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At least 397 records · Page 22Linked to original sources
PubMed2006

Ventilator Y-piece pressure compared with intratracheal airway pressure in healthy intubated children.

OBJECTIVE: Compare airway pressure measurements at the ventilator Y-piece of the breathing circuit (P( Y )) to intratracheal pressure measured at the distal end (P( T )) of the endotracheal tube (ETT) during mechanical ventilation and spontaneous breathing of intubated children. METHODS: Thirty children (age range 29 days to 5 years) receiving general anesthesia were intubated with an ETT incorporating a lumen embedded in its sidewall that opened at the distal end to measure P( T ). Peak inflation pressure (PIP) was measured at P( Y ) and P( T ) during positive pressure ventilation. Just before extubation, all measurements were repeated and imposed resistive work of breathing (WOBi) was calculated at both sites while breathing spontaneously. RESULTS: Average PIP was approximately 25% greater at P( Y ) (19.7 +/- 3.4 cm H(2)O) vs. P( T ) (15.0 +/- 2.9 cm H(2)O), p < 0.01. During spontaneous inhalation P( T ) was 59% lower ({bond}8.5 +/- 4.0 cm H(2)O) vs. P( Y ) ({bond}3.5 +/- 2.0 cm H(2)O), p < 0.01. WOBi measured at P( Y ) (0.10 +/- 0.02 Joule/L) was 86% less than WOBi measured at P( T ) (0.70 +/- 0.40 Joule/L), p < 0.01. CONCLUSIONS: In healthy children P( Y ) significantly overestimates PIP in the trachea during positive pressure ventilation and underestimates the intratracheal airway pressure during spontaneous inhalation. During positive pressure ventilation P( T ) better assesses the pressure generated in the airways and lungs compared to P( Y ) because P( T ) also includes the difference in airway pressure across the ETT tube due to resistance. During spontaneous inhalation, P( T ) reflects the series resistance of the ETT and ventilator circuit, while P( Y ) reflects only the resistance of the ventilator circuit, accounting for the smaller decreases in pressure. Additionally, P( Y ) underestimates the total WOBi load on the respiratory muscles. Thus, P( T ) is a more accurate reflection of pulmonary airway pressures than P( Y ) and suggests that it should be incorporated into ventilator systems to more accurately trigger the ventilator and to reduce work of breathing.

Anesthesia, General↗
PubMed2000

Extubation from low-rate intermittent positive airways pressure versus extubation after a trial of endotracheal continuous positive airways pressure in intubated preterm infants.

BACKGROUND: Failure of extubation and subsequent reintubation may result in additional stress and trauma to the premature infant. Testing infants about to be extubated with a period of endotracheal CPAP has been suggested as a method of demonstrating readiness for extubation. However, this process has been criticized as increasing the neonate's work of breathing and perhaps increasing the likelihood of extubation failure. OBJECTIVES: In premature infants having their endotracheal tube removed, is direct extubation from low rate intermittent positive pressure ventilation (IPPV) more successful than that following a period of endotracheal continuous positive airway pressure (CPAP)? SEARCH STRATEGY: The standard search strategy of the Neonatal Review Group as outlined in the Cochrane Library was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register, MEDLINE, previous reviews including cross references, abstracts, conferences, symposia proceedings, expert informants and journal hand searching mainly in the English language. SELECTION CRITERIA: All trials using random or quasi-random allocation of premature infants to endotracheal CPAP or direct extubation following a period of IPPV were included. DATA COLLECTION AND ANALYSIS: Data were extracted using standard methods of the Cochrane Collaboration and its Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk. MAIN RESULTS: Direct extubation from low rate ventilation is associated with a trend to increased chance of successful extubation when compared to extubation after a period of endotracheal CPAP, RR 0.45 (0.19,1.07), RD -0.103 (-0.200,-0.006), NNT 10 (5,167). When only truly randomized trials are considered, this result becomes both statistically significant and clinically important, RR 0.10 (0.01,0.78), RD -0.201 (-0.319,-0.083), NNT 5 (3, 12). Similar differences are seen for the secondary outcome, apnea. REVIEWER'S CONCLUSIONS: Preterm infants no longer requiring endotracheal intubation and IPPV should be directly extubated without a trial of ETT CPAP.

Humans↗