• Door Han Franssen
  • In ARDS
  • 2016-01-30 10:54:45

High-frequency percussive ventilation improves oxygenation and ventilation in pediatric patients with acute respiratory failure.

PURPOSE:

High-frequency percussive ventilation (HFPV) in pediatrics has been described predominantly in burned patients. We aimed to describe its effectiveness and safety in noninhalational pediatric acute respiratory failure (ARF).
METHODS:

We conducted an observational study in a tertiary care pediatric intensive care unit on 31 patients with ARF failing conventional ventilation transitioned to HFPV. Demographics, ventilator settings, oxygenation index, oxygen saturation index, oxygen saturation as measured by pulse oximetry/fraction of inspired oxygen (Fio2), and Pao2/Fio2 were recorded before and during HFPV.


  • Door Han Franssen
  • In ARDS
  • 2016-01-30 10:53:15

High frequency percussive ventilation and bronchoscopy during extracorporeal life

Mortality from pediatric respiratory failure treated with extracorporeal life support (ECLS) remains high at 43%.1 Studies evaluating predictors of mortality for pediatric ECLS for respiratory failure have identified patient diagnosis,1-3 presence of co-morbidities,1 pre-ECLS oxygenation,1, 2, 4, 5 and pre-ECLS length of mechanical ventilation1-3, 5, 6 as associated with higher mortality. Stratified analyses have suggested that the effect on mortality is not apparent until pre-ECLS mechanical ventilation exceeds 14 days.1, 5 Prolonged ECLS is associated with poor outcomes.2, 3, 7, 8 Analysis of 1489 pediatric patients with pneumonia in the Extracorporeal Life Support Organization (ELSO) registry between 1985 and 2010 showed predicted mortality decreasing by 1.3% daily until day 14, after which mortality increased by 1.8% per day.2 Separately, ELSO patients between 1993 and 2007 receiving > 21 days of ECLS for respiratory failure had higher mortality (62%) relative to those on for _ 14 days (39%).8 Time on ECLS may be either a marker for illness severity, reversibility of underlying disease, or recoverability of cardiopulmonary function. It is unknown whether therapies aimed at decreasing time on ECLS will improve outcomes. Pulmonary management during ECLS may affect duration of support. Traditional “rest settings” may risk unnecessary atelectasis and derecruitment in the attempt to limit ventilator induced lung injury during ECLS. A single neonatal study suggests that higher levels of positive end-expiratory pressure during ECLS may shorten the duration of extracorporeal support,9 but otherwise there is no literature to guide ventilator management. Additionally, flexible bronchoscopy on ECLS10-12 has been reported to improve pulmonary function leading to reductions of ECLS flows.11, 12 However, the optimal role of bronchoscopy during ECLS is undefined.
Since May, 2011, our pediatric intensive care unit (PICU) has approached ECLS for respiratory failure with a focus on improved secretion clearance and early recruitment. To this end, the initial and predominant mode of ventilation utilized on ECLS was changed to high frequency percussive ventilation (HFPV), which has been well-described in inhalational injury for its ability to safely oxygenate and ventilate, with continuous pneumatically-powered high frequency percussions to facilitate clearance of airway debris.13-16 An increase in therapeutic bronchoscopies was also instituted. The purpose of this study is to compare the outcomes of the patients who underwent HFPV and therapeutic bronchoscopies while on ECLS with a samecenter control population immediately prior to these interventions. We hypothesized that use of HFPV and bronchoscopies were associated with shorter ECLS runs and improved outcomes.


  • Door Han Franssen
  • In ARDS
  • 2016-01-30 10:50:30

Characterization of the mechanical behavior of intrapulmonary percussive ventilation

A new device delivering intrapulmonary percussive ventilation (IPV), called Impulsator® (Percussionaire Corporation, Sandpoint, ID, USA), has recently been introduced in an effort to provide effective clearance and to promote homogeneity of ventilation in the lungs of patients with cystic fibrosis. In order to optimize the treatment based on its use, a better understanding of its functioning is still necessary. In fact, up to now, a complete characterization of this device has not been carried out, thus reducing its effective utilization in clinical practice. With the aim of overcoming this lack, in this study, data concerning flow and pressure delivered during in vitro IPV were acquired under different combinations of device settings and respiratory loads. Quantitative information was obtained about the physical variables administered by the device like percussive frequency, ratio of inspiratory to expiratory time, flow and pressure magnitudes and volume exchanged. The analysis of the data determined the relations among these variables and between them and the mechanical loads, laying the basis for an optimal clinical application of the device.


  • Door Han Franssen
  • In ARDS
  • 2016-01-30 10:49:44

Clearing away pulmonary secretions

Abstract
Excess or retained pulmonary secretions impair ventilation, invite infection, and may threaten survival. Find out who's at greatest risk and how to keep airways clear.
Background: In individuals with cervical spinal cord injury (SCI), respiratory complications arise within hours to days of injury. Paralysis of the respiratory muscles predisposes the patient toward respiratory failure. Respiratory complications after cervical SCI include hypoventilation, hypercapnea, reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Ultimately, the patient must use increased work to breathe, which results in respiratory fatigue and may eventually require intubation for mechanical ventilation. Without specialized respiratory management for individuals with tetraplegia, recurrent pneumonias, bronchoscopies, and difficulty in maintaining a stable respiratory status will persist. Objective: This retrospective analysis examined the effectiveness of specialized respiratory management utilized in a regional SCI center. Methods: Individuals with C1-C4 SCI (N = 24) were the focus of this study as these neurological levels present with the most complicated respiratory status. Results: All of the study patients’ respiratory status improved with the specialized respiratory management administered in the SCI specialty unit. For a majority of these patients, respiratory improvements were noted within 1 week of admission to our SCI unit. Conclusion: Utilization of high tidal volume ventilation, high frequency percussive ventilation, and mechanical insufflation-exsufflation have demonstrated efficacy in stabilizing the respiratory status of these individuals. Optimizing respiratory status enables the patients to participate in rehabilitation therapies, allows for the opportunity to vocalize, and results in fewer days on mechanical ventilation for patients who are weanable.


  • Door Han Franssen
  • In ARDS
  • 2016-01-30 10:48:52

Intrapulmonary effects of setting parameters in portable intrapulmonary percussive ventilation devices.

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:


  • Door Han Franssen
  • In ARDS
  • 2016-01-30 10:47:50

Safety and effect of intermittent intrapulmonary percussive ventilation on oxygen saturation and hemodynamic functions

Intrapulmonary percussive ventilation (IPV) is a ventilatory technique which is used to clear endobronchial secretions in patients. IPV uses a Phasitron, which delivers rapid, high-flow, minibursts of air mixed with oxygen to the patients. We investigated the safety of IPV on hemodynamic values and the effect of IPV on oxygen saturation and respiratory rate.
Methods:
From April until August 2011 we investigated 42 consecutive patients admitted to our eight-bed adult general ICU with respiratory failure. Variables such as heart rate, mean arterial pressure, respiratory rate, and oxygen saturation were measured and compared at three different time points: before starting IPV therapy, directly after and 15 minutes later. All patients received IPV using a Bird Intrapulmonary Percussionator Ventilator Model IPV-2C for a period of 20 minutes consisting of two cycles of 10 minutes. After the first 10 minutes of IPV therapy in combination with chest compressions the frequency rate was reduced in order to suction the mobilized secretions. This cycle was then repeated. Statistical analysis was done with SPSS version 17. Student's t test was used to compare values before therapy with directly after and after 15 minutes of therapy. P <0.05 was considered significant.


  • Door Han Franssen
  • In ARDS
  • 2016-01-30 10:46:48

Airway Clearance in COPD: Need for a Breath of Fresh Air? A Systematic Review

Background: Airway clearance is a key component of respiratory physiotherapy management for patients with excess secretions, including patients with chronic obstructive pulmonary disease (COPD). The aim of this review is to give an overview of the available evidence for the use of different airway clearance techniques (ACT) and their effects in patients with COPD. 
Methods: A systematic literature search was performed on CEBAM, PUBMED, Cochrane CT, Science Direct and Biomed central data bases. After screening, a total of 26 articles were included.


  • Door Han Franssen
  • In ARDS
  • 2016-01-30 10:45:06

Safety and efficacy of short-term intrapulmonary percussive ventilation in patients with bronchiectasis.

PURPOSE: 
Intrapulmonary percussive ventilation (IPV) is a high-frequency ventilation modality that can be superimposed on spontaneous breathing. IPV may diminish respiratory muscle loading and help to mobilize secretions. The aim of this prospective study was to assess the short-term effects of IPV in patients at high risk for extubation failure who were receiving preventive non-invasive ventilation (NIV) after extubation.
METHODS: 
Respiratory rate, work of breathing, and gas exchange were evaluated in 17 extubated patients during 20 min of IPV and 20 min of NIV delivered via a facial mask, separated by periods of spontaneous breathing. The pressure-support level during NIV was adjusted until tidal volume reached 6-8 ml/kg and positive end-expiratory pressure (PEEP) 4-5 cmH(2)O. For IPV, the pressurisation frequency was set at 250 cycles/min and driving pressure at 1.2 bar. The pressure-time product of the diaphragm (PTPdi/min) was measured using an oesophageal and gastric double-balloon catheter.