of a closed suctioning system (531 ml). The decrease in lung volume during suctioning was no longer statistically significant when pressure support produced peak inspiratory pressures of 40 cm H₂O during suctioning through the swivel (168 ml) or a closed system (284 ml). Oxygenation paralleled the changes in lung volumes. The authors conclude that endotracheal suctioning decreases end-expiratory lung volume in patients with acute lung injury, and that the decreases can be minimized by avoiding disconnection from the ventilator and through the use of a closed-suction system.

During bench application of modern ventilators, Miller and coworkers investigated the key variables affecting aerosol delivery and also assessed the relationship between bench predictions and in vivo end points in patients. With the bench studies, inhaled mass (percentage of nebulizer charge) ranged between 5.7% and 37.4%, and breath-activated nebulization and humidity were found to be the most important determinants of aerosol delivery. In patients, levels of deposited antibiotics in sputum of patients ranged from 1.1 to 19.6 µg per ml per mg, and the level correlated with predictions from the bench model. The authors conclude that bench models of aerosol delivery during mechanical ventilation can predict the delivery of aerosols in intubated patients. An editorial commentary by Dhand accompanies this article.

Inhalation of nitric oxide has been advocated as a method to prevent ischemia–reperfusion injury after lung transplantation. Meade and coworkers did a randomized controlled trial of inhaled nitric oxide (22 ppm) versus placebo in 83 patients, initiated 10 minutes after reperfusion. PO₂/FI_O₂ was equivalent in the nitric oxide and placebo groups (361 versus 351) on admission to the ICU. Severe hypoxemia (PO₂/FI_O₂ less than 150) taken as an index of severe reperfusion injury, was present in 14.6% of the nitric oxide group and 9.5% of the control group. The nitric oxide and placebo groups had equivalent times to first trial of spontaneous breathing (medians of 25 versus 27 hours), successful extubation (32 versus 34 hours), ICU discharge (3 days for both), and hospital discharge (27 versus 29 days). Five patients in the nitric oxide and six in the placebo group died in the hospital. The authors conclude that inhaled nitric oxide shortly after reperfusion does not alter clinical outcome in patients undergoing lung transplantation. An editorial commentary by Glanville accompanies this article.

Citations 1-7 of 7 total displayed.

Aerosol Therapy during Mechanical Ventilation: Getting Ready for Prime Time

Rajiv Dhand
Am. J. Respir. Crit. Care Med. 168: 1148-1149. [Full text]

Aerosol Delivery and Modern Mechanical Ventilation: In Vitro/In Vivo Evaluation

Dorisanne D. Miller, Mohammad M. Amin, Lucy B. Palmer, Akbar R. Shah, and Gerald C. Smaldone
Am. J. Respir. Crit. Care Med. 168: 1205 -1209. First published online as doi:10.1164/rccm.200210-1167OC [Abstract] [Full text]

Inhaled Nitric Oxide after Lung Transplantation: No More Cosmesis?

Allan R. Glanville
Am. J. Respir. Crit. Care Med. 167: 1463-1464. [Full text]

A Randomized Trial of Inhaled Nitric Oxide to Prevent Ischemia–Reperfusion Injury after Lung Transplantation

Maureen O. Meade, John T. Granton, Andrea Matte-Martyn, Karen McRae, Bruce Weaver, Paula Cripps, and Shaf H. Keshavjee
Am. J. Respir. Crit. Care Med. 167: 1483-1489. [Abstract] [Full text]

Prevention of Endotracheal Suctioning-induced Alveolar Derecruitment in Acute Lung Injury

Salvatore M. Maggiore, François Lellouche, Jérôme Pigeot, Solenne Taille, Nicolas Deye, Xavier Durrmeyer, Jean-Christophe Richard, Jordi Mancebo, François Lemaire, and Laurent Brochard
Am. J. Respir. Crit. Care Med. 167: 1215 -1224. First published online as doi:10.1164/rccm.200203-195OC [Abstract] [Full text]

Je Peux Parler!

Jeannette D. Hoit and Robert B. Banzett
Am. J. Respir. Crit. Care Med. 167: 101-102. [Full text]

Comparative Effects of Two Ventilatory Modes on Speech in Tracheostomized Patients with Neuromuscular Disease

Hélène Prigent, Christiane Samuel, Bruno Louis, Marie-France Abinun, Françoise Zerah-Lancner, Michèle Lejaille, Jean-Claude Raphael, and Frédéric Lofaso
Am. J. Respir. Crit. Care Med. 167: 114 -119. First published online as doi:10.1164/rccm.200201-026OC [Abstract] [Full text]

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