FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2092360076> ?p ?o ?g. }

• W2092360076 endingPage "631" @default.
• W2092360076 startingPage "630" @default.
• W2092360076 abstract "The use of mechanical ventilators to provide the work of breathing to support ventilation and oxygen transport is well established. Patients with all forms of acute respiratory failure can thus be supported until the integrity of the lungs, the thorax, the circulation, and the respiratory center can be restored. This is true for all forms of acute respiratory failure including that occurring in chest trauma, the adult respiratory distress syndrome, the postoperative period, overwhelming pneumonia, acute and chronic obstructive lung disease, poisoning, and neurologic emergencies. The time to institute mechanical ventilation is usually clearcut as guided by blood gas determinations and the clinical appearance of the patient including his level of respiratory distress, fatigue, the presence of circulatory disorders, and mental status. Conversely, the time to discontinue mechanical ventilation following a period of prolonged respiratory support is generally less clearly defined. Various techniques of weaning patients from the respirator and bedside criteria for ceasing mechanical ventilation have therefore been offered to assist the medical team in its judgment concerning the timing for discontinuation of ventilator care.1Sahn SA Lakshminarayan S Bedside criteria for discontinuation of mechanical ventilation.Chest. 1973; 63: 1002Crossref PubMed Scopus (230) Google Scholar Most recently a considerable wave of enthusiasm has developed over a ventilatory technique called intermittent mandatory ventilation (IMV).2Luedke J Kosmatka A A new method of weaning from respirator support.Respir Care. 1973; 18: 501Google Scholar, 3Downs JB Derkin HM Modell JH Intermittent mandatory ventilation.Arch Surg. 1974; 109: 519Crossref PubMed Scopus (54) Google Scholar Briefly, this technique maintains the machine-patient interface and airway (endotracheal tube or tracheostomy) but allows the patient to breathe in parallel with a circuit which provides moist oxygenenriched air together with intermittent machine ventilation. The patient receives a decreasing rate of tidal breaths from the respirator, and as the rate is reduced the patient assumes more and more of the minute ventilation. This technique is offered as a faster, safer, method of discontinuing mechanical ventilation, because it allows the patient to gradually assume the respiratory work while still interfaced to the machine, as the rate of machine-supported minute ventilation is slowly and progressively reduced. Data to support the contention that patients can be weaned more rapidly by IMV have been published elsewhere.3Downs JB Derkin HM Modell JH Intermittent mandatory ventilation.Arch Surg. 1974; 109: 519Crossref PubMed Scopus (54) Google Scholar This study must be immediately rejected on the basis that the two small groups of patients, one receiving controlled or continuous mandatory ventilation (CMV) did not compare in terms of underlying disease process with those receiving IMV (12 patients in each group) (Table 1). The contention that CMV caused hypocapnia leading to increased oxygen consumption compared to IMV is also unacceptable. CO2 homeostasis can easily be maintained in CMV by adding mechanical deadspace or increasing FIco2 to keep the Pco2 at any level (usually normal except in severe chronic obstructive lung disease) and this can almost always be accomplished without the use of pharmacologic agents, in our experience. Thus, the data offered in this completely uncontrolled and unmatched study can not be used in support of the technique of IMV.Table 1Comparison of CMV and IMV in Treating Respiratory Complications of Various Conditions*Abstracted from Downs.3CMVIMVHead injuryAspiration pneumonia10Lung contusionGunshot wound, chest Lung contusion10Septic shock20Postoperative MI10Hyperkalemia10Postoperative valve replacement32Coronary artery bypass32Portocaval shunt Aspiration pneumonia01Colostomy01Fractures, fat emboli01Lobectomy, lung cancer01COPD, metastatic lung cancer, laminectomy01Cholecystitis01COPD02Mean age, yr.55.4 ± 3.852.6 ± 2.3* Abstracted from Downs.3Downs JB Derkin HM Modell JH Intermittent mandatory ventilation.Arch Surg. 1974; 109: 519Crossref PubMed Scopus (54) Google Scholar Open table in a new tab This technique also loses sight of one important fact: the resistance of the artificial airway. As the patient is allowed to breathe through the nonventilator circuit he must still breathe through the artificial airway (usually an endotracheal tube). Resistance of this airway may be quite high, and of course, is directly proportional to the length of the tube and inversely proportional to the fourth power of the radius. As a result, if the weaning period is prolonged, the patient is placed at a great disadvantage breathing through the added resistance of the artificial upper airway. Any measure burdening the patient for a prolonged period can only interfere with weaning, if one considers the basic principles involved. The time that mechanical ventilation can be discontinued occurs when the patient can support his own work of breathing and does not need high oxygen fractions or modification of pressure wave form such as PEEP4Petty TL Ashbaugh DG The adult respiratory distress syndrome.Chest. 1971; 60: 233Crossref PubMed Scopus (365) Google Scholar, 5Petty TL Nett LM Ashbaugh DG Improvement in oxygenation in the adult respiratory distress syndrome by positive and expiratory pressure (PEEP).Respir Care. 1971; 16: 173Google Scholar to augment oxygen transport across the lung. When high oxygen, PEEP, or other wave form modification is not needed, the only issue is, can the patient provide his own ventilatory work? He either can or he cannot and the patient should not be unduly burdened at this time, nor should the medical team rely on a ventilator set at the progressively lower rate to forestall disaster if the patient is not ready. The criteria for discontinuation of mechanical ventilation set forward in the prospective study by Sahn and Lakshminarayan1Sahn SA Lakshminarayan S Bedside criteria for discontinuation of mechanical ventilation.Chest. 1973; 63: 1002Crossref PubMed Scopus (230) Google Scholar have great merit. The simple bedside measurement of minute ventilation using a Wright spirometer first establishes a patient's resting minute ventilation. If this is low (less than 10 liters/minute) and the patient is in no distress during the test, suggesting a low requirement for ventilation, and if the patient can double this on command, indicating a reserve, and finally if the patient can generate an instantaneous negative pressure at the airway of —30 cm H2O measured by a simple aneroid manometer indicating a good respiratory force, the likelihood of successful weaning is high. The patient is then given the opportunity to prove his capability, still breathing through the artificial airway with moist oxygen under the watchful eye of the nursing, technical and/or medical staff. Blood gas levels are checked at the end of 30 minutes, and if all is well the patient is immediately extubated. This reduces the resistance through which he must breathe, with the patient in the optimum condition for breathing independently. If his performance during the test period is marginal, it may still be possible to discontinue mechanical ventilation when the added resistance to the upper airways is removed. This patient, of course, must be carefully observed after extubation. Any patient developing signs of respiratory distress including labored breathing, tachycardia, diaphoresis or obvious discomfort should immediately be returned to the respirator and the weaning postponed until a time when the patient's requirements are less and capabilities for spontaneous ventilation are greater. Any patient with an oxygen transport problem after extubation should also receive supplemental oxygen by nasal prongs following extubation. These simple steps offer an uncomplicated, safe and rational approach to weaning, and require no special circuitry or ventilator modification, but do require considerable judgment on the part of the respiratory care team. They also offer the patient the greatest chance of assuming his own ventilation. IMC (intermittent mandatory cerebration) is therefore the preferred method of discontinuing mechanical ventilation. Even better, continuous mandatory contemplation (CMC) must emerge as the preferred method of weaning used in all forms of respiratory care. It costs nothing and is within the grasp of everyone practicing respiratory care. Try it, you'll like it!" @default.
• W2092360076 created "2016-06-24" @default.
• W2092360076 creator A5049883838 @default.
• W2092360076 date "1975-06-01" @default.
• W2092360076 modified "2023-09-27" @default.
• W2092360076 title "IMV vs IMC" @default.
• W2092360076 cites W1974548229 @default.
• W2092360076 cites W2020199761 @default.
• W2092360076 cites W2127126101 @default.
• W2092360076 doi "https://doi.org/10.1378/chest.67.6.630" @default.
• W2092360076 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/1126217" @default.
• W2092360076 hasPublicationYear "1975" @default.
• W2092360076 type Work @default.
• W2092360076 sameAs 2092360076 @default.
• W2092360076 citedByCount "22" @default.
• W2092360076 countsByYear W20923600762015 @default.
• W2092360076 crossrefType "journal-article" @default.
• W2092360076 hasAuthorship W2092360076A5049883838 @default.
• W2092360076 hasBestOaLocation W20923600761 @default.
• W2092360076 hasConcept C126322002 @default.
• W2092360076 hasConcept C164705383 @default.
• W2092360076 hasConcept C71924100 @default.
• W2092360076 hasConceptScore W2092360076C126322002 @default.
• W2092360076 hasConceptScore W2092360076C164705383 @default.
• W2092360076 hasConceptScore W2092360076C71924100 @default.
• W2092360076 hasIssue "6" @default.
• W2092360076 hasLocation W20923600761 @default.
• W2092360076 hasLocation W20923600762 @default.
• W2092360076 hasOpenAccess W2092360076 @default.
• W2092360076 hasPrimaryLocation W20923600761 @default.
• W2092360076 hasRelatedWork W2011347913 @default.
• W2092360076 hasRelatedWork W2049397185 @default.
• W2092360076 hasRelatedWork W2073151595 @default.
• W2092360076 hasRelatedWork W2074833529 @default.
• W2092360076 hasRelatedWork W2125804349 @default.
• W2092360076 hasRelatedWork W2159512267 @default.
• W2092360076 hasRelatedWork W2304633692 @default.
• W2092360076 hasRelatedWork W2355498105 @default.
• W2092360076 hasRelatedWork W2399063111 @default.
• W2092360076 hasRelatedWork W3141700921 @default.
• W2092360076 hasVolume "67" @default.
• W2092360076 isParatext "false" @default.
• W2092360076 isRetracted "false" @default.
• W2092360076 magId "2092360076" @default.
• W2092360076 workType "article" @default.