Biomedical subjects

Belen Cabello

Publications and source records attributed to Belen Cabello.

5 recordsLinked to original sources

PubMed2007

Mechanical ventilation: let us minimize sleep disturbances.

PURPOSE OF REVIEW: This review provides a background in mechanical ventilation and sleep. RECENT FINDINGS: Sleep pattern in mechanically ventilated patients differs largely from physiological sleep. The ventilatory mode and the ventilatory settings could have an influence on the sleep quality and quantity. Pressure support ventilation can increase the sleep fragmentation and decrease the sleep quantity, due to central apneas when compared with assist control ventilation. An excessive level of ventilatory assistance during sleep promotes central apneas and ineffective efforts. These two respiratory events can trigger arousals and awakenings, thus altering the sleep quality and quantity in mechanically ventilated patients. Ventilatory settings adjusted according to the patient's effort during pressure support allow reducing the number of ineffective efforts and improve sleep quality when compared with a clinical adjustment. A physiological approach to set the ventilator and the ventilatory mode may improve sleep quality and quantity. SUMMARY: Minimizing the sleep alterations in mechanically ventilated patients could be obtained by setting the ventilator in such a way to avoid hyperventilation during the sleep stage. The impact of sleep derangements in patient outcomes is, however, unknown.

Humans↗

PubMed2006

Patient-ventilator asynchrony during assisted mechanical ventilation.

OBJECTIVE: The incidence, pathophysiology, and consequences of patient-ventilator asynchrony are poorly known. We assessed the incidence of patient-ventilator asynchrony during assisted mechanical ventilation and we identified associated factors. METHODS: Sixty-two consecutive patients requiring mechanical ventilation for more than 24 h were included prospectively as soon as they triggered all ventilator breaths: assist-control ventilation (ACV) in 11 and pressure-support ventilation (PSV) in 51. MEASUREMENTS: Gross asynchrony detected visually on 30-min recordings of flow and airway pressure was quantified using an asynchrony index. RESULTS: Fifteen patients (24%) had an asynchrony index greater than 10% of respiratory efforts. Ineffective triggering and double-triggering were the two main asynchrony patterns. Asynchrony existed during both ACV and PSV, with a median number of episodes per patient of 72 (range 13-215) vs. 16 (4-47) in 30 min, respectively (p=0.04). Double-triggering was more common during ACV than during PSV, but no difference was found for ineffective triggering. Ineffective triggering was associated with a less sensitive inspiratory trigger, higher level of pressure support (15 cmH(2)O, IQR 12-16, vs. 17.5, IQR 16-20), higher tidal volume, and higher pH. A high incidence of asynchrony was also associated with a longer duration of mechanical ventilation (7.5 days, IQR 3-20, vs. 25.5, IQR 9.5-42.5). CONCLUSIONS: One-fourth of patients exhibit a high incidence of asynchrony during assisted ventilation. Such a high incidence is associated with a prolonged duration of mechanical ventilation. Patients with frequent ineffective triggering may receive excessive levels of ventilatory support.

Aged↗

PubMed2006

Work of breathing.

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Energy Metabolism↗

PubMed2006

A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation.

RATIONALE AND OBJECTIVES: Duration of weaning from mechanical ventilation may be reduced by the use of a systematic approach. We assessed whether a closed-loop knowledge-based algorithm introduced in a ventilator to act as a computer-driven weaning protocol can improve patient outcomes as compared with usual care. METHODS AND MEASUREMENTS: We conducted a multicenter randomized controlled study with concealed allocation to compare usual care for weaning with computer-driven weaning. The computerized protocol included an automatic gradual reduction in pressure support, automatic performance of spontaneous breathing trials (SBT), and generation of an incentive message when an SBT was successfully passed. One hundred forty-four patients were enrolled before weaning initiation. They were randomly allocated to computer-driven weaning or to physician-controlled weaning according to local guidelines. Weaning duration until successful extubation and total duration of ventilation were the primary endpoints. MAIN RESULTS: Weaning duration was reduced in the computer-driven group from a median of 5 to 3 d (p=0.01) and total duration of mechanical ventilation from 12 to 7.5 d (p=0.003). Reintubation rate did not differ (23 vs. 16%, p=0.40). Computer-driven weaning also decreased median intensive care unit (ICU) stay duration from 15.5 to 12 d (p=0.02) and caused no adverse events. The amount of sedation did not differ between groups. In the usual care group, compliance to recommended modes and to SBT was estimated, respectively, at 96 and 51%. CONCLUSIONS: The specific computer-driven system used in this study can reduce mechanical ventilation duration and ICU length of stay, as compared with a physician-controlled weaning process.

Aged↗

PubMed2005

Computer-driven management of prolonged mechanical ventilation and weaning: a pilot study.

OBJECTIVE: To evaluate the ability of a computer-driven system (CDS) to manage pressure-support ventilation over prolonged periods and to predict weaning readiness compared to intensivists. The system continuously adapts pressure support, gradually decreases ventilatory assistance when possible, and indicates weaning readiness. DESIGN AND SETTING: A two-center, prospective, open, clinical, pilot study in medical ICUs of two university hospitals. PATIENTS AND PARTICIPANTS: 42 consecutive mechanically ventilated patients (60+/-14 years, SAPS II 39+/-15), 9 of whom were excluded. INTERVENTIONS: As soon as patients could tolerate pressure support, they were ventilated with the CDS. The times of weaning readiness determined by the intensivists and CDS were compared. MEASUREMENTS AND RESULTS: Weaning was successful in 25 patients and failed in 7; unplanned extubation occurred in 1 patient. Time on CDS ventilation was 3+/-3 days (maximum, 12 days). The CDS detected weaning readiness earlier than the intensivists in 17 patients, and intensivists earlier than the CDS in 4; in 11 patients detection times coincided. CONCLUSIONS: A CDS was successful in fully managing pressure-support ventilation over prolonged periods and often proposed weaning readiness earlier than the intensivists did. Use of this CDS may reduce the duration of mechanical ventilation.

Adult↗